For one North Texas family, that resilience is embodied in their little boy, Gabriel “Thor” Munoz. Not because life has been easy, but because from the very beginning, he has faced it with a strength that is impossible to ignore.

The Origin Story: The Birth of a Superhero

It regularly takes 40 weeks for a baby to be born, but not for a superhero. For Thor, it only took 24 weeks and three days, weighing just one pound and seven ounces. His parents, Michael and Mary Munoz, stood by Thor’s side while he spent his first six months fighting, and winning, every battle his tiny body faced.

Thor encountered one of his hardest battles at just a few weeks old when he was diagnosed with necrotizing enterocolitis (NEC), a serious gastrointestinal condition typically seen in premature infants. NEC left Thor with only a 2% chance of surviving corrective surgery. Despite the daunting odds, Michael and Mary chose to take the risk, clinging to that small window of hope for their son’s future.

On the day of the surgery, Cook Children’s surgeon Marty Knott, DO, Ph.D., arrived wearing a surgical cap covered in superheroes, including the well-known god of thunder, Thor. As soon as Michael and Mary saw the cap, they took it as a sign that their little boy was in the right hands.

Three years later, Dr. Knott and Thor’s family reunited to reflect on the profound bond they formed during those vulnerable early days. To honor Thor's journey, Dr. Knott presented the family with the surgical cap he wore during the life-saving procedure, a symbolic reminder that their child not only carries a superhero’s name, but he is also the true hero of his own story.

The Discovery: A Different Kind of Superpower

Arriving into the world prematurely wasn’t the only challenge Thor and his family would endure. As he kept growing, his family noticed irregular behaviors that concerned them, such as totally refusing solid foods and banging his head against hard surfaces. These behaviors disrupted his health and made it difficult for him to communicate with the world around him.

Seeking answers, his parents pushed for a medical evaluation. At just three years old, Thor was officially diagnosed with autism. For his family, this wasn't just a label; it was the key to unlocking the specialized help he needed.

His mother, Mary, said acting fast made all the difference. "To me, the earlier you diagnose, the more help you can get and the better the outcome," she said.

The Adaptation Process: A Superhero in Training

When Thor arrived at Cook Children’s, his symptoms were so complex that other applied behavior analysis (ABA) clinics had previously refused to treat him. However, the team at Child Study Center accepted the challenge, using ABA techniques to address his severe behavioral hurdles. Duy D. Le, MS, BCBA, Manager of Applied Behavior Analysis, explained that the program is designed to build essential life skills: "ABA therapy techniques can help decrease problem behavior, and increase desirable behavior, including tolerance of hygiene tasks... and expand the number of foods a child is willing to eat,” Le said. By breaking down these daunting tasks into small, rewarding steps, ABA therapy provided Thor with a structured roadmap to navigate a world that often felt overwhelming.

The specialized training focused on replacing Thor’s most difficult struggles with functional communication. Cheyenne Matson, the Lead Program Specialist for the Behavior Disorders Clinic at Child Study Center, who worked directly with Thor, noted that the program was visibly effective when Thor was given a way to be heard.

"When Thor started treatment, we introduced the Picture Exchange Communication System (PECS) to teach Thor a functional form of communication rather than banging his head," Matson explained. As Thor learned to use images to express his needs, his head-banging diminished. This clinical expertise allowed Thor to move past his most severe symptoms, turning high-intensity struggles into a series of manageable victories.

Thor’s progress is now evidenced by milestones that once seemed out of reach. He has successfully transitioned to eating solid foods, adding six new foods to his diet, and his self-injurious behavior dropped to 0% by the end of his treatment. His parents note that while the journey is ongoing, the resilience he displays at Cook Children’s is truly heroic as he continues to bridge the gap between his inner world and the community around him.

The Power Source: Love and Braveness

Although Thor has proven to be a resilient child, he is a superhero with a unique source of power: the unwavering devotion of his loving parents. While Michael and Mary faced a maze of obstacles, they refused to let the search for answers exhaust their hope.

“You just have to keep fighting for what you know your kid needs,” Mary said. “There are people out there who truly care and want to help for the right reasons.”

Thor’s parents now hope to raise awareness and advocate not only for children diagnosed with ASD, but also for the caregivers walking a similar path in search of the right treatment for their children.

Related Stories:

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• Mental Health & Medication: Overcoming Stigmas
• Raising Joy Podcast: Raising a Child With Autism With Bianka Soria-Olmos, D.O.

It was an incredible event filled with vibrant canvases and delicious bites, but the real masterpiece was the confidence and pride on students’ faces. 

