Well, Shana, here we are again!
Welcome to the Hpathy Quiz, everybody! Mom, don’t look now but we’ve got two very important deaths to announce! First of all, star of stage and screen and animal rights activist, Doris Day, died at 97 of pneumonia.
I loved Doris Day’s romantic comedies starring herself and Rock Hudson and Tony Randall. If you haven’t seen “Pillow Talk” and “Send Me No Flowers”, see them now! My Mom and I have seen them so many times, we know the lines by heart! For example…
Dr. Morrisey: Judy, how would you like some fish? I just came back from a fishing trip.”
Judy: Frankly, Dr. Morrisey, I don’t see how you could go fishing at a time like this!
Dr. Morrisey: At a time like WHAT?
Judy: With George upstairs…dying….
Dr. Morrisey: Did you say dying?????? Ha-ha-ha-ha…!!!!! Oh boy, I have seen some hypochondriacs in my day, but, your husband George….
Judy: You mean he’s not….?
Dr. Morrisey: Heavens no! George Kimball will out-live us all!
Was that from “Send Me No Flowers”?
Oh, that was hilarious! Good bye, Doris, we have your great movies to remember you by. And speaking of which, we’ll go out with a clip from “Pillow Talk”. Who else died?
Tim Conway, star of “McHale’s Navy” and “The Carol Burnett Show”. He was 85.
OMG! Tim Conway too? He was a riot! Shana, find me a sketch he did on The Carol Burnett Show.
Check! This is really funny, I hope everybody watches! Tim plays a mild-mannered office manager, stuck with a clueless secretary.
And at the end of the Quiz, we’ll go out with a clip from “Pillow Talk” as a tribute to Doris Day.
Perfect! What’s the quiz this month?
You remember Wonder Woman, right?
It’s Wonder Woman again?
Well, actually, it’s her sister.
Oh, Wonder Sister.
Actually, well, it’s Wonder Sister’s son.
So, Wonder Nephew, then!
That’s right…. Here he is now!
He’s so cute!
He’s much too cute to have autism steal his life away!
Name of child: Wonder Nephew
Client’s name: Wonder Sister
Address: London, England
Date: 14th January 2017
Weight: 20 Kgs
Height: 108cm (approx.)
Date of Birth: 6th July 2012
Body type: tall/thin-average
Nationality/race: Parents are from Indian origin. We came to Britain 8.5 years ago. Settled here now.
- What is the chief complaint?
Wonder Nephew has been diagnosed with Autism Spectrum Disorder recently. The report from the assessment (which we received today itself) is attached for reference.
Wonder Nephew is a lovely child who is very chatty and likes things “his way”. The main issue we have is he would not focus on what the others are trying to say to him or ask him to do. Because of his attitude of wanting things his own way, it gets difficult to get him to follow any instructions.
We generally have to make up a lot of stories to try and convince him to do what he needs to do. Simple things like brushing his teeth twice a day is a routine he knows since he was a small baby. However, we end up reminding him every night why he has to brush his teeth and so come in the bathroom before going to bed and reading a story. He runs around to avoid it as much as he can.
He is capable enough to almost dress himself but rarely is he in a mood to do this on his own. I generally spend a lot of time talking to him while helping him put on his uniform in the mornings which takes up a lot of my time and energy. At the same time, make him less independent.
He has trouble in focusing on the task in hand in school and at home while doing any homework. He finds all sorts of excuses to avoid doing the things he is not comfortable with (although is capable of). He is very quick in saying ‘I can’t do this’ and when prompted and encouraged he can finish the task.
Sometimes, I have got an impression that he is probably not listening. However, it’s hard to judge whether this is to do with poor listening skills or not focusing on the task in hand. I found the evidence to this when he was in preschool. Last summer, kids were supposed to perform a show at the end of the year and we kept hearing from the staff that he is never singing with the kids and is generally doing his own thing. However, they also said that he has been singing the songs lately and when prompted at home, he knew all of them. Hence, I think it’s not poor listening skills.
