Wednesday, May 26, 2010

Preparing for Pittsburgh

Vacations are HUGE language opportunities, as kids are exposed to new vocabulary and experiences. I was hoping to find some children's books on various Pittsburgh landmarks, but came up empty handed. I wanted to give them some familiarity with the sights we would see, so I have been creating some "at-home" activities related to places in Pittsburgh.

Today, we rode our bikes on roads with places we will visit- the Duquesne Incline, Carnegie Science Center, zoo, and children's museum. I have been talking about the submarine at the science center, the polar bears at the zoo, and riding to the top of Mount Washington. It's a great learning experience, and truthfully, I love hearing "Duquesne Incline" come out of Nolan's mouth (Dukang Incwime).

Matt was really into the idea of pretending we were in Pittsburgh. I could have saved a lot of money on the actual trip, since he's pretty convinced he's already ridden the Incline!

Of course, both boys were frustrated because there was "no place to park." I'm pretty sure that will be the case in the actual city, too!

Tuesday, May 25, 2010

Contemplating Swimming Lessons

When Matt was a baby and young toddler, I did several parent-child swim classes at our local YMCA. He segued nicely into the independent swimming classes (sans parents) and is learning how to float and blow bubbles with several other four-and-five year old children.

Things have gone quite differently with Nolan. I have tried to do parent-child swimming classes twice, but his chronic, unrelenting ear infections have caused us to drop the classes due to frequent ear drainage and PE tube surgery dates.

Now that we have this round of infections under control and his third set of tubes in place, I have started to consider swimming lessons again. If only hearing aids were waterproof!

Our local YMCA offers parent/child classes for children under the age of three, which doesn't present a problem. I am with Nolan the entire time, within six inches of his ear, and I can sign and shout and sing loudly in the water. At the age of three, most children transition to the "Pike" swimming classes, without parents. With several classes occurring at once in an indoor pool environment, Nolan can't hear at all. His unaided hearing is entirely below the speech banana, so unless you're pretty close or talking loudly, he can't hear you (even in a quiet environment).

Then, because he has tubes and will be submerging his head, he'll need to wear earplugs. Earplugs which will occlude is hearing and reduce any residual hearing to nothing.

I'm not quite sure what to do about swimming lessons. Do I simply wait until he's older and has more coping techniques for dealing with an inability to hear in the water? Do I contact the Y and try to get someone to create an adaptive program for him? Do I put him in the regular class and hope for the best?

Parents who have "been there, done that"- what did you do?

Monday, May 24, 2010

ENT Visit and Noise Overload

Nolan's tonsillectomy/adenoidectomy/PE tubes post-op appointment was today. These trips to Buffalo are quite wearing, with four hours in the car (round-trip). The ENT is Nolan's least favorite doctor (apart from the urologist, though we rarely see him anymore). I promised him a treat after the appointment, since he was quite upset about seeing the ear doctor.

The post-op appointment went well. We saw the nurse practitioner and she noted Nolan's runny nose (he nearly always has a cold) and checked on his tubes. They're in and functioning, which is no big surprise since our audiologist checked them on Thursday. We also discussed his post-operative state, which is generally good. He still does not sleep through the night most nights, but this could be due to his reflux and not necessarily due to apneas (central or obstructive). The sleep study in August will tell us if the obstructive apnea has been eliminated, and hopefully the central apnea will be greatly reduced, as well.

She was concerned about having to increase the volume on his hearing aids, but they don't have his hearing test report yet. I told her that his hearing levels aren't drastically different, but his aids had been set to levels recorded a year ago. There has definitely been change in a year, so he needed to be reprogrammed. She was concerned about the progression, though we're not sure if it is a permanent conductive or permanent sensorineural change (we didn't run bone conduction). John Tracy will run testing in July, so I'm not worried about it. Either way, it is a permanent change, so the increase in amplification is only a good thing.

We left the ENT's office in Depew, and I thought about heading to East Aurora to the Explore and More Children's Museum. Unfortunately, they're closed on Monday. Not knowing what to do, I headed toward Orchard Park and took them to Chuck E. Cheese.