When the Padilla family of Fort Worth adopted their son, Eduardo, from a town north of Mexico City when he was just 3 months old, they dreamed of giving him a future full of opportunities he likely wouldn’t have in Mexico. He was a tiny baby. So tiny, in fact, that even preemie clothes were too big for his little frame.

“Since he was given to us, the whole idea was to change his life with a better future and nicer opportunities,” said Eduardo’s father, who shares his son’s first name. “But the reality, at least in my case, has been the opposite. He’s been changing my life with a lot more motivation. Eduardo has always been a good son, a good brother, and I believe he’s a good citizen. He’s a good guy, a cool guy.”

But those opportunities didn’t come easy. Early in his childhood, Eduardo began to show signs of a learning disability, and the dreams his parents Eduardo Padilla and Karla Tamez once had for their middle son were dimmed at the reality of growing up in a world that often disqualifies those who are differently abled. Eduardo attended several schools, none of them a good fit, and his dad worried that he’d never learn to read or write.

For many parents, learning that their child has a developmental disability is one of the most difficult days of their lives. With the news comes a realization that special milestones parents often look forward to for their children — prom, a first date, college, holding a job, marriage and having children — may never become reality. 

“Their grief with the loss of these dreams comes in waves that hit at every missed milestone and with every announcement received from loved ones or seen on social media,” said Kimberly James-Kelly, assistant principal of the Jane Justin School at Cook Children’s Child Study Center, where Eduardo became a student.

The Jane Justin school is a state-of-the-art, individualized, evidence-based private school for children kindergarten through twelfth grade with developmental, intellectual and learning disabilities. With an annual enrollment of 90 students, it has both a Lower School for elementary through junior high education and an Upper School for high school and career readiness training. Through individualized learning plans, it is the vision of the Jane Justin School to develop capable scholars, responsible citizens, and loyal friends prepared to succeed in every step of their educational journey.

A Photographer is Born

Eduardo excelled at the Jane Justin School and his parents' doubts and fear quickly began to melt away. Not only did he learn to read and write, he achieved a number of educational milestones, including graduating from the Upper School in May 2024. Thanks to supportive parents who encouraged their son to find and pursue his talents, Eduardo also discovered a passion and gift for photography and video editing. Eduardo is now taking part in the Upper School’s Post-graduate Program where job coaches equip students with job skills and pair them with community organizations, including Cook Children’s Medical Center, for volunteer opportunities or internships that provide students on-the-job training.

The program helped Eduardo turn his photography talent into a marketable skill, and he landed an internship with Cook Children’s Public Relations and Communications Department, where he has worked for the past 18 months. He is the first Jane Justin School intern to become a hired employee at Cook Children’s.

“One of my favorite memories has to be going to the groundbreaking for the Las Vegas Trail Neighborhood Health Center because I got to see the Mayor of Fort Worth and that’s pretty cool,” Eduardo said. “I got to see the whole team for the first time, and that was my first off-site from school. It was really cool.”

Cook Children’s became a partner in the intern program in 2022. Since then, the partnership has grown to now include three to five student interns per semester who work in various departments throughout the hospital. Other community partners hosting Jane Justin School students and volunteers include Tarrant Area Food Bank, Fort Worth Botanic Gardens, Ronald McDonald House and Welman Project.

“The Jane Justin School has done such an incredible job of preparing these students and they were looking for other partners to hire them,” said Wini King, senior vice president and Cook Children’s chief Communication & Employee Connections Officer. “These are our children. They are a part of the Cook Children’s family so it just made sense for the medical center to be one of those partners. So far, we’ve been able to place interns in Volunteer Services, Radiology, Zooty Fruity Yogurt Shop, Build-A-Bear and some of our retail spaces, and I’m extremely proud that they are also working in my own department.”

Eduardo has more than proven himself to be a valuable member of the communications team. He’s often called upon to photograph patients and families for stories that appear in the health system’s online newsroom, CheckupNewsroom.com, and to take photos at various medical center events. He even took many of the photos accompanying this article.

“At the beginning of Eduardo’s internship, he came in very shy, but as he became more comfortable with us and just photography in general, he’s become very proactive in his projects in that he’ll think of ideas of things to do or things to shoot,” said Sydney Hanes, Cook Children’s manager of Public Relations. “He’s very open and much more comfortable talking to everyone. We all love having him on the team.”

During his internship, Eduardo says he’s learned about various camera settings, video editing software, how to shoot different angles and how to get the perfect shot. The job, his dad says, changed Eduardo’s outlook.

“When he noticed that this was something with a future when they offered the opportunity to be an intern here helping with pictures and videos last year, that’s the first time that I really saw on his face a passion for something,” Eduardo’s father said.

