Friday, January 25, 2013

Joshua - Two Months Home

It's hard to believe that Joshua has been with us for two months.  In some ways, it feels like he's been here much longer, and in other ways, it feels like it's only been a week or two.  Joshua continues to inspire and amaze us.

Physically, he continues to gain weight and eat well. His diet is not entirely age appropriate, but he is eating textures (such as gently mashed sweet potatoes - one of his favorite foods).  We put whole wheat bread chunks into soup broths and have increased his protein with chili, baked beans, and refried beans.  These sometimes lead to some pretty incredible diapers (!!) but they are rich with protein and fiber, both things he needs.  He still only prefers to drink water and struggles to drink from a cup, but we are working on these things.  He loves to rough house with my husband and his smile simply lights up the room.  There is no one he  has met that he has not thoroughly charmed.

Emotionally, he is learning the routines that we've instituted and tantrums have decreased.  He understands that crying is not an appropriate way to make a request and has learned the signs "more" "help me" and "drink".  He knows the sign for eat, but only uses it when he actually sees food or hears us say "eat".  He also knows the sign "all done".  In language, we know he understands a great deal more of what is being said to him.  When we say "all done", he signs "all done" and then  hums, with proper intonation, what we are saying.  I often say I wish I could just "unzip" his mouth, because we hear so much humming in response to our language to him.  He will look at me and wag his finger (a sign for 'no') and then hum, "Humm-MMM!"  which is "No TOUCH!"

We use simple language with him in repetitive format so he can start to understand.  Redirection comes in the form of "No....[insert thing]."  No touch.  No throw.  No push.  No hit.  With each, we try to use a sign.  I have been forced to be incredibly vigilant because it's important to catch him in the undesired behavior as he's doing it.  Otherwise, he may not make the connection that we are correcting him based on an action.  I have literally stopped mid sentence, excused myself from guests, or stopped in the middle of cooking dinner if I observe an unwanted behavior.  There has been much progress in this area.  He has learned that there are consequences, and they are universally applied.  We employ a "time-in" chair for him.  When he does something he should not, he is approached, and the undesired action is reinforced, "Joshua, no throw."  Then he's placed in a chair in our family room.  We do not leave him alone, but do not engage him.  When time is up, we approach him again, repeat what he did, "Joshua, we no throw!" and then ask, "Okay?  All done?"  Then we get him up, give him lots of hugs and kisses and encourage him to "try again".  We try to go from that to a preferred activity that he enjoys so he understands that, while there are behaviors we will not tolerate, he is loved always.  Doing this consistently, the "time-in" chair is used less and less.

Because the consequences are so predictable, I knew we were making progress when I entered our family room and discovered Joshua sitting in the "time-in" chair without being placed there.  This has happened more than once.  Sometimes, I can ascertain what he's done (I may see a toy thrown, for instance) but other times I cannot.  When I don't actually view it, I don't allow him to sit there.  Instead, I might say, "Okay, Joshua, we don't throw, now let's get up."  I have to admit, this was also funny :)  It is clear that he understands our displeasure, as he normally gets a very sour face the moment he hears us correct him.

Having experience with a child on the autism spectrum, I'm not confident he's there.  There are some things that I see, but many that I do not.  He may very well be a child with some sort of intellectual disability and global developmental delays.  At each doctor's appointment, we are happily surprised.  His neurological work up was overall positive, another blessing.  He will be monitored, but his external hydrocephalus has done what it is supposed to do, which was recede around age 2.

We are waiting on several rounds of blood work, stool tests, and urine samples.  Some of these were done weeks ago but we have not yet received results.  We are also waiting on a developmental evaluation which will permit us to construct Joshua's IEP and receive therapy.  Finally, we're considering an educational placement for Joshua, but it must be contingent on his attachment to us.  Right now, he certainly prefers us but will still go off with obliging strangers!  This is not a surprise, but we don't want to put him in a school/therapy environment if this disrupts his ability to attach.

In terms of attachment, though, we are QUITE attached to him!

He had a haircut.  We chose to do it at home, because we feared he would be VERY  unhappy.  We were right!

Poor little guy!  The saddest we've seen him, except for his blood test :(

He's just so precious to us.  Thank for everyone who prayed for him and for us and continues to follow our story.  Redemption is beautiful.

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