Kindergarten: The First Few Weeks

Nolan loves Kindergarten. "Loves" might be an understatement. He is absolutely thrilled to go to school each day. He loves his teacher and he loves his TOD (teacher of the deaf). He's doing really, really well.

He is getting some help from the Occupational Therapist. His fine motor skills are lagging and his hyperflexible joints/hypotonia in his hands does create a few minor issues. It is something we're monitoring and we haven't written the OT into his IEP yet, but that is on the table. Hopefully a few sessions with the OT will help him develop some coping skills for his weak(er) hands.

He knows all of his letters (except for G, which he has apparently forgotten over summer vacation). He knows most of his letter sounds, with the exception of E, L, U, X, and Y. Not too shabby, though I'm a little bummed that he forgot a few of his sounds over the summer. We did work on them, but we also had a lot of other experiences (like fossil digging and swimming) that I feel are equally important to creating a well-rounded child. We'll work on the forgotten letter sounds and he'll have them down pat soon.

His FM system is working wonderfully. He came home today and recited the following poem to me:

"I am mother circle, round like a pie.
I am baby triangle, three sides have I.
I am papa square, my sides are four.
I'm cousin rectangle, shaped like a door."

This thrills me for a lot of reasons. Firstly, he is hearing his teacher very well. Secondly, his auditory memory is excellent to remember the entire poem. His hearing aid batteries died at school last Friday, and his teacher changed them without incident. I love her.

His eating is hit-or-miss at school. He often only eats a couple bites of his sandwich at lunch, a Go-Gurt and a small clementine. Sometimes he manages to eat more of his sandwich. He does eat all of his snack in the afternoon. On the days he doesn't eat well, he'll often come home and eat a large after school snack - which then impacts dinner. We're not too worried about it - if he's hungry, we give him food. If he is bloated or simply "too full," we just let it go. We can always make it up at night.

I can't wait to see him blossom throughout the year. He absolutely loves everything about Kindergarten, and is happy to be participating in gym again. Now that things have quieted down on the medical front, we can relax and enjoy the school year!

Finally, Dry Ears

Watching the Grinch Who Stole Christmas

Nolan's ear dried up on Wednesday. His hearing still seemed "off" in that ear (he should still hear unaided in that ear if you are within three feet or so and speaking loudly). His hearing seems to have improved today, though, which is wonderful. He has a hearing test slated for tomorrow afternoon, and we really wanted clear ears and a return to his standard level of hearing. His hearing is pretty crummy anyway, but we'd rather see his normal moderately-severe level than the severe-profound levels that an infection incurs.

The Teacher of the Deaf (TOD) for the elementary school called and asked about budgetary requests for next year. Nolan already has his FM system, so I couldn't really think of anything to add to his IEP. She did put in some extra money for batteries, since the FM system drains batteries fairly quickly. The only "snag" that we might hit is if we change hearing aids and need different receivers for the FM system, but I am pretty sure the receivers we have will work with nearly all hearing aid brands. Plus, the next set of aids will probably be Phonak, which happens to be the same brand as his FM system - they should function seamlessly.

I did have a laugh when she said that Nolan could just use a speaker soundfield system if his ears are infected. The school's only other child with a hearing loss has a very mild loss in the high frequencies. If Nolan has an ear infection and is unaided, he can't hear anything. Period. He drops down past the 90dB range and is functionally deaf - there is nothing to help that situation! Even when his ears are clear, he can only understand words projected at a 90dB level (unaided) - his last test showed 88% accuracy with words at 90dB. Unless she's going to set up a speaker to blast out rock-concert levels of sound, it won't work. I have a feeling the school will need a bit of an education to deal with his level of loss - he has to use his personal FM system at all times in the classroom. Nothing else will allow him to hear in noise (and if he's unaided, he simply can't hear conversational speech at all).

In any case, hopefully Nolan's hearing test tomorrow will show stability. I'm worried about that right ear, which has been having difficulty for the past two months. It was really a problem when the little guy (temporarily) lost the rest of his hearing in the left ear - let's just say that we have been using a lot of sign language in the classroom over the past 2 weeks, because he simply couldn't hear a thing. His right ear was also the first to drop the high frequencies back in 2008 (the left ear fluctuated up and down and then finally followed suit in 2010). The right ear seems to precede the left ear when we do see changes in hearing, so I will be greatly relieved if that right ear is nice and stable!

