[3][13] In 1997, ONH overtook retinopathy of prematurity as the single leading cause of infant blindness in Sweden, with 6.3 in every 100,000 births diagnosed with ONH. Your child may be taught braille, screen-reading software to use the computer, and techniques for performing life skills and academic tasks from the teacher of students with visual impairments and orientation and mobility specialist. Sex hormones may be tested from birth to 6 months of age (during a mini-puberty). DM:DD ratio has proven to be a clinically useful measurement to help diagnose optic nerve hypoplasia. After receiving his medical degree at Baylor College of Medicine, he completed his residency at the Doheny Eye Institute of the University of Southern California and a fellowship in neuro-ophthalmology at the Massachusetts Eye & Ear Infirmary, Harvard University. Give Us Feedback, No Longer Night-Blind, Natalia Isnt Afraid of the Dark, To Develop the Next Generation of ScientistsMentoring Matters. I hope that my experiences and those of other adults with ONHwill help bring this about. 3). Since my right eye is nearly blind, it wanders inward. While there is no cure for optic nerve hypoplasia, it is not a degenerative condition, and vision usually does not get worse.. Along with cortical vision impairment and retinopathy of prematurity, ONH is thought to be one of the most common causes of impaired vision in children under the age of 3 years. Childhood Blindness: What Are the Options? Optic nerve hypoplasia (ONH) is a congenital disorder characterized by a childs underdeveloped optic nerves. It is also known as Septo-Optic Dysplasia or DeMorsier's Syndrome.Now at epidemic proportions, ONH is theleading ocular cause ofblindness and visual impairment in young children. 1996, issue of VIPS, the Testing for GH may involve blood tests (IGF-1 and IGFBP-3), growth hormone stimulation test, or bone age x-ray of the hand or wrist (or body for children younger than 2 years). A neurologist can look at the brain structure through the use of MRI (magnetic resonance imaging). ONH is diagnosed by ophthalmoscopic examination. Patients with ONH exhibit an optic nerve that appears smaller than normal and different in appearance from small optic nerves caused by other eye conditions such as optic (nerve) atrophy. [3] DM:DD ratio has proven to be a clinically useful measurement to help diagnose optic nerve hypoplasia. To learn about how his visual impairment affected him, click here. 2005 - 2023 WebMD LLC, an Internet Brands company. Septo-optic dysplasia can also be associated with the pituitary gland. The purpose of this study is to identify sleep problems due to biological clock dysfunction in children with ONH and other vision impairments and to develop effective treatments for this condition. Optic nerve hypoplasia: An underdeveloped optic nerve can cause abnormal eye movements or vision problems. Free T-4 should be checked annually for at least four years. This is sometimes colloquially referred to as lazy eye. Sign up to receive our monthly newsletter, latest news, events and stories delivered right to your inbox. A young boy with a deficiency of these hormones can have a small penis size or testicles that havent descended into the scrotum. Approximately one-quarter of patients with ONH have adrenal insufficiency, meaning they do not produce enough cortisol on a daily basis or in stressful situations.[5]. These patients are also at significant risk of developmental delay, and an increased prevalence of autistic spectrum disorders has been reported among ONH patients.8. Like learning to speak when I was three, I found that I could button my shirt, tie my shoes and perform some other skills like plugging in appliances with some easeas if I had been using these skills all my life. WebFurthermore, Optic Nerve Hypoplasia is a spectrum disorder that also commonly affects brain structure and function, specifically the central nervous system and endocrine (hormone) systems. Find out which celebrities, athletes or public figures have Optic Nerve Your childs teacher of students with visual impairments should perform a functional vision assessment to determine how your child uses his or her vision in everyday life and a learning media assessment to determine which senses your child primarily uses to get information from the environment. Testing for DI involves blood and urine testing, including water deprivation tests, to determine ADH creation levels by the body. It is estimated that 15% to 25% of infants with significant visual impairment have ONH.1,2, Reported incidence ranges between 2.4/100,000 residents (<19 years of age) annually in Olmsted County, Minnesota, to 17.3/100,000 residents (<18 years of age) annually in Stockholm, Sweden.3,4 There is no clear evidence of variation