The Angry Drunk

For over a year Peter's pediatrician and I have been concerned about Peter's language skills. We expected Peter to have delays in several (if not all) developmental areas because he was 5 weeks premature, but his language delays seemed to be more severe than what prematurity could account for. Earlier this year, two separate Speech and Language Pathologists (SLPs)identified Peter as having profound delays in both receptive and expressive language. At 18 months, his language skills were placed at the level of a 4 or 5 month old infant. This delay was one of many factors in Peter being diagnosed with an Autism Spectrum Disorder.

Peter's developmental pediatrician, SLP, and I wondered if part of Peter's severe language delays were caused in part to Auditory Neuropathy. Auditory Neuropathy is a hearing disorder in which sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impaired. For example, a person with Auditory Neuropathy may be able to hear sounds, but would still have difficulty recognizing spoken words. Sounds may fade in and out for these individuals and seem out of sync. We knew from hearing tests Peter had at birth and at 15 months that he was not hearing impaired. However, he continued to show signs of a hearing loss including severe to profound delays in language, poor speech perception, hypo and hypersensitivities to noise, and difficulties in getting his attention (although in recent months he's been getting better in all these areas).

Fortunately, it is very easy to test for Auditory Neuropathy. A diagnosis requires a normal or positive OAE (that's the simple test they usually give newborns in the hospital) and an abnormal Auditory Brainstem Response (ABR). Peter already had two normal OAEs so he just needed to have a sedation ABR. The test monitors brain wave activity in response to sound using electrodes that are placed on the person's head and ears and it must be performed on a resting/quiet person. And since it is impossible to get a toddler to lay quietly for over an hour toddlers are sedated for the test. Normal sedation causes brain activity to decrease, so toddlers are given a conscious sedation. This combined with prior sleep deprivation allows people to sleep soundly during the test.

Peter finally had the ABR this past Wednesday (after almost 3 months of waiting to get in!). Per the doctor's instructions, Peter could not go to bed until midnight Tuesday night. We then woke him a few minutes before 6 am and gave him 4 ounces of apple juice. Peter was not allowed to have any solid food or milk after midnight, and nothing including water after 6:30. Once Peter was awake we couldn't let him nap for even 5 minutes. I had to sit in the backseat with him on our 50 minute drive to Primary Children's Hospital to keep him awake. We arrived at the hospital at 8:45 am. After being admitted, the nurse put an ID tag on Peter's ankle that he furiously tried to get off.

Up to that point Peter had been incredibly good. When Ryan and I had received the instructions to cut 6 hours out of Peter's sleep the night before and to not feed him in the morning, we thought that Peter would be a nightmare. This is a boy who hates getting up early in the morning (so much like his mother!) and wants a bottle of milk as soon as he is awake. So we were pleasantly surprised when Peter was so calm Wednesday morning (apparently sleep deprivation occasionally has its benefits). Over the next hour we met with a couple of nurses, the audiologist, and the anaesthesiologist to discuss the sedation, test, etc. Peter stayed busy and awake during this hour by playing with the hospital bed in the room. Now he wants a bed with buttons that light up, move the bed, and call a nurse.

At 10 Peter was sedated. Because it wasn't meant to knock him out, I had to rock him to sleep. He fell asleep after about 10 minutes of rocking and listening to me sing (I think he fell asleep to escape my awful voice). At that point I put him in the hospital crib and the nurse hooked him up to various monitors. (I know the picture below is really dark, but I didn't want a flash to wake him up and the photos taken at an higher ISO were too noisy to use.) The audiologist then came in and put two electrodes on Peter's forehead, one behind each ear, and a small earphone in each ear. Then she began the test and Ryan fell asleep.

The audiologist finished the test in under an hour. I immediately knew that the test had gone well because if the test doesn't take the full 90 to 120 minutes that usually means few or no problems were found. After waking Ryan up, the audiologist then gave us the good news: Peter definitely does not have Audiotory Neuropathy and the results of the ABR combined with previous testing rule out any auditory issues! Peter already has enough working against him so we were both very excited and relieved by the results.

Next came the fun part: we had to wake Peter up. The anesthesiologist warned us that it might take a little while for Peter to wake up and that when he did he might act a "little drunk." Their plan was to wake him, give him some juice, and then observe him for 30 minutes up to several hours. They wanted to make sure that Peter wasn't too nauseated, could keep liquids down, and that his gross motor skills were close to normal. So we spent over 15 minutes trying to wake him up (it's amazing what a wet washcloth and picking his nose can do!).

Once he was awake, Peter was one cranky kid. When the doctor said Peter would act drunk, he wasn't kidding. But instead of getting the maudlin drunk or the crazy drunk, we got the angry drunk. Now I should have seen this coming because both times Ryan has come out of anaesthesia since we've been married he's been an absolute beast. He's angry and he swears more in 1 minute than he usually does in 1 year. Peter was pretty much the same (minus the swearing). He cried, screamed, kicked and thrashed. He really wanted to run but considering he couldn't even sit up without falling that was not an option. His equilibrium was completely off and his muscles were like noodles. He refused to drink anything and basically wouldn't do anything but scream and try to get down from the crib or Ryan's arms. The anaesthesiologist decided to go ahead and send Peter home. He said that if he was fighting us as much as he was, he was probably okay. So we headed home with a raging kid and a stack of instructions. Fortunately, Peter went to sleep when we got home. When he woke up that evening he had transformed into a loopy and fun drunk. Lots of staggering, lots of tumbles (don't worry, we kept him away from hard and sharp objects), lots of laughs and lots of goofy grins. Now we just need to convince him midnight is not a reasonable bedtime!