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)

Articulation:
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).

Pre-CPSE Meeting

We had considered canceling the pre-CPSE (for those not in the know, CPSE stands for the Committee on Preschool Special Education) meeting because of all the medical appointments we knew we would have this spring. We decided to reinstate the meeting once we had all the dates nailed down for Nolan's future medical procedures.

This meeting is not the official transition meeting, but just a "meet and greet" to let the district know about Nolan and to get a feel for what his needs are. Everything went great until we started discussing what Nolan would need once he started pre-kindergarten. There were two things the special education chairperson paled at: a teacher of the deaf (TOD) for Nolan and an FM system.

Children in the preschool age group are at a distinct disadvantage. They are no longer covered by Early Intervention, but are not yet covered by the services offered in school. Frankly, a 0-5 age group for Early Intervention makes more sense, but the system isn't set up to be practical. Thus, the TOD cannot consult on Nolan's education until he is in kindergarten, which will be in 2012-2013.

When we mentioned an FM system, the chairperson got excited and said, "every room in our elementary school has an FM system!"

"No, we don't want a sound-field for Nolan. We want a personal, ear-level FM system. Not now, but by pre-kindergarten."

Her demeanor changed slightly. Oh, we were those parents. The ones who know what their child needs to succeed in the classroom and won't back down. The ones who aren't afraid to break out the "equal access to his education" phrase. Darn those pesky IDEA laws.

She did state that he cannot have an FM system until kindergarten, even if he attends pre-kindergarten at their school. They might not have enough, you see, and if they don't have an extra one laying around... then he doesn't get one.

The school district isn't responsible for funding technology until kindergarten, and he isn't in Early Intervention for preschool. It will be very interesting to see how this will be covered, because he will have a personal FM system for pre-K. I don't care which agency covers it- he has to have one. It's the law.

The meeting wasn't negative in any way, but I did sense that we might have a fight or two coming up over technology. To be fair, the school district has never dealt with a child who needed assistive technology (AT) at such a young age. This is new for them, and it looks like we're going to pave the path for families who follow after us. Hopefully, by the time we're through the preschool years, the system will be "smoothed out" for any other mainstreamed children who require AT at the preschool level.

The Annual Stress-Out

Testing stresses me out, but the kids could care less

Every year, children in the early intervention system are required to have a full evaluation of developmental skills. This is important, because it helps with setting new goals and in monitoring developmental growth over time. Unfortunately, it also totally stresses me out.

If the little guy scores poorly, then I am afraid that we aren't helping him enough and for the implications of a language delay on his future. If he scores too well, then I am afraid he will get kicked out of the system entirely. For a kid with congenital hearing loss, getting "kicked out" of the system could be devastating, because without ongoing therapy the child will lose ground and begin to slip behind their hearing peers.

Nolan recently had testing, with the Preschool Language Scale-4 (PLS-4) and the Arizona Articulation Proficiency Scale-3 (AAPS-3). When the testing was completed, our speech therapist told me that his receptive language score was 117. I took this to be the percentile, and my panic button was immediately triggered. For those who missed the third grade, the 50th% is average. This would have meant that Nolan's receptive language was amazingly high.

Yes, I was thrilled that my little word-hound was doing so brilliantly well (his expressive score was 108), but we are coming up on his CPSE (Committee for Preschool Special Education) meeting for entering the school district. Early intervention allows a child with hearing loss to remain in the system without a delay, because the hearing loss has a high probability of causing a delay if untreated. The school district system doesn't work in the same way: the child must have a demonstrated academic delay in addition to their disability to qualify for services. Otherwise they are shunted to a "504" plan- for a preschooler who does not yet attend the neighborhood school, this means that they receive exactly nothing.

My angst stems from the worry that Nolan will be denied all services once he turns three years old, which will mean that he will begin to lose ground in the two "interim" years between early intervention and elementary school. At least once he's in school, there will be regular classroom evaluations to monitor his progress. A child on a 504 in preschool receives no regular monitoring.

