Autism Screening: Part II

Groundhog Day has come and gone. I heard Punxsutawney Phil saw his shadow, so we are in for six more weeks of winter. Fortunately for us, the weather was on the mild side for our drive to and from Cleveland on Thursday morning. Better weather and better directions led to a smoother drive to Philip’s appointments at the Autism Center.

Not only were we not late like last week, we were early. As soon as we entered the building, Philip twisted free from my hand so he could go play with the toy mounted on the wall. This kept him entertained for a while, but he soon took to exploring other areas of the lobby. In the top photo, you can see the crocodile bookcase that Philip checked out. In the photo right above, Philip examined the chairs that have different animals carved into the seat back. The chair pictured had a tree frog. During our twenty-minute wait, Philip kept venturing over to the hallways leading back into the heart of the center.

At just past 9 am, a speech pathologist met us in the lobby and took us to a large room. She was joined by a student from Case who took notes and observed both this play-based assessment and the speech evaluation.

Both assessments lasted almost an hour each. And Philip only spun once. Literally. One quick turn as the first speech language pathologist (SLP) had her back to him setting up for the next task.

The play-based assessment took place in stages. During the first phase, the room was preset with a variety of toys. The SLP wanted to see what toys Philip chose and how he used them. She tested his reaction to her taking away an object that he was using. She interacted with him to gauge if he would play with her, ignore her or even imitate her. During this first “set,” she tried to get Philip to stack blocks with her. He briefly did, but he was more interested in lining them up. When he did stack them, she would playfully knock them over saying, “Uh-oh!”

Next, the examiner swapped out the toys. In the second set, Philip was most interested in an airplane. The SLP would take the plan from Philip, fly it through the air and say “Zoom! Zoom!” She would give it back to Philip to see if he would copy this. At first, he scooted the airplane on the table top. Eventually, he moved it in the air. Each time he did this, the SLP would say, “Zoom! Zoom!” to see if Philip would mimic her or associate the sound with the plane.

The next activity was “The Birthday Party.” This stage was a chance to see Philip’s interest and skill at pretend play. It was the baby doll’s birthday, and the SLP made a cake from Play-Doh. After she made the cake, she put in candles. She put in two, and I was surprised to see Philip add two more. The SLP tried to get Philip to blow out the candles, but he didn’t copy this. They took the candles out of the “cake,” and then the tester took a plastic knife to cut a piece of cake. She tried to get Philip to feed the baby, but he pushed the fork away. The same thing happened when she tried to get him to give a drink to the baby. Instead, Philip preferred to gather the utensils on the table and sort them by type. The therapist pointed out that the had separated the two kinds of forks. I hadn’t even noticed they were different.

When the party was over, she next brought out a motorized lion. This had been on a counter covered by a sheet. There was a button to push. One push caused the lion to roar. A continuous push propelled the lion forward. I was surprised to see that Philip wasn’t scare of the toy, but he wasn’t really interested in it either. He went over to the other counter where the first of toys had been stashed.

In the next phase of the assessment, the evaluator offered Philip a snack. She steered him back over to the table and then tapped the chair, asking him to sit down. He tapped the chair back before sitting down. Peter and I were both surprised. After Philip sat, he was given a choice between cookies or pretzels. These were in clear plastic containers. The SLP wanted to see how Philip would show a preference. She also tried to get him to ask her to open the container. He did make a brief “o” sound, and she ran with it. She explained that, whenever we hear a vocalization that approximates a sound, that we should assign it meaning and encourage its use.

After Philip ate a few mini Oreos and half a pretzel, snack time was over. The evaluator asked if Philip would play peekaboo. We told her about his recent innovation of responding to “Where’s Philip?” by lifting the quilt he is hiding under. She used a sheet to play. She asked me to demonstrate our game. Then she resumed being the partner in the game. This morphed into a tickling game. When Philip uttered a sound that started with “D,” the SLP assigned it the meaning of “tickle, tickle.”

At this point, Philip was really opening up. Even though he slept the previous night through, he woke up with a stuffy nose. He had sneezed several times during the ride there, and I had to keep wiping his nose. I think this might have caused him to be rather quiet and subdued when the assessment began. Now he was laughing and smiling, really enjoying the “tickle, tickle” game.

The last activity in the assessment was bubbles. The evaluator had a motorized bubble gun like we do at home. Just like at home, Philip cringed at the whir of the motor. However, he likes bubbles so, he did come over to see them. The SLP wanted to see if Philip would copy her “Pop, pop, pop!” sounds and motions. He was usually too slow to pop the bubbles in time, but he did try.

The other skill she was exploring was Philip’s imitation. She counted, “One, two, three, go” before turning on the bubble gun. When she said, “go,” she would shoot her hand into the air. She wanted Philip to make the “go” motion to show that he wanted her to make more bubbles. Even if the movement seemed coincidental, she treated it as a go and would make the bubbles appear.

Since her part of the evaluation was over, this speech language pathologist handed us the bubble gun and went to see if the next person was ready. She noticed that Philip was eying a ball, so she handed that to him. He and I played with the ball while we waited.

The next and final part of Philip’s screening was a speech evaluation. We were escorted to a cramped office. There were four adults and Philip in the room that, at most, was 8′ x 8′. Also included in the space was a desk, cabinets and small table and chairs and the testing equipment and toys. It was a tight fit.

This SLP had a box that looked like it was an official testing kit. She wrote on formalized assessment form, marking 1s, 2s, and 3s as she asked questions and did activities. In some respects, there was a lot of similarity between the play-based assessment and what she was doing. Afterwards, Peter commented that he didn’t understand why they had used two separate assessments. He’s all about efficiency.

The evaluation started with questions about how Philip communicates with us now. We explained his strategy of getting us and leading us to desired objects. We told her he is using PECS. We talked about the speech services that he receives at preschool. While she asked questions, Philip played with the toys in the room.

I thought that in this portion, the evaluator kept offering Philip too many choices. She started with a small plastic container of toys. I don’t know how other children respond, but Philip likes to explore all of his options before selecting a toy. When he did finally choose a favorite, it was actually a toy that had been stashed on the shelf behind the desk at which the student sat. He went and got a ball toy in which balls roll down a spiral slide and then are pushed out of a tube with air. He did not want to stop playing with the toy once the SLP was ready to pull out a book of pictures from the testing box. She eventually had to put the toy in the hallway, and there was some crying and throwing of toys.

Philip never did sit down to look at the pictures in the book. He didn’t want to pretend to feed a stuffed animal. In fact, we told the SLP he was afraid of this animal. I’m not sure why, but I could tell by the expression on his face. She soon figured it out because Philip cowered behind her.

After some more questions and more observations, it was time to go. She asked us if we had any questions, to which Peter responded, “When are you getting a bigger office?” She laughed. He wasn’t joking.

It was time for a diaper change before hitting the road. Philip cried when I first took him into the restroom, but he stopped once he was on the changing table. I thought this was progress.

We decided not to worry about the blood work that day. Things had been going well, but Peter was starting to run out of patience. We got in the car and headed home. Philip felt asleep soon after we hit the interstate.

On Monday, Philip is going to Grandma’s house after school, and Peter and I will drive up to the center one more time for the results of the screening.

I’ve received positive feedback as I’ve linked up these older posts with the yeah write weekend moonshine grid, so I’m continuing to share the story of how Philip got his autism diagnosis.

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