Updates from 08/24/2010 to 08/30/2010
It has been really hard for me to keep up with Keshav's daily blog as i have been terribly busy at work. Keshav had an overall OK week. His balance his still off, he still drools, he still mouths object, he still is unaware of people around him,his abdomen is still extended and he is still non-verbal and his babbling hasnt returned yet. Yesterday sunday 08/29 at Nitya's B'Day party he wasnt interested in anyone around. He wouldnt even look at anyone. So socially we havent seen any changes/gains in him whatsoever. He does seem, more attached to his mother as she takes care of him 24/7. He is still unresponsive to his name and does not address his mom as mama or me as dada. He still does not point and still does not follow any simple instruction(s). So all the classic autistic symptoms still remain inspite of all the intervention that we have done for him. He can point to all his body parts but he was doing that in Feburary of 2010 even before we started any kind of intervention.
His sleep is definitely better and he sleeps through the night. However if he takes a nap in the afternoon it is still hard for him to fall asleep and he tosses and turns in the bed. We have discovered that it is just best to keep him up in the afternoon.

ABA therapist note 08/28/2010
Keshav flew again with all his programs today. His GMI look really good considering today was just the second day "turn around" and "point" was introduced. With "raise hand" he responds and imitates quickly when I say, "I'm ready" since this is what he learned from school. I know it's a verbal prompt so I only do it in the first trial then 2nd and 3rd trial he does imitates spontaneously. Object Imitation including discrimination looks wonderful. I really can't believe how well he is doing with this program. I could just remember when Morgan first introduced the "sunglasses on" Keshav was just so distressed, and thought of holding it off...but now he is a pro... Great job! Keshav. Receptive ID as well as 2D&2D Non-ID matching looks awesome! Play skills with car is looking a lot better and he did follow my car with his own car going up the ramp that I made but he doesn't seem to be as interested playing with it right now. His manding looks really great. His discrimination with the use of signs is much better, occasionally he still scrolls through them during playtime because I'm waiting for his eye gaze/contact with mands and he gets impatient and scrolls through all his signs, so I just correct him right away so it won't confuse him.


ABA therapist note 08/27/2010
Best session ever! Keshav scored 100% on ALL of his Object Imitation targets, including those done in discrimination! We also included two new targets in Gross Motor Imitation, including "turn around." Keshav only required a partial prompt the first time presented to imitate turn around! All of his responses are much quicker and much more concise as well! We also had the most successful free play time as well today! Keshav seemed much more interested/motiviated by our activities than he ever has, manding for "more" with great eye contact! Keshav is also doing very well with his manding for chips. I would say the he is manding appropriately about 90% of the time independently! Great job! We noticed that he was eyeing the musical helicopter anout 10 minutes into this portion of the session, brought it over, and Keshav successfully manded for "music" and then "chip" while the music was playing! :) Lastly, we have been doing musical chairs (about 5-6 trials) at the end of the session and although Keshav requires prompting to walk around the chair, Keshav has begun sitting down when the music stops! :)


Morgan Mix at 11:48 AM
Keshav had a great session today! I worked through all the programs and some we went through twice. He did awesome with object imitation almost 100% throughout the targets! He is having a hard time with hands down and arms out with receptive instruction. Many prompts needed for him to be successful. Receptive Identification is getting much better, the first 3 trials are 50/50, then when ran again later in the session, Keshav got 100% throughout both targets! Tons of independent mands today. 125 total, chip is shaping up to be very clear and concise. 20 independent signs for chip today! Non-identical matching was also really good, 100% 5 trials at the beginning of the session and 5 at the end - I even switched up the pictures of different animals and Keshav still got all of them correct. Overall, fantastic session!

ABA therapist note 08/26/2010
Keshav had a great session today. We got through all of his programs with ease. He is doing a great job with gross motor imitation almost 100% for all targets. Manding was great today, 112 mands total throughout the session! He is independently signing chip, about 16 times the last 15 minutes, very little prompting was needed. With object imitation and object imitation with discrimination he needs prompting for the first trial, and then he does a great job the 2nd and 3rd time it's presented. Play skills are also going really well. I incorporated rolling with playing bowling and Keshav is having a blast playing this! I am continuing to probe musical chairs, a lot of full prompts are needed with this still. Overall, great session.