He also gets upset when things don’t happen or people don’t react or behave in “his way”. While reading a book if he doesn’t like the action of a particular character, he gets upset and hits the book. We constantly try to explain to him that this is not how he should express himself when he is upset. He should probably just mention that he is upset and didn’t like a particular event so we can give him reasoning as to why the event happened the way it did. This however, as you can imagine is often hard to explain as not all events or behaviour of people are explainable. I have also tried to explain to him that each one of us is different and so react in a different way and it’s OK if the kid next to him does not want to play the game he wants to play. He doesn’t like the idea though.
Another peculiar thing about Wonder Nephew is the inability to control his spatial movements especially when he is excited. He struggles to show his excitement in a contained manner and can sometimes jump on people or give jerky movements to his body which can become quite dangerous for people sitting next to him as his head generally bangs somewhere or the other. He has accidentally banged his head multiple times on dad’s nose/lips/teeth while dad was sitting next to him.
Wonder Nephew has a habit of holding mum’s hair when he is anxious/ tired. He keep caressing it, sometimes even pulling it. He definitely likes doing it in the night while going to sleep due to which we put him to sleep on our bed and then put him to his bed. He has reduced this a lot as compared to when he was younger but it still happens as I said if not other times then at night while going to sleep.
Four things that worry me the most about him are (in the order below):
– His lack of focus
– His lack of listening, or ignoring things even after listening
– His lack of spatial awareness.
– His wanting to have everything his way.
- When did the problem start if not already mentioned? Do you have a theory about what caused it?
The concerns were actually raised when Wonder Nephew was 20 months old and joined a nursery where the nursery staff noticed this about him and raised concerns. He had joined nursery when was 18 months old. He had already been speaking at home and once he gained confidence, he was OK at nursery at about 24 months. They closed the case but then reopened it a few months later saying they had other concerns. We were meeting the learning coordinators with nursery staff regularly and soon started getting regular paediatrician appointments as well. We were then booked for a joint assessment for the diagnosis of ASD. The doctors diagnosed him recently with this.
I don’t have a theory of what caused this or whether he was always like this. As a baby, I did not find anything odd.
- What aggravates the complaint? What makes it worse?
– Lack of focus and listening increases when he eats anything with high content of sugar in it leading to sugar rush in his body.
– Saying ‘No’ to his demands. He has recently been asking for new toys every day. When answered with a ‘No’, he starts crying/ screaming/ banging his head against our body/hitting and throwing things.
– He always wants to do things his way. He enforces his demands not only on mum and dad but close relatives/friends who visit with us/ friends who come home to see him. I haven’t heard similar complaints from school though. In fact, I think at school he is quite reserved. I observed this on a school trip I volunteered for in November
– At times due to slight delay in meals/ tiredness/ sleepy etc..
– Influenced by other kids’ behaviours or characters in TV Kids shows.
- And now the opposite of #3: what makes the complaint better?
– at times by leaving him alone and bringing distance
– at times by bending to his level, hugging and asking to calm down
– at times by counting till 20 while holding him firmly and then hugging him.
– In situations where I have felt that he is tired and so misbehaving, I hug him and let him play with my hair which he loves doing. It sometimes calms him down.
– making sure he is fed at right time
- What is the worst time of day for your child?
There isn’t a particular time as such that I have observed.
- What symptoms accompany the chief complaint if you haven’t already said?
- My son used to a speak Gibberish language before for fun sometimes but now he has increased it a LOT. On an average, he twists at least one word in every 2-3 sentences he speaks.
To quote a few examples, he used to call us as ‘mum’ and ‘dad’. He has started calling us ‘munk’ and ‘dunk’ recently. One more thing to add here is, Wonder Nephew and his cousin used to talk a lot of Gibberish back in India and still do on skype calls at times.
