Last week pegi another session of speech therapy. What a wasted RM125 per hour. Ammar wasn't in a mood and wasn't paying attention at all (he slept all the way back home after that). Dia buleh buat bila kena gertak ngan Ayahnya tapi balik semula ngan aksi2 bosannya bila Mdm Lydia wat assessment. Aku mula rasa cuak. Setelah berbincang ngan Lydia, kami rasa kena bawa dulu budak ni jumpa Dr Subash kt HU utk re-diagnose. Lydia still insist Ammar is more ADHD than Autisme. Well I have no idea at all, sometimes budak ni ok, pas tu tak ok langsung.
Aku rasa Ammar kena 'tackle' dr sudut lain sblm speech therapy. Lydia cadangkan Occupational therapy macam SI (Sensory Integration). Kata dia, compare to Autisme, ADHD bukanlah life-long punya masalah, ntah lah. Tadi bincang ngan cikgu sekolah, cikgu cadangkan Ammar masuk Taekwando dan SI. Nasib baik kt sekolah tu ada SI therapist. RM100 a month is reasonable than RM125 sejam. Maybe kami akan sambung ST kemudian, sekarang nak daftarkan Ammar SI kt sekolah n Taekwando dulu. Now he will have 3 therapy - Swimming, SI n Taekwando (ada jurulatih special utk special kid). Alhamdulillah, sume ada kt sekolah gomen (yo, still kena bayaq yooo..) . Takpelah, tak le semahal kt luo tu.
Last week juga dpt email from Lydia pasal 1st assessment result, as follows :
Speech and Language Initial Assessment Report
File Ref: SH 0637
26th March 2009
To Whom It May Concern
Re: Muhammad Ammar Firdaus(D.O.B 23.8.2001, age 7;7 years old)
Muhammad Ammar came in to the clinic for a speech and language assessment with his mother and father.
On presentation, he appeared to be an active, friendly and alert boy. He showed a keen interest with his new surroundings. He was referred from Dr Mary MARY at UH who diagnosed him with mild autism. He currently attends a special class at Seri Kelana School and was previously at NASOM only for one year. Before that he was in a normal kindergarden.
His parents are concerned that he does not speak in sentences, only single words. He can use some two word phrases but mainly gestures for things at times. He parrots speech occasionally. They feel that he can understand things that are said to him but he is described to follow through with instructions sometimes only and ignores his parents at times if they call him. He is also described to be very active and have very short attention span. He is looked after at a daycare center after school. At home his parents said that he mainly plays computer games for long stretches at a time. He also enjoys drawing.
Medical and Development History include that he is an only child. He started walking at 12 months of age. All other motor milestones are reported to be normal. He only spoke at three years of age. He is reported to be reading and writing. There are no reported problems with eating. His first language is Malay but parents said he also knows some words in English. Currently he only interacts or socialize with other special needs children in the school but with normal children at the daycare. His hearing has been tested by an audiologist at UH and this was normal. His parents described that recently he has developed the behaviour of clapping his hands and bite his clothes from time to time.
On language assessment, Muhammad Ammar presented with the following skills:
Receptively and Expressively, he was unable to converse using more than 3 words in a sentence. Ammar struggled with understanding of concepts (i.e long/short, prepositions etc.) and in following directions with two or more instructions. He was able to listen and retain information (auditory memory) of up to four elements only. Inanswering yes/no questions, he had difficutly with negation and answering responses with 'yes/no'. It was also hard for him to listen and retain information in paragraph and story and answer questions(auditory comprehension). He had no rpoblems with auditory confrontation of nouns. It was noted that that his vocabulary of verbs were more limited. It was observed that he would fidget in his seat during the assessment at times.
Processing skills, Ammar is unable to carry out simple processing skills i.e.divergent task (naming as many items in a category) and convergent tasks e.g. (i.e. 'car, truck, ship' What groups do they belong?) and more complex task ie.e." This food is cold and soft. What food is is thing? - ice cream." Understanding of WH-questions (who, what, when, where, why) were also inadequate.
Reasoning skills, Ammar struggled to proivde a reason and solution to a simple problem. At times his listening skills were poor when he was not concentrating on the question being asked of him.
Reading of single words alone, that is matching a word or simple sentence to a picture e.g. 'He is singing and playing a guitar', he had no problems. We had not looked at a reading of a passage.
Aritculation of single words in Malay, revealed that Ammar was able to articulate all words clearly. His parents commented that he had difficulties describing pictures in phrases and sentences though.
Oral-Peripheral Examination resulted in him being able to cooperate to imitate lip movements but not tongue movements.
Based on the observations during the assessment, it revealed that Ammar had difficulty concentrating more than 5-10 minutes into the task and had to be consistently redirected back to attending the task at hand by looking and following out the simple instruction given. He does demonstrate signs of learning disability. His speech and language skills are severely delayed and that of a much younger child. I feel his behavioural and or sensory issues should also be assessed and addressed by an occupational therapist who practises sensory integration.
Due to the above mentioned, the following is strongly recommended:
a) Biweekly speech and language therapy that will focus on:
· Encouraging spontaneous use of words to request and ask for things
· Increasing attention, listening skills and following of instructions
· Increasing vocabulary of phrases and sentences to acheive higher language needs
· Home assignments that will be provided after each session, to facilitate carryover of skills with his parent
· b) A referral to a consultant psychiatrist or clinical psychologist to ascertain whether Ammar falls on the Autistic Spectrum (Dr.Subash, UH)
I found his parents to be concerned and willing to assist in addressing the issues their son is facing. I do encourage his parents that he be also seen by an occupational therapist and his behavioural issues may be reduced. I strongly encourage him to come in at least alternate weeks to therapy if possible.
I look forward to his parents being involved in therapy to help him overcome his communication difficulties.
Should you have any queries or concerns, please do not hesitate to call me at the clinic.
Speech Language Pathologist
Budak bertuah... baju kelawo masam aku pun dia sapu...