Yesterday morning I went into Jessicas school, where the next part of the autism diagnostic process was to be completed. After a short wait in reception and a brief chat with one of Jessicas teachers, I was then invited into the room in which the assessment would be carried out. I then met the two psychologists who had been busy setting up the room, and the child disability nurse who came out to ask me a series of questions regarding Jessicas development and behaviours, a couple of weeks ago. It was then explained to me that I had to literally just sit on the chair next to the door, and not give Jessica any help, or interact with her at all, unless asked by Jessica. The idea is they want to see how much of the assessment she could do on her own without any help. Turns out she did it all.
Jessica was brought into the assessment room by her teacher, she then looked at me, gave a big smile and shouted ‘Mummy’! And gave me the biggest and longest hug I think she ever has. She then looked around at everyone in the room, then pointed at me telling everyone ‘Look, that’s my mum’. Jessica then noticed the selection of toys on the floor. Amongst the toys was a jack-in-a-box which Jessica played with briefly, some small wooden bricks which she then began to stack up, a book which Jessica read all of (she can’t read the words just yet, she just reads what she sees whilst following each word with her finger), some plastic cutlery, and a car, I’m struggling to remember what else was amongst the toys, but it was easy to see why each one had been selected. I’ve just realised that the car was there to see if she would play with it, or be more interested in spinning the wheels, however, I don’t even think she even picked the car up.
Jessica played with each toy appropriately, without any help, and until she was invited to do the next activity. I was asked if she would play like that at home and I reinforced my answer given during the questionnaire, that Jessica never plays with or shows interest in any toys. If she had those toys on the floor or table at home, she would still be walking along the back of the sofa, doing roly polys and climbing on the furniture.
Jessica was then invited by the psychologist carrying out the assessment, to sit on the chair next to her. She then said ‘Okay’, got up, walked over and sat down. Jessica was then presented with more toys. I could see that the idea was to now observe her imaginative play skills, aswell as joint attention, and sharing. Jessica was asked if she would like to play with the little wooden dolls, which she did, picking up the miniature plate for ‘dad’ when she was told he was hungry and picking up the tiny baby doll when she was told it was crying, which she then said she would put into bed as it needed some sleep. Some more items were then placed on the table. A plastic cup with a spoon, a small plastic ball, a small square of material and what looked like a box a necklace would be presented in, with the foam padding inside. I was pretty gobsmacked when Jessica then opened the box, saw the foam inside and said that the baby needed a bubble bath and put the baby inside. It didn’t even occur to me that was the idea of the box. She then said she would dry the baby and picked up the small piece of material wrapping the baby inside of it. I didn’t notice the link between the actual wooden dolls toys, and small non related items which were to be incorporated into her pretend play. Again, Jessica doesn’t do any pretend play at home. She has monster high dolls which she wanted for her birthday, but rather than play with them, she carries round in her Monster High bag, along with her Monster High books and pens. She also has a baby doll which she may pick up, give a cuddle to, then throw on the floor. We ended up binning her Hello Kitty kitchen about year after we got it, as she would just dismantle it rather than use it for imaginative play.
Whilst playing with these toys, the psychologist then said ‘Jessica, look’, and pointed to a fluffy toy rabbit on the table opposite. She looked, said what it was and was excited as it then started to move as the nurse controlled it.
The tasks which followed included Jessica being presented with a picture of a beach. She then started to describe what she could see, using verbs such as ‘boy swimming’ ‘playing football’, and adjectives such as ‘holiday’, and a series of nouns. Jessica was asked if she had ever been on holiday before, which she replied with ‘No’, even though we went away three times last year. But we’ve never been abroad, just for long weekends away in this country, so Jessica in this context was associating a holiday as in somewhere with a beach. Jessica was the given a baby doll, and the psychologist used some play-doh to make a birthday cake. Jessica then put four candles in the cake, began singing happy birthday (without being asked to), cut the cake when asked, but not before she took out the candles, fed the baby, then wiped it’s face. When asked how old the baby was, she said 7.
Jessica then had a snack of grapes and biscuits, and was told to just ask for more if wanted. The psychologist then started blowing some bubbles, which Jessica jumped up and began popping.
At the end of the assessment, I said goodbye to Jessica and the psychologist took her back to her classroom, Jessica leading the way there. I was then told she had done really well, and was asked my thoughts on how it went. I agreed, really well. Jessica had also counted to 40 during the assessment (skipping from 20 to 30). I’ve only heard her count to 10 as she stops at 10 every time we count, refusing to count further. I also said I was very impressed with her role play, although role play is something she has learned through therapy, and it is repetitive rather than spontaneous. I then asked if they could give any thoughts and feedback but was told no, as this assessment is just part of the diagnostic process, which I already know I was just interested to hear if they had a clearer picture of where this will go. But I take it it’s their procedure to not give any results or indication of what the outcome of the assessment was.
The next steps are another questionnaire for me with more in-depth questions of family history and Jessicas development (I’m not sure how much more in-depth can they be from the last questions?!), and Jessicas observations at home, where I expect she will fully cooperated, participate and interact. I came home and did some more research in the ADOS assessment, and reading other parents experiences. I realised there are 4 different Modules, depending on a childs age and ability. Jessica did Module two, the module for children with some speech and phrases. Some parents had feedback and results straight after the assessment, some were sent a letter and score in the post, and some waited upto a year for a diagnosis. I had a look at the criteria and what exactly Jessica would be scored on. My initial feeling was she will fall short of the score needed for an autism diagnosis. Her interaction was brilliant, as was her attention, and eye contact, which made me feel disheartened. But I’m not a psychologist or nurse and they’re trained to look for things I probably never even noticed, so I guess it’s still a waiting game.