- Wonder Nephew for some reason has developed a sort of dislike for girls. He always says he does not want to play with girls or with anything that is girly. This suddenly started in his pre-school when he was few months over 3 years old. He prefers boys all the time. Coincidentally, He now goes to an all boys school and is super thrilled to be there with boys. At the same time, he still is friends with one of his good girl friends from pre school and loves any play dates we set with her. He also tells me that “Other than you, I don’t want to be close to any lady.” We have also seen this in the family where he is more comfortable with his grand dads rather than grandmas. Same applies to uncles over aunts.
- What was the mother’s pregnancy and birth like? Any traumas? Complications? Any drugs used? Anything to report about the mother’s health and disposition during pregnancy? Did she take any drugs or alcohol or cigarettes or marijuana, etc.?
I have had a miscarriage in May 2011 at 8 weeks of pregnancy. I conceived Ryan in October 2011. I was quite shaken by the miscarriage and was very worried when I conceived Ryan. I was very careful of what I ate at the time and tried to stick to a healthy diet as much as possible. I had an iron deficiency and so was put on iron tablets. I also took folic acid at the time.
In my late second trimester, I was diagnosed with obstetric cholestasis and was put on the medications for it. I can’t find details of these medicines with me as I have unfortunately lost my records. With the medication, the bile counts lowered but the doc had booked me for induction at 38 week. They asked me to go to the midwife for a membrane sweep. I visited the midwife and her opinion was that my cervix was very closed and I can request a full term but the risk was of having a still born so I decided to go against her advice and went with the doc’s advice.
I was admitted in the hospital for 9 days. They induced me thrice but all I was getting was false contractions (but very painful ones) that were shooting up and down quite sharply. I almost felt like I wanted to push! The third time the midwife removed the tablet. They gave me a day’s break, let me visit my home and said they wouldn’t stop and will continue with another attempt the next day. I was dreading this and was very worried about my son all the time. The atmosphere wasn’t helping either as I was in a maternity ward with 7 other ladies of which some had the birth in 2 hours and left the ward. With so many women coming and going from the ward so quickly and me sitting there for so long-I wasn’t having very positive thoughts and was very worried.
Luckily the next day after my break to visit home, my water broke! I was able to bear the pain only for a couple of hours and because the midwives couldn’t interfere with my water breakage (as it could cause infection), I was given Pethidine. I ended up being unconscious for I think about 5-6 hours, after which the midwife came to check me and I was dilated 5 cms by then! I was taken to the labour room, where I opted for gas and air which wasn’t of much help. I then allowed them to use Epidural on me and I have no counts on the number of top ups that were given. The midwife told me that it doesn’t matter now that you have taken one, you can take 100s of top ups and it wouldn’t be a problem. I was in the labour room for 12 hours but not a cm dilated more than I was when I was in the maternity ward. My cervix was stuck at 5 cm! That’s when the doc came and offered me caesarean section (which I had never wanted to do) but was left with no choice! This is how my son was born on 6th July 2012 at 6.56 am.
Post his birth, I was in the hospital for 3 days. He was all normal. I however, had become very delusive and worrying for him all the time even after coming back home. My parents came from India and stayed with us for 5 months here to help me around at the time. I however was very paranoid at the time for him. Any small thing like a missed feed, sleeping too long, losing weight etc. worried me. He was totally breast fed until 9 months.
I joined my work after 9 months and left him with a friend who was child-minding him. She took care of him for 7-8 months which is when we realised that she was probably strict to him and my son was scared of her. As soon as we realized this, we took him out of her care and had him admitted in the nursery where he went until he was 4 years old and then started school in September 2016.
- Father’s health at time of conception: What was the father’s state of health and temperament? Was the father on any strong or addicting substances at the time of conception including Rx drugs, alcohol, etc.?
My husband was in a reasonable good health at conception. He was probably in a little stress due to the hectic travel associated with work during those days but was otherwise absolutely fine.
