Case in Progress
Tyler - Year 3
Just after Tyler’s second birthday, he had his initial visit with the diagnostic pediatrician from the regional center. The pediatrician was very thorough, and went through a long and involved work-up of Tyler’s medical history with his parents. The pediatrician recommended that Tyler have a serum CPK level test immediately to rule out any muscular dystrophies and a hand x-ray to determine bone age and growth. He also recommended a repeat MRI in the future with particular attention to the posterior fossa. Doctor agreed that Tyler needed to have an orthopedic consultation for his ankles and feet. He was given a tentative diagnosis of being at-risk for developmental delay due to undetermined etiology and mild to moderate ataxic quadraparesis.
Pediatric Services continued to work with Tyler on all areas of his development. We were beginning to see areas of real growth. He began walking with the aide of a push toy, but still preferred to crawl. His feeding and fine motor improved, although his tremors still interfered at times. His cognitive development really blossomed - and he became only slightly delayed in this area. Speech remained a concern, as Tyler’s ataxia extended to his oral-motor development.
California Children’s Services evaluated Tyler and it was decided that he would begin physical therapy and occupational therapy twice a week. They began by fitting him for ankle-foot orthotics to help brace his feet and lower legs, and beginning the process of obtaining a walker for him. His occupational therapist worked closely with him on such areas as feeding, dressing, and fine motor skills. A nutritional consultation was eventually provided. We continued to work with the family in the areas of parent and child education and speech and language development. Tyler was beginning to sign many more words, and attempted to make lots of sounds.
In the fall after his second birthday, Tyler’s dad joined the armed services and was sent out of state. There were concerns about the possible emotional affect this would have on Tyler, but he has a good, sunny disposition and a supportive extended family. During the winter he had his usual numerous bouts of upper respiratory infections and ear infections, but seemed somewhat healthier than previous.
At his 2.6 birthday (2 ½ years) we had a transitional meeting for Tyler with the school district.. This entails the preliminary discussions of preschool and possible placements within the school system when he turns 3 years old.
At the age of 2½ years Tyler was noted to weigh 21 pounds and be 33 inches tall. He remained well below the 5th percentile on the growth charts. His fine motor skills were at 21 months and scattered to 24 months. Tyler had many of the concepts intellectually, but his tremors prevented him from accomplishing some tasks such as stacking small blocks. Never the less he made 6 months progress in this area in the past 6 months. Cognitively, Tyler was assessed to be solidly at 21 months and scattered to 27 months. Tyler was able to imitate an activity from memory, match blocks by color, and place 2 puzzle pieces. Communication skills receptively were at 21 months and expressively at 18 months. Tyler could ask for more, food, drink, and ask "what’s that?". Tyler had made 6 months gain in the area of expressive language and continued to make gain receptively. Socially and emotionally (a real strength) Tyler continued to display age appropriate skills at 30 months. Self help was at 18 months - showing growth. Tyler at this time was still using a bottle for added nutrition. Gross motor skills were at 18 months - also reflecting significant growth. Tyler’s climbing abilities had grown in particular. It was decided that all intervention strategies would stay in place until his third birthday.
The following spring we accompanied Tyler’s mom in visiting several preschools throughout the area. Mom had decided to continue her college education at the local junior college. This college has an excellent preschool, which has special education component in addition to mainstreaming the children. It was Mom’s desire that Tyler attend this program. We applied to the school district for this classroom and in May 1999 a formal individual education plan (IEP) was held. Tyler was admitted and he would start preschool in September, following his third birthday.
In the meantime, Tyler was making great strides using a walker, and had begun to use Canadian crutches, for walking. He had given up the bottle, and as his eating habits continued to grow, so did he. He had up to 40 words in his vocabulary, and was beginning to put two and more words together.
In July, he went back for another visit to the regional center pediatrician, who told Mom that he did not feel that Tyler needed any more tests at this time, and recommended that he continue as a regional center client. It was noted that due to Tyler’s ability cognitively and in receptive language, that he is not retarded, but delayed due to his diagnosis of ataxia quadraparesis.
At the end of August Tyler graduated from the Pediatric Services program and began preschool. He loves it there - and has already begun to be potty trained (watching your peers is a great way to learn) and follow the school routine. He loves to ride the tricycles and play with the other children and has received his first "owie". Mom is excited about her schooling, and they are very happy. Tyler and his mother were a great joy to work with for all of us, and we will miss them. He was also a great learning experience in trying to find a diagnosis. We have great hopes for his future.
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