John Tracy Clinic: Week 2, Day 1

It is way past my typical John Tracy bedtime, but I am going to try to fit a post in today. Dennis helped me set up our camera, so I am now able to post pictures with my blog posts. While I'm updating the blog, he is in the exercise room on a treadmill (marathon training waits for no man).

Today's lectures were great, and I was especially interested in the classroom amplification system lecture. Since we are going to have Nolan's IEP meeting when we return to New York, I wanted to get more information on the available systems for children with hearing loss.

The lecture covered soundfield amplification systems and personal FM systems. For Nolan, a personal FM system is a good choice because he is a hearing aid user and his private preschool program will not be able to provide a soundfield system. In addition (and perhaps, most importantly), Nolan has a lot of language. He has a lot of language, and he's not afraid to use it- he tells us if his hearing aids are not functioning properly or are not fitting well. He is a "good reporter," which is the most vital component to using a personal FM system.

There are times a personal (ear level) FM system is not appropriate. For very young children with cochlear implants, there is no way to verify the FM system is working properly with the implant. If there is static, the child must be able to report the malfunction in the system. For this reason, a soundfield may be a more appropriate choice for a young preschooler with a CI.

In any case, children in a classroom situation need some sort of FM system (soundfield or personal FM) to increase the signal to noise ratio. Children with hearing loss require the teacher's voice to be 15dB greater than the ambient noise for audibility. Distance, background noise, and reverberation all affect the signal's clarity, and the FM system helps to reduce these listening problems.

We also had a lecture on oral anatomy, feeding issues, and speech disorders related to oral motor skills. We discussed the detection and treatment of verbal apraxia of speech, and I learned of two speech therapy methods for speech disorders I had never heard of before (the Kaufman and Prompt methods). Apparently, the Prompt method is useful for children with developmental apraxia of speech and for children with low tone.

We concluded with a lecture on sensory integration, which is necessary for being able to make sense of the world (and therefore, necessary for learning). I won't go into detail (because this blog post would be ridiculously long), but I did learn two very interesting things today. The first is that in a recent study including 48 deaf children, ALL of the children demonstrated abnormal vestibular responses. This included children with all levels of hearing loss, so even children with moderate hearing loss levels showed an abnormal vestibular response. This makes sense, since the same hair cells that line the inner ear line the semi-circular canals. Still, I was surprised to learn that 100% of the deaf and hard of hearing children tested had varying degrees of vestibular dysfunction.

The second interesting thing is that the style of children's play has changed over the years. Children are more sedentary, which leads to less exercise of the vestibular system. What surprised me was the statement that deaf or hard of hearing children are more sedentary than their hearing peers. I asked why, and found out that the time in therapy ("sit and listen"), time in the car to appointments, and vestibular issues (balance problems) reduce the active play time of deaf and hard of hearing children. This is very true for Nolan, who has had various medical appointments/procedures, therapy, and long car trips. Fortunately, we are a family that desires natural play opportunities, so Nolan has been provided with lots of free play time and physical experiences despite the amount of time in therapy or in the car. The point being made during the lecture was that parents of deaf/hh children need to make an extra effort to ensure their children are getting the physical/gross motor play needed for healthy development.

Inspired by the lecture, several parents gathered together for a walk to a park on Flower St. A very nice mama from the June session told me about this park, so we headed out to find it. There was quite a bit of construction, and I'm sure several people were staring as we tried to cross a busy street in a construction zone with several strollers. We looked like an out-of-place toddler caravan! Luckily, we ran into a local family, and we followed them into the play area. The playground was truly amazing- there was a water sprinkler we had to keep the kids away from (next time, we'll bring swim suits), soft surfaces, a sound system that was activated when the children ran past sensors, spinning toys, a roller slide, and a million other neat play items.

Nolan and G. race down the slides!

Nolan and Noah play "chase."

