New Member requesting assistance

SRL

Active Member
OTE, I don't know what your experience has been with neurologists but what I'm hearing from parents is that while it's good to include them when indicated, many are *not* good at Pervasive Developmental Disorder (PDD) diagnosis for a child who has slipped under the radar. I'd only use a neurologist for Pervasive Developmental Disorder (PDD) evaluation if they came highly recommended by other parents of children with ASDs.
 
O

OTE

Guest
SRL, Pervasive Developmental Disorder (PDD) is a neurological condition, a developmental disability, not a psychiatric one even though it is listed in DSM. The doctor who specializes in Pervasive Developmental Disorder (PDD) should be a developmental neurologist. I know Medwest Mom got a diagnosis she was happy with from a non-doctor and that's fine if that's what she wants. Pervasive Developmental Disorder (PDD) is a specialty and all kinds of disciplines look at it from different sides. Also, as with any other specialty there are sub-specialities. A developmental neurologist is a sub-specialty of neurology. In terms of having a medical dr make a diagnosis this is technically the appropriate specialist. I agree with you that most general neurologists, while they may diagnosis Pervasive Developmental Disorder (PDD), are not expert enough at Pervasive Developmental Disorder (PDD) diagnosis to catch a kid who is flying under the radar. My Pervasive Developmental Disorder (PDD) kid went to a neurologist once who I though was competent when he saw my ADHD kid. What I got from his "evaluation", which was mostly done by a nurse, was that my kid had Pervasive Developmental Disorder (PDD). When I said, yes, I know that, that's why I brought him here, I want to talk about the different kinds of Pervasive Developmental Disorder (PDD) therapy and which I should put him in. He said, I don't know anything about that, he has Pervasive Developmental Disorder (PDD). FYI: When I made the appointment I told them that he had Pervasive Developmental Disorder (PDD) and I wanted to discuss the different potential treatments. I asked if I could do that with this dr and they said sure. So when I walked out I told them that there was no way I or my medication insur would give them a penny for wasting all my time. LOL. They never billed. LOL So I don't disagree with you. But I can also say that I've never met a psychiatrist who knew much about Pervasive Developmental Disorder (PDD). And the best Pervasive Developmental Disorder (PDD) docs I ever met were developmental neurologists.
 

SunnyNC

New Member
I checked the Levine Children's Hospital at that website link, THANK YOU!

I contacted my health insurance company to find out if any of the doctors listed were in plan...of course they are not! Within 50 miles, there are only 4 pediatric psychiatrists covered in network. I asked them what if those 4 doctors do not deal specifically with whatever my pediatrician wants my son to be evaluated for. They told me to find out what they want him evaluated for first, then call back if it is going to be a problem.

I feel a battle coming on...I hope not. If the doctor wants us to see a pediatric neurologist, I will again find out who is in network and go from there. I don't mind driving wherever it takes us...I just want to know that we will be getting the best treatment for what is going on by a doctor who specializes in whatever my son is ultimately diagnosed with.

Have a great day!
Rachel
 

Marguerite

Active Member
OTE made an earlier suggestion to organise a multidisciplinary evaluation - I think that's going to be the best direction for you, in the long run. It takes time to set it up but it could turn out to be needed.

SRL, correct me if I'm wrong, but your concern about neurologists is that they don't often come equipped to handle something such as autism, which is harder to evaluate in terms of the sort of brain function you can measure with a machine. I understand this - I have had to deal with neurologists who said there was nothing wrong with me because their machine didn't pick it up.
The thing is, that although autism IS neurological, a run-of-the-mill neurologist is often not the person to go to, unless they have some experience of diagnosing and assessing autism. There ARE specialisations within specialisations. Not just any neurologist will do, as OTE was pointing out. I saw a neurologist once who specialised in migraines. Another specialised in reading nerve conduction studies (which won't do a darned thing when it comes to assessing autism). I wish it weren't so, but unfortunately too many neurologists have to SEE the dials flick and the meter needles twitch in order to agree that there is a neurological problem. But there are some out there who are definitely worth seeing. It's a matter of doing your own research.

