Accidentastic

C came home at normal times for the last two nights and so our lives feel more normal. A is doing well. He had an exit developmental evaluation today, and he's doing great, actually. He had the Bayley developmental assessment today, and that tracked him as on target for all areas of development, including speech. (I know! Speech too!)

The doctor doing the test made two recommendations: one, that we keep him in preschool (which was like, duh, no kidding), and two, that we keep him in speech therapy once or twice a week to work on his articulation. She said the words, vocabulary, sentence structure, and syntax he has are all on target, but that he needs help learning to articulate. This is super news as far as we're concerned.

This all makes me wonder how the hearing test plays in.

Anyway, I felt confident enough (read: not too lazy) today that we went back to potty training, hard core, Supernanny style: underpants, no Pull-ups. (I would like Supernanny to get over to my house and clean up the resulting mess.) But I am resolved and stalwart and he will be potty trained.

Audiology

So the second band of merry wanderers have been through and back again, and they were a pleasure to have around, as always. Now they're gone and it's all drudgery here. Sigh. But this post is about A's hearing.

As part of any normal speech assessment, they want to do a hearing test (because if you can't hear or hear clearly, you may not talk). Way back in August when all of this assessment stuff started, the First Five people told me that it would take forever to get the state to do a hearing test and that it would be more expedient to pursue a hearing test through our private insurance. At A's two-year checkup the first week of August, his doctor wrote him a prescription for an audiology referral.

That test was originally scheduled for December, the day he had his massive asthma attack and was almost hospitalized. I called in the day before (when he was just coughing and not yet limp) and left a message canceling it. There's no way to talk to a human; they promise to return your call in one business day.

They rescheduled him for today. Three months later! Unbelievable. I know it's unbelievable, because the next time he was sick for an assessment appointment, I marched him down there, let him cough all over their office, and then asked them to reschedule. That time I got an appointment two weeks later and the supervisor's personal line to call with any problems. I should have asked for the audiology to be rescheduled then, but I didn't. So we're having the test seven months after I requested it. Argh.

An audiology test for a toddler works like this: they put tiny tubes in his ears to transmit the tones. Then he sits on my lap in a controlled room where there are shadowboxes containing animatronic animals which light up at various times. Through the tubes, the tester asks him to point to where he hears the tone. I assume the animals light to make sure he's responding to the tone and not just stimuli in the room. Also, they keep it interesting. He was pretty bored by the end of this.

Then they did two separate tests to show how his eardrum and inner ears are responding to sound. His right eardrum was not as responsive as it should have been. The tester looked in his ears and said the right one looked red.

So the audiology tests were inconclusive. The tests could show some minor to moderate hearing loss, but his eardrum looked bad and he's had a cold. The audiologist refused to make a diagnosis based on these tests. She said we should get him to the doctor, get his ear issues cleared up, and then do the audiology exam again in four to six weeks.

I'm not sure what to think. He doesn't seem to have any hearing loss to me, but I'm not an audiologist. There are members of our family who have hearing loss (and not just the ones who were on carriers) so it's a real possibility. I liked the audiologist; she seemed to know what she was doing and half-way through our assessment, another audiologist pulled her in for a consult, so they think she knows what she's doing too. Happily, there's nothing I can do either way but take him to the doctor tomorrow and have his ears checked.

The worst part is that he had a fever on Tuesday and couldn't go to preschool. No preschool at all this week for him--poor boy, poor mommy.

Progress reports

Yes, we get them. It's been about twelve weeks now since A started the extravaganza of classes and speech therapy, so we've got progress reports.

Preschool says he's doing super. He participates in circle time, initiates two-word phrases, and they're pressing him to say, "May I have such-and-such, please?" which means the "More such-and-such, please," requests we've been hyping at home are no longer going to cut it.

His speech therapist is thrilled with him. She's caught him saying three-word sentences, and saying everything from descriptions to commands/requests to narratives, which is fabulous. He has mad play skillz, yo. He's demonstrating new uses for objects and toys every time he sees them, which shows his creativity, problem solving acumen, and general astonishing brilliance. And the speech therapist says his family is super too.

His speech is getting more coherent, but I'm not sure how many other people would be able to tell. The swarms of friends are descending from Portland and Denver in quick succession, so hopefully we'll be able to tell then.

Cross your fingers that when they start turning out lights and closing offices all over California tomorrow due to budget morasses, A's speech therapist and preschools still get paid.

Regional Center Assessment

Today we had another speech evaluation. It's the same-old, same-old: two assessors, one graduate student observing, playtime for A, talking to me.