ABA therapist note 08/25/2010
Great day! Keshav is making good strides with Receptive Object Idenification, clearly and concisely identifying "car' and "book" 2/3 times. (We continued beyond the 3 trials and Keshav identified each object 4/5 times!) Great job! Also, Keshav's sign for "chip" is looking really good! He is signing like a pro, making the sign very swiftly (like he does for "open"). We were able to set up 26 opportunities for this today. It is difficult to get more because he becomes satiated with the chips, but his independence level with the sign is probably around 50-75%. I will keep close track of this on Friday and report back. Keshav's participation in the car scenario has greatly improved this week! He is imitating and even initiating specific favorite activities with the cars (crashing :) ). Per parent report, Keshav is playing appropriately with the trains/tracks at school as well! Great job again today with discrimination between "bubbles" and "music." I set it up on a couple of occasions where Keshav switched back and forth between mands and he deomnstrated good independence with these!

ABA therapist note 08/24/2010
Keshav had a good session today. He was a little more distracted than usual, he was very interested in his toys and would scroll through signs to get music or open while doing some programs like gross motor imitation. But he did very well with all of his programs, more prompting was needed for some skills but overall he did a great job. Pointing was excellent today, he was even pointing at the pictures while doing receptive ID (3D & 2D). Receptive ID (2D) was 50/50, and (3D) was about the same. He is typically touching the picture or object that was requested. Non-identical matching is going a lot better, he is responding better the second and third time the cards are presented. Play skills were great, along with manding and all imitation. Musical chairs is going okay, a lot of prompting is needed to walk around the chair, then sit when the music stops. Overall, great session.

Last night Keshav went to bed around 8:30PM. He slept through the night without waking up and woke up only in the morning around 7-7:30AM.
Rochelle reports that Keshav fell down at the school and he has a bluish bump on his head. He wouldnt let us put an ice pack on it. Keshav slept after his school around 4:15PM and slept until 6PM. Later in the evening we took Keshav to the park and he was very happy being on the swing. He did not want to get off the swing and wanted to keep swinging. Today, I revealed Keshav's condition to some family friends. Keshav went to sleep around 11:30PM at Nikhil's house and slept through the night waking up by himself at around 7:30AM.

ABA Therapist Notes
Great day for Keshav! He is doing a fantastic job with his programs! We flew through his targets today and I was very impressed at how much he has improved with putting sunglasses on! He is no longer demonstrating any signs of distress and imitated putting them on 100% of the time today! He also did very well with his new object imitation target, "hat on." I had anticipated that his initial reaction to the hat would be similar to that of the sunglasses, but he only needed inital prompting to put it on! :) We also used some of our free play time today to work on discrimination with his signs and Keshav did a great job discriminating between "music" and "bubbles!!" He even switched his request up throughout the 10 minutes or so that we worked on this! At this beginning of the session, when a couple of options were presented to serve as reinforcement, Kesahv signed "music" and pointed at the musical book!! Great job! Keshav has also begun imitating some of my oral motor movements during play. For example, today I began whistling the tune that was playing on one of his toys and Keshav imitated the shape of my mouth with his! Keshav has also greatly improved with the car scenario, requiring less intrusive prompts to race, go up and down the ramp, and follow me on the track! Lastly, we started Mr. Potato Head today and Keshav put one of the ears, one of the arms the nose, and the hat in the correct place on the head without prompting! Great job, Keshav!

Keshav slept at 9:30 PM last night and slept through the night waking up only at 7AM. In the morning today i noticed that his vocalization is a little bit more. No babbling or anything but some noises here and there mostly screaming screeching sounds. Rochelle also tells me that in the past week, he has been happy to see her when she comes to pick him up at the school. The only new thing that we did with him is the TriEnza Enzyme from Houston Enzymes. Rochelle tells me that Keshav pooped twice today and both times poops were soft. Yesterday saturday he pooped twice both were soft poops.
ABA Therapist Notes
Keshav had a wonderful session today. I really worked on shaping up some of his "lazy" gross motor imitations and mands. For example, working on pointing index finger for touch nose, instead of just using all of his fingers to touch his nose. Also, shaping up pointing for the sign chip. He did a great job with all of his programs. I probed receptive picture id with the picture of an apple. I did 5 mass trials of errorless teaching and then moved to partial prompting, mostly gestures toward the apple. By the end of the session he was touching apple without any prompts! He did a great job manding today! 122 total mands for today's session! Great job with chip, 15 independent signs. When playing bowling, Keshav learned to "roll" the ball by imitation and did a great job! Overall, great session!
Keshav slept at 8:45PM tonite.

