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.

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.

moving up from the MINC program...

Originally it was a judgment call between putting Ella into a MINC-T (multiple intense needs class for toddlers), or putting her into the normal special ed toddler class. Ultimately, the MINC was chosen to afford Ella extra therapy time, and a smaller class for her first school.

Recently, the paperwork was done for Ella's school starting this fall. For age reasons, she's going to be moving from toddler class to preschool class. Given how well she's been doing in the classroom, and how well she socializes with other children, the staff recommended that Ella move up from the MINC program to the normal special ed preschool. We've decided to go ahead and do that.

This does mean Ella's one-on-one time with school therapists will be going down, but it also means the class activities will be more challenging for Ella, and provide her with better opportunities to advance on her own or from her peers. With her current progress in motor and social areas, I think this is very important. She's also been babbling back-and-forth with her peers, and this class is also likely to have more students in it for Ella to "talk" to.

This isn't terribly fresh news, as we've known about it for a while, but the paperwork was finalized this past week, so I figured it's past due to put it up on the blog.

Go Ella Go!

slow but steady progress

I haven't posted in a while, mostly because nothing "unusually exciting" has happened with Ella lately.

Of course there's lots of small cute things she does every day, and perhaps I should make a point to post more of those. Thinking of that, here's one now:

A couple of nights ago, when Ella got in bed after her bath, she started giggling and shaking her head all over the place while laying down. This, of course, made a giant mess of her freshly combed hair, and I commented "Oh, you're going to be fuzzy tomorrow". She immediately stopped, looked at me, and started stroking my beard. "Yes, fuzzy, like daddy's beard". It was immensely cute.

As for progress, Color wise, Ella's starting to get the hang of identifying and signing black and brown, although these are still a bit rough and she'll sometimes label black things as being brown.

Motor wise, Ella's continuing to get more confident and bold climbing on play structures, stepping over things, jumping, etc. It's all very gradual, but looking back at even a month ago, her ability to navigate barriers is much smoother now.

On the speech front, Ella's continuing to babble, and it's still mostly "Da". However we are starting to get her to vary the sounds a bit. She's sometimes distinguishing vowel sounds to make word approximations. Most of the time it's all just "da" or "da da", but sometimes she'll intentionally shift towards "eh-da!" (ella), "die" (bye), and rarely she'll even make a little twist towards "Dahn" (done) although it's still more like "Dahd".

We've also recently seen a return of B and R sounds, although these are rare just like "tooka" "Ha" and "Ga" are.

At any rate, I hope you all are well! Hope to see you all soon.

Something Ella is ahead in..

Much of the time, I discuss area's ella is behind in. Well, for once, I'd like to mention one she's ahead in.

Colors.

Ella has been obsessed with colors since she was around 24 months old. She's gone through phases of forcing us to work with her book of colors a dozen or more times a day, every day, for weeks straight. Around 27 months or so she started being somewhat accurate at picking out objects of a requested color, at least for red, blue, and green. (Ella, which ball is green? ) At the time, this was largely dismissed as highly unlikely by her special educator.

By 31 months, she could identify red, blue and green objects, and label them expressively with signs. ( Ella, what color is this? )

Ella is currently just under 34 months old, and she can reliably identify and label the colors: red, blue, green, and orange, and usually nails yellow too (sometimes she calls it orange). She can sign brown, but is a bit shaky on identifying objects as being brown. She can also reliably identify purple objects on request, but cannot form the sign.

As milestones go, they say most children should be able to label 1 color by 36 months. In the "what to expect the toddler years" book, identifying 4 colors is in the "may even be able to" section for 34-36 month olds. Ella's reliable with 5 colors, sometimes 6.

Is any of this really that unusual? No, not really. It just goes to show how much a child's interests impact their learning. Children generally learn a lot faster when they're really interested in something. Colors deeply fascinate Ella, so this isn't surprising.

School..

Bad blogger, no biscuit!

I mentioned back earlier that Ella would be starting school on the 17th, and it's almost two weeks after that and I've not blogged about it. Tsk. Tsk. Tsk. So, there's no a LOT to blog about, and I apologize in advance if this post is a bit long and desne.