Dennis and I returned "home," then took off for El Cholo, a Mexican food restaurant in Los Angeles. We are now thoroughly stuffed, and Nolan was very grateful for the rocket popsicle the restaurant gave to him. After dinner, we ran to Ralph's grocery store to pick up some more lunch items, then Dennis gave Nolan a bath while I ran the laundry. All of this activity explains why I am blogging at nearly 10:00pm in a semi-comatose state. It is definitely time to turn everything off and go to bed!

Disney Weekend

I am so tired and I won't post much, but we had a great weekend at Disneyland. This weekend:

• Matt became a Jedi in the Jedi Training Academy.
• Nolan discovered that he LOVES rides, especially if they go fast.
• Matt rode his first "big boy" rides: Star Tours, Soarin' Over California, and Mulholland Madness (first roller coaster).
• Nolan screamed because we wouldn't let him ride roller coasters.
• Matt met Mickey Mouse and hugged him.
• Nolan met Mickey Mouse and screamed bloody murder, because any mouse that stands six feet tall must be a mutant bent on destroying the world.

Dennis has taken Matt back up to Oxnard, and Nolan is very deeply asleep. Tomorrow is the first day of our second week at John Tracy, and I am excited to get back to the routine. The routine is a bit of a relief for Nolan, and he when he heard me mention John Tracy at Disneyland, he cried, "I go back my John Tracy!" So there you go: John Tracy rates much higher than Mickey Mouse. I think Nolan misses all of his friends.

Tomorrow's lectures are on Classroom Amplification, Oral-Peripheral Structures and Functions, and Sensory Integration and Behavior. I'm off to bed, so that I can be alert for the information deluge tomorrow!

Just Plain Tuckered Out

Today was only a half day at John Tracy, but this is a very good thing for Nolan. He is quite tired today, and had quite the tantrum this afternoon once Dennis and Matthew arrived. I realized he must be quite tired (he's been sleeping in my bed to keep him from wandering the apartment at night). I laid down with him, and he fell asleep after some kicking, screaming, and throwing items from the bed. Dennis ran 17 miles this morning (in training for the Rochester Marathon), so he settled down for a nap, too. I took Matt on a little walk to see John Tracy, so he could understand where Nolan was going during the time he is at Grandma's house.

The lecture topic today was on behavioral regulation in children, which is a very important topic. A dysregulated child (not in control of their mood and impulses) will not be able to learn. For a child who is deaf or hard of hearing, having good self regulation is critical to maintaining the focus necessary to learn language and all other skills.

We learned that difficulty with sleep, feeding, transitions, etc. are all signs of dysregulation, and that there are two types of dysregulated behavior. One is the "hot" child (impulsive, hyper, explosive, poor sleeping). The "hot" child is often identified as having difficulties because of discipline problems in class. The "cold"child is one who is apathetic, depressed, withdrawn, and drowsy. Unfortunately, "cold" children often slip through the cracks because they don't ever present a discipline problem. Being "tuned out" presents just as much of a challenge to learning as being "revved up," so parents and professionals should be on the lookout for children who are showing signs of detachment or are frequently shutting down. There is also "mixed behavior," which is what Nolan is showing in response to his classroom when the activity level gets high. He literally will huddle on the floor if the class does "run around the rosie" instead of "ring around the rosie." He can't handle that much stimulation, so he becomes anxious and clingy. Luckily, Nolan's behavior is usually not of this type- it is only in the specific situation (lots of people + lots of noise and activity) that he gets so overwhelmed.

As a side note, I will post photos when I get home. I don't have the program or USB cable that goes to the camera, so there will be some "editing" when I get home to add pictures! In the meantime, check out Lucas's blog. You can see Nolan and me in some pictures on Day 3 (and Gilbert's El Indio Mexican Food is delicious)!

Laundry Time (JTC Day 4)

Thanks to a certain mom who visited John Tracy for the June session, today's laundry was totally free. She sent me her unused laundry card, which is good since we have a lot of Crystal-Light tainted clothing. We are eternally grateful! I am trying to get everything tidy and all of the jobs out of the way, since we are leaving for Disneyland after school tomorrow (note: there probably won't be any updates until we're done with the House of Mouse).

