mama whose curiosity knows no bounds

Posts tagged ‘developmental pediatrician’

Journey with K: 18 months to diagnosis #9

After the serious-faced psychologist was gone, we had some break.  I spoke to my husband that K must be autistic.  And then, he responded, “who knows? result is not in, yet.”  Yes it was.  It was all in her face.  I was irritated by his denial attitude.

The developmental pediatrician walked in.  She did other testing (later found that Mullen Scale of Early Learning) as well as physical exam.  She was cheerful along the way.

Then she walked out.  After a while, she and the psychologist walked in.  The developmental pediatrician said that they need no additional testing by OT and SLP waiting and watching the whole exam from some other room. The psychologist’s eyes were wet and she was apparently trying not to cry, she faced upward, not looking at us at all time.

The developmental pediatrician started speaking.  I really don’t remember everything, but I do remember, “are consistent with Autistic disorder”.

There you go.  The verdict is in. I think this is a sort of self-protection mechanism. I felt as if I observed myself from outside.  Then she started speaking like (parenthesis is the voice I heard in my semi-hallucinated state):

  • K’s developmental age is 21 – at 30 months, this is considered HIGH FUNCTIONING. (“Hey, what does it mean to you?”)
  • K could be a genius and live independently or he could end up in institution.
  • K’s diagnosis is NOT PDD-NOS or anything, it is AUTISTIC DISORDER (“Don’t be so hopeful, lady”)
  • K needs to have ABA therapy right away (I didn’t even know what that is). UC Davis must have an intern referral service.  Ask ALTA regional center for more.
  • You need to come back in three months to make sure ABA IS IMPLEMENTED. (“Okay, it MUST be A.B.A.!”)
  • Sensory integration therapy is a simple desensitization and there is no evidence that it works (“I have no time for a quackery, ma’am”)
  • You need to have the pediatrician order “Fragile X testing by KARYOTYPING” (“Otherwise, I can add your son to my data! So re-test at your and your insurance’s expense”)
  • You need to have him order “chromosome 15q duplication by FISH probe. (“Well 15q will be HOT and will my paper go, well, Nature?”)

Probably I should explain the last two.  K was tested for Fragile X syndrome by PCR, cheaper, slightly less accurate, method. Fragile X is the most common genetic cause of intellectual disabilities and autism among boys.  X chromosome, one of the sex chromosome (the other is Y) of boys with Fragile X syndrome has a three nucleotide sequence repeating thousands of times.  Then that repeats do not fold properly before cell division like all other regions of chromosome, thus, if the chromosomes right before the cell divisions are looked at, the X chromosome will look to have a fragile region.  This is called Karyotyping.  It takes cells to stop at the cell division stage and needs to look at multiples cells to verify it.  Therefore this is labor intensive and expensive.  On the other hand,  PCR (polymerase chain reaction) is just amplifying that repeats.  It is much less labor intensive and less special skill is required.  The developmental pediatrician–I’m positive about this–asked to redo the test at our expense so that in HER paper can say, “all the subjects were ruled out of Fragile X syndrome by karyotyping.”

15q duplication was less offending to me.  But there wasn’t enough evidence to justify that IS the abberation that cause autism.  Therefore, the doctor was collecting the evidence — again, at our own expense.  FISH (Fluorescent in situ hybridization) uses a short synthesized DNA with fluorescent dye that can bind to that duplication area of chromosome 15. This is even more complicated technique. Now most everyone can do it, but at that time, only select lab can do it.  So ordering must be really expensive.  Since K was covered with HMO and it somehow covered these, we didn’t pay anything, and we didn’t receive any explanation of benefit to see how much it costed. But both my husband and I are biologists, though we were biochemist specialized in DNA metabolism, not a cytogeneticist, we understood that much. So I couldn’t help but felt we were “samples” to her.

Anyway, the verdict was over, so we arranged the follow up appointment, and headed home. It was well past 2pm. K was exhausted and asleep. I cried all the way. My husband didn’t say anything.

To be continued.

B.

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Journey with K: 18 months to diagnosis #8

It was mid May of 2002 K was scheduled to visit UC Davis MIND institute for a full evaluation.  In advance, we filled pages after pages of forms.  The appointment was 8:00 a.m. My husband and I took a day off and arrived about 30 minutes early. At that time, MIND institute didn’t have its own building, so it operated on the basement of ambulatory surgery center.  When we went down the elevator, I noticed that MIND institute was located right next to ultrasound department, where I had ultrasound exam when I was pregnant with K.  I felt like I was drawn to a gate to a hell, being sucked and couldn’t come up forever.  I know this type of expression really offends many, but I must be honest.  That was what I felt.

After we checked in, we waited in a waiting room full of good toys. But K didn’t play with none of those, except one puzzle. I believe it had a fish drawing.  For whatever reasons, he was fascinated with this particular puzzles and even though I had many toys with me, he wouldn’t let it go.

We waited.  And waited.  Then we were called and taken to an exam room.  Then we waited.  Nurse told me that the doctor was stuck in a traffic.  Oh well, I think traffic problem is a norm in Sacramento.  The developmental pediatrician finally appeared around 9:30 a.m. We were already exhausted.

The doctor looked young, maybe in early 40’s.  She had a refreshing voice and cheerfully greeted me.  Too cheerful for that occasion.  She reviewed what we were there for, and explained what will happen.  And then let us sign a release of video, and default was to use the video for DIAGNOSTIC USE ONLY.

Then while waiting for a psychologist to perform a test (it turned out to be ADOS, of course I didn’t know such a thing), we played with a pop-up toy, like this.  It had sesame street characters instead of farm animals.  This was one of the toys I brought.  K grabbed my hand to press the button to pop the character up.  He repeated, over and over.  That’s when the doctor came in again, more cheerfully than ever.  She told me that what K did was very interesting so she would want to use it for educational and other purposes (like presenting in academic conference), too.  So I signed a new release approving such use, not just diagnostics.  I wasn’t happy at all with this attitude.

Finally a psychologist, a tall, well-dressed hispanic woman with curly, long black hair.  She donned a little more serious face when she greeted us.  Then she started a test.  She changed her mask to a cheerful, child-friendly face and brought a toy up. “Hi, K.  Let’s play.” At every play, she filled a form.  It seemed like the form itself was a flow-chart, that determines the next test based on the current test result.  I really don’t know how ADOS works so I’m not sure if this was correct or just my impression.  She was very careful checking the chart.

One test that shocked me was a birthday cake.  The psychologist brought up a plastic birthday cake and K, of course, didn’t blow.  I felt, “what’s wrong with not blowing a birthday cake? We’ve done only one birthday celebration at home and he was one.  He had never been to other’s birthday party.  Does this determine if he was autistic?”  The test was mostly focused on social skills, like playing with a doll (“we don’t have a single doll in my house!”).

By the time test was over and the psychologist left the room, her face looked doomed.  I didn’t need anything further.  Her face told what she was going to say.  At the same time, I felt rebellious with the fact that the tests contain some cultural contexts like blowing birthday cake.  That was a disadvantage for K.  Looking back, this was a typical symptom of DENIAL.  The characteristics of DENIAL is that the person who denies doesn’t think she is in denial.

To be continued.

B.

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