Monthly Archives: March 2008

Basket case

When I was pregnant with Jamie, I spent a great deal of time researching those lists that tell expectant parents what they need to buy and what they don’t.  The latter was just as important to me.  I knew, because of all the reading I’d been doing, that parents and parents-to-be were major potential targets for advertising and liable to buy all sorts of stuff they Didn’t Really Need.  Which, of course, was not good because it meant you were getting sucked into the trap of buying your child Things instead of giving them the time and love that they really needed (it was, of course, an either-or).  Since I’m the earner in the household and financial considerations were therefore going to limit my maternity leave somewhat, this had something of an immediate practical application as far as I was concerned – if I spent as little as possible on buying Things for my child, I would save money and therefore be able to afford to spend longer at home with him.  So, I was very picky when it came to spending money.

One of the things I decided not to buy was a Moses basket.  Sure, I could see that it might be a nice thing to have – but the books and lists I consulted agreed that it wasn’t necessary.  After all, I would be getting both a cot and a travel cot (the latter being a necessity with grandparents who live far enough away that day visits would be impossible in the one case and impractical in the other), and that would provide my child with quite enough sleeping places.  Providing him with a third alternative that would only last a few months anyway appeared to be firmly on the non-essential list.  That settled that, then.  Didn’t it?

My son, when he arrived, had something of a different opinion on the matter.  He had no interest in settling happily to sleep in either his cot or his travel cot despite the hours I spent trying to persuade him to do so.  I think that some of the people on the parenting forums I consulted for advice on how to get him to sleep may well have mentioned that buying him a more comfortable, snug sleeping place was an option worth considering, but, if so, it was one I firmly discarded.  After all, I had done my research on the matter and that must mean that I was doing things Right, so of course I shouldn’t change course.  The books had assured me that I did not need a Moses basket.   Buying unnecessary items = frivolous materialism = Bad Motherhood.  Everyone who knew anything about such things knew that.  QED.  By gosh and by golly, I was not going to buy a Moses basket.

And by gosh and by golly I didn’t.  I spent the first six months of Jamie’s life carting him around everywhere in my arms during the day even when he napped, interspersed with bouts of trying to persuade him to settle in his cot for naps the way The Books assured me I should be doing.  At night I struggled on for two months of miserable long-drawn-out sessions sitting in a chair or hovering by his cot trying to get him to sleep, interspersed with increasingly long periods of falling asleep thankfully on the camping mattress I’d installed on the bedroom floor while trying to pretend to myself that I wasn’t really co-sleeping (because, of course, that was another thing that I’d decided after reading all The Books that I wouldn’t do) before deciding that the hell with it, I was officially a co-sleeper, and simply falling asleep with him on the mattress every night.  That last did at least make life easier, but the whole issue was still one of the major contributors to my less-than-blissful experience of the first few months of motherhood.  However, as you may have noticed, I am a pig-headed stubborn determined person; I stuck it out.  I made it through those months without buying a Moses basket.  I arrived triumphantly at the end of his first six months a Moses basket-free zone.  At which point, I thought to myself "Congratulations, Sarah.  You managed not to buy a Moses basket.  Which means you saved – what, £30?"

It was at this point that I started to realise that building Moses baskets up in my mind into the symbol of all things materialistic and of Bad Motherhood in general had, just possibly, been the teensiest bit excessive.  Perhaps they might have been more constructively viewed, instead, as something that would make my life somewhat easier in return for a sum of money that I would, now that I thought about it – maternity leave or no – have found quite piddlingly affordable.

Of course, the nice thing about having a second child is that you actually get to do all the stuff differently that you wish you’d done differently with your first.  So, when I was pregnant with Katie, I did what I should have done long before and bought a Moses basket.  It didn’t even cost me £30, as it happened – I just went to the local NCT sale and bought one there second-hand.  As far as I can remember, it cost me £12, plus another £2 for the stand (I hadn’t originally planned on buying the stand, but for that price I figured it was hardly possible for it not to be worth it).

And it was brilliant.  Katie settled down in it perfectly happily, although I don’t know how much of that the Moses basket gets credit for – I think she’s just better at falling asleep than Jamie was at this age.  But it was so convenient.  It took up a lot less space next to our bed than the cot did, and when she got sleepy during the day I simply carted the basket downstairs, parked it in a shady corner of the dining room, put her down in it, and got on with doing some of the many things that are more easily done without one arm being occupied by a baby, knowing she was comfortably within earshot and checking on her when I went past.  It was all just so relaxed, somehow.

(By the way, the stand did indeed come in useful too.  As well as saving me a fair bit of stooping, it was somewhere handy to hang those old cloths you always need to hand when you have a spitty baby, thus saving me from having to grope round drawers or the floor for them in the middle of the night.  And it was something to prop my toes on as I sat on the edge of the bed for night feeds.)

This, of course, couldn’t last any more than anything in parenthood can.  Within sixteen weeks, the tiny baby who’d looked so lost in the basket when I first put her in it had almost doubled in size and practically filled it.  While we probably still had a few weeks before she started exploding out of it Incredible Hulk-style, my maternity leave was about to finish, and we knew that free time to get anything done would be hard to find once I was back at work; accordingly, on the last weekend of my maternity leave Barry took the chance to put the cot back up next to our bed.  So the Moses basket has now been relegated to the aforementioned corner of the dining room.  It’s still used for the occasional afternoon or evening nap (I put Katie in it while writing part of this, as it happens), but its days are clearly numbered, and they aren’t very large numbers, either.