From Classmates to Colleagues

Eduardo joins four other interns currently working at Cook Children’s.

Luke Harris and Zachary Pollack are the dynamic duo who travel throughout the medical center with the comfort cart, which is stocked with items such as toiletries and snacks to make a hospital stay a little more comfortable for children and families. The two are often a welcome sight, not only for their cart full of goodies but also for their enthusiasm and smiles.

Harris says he wanted to be an intern so he can “be a helpful person.” He doesn’t just enjoy his job, but loves it.

“I really like to take care of the patients, because I feel like I’m a superhero,” Harris said.

Pollack hails all the way from Edmond, Okla., where his family resides. He spends weekdays in Fort Worth with his grandparents in order to attend the Jane Justin School and travels home to Oklahoma every weekend to spend time with his parents. He recently passed his driver’s exam and is now a licensed driver.

Hannah Washington works at the medical center’s Build-A-Bear Workshop, a favored stop for patients and visitors alike. She helps keep the bears’ clothes and accessories stocked and organized, and does it all with a thankful heart.

“It makes me more grateful than ever,” Washington said of her internship.

Her favorite bear is the Fairy Bear because, like most things at Cook Children’s, it’s magical and enchanted, she says. Hannah has also worked in Radiology and at the Under the Peaks retail space. When she isn’t at school or work, you’ll find her singing. Mariah Carey and Whitney Houston are two of her favorite artists.  

Brooklyn Dilworth is an administrative ace. She works for a number of departments throughout the hospital making binders and folders that contain educational materials for patients. She also attends Tarrant County College where she is studying money management, math skills and taking cooking classes. Fried chicken is her favorite dish to cook. This holiday season, she’ll be rocking around the Christmas tree with fellow singers in the Jane Justin School choir as they present “Rock and Roll New Year’s Eve.”

As manager of Cook Children’s Volunteer Program, Marie Howell interacts with many of the Jane Justin School students and interns and says the departments and people who host them often learn as much from the interns as the interns learn from them.

“Our interns show us how to be understanding and empathetic, and how to tailor opportunities to the abilities that the person has,” Howell said. “We have a lot of people with different kinds of challenges, but there is a place for everybody. There's a task for everybody. It's just a matter of finding the right fit.”

Coaches of Confidence

All of the student interns are led by Jane Justin School job coaches. Together they help shepherd the students in their various roles and act as liaisons between the interns and their department managers.

“We go to the job with them, so we're just there basically as a support and to train them on those basic job duties,” said Courtney Galindo, Jane Justin School job coach. “Our main goal is that we can kind of transition out and that they're able to be independent in their job. We want to get them to that point. Eduardo is now an actual hired employee, which is amazing. He's the first one that we've had get to that point.”

The job coaches are key to the students’ success. Without them, says James-Kelly, students like Eduardo, Harris, Pollack, Washington and Dilworth wouldn’t have the opportunities that are presented to them.

“The contributions of our job coaches in the lives of these students are invaluable,” she said. “We have three incredible professional women who work alongside every single student that we serve in our school and help them achieve their goals with respect to their career and post-secondary education. That is a lot for three people but they do it with such grace and professionalism. They create a bond with our students that really helps to garner trust, not only within our community of families we serve, but within every organization that we enter.”

This job, Eduardo says, is an opportunity he never thought possible. He hopes his success will inspire others and pave the way for his classmates to use their skills and talents to achieve personal success while contributing to their communities and workplaces.

James-Kelly couldn’t agree more.

“The restoration of hope and the understanding that it is okay to want and expect more for your child is the best gift we can offer the families we serve,” James-Kelly said. “Eduardo’s story is a great example of this and I hope it inspires more like it in the future.”

The Jane Justin School, under the Child Study Center at Cook Children's, is a private school that provides special education to children. This year, 86 students are enrolled.

Early Monday morning, students hugged their parents, took photos in front of the school and met their teachers. Friends reunited with hugs and talked about their summers.

“The friendships are strong here,” said Tracie Mann, Ph.D., Headmaster at Jane Justin School. “A lot of them do things after school together and get together over the summer. Everybody is really excited for the first day.”

“I'm ready to get back to lessons and play with my friends – and not go outside because it's way too hot," student Wyatt Merchant said. 

Students in the Purple Room class are between 7 to 9 years old. They gathered around to color a large “back to school” sheet together.

“We're such a small community of people and we're so welcoming and so warm,“ Dr. Mann said. “I think it makes it easier for children to come in every year and kind of make that transition.”

