Monday, July 31, 2017

A Neuro Exam Provides Explanations

As our time in Missoula was coming to an end, we were able to squeeze HD in for a neurological evaluation, as recommended by his OT, so we could have a better picture of what problems HD was facing. A year ago I was presented with that opportunity and I passed on it, but this time around, though I was still hesitant, I proceeded with the process. More forms and more questionnaires. It seemed endless.

His neuro exam took two weeks to do. The first week was a parent plus child meeting. More questions - how does he sleep? Talk to me about school. Tell me about home. During the duration of our meeting, she was observing him, often asking him questions too. I think it's also notable that having eye contact is a huge struggle for him, and he clearly showed that during his observation. (At home when he's re-telling stories, or being spoken to, he cannot keep eye contact. At all.) The following week was a series of "games" for HD to complete. The session took about three hours to complete so it was something where I dropped him off, went to work, and picked him up later. The following week, his neuro doctor went over the results with just myself present.

I should have taped the audio of our discussion. I'm kicking myself for not. It was clear to the doctor that HD does have Executive Function delays. To sum it up, he recommended to continue with OT because we are seeing significant gains with his emotional regulation. He also confirmed that while he does present a lot of symptoms consistent with ADHD, he doesn't feel there are enough to say, yes, he does have it. (That will continue to be monitored though.) A lot of what he said was spot on though. While we would have the option for trying medications, we both felt we should try modifying his diet first. (That's a topic for its own post!)

His doctor explained to me how HD's brain was processing memories and it completely makes sense. Think of your brain as a file cabinet. Some people are able to sort through their memories and file them accordingly - like by topic for instance - so when it comes time to recall them, they are easily found. HD on the other hand, is not really able to do that yet. Instead, everything is stuffed at the front of the cabinet. Recalling things that just happened are easy because they can easily be found at front, after maybe moving a few pieces of paper. Things that happened a while ago are harder to recall because he's digging through a random "stack of papers" to find it. It was very obvious when that theory was applied to his everyday life. Take math for example. They will work for weeks on end on a particular way to, say, add numbers and he finally understands it. But then weeks later when it's time to apply it, he's completely stumped on how to get the problem done. As a parent, helping him with homework is beyond frustrating because I know he knows how to do it.

Sleep is another hard topic too. As I mentioned before, we have struggled with bedtime for YEARS. After I was done fighting naps to happen, bed time was at 7:00pm. By the time 7pm rolled around, JP was ready and Ms. Gail just fell into that routine too. HD was ready for bed at that time too, but he struggled with falling asleep. When he was finally asleep, he would sleep for a good 11 hours. In fact we had a 7:00 bedtime up until we moved. HD needed that extra hour or so to get his body ready for sleep. It didn't matter what time bedtime was, it always took an extra hour, at least, to get him calmed down enough for sleep. Because of that, his neurologist recommended we try giving him a little bit of melatonin about half an hour before bedtime. BEDTIME WAS A BREEZE for the rest of the time we were in Missoula. Five minutes - ten minutes and he was OUT. Did I mention he was often sharing a room with JP + Ms. Gail + me? I wanted to shout in excitement! Bedtime overall has been much better in the last several months, even though I stopped giving him melatonin on a regular basis. Now I only use it when I can tell bedtime is going to be rough. Sometimes he'll even ask for it after trying to sleep for hour and is still awake.

Towards the end of our meeting, we touched on his social life. He's never really had a group of friends to play with - he usually just plays with everyone. In our discussion, and those vent sessions with Robin, it was made clear that he doesn't have the skill set yet to be able to build and maintain relationships. Often times on the playground, he'll play with kids but isn't able to pick up on their social cues that they've moved on to play something else. He's left playing by himself and he doesn't realize it.

Both HD and I were sad to have to move just as we were becoming accustomed to our new schedules and the changes we had implemented into our lives. I was nervous to start over again. Building trust is huge for OT's and their patients and it did take HD a little while to build that trust in Missoula, so to start over again was going to require a lot from HD. Moving and starting over can be really hard on kids, but I think overall he's adjusted as well as expected.