Early Intervention

Monday, June 11, 2012

Nora is a child of very few words. Quiet, she is not. But words? Well, she really doesn't have them.

I think I've mentioned this concern on my blog before, perhaps in posts about her chronic ear infections and the surgery to place her ear tubes. Or maybe in passing in other posts as well. But I've never dedicated an entire post to it because, well... we've always just hoped that--like with a lot of other things--Nora is a "late bloomer" when it comes to speech.

And maybe she is.
Nevertheless, at Nora's 18-month well-baby visit, her pediatrician said that she wanted an update on her speech development at 21 months. She said that if she hadn't made marked improvement, she would refer her to an early intervention program. She noted that it would mostly be precautionary--she doesn't really worry until they are past two years old--but that it was worth at least being evaluated by early intervention at 21 months because the process is easier when working with the county (as opposed to the school district, which is apparently who we would work with if she was 2+).

A little more than a week ago, I called the doctor's office to talk to her about behavioral issues--tantrums. She loves the behavioral stuff, so we have an open invitation to call her with questions whenever, which is really nice. Anyway, during the conversation I mentioned Nora's speech, and when our doctor heard that Nora had really only added one new word in the past three months (which is "no," by the way), she told me to go ahead and call early intervention.
It's a process just to be evaluated, so I don't know when we'll actually find out anything noteworthy. But we have an appointment with the service coordinator this week, who will go over our "options" and then I guess we'll get on the schedule for the actual evaluation.

The funny thing? I don't even think she's going to qualify for services. I really don't.

In talking to a few friends who have been through the process, the therapists evaluate the children using a number of different factors--and then come up with an overall score. If the score is too high, the child doesn't qualify for therapy. Apparently, half of that score is based on receptive language--and Nora understands. Nora understands a lot.
Even more amusing is the fact that in the last week since I made the appointment, I swear we've noticed a handful of new words. Like when she's in the bath tub and she lines up her little sea animals on the edge--we always count them. And a few times, I've said, "Count your animals, Nora." And she'll take her little finger, point to them, and say "wuhh. tooo. tee." (one. two. three.)

Or last night, when Michael kissed her goodnight, said "I love you," and started to leave the room when we both heard what very well could have been a version of "I love you" escape Nora's lips.
Also new this past week has been a couple of animal sounds. We ask her "What does a tiger say?" and we get a "Raaaahh." and "What does a cow say?" and we get "Mmmmm!"

Thankfully, she has also picked up "Yeah," which is a nice complement to "No" (although not used nearly as often, I'm sorry to say).

I don't know what the evaluation will bring. Maybe she would benefit from some time with a speech therapist. But I can't help but feel like perhaps the "language explosion" is just around the corner.

One way or another, we should be making some progress very soon.

Of all words in our language, of all of the things that I can't wait for her to say, there is just one magical word that I look forward to most.

I hope that I will finally--someday very, very soon--get to hear her little voice say "Mama."


Katherine June 11, 2012 at 10:06 PM  

I was hoping you'd do a post about this. We're having the same problem with our 18 month old daughter. I've been resisting the pediatrician's suggestion to get her evaluated b/c I really do think she's fine. Like Nora, she understands EVERYTHING. And she does have 5-10 words but her pediatrician wants her to have 20. But sometimes I worry that maybe she isn't fine. For us I think the problem is 3rd child syndrome. She has two sisters who are 3 and 5 and no one can get a word in edgewise when they're around. Any day now she'll probably have a language explosion and tell everyone to shut the heck up.

I'll be very interested in hearing what the therapists think given Nora's receptive language skills.

basebell6 June 11, 2012 at 10:26 PM  

we also have a late talker here. i'll be very interested in the details of how the eval goes and what all they do. i'm not worried, nor is my mother-in-law [a nurse who has worked for our pediatrician for 20+ years], but every time i go on babycenter it seems like i'm the only mom who HASN'T had her child evaluated.

Katie P,  June 11, 2012 at 11:37 PM  

I am continuously surprised by peds suggesting this! I guess I was lucky to escape this diagnosis bc Carter really, REALLY didn't start talking until 22+ months and the explosion definitely came after 2. He understood everything and we practiced signs at home. I'll be interested to hear how your eval goes! GL!

Elizabeth June 11, 2012 at 11:54 PM  

Interested to hear how the evaluation goes. I'm sure Nora is just doing things at her own pace, and her language explosion will come out of nowhere.