Autism spectrum disorder (ASD) is a life-long neurodevelopmental disability characterized by communication and social skills deficits, in addition to restrictive and repetitive behavior. Recently, the Centers for Disease Control and Prevention updated their estimates, which now show that one out of every 36 children in the US has ASD. If your own family has not been directly impacted by ASD, chances are you know someone who has.

Autism impacts many different areas of an individual’s life, and Cook Children’s Child Study Center offers medical, psychological, behavioral, speech, and academic services to help address the unique needs of each individual child with ASD.

Perhaps the most fundamental skill affected by ASD is a child’s ability to communicate. Less than half of children with ASD will develop fluent speech by age 8, and approximately ¼ will remain nonverbal, relying on an alternative form of communication to interact with others.

Regardless of how your child speaks, you can help bolster their ability to communicate by focusing on four critical areas of language development.

What is CLEaR Speech?

Research on language development has identified four critical areas of communication that may require systematic intervention: Conversing, Labeling, Echoing, and Requesting (CLEaR). You can help your child develop CLEaR speech by practicing each of these language domains during their everyday play. For example, suppose your child enjoys playing with a toy train:

Conversing: Can they say the name of the toy when it is described? Ask your child to fill-in-the-blank using a description of a toy that they are not currently playing with. For example, say, “Choo, choo goes the ….”

Labeling: Can they say the name of the toy when it is present? Ask your child to say the name of the toy they are holding. For example, give the train to your child and ask, “What is that?”

Echoing: Can they say the name of the toy when you name it? Ask your child to repeat the name of a toy that they are not currently playing with. For example, say “Say, ‘Train.’”

Requesting: Can they say the name of the toy when it is absent? Ask your child to say the name of the toy they want to play with. For example, hide the train from your child and ask, “What do you want?”

Note that you have asked the child to say the word train four different times. It is the different contexts that make each word unique. Many children with ASD have some ability to label or echo, but struggle with conversing and requesting. Others may only speak when requesting preferred items. The goal of CLEaR speech is to help the child understand the different contexts in which a word can be used, and to gradually develop their language abilities in each area through a process called abstraction.

Abstracting CLEaR Speech

^[1] Mario is not a real child, but an amalgamation of different patients treated in Autism Services.

To demonstrate the process of abstraction, let me introduce you to Mario^[1], a 4-year-old boy receiving early intensive behavioral intervention through Child Study Center’s Autism Services department. Mario’s parents noticed his lack of eye contact early on, and had trouble engaging him when he was an infant. 

As a toddler, Mario did not respond to sounds (e.g., he did not look up when called by name), and his parents suspected hearing loss. They were surprised when he received an ASD diagnosis at age 3. Though Mario sporadically repeats phrases from his favorite TV shows, he lacks the ability to express his basic wants and needs. He may lead mom to the refrigerator when he is hungry, but often resorts to tantrums until his parents can guess what he wants. Mario’s parents use CLEaR speech to help him learn to request his favorite things. 

They begin by letting Mario choose what he is going to talk about, by simply allowing him to select a toy or snack. Whenever his interest shifts, they will direct his speech toward the new activity. Throughout his play, Mario’s parents alter the different environmental configurations that support Mario’s CLEaR speech. Mario picks up his toy car and rolls it down a ramp. His parents use the following sequence to help strengthen Mario’s ability to request by purposefully changing the non-critical details of requesting across each step:

CLEaR: After the car goes down the ramp, Mom picks it up. She shows it to Mario (labeling), and says, “Drive the car” (echoing), “Drive the …” (conversing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

LER: After the car goes down the ramp, Dad picks it up. He shows it to Mario (labeling), and says, “Car.” (Echoing). When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again. 

CLR: After the car goes down the ramp, Mom picks it up. She shows it to Mario (labeling), and says, “Drive the …” (conversing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

CER: After the car goes down the ramp, Mom picks it up and hides it. She says, “Vroom, vroom goes the car” (echoing), “Drive the …” (conversing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

LR: After the car goes down the ramp, Dad picks it up. He shows it to Mario (labeling). When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

ER: After the car goes down the ramp, Mom picks it up and hides it. She says, “Car.’” (Echoing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

CR: After the car goes down the ramp, Dad picks it up and hides it. He says, “Drive the …” (conversing). When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

R: After the car goes down the ramp, Dad picks it up and hides it. When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

The order of the steps is less important than the variation of supports across steps. Children with ASD may rely heavily on a particular aspect of their environment, like the presence of the toy. We can use that feature to help support their language development, while also helping the child become more responsive to changes in their environment. 

The presence of the toy is necessary for labeling, but it shouldn’t also be necessary for requesting. It may take repeated practice with one step before your child is ready to move onto the next. Similar abstractions can be arranged to strengthen conversing, labeling, and echoing skills. While language development comes naturally for many children, others require targeted intervention. If you have questions about your child’s language development or concerns that your child may have ASD, speak with your pediatrician and contact Early Childhood Intervention or your local public school to find out what services are available to your family.