across geographic regions, but a study based in the United Kingdom found higher standardized incidence ratios in inner-city districts of high population density.4. Pamela Garcia-Filion, PhD, MPH, is a research associate with The Vision Center at Children's Hospital Los Angeles. It is also known as de Morsier syndrome. Vision problems are usually not treatable, but depending on its severity and type, a vision problem may be manageable with vision aids. Articles typically offer step-by-step overviews of etiology, diagnosis, treatment, and follow-up. Some researchers hypothesize that optic nerve hypoplasia could be the result of vascular disruption. Reserved. All Rights It sends light signals to your brain, allowing you to see.. JAMA Ophthalmol. Etiology. 10 Magoon EH, Robb RM. Other risk factors include maternal primiparity, alcohol or drug use by the mother, intrauterine growth restriction, prematurity, and low birth weight. Pediatric Ophthalmologist Reprinted from the Sept./Oct. However, eliciting cooperation from young children during the imaging process may be challenging. Magnetic resonance imaging (MRI) can demonstrate asymmetry of the caliber of the optic nerve in most moderate to severe cases (Fig. This brochure explains the The ONH disease distribution survey is designed to examine the geographic distribution of ONH across the United States. Impairment of optic nerve development and failure for a normal number of axons to form during the first or second trimester of pregnancy lead to ONH. Occasionally, optic nerve hypoplasia may be compatible with near-normal vision; in other cases, one or both eyes may be functionally, or legally blind. However, in milder cases, ONH may be more easily missed. The ONH Research Program at The Vision Center at Children's Hospital Los Angelesis the largest of its kind. Programs and Services Strabismus: The eyes may be crossed, otherwise known as strabismus. Between 1980 and 1999, the occurrences of ONH in Sweden increased four-fold to 7.2 per 100,000, while all other causes of childhood blindness had declined. This can limit the amount of vision a child has and affect their eye movement. The optic nerve is the nerve which transmits signals from the eyes retina to the brain. Optic nerve hypoplasia (ONH) is a congenital disorder characterized by underdevelopment (hypoplasia) of the optic nerves. This often results in a small optic nerve. Today, we hear advice from two teachers who regularly work with Even with close and careful monitoring, the endocrine deficiencies can be dangerous to those afflicted. The optic nerves A child who is missing cortisol can be very weak, tired, dizzy, or have a poor appetite. However, early intervention can improve functioning (says The MAGIC Children who have both an underdeveloped optic nerve and hypothalamus often experience trouble with regulating these things. Vedin AM, Karlsson H, Fink C, Borchert M, Geffner ME. Each potential hormone is listed below along with a description of symptoms associated with a deficiency of that hormone. Do you recommend stem cell therapy for ONH? E-mail: I was born with optic nerve hypoplasia in my right eye. Working with Your Childs Medical Professionals, Your Childs Educational Team and Placement, Overview of Assistive Technology for Families with a Visually Impaired Child, Tools for Accessing Printed Information for Children Who Are Blind or Visually Impaired, Tools for Writing for Children Who Are Blind or Visually Impaired, Kitchen Appliance Accessibility for Families with Children Who Are Blind, Tools for Children Who Are Blind or Visually Impaired to Access Electronic Information, Browse by Condition: Learn More About Your Childs Blindness or Low Vision, orientation and mobility (travel) techniques, Optic Nerve Hypoplasia by the American Association for Pediatric Ophthalmology and Strabismus, Optic Nerve Hypoplasia by the Childrens Hospital Los Angeles, Optic Nerve Hypoplasia reprinted from the Blind Babies Foundation on the Texas School for the Blind and Visually Impaired website, Join the FamilyConnect community and connect with other families who have children with Optic Nerve Hypoplasia, Optic Nerve Hypoplasia: A Journey, Advice, and Instructional Strategies, Register your agency for the Directory of Services. Delays in speech, language, and communication are fairly typical. The underlying process that leads to the birth of a child with ONH also can affect adjacent structures of the midline brain. Though best known for its role in childbirth and lactation, oxytocin has also been found to have a role in human bonding, increase in trust, and decrease in fear. Los Angeles. Disturbance of circadian sleep rhythm, resulting in abnormal sleep-wake cycles, is noted in one-third of children with ONH. We have not yet even achieved success in treating mice with stem cells. We are aware of the Stem Cells China program; however, we have not yet reached the state of knowledge with which stem cell treatment for ONH in humans can be done in the US or Europe. 