Of course, all of this angst is premature. For one thing, Nolan has another 6 months or so before our big CPSE meeting. For another, Nolan's score of 117 was not a percentile rank. It was the standard score, which translates to a percentile rank of 87%. Still wonderful (and ahead of most of his hearing peers), but not so amazing as to have him nearly ready for kindergarten at the age of two. His expressive score is at 58%, a little better than average. And his articulation is at 38%- at the low end of the normal range.

Our speech therapist wants him to remain in therapy, which is wonderful. She mentioned the need for ongoing therapy to maintain his language level, and the fluctuant/progressive nature of his loss to date. His loss used to be 40dB rising to normal, as estimated from ABR- it is now 60dB rising to 35dB in his better ear (moderately severe rising to mild), and 60dB rising to 45dB and dropping back down to 55dB in the other ear (moderately severe rising to moderate). We have another hearing test on the 23rd of November, so we'll see if those levels have stabilized.

We'll cross the CPSE bridge when we come to it. Hopefully our local school district will understand the needs of hard of hearing children to continue with speech and language therapy. In the meantime, I'm glad that we have a nice, long break from the formal testing!

Goal Time

We are at Nolan's six month review for early intervention. The semi-annual review is fairly informal and just requires an update of goals (no formal testing is conducted). Nolan has met all the goals from his IFSP written at 15 months of age, with the exception of identifying verbs. We've never seen him do this, and if we ask him to point to someone "jumping" or "drinking" he has no clue. Identifying verbs will continue on as a goal.

Since he has met the rest of his goals, we drafted entirely new ones. The new goals are targeting the age of 27 months (the age he'll be at the next review):

• Engage in appropriate conversational turn-taking without additional prompting
• Pronounce the following consonant-vowel combinations 75% of the time: t/d/m/n/p/b
• Nolan will expand his sign language vocabulary
• Identify objects by function
• Answer simple "wh" questions
• Will ask simple questions
• Will auditorilly discriminate sounds in structured activities from a field of six
• Will identify and use age appropriate descriptive concepts (big/little, wet/dry, etc)
• Will identify 15 verbs by pointing to pictures

Nolan seems to be flying through most of his goals, so I'm sure he'll meet these new ones in short order!

Early Intervention WORKS

Yesterday morning our speech language pathologist arrived with a box full of blocks, toy utensils, a teddy bear, and a testing manual. After having Nolan take a block off the box, put the block in the box, and select various objects, he received a receptive language score of 124%. That score is ABOVE the level of his normal-hearing peers. His expressive ranked at 108%.

This is the kid who couldn't understand simple words like "kitty," "truck," or "cup" two months ago. One month ago, something clicked and he has never looked back! We did identify some language holes (he can only identify one body part and should be able to label four), but overall he is thriving in his language rich environment!

We are sans hearing aids today until we visit the pediatrician. Nolan has a nasty cold with drainage out of one ear which makes me leery of inserting the earmolds. With his hearing test only 2 days away, I want to make sure his PE tubes are open and any infection is addressed!

Yesterday evening the "lady game" (Matthew's term) came to our house to evaluate Matthew. He has already been evaluated for speech and language, so we know he still qualifies for services based on articulation. This testing was a formality to assess his general cognitive skills. We won't have the results back for a week or two, but the psychologist did tell me she's confident he's performing at age level.

The testing was interesting. There were puzzles to put together (Matt got to the five-piece puzzles and was stymied after that). Blocks to build in patterns that matched a template set up by the psychologist (he could do anything with three blocks, but four blocks were a little difficult). Lots of questions for information (he couldn't name the colors in a rainbow, for instance). There were also a lot of receptive language questions. He missed two that I thought he would get- one of a lamp (we don't have bedside lamps, so he isn't familiar with the term) and one of an iron (embarrassing, but I don't iron our clothes very often).

Matt's responses to some of the questions were rather interesting. A selection of his answers are below:

Lady Game: Matthew, can you name some animals?

Matt: Animals live at the zoo.