You will have a hard time finding someone better suited than Parker Vickers to help children choose and build a cuddly friend at the Build-A-Bear Workshop at Cook Children’s Medical Center. Funny, charismatic, kind and big-hearted are a few of the words people use to describe the 18-year-old.

Vickers is a trailblazer, too. As the first to participate in a Cook Children’s Medical Center pilot internship program designed to employ students from the Child Study Center at Cook Children’s Jane Justin School, he’s paving the way for his current and future classmates to join the ranks of the medical center’s workforce.

Vickers is in his fourth year as a student at the Jane Justin Upper School where children with developmental and intellectual challenges are educated using individualized lessons designed to meet each child’s unique learning needs. Teaching life skills necessary for students to achieve productive and meaningful lives is a big part of the curriculum.

“Our mission is to impart skills so that our students can transition successfully into the next learning environment,” said Kimberly James-Kelly, M.S., M.S. Ed., LBA-TX, assistant principal, Jane Justin Upper School. “So we want to create lifelong learners, and that is the case for students transitioning on to more traditional educational settings or for students transitioning on to the workplace setting or to post-secondary education. Really, we just want to help our students achieve the goals they have for themselves and support them in achieving the goals that their family has for them as well.”

The internship offers students a real-life work setting to practice and hone the skills they’ve learned while attending the Jane Justin School—skills like listening to and following instructions, customer service, adjusting to changes in the work environment, accepting feedback from a manager and working independently. A job coach from the Jane Justin School joins the intern during their hours, usually four hours per week, to guide, advise and offer support while on the job.

Just like their in-school instruction, the internship is aligned with the student’s unique strengths, interests and hobbies. Vickers is particularly fond of stuffed animals and plushies, making him the perfect fit for a post in the Build-A-Bear Workshop.

“We work with the administrators of the Child Study Center and they identify a high-potential student,” explained Tracy Vang, Cook Children’s ID&E director. “Once they identify the student, we look at their strengths and try to match them to the opportunities that we have available. It's very important that we don't pick and choose where the student goes because we have bias that leads us to put people where we think they belong. That's not our goal or our intent here. We want to match students to where they feel they belong.”

Vickers started his three-month internship in September as a front-of-the-store greeter. He progressed to helping guests choose their bear and, as a testament to his initiative, now holds the coveted role of bear stuffer.

“If you know anything about Build-A-Bear, you know that stuffing gets everywhere,” said Kimberly Johnson, Build-A-Bear Workshop manager at Cook Children’s. “Parker was quick to get brooms and sweep up the stuffing. When he noticed that the bear inventory out front was low, he went and grabbed bears from the back to stock in the store. I was so amazed and proud that he took that initiative upon himself. So the next step was to teach Parker how to stuff and, if you've been in here, you know the big machine and loud noises are a little ominous. But he took to it like a champ.”

Vickers has been so successful at his job that, over the Thanksgiving holiday, he worked without the oversight of his job coach. It was a proud moment for James-Kelly and his Jane Justin School family.

“He has worked so hard to learn what it means to be an employee at Build-A-Bear and at Cook Children's,” James-Kelly said. “He attended the onboarding training for all new hires. He pays close and careful attention to instructions in the workplace. He asks questions and acquires the skills pretty quickly. He practices them on his own. He takes pride in his work. So when the opportunity arose for him to work independent of our support, we looked at data and we talked with the staff at Build-A-Bear, and we all thought it was time. We’re incredibly proud of him.”

The program is as much a win for the medical center as it is for Vickers and his peers, Vang says.

“I would say the biggest benefit to the hospital is in the spirit of diversity and bringing everyone with different backgrounds together,” she said. “We have kids that have developmental disabilities and challenges and, when they see someone who looks and learns like them, they are able to connect with that person for a more meaningful experience. That really helps us improve our business goals by creating a patient experience marked by our core values of respect, kindness, collaboration, safety, generosity and imagination.”

Speaking of imagination, Vickers has it in spades.

“I’ve got lots of ideas in my head,” he said.

Those ideas are on full display when he performs the Build-A-Bear Heart Ceremony where children make a wish and promise to care for their bear. The ceremony is led by Bear Builders who tailor the dedication to each child’s interests, hopes, dreams and circumstances.

Once the pilot is complete, program leaders are exploring other opportunities for Jane Justin School students to receive real-world training at Cook Children’s. Potential work experiences include the cafeteria, transportation department, dietary aid and environmental services, to name a few. The hope is that Cook Children’s will be able to offer students employment once they complete their internship and that they become members of Cook Children’s work family. Vickers feels “very good” about blazing that trail for those that come behind him.