We Have the Best School District, Ever

Nolan wields The Force at his IEP meeting

Some people live in school districts where it is an absolute nightmare to obtain services. Our school district is the opposite of that scenario - the special education department is an absolute joy to work with.

Nolan's IEP meeting went smoothly, and we obtained some push-in services from his SLP. We also obtained direct services from a teacher-of-the-deaf (TOD) once per week. For the first time, we are adding some real sign language goals to his IEP. Swimming lessons have proved that Nolan cannot hear in the water, which presents a very real communication issue. He is in that odd in-between hearing level state: he can hear (sans aids) in a quiet environment for a distance of about 5 feet. In noise, he hears almost nothing. Since we can't waterproof his hearing aids, we need an alternate communication method - so we have put in a goal for understanding and producing 75 "survival" signs.

Obviously, Nolan continues to be very verbal, and he has an auditory learning style. His remaining goals are for using the FM system in the classroom, filling in those odd language gaps (which have been noted by his SLP and TOD), and eliminating some articulation errors.

Since Nolan has a few other health issues, those are also mentioned on the IEP. He won't be eating in the cafeteria in pre-K, since it is a half-day program. Nonetheless, they included the dietary restrictions into his IEP. His medical information is also included, since he fatigues easily. Nolan looks very healthy, but he will completely slump to the ground and have to be carried at times - particularly in the afternoon. This is just something we are monitoring - it could be related to his apneas at night, or it could be something else altogether. He did have one of his fatigue-slumps during the meeting - he slid off his chair and his tears began. He ended up on Dennis's lap, and a cookie made him feel better.

We had almost finished the meeting, when the Special Education Coordinator watched Nolan holding a crayon. We know he has some low muscle tone, particularly in his hands. This hasn't caused any delays yet, but she was concerned with his grip (fisting the crayon). He passed an OT evaluation last year, but the team at the meeting wasn't really convinced - so they wrote monitoring for fine motor delays into the IEP.

We got what we asked for (hearing and language services), and some things we didn't think to ask for (fine motor monitoring/evaluation). The school district team really, really cares about their children - this is probably why we have the highest elementary school test scores in the region. The staff goes out of their way to ensure that every child has the best opportunity to learn and succeed.

I am so excited for Nolan to start Pre-K next year - we know he is going to excel in our amazing school district!

A Mish-Mash of Updates

• Nolan's IEP meeting is on the 25th. This should go pretty smoothly, since his language is generally age-appropriate and we're going to maintain his services. Once we get his new goals into place, we should be set for another year.


• I finally managed to get an appointment to adjust the settings on Nolan's FM system: it is currently set to 100% FM, which is not great for the classroom setting (he can't hear his peers with it on). Since his ENT wants a hearing test, he'll have an audiological evaluation and FM System adjustment on June 7.


• Matt obtained his prescription for DDAVP (Desmopressin). We had the option to try this drug prior to starting on invasive testing through a urologist. If the DDAVP works, then we know that the little guy's bladder just needs to mature. If it doesn't, then we will have to see a urologist. We will start with 1 pill/day for week one, and if there is no improvement we will go to 2 pills/day for week 2. The last step is 3 pills/day during week three - if it doesn't work at that dosage, then we have to go to the urologist for more testing.


• The Nurse Practitioner has seen the sleep study results for Nolan, but won't review them with me. She said she would really prefer Dr. Brodsky to review the results with us, so I won't see the sleep study report until Monday. I hate having to wait until the main appointment to see the written report, because it is easier to formulate questions after I've had time to digest the information in the report. If he passed it, then I wish our pediatrician's office would just tell me - the extra stress of waiting isn't really appreciated. If he failed it, then several more procedures will likely be recommended - and it would be nice to not get blind-sided by the information (and have to make decisions) at the appointment on Monday.


• I made a vision appointment for Matt - I don't suspect any issues, but he starts kindergarten next year, and I thought it would be a good idea. Also, siblings have a higher rate of developing amblyopia than the general population, so it is probably a good idea to make sure both eyes are in good working order.

The weather has been truly awful: this entire spring, we have seen exactly 7 days of sunshine. We are supposed to see the sun and hit *gasp* SEVENTY degrees on Saturday. Otherwise, it has been rain every. single. day. With temperatures in the 40's. I will be glad when the weather warms up and we can get outside to play again!