- The child’s milestones: was he late or early in learning to–crawl, walk, talk, wean, teethe, toilet-train, etc.?
Crawl – 7 months
Walk – 13 months
Talk – with parents (17-18 month), at nursery (24 months)
Wean – 6 months
Teethe – 5 month
Toilet-train – 3 years and 1 month.
- Was the child vaccinated? Which ones did he have? Did he have a reaction to any of them?
His vaccination chart is attached for reference.
I think he had a slight temperature after one of them at the age of 2+. Don’t remember which one but otherwise has been fine post vaccination.
- How did the child react to the birth of a younger sibling?
No younger sibling
- How does the child react to school?
He was very excited to start school. He still is generally happy to go there other than the usual morning mood swings at times which can get dragging.
- How does the child react to spending the night away from home?
He is fine to stay outside in hotels, relatives’ houses (grandparents etc. ) provided we, parents are along with him. Also, he generally sleeps with us on our bed when we go out.
- How does the child react to traveling?
We like traveling, so now our son’s got accustomed to it. He is generally happy to travel by any means – car, train, bus, aeroplane, etc.
- How many rounds of antibiotics or other drugs has the child had and for what?
He has probably had 2-3 rounds of antibiotics until now which have been mainly due to bacterial infection in ear, throat etc.
- Any skin conditions treated with cortisone-type cream?
- Did the child have an especially severe childhood illness?
- When your child is ill or upset, does he want to cling or be left alone?
Generally, likes clinging to mum
- How would you describe your child’s behavior when interacting with his or her peers?
Wonder Nephew is very interested in making friends but is struggling on social interactions, communication etc. due to his condition of ASD. He generally plays along-side kids although he loves to be around them and desires making friends with them. Unfortunately, he does not know how to make friends and so keeps yearning for them.
He loves to play rough and tumble or any game that requires screaming and being playful. He is not a very calm child and so has limited interest in board games.
- What feed-back do you get from the child’s teachers, baby sitters, school counselors, camp counselors, etc.?
We have recently had a meeting with the school teachers where we informed them about Wonder Nephew’s diagnosis and they have said that they have observed the same that he is still reserved and plays alongside of kids rather than with them. However, they also mentioned that he has made good progress since he joined school (then he couldn’t hold a straight pencil, he can now write sounds and has started blending and reading small three letter words). They gave us instances where he raised his hand in assembly (40+ boys) and shared his thoughts.
- How does your child feel about and treat animals?
Wonder Nephew is very interested in having a pet. He is not too much into them but is very keen on having pets like a fish/dog/cat etc. He keeps saying he does not like carnivorous animals as they eat other animals while he himself is a non-vegetarian!
- What foods and drinks does your child love?
He loves fish, baked beans, mushrooms, chicken sausages, rice, broccoli, green beans, chocolates, clementine, strawberries, blueberries, butter, almonds, pistachios etc. He likes to drink juices but is not always very fond of them. There have been phases when he wouldn’t drink water and only ask for juices. However, since he has started school he is fine in having water as his main drink. He’s never been very fond of milk. He takes little with his cereals and a cup in the night with some chocolate in it.
- What foods and drinks does your child hate?
He does not like anything gloopy in texture to eat. He does not like avocado, melons etc.
- Does your child want ice or ice-cold drinks? How thirsty is he or she?
Not really, he is fine in having drinks at room temperature. He is not very thirsty actually considering it’s winter. He takes probably 3-4 glasses of water in a day.
- Describe the kind of eater he or she is–fussy, picky, etc.
He is a bit picky but he likes some good things as well like some veggies and fruits so I wouldn’t say he is too troublesome.
- What fears does your child have?
He gets afraid of the dark if left alone. I have recently observed this decreasing a bit though.
He also cannot watch/read/experience anything violent like shooting, killing, etc.
- Does your child tend to be chilly or hot?
I would say normal
- When is your child most likely to perspire and on what parts of the body?