“I’m the first one,” he said proudly. “If this turns out to be a success, then everyone else would be able to have a chance to do this.”

Attention-deficit/hyperactivity disorder (ADHD) made school a struggle for 17-year-old Moses Hernandez as far back as kindergarten.

“Basically I was all over the place. I would talk a lot, always. I couldn’t stay focused on one thing,” he remembered. “It was hard for me to listen to the teachers.” At home, he caused trouble.  

Moses came to the Cook Children’s Child Study Center in 2009 for an evaluation that diagnosed him with ADHD and disruptive behavior disorder. Through medication and therapies -- targeting his anger and impulsiveness – Moses’ symptoms diminished while his self-discipline and academic success took off.

He’ll graduate in June from Fort Worth’s Benbrook Middle-High School, where he took rigorous courses such as Advanced Placement calculus, economics and engineering. He played football and wrestled, worked part-time, and won full-ride scholarships to study mechanical engineering at Texas Christian University.

Moses gives credit to the medication and care he received at Cook Children’s to overcome the distractions and behavior problems when he was younger. ADHD is a chronic condition that can’t be cured but managed. This article explains the complex challenges and the treatments that can help patients like Moses and their families.

Focus and Self-Control

In elementary school, Moses and his brother lived with their grandfather. Their grandfather tried to read with Moses and go over the homework. But Moses wasn’t interested in school, and his grades showed it.   

“I was like, ‘I am not doing this work. Why do I have to study?’ I would fail every word test,” he said.

Staff at the Child Study Center began working with Moses to rein in his ADHD and disruptive behavior. The first medications prescribed made him prone to crying and staring at the wall, he said. At a reduced dosage, he felt better.    

Meanwhile, the death of his grandfather created more difficulties. A cousin, Jenean McDowell, became the boys’ guardian in 2014. Jenean recalls Moses arguing about chores, rebelling, picking on his brother, and even climbing on the roof. “He was a rough piece of work,” she said.

Moses was additionally diagnosed with adjustment disorder, defined as an unhealthy or excessive reaction to a stressful event or life change. He also suffered from mixed anxiety and depressed mood. Therapists at the Child Study Center coached Moses on coping skills and techniques to calm himself down. Jenean noticed greater motivation, organization and cooperation after about one year.

“He didn’t talk back anymore. He didn’t sneak around and tear things up. He decided he liked straight As,” she said. “He’s like a totally different kid.”

Moses explained that the medications he takes allow him to focus on tasks. He describes himself as more in control of his emotions, less likely to “do something that’s really dumb” on a whim. During the COVID-19 lockdown in 2020, he temporarily quit taking his medication as an experiment. But without the meds, he said, he couldn’t sit still or stop himself from aggravating his brother.

Therapy sessions over the years at the Child Study Center taught him to think through his options before acting impulsively. He learned breathing techniques to manage his anger. Although he didn’t initially want the treatment, and the medication caused some side effects early on, now he encourages others with ADHD to consider the meds as a tool.    

Moses remains energetic and – as he puts it -- goofy and excitable. He’s also confident in the classroom, a leader on the wrestling mat, and a hard worker who aspires to start his own business by the time he’s 30. He’s grateful for Jenean’s love and the Child Study Center’s expertise.

Becky Neander, MSN, APRN, CPNP-PC, joined Moses’ care team in 2017, providing resources and medication oversight. She sees him as an example of tenacity and hope for those who deal with ADHD and behavior disorders.

“I could not be more proud of Moses,” Neander said. “He has achieved so much already, and I look forward to hearing about all of his successes as a TCU Horned Frog!”

Moses takes Concerta (a stimulant) and Intuiv (a nonstimulant that requires careful monitoring for a potential drop in blood pressure) once a day. Checkups at the Child Study Center every three months have helped keep Moses’ medications at the right level, and his behavior in check, Jenean said. “It really 100% worked. That is what saved us.” She offered this advice to caregivers and parents: “Don’t give up.”

Understanding ADHD

The Diagnostic and Statistical Manual of Mental Disorders -5^th edition lists several criteria for diagnosing ADHD in children and adolescents, including these signs:

• Inattention: Seeming to not listen; careless mistakes; frequently losing things; getting sidetracked; forgetfulness  
• Hyperactivity and impulsivity: Fidgeting; difficulty staying seated; running and climbing at inappropriate times; interrupting and blurting out; difficulty waiting their turn
• Multiple symptoms have been present for at least six months; symptoms are inappropriate for the child’s development level; symptoms interfere with school, friendships or work activities.

