Sunday, January 17, 2010

Early Interventions Screening

We've been keeping a close eye on Jonah's development ever since he was admitted to the hospital a year ago for failure to thrive. Not only has his physical development, such as weight and height, been closely monitored, but also his cognitive and motor development. It did not take him long to catch up, physically. At his appointment in December, we were thrilled to hear that both his height and weight were in the 25th percentile. This may seem like he's a scrawny shrimp, but it was music ringing in our ears.

However, his motor skills were in the 1st percentile and he seemed to be having delays in speech and other areas of cognition. I called our early intervention office and discussed having him screened. He was put on a waiting list, but I was told that if he didn't make any progress, I should call them and they would get him in sooner.

Last Monday, I made the call. It seemed that his language had actually regressed. He went from having three words, "Momom" "Daddy" and "yum" to having none. From thirteen signs down to the three that related to his basic needs- potty, eat, and milk. He had turned to using only two phonemes in babble. "dadada" and "aaaaah" are all that we would hear from him. I played several games with him to make it easier for him to hear and repeat different verbal noises. Although he enjoys the games, they have not seemed to help. He does make an effort to repeat the sounds during the games, but he will not spontaneously babble them. He also has not progressed at all towards walking, and I realized that one of his biggest problems is that he cannot stand unassisted or keep his balance for even a fraction of a second. So, I started to play some balance games and some games/exercises to strengthen his legs. They also have not seemed to help a whole lot.

So I called them and gave them an update on his lack of progress. They were able to schedule him for a screening on Thursday. The woman came to our house, and watched him play for about twenty minutes. Then she asked me tons of questions. She asked me what he eats, how often he gets free play, how his pregnancy and birth went. She asked me about his other developmental milestones like sitting and crawling. She asked about how he gets around if he doesn't walk, and about different things that he does or doesn't do. She watched him move around for a while, crawling, walking on his knees, and cruising. She was able to get him to climb up onto the couch, which I had no idea that he could do.

Then she sat on the floor to play with him while I filled out a little questionare about my concerns for his development. I really liked that she used his own familiar toys for the screening. She gave him the best chances at succeeding for each task, and then worked into more difficult situations from there. She tried to have him stack two blocks,which I knew he wouldn't do. I was surprised that he didn't line them up, because that is what he usually does. She did notice him lining up his other toys in the beginning of the appointment. She tried to have him "help" her pick up by putting items into his basket. She was looking for him to put three to six items in before he started to take them back out or lose interest. He focuses on one item, though. Putting the same object into the basket then taking it out, putting it in then taking it out, over and over. She also noticed him spinning his lids. We keep lids from containers such as orange juice or cottage cheese etc, because Jonah loves to sort them and put them in drawers/cabinets. He also likes to spin them. She noticed he throws things almost impulsively, more than is developmentally appropriate. He also bangs them together more than is appropriate for his age.

There were a slew of other items that she went through. Some he couldn't do and others that he could, like turning pages of the book and looking when his name is called, but it seemed like most of them he couldn't. He is most delayed in his expressive language and verbal skills. He is the best at sorting, and his attention (he'll "read" a book from cover to cover several times, for several minutes)

The screening is only to see if the child qualifies for further testing and further programs through the Help Me Grow Early Interventions program. It was not really to give us any answers as to what is wrong etc. She has put in the referral to see a panel of specialists, who will determine exactly what areas he is delayed in, why he is delayed in those areas, and what our plan of action should be for those delays. I will be getting a call from the center this week, and they will tell me what my options are for dates. It takes three to four weeks before they can see new clients.She said that this week they were just finishing scheduling the first week of February.

We will also be seeing an audiologist, to test his hearing. Although it is very obvious that he can hear- he responds to music as well as understands the meanings of words- there may be fluid in his ears causing the sounds to be muffled. If this is happening, then he may not be able to distinguish individual phonemes well enough to produce them properly. There could also be an issue with his inner ear, causing both the speech delay as well as his balance problems.

And finally, we will be seeing an occupational therapist for his hips. It is evident that there is something wrong with his hips, causing his feet to be turned in to an extreme. When he crawls, he lifts his knees up and out to the sides. I had never thought of this as anything more than his own quirky variation of crawling. There are hundreds of ways that kids crawl, so I never thought it was important to bring up to the pediatrician. And she, of course, has never seen him crawl (I don't let him on the floor at the doctor's office for fear of germs.) She had mentioned when we first started seeing her that his feet were turned because of his hips, and usually it would correct itself or could not be corrected until he got a little bigger.

And thus opens yet another chapter of specialists and doctors. I am extremely relieved that there are plans underway to help him. I firmly believe that the earlier we get him help in these areas, the easier they will be to get back on track.

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