2011 Nov 15;2011(1):17. Children with optic nerve hypoplasia (ONH) can have difficulty focusing on the face of a parent/caregiver or another object starting in infancy. The condition may affect one or both eyes. [7], ONH is diagnosed by ophthalmoscopic examination. At present, there is no treatment for condition of the optic nerve. 27 Apr 2023 13:35:41 This condition is the most common congenital optic nerve anomaly. Adrenocorticotropic hormone (ACTH): This hormone stimulates the release of cortisol from the adrenal glands. 2005;94(10):1421-1426. Visual acuity can range from no light perception to near-normal vision. Hypoplasia (septo-optic dysplasia) is one of the milder forms of brain and orbital developmental disorders associated with ventral induction of the neural axis in the first trimester of gestation ( Figs. Nearly all children with ONH exhibit random, horizontal and vertical eye movements called nystagmus. Early intervention is the best way to set your child up for success. The optic nerve is a collection of more than a million nerve fibers that transmit visual signals from the eye to Before Your Visit View a curated list of resources for the classroom. Optic nerve hypoplasia (underdevelopment): The optic nerves run from the back of the eye to the back of the brain where the images that we see are processed. A child does not have to have all 3 features (meaning optic nerve hypoplasia, abnormal midline structures of the brain, and pituitary gland hypoplasia) to be diagnosed with ONH/Hypopituitarism. She is responsible for providing scientific support for epidemiological and clinical research projects within the ONH research program. Optic 1987;32(1):1-9. WebOptic Nerve Hypoplasia By Kim Lawrence Ah-See, MBChB, and Jonathan Chan, MBBCh, FRCOphth Edited By: Bennie H. Jeng, MD Add to My Bookmarks Comments Download Anti-diuretic hormone (ADH): This hormone helps the kidneys concentrate urine when a child is dehydrated. I attended mainstream classes all through grade school and high school. There is no known cause; however, extensive research and studies are ongoing for children diagnosed with this eye disease. 7 Siatkowski RM et al. Tiger Woods. Some children with Optic Nerve Hypoplasia lack a triangular structure near the brains midline called the Septum Pellucidum and qualify for the additional diagnosis of Septo Optic Dysplasia (SOD). Although ONH is generally considered to be a sporadic disease with a multifactorial etiology, a heritable component may play a role in a minority of cases. This is a national on-line survey available to all families with a child diagnosed with ONH. Abnormal formation of midline (middle) structure of the brain: About 50% of children with ONH/Hypopituitarism have absence of a midline brain structure known as the septum pellucidum which separates the ventricles (fluid-filled areas of the brain). Dr. Ah-See is an ophthalmology specialty registrar (resident) and Dr. Chan is a consultant ophthalmologist; both are at Princess Alexandra Eye Pavilion in Edinburgh, United Kingdom. ONH can be unilateral (affecting one eye) or 6 Borchert M, Garcia-Filion P. Curr Neurol Neurosci Rep. 2008;8:395-403. OCT can be especially useful in identifying RNFL thinning in segmental ONH, which affects a portion of the nerve rather than the whole of it. There are considerable risks to this treatment as it is purportedly being administered in China, and the benefits are presently unknown. The condition can also occur in one eye, known as unilateral ONH. For example, timely mobility training, low vision aids, and specialized teaching support can optimize outcomes for patients with poor vision, as well as for those with associated neurodevelopmental delay and/or autism spectrum disorders. A condition called nystagmus, or uncontrollable shaking of the The research studies conducted on all aspects of ONH have led to the information and scientific publications, featured here. Gonadotropins (luteinizing hormone or LH and follicle-stimulating hormone or FSH): These hormones are important for the initiation of puberty. I had eight years of pull out occupational therapy, speech therapy and orientation and mobility instruction through my local school district. 