Generally, he perspires after sport activities. He generally sweats a bit on the underarms.
- How affectionate is your child?
- How sympathetic is the child? (Affected by the suffering of others)
He is unlikely to be sympathetic to others considering his condition. Even if he is, he is unable to express it.
- How is the child affected by music?
Wonder Nephew likes music and loves singing and listening to the music that he likes. The music he likes is generally loud. Recently, I introduced him to instrumental but he preferred workout instrumental more than melodies.
- What emotion tends to predominate in the child?
He shows a face of anger (more frowning really) a lot these days. He has started using foul language like shooting/killing etc.
He has also recently started hitting his head with a fist when he is upset. When asked where he picked it from, he said a character in the TV show he likes does it. We keep prodding him not to do it.
- How neat or messy is the child?
He is moderate.
- How sensitive is the child to criticism and reprimand?
He does not take it seriously and generally not in the right spirit and portrays his unhappiness or anger.
- Are there any digestive complaints?
- Any complaints with the child’s sleep?
He does not go to sleep independently. He sleeps with us on our bed and we carry him across to his room. He comes in our room early morning generally and we let him sleep with us. He takes about 10-11 hours of sleep in the night and is on no naps.
- Any skin issues–warts, moles, eczema, etc.?
- What is most striking, defining or characteristic about your child?
He is a very opinionated child. Creative and detail-oriented as well.
- How cooperative is your child?
Not a lot. Dressing in the morning is generally very demanding on us as parents.
- What’s standing in his or her way of getting ahead?
His lack of focus and social interaction.
- How often does the child get sick? Does he tend toward certain ailments?
With God’s grace, not a lot. He gets flu once or twice a year generally in the main season.
- What illnesses run in the family?
My in laws have high diabetes and my husband has been diagnosed with it as well recently at borderline. My husband’s late younger brother had depression.
- What does the child really love to do?
He loves playing with cars, painting, drawings etc. He also likes talking to his toys when he is playing with them alone, especially with cars.
- Does your child have any peculiar “sensations” or “traits” that may or may not have anything to do with the chief complaint?
He does talk a lot and repeats himself until someone clearly responds to him.
He also has a habit of looking down on the floor while responding to any non-family member.
I would also like to bring in notice a few things we observed around our last trip to India in December to visit Grandparents below:
We went to India on holiday for 3 weeks during the Christmas break. Our son’s routine was very different there at his grandparents place as compared to here at home. He also met his 6 year old cousin. The two kids did get along in spite of language gap (My son cannot speak our native language, Hindi. He only speaks English). However, they did have quite a lot of disagreements when playing with toys which led to hitting each other. At one instance, Wonder Nephew bit his cousin.
He had also developed swelling in the right ear cartilage and some on his left palm on the area near the thumb. He visited the doctor in India who gave him a prescription of three days:
Allegra – two doses of 5ml each per day
Cetrizine – two doses of 1 tablet each per day
I did not complete the course of Cetrizine (he took half the dose with milk). He did a full course of Allegra.
When we came back to London, he had a viral (diagnosed by the GP here) infection (cough/cold and some temperature 38C+) and so was put on alternate dose of Calpol (10ml) and Neurofen(7.5ml) (with a period of 3-4 hours) to keep the temperature down. We continued the medicine for 1 day and he complained of stomach ache when he took the med so we reduced the dose to 5ml each which we continued for half a day more. His temperature came down and we stopped the meds.
At that point, (the first week of our return), our son showed a very aggressive challenging behaviour that included hitting, banging head on us and biting. On some occasions, he bit me so hard that I was in terrible pain. He had shown a sign of remorse at times and at times none at all. During calm moments like while following bedtime routine, I tried to explain to him that hitting is bad and it hurts others. He was quite receptive in understanding and promises not to repeat this behaviour again. However, he reverted back to the behaviour quite often since then.
As time has passed by (3-4 weeks), he seems to have started settling down a bit.
I don’t have many major traumatic events to add.