Katie made the transition like a little trouper, looking temporarily bewildered at suddenly finding herself in a cot but settling to sleep there almost as willingly.  And, now that she’s managed to keep breathing for a whole four months, some of that without me hovering over her, I feel quite happy to tuck her up in the cot for naps and head off to distant parts of the house with the baby monitor in hand.  However, I still found it quite a wrench when the cot went up and I realised that the Era Of The Moses Basket had, for practical purposes, passed.  This was, of course, worsened by the whole Last Child Syndrome – the knowledge that every phase you move out of is gone for good, never to be revisited.  I will never again settle a tiny new baby comfortably into that snug basket so handily next to my bed. 

And I feel sad about saying goodbye to the Moses basket.  For one thing, now we have a great big clunky cot filling up all the space next to my side of the bed, which is something of a nuisance.  But, more than that… the Moses basket has once again become a symbol.  A symbol, this time, of how much better motherhood is second time around.  A symbol of the fact that, this time, I’ve found my way to being the relaxed, laid-back getting-on-with-life mother that I meant to be when Jamie was a baby but somehow lost sight of in the anxious scrabble to Get Motherhood Right.  A symbol of the fact that I’ve finally got it the only ‘right’ that counts – right for me and for us, not bothering too much about what The Books say but doing what works for this family.

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Weekend

If you were paying incredibly close attention to my account of the day Katie was born, you might have noticed that, while I was in labour, Barry took the cover off the pushchair to wash it.  Fifteen weeks later, we finally got round to putting it back on again.  Since Jamie is big enough to walk and Katie is small enough to be carried in the front carrier, the pushchair has been redundant.  However, carrying Katie plus the small rucksack I use to cart the nappies and other paraphernalia needed for two small children is becoming an increasing strain on my shoulders (Katie was 14 lb 1 oz when last weighed on Monday, so this is not surprising), and on Sunday Barry reassembled the pushchair and introduced Katie to it for a family outing to the park.  It had been several months since I last pushed a pushchair, given that Jamie had been walking everywhere for some time before Katie’s birth; it had, of course, been some years since I pushed a pushchair whose occupant was a small baby and not a large toddler, so I was pleasantly surprised by how light it felt.  Jamie had great fun pulling the hood up over her head and then back down again to reveal her ("And now Katie is awake!").  Katie was somewhat bemused by the whole experience.

Another first from the weekend was Jamie’s first experience of sibling rivalry (or, at least, his first to which he has given voice – for all I know, his feelings may have seethed within yet been repressed).  He normally takes Katie’s presence on most family scenes in his stride, but on Saturday Barry took Katie for a few minutes while I took Jamie off for a nappy change, and we then started reading a story together, so perhaps the rarity of one-on-one time reminded him of what he was missing.  In any case, when Barry restored a hungry Katie to my lap, I found Jamie trying to push her off.  "Daddy wants Katie – please?" he pleaded.  It seemed a shame to cut into his time with me when he was obviously upset about it, so we compromised by using the time to try Katie with the token practice bottle we keep on giving her each day (to no avail, alas – the one she took several weeks ago did indeed prove to be a fluke, and she disdains to do any more than mouth the nipple and occasionally take a few swallows).  While this time was as useless as all the others from the point of view of persuading her to actually take any, it did buy us ten minutes or so for me to finish Jamie’s story and choose the week’s duvet cover for his bed with him, and the extra time with Mummy seemed to be enough for Jamie to accept Katie’s reappearance with his usual equanimity when Barry brought her back.

The other noteworthy event of the weekend was that Barry completed the bookcase he’d been working on during the week, a glorious floor-to-ceiling affair waxed in a shade of pine colour designed to fit in a corner of our room (there was a bookcase there already, but it was only three shelves high and a plain cheap brown colour).  This now stands at the foot of our bed where I can admire it last thing at night on going to sleep, not to mention on numerous other occasions during the day.  In addition to being a thing of beauty and a joy for the few days that it’s been up, this has also enabled me to clear the small bookcase in my study, moving the books to the new bookcase.  This is an initial step in a further-reaching plan that will continue with the moving of the small study bookcase upstairs into Jamie’s room, thereby giving him some shelf space for his books and toys (we’ve put the old one from the bedroom in there as well), and the moving of Jamie’s computer desk into the space thereby created where the small bookcase currently stands, thereby freeing up some much-needed floor space in my study and enabling me to regain access to the lower shelves of my big bookcase without needing to go through peculiar contortions.  All of this will lead on, by steps which I have not quite figured out yet but which I am sure will prove to exist, to the further reorganisation and tidying of both of the rooms involved and, eventually, get me that bit closer to my ultimate goal of having a perfectly organised and tidy house, at which point I am sure world domination will not be far behind.  In the meantime, I shall continue to enjoy admiring the new bookcase.

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Please Look After This Bear. Thank You.

The week before last, Jamie’s nursery sent home a letter asking us to send our child to the March 6th session dressed as a book character in honour of World Book Day.  The staff were at pains to assure me that in fact we didn’t have to do this if we felt it would be too difficult – sending him with a book would be a perfectly adequate substitute (have I mentioned that I love this nursery?).  However, my husband, who is more enterprising than me, rose to the occasion – he searched the local charity shops, came up with a small blue coat in Jamie’s size, and made a large label to attach to it saying ‘Please Look After This Bear. Thank You.’  None of the charity shops had an appropriate hat, but Barry’s hat, although the wrong colour, approximates the right style, and he lent it for the morning.  A brown pair of trousers to simulate brown furry legs and an old computer case of mine decked out with a ‘Wanted On Voyage’ label completed the ensemble.