Everyone is different, my little sister did everything at a younger age than I did. Except talk. Why? She didn't need to, I talked for her.
"Mum, 'little sister' wants an ice block...I'll have one too".

BTW Nora just keeps getting cuter! Such a lovely smile.

Anonymous,  June 12, 2012 at 12:08 AM  

I've been a reader of your blog ever since your pre-wedding days. I've really enjoyed following along with your family. I'm also an SLP, and there isn't any harm in getting the evaluation. If she doesn't qualify for therapy, then at least you know. And if she does, then it's possible she may only need a brief period of therapy. The therapist can give you and your husband some tips for language development, as well. I'm not an early intervention SLP, but I do work in the schools, and we can use just an expressive language delay as our qualifying score, rather than needing the overall score(which includes receptive as you mentioned) to meet the cutoff. Also, I believe most EI services continue until the 3rd birthday, at which point they transition to the school district. Whatever outcome the evaluation brings, look at it as a positive thing. :)

Vanessa June 12, 2012 at 8:34 AM  

Hi Heather
Whilst in your shoes I'd probably do the evaluation, I do bemoan today's culture of making normal things into problems... I think it's perfectly normal for kids to start talking at different times and I think nowadays there is too much 'labelling' of things that are normal. Since she understands so much I am sure there is nothing to worry about at all.
Good luck!

Maplewood June 12, 2012 at 8:50 AM  

Long time lurker here. My daughter is 22 months and only had about 10 words when we called Monroe County Early Intervention. Within a month, we had the intake appt, eval, and had started weekly Speech and PT services.

There's been a definite jump in her words in the past month, though I'm not sure it's directly related to speech services. The nice thing about the therapy is that the therapist works with me to teach me what I can do to help my daughter communicate more, both with speech and sign.

PhaseThreeOfLife June 12, 2012 at 11:35 AM  

I can very much relate. Ryan has been slow with speech, too, and I've always suspected it is tied to the chronic ear infections/tubes. He understands a lot and follows simple commands (put your shoes on, etc). What's interesting is that we went to Ohio to visit family last month and he was around my three nieces, all of who are older (5, 3 and 2). I noticed a huge difference in his speech after being around them for 5 days. I mean, he's around kids all day long at daycare, but they're all his age... being around the older kids seemed to make a difference. Anyway, no real advice for you, just wanted you to know I understand how you feel!

Sarah Bryant June 12, 2012 at 8:29 PM  

I doubt you have anything to worry about. I think she is probably one of those kids that just sits back and watches everyone else talking and then one day, she will just bust out a sentence or two. :D Here are two links to help that I came across today if you are interested: http://www.babycenter.com/0_warning-signs-of-a-toddlers-language-delay_12293.bc?scid=momstodd_20120612:3&pe=MlV4R2VSSHwyMDEyMDYxMg..


Helen June 13, 2012 at 2:11 PM  

We just went through this with our three and a half year old. He tested well above fine, despite his preschool's claims to the contrary. My gut kept telling me he was FINE, but having him tested gave me that extra piece of mind. And the therapists were really helpful with suggestions for the 'issues' he does have. There is no harm in getting her tested, and it will give you the extra piece of mind.

But I also agree with the others. I think sometimes doctors and others go looking for problems that aren't there when a kid tracks slightly behind their peers on one thing.

Cara,  June 13, 2012 at 6:55 PM  

Hi, Heather. I am an occupational therapist for early intervention. I agree with the SLP who commented. It doesn't hurt to have an evaluation. Even if she doesn't qualify, the therapist may have some helpful suggestions to encourage her. Good luck!

Meghan June 15, 2012 at 10:19 PM  

We were worried about this with my son. At his two year old visit the doctor told us if he hadn't starting putting small sentances together we would need to do this. Low and behold 2 months later is talking my ear off. I am sure she will be fine and start talking soon enough!

Giana June 16, 2012 at 1:13 PM  

My Giana is about 2 months older than Nora. She doesn't have a lot of words also, although she's very noisy (but no clear words come out). she understands what we say and she follows what we tell her so we werent worried. then lately we hear random words that sounded like expressions we use, but still not very clear. until she learned to count to five and started to say the abc.. so i think if Nora understands what you say and follows instructions, then i think she;s just shy. one of these days she would surprise you by following random words she would hear from conversations.

Kristi June 26, 2012 at 1:04 PM  

I hope you will update on us on this!

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