Lady Game: Can you name some of them?

Matt: My mommy drive me there.

Lady Game: Matt, can you name two items that have wheels?

Matt: A choo choo train!

Lady Game: Can you name a second one?

Matt: Another choo choo!

Lady Game: Matt, what is this picture?

Matt: A banana!

Lady Game: Matt, can you tell me what this is (picture of an iron).

Matt: That a plug on it.

Lady Game: Yes, but what is the whole thing called?

Matt: I go eat banana now.

Testing almost-3 year olds is a job reserved for saints!

Review of Our Goals

I've been reviewing Nolan's goals, which were set six months ago. Our overriding goal is for him to maintain both expressive and receptive language milestones on par with his hearing pears, and I would venture a guess that he is at least at peer level. As he is approaching his annual testing date, I thought I'd look over his goals again. The goals we set last May (for a 15 month old child) were:

• Respond to name on a consistent basis and turn to parent's names on a consistent basis.

He doesn't turn to his name on a consistent basis, but this could be due to his age. He gets engrossed in things that are far more interesting than turning to his name. A hearing test in one week will verify that this is an attention issue vs. hearing issue.

• Respond to basic questions (i.e. "where is the ball?") with a sign or gesture.

Check! He will find anything with a known vocabulary and will point to it or bring it to us.

• Identify at least 30 nouns and 10 verbs by choosing picture.

Hmmm... He'll probably get 30 nouns, but he hasn't figured out the verb thing yet. Maybe we'll work on "jumping" and "sitting" next week!

• Identify 5 body parts on himself or a doll.

He can identify his nose, but that is it at this point in time. If you ask him where his mouth is, he'll point to his nose. If you ask him where is ears are, he'll point to his nose... another thing we're working on.

• Respond to "no."

Check! Though his response is usually to laugh and continue doing what he wants to do! Sigh...

• Engage in social games (i.e. Pat-a-Cake)

Check! He loves "ring around the rosie" and other games we play at home. He doesn't quite get the turn-taking idea of Pat-a-Cake.

• Follow simple routine directions (i.e. put ball in box).

Check! He likes to put things IN other items, so he understands that concept. He may or may not understand "on top" or "beside," but he's a little young for that.

• Use three words in addition to mommy and daddy

Check! Well, sort of. There is no "mommy," but we have daddy, light, doggie, meow, roar, ball, and uh-oh.

• Attempt verbal imitation

Check! He will imitate when he feels like it.

• Imitate bilabial p, b, and m in 2/3 of prompts.

Hmmm... He doesn't do /p/ yet, and /b/ is just emerging. He does say "mamama" in babble but doesn't consistently imitate 2/3 of the time.

• Imitate vowel/consonant combinations with t, p, and n (at, up, and on) in 3/4 of opportunities.

Not so much. He has no /t/ or /p/, so those are missing entirely. He does have /n/, but when he imitates "on" it just sounds like "aw."

• Imitate consonant/vowel combinations (t, d, m, n, p, and b) at 75% of opportunities.

Another one he won't do. He sometimes will imitate "mamama," but none of the others. We have no /t/ or /p/. We are just starting to get a /b/.

We have testing in a week or two and a hearing test next Thursday. Then we'll be ready to set goals for a (gasp) 21 month old!

First Sign and Verbal Imitation!

We went to the Erie Zoo on Sunday to check out the new wild dog exhibit and had two wonderful language events occur. We ate lunch at Panera Bread and Nolan signed "more" to request more bread. His version of the sign is clapping, which is pretty cute.

Later that day he dropped a toy out of his stroller. I said, "uh-oh!" Nolan looked at me and said, "uh!" Now if we say uh-oh or up, he'll imitate and say, "uh!" Very exciting stuff in this house!