The nursery staff were enchanted with the outfit.  "Please look after this bear – oh, we will!" the teacher at the door assured me delightedly, as I dropped him off.  I’d planned to catch Manda, the nursery supervisor I’d been dealing with, at the drop-off so I could let her know how our consultation with the paediatrician had gone, but she wouldn’t be in until a bit later, it turned out, so I looked out for her at pick-up time instead, meanwhile leaving Jamie with a couple of fairy princesses, a sailor, Spiderman, and assorted children in ordinary clothes.

Manda was also looking out for me, it turned out – we’d been talking, the last time I saw her, about how she’d been trying the little pictures from their visual timetable to get things through to Jamie on occasion when he seemed to be having a hard time taking things in (for example, showing him a picture of a coat to show him it was time to put coats on), and, since she’d found it seemed to work very well, I’d been interested in the thought of trying it at home and had asked her where I could get hold of some of the pictures.  In an act of kindness that took my breath away, she had photocopied a bunch of the pictures to get me started, even laminating some of them ready for use.  She’d included a couple of handouts – one with general information about using visual timetables, and one with a long list of suggestions for encouraging communication in children with communication impairments.

Manda brought out a box of cars for Jamie to play with while we talked.  She went through the pictures with me and showed me a few Makaton signs.  She is also planning to draw up an IEP – an individualised educational
plan – for Jamie, which might with a bit of luck be ready by this week
so that we can then discuss it with her.  She is indeed, it turned out, the special educational needs co-ordinator for the nursery (abbreviated catchily to SENCo – I have a new vocabulary of acronyms ahead of me, it seems), and will thus be the one that Dr M. will be needing the report from.  She explained that after qualifying as a nursery nurse she’d spent four years working in a school for autistic children, hence her experience in this area.

I told her that Dr M’s provisional diagnosis is autism, and explained the proposed further investigations.  She was pleased to hear about the plan for the speech therapist to assess him, as she feels it would be helpful to get a speech therapist involved.  One detail I forgot to mention in my post about the consultation was that, before we left, I asked Dr M. whether he felt we should try to get Jamie more nursery time; he agreed that we ‘might as well’ try this, although he did not sound too bothered either way.  He came up with the suggestion of seeing whether a place was available at the local nursery for children with special needs, although he wasn’t quite sure whether this would be appropriate for Jamie given that the children there are rather a mixed bag as far as diagnoses go and Jamie is, as he said, clearly very bright.  I’m not too bothered about that aspect of things – after all, I don’t send him to nursery for the academic education but for the play opportunities a nursery can offer, and it looks as though getting him used to managing in a group setting is also now an important reason, so I suspect this other nursery will do a perfectly adequate job on both counts in addition to having the bonus of some specialist support staff who can throw in ideas as it seems necessary.  So I’m quite willing to give it a go, and Dr M. agreed to write a referral and see whether any places are actually available right now.  Meanwhile, he’s on the waiting list for more time at his current nursery – there will definitely be more sessions available in September, but anything before that is just pure luck as to whether any other child drops out.

I signed a further copy of the information release form, giving the nursery staff permission to pass on information as needed to Dr M., the speech therapist, this other nursery, and the SENCo for the area, though I declined as before to authorise them to inform Uncle Tom Cobley and all.  (This may be a mite paranoid on my part, since I have great faith in the nursery and can’t actually imagine them doing anything careless with Jamie’s information, but, given some of the scares that have been in the news recently and our government’s apparent desire to get detailed information on file about everyone, I figure it’s probably worth exercising a wee bit of care in the matter of who gets to see what.)

At one point during the chat, when Manda had got up to get something, I had a moment of thinking: I am about to tell someone else that a paediatrician thinks my child probably has autism.  How will it feel to say that?  Will it feel different, somehow, from all the things we’ve said on the subject already?  To take that extra step into this new world?  I looked over at my son playing on the carpet, the little boy with the label.  The great big label attached to him saying ‘Please Look After This Bear. Thank You.’  You know those moments you get, as a parent, when you take a look at that wonderful special child of yours and get such a fierce rush of pride and love and joy that it just about overwhelms you?  That’s how I felt right then, as I looked at my son.  Overwhelmed with the wonder and joy of getting to be this little person’s mother.

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Mother’s Day

Last Sunday was the first Mother’s Day since I became the mother of two children.  Since it was also the day before my sister’s birthday, we marked it by going to stay with my own mother for the weekend.  This was not only the first overnight trip we’d been on since having a second child, but the first in about six months, as we’d stopped making long trips in the latter months of my pregnancy and had not been organised enough to anticipate that we would be doing this and arrange a Last Trip Before The Baby’s Here at the point where I still felt up to doing so.  So I approached the weekend with a major degree of trepidation – on top of the extra difficulties caused by having double the number of small children to transport around, I felt totally out of the swing of packing for a night away at all, and was convinced I’d forget something crucial.  (I’m always convinced I’ll forget something crucial, but at least when we’re going somewhere every few weeks I feel I’m staying in practice in the not-forgetting-anything-crucial department.)