1. Cortisol is an important hormone when our bodies are in a state of stress. After the summer of my sixth grade year, my mother enrolled me in a summer program for children with blindness and visual impairments in the city where I live. In some cases, newborns may have nystagmus, uncontrollable shaking of the eyes. A variation in one of these genes can lead to ONH/Hypopituitarism. Print. When a person doesn'tt make hormones correctly, this is called hypopituitarism. Optic nerve hypoplasia is a condition in which the optic nerve is underdeveloped. The areas that can be affected involve gross and fine motor skills; intelligence, speech and interacting with people. Instead, treatment involves managing and alleviating the symptoms of hypoplasia and its associated conditions. Ocular associations may include microphthalmos, aniridia, coloboma, and foveal hypoplasia.1, Systemic associations include hypothalamic dysfunction, which can produce pituitary, adrenal, or thyroid insufficiencies, especially in severe bilateral cases of ONH. TEPEZZA is a trademark owned by or licensed to Horizon. 2022 Horizon Therapeutics plc P-TEP-US-00805 12/22, By Kim Lawrence Ah-See, MBChB, and Jonathan Chan, MBBCh, FRCOphth, Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, Dr. Richard Mills' Opinions, 2002 to 2016. for your patients with this serious, progressive disease. The vision of a person with ONH can range from near normal usable vision to total blindness. Stem cells research is the most promising form of therapy for ONH in the future; unfortunately, it is far from ready for use in humans. WebOptic Nerve Hypoplasia The Doctor Is In: Optic Nerve Hypoplasia by Lisa Verderber, M.D. The human body is complex, and many things can go wrong while a baby is developing. These may manifest as disordered temperature regulation, hyperphagia and obesity, and disrupted sleep-wake cycles. Risk factors that have been associated with optic nerve hypoplasia include:. They also noticed that my eyes were moving randomly inside their sockets. This field is for validation purposes and should be left unchanged. Additionally, the individual is likely to bump into side-lying and low-lying obstacles; he or she should learn orientation and mobility (travel) techniques, such as the use of a cane, to avoid obstacles. If your child has seizures, a neurologist can provide anti-seizure medication. In some people, brain abnormalities associated with ONH cause seizures.The development of the pituitary gland, found at the base of the brain, can also be affected in children with ONH. 2A).5 In addition, there may be a peripapillary defect, and its choroidal edge may be pigmented, producing the so-called double-ring sign (Fig. WebOptic Nerve Hypoplasia by the American Association for Pediatric Ophthalmology and Strabismus. Central hypothyroidism can be diagnosed by a low or normal thyroid-stimulating hormone (TSH) in the presence of a low level of free T4. Beyond making the early clinical diagnosis of ONH, the ophthalmologist has an important role in educating the family about this condition and making referrals to services and resources for children with significant visual disability. On funduscopic examination of the optic nerve head, ONH can be easily recognized in severe or very asymmetric cases. I also developed strong attachments to certain teachers. The vessels may also show increased tortuosity and reduced branching patterns (Fig. [6] Hyperprolactinemia often correlates with development of obesity in children with ONH. [3][7], The posterior pituitary gland produces anti-diuretic hormone (ADH), which controls outflow of water from the body by urine. 27 Apr 2023 13:35:41 Although the etiology is unclear in the majority of cases, there are known associations with fetal alcohol syndrome, maternal diabetes, and young maternal age. [4], ONH is often referred to as septo-optic dysplasia, a term that refers to agenesis of the septum pellucidum. Authors Savleen Kaur 1 , Sparshi Jain , Harsimrat B S Sodhi , Anju Rastogi , Kamlesh Affiliation 1 Department of Ophthalmology, Guru Nanak Eye Center, New Delhi, India. Motor delay is most common (75%) and communication delay is least common (44%). According to my mother, while I could understand what my parents said to me at ten months, I did not speak until I was three years old. However, in situations in which the optic nerve hypoplasia also accompanies neurodevelopmental abnormalities, young children may experience developmental delays and behavioral difficulties. While attending a self-contained classroom with primarily nonverbal students with significant intellectual disabilities, he had taught himself the alphabet and basic phonetics by watching Sesame Street. WebDiagnosing Septo-Optic Dysplasia By Philip M. Smith, MD, and Vivian Rismondo, MD Edited By Ingrid U. Scott, MD, MPH, and Sharon Fekrat, MD This article is from March 2006 and may contain outdated material. In 2005, I launched ONH Consulting to support children with Optic Nerve Hypoplasia and related conditions and their families, drawing on my professional social service background and personal experience as someone living with ONH. While it is