We had more speech therapy today and obtained a few more games to play with Nolan. One is sound vs. no sound. This one is very easy and we simply shake an object which makes sound and say, "I hear it" while pointing to our ear. If the object doesn't make any noise, then we say, "no sound." She also gave us some ideas for creating sound opportunities at home, like setting the timer when I'm in the kitchen. When it goes off, I can say, "I heard that! It's time to ...." and then fill in the blank with whatever I was going to do next. We can also have Dennis ring the doorbell when he comes home, and I can say, "I heard that! Who is at the door?"

We also learned some new signs today: uh-oh, again, off, and on. Our SLP is going to bring some sign books by tomorrow so we can look at ASL vs. SEE and start really considering communication choices. We're taking a lot from the auditory-verbal camp, but we're also using some sign language. It is so hard to know what choice is the "right" choice and which one will work the best for our child.

Our former SLP had never really delved into this, so we were flying by the seat of our pants and not really doing much of anything (I was taking some sign language lessons and we had the speech therapist, but there wasn't any real "method" or "plan").

A Fresh Start

Our new SLP called and set up times for therapy this coming week. After ten minutes on the phone, I realized several things:

• Our former SLP never took a look at Nolan's audiogram.
• Our former SLP never asked about communication modalities.
• Our former SLP really knew NOTHING about hearing loss!

The new speech language pathologist asked if I had a current copy of Nolan's audiogram. I told her we most certainly did, and would be repeating a few frequencies on Tuesday. She asked if we had thought about communication styles, and noticed we had expressed an interest in auditory verbal therapy in his IFSP. I had put AVT in his IFSP on a lark, knowing that there were probably no therapists familiar with the technique in our area.

Lo and behold, the new SLP has done AVT with one of her former charges. She has also worked with a total communication model, so she will accomodate whatever we choose to do. We actually get a speech pathologist who has experience with hearing loss? I'm doing a little tap dance as I type this! We want to proceed with AVT, so she requested that we get an aided audiogram to make sure Nolan is getting full access to all the sounds of speech. His level of loss should mean that he has access to all the sounds of speech with his aids, but we should verify his responses when aided.

She will also work with Matthew, since we have a package deal going in the early intervention department. Matt will probably graduate from EI at his six month review (the child still has some articulation issues, but has broken out with 3 and 4 word sentences lately). I would like to get one last hearing test before we boot him out of the system, though... just to make sure!

Staying on the Path to Success

Nolan has been demonstrating wonderful verbal skills for his age (babbling five different consonants and two vowels), which led to his speech language pathologist recommending his discharge from Early Intervention two months after he started the program. I fought that and won, so I was obviously surprised when she suggested reducing services two months after the issue was settled. Luckily we had an IFSP meeting coming up, so I called various sources and found a person who would be a better speech therapist to Nolan (via our local stellar audiologist).

Our (now former) SLP wanted to reduce Nolan down to once per month, then once per week after I argued. With no other options for services in the area (no auditory-verbal therapy, no teacher of the deaf, no cued speech classes), I would really like him to continue his twice weekly sessions.

We are very fortunate with our EI coordinator. She is behind us 100% and has assigned us the speech language pathologist who has worked with a deaf child in the past. Nolan's level of loss is only moderate, but at least this SLP has a background in the needs of these kids. We get to keep our twice weekly sessions and the new SLP starts next week! I am a happy camper.

We did note a couple of "discrepancies" in the testing report written up by our former SLP, including that Nolan responds to all environmental sounds (this is the one area that he is not at age level). She also stated that the reason Nolan was referred to early intervention was for a severe speech delay. His hearing loss was only mentioned in a brief sentence in the middle of the report. This is definitely one that didn't "get" the effects of hearing loss on development.

We have won this battle, and are staying on the path to success for Nolan. With the right supports in place, I know he's going to soar.

Smart Little Guy

We're gearing up for our IFSP meeting later today. Nolan has been doing so well that they want to reduce services. I would rather wait until he's talking and listening consistently before we cut off his only intervention possibility. The goal here is prevention. Unfortunately, most early intervention services work off a "failure" model and want to withold services until the child fails, then start services again. I would much rather keep services going to prevent a delay in the first place!

