Lovaas schmoovas

7 April 2010
Now, onto the assessment yesterday. First of all, I was in a total flap about it because not only did we sense this would be quite an important meeting, but also I had managed to lose the bit of paper that told me what time it was happening at. Usually that wouldn’t be a problem because I put all important dates (as well as many unimportant ones, like the birthdays of people I barely know) in my Outlook diary, but somehow amidst all the chaos of upgrading my computer to Windows 7 and reinstalling Microsoft Office, the diary entry about the appointment managed to get lost completely. I had a horrible feeling the appointment was at 9am, so we had R breakfasted and ready to go by 8:30, at which time the unit opened for business and I could call them to check what time his appointment actually was. It turned out not to be until 2pm.

Although the breather was welcome, this created all sorts of problems about what to do with E while we were with R at the unit. D, our heroic nanny, stepped into the breach and offered to take E with her while she went to babysit the family of three girls she used to mind full time but who she only sees on Tuesday and Wednesday afternoons now. I said I fully expected E to come home with painted fingernails and lipstick, but I draw the line at mascara. E had a marvellous time playing with the girls, especially the youngest one who seems to think of E as some kind of living doll whose utter cuteness is only marred by the occasional need to have her nappy changed.

We got R to his appointment right on time, which is at the same NHS facility where he has speech therapy so he thought he was going to see G, his lovely speech therapist, and started asking for her straight away. Instead we met with Doctors L and M, the consultant psychiatrist in charge of our assessment and the educational psychologist respectively.

Dr L is an efficient woman in maybe her 50s with close-cropped hair and a friendly but strictly professional manner. For some reason my gaydar blinks with her and I think she may be a lesbian. Dr M is a younger woman who looks partly South Asian. I hadn’t really warmed to her brisk, stictly professional manner back in November when we first met her, but she seemed more likeable this time - smilier, kinder in the eyes, more open to explaining what they were up to.

The object of the appointment was to do a videotaped assessment of R mostly for Dr M’s sake so she could look through it and review his social, communicative and play skills based on what she saw there and earlier at his pre-school. Dr L held the camera and I was a little concerned she wasn’t using a tripod, but I suppose they’re don’t need Barry Ackroyd levels of quality here. We were told to hang back and let them get on with it at first as they watched him react to the room full of toys, but in the end we interacted with R quite a lot and talked to them throughout.

As I mentioned, Dr M had observed R at his pre-school and written up a report about her findings, which she gave to us to read later. She played with him with some blocks, pretending first that a round, cylindrical one was a car and then gave it to him with a “your turn.” He copied her. Then she pretended to drink from the same block, as if it were a cup. Again, he copied her. I’m guessing this was to test his aptitude for imaginative play or maybe just his ability to imitate behaviour, and it looked like it was all going swimmingly.

Next Dr M got out a bubble-blowing gun and started blowing bubbles. R looked a little taken aback, but intrigued and with lots of coaxing from me and T he came forward and tried popping some tentatively, like they might bite. Then Dr M blew up a balloon, which excited him, but when she let it go and it flew around the room he freaked out. Given that the next day he was happily playing with a mechanical chicken that made a noise equivalent in decibel levels to the Fall playing on the Pyramid Stage at Glastonbury, it was an odd reaction, but you never know what he’ll be spooked by. The remote control car she got out next was just as loud, but he loved that, although he preferred to play with the car on his own.

She also got him to choose which he wanted: sweeties or biscuits from a couple of boxes, using the exact same verbal formula ("which one? You choose.") that G uses in speech-therapy and he got that right away, although he preferred to feed his sweetie rewards to his daddy rather than eat them himself.

A key test involved me trying to get his attention just by calling his name and then getting him to look at something interesting just by using my eyes, not pointing. That he didn’t get. The only way I could get him to look was by shouting his name several times, touching his arm to get his attention, and then waving my finger at the object in question like I was trying to land an airplane with invisible flags.

After about an hour, it was all done. The doctors fetched their diaries and we set up an appointment for a feedback meeting on the 27th of April to discuss their findings, at which R won’t attend. I asked when we were going to get a diagnosis at last, and it turns out it will basically be on that day, although they were still kind of cagey about it and kept trying to explain that there is a particular procedure they have to follow with all this. It was all very redolent of social worker-speak or lectures from Health & Safety officers.

But we pushed a bit more and I said that I expected that we’re going to have a diagnosis of autism at the high-functioning end. Dr L nodded her head, and later T said he remembered that she said something like yes, that she verbally agreed, but I can’t remember her actually saying those words. I suppose it doesn’t really matter – we’ll find out on the 27th.

Dr M said that she was going to recommend that the school focus more on getting him to concentrate on tasks and finish them because he flits around so much when he plays, although we noted that he can concentrate on books being read to him and favourite DVDs for quite long periods, it’s just that new environments like their examination room and school are too exciting. T and I conjectured later that they may tell us on the 27th that they think he has Attention Deficit Disorder too.

But the interesting thing was that they seem to think his verbal skills are coming on pretty well now and that he’ll continue to develop in that area. Where he seems to be really behind is in social skills, especially paying attention to other people, responding to his name, playing collective games and so on.

This sort of took T and me aback a bit. We’d been going along thinking he was really improving because we just see him and E as examples, and by his standards he is improving. When I see the difference between him and other kids at school, I clock it, but somehow I filter out just how different he is from them after 20 minutes.

One other interesting thing was that we mentioned that we were curious about the Lovaas technique, and intensive interaction therapy that requires an autistic kid to be coached for around 40 hours a week one-to-one. I’d read about it before, and wondered if it might help him although it sounds like an extreme solution. FAE is dead against it, and says it really just works by behavioural reinforcement and turns autistic kids into robots who say please and thank you on cue, but have no idea why they need to say it.

T’s sister C has a friend (R) who has a friend (P) who has an autistic child and R was telling C that Lovaas worked wonders for them. I told C that I’d heard it was very full-on and required 40 hours of practice a week and she got a bit huffy like I was poo-poo’ing it out of hand. This was all very typical of C who, since she’s training to be a therapist, thinks she knows everything about psychology and I’d clearly got her on the back foot by knowing fractionally more about this particular subject. Just out of curtesy, I’m going to call P and ask her about how it’s worked for her and hear about “her journey” with her kid as she rather ickily put it in an email, but I don’t think it will be for us. Just to confirm my suspicion, Dr M said that she actually worked in a Lovaas centre years ago and although she didn’t exactly slag it off she was very keen to insist it doesn’t work for all kids and it might not be right for R. I presume that’s another thing we’ll all discuss on the 27th.