Here’s the final installment of How Nate was Diagnosed with autism.  Click on Part One and Part Two to read the other entries.

So the mother of all tests is the Autism Diagnostic Observation Schedule, also known as the ADOS test.  This special test determines if you have Autism, Pervasive Developmental Disorder-Not Otherwise Specified (also known as PPD-NOS), developmentally delayed, or fine (which means you’ve been put through hell for nothing).  It was explained to us that the ADOS test is designed to be administered in a “neutral” environment, one free of the distractions from home.  Out of all the tests Nate took, we were told this was the most important one for Chad to attend.  We scheduled an appointment for 8:30am to go to the therapy clinic for Nate to take the test and Chad went to work late that day.

Still convinced that we can kill this thing with knowledge, I googled “ADOS Test.”  Up popped a series of links to purchase (you read right) an ADOS kit.  I clicked on the link and found this.

It was a treasure chest of toys.  And it was expensive.  For $1,485.00 (US), you can own the full ADOS kit, which includes a whole bunch of a DVD training package, observation/coding booklets, some computer software, and a bucket of toys “all in a durable plastic container, with handles.”  I recognized some of the toys in the bucket.  Nate knew how to play with those.  If this was a test about playing, we’d be fine.  Yup.  We’ll be fine.  Moving on….

Bright and early on the morning of December 23rd, we got Nate dressed in a really cute outfit.  (Surely there must be an observation/coding booklet for “cuteness.”)  When we got there, we were ushered into a little waiting room designed especially for toddlers.  Lots of toys, mini chairs, and a teevee with a built in VCR.  (Thankfully, this one was off.  No 1998 previews here….)  We introduced Nate to the wonderful world of Bristle Blocks and he toted a little wagon all around the room as we waited.

Finally, Gail, a social worker who would be observing Nate’s test, came in and we were taken to a private office.  It had three chairs, a desk, and a small round table with a tape recorder on it.  Nate made a bee-line for this electronic device that someone left on his level.  As she explained the test to Chad and me, Nate proceeded to open and closet the tape recorder lid about fifty times.  Over and over and over again. We were trying to listen to the lady but we both sat in fear that Nate was about to destroy our test administrator’s electronic device—and that might be a black mark on his test score.  We told Gail we were sorry about Nate’s instant obsession with her tape recorder.  She laughed and explained this wasn’t her office, so Nate should feel free to break whatever he wanted!  (Yay!  No ding!)  Before heading to the testing room, Gail asked if Nate had any difficulty transitioning between activities.  I replied that he had no issues whatsoever—he was a very easy, go lucky guy.

Right before Nate was able to destroy the tape player, we were taken to the testing space.  It was a small room—it could have probably held a twin size bed and a little desk.  There were three chairs against the wall, two for me and Chad and one for Gail next to a desk that she used to take notes on.  We met the two test administrators, Lisa and Katy, who sat on the floor with Nate.  When they came in the room, they brought in the same bucket (with handles) of toys that we saw online.  It suddenly sunk in.  Crap.  We could have studied for this test. We should have played with the trucks a few more times for good measure.

Then the test began.  Lisa had a great rapport with Nate; he liked her instantly.  But Nate also wanted Chad to play, so he kept running over to Chad and tugging on him to join in the fun.  A big part of the test is observing how Nate interacts with the test administrators, not us, so we encouraged him to go back to playing with Miss Lisa.  While Nate was tugging at Chad with his back to the test administrators, Lisa started the first activity: bubbles.  She had a squishy wand that blew bubbles when she squeezed it.  I was thrilled—Nate loves bubbles!  Happy that Nate would start the day with something he loves, I hollered out, “Hey, Nate!  Look!  BUBBLES!” I pointed at them with a big grin on my face.

See?  Nate likes bubbles!!!

Apparently, my joy for Nate’s activity essentially equated to cheating on the test.  I suddenly had the three test administrators sweetly tell me that Chad and I can’t lead Nate to noticing something; the test is designed to measure his response to each activity.  (Oops.)  Since I had helped him cheat on the test, Nate was now dancing around in the bubbles, poking at them and trying to pop them.  It was good times.  Then Lisa stopped blowing bubbles.  She asked Nate if he would like more bubbles.  Being the easy, go-lucky guy that he is, he gave her a blank stare which, in my mind, said, “I don’t care.  We can blow bubbles.  Or we can do something else.  What do you think?”  She asked Nate if he wanted “more bubbles” again.  No response again. So the bubbles were put away.  Pens started scribbling on paper.

Another one of the activities was having a birthday party for a baby doll.  Chad and I froze.  Nate doesn’t have a baby doll. He has Hobbes, his best tiger friend in the world.  But no baby doll.  Crap.  We screwed that one up.  And this baby doll was, well, loved.  It wasn’t as fresh as the one in the online ADOS kit photo.  Then Lisa takes out a can of pink Play Doh.  Play Doh.  Nate’s never played with Play Doh before.  Chad and I instinctively knew that he would hate the texture of it.  (He has texture issues.  More on that later….) This was going to be a disaster.

Lisa rolled a ball of Play Doh into a birthday cake and showed Nate some candles.  She asked if he wanted to put the candles in the cake.  Nate didn’t want the candles.  Lisa offered them again.  No response.  (To Nate’s credit, the only time he’s seen birthday candles, they were on fire, and fire is on the no touchy-touchy list.)  She tried a third time.  Nada.  So she stuck one in his hand and helped him smush it into the dough.  Yay.  One candle in.  Of three.

Then we had to sing Happy Birthday to Baby.  (Thankfully, Nate was not expected to sing.)  Then Lisa cut the birthday cake and asked Nate if he wanted to give a piece of cake to Baby.  I’m pretty sure the LED board in his head read, “Nah.  That’s ok.  You go ahead.  That baby doll looks freaky.”  She held out a piece of “cake” and asked Nate again if he wanted to give it to Baby.  Same little LED message went across his brain.  Finally, Lisa put the cake in Nate’s hand and helped him offer it to Baby.  Nate could have cared less.  Then we said bye-bye to Baby.  Lots of scribbling on paper.

We moved onto the snack portion of the test. This Nate would ace.  He loves to eat.  Two containers were placed in front of him.  One had Goldfish crackers and one had vanilla and chocolate Teddy Grahams.  Lisa let Nate sample each snack.  Then she asked him to choose: Goldfish or Teddy Grahams?  Goldfish or Teddy Grahams?  Nate said, “Both, please!”  Lisa said, “No.  Goldfish or Teddy Grahams?”  With his grabby fists, Nate said, “BOTH, PLEASE!”

Nate could not decide and didn’t understand why he couldn’t have both, so he continued to go for all the snacks simultaneously.  After a few grabby fists of crackers and cookies, the testing was over.  These three ladies, in addition to the woman who administered the Vineland Adaptive Behavior Scales (Second Edition) the day before, would now gather in a room for the next four hours.  They would go through all of their notes and look up their conclusions in the DSM (Diagnostic and Statistical Manual of Mental Disorders).  They’d call us with Nate’s diagnosis.

Nate and I drove Chad to work and then we headed back to our hometown and I took Nate to school.  Nate’s teachers gathered around and wanted all the details of the test.  They, too, lamented the fact that they never introduced Nate to Play Doh.  Nate went down for a nap and I headed home to wait for the phone.

At 1:30pm, I got the call.  Nate was autistic.

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