The only thing that strikes me is the time he spent in child care as a baby (9 months – 17 months).
The childminder was strict and she made sure Wonder Nephew ate good quantity at every meal. I was influenced from her for quite some time and followed the same approach. It was a struggle for me because I was unsuccessful in force feeding him although it seemed much later to us that she was successful in doing so only because he was scared of her.
She also suggested some allopathic medicines to me which I bought from India. These were to do with cold, cough, vomiting etc. I have given him those sometimes ( less than 10 incidents) and then realised that it’s not safe to do so and hence, stopped.
We tried to overcome the situation by shifting him to nursery but am not sure if it was too late.
- Is your child on any drugs or supplements at the moment, if not already stated?
- Does your child throw the covers off at night or stick his or her feet out of the covers?
Yes, he generally throws his covers off at night.
- For the next two days, every time your child eats or drinks something, write it down, along with the time, and report back here. Make sure you don’t change what he’s eating just for my benefit.
Sunday, 5th Feb 2017
9.45am – 2 butter toast, 1 egg omelette, 7 almond nuts
11.30 am: 1 pain au chocolate
12.30pm: 2 indian multigrain breads, salmon curry and tender stem broccoli,
1.5 cups of water
3.30pm: 2 party ringer biscuits
4.30pm: some raisins
5.00pm: 2 chicken fingers and steamed mixed veggies, 1 cup of water
6.30pm: 1 cup of warm chocolate milk
Monday,6th Feb 2017
7.30 am: 2 butter toast, 1 egg white omelette, 7 almond nuts
9.30 am : 5 cherry tomatoes
12.00 noon: plain pasta and peas (school lunch)
2 cups of water in the day
3.00 pm: 2 cheese strings
3.30pm: 2 Pain au chocolate
4.15 pm: 2 indian multigrain breads, lentils, some potatoes and pepper veg
1.5 cups of water
6.30pm: 1 cup of warm chocolate milk
7.00pm: 3/4th apple
Wonder Sister, give your son a dose of ____________________ 200C. Let me know what happens.
Oct. 16, 2018
Elaine…. It has been a while since I got in touch with you about things at our end. Wonder Nephew has been keeping well mostly.
Really? How is he doing? Do you remember his original case? As I recall, he was very demanding when he wanted something, there was the whole “springing up suddenly” behavior where he would sometimes injure people; he wouldn’t brush his teeth, there was a problem with getting dressed in the morning for school, plus a lack of empathy for other kids who may have hurt themselves and some trouble doing school work as well. Am I right?
He is still demanding but just like any other 6 year old would be :). The “springing up” has gone down a LOT and so have the injuries. It is generally due to a reason. When asked why he behaved like that, he is able to articulate better so we can help him. Brushing isn’t an issue, he does get lost sometimes while brushing when he is thinking of something else but we are mostly able to get him back to do the job! Getting dressed is a lot better. I lay down his clothes at the end of the bed in order and he then dresses himself in the morning. Some days he needs a lot of prodding and reminding him about the task at hand but it isn’t as bothering as it was before. School work is a lot better and so is the empathy with other kids. He is generally not the first to offer help if he sees there are others around but I guess that is his nature. If the person hurt is close to him or he is the only one around, he does offer any help he can 🙂
It is not a perfect world but its a lot better. He does have short attention span, he gets these short bursts where he focuses well. I’m hopeful that with the right support and lot of encouragement and ______________ to the rescue when we are clueless what caused the down-turn, he will get to where he wants to be 🙂
OK, everybody, that’s it! If you know the remedy, write to me at [email protected], the answer will be in the June issue.
And now, in remembrance, here is Doris Day and Rock Hudson in, “Pillow Talk”:
Bye, see you next time!
Elaine Lewis, D.Hom., C.Hom.
Elaine takes online cases and animal cases too!
Write to her at [email protected]
Visit her website: https://ElaineLewis.hpathy.com