Tuesday, August 3, 2010

IEP Booklet, Part I: History

I am putting together a packet of information for those on Nolan's IEP team. The first section will be his history, and this is what I've written (yes, I plagiarized Drew's Mom's report, changing it where necessary):

Nolan was born with mild/moderate hearing loss in both ears. Nolan’s hearing loss is now moderate/moderately severe with a history of fluctuation and progression. Recent tests have demonstrated an air-bone gap, indicative of a conductive component to his loss. As tympanometry, patent pressure-equalization tubes (PE tubes), and normal CT scan indicate no cause for a conductive low-frequency hearing loss, the loss is permanent. In addition to the conductive low-frequency hearing loss, a sensorineural mild/moderate high frequency hearing loss is present. Hearing loss characteristics are currently under investigation due to conflicting bone conduction test results from two audiological testing centers. His air conduction thresholds remain in the moderate/moderately severe category.

Nolan obtained bilateral hearing aids in January 2008 at 4 months old. With amplification, Nolan is demonstrating a moderate loss in the low frequencies, normal hearing levels in the mid frequencies, and a mild/moderate loss in the high frequencies. While Nolan responds to speech sounds when amplified, he is not obtaining all of the sounds of speech with his hearing aids at the current levels. His current aided speech awareness thresholds are 30dB, which is consistent with a mild hearing loss.

Nolan started speech therapy through the Early Intervention system at the age of five months. Through intensive rehabilitation and therapy, Nolan has learned how to discriminate the sounds of speech with the use of his hearing aids. Nolan is meeting listening and language milestones for his overall language and communication progress. Unfortunately, due to fluctuating hearing loss characteristics and underamplification, Nolan is testing one chronological year behind his hearing peers with regard to articulation (Goldman-Fristoe: See testing reports).

Nolan has also suffered from chronic otitis media with effusion, which adds to his permanent, pre-existing hearing loss. Thresholds as high as 80dB have been observed in the presence of fluid. Nolan has had three sets of PE tubes placed, in addition to a tonsillectomy and adenoidectomy in an effort to eliminate the effects of chronic ear infection. He has had two ear infections since the placement of his third set of PE tubes in April 2010.

Nolan also has a significant medical history consisting of the discovery of posterior urethral valves, which were ablated at 18 months of age. Severe gastro-esophageal reflux disease (GERD) with mild delayed gastric emptying was discovered when Nolan was two years old, in conjunction with failure-to-thrive. He was placed on a special diet and started taking Nexium (Esomeprazole), which has allowed him to gain sufficient weight to place on the growth charts. In January 2010, a sleep study was performed and found the presence of severe obstructive and central sleep apnea. A tonsillectomy was performed to help eliminate any potential cause for the obstructive apnea. The central sleep apnea is neurological in origin and is still under investigation. A second sleep study will be performed in August 2010 to determine if the central sleep apnea is still present.

Potential Problems

1) Equipment Maintenance

Equipment problems can crop up at any time, and will significantly impact Nolan’s ability to hear. Dead batteries, dirty microphone covers, moisture, earwax in the earmold, and intrinsic mechanical failure of the devices will prevent the hearing aids from functioning appropriately. Some potential areas that could affect microphone clarity include dirt, sand and moisture. Also, if anything is placed over Nolan’s ears, such as a hat or hood, ability to hear is compromised.

2) Ear Infections

Ear infections have a deleterious effect on Nolan’s hearing levels. His permanent loss is currently moderate/moderately severe, and will increase to a severe level of approximately 80dB when fluid or infection is present. Nolan has a history of chronic ear infections that are partially alleviated by the presence of patent PE tubes.

3) Moisture

The hearing aids (“ears”, as they are referred to by Nolan and his family) are not allowed to get wet, so he can not wear them when swimming or bathing. Nolan cannot replace his hearing aids without help, and assistance is needed when he is entering a wet or moist environment. He is also now able to sometimes let his parents know when his hearing aids are not working.

4) Hearing In Noise and Sound Localization

Noisy situations, including classrooms, restaurants and the outdoors, can be difficult for Nolan, as sound localization and quality are affected.

Educational Implications
His parents judge Nolan in need of continued auditory training/listening therapy, in order to develop his communication skills and ultimately literacy skills. They would like a teacher, specifically one for the deaf, who would reinforce what he learns in an auditory training program, which will fine tune his ability to listen within his environment and will benefit him significantly when he moves to the mainstream.

As Nolan’s hearing changes over time, his parents check his hearing daily using the ling six sounds. Nolan’s teacher will also be expected to review Nolan’s ling sounds each morning as he arrives at school. Lings are six sounds (/ah/, /oo/, /e/, /sh/, /s/, and /m/) that predict well his ability to hear all other English phonemes. This check needs to be conducted in a variety of conditions, such as with noise, at a distance of 6, 9 or 12 feet and when the speaker is using a listening hoop. Currently, Nolan is able to correctly repeat the Ling sounds at a distance of 3-5 feet. An equipment check is required at the beginning of each day to make sure his hearing aids and FM System are on and working.

Other concerns include, but are not limited to, literacy, socialization, articulation, consonant deletion, consonant production through listening only (using a listening hoop where the speakers mouth is concealed) and grammar.


Melanie said...

Wow! That's a lot of information.

Maybe I'm not giving your district a lot of credit, but do you think the people who will be reading this history will have any idea what you are talking about? Maybe I'm missing the point of the document?

rouchi said...

I think you have a great summary of Nolan, at least for yourself when you want to understand at one go.It is a good thing and I think every parent should do it.I still have to get all her testing done for Prisha which should happen once I am settled next week in the new place.No internet for 2 weeks, boohooo, but would catch up after that.

leah said...

Melanie, it goes into a booklet with the information and testing results backing up the accommodations and goals we are requesting for Nolan. All material submitted by the parent must be placed on an equal level with materials submitted by other team members (Nolan's school doesn't know what a personal FM is and doesn't want to provide one for a preschooler- for Nolan, it is vital because of his type of loss).

Parents at the John Tracy Clinic use these booklets and are highly successful at obtaining the necessary accommodations for their children. Remember, we live in an area that NEVER sees a child with hearing loss, so when they see a child able to speak, they want to drop all services and accommodations. They still think that hearing aids "fix" the hearing loss.