Nolan is quite happy with his new books, and loves to read his "Friends, Friends, Who Do You See?" book. He can't name all of the friends in his class yet, but he gets excited when he sees Sam, Gracie, and Lucas. When he sees Lucas, he shouts, "That my Wucas!" He actually "reads" the routine book to us- this is probably because we've been talking about the classroom routine constantly since the first day.

Nolan really enjoys "Going John Tracy," as he puts it. Since we don't have auditory-verbal therapy at home, he is not very familiar with the Ling Six sounds and has no idea how to perform the listening checks in the morning. I have read about the Lings online and through the John Tracy course, but it is hard to put a theory into practice when you've never seen it done. The summer course really cements the correspondence course ideas- we saw how the Ling sounds are used with a hand cue, and saw ways to help Nolan learn to respond to them. His teacher (the fabulous Miss B., who is absolutely amazing) uses little Crayola stampers as an incentive for certain tasks. To help Nolan with the Ling sounds, she had Dennis and I model the task. When we gave the sound in response, we got a heart stamp. Nolan is painfully shy in class, so he was reluctant to give any response. He finally gave an "Ah" in response, and received a stamp for that. Hopefully tomorrow we'll get a bit more.

Nolan is quite shy in large groups. I'm not quite sure how to handle this- I hate to see him hunch over and not want to participate in the circle time activities, etc. He does put his picture on his dolphin in the morning, but crawls to the bulletin board and then hides his face. I wonder if he just doesn't like being the center of attention. One problem I'm seeing is that he sometimes will even push other children away when he's in "shy mode." This isn't a good thing, because we want him to socialize freely with others. The good thing is that he's not always in "shy mode," and his clingy behavior is often worse when I'm in the room. I'm glad he is in a classroom without Mommy present, because he can come out of his shell and branch out a little.

The parent portion consisted of lectures on audiology. While much of the information is fairly basic, I still learn something new each day. They do complete audiological testing here, so Nolan will receive some tests he has never had before. One is called a stapedial reflex test- if this is absent, there is typically significant hearing loss (usually >60dB). It will be interesting to see if Nolan has a present reflex, since his loss is 60-65dB rising to 40dB. The audiologist thought that the reflex would probably not be present with this level of loss (it is present in mild losses). We also discussed the differences between ABR's and ASSR testing (rather technical and boring to most, but I really liked this section).

We also had a demonstration of computer-driven speech programs. They showed us why it is not good to use computer generated speech programs, because the programs can positively reinforce incorrect speech patterns. For instance, if you are working on sound presence, a child who says, "AHHH" appropriately is rewarded. Unfortunately, so is the child who has a raspy, breathy, "Ah-hhh-ah-hh." Since practice can make permanent, you don't want to give a big reward for the incorrect sound. A live person is able to listen to the child's speech, and if it is not quite on target, give a better model of how the specific sound should be said. For instance, if the "Y" in Yogurt comes out as an /n/, acoustic highlighting could be used to get a /y/ sound. The therapist or teacher (or parent) could lean in close to the child's microphones and say, "eeeyummy!" to highlight the /y/ sound. I found this useful, since Nolan often uses a sound close to /n/ when he says "Yeah!" We can highlight the /y/ sound to help clear up the confusion.

Formal and informal assessments were discussed at the end of the day. Parents can use informal assessments to ensure their child is still on track- and to know when it is time to up the ante and move to the next level. Things like pragmatics (the use of language in social contexts), word counts using vocabulary lists, and language samples can be monitored informally. Professionals use formal assessments to get unbiased language data, including tests like the PLS-4. We were able to watch a video of one of the children in our session having a language evaluation. The personalized videos they show us really drive some points home! They did stress not testing children with the same test too frequently, as children can memorize parts of the test. This would invalidate results, so if testing is going to be given less than six months after the previous test, a different test should be used. For that reason, Nolan will be tested with a different articulation and expressive/receptive language test than the PLS-4 (the test that was used in May).

