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Re: Is he Autistic?

Posted By CCF Neuro[P] MD, RPS on November 06, 1998 at 14:31:18:

In Reply to: Re: Is he Autistic? posted by Marie on November 02, 1998 at 12:06:24:

Angelina - sounds like you have a very rough road ahead of you with your sons' difficulties.
I have a 4 year old who has been diagnosed with a mild form of autism, so I'm writing from a parent's perspective, rather than that of any medical practitioner.  I am absolutely NOT qualified to make any sort of clinical judgement for either of your older sons.  It does, unfortunately, sound to me as though your middle son may have some issues in the autistic realm; your older son might possibly have problems with "hyperactivity" (attention deficit / hyperactive disorder), though I don't know all the signs of that.  I have heard of cases in which one child in a family to be on the autistic spectrum, and to have a sibling who is ADHD though.
Regarding a "diagnosis" of autism, or any other condition in that realm, many doctors and other practitioners are reluctant to give that label.  Instead, I've found, they like to use the term PDD (Pervasive Developmental Delay or Pervasive Developmental Disorder), which is really a catchall phrase that, somehow, sounds better than "autism" (I know it scared us less than the A-word did).
It sounds like you have had him seen by a neurologist, I'm assuming he is the one who ordered the MRI.  Did he order any other tests (blood, urine) to rule out any metabolic or genetic issues? What about an EEG (electro-encephalogram) to rule out any kind of seizure disorder?  I know these things can cause or contribute to developmental delays; they can contribute to autistic-like symptoms.
The teachers at your son's school should have information on places you can go, to get more information.  Similarly, your pediatrician, and hopefully your neurologist (ours was NOT much help :-O  ).  You can also contact the Autism Society of America; they maintain a website but I don't know the URL offhand. There may be a local chapter, and the local folks can help guide you as well.
Some things you can look into that have proven helpful to us include diet (some food proteins appear to aggravate autistic behaviors, and undiagnosed food allergies might possibly affect behavior as well).  These are not officially accepted concepts, though there is research, and a fairly large amount of anecdotal evidence.
Good luck!
Dear Doctors,

Sorry if this letter is too long.  I've post before in September 1998.  Please be patient with reading.

I am a mother of three boys. The eldest one is 6 years old, very bright and active but he had poor memory and distracted easy by everything. He can't concentrate on anything he knows already and refuse to do stuff that he had done before. He is not good in spelling and always got alphabets written the opposite way( something like looking into a mirror). He used to drop everything and lost his belonging in school or at home. My second boy is 4 years old and I suspect he is an autistic child ( I'll describe him later). While my youngest boy is 18 months old, active and bright like the eldest but had a very bad temper. I can't see any 'abnormality' as he is too young.

The one I'm concerning most now is the second boy. Since last year December, he had shown some very 'funny' characters and he had been to the doctors and do some checking with his eyes and ears, which found to be normal, in August this year, he went for a MRI examination and the result is as follow:
MRI Examination Report:
Clinical History : Big head. Delay development. CT showed megalencephaly.
Imaging Protocol: SE T1 sagittal 5/1.5; SE T1 axial 5/1.5; FSE PD/T2 axial 5/1.5; FSE T2
coronal 5/1.5
Imaging Findings:Thickened cortex with relative paucity of underlying white matter was noted over the temporo-parietal regions bilaterally. Suspicious hyperintensity was noted in the posterior white matter bilaterally; ?gliosis.
Otherwise, no abnormal signal intensity lesion or mass lesion was noted in the brain. No obvious cleft to suggest the presence of schizencephaly was noted. The corpus callosum was well formed. No midline shift was detected. The lateral ventricles were mildly prominent. Prominence of the nasopharyngeal soft tissues was noted which probably represents enlarged adenoids. Signal intensities were noted within the right mastoid and right maxillary sinus, ?inflammatory changes.
Impression: Thickened cortex with relative paucity of underlying white matter over both
temporo-parietal regions. Features could represent some form of bilateral focal cortical dysplasia.

Since then, I make him go for all those Speech therapy, Occupation therapy, phycotherapy. I managed to put him in special educational program. At the same time he began to act 'violently' such as beating people, biting and recently he learn to struggle the baby. he had ear infection too. He is slow in everything.

Some of the examples are:

He can't hold a scissors properly and can't cut anything.
He can't walk without this right hand bending upwards,he can't walk single step up a stair.
He also can't walk down a stair case without holding to something.
He had to walk with right leg first and put both legs on the same step before proceed with right leg again.
He can't jump.
He can't answer questions ( He talk like a parrot ----repeating everything you said).
He also will have saliva flow out when ever he is excited, angry, happy, sad and so on.
He can't blow his nose, can't control bladder and bowel.
He don't understand dirty ( He ate his stool and drink the water from toilet bowl).
His hand can't move in co-ordination.
He paid too much attention in advertisement ( TV).
He will hold on to anything long and began to move his head to and for and repeat for hours. He likes car and especially bus and final. Nothing else can attract him more.
He don't eat vegetable at all.
He is always being 'bullied' in school.
He does improved and he actually showed positive improvement that surprised the therapist. He has being tested to had a developmental age of 38 months when his chronological age is 4 years and 5 months.
He had little eye-contact with everybody except me.
He enjoyed story books that has huge colorful pictures.
He can read a lot as he has good memory.
He can write single character, small and capital letters and also some Chinese characters.
He can feel hot and cold.
He loves to play with the computer and especially 'Sesame street's Elmos'.
He can't throw or catch a ball.

That's part of my self introduction of him.
I've read the 'Autism Symptom Checklist' and found that he is something like Autism. The local doctor didn't offer any advice and I'm in a lost of what he is suffering. Thus I really hope somebody out there can give me a piece of advice on whether he is an Autistic child or not.
Below is the Check list and I'll put a YES behind of the item if he has that symptom.
Difficulty in mixing with other children YES
Insistence on sameness; resists changes in routine YES
Inappropriate laughing and giggling
No real fear of dangers YES
Little or no eye contact YES
Unresponsive to normal teaching methods YES
Sustained odd play YES
Apparent insensitivity to pain YES
Echolalia (repeating words or phrases in place of normal language) YES
Prefers to be alone; aloof manner YES
May not want cuddling or act cuddly
Spins objects
Noticeable physical overactivity or extreme underactivity YES
Tantrums - displays extreme distress for no apparent reason
Not responsive to verbal cues; acts as deaf YES
Inappropriate attachment to objects YES
Uneven gross/fine motor skills; (May not want to kick ball but can stack blocks) YES
Difficulty in expressing needs; uses gestures or pointing instead of words YES

By the way, my boy had a very large head ( head circumference is 57 Inch).

Please help me. Please tell me whether my boy is Autistic or not.  And how can I find out if he is in case you also not sure.
Wishing everybody best of health. Thanks for all advice and sorry for my long letter.

With all my heart,

Angelina Thio
Dear Angelina:
Pleas see my response on Novemeber 3. 1998.
CCF Neuro:[P] MD, RPS
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