Speech Evaluation

I was starting to feel really good about where Justin was developmentally but J had his speech evaluation last week and he was diagnosed with a moderate to severe expressive and receptive speech delay.  So when the speech pathologist told me that J has a 6-12 month speech delay I felt like a complete failure.  His expressive language (use of language) is between the 18-21 month range and his receptive language (understanding of language) is between the 21-24 month range. And since preemies should be caught up by the age of 2 his evaluation was based on his actual age of 30 months and not adjusted for his prematurity.

Between 24 – 30 months Justin should be able to do the items below and I highlighted the things he's currently doing:

• Imitate 2-3 word phrases
• Begin combining words into simple sentences (i.e. go bye-bye, more cookie, no nigh-nigh)
• Speak more and more new words each week
• Use 50 or more words
• Change intonation to ask questions (i.e. cookie?, mine?)
• Understand size concepts (big & little) and number concepts (one)
• Understand action words
• Point to most body parts
• Use most toys appropriately in play
• Speak clearly enough for people to understand him most of the time
• Use words with many different consonant sounds
• Follow two-part requests (i.e. please take off your boots and put them on the shelf)
• Know a word for almost everything he wants to say or identify and ask for or indicate objects verbally

So if you were to grade J on the above he’d obviously fail; 7 out of 13 (54%) isn't even close to acceptable.  And you all know me by now; this of course freaks me out so I discussed my concerns with J's Early Intervention teacher.  Since she sees J on a weekly basis I felt she'd have a better feel for where J is developmentally versus someone who evaluated J after only 45 minutes of observation.   In short, she does believe there is some speech delay but no where near where the speech pathologist put him.  And since he has a rich home environment, where he is being exposed to language on a regular basis, she didn't feel there was a need to rush into therapy.  She also mentioned that J will get a thorough speech evaluation during his year-end review.  So that made me feel better.  I'm also going to talk to my boss' daughter who is currently working on her master's in speech pathology to get a 3rd opinion. 

In the meantime I’m going to try and relax, look at the positives and work on the things the therapist suggested.

Positives

 - J has good social/communication skills and makes meaningful eye contact

 - J can properly use objects (i.e. uses a brush to brush his hair, feeds himself, stacks blocks)
 - J knows his ABCs & 123s
 - J understands and completes requests upon demand (i.e. step back, don’t touch, clean up)
 - J identifies/recognizes pictures in books
Items To Work On
 - Imitate or match J's sounds, words and actions
 - Label what J sees, does, and hears with sounds and words
 - Use short, simple words and phrases
 - Repeat, repeat, repeat
 - Wait, wait, wait (pause & count to 5 before saying/doing something else to give J a chance to figure it out)
 - Tempt J to talk (i.e. put a desired item in sight but out of reach, create minor obstacles)

DAC Appointment

Weight: 23.2 lbs, less than 5th percentile
Length: 31.5 inches, less than 5th percentile

Thursday Justin had an appointment with the DAC (Developmental Assessment Clinic) which is run by the neonatologists at the hospital where he was born. They were responsible for all of his medications, oxygen, nebulizer treatments, etc. so needless to say he had frequent visits after he was discharged from the NICU. They also monitor his developmental progress, thus the name, lol.

But I was pretty nervous about this appointment. Even though I think J has made great strides (all things considered) and seems to be on track developmentally I was worried about what the Dr's would say. Sure I can tell them all the things he's doing, but of course there are some things I may forget. And it's hard to get a full picture of where a child is developmentally just from an hour long appointment. And obviously there's the issue of his size and weight gain.

The occupational therapist evaluated Justin first and J did great. He stacked blocks upon request and then had a ball putting various sized pegs in the right holes. When the OT put it away he walked over to the OT's bag and pulled it back out. He was able to put shapes in the proper spots and called out each shape as he did it, except for triangle which he can't say. He got upset when the OT switched sides and sizes on him to see if he could put smaller shapes in the correct spots. Of course we all know how much J loves balls so when the OT brought one out he smiled and ran towards him yelling ball.