I did peek in on Nolan during his speech session today. He was having standardized testing done- I think it might have been a picture vocabulary test (or a receptive language test- not sure). His SLT asked him to point to "buckle," and he did! I was shocked that he knew that word. Another set of parents was also in the observation room, and she noted that it can be easy to underestimate what our little ones know. I agree- I suppose it is time to up the ante for Nolan's vocabulary (next up: words like jubilant and ecstatic)!

When the Sun Goes Down on Santa Monica Boulevard

Day Three at John Tracy was wonderful. I missed Dennis, who was with our older son Matthew during the day. Today's lecture was on language opportunities, acoustic highlighting (repeating the child's words, but with the correct pronunciation), and ear anatomy. The "tip of the day" was to get at the child's level, so that you are able to easily converse with little ones.

We had a brunch reception at 10:15am, and I ate some fruit and a few donuts (remember the donuts- they will come into play later). We asked so many questions during the audiology lecture that we ran over the amount of time. Interestingly enough, it was the conductive system that drew a lot of questions. There are a few families here with hearing aids, and obviously a conductive component wreaks havoc on the sensorineural loss. Someone asked if fluid had any effect on children with cochlear implants, and the answer is it does. While the electrode array is NOT in the middle ear, the wire does pass through the area to reach the cochlea. Some people have reported a change in hearing sensation with the presence of fluid, so it is important to monitor middle ear fluid in all children with hearing loss, regardless of device type.

Nolan took another nap today, of his own volition. He was placed into the book area and he looked at books for a while, then took his "ears" out and went to sleep. I went to check on him, and he was snoozing away in his little corner, as content as can be. It is nice to see him jiving so well with the classroom routine, even if he is awake at 9:30pm and keeps coming out to tell me is isn't sleepy, he is scared, and there is a dinosaur in his bed. I checked for rogue stegosauruses and found none, so I'm pretty sure he just doesn't want to go down tonight!

I am trying to find a concise way to describe how John Tracy is different than other preschool experiences I've encountered. The student:teacher ratio is amazing, of course. The teachers made two different books for the children (including their actual pictures) that describe the day's routine and a "friends" book in the format of "Brown Bear, Brown Bear, Who Do You See?" The teachers truly care about each family and child. The children's pictures are everywhere, making every learning experience a personal one. But really, I suppose it comes down to this:

John Tracy Clinic isn't about the kids. It's about the parents.

Along the lines of "If you give a man a fish, you feed him for a day, but if you teach him to fish, you feed him for a lifetime," John Tracy strives to teach the parents how to teach their children.

I'm so used to being in the doctor's office or other professional's office, apologizing for the fact that I'm "just the parent." I have a concern about this or that, but really, I'm "just the parent."

At John Tracy Clinic, you are The Parent. You are important- the most important person in the child's life. You have the power to truly make a large difference in your child's world. The entire aim of the John Tracy Clinic is to give parents the tools they need to make great things happen.

After school, we hopped into Lucas's parent's car and went to Santa Monica with them. Truthfully, this involved squeezing into the back seat of a very small rental car, between two carseats. This is where the donuts come into play- if I had eaten just one less, the fit would have been a bit easier. The entire drive down the 10 freeway was spent cursing that extra donut and the adjustment knob on the side of Nolan's carseat!

We made it to the beach and the boys had a blast. We're always thankful for Nolan's residual hearing in these circumstances, because within a certain distance he can hear what we're saying. Of course, Nolan is quite fearless of the waves and decided that he would like to try and swim to Catalina, so there was a lot of chasing after him when he got out of range. The amount of sand that can be contained in one boy's clothing, diaper, and shoes is impressive. Really, we could recreate the Sahara on the front lawn if we wanted to. I think we'll be borrowing the vacuum tomorrow night!

Lucas and Nolan on the beach.

Nolan has no fear of the water.