We'll see how it goes...

Review Time

We have Nolan's six month IFSP review in two weeks, and I have to come up with goals. He'll be almost nine months old at the meeting, which means the goals need to be applicable for the ages of 9-15 months. Our ultimate goal is to have him attend our neighborhood mainstream school, so we are including this as a goal.

For language milestones I am thinking of:

Receptive Language:

• Follows a one step command
• Understanding the terms "look," "show me," and "come here."
• Identify one body part

Expressive Language:

• Spoken vocabulary of 5 words
• Uses "Mama" and "Dada" to get our attention
• Signs "more" and "all done"
• Points to objects
• Waves bye-bye

My brain is running on empty and I can't think of very many speech and language goals. We are doing some sign with Nolan, since his hearing brother has severe speech delay. We're hedging our bets and hoping that we don't have the same frustration issues we had with Matthew due to an inability to communicate. I can't really think of signing goals, since I don't know what to expect with development in this area.

Any ideas for goals are appreciated!

Deja Vu All Over Again

So, Nolan's SLP tested him AGAIN with the PLS-4. This time, he came out ahead with expressive langauge (he babbles with four consonants and that puts him at an 8 month old level) and a bit "behind" with receptive language (because he won't interrupt an activity when his name is called and doesn't understand the word "no"- this puts him at a six month old level).

She gave me the scores today and wanted to reduce his sessions to twice per month. Haven't we been here before?? I told her I wasn't comfortable with that, and she suggested once per week for monitoring purposes. Since Matt sees her twice per week, she'd be here for him, anyway.

I called our EI coordinator and asked her about switching Nolan to a Speech Language Pathologist who has worked with deaf and hard of hearing kids before. I obtained her name from our local audiologist, who has been very supportive of us. The EI coordinator surprised me and said there is a new TOD who works with Buffalo Hearing and Speech Center, and the TOD might be available. If the TOD is available and able to come this far, we'll take her! If not, we'll switch to the SLP who was recommended by the audiologist.

Either way, I won't be left constantly fighting for Nolan to retain services, and I won't have to worry about a SLP who really isn't familiar with the needs of deaf and hard of hearing kids. Granted, Nolan's loss is moderate and not severe or profound, but reducing services before he is really talking seems premature. Matt, my HEARING kid, babbled just fine at seven/eight months of age. He quit babbling at 15 months and didn't start talking again until after he turned two! I'm a little "on edge" when it comes to losing services, since my hearing kid doesn't talk all that well! Sheesh.

Off to get some tea and a bagel. And some Advil (from banging my head against the wall)....

More Babbling

We've noticed an uptick in Nolan's babbling since he had his tubes placed. This is rather reassuring, since we had noticed his response to sound wasn't where it should be with his level of loss. Since the tubes were placed, he's turning to his name again and is making a bit more noise. So far, we have heard the following consonants out of the boy:

Dadadada
Nananana
Babababa
Mamama

I'm still working on getting him to sign "more." He claps his hands, so he should be able to pick up that sign fairly quickly. Some other kids learned to sign "more" at the age of seven months, so it is possible!

Matthew is adding new words daily. Some are clear and some still sound like he's speaking Klingon. Airplane is "thleeee," for example. On the other hand, he ran to the window and said, "I see deer" yesterday. Go figure!

Mommy Panic Attack Over

I've talked to the EI coordinator and to a speech pathologist at the center where Nolan has his hearing checked- they both have said that he cannot be "graduated" from early intervention because he has a permanent condition with a high risk of causing a developmental delay. Basically, our SLP can test him until the cows come home - even if Nolan gave a dissertation on the works of Sophocles, he still qualifies.

The SLP at our hearing and speech center stated that all babies (deaf/hh and hearing kids) are similar until sometime AFTER six or seven months of age. A language delay is often not noted until the children are between 12-18 months of age, so six months is EXTREMELY premature to pull the plug on services. She is sending me an informational packet to share with our current speech therapist.

