Ugh.

Isla has had such an attitude lately. I'm trying to ignore it, but wow, it's full-on. She's uber emotional at the moment, the slightest thing sets her off into a stream of tears. And she's cranky, defiant, and just generally naughty.

We've never really had any behavioural problems (well, I shouldn't say problems, this is really an 'issue' is suppose) so it's all new to us.

I know there has been a bit of change for her to get used to lately, me going back to work, then leaving work, botox, we've moved, I'm now going to school, she's being minded by my Mum and Ian more. I guess it all contributes to the 'issues', but ugh, I just want my lovely little girl back!!!

On her progress though, we've been having weekly physio and she's improved SO much. Huzzah! She's happy to do her exercises these days, which is a welcomed change.

We're accessing therapies through the Spastic Centre again, they're going to contact us about group therapy, dancing and something else, I can't remember.

They seem to have it all going on, so I'm happy with the decision to go back there. I explained that in the past Isla was the mildest child there and missed out on interaction with the therapists, they understood and said they'd work on something for her.

We have a speech assessment next Monday. Should be interesting.

Remember we saw Dr B a few weeks back? Here's the report (feel free to fast forward to the results).

"Isla is referred by Dr F, Paediatrician, because she has Cerebral Palsy and will probably go to school in 2010 and this is a developmental assessment towards that. She attended an appointment with her mother Allison on Friday morning the 12th of June.

CURRENT CONCERNS:
There was some concern as to how her needs will be met in school. Isla is considered to be thoughtful and a caring child who is affectionate towards the family and friends. She has good communication skills and a large vocabulary.

HEALTH INFORMATION:
Isla was born at Liverpool Hospital five weeks early weighing 2.585kg. She had a head circumference of 34cm. She was born by emergency caesarean section. There was grade IV placenta praevia and there was severeal antepartum haemorrhages during the gestation. Her Apgar scores were good at birth 9 at 1 minute and 9 at 5 minutes. She was discharged home at 5 days.

There were no neonatal seizures. There was some jaundice.

She has had occasional viral illnesses. She has had suspected seizures though they are considered to be day-dreaming episodes. She has had Botox injections at the Sydney Children's Hospital. Her current diagnosis is Spastic Diplegia/Quadriplegia.

She has had her vision and hearing tested and all is considered to be well though she has not had a recent hearing test.

DEVELOPMENTAL HISTORY:
Isla pulled herself to stand at 12 months and walked at 26 months. She walked upstairs at about the ages of three and a half. She can pedal a tricycle at the age of three and a half. She started babbling at six months, said her first word at 9 months and started joining words at 18 months. She started speaking sentences at around the age of two. She tries to do buttons but has difficulty with that, She tries to help with dressing but has difficulty. She is is able to feed herself with minimal difficulty. She is learning to use a knife. Isla knows numbers, letters, colours and shapes.

PLAY AND BEHAVIOUR:
Isla is generally very well behaved. She plays happily on her own and with others. She attends Kindy on Wednesdays and Thursday s from 10-4 and enjoys the time there. She has occasional toileting accidents and she is generally considered to be physically awkward.

Past assessment using the Bailey's Scale at 20 months by the CAT team at Campbelltown Hospital found that she had some motor difficulties.

AGENCIES INVOLVED:
Speech Pathologist, Physiotherapist, Occupational Therapist, Ophthalmologist x2, Neurologist x2, The Spastic Centre.

OBSERVATIONS DURING GRIFFITHS ASSESSMENT:
Isla at 4yrs and 5 months (53 months) was presented with tasks from a test called the Griffiths Mental Developmental Scales Extended Revised (GMDS-ER) which assesses the mental development of young children (from Birth to 8 years, May 2004). Standardised tests are constructed for the purpose of determining a child's level of performance relative to other children of similar age. The Griffiths Scales examine a child's mastery of a number of different skills and thereby provide a behavioural yardstick of a child's level of maturity. The following abilities and levels of performance were obtained in 5-6 sub scales:

A. Locomotor Skills - This scale assesses gross motor ability to balance, and to coordinate and control movements. This includes assessing walking up and down stairs, kicking a ball, riding a bike, jumping and skipping.

B. Personal-Social Skills - This scale assesses the proficiency in the activities of daily living, independence and ability to interact with other children. This includes activities such as dressing, competency using cutlery and knowledge of information such as name, date of birth and address.

C. Hearing-Speech Skills - This scale assesses the expressive and receptive language skills. Items tested include naming objects and colours, repeating sentences, describing a picture and answering questions about comprehension, similarities and differences.

D. Eye-Hand Coordination Skills - This scale assesses fine motor movements, manual dexterity and visual perception skills. This includes threading beads, cutting with scissors, copying shapes and writing letters and numbers.

E. Performance Skills - This scale assesses the manipulation skills including the speed of working and precision. This includes building bridges and stairs, completion of puzzles and pattern making.

F. Practical Reasoning Skills - This scale assesses the ability to solve practical problems, understanding of basic mathematical concepts and questions about moral and sequential issues. This includes counting and comparison of size, length and height.

RESULTS:
Locomtor Skills Age Equivalent Less than 24months
Personal-Social Skills Age Equivalent 40 months
Hearing and Speech Skills Age Equivalent 56 months
Eye and Hand Coordination Skills Age Equivalent 52 months
Performance Skills Age Equivalent 37 months
Practical Reasoning Skills Age Equivalent 50 months

SUMMARY:
Isla is a delightful child to assess. She has very good language and communication skills. She scores in the low average range principally because she has fine motor and gross motor difficulties (she has difficulties with motor planning). Isla is doing very well and will fit nicely to a mainstream school where her physical needs can be met.

Because of this she requires a transition to school referral so that the family can investigate with the DET an educational setting where her physical needs can be met. She might need things such as gradual access ramps for easy access and she might need tilted writing surfaces. Isla is noted to be able to walk about 100 metres before she becomes tired and so these things need to be taken into consideration. She falls over fairly frequently and though this should be no reason for her not to attend school it is something that needs be taken into account.