
Wow, I can't believe the month is almost over! It's funny, I was looking over my 31 for 21 posts and few of them have anything directly to do with Down syndrome. I suppose that's because while Ds is part of our lives, it's no longer this huge unknown dominating our lives like it seemed in the beginning. Sure, Ds affects us. After all, Kayla is five and functions more like a two year old. But other than that, it's not a big deal.
But I did want to make sure I got a post in about Down syndrome and autism. It's only been recently that medical professionals realized that these two conditions could coexist. Many professionals STILL don't think they can exist together, as evident by Kayla's pediatrician who questioned the autism diagnosis and wanted to know if we were sure she wasn't just "really mentally retarded". Ummmmm, NO. Whatever.
One thing I love about the internet is that everything is saved for eternity, LOL. I can look back at an early post on
Downsyn about my concerns about Kayla. This was from March 2007, about a month before Kayla's 3rd birthday:
OK, reading some other posts, now I'm getting a little concerned. Here's some things I'm worried about with Kayla:
--Language regression. She used to use words and signs, now she just mostly grunts and yells. Thought this was just because she was learning to walk, but it hasn't come back yet.
--Stimming on electronic musical toys. She'll sit for almost an hour with her head pressed up against the speaker of her favorite toys and push the same button over and over and over...
--Tactile defensiveness. Doesn't like any new textures. Won't play with playdoh, foam, sand, etc. Doesn't like certain types of motion (can't put her on a rocking horse or one of those quarter rides at the mall). Won't tolerate very noisy places, like a bowling alley. Doesn't like stoppage in movement. Screams and cries when the car or bus stops. Hates water and the bath.
--Arm flapping
--Fascination with her hands and binky. She'll lay in bed for an hour just shaking her binkies in front of her face, so close she goes cross-eyed
BUT...
--she is very affectionate, loves giving hugs
--does play with other people/kids, will roll a ball back and forth, for example
--makes good eye contact.
Ugh, I'm soooooo confused! Wish there was some way to get an easy diagnosis!
Ahhh, diagnosis! Here's the diagnostic criteria for autism:
(I) A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and (C)
(A) qualitative impairment in social interaction, as manifested by at least two of the following:
1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
4. lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )
(B) qualitative impairments in communication as manifested by at least one of the following:
1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. stereotyped and repetitive use of language or idiosyncratic language
4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
(C) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:
1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects
(II) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(A) social interaction
(B) language as used in social communication
(C) symbolic or imaginative play
(III) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder
It's usually the social part that throws off people when considering the dual diagnosis. Often kids with Ds/Autism are still very social, but perhaps atypically or inappropriately so. In Kayla's case, she may hug everyone, but she doesn't play with or acknowledge her peers these days.
Every now and then I run across a blog posting or forum posting about a parent who is concerned that their child might have this dual diagnosis. If your kid is JUST stimming, or JUST sensory defensive, it's likely NOT autism, but probably some sort of sensory integration issue.
Impairments need to be in all three areas -- social interactions, communication, stereotypical behavior. Although technically if someone shows some but not all of the above behaviors, they can get the catch-all PDD-NOS diagnosis, which I hate and hope they get rid of in the next DSM.
Some people think that autism affects a larger percentage of people with Down syndrome than the general population -- 5% - 10%.
If you still have concerns, I highly recommend downloading
this Disability Solutions. Also,
Riverbend has a nice section on Down syndrome/autism, click on the Medical Series folder (the info is a bit dated, but still pretty good). Try to find a professional familiar with the dual diagnosis if you want a formal diagnosis. I recommend Dr. George Capone at Kennedy Krieger Institute in Baltimore, Maryland. He's considered "The Man" when it comes to the dual diagnosis (apologies to
Amy, who didn't have a great experience).
Why would you want a formal diagnosis? Because a lot of doors open up when your kid has an autism diagnosis. Obviously it's what's on everyone's radar screen right now. And although education and therapies are supposed to be based on an INDIVIDUAL and NOT a diagnosis, in reality that's not the case. You often can't get ABA without an autism diagnosis, even though that method has also been shown to be helpful with kids who just have Down syndrome or other developmental disorder.
Finally, I just want to say that the whole autism thing is just another "thing". I know people get terrified when they hear the A word. Understandably so. It's been played up in the media as some horrible thing. It's another obstacle our kids have to overcome. And, yeah, I sometimes wonder if Kayla would have been one of those "superstar" kids with Down syndrome if she didn't have the autism, instead of being so "delayed" she doesn't even register on any of the evaluations.
But autism doesn't change who KAYLA is, it is a part of her as much as Down syndrome is, maybe more so. And who KAYLA is, that's all that matters.