I can relax and get my panties out of the knot they are currently in. Now I just need to work on my next project: finding a teacher of the deaf (TOD) willing to work with early intervention in Chautauqua County. When we revisit Nolan's goals, the request for a TOD will definitely be in the wish list.

Got My Mama Bear Fighting Gloves On

We had a list of specific goals for Nolan in the Early Intervention system:

• Begin babbling (not yet- at least with consonants)


• Turn and respond to voices (check! accomplished)


• Start to recognize and respond to environmental sounds (i.e. doorbell) (doens't recognize these yet)


• Begin to vocalize needs as demonstrated in pitch of cries (i.e. hungry, mad, etc) (Check! accomplished)


• Vocalizing more to identify/recognize people/objects (e.g. mamama dadadada) (not yet)

Our SLP believes he has met his goals and is now age appropriate. She is going to test him on Monday so that EI can disenroll him from the system.

AAAAAARRRRRRGGGGGGHHHHHH!

Why does EVERYTHING have to be a fight? There are so many reasons I want Nolan to stay in the early intervention system. Among them:

• Nolan has a moderate hearing loss. This level of loss is educationally significant in prelingual children. Heck, it's educationally significant in postlingual children!


• We do not yet know if his hearing loss is stable or progressive.


• Meeting goals at six months does not mean that he will remain on target for speech and language at a later date.


• Prime language acquisition time is from the ages of 7-12 months. Kicking him out of the system just before that time period could be detrimental to his development.


• Kids with hearing loss qualify for EI regardless of performance on standardized tests.

I would never forgive myself if I allowed the system to disenroll Nolan, and then find out that he had slipped further behind because services were discontinued just as he really needed them!

Thanks to some very helpful advice on the listen-up email list, I am going to ammend his IFSP to state different goals. Goals that are more far-reaching, such as including a goal to be included in a mainstream school setting. I am going to request that if speech therapy stops, then the services of a ToD (Teacher of the Deaf) begin.

Wish me luck as I call EI tomorrow, and begin the fight to keep my little boy at an age-appropriate level for language development!

Passing by Failing

Matthew had his Early Intervention evaluation for speech and language. I was really worried that he would not qualify due to his receptive language skills, even though he can't talk. The speech language pathologist arrived and Matthew was in a quite "busy" mode, not really answering the questions for receptive language. This really worked in our favor, as it kept his receptive language at a 22 month level (he's almost 26 months old). That's in the normal range, but didn't kick his total language score out of the ballpark. His expressive, with 0% intelligibility to a stranger and only 6 word-like phrases (apparently "ewwww" and "oh" don't qualify as true words), registered at a 12 month level. This kicks him into the severe range for speech. With a moderate language delay and a severe expressive delay, he should qualify. The lack of progress with his receptive does keep me cautious about hearing loss with him, though I know we had him down to 20dB in a soundfield.

At least we can start getting help for him. It's really depressing when I drop him off at the 2 year old room at MOPS and all the other 2 year olds say things like, "look! Radio's broken!" and Matthew only says something that sounds like, "favahfafa!"

This and That

I went to pick up Nolan's new earmolds yesterday (impressions made on January 9) and they were too already too small! At least they don't fall out of his ears like the previous set, but there are gaps at the edges. Our audiologist took new impressions and is airmailing the earmolds with another baby's. We go back on Friday to pick them up- these ones should fit for a little while (I hope)!

Along with outgrowing earmolds like crazy, I think I need to buy the next size up in pilot caps. He was in the XS size, and he definitely needs a small now. I'm going to see if I can cross-stitch something onto the hat. I'm definitely not a crafty person, but I can cross-stitch. I'm not sure what I want to put on the hat, though. My husband is lobbying for a Red Wings design, but I don't have a pattern for that!

