Early Intervention

The ball is set in motion. Inquiries were made, evaluations took place, assessments drawn up, and plan of action determined. We are now participants in "the system."

Starting next week my kids will start receiving speech therapy through New York State's Early Intervention (EI) program. Though I have not written about this topic on my blog, it has been a nagging issue on the forefront of my mind for many months. It's a little hard to sort out my feelings about it all. In a nutshell, I'm very glad to be getting my kids the help they need to catch up and I can't wait to get started with the therapy. But beyond the nutshell there's an array of conflicting emotions. It's hard to read literature on where my kids should be verbally by this point and see that they are nowhere near. Or to hear about my friends who have children younger than mine, sometimes by six months or more, and hear that they are already speaking.

The more you know, the more you realize just how much you don't know. Wasn't it Socrates who came up with that one, or something along those lines? I knew my kids were not developing language at a typical rate, but I was not overly worried. For several months I just waited it out to see if they were late bloomers. By 15 months I spoke to their pediatrician who assured me that not talking yet was well within the range of normal and I should wait a bit longer. At 18 months, when nothing had improved, their doctor still sounded unconcerned, but said it wouldn't hurt to contact EI and have them evaluated for services. I was planning on having them evaluated by that point anyway, but I was glad to finally have their pediatrician's endorsement.

But then I began to learn just how far behind they are. In some ways I can be encouraged because we are actually getting help now. In very short order they will each be getting two speech therapy sessions a week and I have every reason to believe they will respond and improve quickly. That is certainly my prayer. But part of me is still processing the very fact that they need help at all. When I called EI back in early January I was just thinking about speech. My kids aren't talking yet, and I think they should be. Though they have all at one point or another said a word or words, none of them at this point have any words they say consistently, and some of the words that appeared months ago have long since disappeared. But when the speech pathologist came to evaluate them, my eyes were opened to just how detailed and specific that evaluation was, and how each of my kids have different issues to overcome. And the realizations, while I'm grateful for them, also left me feeling a little dumbfounded. Like I missed the boat without even realizing it was at the dock right in front of me, waiting for me to get on.

The evaluator was looking not just at speech, but overall communication, and in a variety of forms. Do my kids imitate behaviors? Do they imitate sounds? Do they initiate communication? Do they indicate they understand communication aimed at them? Do they follow directions? They were tested for receptive as well as expressive language skills and as the evaluation progressed I was made aware of just how different each of my kids is, down to the details.

Abigail is a big communicator. She intitiates contact all the time and she makes her needs known. She points, vocalizes, shakes her head, and is using increasingly more sign language. She follows directions, points to objects in pictures and books, and waves hello and goodbye. She expresses opinions. But she doesn't talk. She doesn't babble. The speech pathologist looks for specific consonant sounds and consonant/vowel repetitions, and Abigail uses virtually none of them. It doesn't even appear that she's trying. Many months ago she used to imitate me when I made animal sounds, but that faded long ago, possibly as far back as her first birthday. I'm not sure about the timing, but I know that "moo" is no longer in her repertoire. In fact she has virtually no linguistic repertoire, relying heavily on "eh" sounds and accompanying gestures or facial expressions to make her point. She has a very obvious "yes" now, consisting of a high pitched "eh" followed by a giggle and usually a smile. It's cute, for sure, and I'm glad Garrett and I figured it out, but it's not exactly useful to anyone outside the walls of our home. That part is discouraging.

Gabriel, on the other hand, is really not much of a communicator. He interacts with me all the time and he does make more vocalizations and babbling noises than either of the girls, but I was surprised to learn that even his babbling does not have the variety and consonant vowel combinations that are expected at his age or younger. I was also somewhat stumped when the evaluator asked Garrett and me what Gabriel does to indicate what he wants. What does he do when he wants one of you to come to him? What does he do to indicate he wants something? The more I thought about it, the more I realized that he doesn't really do much at all. If he wants one of us, he either cries and fusses until we come to him, or he just comes to us. If he wants something he just tries to get it. He's an independent little guy and most often tries to get to things on his own. Sometimes he'll point and grunt for a binky or a drink of water that's out of reach, but by and large he's a do-it-yourselfer. That in an of itself is just fine with me, but in the context of communication it's upsetting to me that he does not initiate more. And if his expressive language is behind, his receptive is just as delayed. He only sporadically responds to his name. He only ocassionally follows directions. He does not point to objects in books or pictures. He does not obviously express opinions when given two choices. He does not answer yes or no questions definitively, or at all. He is smart, capable, adept in gross and fine motor skills and he has a long attention span. He is cooperative and social and affectionate. But he doesn't really "talk" to me.

And then there's Amelia. Sweet adorable little Amelia, caught somewhere in the middle of the other two extremes. She makes some noises and does like to use the words "uh oh" and "hi," though not as frequently and repeatedly as the evaluator suggested was typical. She sometimes does imitate language and at different times has had moments of brilliance with the words "dada" and "mama," though nothing stuck and there was no indication that she actually knew what she was talking about. Amelia is really middle of the road, at least in terms of her siblings. She usually responds to her name, she sometimes follows directions, she likes to point at things in books and pictures but she often points to the wrong things. She makes her needs known with cries and fussing and pointing, but still does not try using language to get what she wants. She is picking up some sign language like her sister, but she does not typically use it spontaneously.

There are several measurements to indicate where on the spectrum of language and communication skills my kids lie, incluing percentiles, standard deviations, and numeric test scores. Those all get confused in my head and when I do remember something--first percentile, second percentile, two standard deviations behind, at least 33% delayed--I don't usually remember what the measurement specifically referred to. What I do know is that my kids are behind, and they need help. And I do know that they will get that help. And I do know I'm glad about that, and I only wish the help had started yesterday.

I also know that my kids are going to be fine. In fact I believe that wholeheartedly, and at this point I harbor no long term concerns for my kids' communication and language skills. I fully expect they will catch up in good time and that in a year or two they will not need any services at all. This is what I believe. I also believe that God's desire is for them to reach their full potential, and that no matter what challenges they face, His glory can and will be revealed through the journey. But right now, even as I believe these things and praise God for the work He is doing and will do, it is still hard to watch my kids be unable to tell me that they want water, a binky, a hug, or that they need a diaper change. I am still doing a lot of guess work and it makes for some long days and some frustrating moments.

So this is what I've been thinking about a lot recently. Finally out on the page for the world to see. But praise God, I wanted to wait to bring it up because at the same time I brought up the problem, I wanted to be able to say there is a solution in progress. And there is. Next week my kids will meet their therapist, my schedule will get much busier, and my home has the potential to be filled with three little voices saying "No no no no no!" and "Mine, mine, mine!" And who could want anything more than that?