In any event, Ella is taking well to school. During the first week there was definitely some crying, particularly while being dropped off, but she has now acclimated to school as a part of her regular routine. Of course, she's off 7 school days in a row for spring break starting Friday, so we'll see how she does after a longer break than just a weekend.

Ella's class consists of 8 children, a few of whom are typically developing and the rest are other children with delays from a variety of different situations. Being a toddler class, the classes are mostly learning play oriented. The staff consists of a teacher, a few teaching assistants, and 3 therapists. Generally speaking, the therapists rotate in and out of the class, while the rest of the staff is present more-or-less every day. The children spend most of their time in group activities, and some of their time one-on-one with a therapist.

As for communicating home, there are a couple of things that are used to keep us informed. Every day, there's a binder that she takes to school with her, and brings home when she's done. These binders contain a series of laminated pages with pictures of the other children, staff, foods and toys. Near the end of the day, one of the staff places stickers on the pictures of who and what she played with, and what she snacked on at snack time. The binder also allows us to pass notes and references to the school staff, such as the list of Ella's signs we've placed in there.

In addition, Ella's teacher comes to our house once a week. We've only had one of these sessions so far, but these visits mostly focus on passing information back and forth. Her teacher tells us what she's been doing in class, and we tell her about some of her recent developments at home. Of course, Ella participates in the meetings to. This gives her teacher a chance to see some of the things Ella does in a home environment, where she's more comfortable, that she won't do in school.

One thing I have noticed is that she's been *really* excited about babbling lately. Obviously I can't prove the extra social interaction is causing it, but it's certainly not hurting. Also, Mental Mother tells me she's been coming home rather tired and napping quite hard most days. That's also a good sign, as it means the class is successfully stimulating her.

Whew. That's quite a dense post. I'll (hopefully) post more in the next few days.

Going to school...

Whew, it has, once again, been a while since I've posted.

Recently it has been time for Ella's progress to be formally reviewed by her therapists, and to revise her education plan. So there's been lots of meetings, testing, planning, etc going on.

As a summary of her evaluation, Ella is more-or-less in the same relative place she was last time she got evaluated. Her motor skills are 7-9 months behind where they "should" be, which is roughly how far behind they were before. Of course, she's older now so that's less of a percentage than before. She is most severely behind in expressive communication skills, as she's still not speaking on any consistent basis. Here she's behind by approximately 18 months, and although that doesn't count her signing, she's still behind even if you were to count them.

And of course, all that evaluation has led to a new education plan for Ella. Currently Ella is in a home based therapy arrangement, where the therapists come to our home for one-on-one sessions with Ella. The plan now is to transition Ella into a group therapy arrangement at a school. This would normally happen anyway when she turns three, but we're doing it a tad bit early. The basic thinking here is the increased exposure to peers will help her model off others, and that's a philosophy that makes sense to both of us as parents.

So, starting in two weeks, Ella is going to be going to a local elementary school for a class called MINC-T (multiple intense needs class - toddler). She'll be going 5 days a week for 2 and a half hours a day. We've already had a chance to go to the school, visit the classroom, meet the teacher, therapists, and most of her fellow students and their parents. So far I'm reasonably impressed with everything.

At any rate, it's getting late (or early) and I best be off to bed.

General misc news..

Sorry I haven't posted lately, but with the holidays and all, a lot was going on.

Regardless, on the Ella front the news is mostly small things.

She had a wonderful holiday, and particularly loved the tree. Every morning she'd come out and sign tree, then star. After we took it down, she would ask about it for several days by signing tree.

In the progress department, her signing continues to progress. She's now up to 90 signs, and we're working on colors. At this point, a lot of her signs are distorted to be similar to others she already knows, but in context we can figure them out quickly enough.

Recently she's been on an upswing of babbling again, which is good. She'd slid off her speaking for a while there, devolving at one point to everything being "rah-rah". It's good that the variety of sounds is back again, but this still remains an area of concern for us.

She's also starting to make "play noises", such as "num num num" when pretending to eat off a spoon, and making slurping noises while pretending to drink. This is also a good thing, as it's using a vocalization for a specific purpose, and provides some foundation for us to build on while working on speech.