Chuck E. Cheese must be the worst place on the planet for a deaf or hard-of-hearing child. The "background noise" must have been at 90dB! Still, Nolan was literally dancing for joy, and we were the only people in the place. The employees had just run the tickets through the machines, so they told the kids that they could grab all of the left-over tickets. Matt and Nolan ran around the arcade in a giddy, hyperactive state, clutching tickets and thrusting tokens into games and rides.

This ride had its own camera.

I did use sign language at Chuck E. Cheese, because Nolan couldn't hear anything in the place. I was concerned about losing him in the arcade, but I only handed him one token at a time. Within a few seconds, he would reappear, calling out, "Money! I need more money!"

Pizza, juice, and several cheap plastic "reward" toys later, we headed home. We don't have to see the ENT again until October, which is a great relief! We are now "doctor free" until late June (kidney ultrasound- routine monitoring because of his posterior urethral valves)!

Thursday, May 20, 2010

Pump Up The Volume

The boys at the Buffalo Zoo

We had a successful hearing test today, which was nothing short of a miracle considering Nolan's recent state of mind (hint: it is not "cooperative"). Many things that could have gone wrong DID go wrong on this trip, but we still pulled off a good hearing test.

I showed up late for the appointment- for some reason I had written down the time as 10:00am, when the appointment was actually for 9:30am. Well, at least I had the right day this time! Of course, this gave Nolan less time to adjust after a two hour car ride. We all know how much he loves cars.

I was "in solo parentis" today, so I had both boys when I escorted Nolan to the audiology booth. Our wonderful audiologist reached over to remove Nolan's hearing aids, and he howled in indignation. I might have forgotten to note that Nolan has become a wee bit "attached" to his aids. In that no-one is allowed to touch them, or he goes berserk. He lets me remove them, of course, but he freaks out if anyone else gets near them.

Luckily we used his earmolds as the inserts for the hearing test, so he was happy once they were back in place. He wouldn't touch the picture cards for the speech reception threshold test, though. For those who aren't familiar with hearing tests, they use a certain set of words (snowman, bathtub, toothbrush) and present them at various levels. Nolan wasn't going to perform this task, so we invited Matt to the table to see who could "win" the pointing game. With a little competition spicing things up, Nolan decided to cooperate!

We were afraid to move once Nolan was happy, lest we set off the tear-fest again. Matt and I sat on the floor near the play table and I tried to keep Matt absolutely quiet. Those of you who have four-year-old boys know what a difficult task this is- let's just say there were many whispers of, "If you want to go to the zoo this afternoon, stay quiet!"

The testing was completed after about half an hour. We didn't get bone conduction testing done, but his tubes are patent and functioning. His hearing levels are a touch better than the last time we had testing performed, but worse than his levels in June 2009. I can't remember all of the numbers exactly, but his audiogram looks something like this:

His SRT's were 45dB and 50dB, slightly better than the January test, but worse than the June 2009 levels. Essentially, we've eliminated a slight amount of conductive loss, but the permanent loss has still progressed a little in a year. His permanent loss is now categorized as moderately severe rising to moderate (his better ear used to be moderate rising to mild based on the last bone-conduction test).

His audiologist turned up his hearing aids, especially in the high frequencies. They were set for a mild level of loss in the 2000-4000Hz range, and had to be adjusted for a moderate/moderately severe loss in that range, depending on the ear. He does squeal (feedback) a lot more, especially if you get too close to his aids. Knowing that our little guy has more access to sound is wonderful- maybe we'll get those /f/ /p/ and /s/ sounds back!

Wednesday, May 19, 2010

Hearing Test Tomorrow

Nolan was rather uncooperative today, which makes me nervous for tomorrow's booth test. With a two hour drive up to Buffalo, I seriously hope he wants to play the "hearing game" tomorrow. We plan on using the same techniques that worked last time, which include doing the test in the morning and keeping Mommy out of the testing booth. He fell for the "I have to get some coffee" trick last time- hopefully it will work this time, too.

