Emily sees a speech therapist once a week through our insurance (Kaiser). She's gone to 6 one-hour sessions. During this hour, we play with toys and practice making the sounds that each toy would make in the real world. We say "vroom!" when we play with the car. We say "boom! boom!" when we play with the elephant. Elmo goes "in! the CuP!" We "PoP" "BuBBles!"
She does well during these sessions. Most of the time, she's very happy to play along for about 45-50 minutes. The last five, we have to put in a bit more energy to keep her focus. But, for a two year old, that is pretty impressive.
After some church friends of ours heard about Emily's diagnosis, they recommended a county program that captures the under three sect of children who have delays. The school system takes care of them after three, but we were lucky enough to have intervention before then. Anyhow, they came out to do an assessment of Emily's development to see if we qualify for treatment.
They sent a team of therapists out (who work for a private group that contracts with the county to provide service) to do a complete assessment of all of the areas where we could see a delay: cognitive, social, speech, motor skill, memory, etc., etc.
This is what they reported to us (Emily was 27 months old when they tested her):
Self Care: 22 months. Her setback here was that she can't round her lips to drink from a regular cup very well. That is one of the more challenging shapes for her to make with her lips because of the apraxia.
Personal Responsibility: 34 months.
Adult Interaction: 28 months.
Peer Interaction: 28 months.
Self-Concept & Social Role: 23 months. She cannot say her own name and that is a big part of self-concept. One of the most difficult sounds for her to make is "mmmm". The other is "eeeee". Thus, her entire name is nearly impossible for her to say at this point.
Receptive Communication: 29 months.
Expressive Communication: 12 months. This is speech.
Gross Motor: 32 months.
Fine Motor: 34 months.
Perceptual Motor: 37 months.
Attention & Memory: 34 months.
Reasoning & Academic Skills: 24 months.
Perception & Concepts: 32 months.
For some of these areas, they could have tested further up the age scale if Emily could have verbally given them a response. Overall, she is doing very well. Obviously, she has a significant delay in the speech department - no surprise there. Because it is greater than 50% we did qualify for care!
We will be seeing a speech therapist once a week and a regular teacher once a week. And they come to our house. Sa-weet!
It's common for kids at age two to take off with their verbal communication. Emily has followed suit, but it's not been with words. Some words have emerged as we've been in therapy, but it's still mostly "The Emmy Show" when she's telling us something.
As speech increases at age two, kids seem to have a reduction in their patience. And even though they have more words, they often fail to use them (hello, terrible 2s) when they get upset. Emily is no different. If she could use words to get the attention of others, that would go great lengths to prevent the frustration, though. Here is our disadvantage.
A few weeks ago, Emmy was trying to get Lexi's attention. Lexi didn't understand this (Emmy was gesturing and grunting, but nothing clear to Lexi) and walked right on by her. Emily started yelling at Lexi and clenching her fists in frustration. I explained to Emmy that she can't yell at us and must try to use words to get our attention. She continued to yell - scream, really - so I told her she would need to go to her room to calm down and then we would try again. I carried her up into her room and placed her in her crib, reminding her that as soon as she had a calm face and body, we would talk.
I shut the door and went downstairs. I heard a loud thump from upstairs. I knew that's she'd jumped out of her crib. As I topped the stairs, I also saw her door open. Let me clarify - it had been pulled from the hinge. She was so enraged, she threw herself out of the crib, bloodying her nose, and then pulled her door from the hinge trying to get it open.
She'd really scared herself. I picked her up and held her for a while. At that point, she needed my support, not a lecture. After she'd calmed down, we talked about yelling and jumping out of the bed and how that wasn't a good idea. She wholeheartedly concurred.
Later than day, we went to speech. She "told" her teacher what happened. She climbed in a chair, clenched her fist and growled to show she'd been angry, wiggled back and forth and then leaned over the side to show falling, and then pointed to her head, nose, shoulders and legs to show the parts of her body that hurt when she fell down.
I think we will have a tough year ahead as she wants to gain independence, but can't tell us exactly what she's trying to accomplish. Being two and three is pretty terrible for any kid, but a kid who can't really tell you what's going on is probably going to have more than their share of tantrums. That isn't an excuse for bad behavior; she has to work with what she's got, but I think it's gonna suck a little more than usual.
The good news for Emmy is that she is motivated to communicate. She is learning new words fairly frequently, probably weekly. If I look to long at the big picture, I feel intimidated. When I take a deep breath and focus on what's important for us to worry about today, life is suddenly very manageable. We just keep on keepin' on like we do, right?
Plus, she's cute. That makes it a little bit easier.