Failure

This morning I met with the speech therapist at Justin's school. Long story short J's language development is the equivalent of a 21 month old; J is 41 months so that's about a 1 1/2 year delay, OUCH!!! I couldn't help but feel like a complete failure after hearing that. Especially considering J had a speech evaluation last year which put him at about the same delay. Perhaps I was in denial a year ago; after all the therapists only have one 30-45 minute session to evaluate him and in both cases J didn't do half of the stuff we know he can do. And after last year's evaluation I discussed the results with J's Early Intervention teacher who works with him weekly and she didn't feel that his delay was that severe. Between her weekly sessions and us working with him regularly at home we didn't feel the need to rush to therapy but now I'm second guessing that decision. I know I shouldn't compare but I look at other preemies, all born around the same gestational age as J, whose language has just really taken off and I can't help but wonder what I did wrong.

But after talking to Carl and a couple of friends I've realized I can't let this get me down. On the bright side J's expressive language (use of words and sentences to communicate thoughts, needs or wants) is only slightly below average. It's his comprehensive/receptive language (process of understanding what is said) that really brought his score down so we discussed her goals for him. Two of them are things that J is already doing but he didn't show during his evaluation so the therapist said she will adjust the goals accordingly once they get into their sessions. One of them was something Carl and I had already identified so at least we're on the same page there. The last two were things that I've actually never considered or thought about but now realize are key to his development so I'm glad she'll be working with J on them. She gave suggestions on things for us to do at home, some of which we're already doing so we just need to continue with what we've been doing even though it doesn't seem like it's helping. The therapist will provide weekly updates on what they worked on during the week so we can reinforce things at home. So we have a plan; the hope is that we'll see significant improvement by the end of the school year.

On another note, I finally got a chance to see J with his classmates while I waited for the speech therapist. Since there are some kids that get dropped off and others that ride the bus the preschool kids wait in the hallway with the teacher and her aide to give everyone enough time to get in the building and to let the older kids get into class. Once everyone is rounded up they walk in a line (follow the blue line on the floor) to the classroom. Justin was 2nd in line and walked to class on his own; his teacher was at the middle of the line and the aide was at the back. It's so simple but I was so proud seeing him walk to class.

After the meeting I peeked into the classroom; they were wrapping up breakfast and most of the kids were still at the table eating while a few kids sat on the floor reading. Even though the door was open I couldn't see J but I didn't want to just walk into the classroom and disrupt things. But the aide saw me and told me to go ahead and peak my head around the corner since J was off to the side where I couldn't see him. He was sitting, well more like hanging off the chair with a spoon in his mouth and he saw me but he didn't smile, cry, get up, nothing so I just turned around and left. I didn't see much but it was nice to see nonetheless since we don't get the opportunity to observe or participate in classroom activities.

Preschool

The first few weeks of preschool were tough; lots of crying for both mommy and child, lots of testing boundaries with his teachers and not socializing with the other kids. But all that’s changed; now Justin walks in the building willingly and doesn’t even look back to say bye to me. As soon as I unstrap him from his car seat he grabs his book bag, climbs out of the car and tries to rush across the street to the entrance. Even after being kept home all last week because he was sick, Justin’s teacher said it was like he was never gone and he picked up right where he left off.

Justin is a favorite with the other teachers and the kids. The week before last I smiled when a teacher started yelling for Justin as soon as she saw us walking towards the building. J’s teacher also mentioned that teachers always ask about J when they see him in the hallway. Even the bus driver has taken a liking to J and he doesn’t even ride the bus. The “mom” (another classmate) of the classroom is always helping J with his coat and book bag and one little boy is always in Justin’s face asking him what he’s doing and trying to play with him.

So what has Justin been up to the last month and a half?

- drinking out of a straw
- doing more imaginative play; his teacher said he grabbed a pitcher and spoon out of the classroom kitchen and started mixing
- putting together puzzles
- loves the letters & numbers bulletin boards, sometimes a little too much as he’ll leave group time to go stand by the board and recite his numbers & letters
- becoming more sociable with the other kids and participating in group time
- being exposed to potty training; Justin is too small to use the bathrooms in the boys’ restroom but the teacher still takes him with the other boys. Unfortunately since it’s a general population bathroom they can’t keep a step stool in there for J to use. But I’m really hoping that seeing others using the big potty will make J more curious and anxious to try it as well.
- developing a love of arts & crafts; J especially likes to paint

So all in all Justin is doing pretty well and his teachers are impressed with how smart he is. Our next focus: speech therapy. J’s vocabulary is pretty good; he’s speaking new words day by day and starting to repeat more and more but he still struggles with speaking in sentences, asking for things by name and continues to communicate with us by using gestures rather than verbally. I have a meeting with the school’s speech therapist on Thursday to go over his evaluation/goals and hopefully she can start working with him next week.

Hearing Test & Language Explosion

Justin passed his follow up hearing test with flying colors.  The audiology department has been following him pretty closely since he was born and want to see him back when he turns 3.  Then we can decide if he should be seen annually or simply on an as needed basis depending on how he's doing. 

The extra effort I've been putting in since J's speech evaluation is really paying off.  His vocabulary has increased by about 20 words and he's speaking more and more 2 - 3 word phrases.  He can now match animal sounds to the proper animal; it's so cute to hear him meow (or should I saw eow, lol) when I say cat or bark when he sees a dog.  It's also cute to hear him playing with his cars and yell out vroom vroom or whee.  And I'm so proud when we go through the alphabet and he yells out objects that start with the letters I say.  So keep up the good work Justin (and mama)! 

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)