Monday, September 29, 2008

Working on Receptive Language

Nolan's expressive language is coming along swimmingly, but everyone has noticed an obvious lag in his receptive language. This is definitely new territory for me, since my speech-delayed child always had above average receptive language. While Nolan understands most of what he says (doggie being the exception- he can say it but might bring you a truck if you ask for one), he is far below the average 50-100 words that most 1 year olds understand. The word "mama" even eludes him- a "where is mama" yields a blank stare or a confused looking about for a random toy.

Sometimes I feel a little guilty that we don't live in an area with dedicated oral-deaf schools or even licensed auditory-verbal therapists, but I can't dwell on what isn't. So our solution is to increase the amount that we talk and read to him. Its really time to get working on those experience books!

I found a yahoo group called learn2hear and have been stealing language exercises from the wonderful parents there. The current theme is autumn, so in addition to our speech therapy goals (working on "in" and "out"), we are working on the following words:

Acorn, leaf, tree, colors, falling, spider, fog, frost, turkey, apple, spider web, pumpkin, squirrel.

I've adapted the words from the list on learn2hear for Nolan's age (photosynthesis is a bit beyond him at this point), so hopefully he'll pick up a few of them!

Thursday, September 18, 2008

Wonderwoman (AKA our Speech Therapist)

Nolan had an absolutely amazing speech therapy session on Wednesday. We had lost the words "ball" (pronounced da) and "Uh-Oh" (pronounced uh), which was rather upsetting. We have been working very hard to get them back, and Nolan successfully uttered "Da!" for us several times during our session. Then, to further wow us with his unending potential, he proceded to imitate "eat" (eee!) and "Kitty" (not a consistent sound, but one that usually has a "kh" sound somewhere within the squeal). I'm not quite sure how Mrs. C. manages to get Nolan to become a literal chatterbox when she's here- maybe she secretly puts something in his goldfish crackers! It is interesting that most of his early words and word approximations are ones that he already has signs for. Is it normal to be in love with your kid's speech therapist?

We also discussed Nolan's minor head lag issue. She consulted with a physical therapist, and after talking to his pediatrician and the PT, we feel that it is not a pathological or neurological problem. He can hold his head up in a prone position and doesn't have low muscle tone in the rest of his body, so it is probably just one of those things where he is on the low end of normal for muscle strength in his neck. We'll keep an eye on him, but all the experts who deal with him are sure there is nothing to worry about. That's a big relief!

We had an ENT appointment that afternoon. I did ask about his MRI results and she confirmed they were totally normal. She is concerned about the drop in hearing level and wants another booth test before we see her again in January. We'll be monitoring his hearing levels every three months until he stabilizes. She does feel his loss is genetic due to the symmetry and odd configuration. She also said they used to see a lot of 2-3 year olds show up with severe/profound losses out of nowhere, and the number of these supposedly "acquired" cases of deafness have dropped substantially since the inception of the newborn hearing screening program. She said a lot of these losses were actually mild or moderate losses that progressed and were then found at the age of 2 or 3. Interesting to know, though we hope that Nolan's hearing won't deteriorate any more than it already has. His aids work really well for him right now, and we hope it stays that way. We're prepared for the alternative if it should continue to progress, and know that he'll be just fine no matter what.

We're still battling the weight issue, which hasn't been helped by a recent stomach bug. We are getting about 10 ounces of milk into him every day, but that is still far short of the recommended 24 ounces from the pediatrician. I think my son and I need to switch diet strategies!

Friday, September 12, 2008

Volume Control

I was cleaning the kitchen and came downstairs to a sleeping baby. I was surprised he was able to sleep amidst all the Matthew-created noise, but then saw that Nolan has figured out his own version of volume control. Being able to tune out can be a benefit sometimes!

Wednesday, September 10, 2008

1 Year Checkup and Mommy Worries

Nolan had his one year checkup, and our poor little pincushion is now blissfully asleep after having his iron count/lead test, Prevnar, and Hib shots. The vital stats are:
Height: 29 1/2 inches. That's about the 25th percentile and not too far off from his growth curve.
Weight: 17 pounds, 12 ounces. Uh-oh. That's below the 3rd percentile and he's not even on the charts. Plus, he's fallen off of his own growth curve here.