Notes for Friday 08/20/1010
Keshav woke up at around 8AM by himself in the morning. According to Rochelle he is sleeping through the night. Keshav pooped twice today and both times the poops were soft and not mushy/airy/loose.

ABA Therapist Notes
Morning Session
Very good session for Keshav1 He did extremely well with his Gross Motor Imitation targets today, scoring 100% for all three targets! :) Keshav is also doing a fantastic job with generalizing his mands. Rochelle picked up a bubble blower toy and once Keshav realized what the toy did, he signed appropriately "bubbles" every time! He is also signing "music" for a variety of activities (e.g., helicopter, CD, computer, musical book). He has also begun signing "chip" independently!! Per parent report, Keshav waved and vocalized "hi" to the speech pathologist independently.yesterday! Great job! Also, Rochelle spoke to the staff at Keshav's school and they do not really do group games as part of their curriculum (something we discussed at our meeting on Monday.) Lastly, we probed Receptive Actions today and Keshav was unable to identify any of the actions on the 2D cards. We are going to work on manding for "chips" right now and probe musical chairs. I will include another comment following to let you know how it went!
Evening Session
Keshav was very playful and initiated play a couple times throughout the session! He picked up the tunnel, walked over and handed it to me and signed open! The tunnel was very reinforcing. He did the same thing with the blanket. He picked up the blanket, walked over to me, and signed open. Play skills went really good today, he was very motivated and happy while playing bowling and Mr. Potato Head. Eye contact was also really great today. As far as object imitation, he is still having a hard time putting on the sunglasses and that's the only target he didn't get 100% on. Touch nose as a receptive command and imitation was difficult for Keshav today. He also had a difficult time with receptive identification. The receptive Action pictures were also difficult, but we just started. I used pictures of Keshav eating, drinking and sleeping in hopes that it would help him attend to the pictures more. The Object imitation with discrimination 2 went really well, he had no problems imitating me with the random sequence. Keshav also independently signed chips 10 times!!!! Overall, great session!

Keshav slept at 8PM tonite.

My observations
Whatever the therapist might say, I think Keshav's overall understanding is not a lot. He hasnt gained anything. He is unable to respond to his name, does not point, doesnt acknowledge when i get back home. He also does not know how to discriminate between the signs and will use all the signs in his repertoire to get to stuff that he wants. He is still obsessed with spinning lids and is still looking somewhere else without making proper eye contact while saying bye to me in the morning. His gait is still unsteady, muscle tone still low. Overall i would say Keshav has gained nothing that he wouldnt have gained without all these interventions.


Notes for Thursday 08/19/2010
Keshav woke up at 7AM in the morning and later that day we had to go to the ENT doctor for his check up. At the ENT doctor Keshav did not co-operate and the visit was an utter failure. They couldnt check his hearing in anyway. According to the ENT doctor from Keshav's previous hearing tests, his hearing seems to be fine and he has no inner ear fluid.
Keshav pooped once and it was loose/mushy.
Also, I went to the DAN doctor and according to the DAN doctor, Keshav's urine test(Organic Acid Test) and previously his stool test indicated that he has high yeast.His urine test also indicated that he has very high Oxidative Stress. For yeast they prescribed Nystatin and for the Oxidative Stress they gave a transdermal Anti-Oxidant. I think the transdermal antioxidant might have some ALA,glutathione or COQ10. The DAN doctor probably does not want to use oral ALA as it is shown to aggravate yeast. DAN doctor also indicated that Keshav might have some methylation issues and some mitochondrial issues.
We gave Keshav his second dose of MMR10M in the night yesterday. Keshav has shown no reaction to the MMR1M or the MMR10M. He did show some reaction, that of a runny nose that lasted for about a week on the MMR 200C. Keshav went to sleep at 10PM tonite.