In fact, however, it all went swimmingly.  Katie slept for the entire trip there and Jamie entertained himself beautifully with the Zen, an MP4 player purchased by my technogeek husband for just such occurrences.  (An MP4 is like an MP3, but records and plays films as well as music.)  On the trip back I did a slightly less good job of timing Katie’s feeds around the trip (difficult to do with a baby who still feeds both extremely frequently and very irregularly) and she decided she was hungry just as we set off on the long drive home, but I revived my nursing-in-car technique as tried and tested with my first child (which enables me to nurse a baby in the car seat next to me without either of us needing to remove our respective safety harness – uncomfortable but possible and exceedingly useful), and she went back to sleep for the remainder of the trip, thus allowing me to do the same.

And, during the time period between those two journeys, we had a brilliant time.  I took full advantage of having my mother and sister around to help with the children, we enjoyed my mother’s delicious cooking and my sister’s birthday cake, and Katie took the new environment completely in her stride, settling in the travel cot just as well as she does in her Moses basket back home.  On the Saturday afternoon after lunch, while Jamie had what was at least nominally his nap (actual sleep was a bit too much to hope for, but he spent the time alone in the bedroom that used to be my room once upon a time, and it afforded him and us some much-needed downtime) I took Katie in the carrier and went for a walk up to the nearest Mothercare to hunt for bibs.  Katie is the spittiest of babies and for some reason, probably the fact that I am a moron, it had not occurred to me until that week that perhaps I did not have to spend quite as large a proportion of my time as had hitherto been the case on putting clean clothes on her only to have to remove them a minute or two later as she spits up yet again, as these highly useful inventions known as bibs do at least minimise the need to change her entire outfit.  So I bought out a large proportion of their stock of bibs, getting a nice and healthful walk in the process.

Jamie had great fun with Granny Constance, especially since she had been stocking up on puzzles and books since he was last there – I was quite bowled over by the amount of stuff laid on for his amusement.   The most notable purchase she’d made for him was two enormous laminated posters with numbers on – one of them listing the numbers from one to one hundred, one of them counting to twenty with associated pictures of numbers of items and labels stating that there were seven shirts or whatever – the sort of thing people normally buy because they feel they really ought to be educating their child rather than because the child actually wants them.  Jamie, of course, was delighted.  "I love number 4!" he announced in ecstasy, proceeding to read his way through that one and all the rest of the numbers.  We were very impressed by how many of the words on the poster he knew.  He also loved being asked how many of one object or another there were, a game instigated by my sister which he then wanted me to play as well: "Mummy should say ‘How many?’," he assured me.

And I got my Mother’s Day loot – a card with a No. 1 Mum badge, chocolates, and a small pot of primroses (the latter being a triumph of hope over experience on Barry’s part, but maybe this time I’ll actually remember to water the poor things occasionally).  Best of all, I got the fruits of Jamie’s most recent nursery session – a peppermint cream and a hand-made card bearing more glitter than a 70’s disco night, hand-made for me by Jamie.

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Paediatric appointment

"So, what’s wrong with your little boy?" the heavyset woman sitting next to me asked.  She and her son, a boy of about eight or ten, were the only ones in the clinic waiting area apart from the four of us.  It wasn’t a waiting room, as such – just a widened area of corridor with some chairs the token few rather random books and magazines on a corner table.  There was no sign of any toys, which is something of a drawback when the clinic currently using the waiting area happens to be a paediatric clinic.  Jamie was bouncing around the place with his usual unstoppable energy; I hoped we didn’t inadvertently end up with an ADHD diagnosis while we were at it.

I explained that we didn’t know yet – we suspected autistic spectrum disorder, but were about to see Dr M. with a view to getting a diagnosis.

"Dr M. isn’t as good as Dr H."

"Oh, really?  How so?"

"He doesn’t listen as much.  And rushes you."

"Was he the one who lied about me?" the boy chimed in.

"No, that was your school…" There was one of those quick discussions that leave onlookers lost as to the ongoing plotline, some kind of complicated saga boiled down to a few inadequately-summarising comments.  The school had claimed he wasn’t having problems when he was.  Or something.  "But I got a diagnosis for him in the end," the woman told me triumphantly.

"How?" I inquired.

"I took them to court."

"Oh."

I wondered whether it would be impolite to inquire as to the diagnosis thereby obtained, since no further details seemed forthcoming – on the one hand it was pretty personal information and if she hadn’t shared it at the obvious opening maybe that was because she didn’t want to talk about it, but, on the other hand, she had already asked about Jamie.  Perhaps it would be impolite not to reciprocate the interest she’d shown in my child by asking about hers in turn.  I wished Miss Manners had written a guide to the etiquette of hospital waiting room conversations.

After a forty-minute wait, during which further dribs and drabs of conversation did eventually cover her son’s diagnosis (indeed, diagnoses – it was apparently one of those diagnostic ragbags of this and that which seemed to involve a bit of mild everything) as well as some random snippets such as the fact that their cat’s name was Katie also, they were finally called through by Dr H.  A few minutes later, the maligned Dr M. wandered down the corridor, reading the referral letter clipped to the front of Jamie’s notes as he came, and called us through. 

He seemed, despite my waiting-room-colleague’s opinion, to be a perfectly nice doctor – a thin, greying, quietly spoken man with a slightly absent-minded air.  He led us into the room, which, fortunately, did have a box of toys; between those and the delights of climbing up on the examining couch, Jamie occupied himself quite happily for the whole of our consultation.  The room (or possibly Dr M., now that I think about it) also had a lurking waft of smell which, after a few I-know-I-know-this-from-somewhere minutes, I identified as the smell of the dissecting rooms at medical school.  Since this is a small community hospital nowhere near a medical school, I’m still in the dark about the source of this, which is possibly just as well.  Dr M. apologised for being so late (something to do with some confusion over what waiting area people were waiting in, which had held up clinic) and asked us what our worries were. 