Treatment plans for teens and children ages 6 and up often take a combined approach of medications, behavior management and behavioral classroom interventions. For preschool-aged children, behavior therapy is recommended as the first line of ADHD treatment.

Up to 80% of children with ADHD report improvement when taking stimulants, the most widely used ADHD medications, according to the U.S. Centers for Disease Control. Because stimulants can affect appetite, sleep and weight, patients must be closely monitored so that adjustments can be made if needed. 

Neander said scientific studies have shown differences in the neurotransmitters, which are the chemicals that transmit signals between nerve cells, as well as in brain structure and operation in children with ADHD. The executive function works like the brain’s manager, she said. Impairment to executive function can cause the inattention and/or hyperactivity typically associated with ADHD, as well as other issues. 

“Executive functions help people organize, regulate attention, make decisions, problem-solve, keep information in immediate memory, manage time, control emotions and motivation and control impulses,” Neander pointed out. Possible concurrent symptoms along with ADHD can include aggressive behaviors, anxiety, low self-esteem and learning disabilities.

An estimated 5% of children worldwide are diagnosed with ADHD. Parents with concerns should talk to their child’s pediatrician. Diagnosis can be made by a primary care provider or mental health professional. 

Services at the Child Study Center

The Child Study Center at Cook Children’s is a comprehensive hub for diagnosing and managing a wide range of developmental disorders including ADHD, Autism Spectrum Disorder and intellectual disabilities

“We start by educating the caregivers on the child’s particular symptoms or difficulties, so they have a better understanding of the cause of each child’s behavior,” Neander said. “We then manage the medications that help with impulsivity or other behaviors.  We can provide therapy/counseling through our psychology department or with outside referrals.  We also can work with the school on behavior plans/interventions.”

Neander saluted Moses’ grandparents and cousin for supporting him along the way. Parents, grandparents and guardians are the strongest advocates for their children, she said. 

“It is vital that caregivers educate themselves on their child’s diagnosis, what to expect, and how they can help at home or through the school. We provide resources, but families must take an active role in their child’s management,” she said. “We must work as a team for the child to be successful in school, with friendships, and eventually as independent adults with the tools they are given.” 

My mom gave me a ceramic plaque with this quote on it several years ago when I was going through a tough time. Over the years, it’s amazing how many times this quote has rung true. Plan B has meant … A divorce. Being laid off. A second marriage. Fertility treatments. A baby in the NICU. A baby at home on oxygen. A toddler who doesn’t yet speak or like to eat. And now, an autism spectrum diagnosis for Avery.

We’ve known for a while that Avery’s development is delayed. It hasn’t been any big surprise to anyone considering her early entry into this world and her 234 day NICU stay. We just kept saying “she’ll get there on her own time.” And she has made progress. HUGE progress. In a year, she’s gone from not even sitting up to sitting, crawling, walking, running and being off oxygen! She’s babbling more, making more eye contact and overall becoming more interactive.

But still, my mommy instincts have told me for a while that something else was going on. As much as I wanted to just call her development delayed, most of the time Avery is perfectly happy to exist in her own little world without the need to interact or connect with others. And we know that this is not “normal” when it comes to development.

After mentioning this to a doctor at our last NICU follow up clinic visit, we received a referral to the Child Study Center. And even though I had my own suspicions about an autism diagnosis, I wasn’t ready for a doctor to agree with me. And so I sat on the referral for three months. I kept making excuses. It was too early. Her behavior is just a product of the fact that she was in the NICU for so long. But it became clear to me after mentioning the referral to several of her therapists that others had concerns as well. I just kept hearing “It can’t hurt to go and see what they say.”

And so, I filled out the  application, mailed it in and got super lucky when the Child Study Center had a cancellation and got us in, all within a month of mailing the application in. Our appointment took almost three hours and at the end we walked out with an autism diagnosis and a recommendation for ABA therapy.

Avery’s diagnosis is different than a full-term child receiving an autism diagnosis. The doctor kept emphasizing that Avery’s primary diagnosis will always be prematurity. Because she was born so small and her brain had to develop outside the womb and had periods where it went with little to no oxygen, it developed differently and quite honestly, it has some damage. It pains me to type that. The good news is that Avery is young and she continues to progress.

So many things are running through my head as I try to process this new diagnosis. The one thing that keeps coming up is that I am so glad that God chose me to be Avery’s mom and I’m so grateful that I came to work at Cook Children’s, which has opened my eyes to all the resources that exist in our area. I’m grateful that Avery has given me the strength, passion and love to continue to fight for her and make sure she has the best life we’re able to give her.