If all else fails, I've bribed him with a trip to the Buffalo Zoo as a reward after the test is complete. A new children's playground was unveiled a few weeks ago, and the ribbon-cutting ceremony for the new children's zoo will be held tomorrow. Here's to a fun day tomorrow!

Tuesday, May 18, 2010

Name Recognition Craft

When Nolan tries to spell his name, he always says, "M-O-L-A-M." That pesky /N/ sound is very close to the /N/ sound. We try to emphasize the difference in the sound, but unless he watches our mouths, he has no clue whether we are saying "N" or "M."

Luckily, Nolan recognizes most of the written letters, so I can use this knowledge to support his understanding of the sounds in his name.

I decided to recycle some old magazines into a mosaic name craft. I wrote his name onto cardboard, then cut squares from old magazines. We separated the squares by color, then applied them to the cardboard with watered down glue. As we were applying the green squares to the first N, I would say, "We're turning the N green. N says nnnnn. N is for Nolan!"

When we were done, I cut out the dried letters to round out the edges, and put them on construction paper. I sealed it with clear contact paper and placed it over Nolan's bed. He's quite proud of his name, and hopefully he'll start learning his name as "Nolan" rather than "Molam!"

Thursday, May 13, 2010


Yesterday was a tad rushed. Preschool, speech therapy, a CPSE meeting, a playdate at McDonald's, contractors over to look at the roof (we really didn't want a shower coming through the light fixture, thank you very much), and ice skating lessons.

There wasn't a lot of spare time in the schedule, so I poured Nolan a sippy-cup full of milk and handed him a snack to eat in the car on the way to Matt's preschool. Nolan took the cup, inspected it, and immediately declared, "Want deuce."

I speak Nolanese quite well, and informed him that he was having milk, not juice, for snack. He proceeded to have a temper tantrum as I eyed the clock and realized we had to leave NOW. I scooped up the yelling toddler, put him in his carseat, and handed him his milk.

All the way to the preschool, Nolan screamed at top volume,


I had to pull the car over in an attempt to stop the screaming. Trust me, it was earsplitting. I took his milk away and informed the lad he could have milk, or nothing at all. He begrudgingly accepted the milk and we were on the road again.


I wanted earplugs more than anything else in the world. Truly, the boy was carrying on at an incredible volume.

We pulled into the preschool and I stepped out of the car. Nolan was still howling, and I opened up the slider and Nolan glared at me.

He pointed to his feet and yelled,


Then I realized. He wasn't saying "I need more juice."

He was saying, "I need my shoes."

In my harried attempt to get out of the house on time, I had put him in the car without his shoes on. I felt quite chagrined as I carried him through the rain and into the preschool building. He relaxed once he knew I understood what he was saying, and I promised him we'd get his shoes in a few minutes, as soon as Matt was out of preschool. He wouldn't let me put him down, so I carried him until we had picked Matthew up and returned to the car.

I learned two things today:

  • Twenty six pounds of almost-3 year old boy gets incredibly heavy after five minutes.
  • Communication difficulties can cause one heck of a temper tantrum.
We have another busy day ahead... hopefully I'll remember everyone's shoes today!

Wednesday, May 12, 2010


Today I bundled two children into the car and drove to our local middle school. We signed in, got our visitor pass, and walked into the meeting room in the Pupil Services Office.

Our beloved Speech Therapist brought toys for the boys to play with during the meeting. Honestly, she's the best SLP EVER. And no, you can't have her. She's ours!

We talked about Matt's scores (articulation standard score of 94: 100 is average). He now scores in the "normal" range, with no delay.

We completed the exit form, signed several consent forms, and gathered our things.

Then Matt looked at the secretary, who was taking the notes, and said in a clear voice:

"I don't need therapy anymore. I just need to go to big boy school now."

Today was A Very Good Day.

Tuesday, May 11, 2010

IFSP: Six Month Review and Goals

When will they make mud-proof hearing aids?

Nolan's six month review for his Individualized Family Service Plan (IFSP) through Early Intervention is due this month. We held the meeting yesterday, and nailed down some new goals for the little guy prior to transition to the school district setting.