I explained that we didn’t have worries, as such – we didn’t see any of Jamie’s differences as problems, at this stage.  But, for a long time, we’d been noticing a lot of little things that had led us to speculate on whether he might have mild autistic spectrum disorder; and now that he was at nursery, some of these things seemed to be causing more problems in that setting, so I’d decided it might be time to…. well…  I realised that saying ‘get a diagnosis’ didn’t sound quite right, since, as Sidheag pointed out on one of my previous posts, we might well not be able to get as far as one at this stage.  Start working towards some sort of, um, diagnosis-type-thingy?

With pen poised at the top of a fresh sheet of paper in Jamie’s notes, he asked me to go through our main concerns.  Since the nursery setting seemed to be the one where his differences were actually starting to cause some problems, I decided to start with the concerns they’d raised – his lack of interest in the other children or staff, the way he seemed to go off into his own little world, and, probably most important as a current practical issue, the fact that he didn’t always seem to take in instructions given to the group and the staff were finding that they really needed to tell him things on a one-on-one basis and sometimes use picture cards rather than words to get the message through.  I went on to talk about the other things we’d noticed – the oddities in his language, the not telling us when he wanted food or drink (which, incidentally, he’s actually been getting quite a bit better at over the past few weeks), the marked paucity of imaginative play and lack of any role-play.  (By the way, I didn’t actually use the term ‘marked paucity’.  I’m less pompous in real life.)  It’s surprisingly difficult to remember all of a list of things like that when they haven’t really been concerns at the time but more oh-yes-that’s-interesting-in-passing.  I was glad I’d made out a list to give Carol at Jamie’s assessment, which she’d sent to Dr M. and which he had in front of him; unfortunately, I hadn’t brought a copy myself, and at one point covertly squinted at his copy to try to read it upside down and see whether I was forgetting anything.

"Let’s go back to the beginning," Dr M. said.  "Was your pregnancy normal?"  We went through Jamie’s medical history, such as it was – totally normal pregnancy and delivery, breast-fed although with problems due to the tongue-tie which led to him not gaining weight for ages, otherwise a healthy baby, under the care of the ophthalmologist and orthoptist for his squint.  Family history?  Asthma on my side.  No official diagnosis of anything developmental, but there are things about my childhood – my lack of any real interest in forming friendships, my focus on odd interests such as child development and my lack of understanding of how these might be perceived socially – that have long made me think in retrospect that I’ve probably got a foot on the autistic spectrum myself, even though it never got to a formal diagnosis. 

Jamie’s early development?  Normal.  First words?  "Muh" for ‘milk’ and "dada" for ‘daddy’.  After that, not so normal – after coming out with those two at around a year, he’d then only picked up two more words over the whole of the next year.  He had, however, picked up several letters.  He was fascinated by what things said from an early age and would point to the letters on the front of his books, in response to which I’d tell him what each letter was and what word they spelled.  (By the way, since one of his books was Goodnight Moon and I’m a Stephen King aficionado, this gave me the perfect chance to say "M-O-O-N spells moon!  Laws, yes" at regular intervals.  I haven’t had such a good cue line since I asked to borrow my father’s video card and he said "So how do I know I can trust you?" the day after I passed my final qualifying exams as a doctor.)  And Jamie would repeat the letters.  At one stage, he was saying more letters than words, and looking as though he would fulfil my mother’s wry prediction that he’d bypass speaking and move straight to e-mail.  Then we got the dummy out and – whoomph!  Within weeks, he was talking fluently.

Dr M. went through more details of Jamie’s life.  How was his eating?  All right, though his difficulty in asking for food when he wanted it could present problems – he was definitely eating more since Barry had started noticing what foods he didn’t seem to touch and preparing things we knew he’d like for him to eat on those nights.  Sleeping?  Unfortunately, I told him, we currently seemed to be going through that dropping-the-nap transition stage where Jamie was still tired enough to need a nap during the day but had trouble actually falling asleep for it.  But until recently, he’d napped just fine, and, although he took ages to fall asleep at bedtime, that probably reflected more on our routine for him – he would nap too late in the day and throw off his bedtime sleep.  Once he did get to sleep at night, he slept fine.

"Children with developmental problems often have a lot of trouble settling," Dr M. said.  "What we do is give them melatonin."  I was intrigued – was this why Jamie had been so difficult to settle in a cot when he was a baby?  He slept just fine in my arms or when I co-slept with him, but I never had any luck with putting him down Drowsy But Awake the way all the books tell you you should.  (Eventually I gave in, co-slept until he was one and then did sleep training-lite for bedtimes so that at least I could get evenings to myself.)  I’d always just seen that as an example of how all children are different and the one-size-fits-all solutions blithely offered by the books don’t necessarily work.  Which I suppose is still a fair explanation – I just hadn’t realised that this particular difference was one that might come with a diagnosis attached.

What sort of things did Jamie enjoy doing during his day? Dr M. wanted to know.  Reading, I told him – he loves books.  Climbing.  Getting into everything.  Doing jigsaws.  I told him about Jamie’s skills with his computer – he knows how to switch it on and off and work the programmes, he picks new computer skills up very quickly when shown them, and he’s worked out how to do a lot of things on the computer just by experimenting by himself.  I told him about his passion for numbers and anything number-related.  "He memorised the entire list of Mr Men books by number at one point," I explained.