And so begins the "mommy-worry." This is exacerbated by the fact that we don't have a cause for his hearing loss, so my mind goes in all sorts of directions. I doubt the following are related to the hearing loss, but I'm a mother so I worry anyway:
  • Weight: The pediatrician thinks he's losing weight because we give him too many snacks. And he's walking and was recently weaned. I'm sure that's most of it, but we have structured snacks and good meals. Nolan doesn't eat a lot. In fact, he eats hardly anything at all. He drank a grand total of 3 ounces of milk yesterday. And nothing I can do convinces him to eat more! Anyway, we're under orders to decrease snacking and increase amounts given at meals. No juice is to be given whatsoever, under the theory that he won't starve himself and will increase consumption of high calorie milk. He doesn't get much diluted juice anyway (maybe 4 ounces a day), so this won't be hard to cut out. We'll see how it goes.
  • Head lag. Nolan's head flops back when you lean him backward. This means that when he falls backward, his head hits first because he can't tuck it in. The rest of his gross motor skills seem age appropriate, so we're not too worried. But a part of me wonders why he doesn't have better control over his neck at the age of one.
  • We've lost our only two words. For the past two weeks, there has been nary a "da" (ball) or "uh." Not sure if this is hearing related or if Nolan is going to follow his older brother's speech development pattern. On the other hand, we seem to have gotten our "B" sound back. You win some, you lose some!

The pediatrician also asked me if I had the MRI report. Darn it! I was hoping SHE did! With the additional drop in hearing, all of us want to see the report. The unofficial lowdown from the office staff was "normal," but I do want to see the report for myself. We have an ENT appointment next Wednesday, so I'll bring up my concerns there and see what that doctor thinks.

Other than a mildly weak neck and being very light weight, Nolan is doing great. His fine motor, cognitive, and most of his gross motor are at or above age level. So I guess I shouldn't worry too much!

Saturday, September 6, 2008

Ling Six Song and official audiology report

I found this on another website and thought it worth posting. Any parent of a deaf or hard of hearing child who is pursuing listening and speaking as a primary mode of communication will be familiar with the six ling sounds (mmm, oooo, aaahhh, eee, shhh, and sss) which cover the speech frequency range. Anyhow, I found a song which emphasises these sounds on the web:

The horn on the car goes beep beep beep
Beep beep beep, beep beep beep
The horn on the car goes beep beep beep
all through the town.

The people in the car eat mmm, mmm, mmm
Mmm, mmm, mmm, mmm, mmm, mmm
The people in the car eat mmm, mmm, mmm
all through the town.

The snake on the road says sss,sss,sss
Sss, sss, sss, sss, sss, sss
The snake on the road says sss, sss, sss
all through the town.

The monkey in the car goes ooo, ooo, ooo
Ooo, ooo, ooo, ooo, ooo, ooo,
The monkey in the car goes ooo, ooo, ooo,
all through the town.

The babies in the car sing laah laah laah,
Laah laah laah, laah laah laah
The babies in the car sing laah laah laah
all through the town.

The mommies in the car go shh, shh, shh
Shh, shh, shh, shh, shh, shh
The mommies in the car go shh, shh, shh
all through the town.

We also got the official report in the mail from the audiologist. No surprises here since I saw the audiogram in her office. We've lost 20dB at 4000Hz and 15dB at 1000Hz. The official report states:

“A second audiologist assisted in today’s testing. Insert earphones (Nolan’s earmolds) and visual reinforcement were used to elicit responses. Today’s test results revealed a moderately severe loss at 500 and 1000 Hz sloping up to moderate at 2000Hz then down to moderately severe at 4000Hz bilaterally. A decrease was noted in both ears at 4000Hz when compared to testing in May 2008. Tympanometry revealed flat curves with large ear canal volume indicating patent PE tubes. Adjustments were made to the hearing aid settings based on today’s test results and responses were checked on S-REM. Nolan was also fit with new earmolds.”

His hearing loss is very symmetric and the ears are:

Left ear:

500Hz: 55dB
1000Hz: 55dB
2000Hz: 40dB
4000Hz: 55dB

Right Ear:

500Hz: 60dB
1000Hz: 55dB
2000Hz: 45dB
4000Hz: 55dB

His left ear is currently marginally better than his right ear, but for all intents and purposes they’re the same.

Monday, September 1, 2008

Brotherly "Love"

Playing tag

Oops! Umm.. let me help you put this back in!

Forget it, bro. I'll put it back in myself!