Houston, We Have a "Yes"

Up until last week, if you asked Nolan if he wanted to go outside, his answer would be:

"You go outside."

Or if you asked him if he wanted to have a snack, he would say,

"You want snack."

He didn't nod his head, never said the word "yes" unless it was in direct imitation, and would parrot whatever you said, word for word.

We have worked for months to get a spontaneous "yes" out of Nolan. It literally took months of modeling, practicing, and therapy to eliminate the echolalia and get the concept of "yes" into Nolan's head.

Here it is, in all its glory:



I never knew such a simple word could make me feel so happy!

In other news, we are heading up to Buffalo Hearing and Speech Center tomorrow for a third attempt at getting accurate hearing levels. Our audiologist called on Friday to cancel the appointment (we have had nearly every appointment since June cancelled or moved at the last minute- it's getting a little old). I told the staff I wanted to keep the appointment, so we're going to try the testing with a different audiologist. If we wait any longer, Nolan will have had the sleep study and ENT/GI doctor appointments and will be wary of the sound booth again. Plus, we have already arranged for Dennis's time off from work and for the prescription to get faxed up from the pediatrician's office.

Wish us luck- I hope Nolan cooperates this time around. Maybe a different audiologist will be a good thing, since he doesn't have as much familiarity with her. On the other hand, he could flip out and refuse to cooperate at all, which would mean that we have to schedule a fourth hearing test. Since I really hope to avoid that scenario, I am praying for a compliant and cooperative two year old tomorrow morning. Though I'm pretty sure that "two" and "cooperative" is an oxymoron, there's always hope that he'll be in good form tomorrow!

What We're Working On

Honestly, we could do with a little less snow

Nolan's speech continues to take off, with such spontaneous phrases as:

• "I don't want green sock. I want white sock!"
• "Matthew pushed me! No pushing, Matthew!"
• I don't want take nap."

We do have some minor articulation issues - he misses some sounds- hockey comes out as "hah-hee" and the word four comes out has "hor." He also confuses the B/M/N sounds on occasion ("I meed that" instead of "I need that," or "The moy did it" instead of "The boy did it"). These are really minor and his speech is intelligible for the most part, so we work on these sounds, but don't fret over any of it. It will come in time.

We are actively working on some language processing skills. Nolan struggles with echolalia (the fancy term used to describe parroting back what you just said) and auditory processing. It isn't a severe issue, but it is rather obvious during many exchanges.

An example of the echolalia would be this:

Question: "Nolan, where did you go today?"
Response: "No-wa, where go day?"

He will answer a simpler question, such as "what color is this flower?" because there is only one possible answer, and he doesn't have to think of what to say.

Another example of auditory processing issues is this:

"Nolan, do you want blue or yellow?"
"Yellow."
"Nolan, do you want yellow or blue?"
"Blue."
"Nolan, do you want blue or red?"
"Red."

Instead of thinking about what he wants, he simply mimics the last word uttered. Frankly, it's easier than thinking of both choices and then choosing the one he wants.

So we're working on the echolalia with a lot of modeling. This appears to be working in some ways, because we have gotten a spontaneous "yes" response twice this past week! It will be an ongoing exercise for us, as the more open-ended questions will take a bit more work.

To get Nolan to listen to a whole sentence and retain it (rather than just repeat the last word as his answer), we are giving him two choices, but with one choice far less desirable than the other. And the less desirable option comes last in the sentence. For example,

"Nolan, do you want to go sledding or go inside?"
"Nolan, do you want to play with playdough or do a puzzle?"
"Nolan, do you want juice or water?"

This is working very well. Often he'll stop, start to say "water," then look at me to repeat the sentence. This time he'll listen to the whole thing, retain both choices, and select the one he really wants.

Matt is still in speech therapy, though his speech has continued to progress to the point where the issues are more minor articulation concerns. There is a great likelihood that he will graduate from speech therapy this spring. We are currently working on "cluster reductions" (that's where he omits some sounds from the middle of a word- screwdriver would be pronounced as "'kew-dyer") and getting the /s/ sound in blends (snow is pronounced as "no" and "school" is "kool").

His preschool did a speech screening last month, and I am interested to see how he did with an independent Speech Language Pathologist. I wonder if he "passed" or "failed" the screening. He receives speech services through June no matter what, but we will have to have another IEP meeting next October to continue or stop his current services. He also starts the Universal Pre-Kindergarten program next year, so if he gets speech therapy, it will likely be during school.

Nolanisms

Our future soccer star

Like all two year olds, Nolan has several words that don't sound exactly "right." These toddler words are so darned cute, and I'm going to miss them when they're gone! My favorite Nolanisms:

• Bape (grapes)
  
• Bider (diaper)
  
• Boppy (coffee)
  
• Bet-bet (blanket)
• Tut (truck)
• Mittey Mout (Mickey Mouse)

I know that "Want bape, Mom!" and "Want bet-bet and rock, Mom" are not long for this world, with all the speech therapy he gets and the rate his language is exploding. We are also making headway in other language skills.

Nolan hasn't used the concept or word of "yes" yet. He hasn't even nodded to indicate he would like something. After some games with our speech therapist, he is now (with prompts) using the word yes. It goes something like this:

"Nolan, do you want more bubbles?"