"So you could just say to him ‘What number is Mr Happy?’ and he’d say, um, number 5 or whatever it is?"

"Number 3," I told him automatically.  "Um – sorry.  We ended up learning them all as well.  It comes with the territory.  And he’s like that with Thomas the Tank Engine as well – he knows all the numbers of the engines, but he’s not really that interested in the stories."

We covered various other bits and bobs, including whether he showed any reaction to the other children at nursery (not really, from what Manda told me and from what I saw when I helped out there for a session), whether he made eye contact (he does with me, but, when all this first came up, my mother told me she’s noticed that his eye contact’s poor, so perhaps he does have problems with making eye contact with people apart from us), and whether he would point something out to us just because he wanted to share his interest in it.  This is, apparently, called ‘protodeclarative pointing’, and I think Dr M. said it showed up in normal children by about fourteen months of age, although I may possibly be confusing that with something else he said (there was definitely something that Jamie wasn’t doing that Dr M. said normally showed up by fourteen months).  I hadn’t really noticed the lack of protodeclarative pointing until Dr M. asked about it, but, indeed, Jamie does not do it.  I’ll often hear him chattering away to himself while we’re out and about, in his own little running commentary on whatever, but unless I ask him what he’s saying I won’t get to hear it – he won’t try to attract my attention to share it with me.

Dr M. had a go at talking to Jamie, who had found a number book and was, of course, deeply absorbed in it.  "Six crayons," he read aloud.  "There’s a blue one for the sky, an orange one for the wall of the house…" The picture of crayons that he’d found also pictured a picture, if you follow, and he correctly listed the different colours of crayons and which bits of the picture they had been used to colour in before turning to the next page.  "Seven…" (I can’t even remember what there were seven of – whatever it was, he read it.)  "Eight boxes."  (Nearly right – they were actually blocks.  He reads by the whole word method.)  "Nine yadybirds.  But there is one flying away!  One, two, three…"  He carefully counted all the ladybirds (correctly) before going on to whatever the ‘ten’ was and reading that, all without showing any sign that he was aware that Dr M. was behind him and trying gently to talk to him.

"Well," Dr M. said eventually, at the end of all this, "there’s obviously something here."  I hoped we were going to get more of a diagnosis than ‘obviously something’, which somehow lacked a certain panache as diagnoses go.  Though, of course, it would make a good blog post title.  Before my thoughts could meander off into consideration of Something Spectrum Disorders, that much-needed new DSM classification, I realised that, of course, he hadn’t actually finished.  "…And it does look as though we’re looking at some kind of autism.  Which I believe is what you were thinking, wasn’t it?  Um – how much do you know about autism?"

I assured him that I had read extensively on the subject, in addition to having picked up the odd bit of knowledge professionally, and knew plenty about it.  He went through the description anyway, presumably to make sure I wasn’t missing any of the basics on the topic, which I thought was nice of him. 

Autism, he explained, causes problems in all of three different areas, known as a triad of impairment (I remembered this bit from my reading, although I could never remember all three areas – much like trying to remember all seven dwarfs).  The first area is social skills.  Jamie, obviously, isn’t showing the signs he should be of wanting to play with, or at least alongside, other children, but the lack of protodeclarative pointing is apparently significant here as well – he didn’t automatically look to share his observations of the world with other people.  The second area is communicative skills – I forget which particular examples Dr M. mentioned here with regard to how Jamie was doing, but he did feel that there were things showing up in this area as well.  The third area is imaginative skills – autistic children don’t really indulge in the sort of imaginative play typical of other children.  They tend, instead, to show rather restricted and repetitive patterns of play, which is apparently a fourth sign, a sort of fourth member of the triad, as it were.  Jamie’s play, of course, is pretty typical as far as that’s concerned.

So – check, check, and check.  However, these diagnoses are not made lightly (or shouldn’t be), and, although we do seem to have moved somewhat beyond the well-just-maybe-possibly-but-I-don’t-want-to-be-making-a-fuss-about-nothing stage, there are still steps to go through before the diagnosis can be made official.  Firstly, Jamie needs to be assessed by a speech and language therapist as well.  This will be done with him in the nursery setting, and she may also have some other assessments she wants to do.  Secondly (or possibly even firstly, depending on whether Dr M. has an appointment slot free before or after the speech therapist does), Dr M. needs to see one of us again for a diagnostic interview.  I’d thought that was what we’d just had, but apparently a diagnostic interview is more structured and involves going through a checklist of (gulp) three hundred questions to get as objective a picture as possible.  Dr M. will also be writing to the nursery to get them to fill out a report, and asked me who the special needs co-ordinator was for the school.  I wasn’t actually sure about that one, but gave him Manda’s name as a starting point since she was the person I’d been dealing with.  I gather there’s normally a hearing test somewhere in there as well, but in Jamie’s case that’s already been done, last year, as part of the investigations of his delayed speech.  Dr M. will write all the referral letters needed to get this moving, and will send me copies.  He asked diffidently whether I wanted the leaflet from the National Autism Society that he usually sends to parents at this stage, seeing as I already knew a lot about it; I figured it might be interesting, so opted to have it.  That seems to cover everything for now, so now we’re waiting on those appointments.