Early Intervention also came by to set up the evaluation for Matthew's speech. I should have a date soon- I just hope he qualifies this time. He has about eight unclear words. In most states he would qualify for a speech delay, but NY state does a "total language" score. This means that even if the kid never talks, he may not qualify because he understands so much. He wasn't even babbling by 17 months and didn't qualify because his receptive language was that of a 26 month old. We'll see what happens this time around- he just learned to say "mama" at 2 years of age (and can't always say that), but he understands what it means to "gain altitude." If he doesn't qualify for speech therapy, we will just continue on with sign language for him. All I really care about is communication, but it would be nice if we could get some help on the speech front.

Speaking of sign language, I've been wanting to take an ASL class at our local community college. I can't for the time being because the husband is in Sweden for half of every month, which means I have no place to leave the kids while I take a class. There is a lady (ASL interpreter) who goes to my church, and she gave me a certificate for 5 one hour ASL sessions in our home. AWESOME! That should get me started, and the one-on-one will allow me to focus on vocabulary and phrases for communicating with my little guys. J.K., I am forever in your debt!

IFSP meeting

We had our IFSP meeting for Nolan. It was an interesting meeting because Matthew kept sneaking into the living room to play with the nativity set we have. I wonder what the EI coordinator thought when I said, "stop hiding the baby Jesus!" That kid loves the baby Jesus and carries the little statue around our house. We're often missing the main character in the Christmas story, lol. Anyway, Nolan will get speech therapy twice per week and we have established some goals:

Begin babbling
Turn and respond to voices
Start to recognize and respond to environmental sounds (i.e. doorbell)
Begin to vocalize needs as demonstrated in pitch of cries (i.e. hungry, mad, etc)
Vocalizing more to identify/recognize people/objects (e.g. mamama dadadada)

These are goals for the next six months, so these are things he should be doing by the time he is nine months old. We'll start the therapy sessions in January, because we're off to California and Utah for the latter part of December. Skiing and free babysitting, here we come!

Nolan's EI Evaluation

Evaluating a three month old is rather interesting- he is so young they just asked me a series of questions to determine where he fit into the developmental guidelines. He was at or above age level in every area but speech and language. He actually does have a 33% delay in speech and language (registered as a 1 month old) so he qualifies for EI on the basis of his diagnosis AND by delay. Once we start amplification and EI services, he should start to catch up. We'll start with a speech therapist once per month (probably- we don't get our IFSP until December 6) and increase the therapy sessions as he gets older.

They thought Matthew would probably qualify for speech services, too, so we'll definitely have him re-evaluated in January (when he is a full 2 years old). I am so glad these services exist for kids who need them- an early boost can help them succeed in later years.

Cleaning house for nothing...

Just my luck that the Early Intervention evaluators called AFTER I had cleaned everything to cancel our appointment tomorrow. I am glad Nolan was identified so young, and that I pushed the evaluations to start now, because all the delays/cancellations/postponements can push things out enough as it is.

The wrap-up meeting and implementation of the IFSP is supposed to be on December 6th. I doubt we're going to meet that timeline- they would have to evaluate next week and next week is already pretty tight (Nolan's ABR in Buffalo on Monday and Matthew's eval on Tuesday, not to mention playgroup, MOPS, etc. that I have planned). Luckily I can always cancel going to MOPS and the playgroups.

There are always two evaluators that come out- a special ed teacher and the speech language pathologist. The special ed teacher is out with a family emergency for an unknown period of time, so we can't schedule the evaluation right now. I'm really just venting, but it gets very stressful when you know you're dealing with a child's development and you know your kid is going to need intervention to hear and develop appropriate language skills.

Really, I'm not very good at waiting! Hearing loss teaches you patience - waiting for EI, waiting for a definitive diagnosis, waiting for hearing aids... I just don't want the process to take so long that we get intervention after that critical six-month mark, though I know it is a possibility (with the rate things are going).


Update: The early intervention coordinator called to ask if Nolan had been evaluated yet. I gave her the story, and she said she would call the evaluators on Monday, and if they didn't call me back with an evaluation appointment by Tuesday to let her know. The wrap-up meeting is still scheduled for November 6, so hopefully everything will fall into place by then. By law, it has to.