After the beach, we headed to Gilbert's El Indio Mexican Food restaurant. There was a bit of a wait and both kids were kind of fried (Nolan started screaming for his JUICE! while waiting). Then there was the little incident of spilled Crystal Light from our backpack, creating a puddle the size of Lake Erie on the restaurant floor. The good news: everything now smells like pomegranate-cherry. The bad news: everything is now wet and tinged pink. The food was absolutely DELICIOUS, so it was worth the wait. After another squeezing-into-the-rental-car contortionist act, I was starting to wish I had started a diet three months ago. But the enchiladas were still worth it.

Everyone agrees, Gilbert's is delicious!

We're back now, and Nolan is having a very hard time going to sleep. It's been a long day, so I'm ready to crash, too. Dennis will be coming for tomorrow's session, and I look forward to having a second set of hands around. I honestly can't believe our first week is more than half over- time flies by quickly when you are so busy and the days are chock full of activities. I haven't missed a TV or phone since coming here- we're simply too busy (and tired) to really worry about any of those distractions. I am quite thankful for the wireless connection, though! I'm not sure what I'd do if I didn't have the opportunity to write and stay connected to everyone!

John Tracy Clinic, Day 2

There is no way to write down everything we learned today, because it would be the Longest Blog Post Ever. Instead, I'll try to capture some highlights from the day.

Last night, Nolan whispered. For the first time, ever. Since every preschool classroom at JTC has observation rooms, I'm guessing this little skill was learned while Nolan was not napping. The teachers were telling him to be quiet, and a lot of whispering was practiced. With the soundfield system and the frequent modeling and practice, Nolan figured out how to whisper. So last night, while he was coloring, my little boy whispered for the first time. This shouldn't make me tear up in an emotional sob-fest sort of way, but it does.

Ring Around the Rosie

Today was extremely busy, with lectures on language and communication options. Language was broken down into four main compartments, including vocabulary, syntax, semantics, and pragmatics. Assessments are available for each of these areas, and each area is vitally important. Syntax doesn't come into play until children reach the 3 word sentence level of speech, but Nolan is at or beyond this level, so syntax should be modeled and monitored. Pragmatics (the social rules of speech, both verbal and non-verbal) are equally important (example: shouting "Hooray!" at a funeral= highly inappropriate pragmatics, even if you really didn't like Aunt Mildred).

We discussed communications modes and the pros and cons of each approach. We also discussed pre-lingual vs. post-lingual deafness and conductive vs. sensorineural hearing loss. Later, lectures will discuss how deafness affects cognition, social interactions, etc. We got to play a game using phonology to remember some of the components of oral language (using the letters E N G I B S to create words-bonus points if you can use all the letters to create one word). Most of us have a great understanding of phonology and are able to create words from these letters.

Dennis and I met with Nolan's audiologist today, and we discussed his hearing loss fluctuation, chronic ear infections, and the question of a possible conductive component to his loss. The audiologist was so wonderful, and explained many things for the first time to us. While some behavioral fluctuations may occur in the testing booth, the former presence of OAE in his right ear at birth compared to the 55dB threshold now observed indicates progression. As for the conductive component, they are going to run bone conduction first, to get a good idea of the underlying sensorineural loss. They're also going to run testing at 250Hz, which we've never had before. Nolan has a lot of confusion with the /m/ and /n/ sounds, and both of these occur closer to the 250Hz mark. It will be interesting to see what his thresholds are in that range!

We are also going to get an aided audiogram for the first time. I have always been concerned because Nolan's hearing aids are put into the mysterious programming box and then are deemed "set" for his loss. The audiologist at John Tracy explained what the mystery box does (a sound recording of a man reading an article is played at different volume levels and the computer programs the aids accordingly). This is called speech mapping and is the most reliable way to program digital aids. Aided audiograms are also done at JTC, which is really nice because it gives us a better idea of what Nolan is hearing with his aids. The aids do suppress the pure tones a bit (they're designed to do this, since they want to suppress "nonsense noise" and focus on speech), but the aided audiogram is definitely in the ballpark of what he is able to hear with his aids on. Nolan's aids currently show that they're set a bit too low for the soft speech (when put into the programming box), so they're going to make some recommendations on the soft speech settings after doing his hearing test.