His official assessment is 27-30 months for receptive language - with some 33-36 month behaviors - and 15-18 months for expressive language. So he understands everything and says hardly anything. He's very bright and right on track for all his other developmental areas. They mentioned how outgoing and sociable he was. None of this is different from any of our other assessments.

So he meets the 33.33% delay requirement in expressive speech, which is the cut-off line for qualifying for Regional Center services. So next week our coordinator (who was out today) will start setting up a plan for him. He'll probably see a speech therapist regularly as a start.

I just wanted to thank everyone who's asked about how he's doing and how the assessments are going. It means a lot to me that other people are interested in him.

Speech pathologist (finally)

We met with the speech pathologist today. It's the same song and dance we've done the rest of the time: A plays while she asked me questions, then she played with him for a bit. She confirmed what everyone else has been saying; A has a mild to moderate developmental delay in speech.

She's the gate-keeper to all the services, though, so now we get to be on the track for services. He's wait-listed for the Communication Group, which is like the group he goes to now, only smaller and specifically for speech. He'll get a hearing test the next time the hearing test cavalcade rolls into town (once every two months). C and I will get to attend a parenting class to determine how to help A.

The one new thing today was a referral to Regional Services. The department we've been going to is a stop-gap measure to help kids who are a little behind catch up so they're prepared for preschool/kindergarten. There's another department that offers more extensive services for kids who need more help. A is borderline between the groups, mild to moderate. The criterion he's being assessed against is the 24-27 month old criterion, and he's at the beginning of the range. So the pathologist asked me if I wanted to get the paperwork rolling to get him into Regional Services or if I wanted to wait and see how he did in his groups.

I thought about it for maybe thirty seconds, then said, "Let's get the paperwork started." I know that it's a lot harder to get someone into a program than it is to take them out of it, and even if he does great, I want him to have all the resources he can.

He seems to be liking Group; there's lots of toys and books there for him to play with. He's not done at the end of class and has to be convinced that it's time to go home. The facilitators say he's doing really well, pays attention, remains on task, cleans up. I still waver (worry) about the qualities of the other parents, but he's getting playtime with other kids and attention from trained teachers, and I figure that can't hurt.


Oh, and he's got two new words: baby and bear.

Developmental Assessment

At A's two-year check-up, (he's fine, btw), I talked to our pediatrician about A's speech. He used to use more words than he does now; he used to use two-word phrases and he stopped. This is one of those autism signs that gives me the heebie-jeebies, but he's still very tuned into people and situations, so I thought, no, not autism.

But it's something.

And our super-cool pediatrician agreed that it was odd and so last week we started out on the journey of assessment.

• Tuesday: initial screening: a questionnaire, asked verbally of me, to determine a general development level in five categories: gross motor, fine motor, personal/social (interactions), cognitive (problem solving), communication. He's off the charts for everything but communication, where he's in the 12-24 month category. Ouch. Come back tomorrow to meet with a speech specialist.
• Wednesday: not the speech specialist. This is a more thorough general screening, done by someone who questions me and plays and talks with A. He's in the 30 month range for everything but communication, where he's in the 15-18 month range. Come back tomorrow and meet with another specialist to do a speech assessment, plus we're going to put A into some monitored play groups to make him play with other children and force him to develop communication skills in self-defense.
• Thursday: Speech assessment, general. This is one-hour where the specialist talks mostly to A and some to me and asks him to say things, accomplish tasks, play. He's in the 15-18 month range for expressive communication (him talking) and the 18-21 month range for receptive communication (him listening to what people say).

And so here we are. I figured I'd blog before it got to be too much to describe. He's got the first of the playgroups tomorrow. We have a more in-depth meeting next week with a speech pathologist who will assess him in more detail and set goals.

The last specialist recommended a specific communication-focused play group, an audiology test, and a parenting class for us to be able to help him specifically with communication, but all of those have to be seconded by the speech pathologist.

The audiology test is to make sure he's hearing us since the specialist noted a delay between when A hears a request and when he acts on the request. The suspicion around here is that the delay is the time A takes to decide whether or not he's going to follow a request, but it's good to get him tested anyway.

We're all ambivalent here. I'm glad we got early intervention; I just want to know what's up with him. C still thinks, much like walking, that A just needs to decide he wants to talk and he'll talk. I think assessment is always a good thing, and the earlier the better. But every specialist has taken great pains to tell me: he's smart. He's really really smart. And I say, well, duh.