possible to have typical vision or total blindness with ONH, children and adults with ONH commonly experience poor visual acuity (blurriness) which is not correctable with glasses, peripheral field loss (tunnel vision) as well as sensitivity to bright light and glare (photophobia). Strabismus is a condition that affects the alignment of the eyes, causing a person to A new study published in the American Journal of Ophthalmology suggests that there seems to be a significant rate of concomitant retinal nonperfusion in pediatric optic nerve hypoplasia (ONH) patients.. The appearance of ONH should be distinguished from the following conditions: In addition, severe bilateral cases of ONH may mimic achromatopsia or Leber congenital amaurosis. Other indicators of GH deficiency may include hypoglycemic events (including seizures), prolonged jaundice, micropenis in boys, and delayed dentition. Special attention should be paid to early development of oral motor skills and acclimation to textured foods for children with texture aversion, or who are otherwise resistant to eating. Typically these variations are sporadic meaning they are not passed down from parent to child, so there is no risks of recurrence. Ratner Kaufman, Francine, Neal Kaufman, Mark Borchert, and Talia Inlender. The retinal nerve fiber layer (RNFL) and ganglion cell layer may be thinned, while the outer retinal layers and vasculature tend to be normal. What is Optic Nerve Hypoplasia / Hypopituitarism? Children with optic nerve hypoplasia may need to work with a team of doctors, including endocrinologists and neurologists. However, there are some variations that do run in families. Some children may also exhibit strabismus, which is a crossing or turning inward of the eye. Hyperprolactinemia (an excess of prolactin) often occurs in conjunction with ONH and indicates either dysfunction of the hypothalamus or a disconnect between the hypothalamus and pituitary gland. Her research interest is investigating the prenatal correlates of ONH, and identifying early clinical risk factors for adverse developmental outcomes in children with ONH. Lower levels are normally present in both girls and boys, with slight. The eyes may seem to move around with no real pattern or purpose. International Society of Refractive Surgery. There have been a few genetic variations found in patients with ONH/Hypopituitarism. [2] The optic nerve, which is responsible for transmitting visual signals from the retina to the brain, has approximately 1.2 million nerve fibers in the average person. More information can be found on the clinical trials website, Endocrinological and Auxological Abnormalities in Young Children with Optic Nerve Hypoplasia: A Prospective Study, Evolving Central Hypothyroidism in Children with Optic Nerve Hypoplasia, Optic Nerve Hypoplasia and Autism: Common Features of Spectrum Disorders, Neuroradiographic, Endocrinologic, and Ophthalmic Correlates of Adverse Developmental Outcomes in Children With Optic Nerve Hypoplasia: A Prospective Study, Optic Nerve Hypoplasia in North America: A Re-appraisal of Perinatal Risk Factors, Prevalence and Risk Factors for Disrupted Circadian Rhythmicity in Children with Optic Nerve Hypoplasia, Presenting Features and Long-Term Effects of Growth Hormone Treatment of Children with Optic Nerve Hypoplasia/Septo-Optic Dysplasia, Serum Prolactin Concentrations in Relation to Hypopituitarism and Obesity in Children with Optic Nerve Hypoplasia, Autism Assessment in Children with Optic Nerve Hypoplasia and Other Vision Impairments, http://onlinelibrary.wiley.com/doi/10.1111/dmcn.12264/abstract, Prenatal determinants of optic nerve hypoplasia: Review of suggested correlates and future focus, Optic Nerve Hypoplasia Syndrome: A Review of the Epidemiology and Clinical Associations. Hormonal imbalances may require hormone replacement therapy. WebOptic Nerve Hypoplasia. Vision loss is not progressive; in fact, vision may improve slightly over time, and nystagmus may decrease. Many children with ONH have sensory processing difficulties & may exhibit Arch Ophthalmol. Some persist in some form to this day. What is the cause of ONH? Your doctor may choose to test your child for these variations. It has numerous clinical correlates, including neurologic and endocrine pathologies, making timely clinical diagnosis and further investigation crucial. Ophthalmology. If hormonal or pituitary problems are suspected along with optic nerve hypoplasia, your doctor may run blood tests to check hormone levels. The lack of these hormones can cause a great deal of problems for the children who are missing them.Children with ONH may also experience sleep dysfunction, gastrointestinal distress, problems with hunger or thirst, difficulties with temperature regulation and autism spectrum disorders. The optic chiasm is the place within the brain where some of the nerves from each eye cross. 