We also did a listening check, the first time I've ever seen one done with the full complement of Ling Sounds and the first time I've been shown how to properly conduct a listening test. I didn't know, for instance, that we should conduct the test and then gently squeeze the sides of the hearing aids. Sometimes a loose connection is only apparent when you squeeze the aids, and the sound will cut out. Nolan's aids are just fine, but it was a good exercise to go through.

We also met with Nolan's SLT today, and she was wonderful. We talked about our goals for Nolan and what we want for his IEP. While most three year olds are a bit young for an FM system (failure to report static with the device), Nolan is an excellent reporter and has the language skills to report on a non-functioning device. We worked with his SLT when Nolan was released from school, and did a mini-lesson together. We described items by their characteristics, then Nolan had to guess which item was in the bag. Once he guessed correctly, he would select a toy and then guess if it would sink or float- then he got to drop the item into a bowl of water to see if he was right. This was good practice for us, and reassuring since our own speech therapist does this sort of activity all the time with Nolan.

After school, we collected our coffee pot (hooray!) and headed back to the Annenberg apartments to play on the front lawn with the other kids. Dennis headed back up to Oxnard and will return on Thursday, so Nolan and I headed out to play on the lawn with the other families. We went to dinner with Lucas's family , and enjoyed some wonderful sushi. I'm pretty sure there was nothing more adorable than Lucas saying, "I love sushi," because hearing those words out of a two-year-old's mouth is just impossibly cute. Nolan and Lucas decided to have some heated debates on the walk, which mainly consisted of the word, "MINE!" Lucas would see a bus and say, "Big bus! My bus!" Then Nolan would get rather incensed and shout, "No, my bus!" This happened with nearly every item the boys saw along the walk. We kept talking about being nice to our friends and how the city buses really belong to everybody. It must have made some sort of impression, because Nolan came to me tonight and said, "I not yell at Wucas. He my fwiend. We share." We'll see how that translates to reality tomorrow!

Spoons and cups: improvised tub toys.

As a little public service announcement, if you are the parent of a deaf or hard-of-hearing child between the ages of 2 and 5 years old, get your application into John Tracy now. The 2011 program already has several families signed up and the 2012 program also has family interested. This is definitely not one of those experiences to procrastinate on- if you have the ability to travel to Los Angeles, do it. Trust me, you will not regret it- no matter what language level your child is at, John Tracy will help them get to the next level. Trust me, they're exceptionally good at increasing the skills of both parents and children!

Drinking From a Fire Hydrant

If you have a child who is deaf or hard-of-hearing and can make it to Los Angeles for three weeks in the summer, then go to John Tracy. This place is absolutely incredible. Everything is tailored to helping children succeed, by teaching the parents how to guide and teach their children.

Day 1 of the John Tracy Clinic was a resounding success. Transitions are marked with song, starting with the "Time for school" song, then the "clean up" song, the circle time song, the welcome song, etc. We placed Nolan's lunch into his cubby, along with his diapers, nap towel, stuffed bear, and change of clothing. We played in the classroom for about 30 minutes, during which time Nolan's speech-language teacher (SLT) Ms. C came to talk with us. Nolan will be pulled out daily for individual speech sessions ("stickers") and we will have consultations with her on a regular basis.

Before the parents were dismissed, we accompanied our children to the playground. They had Duplos, bubbles, easels set up with paint, and sand toys set out for the children. Nolan was painting when I left, and he moved over to the bubbles when Dennis left. Not a single tear was shed, much to our relief!

We moved to the parent classroom, which resembles a small lecture hall in college (complete with tiny pull-out desk attached to the chair). From this point on, a torrent of information was given to us. The Los Angeles police talked to us about safety in the area, and they were extremely helpful and caring. The playground across the street is not a safe place to play (we stick out like sore thumbs and it can be a gang hangout), but if we want to play there as a group, we can call the USC division and they will send uniformed officers to hang out while we play. There is another playground off S. Flower St. that is safe (I heard about this playground from energyofx).