We are still figuring out exactly what her diagnosis means and how it’s going to change things. I learned through our NICU experience that writing is a powerful coping mechanism for me. I’m not looking for attention, sympathy, etc., it’s truly just a way for me to document and work through my feelings.

Am I sad? Yes, absolutely. For once in her life, I just want Avery to catch a break. I just want her to live a “normal” childhood, whatever that means…But for the time being, that’s not our path, that’s not her destiny and that’s OK.

Previous articles documenting Avery's Journey:

• Avery's story - part 1
• Avery's story - part 2
• Avery's story - part 3
• Avery's story - part 4
• Avery's story - part 5
• Avery's journey - part 6
• Avery's journey - part 7
• Avery's journey - part 8
• Avery's journey - part 9
• Avery's journey - part 10

About the author

Kelly Wooley is a Marketing specialist at Cook Children’s. She is writing a series of blogs chronicling the birth of her daughter Avery and their time spent in the Neonatal Intensive Care Unit.

Joyce Mauk, M.D., CEO and medical director of the Child Study Center, believes the increase in more kids being diagnosed is because examiners are now more aware of the autism spectrum than ever before because of the attention autism has gotten in recent years.

So what exactly is the spectrum?

Dr. Mauk, who is a Cook Children’s pediatrician and board certified in pediatrics and neurodevelopmental pediatrics, says that most human characteristics aren’t spread evenly across the public.

She compares it to the ability to draw. A few people are excellent. Some are natural artists. The majority of us do Ok and some of us have no skill at all.

Dr. Mauk says that’s also the way to look at the autism spectrum, and some other disorders as having a range or continuum. Children are generally diagnosed with an autism spectrum disorder in the preschool years. Those at the severe end of the spectrum are diagnosed at an earlier age and those at the milder end are diagnosed later. Dr. Mauk says this is because the severe end is associated with more severe developmental delays such intellectual disability or mental retardation.

More severe problem behaviors (self-injury, aggression) are likely to be nonverbal and more likely to have a known genetic cause (etiology).

At the milder end are children whose cognitive abilities are in the normal range and have less significant problem behaviors (rhythmic, repetitive movement, or stereotypies, and rigid behaviors).

“An experienced clinician will make the determination of degree of severity,” Dr. Mauk said. “There is no specific test that will alone determine the diagnosis or the level of severity. In the past children at the milder end of the spectrum would not have been diagnosed with autism. They may have had a diagnosis of Asperger Disorder or a language disorder with atypical features. In general those on the mild end have a better prognosis and will need less lifetime supports.”

Click here to learn more about your child’s development and what you should do.

Previous articles related to this topic:

Why are more U.S. kids being diagnosed with autism than ever before?

Julia brings 'Sunny Days' to kids with autism

But the research may simply be a matter of parents being more mindful of autism than they were previously.

“What is telling is that the overall prevalence of developmental disabilities hasn’t increased,” said Joyce Mauk, M.D., CEO and medical director of the Child Study Center. “Some of this is diagnostic substitution. Many more children with language disorders and some unusual features of behavior are now being diagnosed with autism.”

Dr. Mauk, who is board certified in pediatrics and neurodevelopmental pediatrics, said examiners are more likely to diagnose children with more subtle or mild symptoms of the autism spectrum than ever before because of the attention autism has gotten in recent years.

The Centers for Disease Control and Prevention and National Center for Health Statistics stated reported that 1 in 45 children were diagnosed with autism in 2014, a leap of nearly 80 percent from 2011 to 2013 (1 in 68 children were diagnosed during that time period).

“The survey changed from 2013 to 2014 and the categories for autism were more inclusive in the most recent study,” said Lena Zettler, director of Psychology at Cook Children’s. “They included other developmental delays. The incidence isn’t necessarily changing, but awareness is.”

Both Dr. Mauk and Zettler agree that the focus should remain on the science we know.

Autism is more common if there other family members who are on the spectrum. Higher incidence in autism can occur if:

• The father is older
• Pregnancies are less than two years apart
• Preemies are at a higher risk for developmental delays (including, but not limited to the autism spectrum)

The survey found that the majority of children diagnosed were boys than girls, with a 75 to 25 ratio. Fifty-nine percent were identified as non-Hispanic White.

Another key factor that some point to is the fact that more than 67 percent of the children who were diagnosed had at least one parent with more than a high school education, which could mean they are more likely to be aware and educated of the symptoms of autism, making for quicker identification.

“There is of course a lot we still don’t know about the underlying factors that cause autism, but I think the fact that people are becoming more aware is a great start,” Zettler said. “It makes for quicker diagnosis and care for the child.”