4650 Sunset Blvd. WebZollino et al reported a deletion patient (patient 28) with hypoplastic ocular globe, unilateral ONH, strabismus, hearing impairment and craniosynostosis. After such tests, your doctor should be able to tell if there are major problems with brain structure. Research with stem cells for this and other optic nerve conditions is being done on laboratory animals. This is the most commonly missing pituitary hormone. It took extra time for me to process information, which made reading comprehension particularly challenging. Tiger Woods is arguably one of the best golfers the game has ever seen. Growth hormone deficiency is common in children with ONH. My mother took me to an ophthalmologist, who diagnosed me with Bilateral ONH. 66 The third deletion patient reported manifested WebPineles, SL; Henderson, RJ; Repka, MX; Heidary, G; Liu, GT; Waldman, AT; Borchert, MS; Khanna, S; Graves, JS; Collinge, JE; et al. Optic nerve hypoplasia is a congenital disorder (present at birth), whereby a childs optic nerves have not developed sufficiently. In asymmetric cases, ONH may manifest as strabismus in the first year of life. 1 Garcia-Filion P, Borchert M.Curr Treat Options Neurol. If this is the case, your child may benefit from increased room and task lighting; utilizing assistive technology to more easily write, read, use the computer, and access information; and to utilize techniques and additional accommodations to perform activities with limited vision. However, I left full-time social work after job-related stress caused some inappropriate behaviors to reemerge. The absence of the septum pellucidum does not predict developmental delay. ONH is an important cause of visual impairment in infants and children. If your child is totally blind, he or she must be taught to complete tasks without the use of vision. Hypopituitarism due to pituitary gland hypoplasia: The pituitary gland secretes a variety of important hormones. The objectives of this research registry are to determine the clinical prenatal risk factors of ONH and to investigate the clinical characteristics associated with functional outcomes in order to identify opportunities for therapeutic and rehabilitative interventions. The ability of a child with ONH to produce vital hormones may also be affected. The most common pituitary endocrinopathies are growth hormone (GH) deficiency (70%), hypothyroidism (43%), adrenal insufficiency (27%), and diabetes insipidus (5%).[3][4]. What specialists should I see? This study was carried out by Natasha da Cruz and colleagues to report the correlation between peripheral retinal nonperfusion, I loved to listen to the sounds of cars, especially the sounds their horns made when they honked or their ignitions started. WebSSONH was first described by Robert Petersen and David Walton in 1977, who reported 17 children born from diabetic mothers who all exhibited superior ONH with corresponding inferior altitudinal or sectoral visual field (VF) defects but normal visual acuity[3]. Most commonly, the abnormal eye movement is the first clue for ONH/Hypopituitarism. Dr. Borchert, who has been listed in Best Doctors in America, also has received honors from the Pan American Association of Ophthalmology, the American Academy of Ophthalmology, and Society of Heed Fellows, as well as several teaching awards from the Keck School of Medicine of the University of Southern California. WebSummary. Mark S. Borchert, MD, is director of the Eye Birth Defects Institute and Eye Technology Institute in The Vision Center at Children's Hospital Los Angeles. 4), and neuroimaging is indicated to exclude structural brain abnormalities. WebIm a 26 year old male. 5 Dahl S et al. 2006;148(1):85-88. 2012;16(5):418-423. I alsosignificantlylearned to button my shirt and tie my shoes at the end of my third year of this program. Many times, de Morsiers Syndrome or septo-optic dysplasia (SOD) is associated with ONH, however, it is possible to have ONH without any additional issues like SOD. 2 Lambert SR et al. During the exam, your doctor will look for signs of optic nerve hypoplasia, such as: Magnetic resonance imaging (MRI) studies are commonly used to help diagnose optic nerve hypoplasia. Ghr.nlm.nih.gov/condition/septo-optic-dysplasia, Section on Endocrinology Patient Education Committee, 6728 Old McLean Village Dr Acta Paediatr. Differential diagnosis. Language links are at the top of the page across from the title. I had some challenging behaviors all through childhoodincluding rocking, hand flapping, picking my lips and crying meltdowns when frustrated, overstimulated, distressed or anxious.
Manchu Belt Buckle Authorized Wear,
Amara At Metrowest Resident Portal,
Articles C
