Speech, Ella's way...

Ella continues to make good leaps and bounds lately, as we've seen ever since Ella got her glasses. She's speaking more and her motor skills are making good progress.

On the gross motor front, Ella's learned to make small forward jumps in order to hop her way across the floor. Previously she'd only been jumping straight up-and-down. This is good because it takes a lot more confidence and balance skill to jump forward than it does to jump in place. Her climbing is getting a lot better, but she's still behind in this area, but that will come in time with better balance.

Speech-wise, Ella is now up to using a total of 8-12 spoken words and word approximations, which vocabulary wise is more on par with a 16-month old than a 3.75 year old. Her diction is also pretty crude, again like the younger child.

However, one interesting twist is that Ella is already putting these together to make sentences, and also combining them with ASL signs. This is very amusing, because usually children with such a limited vocabulary only use single words. Hearing Ella very roughly say "Hep Meh" (help me) is an interesting contrast. Her speech ability is really basic, but it contrasts with her more comparatively advanced conceptual language abilities.

Of course, we're used to out-of-order development but it continues to amuse me.

Additional speech therapist...

Last week we started taking Ella to see a private speech therapist, as a supplement to the school-based therapy she gets right now. So far she's had two visits, but these have mostly focused on evaluating Ella's existing speech in detail (using parts of a Kaufman Speech Praxis test).

This isn't to say the school system isn't doing a good job, but the school environment and private therapy settings offer different advantages. The school environment offers a lot of other kids her age to model from, as well as a mixture of both group and one-on-one speech therapy. However, neither of us are present at school, and we do not have frequent interactions with her therapists. This means that our at-home efforts are a little unguided and only sync-up with the school once a month or so.

The private therapy, on the other hand, is all one-on-one and there's no peers to learn from. However, one of us attends each session, and her therapist intends to start giving us plans for at-home therapy tactics.

Adding another therapist now also seems very appropriate. Since she got her glasses she's made a lot of progress in the "raw fundamentals" of speech. This seems to us (and her school therapists agree) to be a very good time to increase the intensity of her therapy and catch her up a bit now that she's starting to pick things up faster.

As for her speech progress, we've recently seen several new bits of speech progress emerge:

-she combines "hi" with a name to form a two-word greeting. (Hi Dada)

-she uses a lot more different letter combinations than before in her babbling.

-she's started jargoning where she's stringing together a stream of different syllables, rather than just repeating the same one or two. ("nabooka dooga aeee!" instead of "booka booka booka")

Of course, there's lots of things she's still having trouble with, such as sounds that involve bringing the tip of your tongue up (t, l, etc.), sounds using the teeth (f, v, th, s) and most sound combinations that involve going from an open jaw to a mostly closed one. But that's what we're all working on.

catching the blog up...

Ok, first a little oldish news that I haven't relayed to the blog:

At a meeting with Ella's OT, she suggested that Ella may have depth perception issues, and we might want to take her to a developmental optometrist. We took that as good advice and the results were that Ella is severely farsighted (+7.5 d), and can't focus on things close to her. As a "stepping stone" the optometrist suggested getting glasses at +6.5 see how she does with them, and visit for a follow-up (which is coming up in a week or 2 now).

Now for the rest:

Since getting the glasses, Ella has greatly improved in several areas, particularly in motor ability. The ability to focus on things close to her has given her a better ability to traverse stairs, jump, and the confidence to run around. Her general activity level is also up quite a bit. It has also increased her attention span for hands-on activities etc. We also expect this will have a positive impact on her speech, as she'll be able to see the details of how we move our mouths and tongues while speaking. She still has some motor obstacles to speech (i.e.: she cannot curl her tongue upwards yet), but the glasses at least remove one obstacle.

Of course, we recently had her mid-term IEP meeting with her teachers, where we plan her education goals, therapy levels, etc. Unfortunately, all of the review was written before her glasses arrived, and some of her goals are likely to be rather low now that she can see better. On the upside, we've got another meeting to discuss summer semester soon, and her teacher mentioned we may amend her IEP at that meeting if needed.

brief news bits..

Just a little quickie here:

Ella's been sick for the past week or so with bronchitis. However, she's finishing up a course of antibiotics, and it is clearing out now.

Ella also seems to be working on a speech approximation for "bye bye", although at this point it is little more than "buh buh". On the plus side, she's continuing with the use of ma ma, da da, and og (frog). She also frequently uses a spoken "I" mixed into her signs, and very rarely she says "Hi". All of this is really good news, as it means her spoken vocabulary is growing. In the past we've seen patterns where a new sound replaces an old one.

Ella has also taken to a lot of play activities that are good for balance and strength. Lots of jumping, bouncing, crab walking, etc. She's even starting to work on a broad jump, not just a vertical hop (I think this is her teachers in action, but I have not directly asked them).

Tech-speak device and speech news.

Again, I'm a bit behind in updating the blog, but the holidays always make life a bit busy. So, with that asside, here's a quick update of what's been going on.

First, Ella's school has sent home a Tech/Speak device. This is essentially a board of buttons with pictures on them, and when Ella pushes the buttons, it speaks words. The hope is that it will make her realize that spoken-word can help her communicate with more people, thus encourage her to work on transitioning from signing to speaking.

As for speech, Ella's had a few new words/word aproximations emerge over the holiday. In addition to "da da" and "og" (frog), she's now using "ma ma" (which she had a long time ago, but disappeared for a year), and "ah ah ooh" (uh-oh). What seems most positive to me is she very quickly started using these words appropriately, because she already has the concepts of how to use language down from her signing. This makes me very hopeful that once we can break through the physical co-ordination of her mouth, she'll fall rapidly into speaking.

In any event, we all had a great Thanksgiving, and I hope you all did too.

Ella's follow-up appointment.

This is a bit of old news now, but I'm just now getting around to blogging it. Back on Nov 5th, Ella had her post-op follow-up at Hopkins. They performed a fairly detailed check-up of her heart, and the placement of the device using both echo- and electro-cardiograms. The Amplatzer duct occluder is in-place, it's not moving, and it's not obstructing normal blood flow anywhere. To quote the cardiologist that did the procedure "It's hers now, she can keep it."

At this point, we've been given some very minor restrictions (i.e.: no dental work for 4-5 months due to infection risks.) and we're scheduled to follow-up with our local cardiologist in a year.

In general Ella has been doing really well. The day after the procedure (Thursday) she was still pretty sleepy, but she went back to school the day after that (Friday), and had a more-or-less normal day. She had some minor tenderness for a bit over a week at her hip where they inserted the catheters, but this went really well.

All is well.

Just to let everyone know, Ella is home and doing very well. She's got a good appetite, when we got home last night she immediately spotted a bowl of goldfish crackers, walked over and stuffed a handful in her mouth. She's been sleeping a lot, but when she's up and about she is acting like her usual happy self. She doesn't seem to be in any serious pain, but was a bit fussy about me changing her bandages this morning. Even that was a fairly mild protest; she was whining about it, not crying or screaming.

At this point, I expect she'll be OK to go to school on Friday, although you never know for sure.