Then Dr. E and Elaine, one of the nurse practitioner's, came in and examined J. We discussed the OT's assessment. Overall J's doing pretty well, he's excelling in some areas but is behind in others (i.e. does not throw or kick balls, use 2 or 3 words together or ask for items by name). Since he still sees a Special Education teacher through the Early On Program they weren't concerned about his gross motor skills and cognitive learning. But they'd like him to get a speech evaluation, so I scheduled an appointment for the 1st week in December.

Diet wise Dr. E was happy. He asked about his activity/energy level and when I told him how active J is he said that's a good sign because kids who aren't getting what they need nutritionally would be lethargic and non-responsive. And although J is small for his age I FINALLY got someone to say "yes, he's small, but now we look to genetics". That being said we have a GI appointment Friday so we'll see what she says, but it should be good. J's eating has improved tremendously and he's gained 3 lbs since his last appointment a month and a half ago.

Here are some pictures while we waited to be seen. J loved scribbling on paper with Grandpa Smitty's pen. I think J may be left handed like me but he kept switching hands when he was writing so we'll see.

Day of fun

Well, for the most part since our day started with therapy at 8:15 this morning. Surprisingly it was a very productive session; J drank about 90% of his Pediasure from his sippy cup which he's never done before. Of course it took him just over an hour to finish, but that's still progress. So going forward Hillary wants us to try his first 2 feedings from a sippy cup. His 3rd feeding can continue to be from the bottle while we're transitioning. She also wants us to start feeding him solids before his first bottle/cup of the day to see if he'll eat more.

After therapy we headed to Great Lakes Crossing to shop for summer clothes for the boys. We found some good deals and also splurged on a few things for our future niece. I'm so going to go broke shopping for this little girl, lol!

We had lunch at the Rainforest Cafe and the boys had a ball while trying out their first kids meal at a restaurant. J willingly munched on french fries and chicken tenders, YAY!



After lunch we let the boys have at it in the play area.





Needless to say both boys were worn out by the end of the day.

Therapy session

Justin hasn't been himself lately; very cranky, no fever but warm to the touch, and throwing up a little more than usual. Carl and I suspected he may be teething but we couldn't get a good look in his mouth. But during today's OT session Hillary confirmed our suspicions, he's cutting his back molars, so she pulled out some new tricks to try and distract him.

Failure to Thrive

That's the official diagnosis by GI. Hearing that really hurt; failure to thrive has such a negative connotation to it and it makes me feel as if I've somehow failed Justin. Oddly enough I find out this information, not from GI, but from the occupational therapist who just called to schedule sessions for Justin.

Justin was being seen by an occupational therapist at Children's Hospital, but our insurance only covers 20 visits so J's last session was last September. I wasn't concerned because he started receiving occupational therapy through Early Intervention around the same time. And although their focus is not on feeding, the OT has been very helpful and given me lots of advice/tricks/tips on getting J to eat.

We're making progress

Today Justin ate 5 of the Gerber graduates puffs during his OT session. I know you're probably thinking "so what, big deal" but this is HUGE for Justin. Until recently he gagged and threw up whenever anything thicker than pureed foods touched his mouth so it looks like the mouth stretches are working. Hilary (his occupational therapist) was very happy with his progress so now the focus is on getting him to feed himself.

Well wouldn't you know he fed himself when we got home from OT. He's been grabbing the spoon and putting it in his mouth since we started solids but he's never grabbed/reached for finger foods. But I went ahead and put about 6 puffs on his tray and he grabbed and ate 3.

Here are some pictures from dinner time. Note to self: don't leave a bowl of food on the tray if you actually want the food to get into your child's stomach.

Occupational Therapy

Justin had his first occupational therapy session Thursday. The main focus will be on his eating and loosening up his mouth muscles. The therapist said it's not uncommon for babies/people who have been on a vent for an extended period of time to have some issues with eating so hopefully we'll see an improvement.