Rachel, you said, " I was not expecting Autism because I just didn't really think it fit."
From your early description, I WAS seeing autism as highly likely. High-functioning autism in some form. Pervasive Developmental Disorder (PDD) is an umbrella condition which includes autism and Asperger's. The multidisciplinary evaluation is going to be needed, but you could organise each step yourself and help the various specialists connect the dots by sharing reports around, or you could take your son to a special clinic which deals with this sort of diagnosis. For ongoing management, your regular pediatrician should be able to handle things (if you're happy with him).
If you want to get a better 'feel', read anything by Temple Grandin, such as "Thinking in Pictures" or "An Anthropologist on Mars". She's an amazing person. And I was telling my difficult child 3 this afternoon, so is he. Someone with high-functioning autism is able, with support, to work around a lot of the problems of autism and thereby take advantage of the special abilities that can also come with this. For us, we began with meeting him where he was and working from there. There is some great work happening with autism these days, a lot more is being learned and these kids have a much better prognosis than we ever thought possible.

difficult child 3 failed his first IQ test. He was barely verbal at the time so it was rather silly to apply a conventional test. On the basis of that test they told us he could never attend a 'normal' school, it would be some years before he could attend ANY school and he had a poor prognosis. He's since been tested at about 145 (which personally I think is meaningless, apart from indicating that his first test was a tad of an underestimate) and after years of struggling at school, he is finally doing well academically. Last year he topped his first year in high school (correspondence is what works for him) in German and Maths, came second in Music and equal third in Visual Arts. He had similar numbers in his year to a mainstream high school. He is now highly verbal but I KNOW he still has some language problems. However, he is functioning so well that he masks the problems most of the time. He is highly sociable, has always loved being around people and WILL hug or cuddle (a lot) but on his terms. HE needs to be in control of the hug - once again, refer to Temple Grandin for more info on that.

Autism as a diagnosis is not the appalling news it used to be considered. I'm so proud of my kids for how well they're doing. I support them through their difficulties and applaud them in their successes. They now value themselves for their individuality and are increasing their independence. The support they need can be surprising at times, but it is always a valuable learning curve.

Hang in there, keep us posted on how you go. And as others have said, do make sure you have time for yourself in there too. This IS a marathon, not a sprint. But if you pace yourself you will be amazed at how far you go without noticing.

Marg
 

BusynMember

Well-Known Member
There are so many replies here that I admit I didn't read all of them...lol. After reading YOUR post, I personally think that he should see a neuropsychologist for testing for autistic spectrum disorder, which my son has. He was misdiagnosed with both ADHD/ODD and bipolar. ODD rarely ever stands alone and, with your son's other issues, he really has tons of red flags for Autism Spectrum Disorders (ASD). These kids aren't defiant on purpose--they are just different and desperately need interventions in the community and school for a good prognosis. I wouldn't count on any pediatrician to catch this. You really do need an expert--Neuropsychs do a lot of intensive testing that other professionals don't. Psychiatrists often miss Autism Spectrum Disorders (ASD) because it's not their field--Autism Spectrum Disorders (ASD) isn't a psychiatric problem. Autism Spectrum Disorders (ASD) kids have a much higher rate of seizures and speech delays are the rule, although many times the speech catches up. They dont "get" social norms and are often seen by their peers as "strange." Anyways, I don't know for sure, but I'd definitely check it out. Sounds possible. My son was misdiagnosed until he was 11, and now he is doing GREAT, even behaviorally. Seems like now that we all know why he behaves like he does, he is very peaceful with himself. Yes, he used to rage. Please don't try to diagnose your child yourself. All kids with disorders have ODD behavior, but it rarely travels by itself (ODD). Hugs and good luck. (Ok, I scrolled back a few posts. Good. Others are also thinking Autism Spectrum Disorders (ASD). in my opinion only, at nine he is ready to see a neuropsychologist. I wouldn't dot he pediatric neurologist at that age, but that's just me--we had bad luck with one. I still recommend a neuropsychologist. A good one will test for hours, over several appointments, and won't miss any possibility. Again, this is just what finally worked for us)
 

SRL

Active Member
Marg, it would make sense since Autism is a neurologically based disorder that neurology would be the specialty area to go but let's face it they can't specialize in it all. Psychiatric problems and learning disabilities also have neurological bases but neurologists aren't the place we typically send parents to evaluate those. I think Autism sort of leans in this direction as well due to the developmental aspects such as speech. They aren't even claiming to be superior at picking it up: a study done by a team of neurologists and pediatricians here in 2000 basically gave the medical community as a whole a failing grade in early identification of ASDs. Since then a joint campaign between the pediatrians assoc. and the govt. Center for Disease Controls has been launched and seems to be making a difference.