*******************************

"So, how do you feel now?" my mother asked me later that evening on the phone, in the hushed tones reserved for those subject to Very Bad Events.  "I know it can’t be an easy thing to hear."

"Huh?" I was surprised.  "Mom, we’ve known for ages that he’s probably got ASD."

"Oh, I know, I know.  But… somehow it’s harder to hear it said, isn’t it?"

I can see how that could be the case for people, but I honestly don’t feel that way.  For me, there just isn’t anything particularly frightening about putting a name on Jamie’s differences. 

If you’ve been reading this blog for long, you hopefully know what a terrific little boy my son is.  He’s bright, funny (sometimes intentionally, sometimes not), affectionate, quirky, filled with enormous enthusiasm and zest for life, and just generally adorable.  He is a delightful child and an absolute joy to have around.  (He is, granted, also sometimes a complete and utter pain, but I don’t think we can blame ASD for that – I think that one’s down to him being three years old.) 

I don’t feel that attaching a label to my son’s special qualities diminishes his wonderfulness; I feel that attaching my son’s qualities to the label enhances the label.  If this is what parenting a child with ASD is like, then I’m all in favour of the experience.

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Addendum

In writing about Katie’s three-month-oldness, I forgot to mention one milestone – she can now hold a rattle for a few minutes (or, at least, has done so on one occasion after I’d been through several rattles to find one that she seemed easily able to hold).

As passionate as my desire is to have every one of these details recorded fully for posterity, I do have to admit that that isn’t really much to base an entire blog post on.  So I shall pad it out a little by also recording that, on Thursday, Jamie and Katie had their first conversation with each other.  I cannot comment on the discussion topic as the conversation was conducted entirely in loud squeals which I had a bit of difficulty translating, but I am pleased to report that they both seemed to find it fascinating and highly enjoyable.

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Assessment

Having been distracted into about a half-dozen other posts on such crucial topics as dummy removal and natural childbirth debates (for the benefit of anyone new to this blog, I had probably better specify that those were not the same post or in any way related to each other), I am now finally getting round to completing and posting the full and detailed account of Jamie’s assessment, as best as I can remember it.  Disclaimers: a) since I do not have total recall, I may well have forgotten something or got these in the wrong order, and b) this detailed account of exactly what is involved in a general assessment of a child this age and exactly what my son said and did in answer to each test is probably going to be of highly limited interest to anyone who isn’t me or my mother, so don’t expect this to be one of my wittier or more scintillating posts.  But it is of interest to me, so I’m writing it.

The assessment was a repeat of the one he had before – a general assessment of how he’s doing in various different areas.  It is, by the way, called a SOG, or Schedule Of Growing Skills.  (Unfortunately it isn’t called a Schedule Of Development.  That would have been a much better acronym.)  We were due to meet the HV at the health centre at 11 a.m., but had the usual trouble we seem to have these days in getting anywhere on time – Katie is currently working diligently towards the world record in maximum number of spit-ups produced by one baby, and, once I finally did manage to get us about ready to set off despite the frequent breaks to change Katie’s clothes and my T-shirt, Jamie had a pooey nappy and needed to be changed.  However, we eventually got there only ten minutes late.  Carol met us and asked us if we’d mind a colleague of hers who was training to do the SOG sitting in with her to observe, which was fine with both me and Barry.  I followed Carol round to the testing room and headed back to get Jamie out of the playhouse, and we started off.

Carol started out by tipping some small coloured blocks out in front of Jamie, who started building a tower straight away without needing to be asked, and managed six or seven blocks.  However, after a couple of attempts at this he got distracted by some exciting-looking toys in the corner which Carol had forgotten to put out of sight.  The other HV who was sitting in was rapidly dispatched to take those into another room, and Carol managed to get Jamie’s attention back to the blocks, getting him to imitate building a bridge from three blocks, which he did with careful concentration after a pause to figure it out.  "That’s good," Carol commented, "he’s looking at me for approval."  I started to wonder whether we’d be told at the end that it had all been an unnecessary fuss and we had nothing to be concerned about.  Carol moved some of the blocks out of sight and left three pairs of different colours – red, green, and yellow – and moved through them picking up one of each and asking Jamie to give her the same one.  Concentrating carefully again, he did, each time.

Carol put the blocks away and got the spoon, cup, doll and brush out to check his receptive language.  He picked out the spoon successfully when asked.  A request to give dolly a drink seemed to bewilder him a little, but he eventually managed to pick up the doll and cup and bring the latter vaguely into the vicinity of the former, which was, apparently, enough.  "And now can you brush dolly’s hair?" Carol asked him. Oh, help!  I never brush Jamie’s hair.  I tried to remember when he’d last seen me brush my hair.  He was going to fail this part of the test and it would be all my fault for being a rotten neglectful mother who never brushed her child’s hair.  Slowly, hesitantly, Jamie lifted the doll and the brush and brought the brush to her hair.  Saved by his good memory.  He went on to point out dolly’s nose and ears, put the cup under the table, put the spoon in the cup, put the brush behind Daddy, and hand one named item to Mummy and one to Daddy, all with the same look of careful concentration and without saying a word himself. 

Carol moved on to the formboards, which, as far as I can recall, were the first item to get a word out of Jamie – he commented on the different shapes and, with a bit of gentle encouragement, named all three of them for her.  Having started talking, he chatted away to himself as usual as he solved the formboard in short order: "Now, where’s the triangellar hole?"  "His speech is so clear now," Carol commented approvingly.  Jamie made short work of the shapes formboard, and, with a bit more difficulty, solved the one with the three fish.  (Most of the difficulty was because one of the pieces had got turned over when they were tipped out- apparently they’re all meant to be presented the correct way round, and, once it was turned round for him, he didn’t seem to have any problems.)