Early Intervention meetings are very informal, consisting of the service provider, the family, and the service coordinator. I love these cozy, low-key meetings. The process to create an IEP through the school district is far more bureaucratic and formal.

We reviewed Nolan's test scores, which are as follows (an average score is a percentile rank of 50, for the math-impaired):

Chronological age at the time of testing: 2 years, 8 months

Auditory Comprehension:
3 years, 5 months (Percentile rank of 82)

Expressive language:
2 years, 11 months (Percentile rank of 55)

Total language:
3 years, 1 month (Percentile rank of 70)

Standard score 79, 100 is average (Percentile rank of 8)

He is excelling with his auditory comprehension, is age appropriate with his expressive language, and is now showing a moderate impairment with articulation.

We reviewed the goals from his former IFSP, to see which ones he has met and which ones need to be continued:

  1. Nolan will engage in appropriate turn-taking in conversation without additional prompting. Goal Met.
  2. Nolan will continue to use sign language in addition to verbalizations to express self. Less emphasis has been placed on signing because he is excelling with language skills/prefers to speak. He recognizes familiar signs- goal to be continued.
  3. Nolan will auditorilly discriminate sounds in structured activities from a field of six: Goal Met. Nolan can discriminate many environmental sounds including bird calls.
  4. Nolan will identify objects by function: Goal Met.
  5. Nolan will use plurals: Goal Not Met. This goal is emerging and will be continued. Some of the expressive fluctuations may be related to the fluctuating hearing loss.
  6. Nolan will answer simple "wh" questions: Goal emerging and will be continued. He is still noted to repeat a question at times instead of answering it.
  7. Nolan will discriminate and use "inside voice" and "outside voice" appropriately. Goal Met.
We created goals for the next six months, which are:

  • Nolan will use sign language in addition to verbalizations to express self.
  • Nolan will use plurals.
  • Nolan will answer simple "wh" questions.
  • Nolan will produce age appropriate consonants and words.
  • Nolan will produce the verb plus "ing" in conversational speech.
  • Therapist to provide suggestions and ideas and provide written and oral updates as available.
This is our last Early Intervention meeting- the next meeting will be in August, to transition Nolan to the school district and implement an Individualized Education Plan (IEP).

Wednesday, May 5, 2010

CPSE Meeting Scheduled

The school district called, and I thought, "Aha! They're calling to schedule Nolan's CPSE meeting!"

It was the school district, and it was the Special Education Chairperson, but the meeting was for Matt. Sometimes I forget that he's still in speech therapy, too (even though I'm a participant in every therapy session)! Next Wednesday, we'll meet to discuss his progress.

Matt has come a long, long way since he entered the Early Intervention system. At the age of two, Matt had almost no words. "Go," and "Uh-oh," were the sum total of his communication. If we tried to get him to say, "Ball," he would strain out a "Fah-vah." Nothing even close to the word.

Now, at the age of four-and-a-half (because you must never forget the "and a half"), he speaks in paragraphs. He tells stories, he sings, he jokes. He even has those dratted /s/ blends. The only sound he still struggles with is the /r/ (weally wed fokes = really red forks). The /R/ sound is the latest developing sound, however, so this is a normal developmental variation.

Pending the results of his recent articulation test, we are planning to "declassify" him at the next CPSE meeting. He will leave the special education system, forever.

My heart sings.

Saturday, May 1, 2010

Off to the Library

Dennis is working all day today, thunderstorms are expected, and I don't want to get stuck in the house today. Two small boys have far too much energy to keep cooped up, even if the weather is threatening.

We're heading out to the library, to make use of the children's area (puzzles galore). I also have a book on hold ("The Help" by Kathryn Stockett, if anyone cares).

Nolan is quite whiny again today, so this might be a very l o n g Saturday. Sometimes I wish there was an indoor playground for children in our area, since we have a lot of inclement weather. I hope the library "re-sets" Nolan's attitude (and mine)- we've already had two hours of non-stop crying.

If that doesn't work, I'm investing in earplugs!