For what it's worth, given all of the various cold, hard realities surrounding Autism evaluation, I personally think we would all do the parents seeking advice here a favor and suggest that they tap into their local resources to look for the best specialists in their area to diagnose (such as in contacting a local Autism Society). All specialty areas have their pros and cons: One parent might emphasize a neuropsychologist because that's what helped her child but neuropsychs lack medical degrees and I feel strongly that young children especially need to be seen by a developmentalist MD type. Neurologists have the brain background but parent reports (and their own internal study) suggest they are hit and miss for accurate diagnosis and downright poor for kids who are most likely to slip under the radar. Developmental peds have a broad background and are good at dxing Autism but the waiting lists for most of them are 6-12 months these days plus they aren't appropriate for older kids and teens. Autism clinics are reported to be good but they are few and far between. Add on restrictions by insurance companies plus distance factors and I think we'd serve parents better by suggesting that X, Y, Z are the specialty areas known to be best at accurate diagnosis and for them to check with local parents for suggestions instead of pushing for our preferred specialist because that’s who helped our child. The possibility also exists that there are others options available in their areas that we know nothing about. For instance there is an ADHD clinic at a hospital near me that is absolutely top notch at diagnosis and treatment of all disorders with ADHD overlap. I wouldn't have one single qualm about referring a parent there with a child who had suspected Autism Spectrum Disorders (ASD) plus ADHD because I know they’d get a highly professional multidisciplinary evaluation and great follow-up. Most of us don’t live in the community of the poster: we don’t know if the neuropsychologist is lousy or if the neurologist is the best in the area at dxing ASDs or the developmental pediatrician not worth the 9 month wait or that a regular psychologist who we'd normally never recommend here totally has their act together inside an Autism Clinic...or if there’s something totally unknown to us (such as that ADHD clinic) that might be the wild card best solution of all.
 

DammitJanet

Well-Known Member
I am in NC and I know Charlotte has a Developmental Evaluation Center located there. I cant remember what age they accept kids up to for testing. I know they have a cut off age. It may be 10. I dont know for sure that they test for autism spectrum disorders but it couldnt hurt to call and ask. I would assume they would take most insurances because they are associated with the state I believe. I had one son tested at a DEC in Greensboro and one tested in Fayetteville. Both were very nice places.
 

SunnyNC

New Member
My son today wanted to go to the movies with a friend from his class. The friend invited him, told him what time he and his family would be at the theatre etc. My son I guess thought that I would let him go without my talking with this child's parents. I tried to explain to him why he can not go, and next time have the child give my son his phone number or he give the friend his phone number so the adults can talk to make sure this REALLY was the plan! HAHA!! Of course he thinks I am a bad person who never lets him do anything.

We are supposed to have a dinner tomorrow over our house (nothing formal) with our dear neighbors/friends that my son recently had a temper tantrum with which resulted in my neighbor carrying my kicking/hitting son home. (see original post) I told my son this was part of the reason he could not go to the movie...we had dinner planned at that time. He asked if he could "take his dinner in his room." I thought he was playing at first (went right over my head). I asked him what he meant. He is still angry at my neighbor for something that happened a week ago...and I mean angry! Prior to him asking this, we were joking around, having a good time, he was laughing and carrying on...then WHAM...his grumpy side returned with a vengence. I dropped the conversation. I am already dreading dinner tomorrow, knowing it is going to be a grump fest. How do those of you who have a child like this handle situations like these? This is really what made me finally put down my foot with the pediatrican....the perpetual grumpiness/bad moods.

Hopefully Monday I will hear back from the pediatrican as to who they are going to send him to for evaluation...I will keep the list posted.