Nolan: "Want more bubbles."

Speech therapist: Nods head vigorously.

Nolan: Also nods head vigorously.

Speech therapist (still nodding), "Yes, I want more bubbles!"

Nolan: "Want more bubbles- yes!"

The good news is that the nodding prompt is now working to elicit the "yes" response (though he doesn't use it spontaneously). The bad news is that we are all going to need dramamine from the motion sickness induced by all that nodding!


Since I'm in brag mode, other new Nolan phrases are:

"Be right back, Mom!"
"Come on!"
"Want watch moodie (movie)."
"Don't kiss my head!"

There seems to be another language explosion around the age of two, and it is a big one. We have heard a six word sentence recently (though the more typical length is 3-4 words). If he continues at this rate, he may be orating speeches by the end of this year!

Small Steps

Nolan's receptive and expressive language is quite good. Not "good for a hard of hearing child," but simply good- for any child. He regularly puts together 3 and 4 word sentences, has far too many words to count, communicates his wants and needs (LOUDLY) and is able to follow 2 step directions.

We do have some concerns with his grammar and his verbal processing, though this may be due to age more than hearing status. Still, because he is at continual risk for language problems, I think we will definitely mention these problems in his IFSP goals this fall.

We have found a way to work with his ability to answer questions. Since Nolan will mimic the question rather than formulate an answer, our speech therapist has devised the following technique: Ask, Model, Ask (wait).

First, she asks the question, "Nolan, what is this?"

Nolan will invariably repeat, "Noh*, what is this?"

Then she'll model the answer by asking me the question:

"Mommy, what is this?"

"That is a frog!" I enthusiastically answer.

Then she asks Nolan again: "Nolan, what is this?"

He'll repeat, "Noh, what is this?"

Then comes the waiting. Instead of answering the question for him or accepting his repeated question, we simply look at him and wait. Finally, after much pause, comes the answer:

"Pwog!"

Then there is much clapping and cheering and running around in circles (Nolan's personal expression of "happy"). This process works about 25% of the time right now, so we're keeping it up and hopefully the success rate will increase with time.

His other "issue" is not uncommon for children his age. He gets his grammar backwards- instead of saying, "the bear has a ball," he'll say, "ball has a bear." Or he'll say, "Work at daddy" to mean "Daddy is at work." Right now I am simply repeating what he says, but in the correct order. If he says, "Asleep a Matt," I'll say, "Matt is asleep! Maybe he will wake up soon."

Otherwise, he continues to astound and amaze us with things we didn't know he could do. Our speech therapist told him to put a green circle on blue square, and he was a bit flummoxed. She backed the complexity of the request down a notch, and asked him to put the yellow triangle on the yellow circle. His little hand reached out and accomplished the task without hesitation. He managed to handle two shapes and one color in his auditory memory, and get them in the right order. WOW! Not bad for a kid who still hasn't turned two!

The "eating thing" is still plaguing us. His appetite varies greatly from day to day, so we never know if it will be a good eating day or a poor eating day. This morning he woke up and threw up until noon. He doesn't appear to be sick (slight temperature, but Nolan nearly always has a slight temperature). It is very similar to what he did in April, when he quit eating well. It is definitely something we will keep an eye on. He has his follow-up GI appointment on the 31st of August, and we will get our assignment to the feeding clinic at Buffalo Children's at that time. I've heard they can do wonders, so if there is no medical cause, we should be in good hands.

*Noh is what Nolan calls himself. Silly parents for giving him a name filled with low frequency sounds!

Random Update

Nolan managed to catch a nasty bug this past week, and has been running fevers of 102-103. Thank goodness, his fever broke this morning! I wasn't too concerned about the virus, but I didn't want to have to reschedule his upper GI. He's still a tad warm, but not burning up like earlier in the week, so we're going ahead as planned with the upper GI tomorrow. Luckily it is in the morning, because he can't have food or drink after midnight.

On a very interesting note, his appetite is better (and spitting up decreased) when he isn't drinking whole milk. We noticed this while away for the Independence Day weekend. I wonder if the high fat content in his milk is slowing down his digestion (kids with delayed gastric emptying are usually put on low-fat diets) or if he is a little allergic to milk? Definitely something to bring up with the gastroenterologist in two weeks.

Language-wise, Nolan is really starting to blossom with using spontaneous communication. Instead of merely answering a request to imitate, he is coming up to me to tell me (in tears) that "daddy baseball" (daddy left home to go play baseball) or, in an excited voice, "want popsicle!" There seems to be a language explosion around the age of two, and we're definitely experiencing that!

We do see a bit of a verbal processing issue, but I'm sure we'll work through that in time. If you ask Nolan a question, he still repeats it verbatim rather than answering it. We know that he comprehends the words, but he isn't able to listen to the entire question, process what the question requires, and then formulate an answer. If you ask Nolan, "Where is Daddy?" the response will be "Where Daddy?" instead of an answer. This may be more of an age-related thing than a hearing-related thing: with his excellent verbal skills I tend to forget that he won't be two until next month!