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.


Filed under Here Be Offspring

3 responses to “Assessment

  1. Sidheag

    Did you get a picture of what it was that made them support the referral, e.g., was there something in what J did that was unusual? This all sounds very much like what I’d expect from my 4y3m-yo (even the drawing: and although he’s behind the average in his nursery group, he doesn’t stand out as behind from what I can see). The only thing I’m not sure of is the eye-contact; I would guess that he would make eye contact with the people asking him to do things. I wouldn’t expect him (or any nursery-confident child?) to look at me for approval, though maybe he would.

  2. I think that, in fact, Carol and I had both separately decided before we got to the assessment that referral was warranted on the other grounds that I’d been noticing. Which of course raises the question of why and whether it was worth having the assessment, and I do have to admit that probably the main reason we went ahead with it was because I’m too interested in these things to want to pass up the chance of watching my son be assessed!
    What happened is basically that Carol had originally planned, back when she did the first assessment on Jamie when he was two, to do a follow-up some months later. Then that slipped her mind until I had the new baby and thus she was back dealing with us again, at which time there was also the incident where he got his finger caught in the door when we were at the baby clinic but didn’t say anything, which rang alarm bells for another HV who mentioned it to Carol. So, that was when she remembered she’d planned this follow-up assessment and suggested to me that it might be worth doing, and I went along with that.
    When I saw her again after that to get Katie weighed again, she did ask whether I wanted to skip the assessment and go straight to paediatric referral, but at that point that still sounded a bit drastic to me as Jamie’s differences really don’t seem like problems from our perspective and we were still happy with a wait-and-see strategy. Talking to the nursery supervisor gradually changed my mind about that – I started to see both that Jamie’s differences were causing problems in the nursery setting in a way that they didn’t at home, and also that there were some things that could usefully be done about them.
    So, by the time we had the assessment, I’d already decided to go ahead with paediatric referral regardless; and I think Carol felt the same way but wanted to persuade me rather than tell me straight out to do this. But since the assessment was all booked and I was interested in how Jamie would deal with it, I went ahead with it anyway. Admittedly not the best use of the NHS’s scarce resources – still, I suppose that if we do start running into any problems with labelling it could be useful to have something official to show that he’s actually doing fine in most ways. Or so I justify it to myself!

  3. Sidheag

    Makes sense! I’m totally with you on being interested in assessments. (Colin is at the university nursery which is used as a resource for all the psychology grad students who need toddlers to experiment on, so he’s often asssessed in one way or another – the latest is to see how he and other monolingual kids are at associating new words with pictures compared with bilingual kids – but we never get to know the results! At least we get to think about the cool experiments…)
    By the way, it’s interesting that your HV *could* make the referral to paediatrics, and so fast, since someone on my LJ friends list has a child with a head circumference under the 0.04th (IIRC) percentile and consistently falling, and has had a very annoying experience waiting to see her HV and being told her child needs a referral and then finding that the HV isn’t allowed to refer herself and she has to see a GP to do it (useless, since the paediatrician is the one who has said the referral is necessary, after a conversation with the HV about the case!) and can’t get a GP appointment inside 2 weeks… argh.

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