Rachel
 

Marguerite

Active Member
SRL, I was trying to speak generally because things ARE very different for us down here. That's why I emphasised the need to do some digging to find out who is recommended. It's not easy to do this, I know. And I guess part of this research is asking people on sites like this one!
There are so many differences in how our various health systems work - your health insurance, for example. Our doctors are all covered nationally, to some extent, so I have trouble remembering that you have a lot of hoops to jump through sometimes. So I can't always follow the degree of issues people have - please bear this in mind, folks. I do try to talk generally on this. For example - you guys have taught me that in the US the best person to assess someone with autism is a multidisciplinary team and/or a neuropsychologist. While we've piece-mealed the multidisciplinary stuff over a few years (speech pathology here, Occupational Therapist (OT) there, pediatrician next week), I'd LOVE to get my son to a neuropsychologist or even a pediatric neurologist or ANY specialist who deals primarily with autism. We do have the general autism specialists, but as soon as word gets out that dr so-and-so is good with autism, they get overloaded with patients,regardless of their specialty. I mean, my adult kids still see a pediatrician because we have no other kind of specialist who WILL deal with this. It's absolutely crazy.
So do ignore me, people, if you feel I'm being inappropriately specific when it comes to doctors.

Rachel - good to see your new ID. I'm not sure what you can do about your son. I would make the decision based on your expectations for the night. How well will your neighbour cope with a sullen kid at the table? Will he understand or is it going to make fur unpleasantness? Will there be a brief chance to socialise informally first? What are your usual practices with mealtimes? So much depends on what you want and what you do and what you expect.
Can you arrange a meeting beforehand with the neighbour and difficult child, to resolve the bad feeling? Does difficult child understand how dangerous "stacks on" is? Or does he still feel that a perfectly acceptable game was ended in a highly embarrassing way?
If you try and have dinner without resolving this and without any prior preparation, you could be in for a rough night. While the dinner could be a good chance at reconciliation, it could also make things a lot worse. MY point of view - this needs resolving. If difficult child can't/won't resolve things right now (because he's still too angry, or because he doesn't understand what was wrong, or because he was TOO embarrassed by the way it all got handled) then it might be better to let him eat in his room (if you normally permit this - we don't). For a situation like this difficult child 3 either eats in the kitchen or he eats earlier so he can put himself to bed earlier (and be a sweeter child in the morning, for all that extra sleep!).
If your neighbour is willing I would try to make peace between them. But this won't work if neighbour is also still angry with difficult child and doesn't fully understand how to get through to him. You would need to mediate, also. difficult child is going to sound rude to the neighbour - kids like this do not distinguish between talking to another child, or talking to an adult in a position of authority. This is sometimes misinterpreted as lack of respect for authority, when that's not the case. They just see everyone as equals and get offended when talked down to, patronised or chastised in what THEY consider a rude fashion (think how YOU would feel if a neighbour said, "I told you before, you're not permitted to go without your coat in this cold weather. You march right on back inside, missy, and get your coat on!" - you would be offended. difficult child is reacting the same way because he doesn't understand any other way).

He's probably also embarrassed over the incident. It IS going to prey on his mind. Has he been back to the neighbour's? I suspect not, or at least not while neighbour was there. You need to see it from everyone's point of view. This doesn't mean seeing your son as right - he wasn't - but it DOES mean seeing what he sees about the incident.
Possibly - try asking him how he feels and see if he can comprehend the neighbour's point of view as a man scared for his children's safety. he is also a man who cares about difficult child and also wanted him to be safe, but when difficult child didn't seem to understand and got angry, this was neither safe nor acceptable, and he needed to go home. It was not rejection, it was putting difficult child somewhere that he would be safe. If neighbour had been rejecting difficult child, would he still be willing to come to dinner at difficult child's house? He still likes difficult child, still wants to be friends, still wants difficult child to play there as long as he does it safely (check this one).
You know best what he is likely to respond to, but something I've found - treat him as you would like him to treat you. When he is angry, anxious or upset he WILL shout, but this is not necessarily at you, just shouting in general, as we would if we stubbed a toe or hit a thumb with a hammer. Their emotional pain is that bad and we have to help them learn to deal with it - not easy. The best way to deal with it is to resolve it.
So I ignore the shouting (I do NOT react to it by shouting back) and maybe, if I feel I must, I respond with, "Hold on, honey, I'm not shouting at you - why are you shouting at me? Can you turn your volume down a little please? My ears are hurting." I say it quietly and calmly, to help him respond with more quiet and calm in return. The trouble with this is it gets you off topic, which can be a problem with these kids. It's just a matter of choosing and using your moment and having to be satisfied with a piece here, a little bit more there, until you finally have helped him up the ladder of appropriate social interaction.

Life ain't easy with these kids, but it sure ain't dull!