Gross motor wise I've been off-and-on working with her to try teach her how to jump. I've managed to get her up off her heels, but no real off-the-ground jumping yet. It's more like standing up really fast at this point. Other than that she's doing very well motor wise. I don't know if these have been mentioned before, but she climbs on and off of the couch without any help, crouches down to pick things up without difficulty, etc. I'm overall quite pleased with her gross motor progress.

Anyway, take care all, and I hope your holidays were as bright as ours

Developmental Pediatrician, round 2..

Today, Ella went to see the developmental pediatrician from UMMC. This is essentially the 6-month follow-up to the previous visit. However, this time Ella saw a different doctor, as the previous has moved on to work for a county government. Actually, she wound up seeing two doctors, as they were running quite behind when they finally got to us and wanted to team up to make the testing parts go faster.

In general, this visit wasn't a whole lot different from the last. One doctor interviewed us while the other gave her a developmental assessment, using the CAT/CLAMS test pair, which showed her to be about 25% delayed (18 months). This is a bit different from what the county school system came up with (12 to 15 months, with one area at 18 months), but they use a different test (ELAP), and the past two weeks have shown a LOT of progress for Ella.

After the developmental assessment, they gave her a physical examination. During this they tested her reflexes noted her muscle tone was slightly low, but not of any great concern. This also matches up with the previous observations of Ella's physical therapist. They examined her eyes, inner ears, mouth, teeth and throat for abnormalities and found none. They also made some observations of Ella's facial and body features and compared them against ours looking for signs of genetic deviation. Ella has a few "off average" features, but she comes by most of them honestly (like my smallish mouth and long toes).

After all that we spent some time talking. They again said there were no signs of autism, just the motor problems we already know about. They said they could refer us to a geneticist, but at this point the only reason to do so would be to find causality (with almost no likelihood of finding anything of therapeutic value) and therefore didn't recommend it. While that might be interesting to know, I tend to agree with them it is not worth subjecting Ella to more tests for something that's merely interesting.

They also suggested a form of speech therapy that works well for children with motor disorders (PROMPT), but after some research, I think our SLP is using some PROMPT techniques.

Finally, they suggested we set up another visit in 6 months to continue to track her progress, this time at a different center as they might want to bring in some other experts.

So, that was basically what happened there.

Revised Therapy services..

Ok, I'm posting a lot lately, but since Ella turned 2, a lot of her specialists are having their annual reviews or follow-ups.

In any event, the Howard County Infants and Toddlers program which handles the bulk of Ella's therapy recently did their re-evaluation of Ella's progress and planned new services.

Previously at 1 year old, Ella was 50% (6 months equivalent) delayed in gross motor, and 25% delayed in communication (9 months equivalent). During the Evaluations in June she was 35% delayed in gross motor (15 months equivalent of 23) and 45% delayed in communication (12 months equivalent of 22). Those numbers are slightly skewed, as the ELAP really doesn't count use of sign language as expressive vocabulary. However, it's still clear that Ella's area of greatest need is communication. It's even more clear when you account for the gross motor progress ella has made since the evaluation.

In light of that, at the end of August Ella is being switched to a different Special Educator that has a lighter case load and can spend more time on her. This will likely result in Ella getting two special educator visits per week instead of one. This is a good thing, as the Special Educator primarily works with us on activities to increase imitation and use of sounds to express herself. The rest of her team is going to remain the same (she also has a Physical Therapist, Occupational therapist, Speech Pathologist).

Progress, etc..

First, sorry it's been forever since I've posted. Ella's been continuing to make progress, but it's lots of smaller things, with no "big items" since my last posting.

First, her special educator has shifted our activities towards increasing Ella's sensory stimulation. This tactic has been fairly successful. In the past, Ella alternated between making progress in motor and communication, completely stalling progress in one while progressing in the other. With the stimulation exercises, she seems to be progressing in both at the same time.

On the motor front, Ella has progressed in skill, but her courage levels have devolved a bit. Her maximum walking distance is much shorter than it was, only 5 feet or so between parents. However her skills are increasing. She's now readily getting herself down from standing onto her hands-and-feet using inanimate objects to brace herself with one hand. She's also fairly regularly letting go with both hands to play with toys while she stands.

However, she's still not willing to stand without being near a hand-hold, and she's not walking around freely yet.