There are two vacuums for the JTC families to share, so two "vacuum monitors" were chosen, and questions about the apartments were answered (one family has broken air conditioning with plastic over the windows, so they're roasting!).

The "Tip of the Day" was given, which was to "Make Your Point." This is pointing to your ear and saying, "I heard that" for various sounds. While Nolan generally responds well for environmental sounds, it was interesting that he did not respond to the drum being struck for circle time until we stopped and said, "I heard that." Then he turned and paid close attention to what was happening in the direction of the sound. He knows that a doorbell means someone is at the door, a microwave beep means food is ready, and now he is learning that the drum means "circle time."

We were given a full three-week schedule with all planned activities. The classes start out with basic information, and conclude with things like "phonological level speech" and "advanced auditory skills." We were given a tour of the facilities, which included the office where the correspondence course reports are received and support letters are mailed. We saw AVT therapy rooms, the school library, audiology booths, and the observation rooms for our childrens' classrooms.

We broke for lunch and Dennis went to pay for the apartment/parking permit/linen fees while I went to spy on observe Nolan in his classroom. They were eating lunch, and the little guy was inhaling his food! The teachers didn't realize there was a sandwich in the lower compartment of the lunch box, but they came to the window to ask if certain parents were in the observation room (one little girl was crying a lot). We said no, but then I mentioned Nolan's sandwich in the bottom compartment. Soon after, he was munching on his PB&J (though I think he was full from the yogurt, blueberries, and pretzel crackers I had packed for him).

After lunch, we met for our support group. We each wrote letters to ourselves expressing our worries, fears, and hopes about our children. These were sealed, and we will receive them back at the end of our three weeks. It will be interesting to see what our feelings are now vs. the end of the program.

The group went around and we gave a brief introduction about our families, including where we are from and when we found out about the hearing loss, type of amplification, and how we heard about JTC. One mom talked about having a progressive loss, and how the same grief of initial diagnosis happens again and again, each time a new loss is discovered. This really hit home with me, since the first real drop in Nolan's hearing (August 2008) was the hardest point for me- far harder than his initial diagnosis.

After the support group, we had a little break. This meant I headed to the observation room, of course! Most of the children were sleeping, but Nolan and little S. were wide awake. Nolan was sitting in the play kitchen area, getting some attention from the classroom assistants. He seemed to be enjoying the individual attention, as he was all smiles as they chatted together!

The final part of the day was going over the four areas the family support counselors would cover (which include sibling relationships, developmental concerns, and two other topics that I forget). Forms for developmental assessment requests were handed out, for parents who would like to have a consultation about specific behaviors or problems. In our case, I will probably turn one in for help with Nolan's screaming and sleep issues. John Tracy focuses on the WHOLE child, not just the set of ears that many professionals care about.

After we were dismissed, I went to check on Nolan again. They were eating snack, and even meal time is a language lesson. Kids were requesting various parts of the trail mix and they were singing a "fish in the sea" song every time a child requested a goldfish cracker. Nolan thought the fish song was hilarious!

He had loosened up a bit by the end of the day, so when the final circle time was called, he started to run around the room like a little monkey. They brought him over to the circle and had him sit down, and he participated in the "goodbye" song. Then the parents were let in through the parent door (this door is only used by parents leaving and entering- the staff use another door so the children don't expect a parent to walk in every time the door opens).

There are six children in the class, and as many as six teachers/assistants/Speech Language Teachers at any point during the day. At the minimum, there are four adults in the classroom (the main teacher, her two assistants, and a volunteer). Nolan's class consists of four boys and two girls, and he is the second-oldest in the class. His non-napping buddy S. is the oldest, and he and Nolan get along really well.

Nolan and I played on the lawn with a few other kids (including the adorable Noah), and then we headed up for some quiet time. Tomorrow will be full of more information than today, and we have a consultation with his audiologist tomorrow morning. We have speech-language consultations scheduled as well, but I can't seem to find the piece of paper with this information (I might have left it in Nolan's classroom).

I am going to give Nolan a bath and then put him to bed, so that he's ready to play and learn tomorrow morning!