Marg
 

SRL

Active Member
One of the critical points to learn about helping a difficult childen-and this is especially true with Autism Spectrum Disorders (ASD) kids--is that you must learn to see things from their perspective. That means if he's grumpy about something that there usually is a good reason from HIS point of view. The whole anger may have no justification in your eyes but to him it's still very real and now the source of his anger is invading his safe territory on top of missing out on something he really wanted to do. Personally if it were me I would let my son opt for dinner in his room and stick in the portable VHS player. If what was going on in the rest of the house was fun enough half way through he'd probably give it up and join us, especially if dessert was involved. The one thing I wouldn't do is to place any demands on him beyond the usual expectations--wouldn't demand he come out, open his room up to kids, etc--make it seem like no big deal and it will usually blow over a lot sooner.

Even my easy child kiddo was making plans with friends for a few years without clearing it with mom. It just takes awhile for it to sink in. When this episode has passed drill it into his head on Friday mornings so he knows the expectation in advance: "If you and T want to think of something to do this weekend, that's fine, but the moms will have to talk."

We lived with Chronic Crankiness Syndrome from about age 4-9 when it started to subside. We still see some of it but nothing like those early years. Several things were key here: we addressed all of difficult children issue head on through therapy, adaptations at school, etc. We started implementing strategies like The Explosive Child and easing up on a lot of things. Really what those have done together was give my difficult child the space and in some cases the skills to develop what he didn't develop naturally along the way.
 

Marguerite

Active Member
Something I also forgot to mention, and it reinforces SRL's comments - our kids can't "hold it together" for as long as we expect. It's good if you can have him with you for a short time (one course? But only if he's not grumpy and things can be resolved) but let him leave the meal table BEFORE he loses it. That way he has a positive experience (and so does everyone else) which reinforces in his mind that he can do this again, maybe for a little longer next time.

Would you expect a toddler to sit with you for the whole meal? A pre-schooler? You can't have the same behavioural expectations of him as you would a easy child. They just can't cut it for as long and when they lose it it looks spectacular.
As I said before, a lot depends on what you know he can handle, but right now he's on a much shorter fuse than you're used to with him.

You learned a lot when you taught at school. Now you've got to unlearn it all and start over. But one thing to hold on to - at the end of all this you will be a better, more socially skilled teacher than you ever thought possible, because you will have many more strings to your bow than you ever thought there was room for.

if you can learn to handle a difficult child at home, you can confidently handle the Boston Strangler in the classroom.

Marg
 

rejectedmom

New Member
Rachel, I am glad you finally got someone to listen to your concerns and to finally refer your son out for testing. I just wanted to address your insurance issues. As far as the EA goes there is a heirachy that you must go through before you get them to send you to a psychiatrist or neurologist. I hated this as by the time I went there we had already done everything we could have as far as parenting classes and behavior modifications for my difficult child 1. We first had to see a SW. She immediately stated that the past didn't factor in and she would only deal with the present issues. She focused on parenting and negotiating with my difficult child 1 who was a master manipulator. At that point I refused to go anymore as I knew it was awaste of my time and money paying for sitters for the other kids. husband went and it took months before we were refered to a Psycologist. I again said that my daughter needed a Psyciatrist but no that was not the protochol. Another several months went by and they couldn't work with her so they stopped seeing her and tried to do marriage counciling on us. Meanwhile my daugher was out of control and raging almost constantly. Finially I said "the heck with this" and paid for a psyciatric evaluation out of pocket and without a refferal. She was diagnosis'd Bipolar 2 and put on medications. She did well for a while but she was soon old enough to decide if she was going to take them or not and she decided not to. I honestly believe that if the pros had listened to me and gotten her to a psyciatrist when i initially asked at age 12 she would have been more medication compliant and would have avoided much trauma to herself and our family. My advice is get the evaluation regardless of insurance coverage if you can afford to. Our insurance kicked in after the diagnosis was made and the medications and visits were covered.
I find it so very frustrating that here is is 30 years later when so much more has been learned about childhoold mental health issues and many of the professionals are still blaming parenting first. -RM
 

SunnyNC

New Member
Thank you all for your incredibly detailed responses. It is a lot of help to know there are many out there who have been there done that and can offer advice to those of us who are just finding out that it isn't US and that there really HAS been something going on with our difficult child and we are not alone! I am going to go to the library Monday and look for some of the recommended readings and start learning as much as I can prior to the Dr's appointments begin. I am already stressing about costs associated with whatever testing will need to be done, but we will figure it out one way or the other and do whatever needs to be done.