On the communication front, her sign vocabulary is continuing to grow. She's got 5 signs she uses regularly, and is "close" on another 3 or 4. Her babbling is increasing constantly, but she doesn't yet use any of it with apparent intent.

Anyway, I hope you're all well, and I'll hopefully post again soon.

Developmental Pediatrician.

As some of you know, Ella saw a developmental pediatrician from UMMC on Friday (hence forth "the doctor"). She was extrordiarily patient, observant, and made every effort to be helpful. However, in her own words "Well, I'm at a place where I can pretty much only tell you what you already know".

She spent some time discussing with us, as well as observing for her self, Ella's current abilities and behaviors.

On the plus side, she was able to confirm many of our observations, and be a bit more specific than we could be. In general the highlights of discussion where:

Autism - Ella's not showing any signs of Autism at present. Her sociability is too high for that, and we already knew this much. The doctor was also able to point out that her chances of developing autism are quite low. According to her, normally children that are sociable, but develop into autism start off with some signs of abnormal social behavior. During her observation, Ella started off being cautious toward the doctor because she was a stranger. Over a period of a half hour, Ella warmed up a bit to her and started playing near her, letting her hold her hand for walking, etc. According to the doctor, that's very normal, and children "at risk" will tend to have either really short or really long warm-up periods. The doctor still can't be 100% positive that Ella won't develop into Autism, but it's unlikely enough that she admits her gut reaction is "no, not a concern".

Cerebral Palsy - This much we already knew quite solidly, but the doctor did point out that she has no signs of Palsy. Her reflexes and muscle tone are both normal. ( Muscle tone is a reaction thing, not a strength thing, thus related to neurological health. If you suddenly straighten a child's arm, leg, whatever they'll automatically engage their muscles to protect the joint from being jolted. A child without low muscle tone will react slowly or weakly. A high tone child will react much too strongly, or may stiffen immediately.)

Metabolic Disorders - Ella's not really showing any signs of metabolic disorders, no enlarged organs, etc. However, the doctor did say she would have Ella's pediatrician review the metabolic screen she had at birth (ie: the PKU, etc they run on the heel stick), and possibly run some additional screens if some of the ones of interest weren't in her test. This is largely a precautionary measure, and the tests are simple enough to run with a small finger-prick sample of blood.

Assessment - In the process, the doctor also performed a developmental assesment, which was a different assesment tool than the E-LAP that the county used, but I forget which one. In general she came up with Ella's gross motor skills now being around 12-13 months, and her communication is much further behind. That's a bit further along than we thought in gross motor (we've been thinking around 10-11 months), but otherwise no surprise to us. As mentioned above, her social development was age appropriate, as was her cognitive and fine-motor.

Dyspraxia (aka Developmental Coordination Disorder) - This is the "working assumption" of Ella's Physical Therapist, and the doctor agreed this is a reasonable assumption. At this stage she couldn't really rule out any other problems, but that is what is evident at present.

My motor disorder - For those that don't know (which most of you do) I have some form of mild motor disorder. Unfortunately, not a whole lot is known about my disorder, largely because it was detected but deemed to mild to worry about by the neurologist I saw as a child. I can tell you that my disorder primarily affects my fine-motor skills (as anyone who's seen me write or free-hand draw will know), but it does have some lesser impacts on my gross motor and hand-eye co-ordination (as anyone who's seen me try to catch a ball will know). Obviously, since I have some kind of motor disorder, this was a significant topic of discussion since Ella is showing signs of one.

Ella is affected a bit differently than me, as mine is primarily fine motor and Ella's is primarily gross motor. However, my fine motor wasn't really noticeable until I entered school and was doing more complicated things like writing, crafts, etc. Also, I had no obvious gross motor issues at her age, as I was walking at 10 months.

Follow-up - The doctor wants to see her again in 6 months to see how she's progressing.

So, at this point, we only have some confirmation of things we knew, and possibly some additional metabolic screening. But a little confirmation is better than nothing at all.

A starting point...

For those of you who haven't been following Mental Mother, or speaking to me in person, let me catch you up a bit.

Our daughter Ella is currently 1 year old, and has some developmental delays. A lot of this blog, for the time being, is going to be involved in communicating her progress to friends and family.