He was less enthusiastic about drawing.  With a little difficulty, Carol managed to persuade him to copy a circle (she got him to do this by suggesting he draw a big circle, so he drew one that went all around hers), parallel vertical lines, and parallel horizontal lines.  (He was more interested in asking "What’s dat?" about each of the things Carol drew.)  She had no luck convincing him to draw a picture of Mummy or Daddy, though.

"Here’s one I think you’ll like better," Carol told him.  She gave him some of those little pegs that used to be used in Mastermind games back in the 70s, and a cup, and asked him to put the pegs in the cup one at a time as quickly as he could.  Jamie, presumably misunderstanding this, put one peg in the cup and sat expectantly awaiting further instructions.  "Sorry, like this…" Carol counted six pegs into the cup one at a time, counting aloud for emphasis.  "One, two, three, four, five, six."  Jamie, of course, took this literally and did exactly the same thing.  "Counting as well!" Carol commented, impressed.  She asked him to keep going with the rest of the pegs and he did, counting those as well, all the way up to eleven.  Carol got out a pegboard for him to put the pegs in and he did this as well.  Then she tried seeing if he could take turns with her in putting them in.  He needed enough prompting on this one that I don’t think I’d have scored it, but she seemed satisfied.

She took the pegs away and brought out a book for the next part of the assessment (I know this one was next because Jamie, who had just been getting started on counting the pegs again, switched over to counting the objects on the front of the book instead).  This test was to see whether he could point to different things in the pictures in response to her questions.  He successfully managed to point out which person in the pictures was doing each of various actions such as eating or sleeping, but had more trouble with the next page, which was a little cartoon story of a mouse trying to eat some bread and a cat chasing the mouse away.  Carol had a hard time coaxing comments out of Jamie about what was happening; but he did manage to answer some of her questions, and even told her that the cat was chasing the mouse, which impressed me as for some reason I hadn’t thought that was a word he knew.  He did better on the next page, which was the "Which one is not…" questions – I remember from having to learn about child assessment for the MRCGP that this is actually one of the more advanced questions, even at the three-and-a-half-year-old level.  So I was impressed that he managed two out of the three correctly.  He also successfully differentiated between the big spoon and the little spoon.

There were also some physical tests – she got him to kick a ball and to try throwing it overarm.  He couldn’t get it to bounce against the wall over the examining couch the way she’d done, so, rather ingeniously, he tried climbing up on the little table to throw the ball higher.  She got him to jump with feet together and to try standing on one foot and hopping – he could easily manage the jumping, but could barely balance on one foot and hopping was still beyond him.

The other test was the colour matching one, which she almost forgot about and remembered only when she was writing up her notes.  This one, of course, he managed just fine (once Carol had persuaded him just to go ahead and match the colours without asking which colour each one was), chatting away to himself as he did so.

Carol added up the scores, asking us some other questions to fill in further bits of the test.  ("Does he like helping you out with everyday activities such as dusting?"  Blimey.  In our house dusting isn’t even an everymonth activity right now.)  She commented that, in fact, apart from the initial glance up at her while he was doing the block-building, he really didn’t seem to have looked at her at all.  He also hadn’t looked round at me or Barry for approval, which she said was significant, given that he was in a strange setting.  (I had a brief moment of chagrin as I wondered how that reflected on the strength of my bonding with my child.  Then I thought that it probably reflected on it rather less than the huge smile on his face when he sees me come in or the way he comes to me to pull my hand to get me to come over and join him in whatever it is he wants to do, and got over that one.)

The other health visitor, the one who’d been sitting in watching, played with Jamie for a bit, but as he was getting restless Barry took him out of the room to play with the toys elsewhere in the health centre.  (They tried weighing each other on the scale there and Jamie got quite indignant at being told he was two stone because, as he knew perfectly well, he was THREE.  I hadn’t actually been sure if he knew his age – after all, it’s not a topic that comes up in conversation very often – so I was pleased to find out he did know it, even if he is a little confused about the difference between age and weight.)

And the crunch question – what did I think about going on to get him referred to paediatrics?   I told her I’d decided that, yes, that would be worth doing.  We had one of those rather confused distracted conversations that you end up having when there are children around – me busy with changing Katie’s extremely pooey nappy, Carol adding up and working out the last of the scores as she spoke, Barry taking part in a fleeting sort of way as he flitted through between Jamie-chasing, all of us getting distracted onto the topic of how best to get him more playgroup time, which is what Carol thinks would really help at this stage – and finally, in amongst all this and the "Well, it’s up to you – what do you think?"s, Carol also said "I think we should refer him."  I’d been wondering how I would feel when and if those words were actually uttered straight out.  How I felt was relieved; this meant my suspicions weren’t just a sign that I was an overly neurotic parent.

So, Carol made the referral.  Our appointment is for this coming Monday, so no doubt I will have more to report after that (probably long after, at my usual blogging pace).  We all agree that if this is ASD, it’s likely to be mild.  However, from the conversations I’ve been having with the nursery supervisor, it sounds as though it’s showing up more in that environment because of the extra challenges involved in being part of a group rather than one-to-one at home.  So I think this is the right time to be stepping in and looking at how we can best optimise things for him to make his path smoother when he eventually starts school.

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