I gave my son a couple of options about dinner tonight. I told him he is very welcome to have dinner before our company comes over, and then if he wants, he can just spend the rest of the time in his room. I told him he can also join us as normal for dinner and participate as he wants, but has to respect those around him in the process. I am usually not one to give an option like this...it has always been you will eat dinner with us, you will not be disrespectful, or there will be consequences (stay in room, go to bed, restriction, etc). Now knowing that the reason he seems to hold a grudge may have nothing to do with things in his control, I am more willing today to be more flexible in my demands with him. As I gave him his options, he was obviously angry that he would even have the option of having to be in the same house as my neighbor (who has LONG since moved past what took place last week) and became tearful but I let him know the choice was his and he seemed to ultimately understand.

I have a chart on my refridgerator for him...a behavior chart. There are rows of blank squares and at the end of each row is a "reward" square. I did something like this when he was MUCH younger, but felt that maybe I should break it out again. It is more of a visual cue as to how he is doing I guess. Anyway, he can put a star in one box on a row every time he is caught saying something nice to someone, being nice to someone, or not having arguing with others. It seems to be working with him so far....on Valentine's day, I had to walk him to his class as we had to bring brownies for the class party. He excused himself before I could get to the classroom saying he had to go do something in the main hallway, but would not tell me what it was. I dropped the brownies off in the classroom and as I was on my way out, he met my easy child and I in the hall. He was carrying a carnation flower for me and a goodie bag for my easy child. He told me later he did this so he could get a star....I gave him 2, one for being nice to me, the other for being nice to his sister. Of course it doesn't work for everything and every day...but he was/is proud of his stars on his chart.

Have a great day!
Rachel
 
O

OTE

Guest
If your insurance won't cover a full evaluation at Levine then come up to Chapel Hill and we'll have lunch or something. This is the full multi-disciplinary evaluation. As Janet said, this is the state hospital and they take any insurance. If you can't afford the co-pay or deductible they'll work that out with you too. Problem with them is that the waiting list is very, very long. I don't know exactly what it is for your child's age right now but you can call and ask. I can assure you that this is a very good evaluation.

I'd also ask the pediatrician for a referral to a multi-disciplinary. Print out the UNC and the Levine pages and take them to him explaining that you're concerned that it could be neurological or Pervasive Developmental Disorder (PDD) or psychiatric eg bipolar and you need him evaluated for all those. Hopefully he or she will know enough to undertstand why the interdisciplinary is best. You might also print off a checklist of symptoms of bipolar and Pervasive Developmental Disorder (PDD) and show the pediatrician why you re concerned.

DO NOT LET THE pediatrician BULLY YOU! Your son needs the full evaluation and sending you to different docs who don't talk to each other is NOT the same!
 

oceans

New Member
You could try TEACCH ...they do evaluations and have supports in NC for autism spectrum. They do free evaluations for NC residents, but they have a huge waiting list. We got in for the intake right away, and then they do a quick interview with you and your child. At that time they decide if there is enough reason for them to invite you back for the full evaluation.

http://www.teacch.com/

Actually, as you can see...they have one right in Charlotte where you live. They offer many free services too.

I think that you could not go wrong to give them a call. We only needed to send them any previous evaluations we had, and get our psychologist to fill out a questioner.
 

SRL

Active Member
I am usually not one to give an option like this...it has always been you will eat dinner with us, you will not be disrespectful, or there will be consequences (stay in room, go to bed, restriction, etc). Now knowing that the reason he seems to hold a grudge may have nothing to do with things in his control, I am more willing today to be more flexible in my demands with him.

Rachel, let flexibility become your new best friend. My way or the highway traditional authoritarian style parenting doesn't work with a lot of difficult kids, and in many cases brings out the worst in them. I had an appointment on the books to discuss medications for behavior issues when The Explosive Child was recommended to me and it literally changed our lives around here. There was an immediate improvement, but for my difficult child the real story has been long term progress that has come from applying it over a period of years. There's a thread at the top of the Early Childhood board which you may want to check out on the topic while you're waiting to get/finish the book.
 
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