Keshav slept at 8PM last night. He briefly woke up at around 10PM and was sitting but then Rochelle patted him back to sleep. He woke up by himself at around 7AM in the morning today. Keshav pooped twice today and the second time the stool was towards mushy.
ABA Therapist Notes
Good day! We followed the new schedule as indicated in the meeting notes and Keshav adjusted well to playing with me vs. playing with me with another toy. Keshav also did well with Object Imitation w/ Discrimination 2 (in the natural environment), scoring 2/3 on all targets. Initially he would attempt to stack his cup on top of my two cups, put the block in my bowl and stack his blocks on top of mine, but he quickly picked up on the expectation and did very well. We actually then played with the foam blocks for a good five minutes, incorporating manding and silly crashing and Keshav really seemed to enjoy it! One thing that I noticed with Keshav's manding for "bubbles" today is that since Rochelle has been working on "chip," Keshav is expressing "eat" and requiring prompting to pull his hand back from his mouth a bit. We will target this again on Friday. Also, Keshav DOES NOT like putting sunglasses on AT ALL. This took both of us to prompt today. On Friday we are going to try using a bit larger pair of sunglasses to see if the tight fit of Keshav's sunglasses around his head may have something to do with his distress (He picks them up and will bring them to his face at mouth level). Lastly, we will probe the Receptive Actions and Musical Chairs on Friday. It slipped my mind until I began typing these notes and from here we are going to work on manding for chips! :)

Yesterday night Keshav went to sleep at around 8:30PM in the evening and did not wake up until 8:00AM in the morning. Rochelle had to actually wake him up in the morning. This is the first time that he has slept 12 hours and that too without waking up in the night and had to be actually woken up by his mother. Since he did not take a nap in the afternoon, it wasnt hard at all to put him to bed.
Rochelle reports that Keshav pooped twice today and both times stool was soft.
Today, night Keshav went to sleep at 8PM.
ABA Therapist Notes
Keshav had a great session. I introduced 2D non-identical matching with 3 animal cards (Bear, Koala, Mouse), he did a pretty good job since it was his first try at this. Bear 2/5, Kaola 2/5, Mouse 2/5. Keshav is still having trouble with receptive identification even in FO2. Book and car were 0/5 each. He is not attending to the materials and is not interested at all. "Turn Around" for both GMI and RI doesn't look too good and was prompted most of the time. ( Morgan, by the way I added "turn around" on the GMI since Saloni said it to do it as gross motor instead to see how he will do with it). I also put out the object imitation with discrimination in a random order and Keshav did not do well with this. He didn't quite seem to know what to do. When I put them in order like the usual way, he flew through them. Other programs were great, he is also doing really good at play skills, he seems a lot more interested in the materials. He tends to over generalize his signs again and tried to work on discriminating each one. I introduced the new sign for chips in the last 15 minutes of the session most of it are prompted to make it error less and will make him to get the sign quicker.Overall, great session.

Last night Keshav went to sleep at 11:00PM. He slept through the night and woke up by himself at around 9:00AM. Keshav's sleep seems to have improved. He is not waking up during the night.

On Saturday 08/4/2010, Keshav did not poop, which is not like him at all. However on Sunday he pooped twice. The first time the poop was hard/soft, the second time it was soft/mushy. Today Monday 08/16/2010 Keshav did not poop until in the evening after dinner which is not like him at all. His poop was hard/soft and it wasnt a lot. He might be a little constipated.

Keshav is does not have a runny nose anymore. He is done with MMR1M and today we will be starting the MMR 10M. Keshav got his MMR10M in the night just before he went to sleep. He went to sleep at around 8:30PM.
Rochelle reports that Keshav is doing OK at school. Keshav still doesnt get exited or acknowledges when i get back home. His pointing towards the light is gone. He is still drooling a lot, still mouthing on objects and his walking is soooooooo wobbly. Nothing seems to have improved in any way. His development seems to have come to a halt. He is not growing. He is still very much a baby as compared to kids his age and even the ones 4-5 months younger than him. Overall I dont see any gains from whatever we are doing whether it be Supplements, Homeopathy or ABA/Speech therapy.


ABA Therapist Notes