She's been evaluated by the local early intervention program sponsored by the school system. The evaluation shoes she has some developmental delays, most significantly in gross motor development (ie: skills involving large movements of the body like crawling, walking, etc). She also has a less substantial delay in communication skills (the ELAP test winds up placing the delays in multiple categories, however the cause of all of them would appear to be communication. See mental mother for more details on this)

Her fine motor development is fine and tested as age appropriate. For her age she has a good "pincer grasp" and hand-eye coordination, etc. Ella also tested fine in cognitive development and problem solving skills. Also, baring being tired, she is quite sociable and enjoys playing with people. There is occasional stranger anxiety, but she generally plays with "strangers" if we're nearby and are calm.

Although not definite, as only time will tell, based on the above Ella's delays are probably not the result of any major disorders. (ie: she's got good cognition and problem solving, so she's probably not mentally retarded, add in her sociable nature and she's not likely on any severe part of the autistic spectrum. Her fine motor development suggests there's no broad palsy or cerebellum issues.)

Thus far she has been responding very well to her current therapy sessions for gross motor development. We've met with a with a physical therapist 3 times, including her assessment visit, but even at the initial assessment the PT left us with some suggested activities to work on.

In general, Ella has good strength development, and to quote the PT "many good building blocks" for gross motor skills, but several other basic skills are missing.

Prior to starting, some of the building blocks Ella already had are: Standing while holding onto things, rolling onto her side to grab toys (but never a full roll, nor a roll off of the stomach), and grabbing onto your hands and using them to pull herself up to sitting.

Right at the start of her eval, but before we'd worked with the PT, she also learned to:
- extend the pulling up on your hands to pull herself up, stiff-legged, into a standing position.
- while sitting, if you put your hands on her shoulder blades and braced her from flipping over backwards she could push herself up to standing with leg power alone. However, even faced with something to grab onto, she'd leave her hands at her sides.

(Neither of those is a useful skill alone, but if you combine them...)

Thus far we have been working on the following things with the PT:

1) Rolling. Ella originally rolled both ways on-time, but stopped shortly after she started. Very quickly she regained the ability to roll if you simply moved one hand into the right place (in front of her, and slightly off-center towards the opposite side.) Recently she started doing this without our help.

2) Deeply bending over to reach toys. We've been teaching Ella how to pull one foot in so she's sitting in a "figure 4" so she can bend deeply to extend her reach from sitting.

3) Tolerating "tummy time" - Ella has always hated being on her stomach. We're now doing things to help her not immediately become upset if placed on her stomach. Little things like always putting her down on her stomach, even if we roll her over right away. This appears to be working well. Even though she still sometimes immediately objects to being on her stomach, she does now generally tolerate it, at least for a little while (ie: 1 minute), and sometimes for more extended periods (ie: 15-20 minutes).

4) Pulling up to standing from an elevated seat. If you sit "Indian style" on the floor and sit Ella on your knee with her feet on the floor, she can grab onto an object nearby and pull herself up to standing. We started off aiding her by bouncing her a bit, but she can now do this with no aid.

5) Kneeling. We're spending time getting her used to playing while kneeling, as this get her used to a position that is important in a lot of transition movements. She seems to do fine with this, although she does eventually tire of it.

6) "plopping" to sit - This is mostly an exercise in getting Ella to realize that not all forms of falling from standing are painful. I've been successful with this a few times, but most attempts result in her resisting by "stiff-boarding" her back or pulling herself back up to stand.

7) shifting from lying down to sitting. This is also one we're still working on. The idea is you tuck one foot up under their butt, and grab their shoulder and sit them up and over it. Today, I was playing around with Ella's feet working on crawling oriented skills. I had pushed her foot up near her butt, intending to put both there and shift her onto her knees. At that point she walked her self up with her hands and got into the sitting position without any help other than my placement of her foot.

Side note for humor: Amidst my research on delays, autism, etc, I found a self-test for Asperger's Syndrome (one of the autism spectrum disorders that is closest to full classic autism). An "average" person scores 16, mathematically inclined folks tend to score a bit over 20, and people with autism tend to score over 32. I scored a 25. I guess that means I'm nerdy, but just an ordinary nerd :)

http://www.okcupid.com/tests/take?testid=1982215450153908026

Anyway, g'nite all.