Hashing Out IEP Goals

Spring is here, and certain parents know what that means: IEP season has arrived. For those that don't know what an "IEP" is, it is an "individualized educational plan" written for children who need educational supports or other specialized education.

For Nolan, the IEP is put in place because of his hearing loss. This is an interesting dynamic, because Nolan's language tests as age-appropriate, and he has no delays. If he were older, we would consider placing him on a 504 plan (this provides physical accommodations for children with physical handicaps).

Nolan is, however, only three years old. We want him to have a "running start" into kindergarten, to strengthen pre-literacy skills, and to have coping skills for situations where his hearing will inevitably be impacted by background noise.

His IEP meeting is on May 25, and we have to hash out some goals for the little guy. There are some areas which need some work, so we have come up with the following goals:

• Nolan will initiate peer interactions. Currently, Nolan will only initiate interactions with adults. In the classroom, he will only partake in parallel play unless aided by another adult. He will never initiate social contact with another child. He's come a l-o-n-g way, but socialization is very important, so we will place this goal into his IEP.
• Proper use of pronouns. Everyone is a "he" or a "him," which makes sense. Our household is almost entirely male! For some reason, Nolan has also reverted back to referring to himself in the third person nearly all of the time. I'm not quite sure where "my," "me," and "I" have gone!
• Articulation. Most of Nolan's articulation errors are age-appropriate (like fronting: using a /t/ for /k/and his use of /w/ for /l/), but he has some related to his hearing loss (confusing M and N). Most of the time, he is intelligible to a stranger, like any other child his age. Occasionally, the articulation errors compound in a single word. "Nilt" is "milk" - a stranger may not understand this word out of context.

Anyhow, I am looking for goals appropriate for a child turning five years old. The IEP will be in place next year (when Nolan is four- going- on- five years old), so I need great goal ideas for a child getting ready to enter kindergarten! Hearing loss mamas out there, do you have any great pre-literacy goals/auditory goals/self-advocacy goals? We are trying to keep the number of goals down on the overall IEP (easier to chart and track), but ideas are most welcome from those of you who have been-there-done-that!

Phone Call Marathon

The boys with Pete the cat

I'm not really a "phone person." This is unfortunate, because Nolan has required a lot of phone calls this week. Today, I have called:

• The ENT's office, to verify Nolan's surgery on October 12 will be covered by insurance.
• The anesthesiologist, to verify the anesthesiology services will be covered.
• The new Teacher of the Deaf, to set up our first meeting (this Friday).
• The County Department of Health, which is currently in possession of Nolan's FM System.
• The billing department at our audiology clinic, because we were incorrectly billed for Nolan's earmolds while he was still in the early intervention system.
• The audiologist, to update her as to Nolan's fluid/ear infection status and pending surgery date.
  

This is not very many phone calls, I know, but I truly dislike sitting on hold while listening to a tinny rendition of "Staying Alive." Especially when I am spaced out on Dayquil.

I do feel like I managed to get some things accomplished: I saved $120 for the earmolds, and verified that our insurance will cover the surgery AND anesthesia on October 12.

Some things are still up in the air, but should get sorted out soon. The County has the FM system up in its office in Mayville. No one knows how to set it up, but as the nice woman on the phone said, "You probably know more about these things than we do."

It looks like I will be reading up on the Phonak Inspiro via The Almighty Google. I have a feeling this will require yet another phone call to our audiologist to get things in order.

Everything is slowly falling into place according to Nolan's IEP, and we should be fully compliant with the accommodations and assistive technology by October!

Yippie!

Nolan's favorite song recently has been "Celebration" by Kool and The Gang. Whenever he hears the song on the radio ("celebrate good times-come on!") he'll shout the "COME ON!" part at the top of his lungs. We should turn on the song now, because we have something to celebrate.

I received an email from the school district that Nolan's FM system has been ordered from Phonak. Within minutes, I received a second email stating that the FM system is here. We were pretty sure the FM system wouldn't be ordered in time for preschool, and they managed to get it ordered and in-house within a couple of weeks. I am so glad we live in our particular school district- for all the worry about getting the services and accommodations Nolan needs, they have made everything happen in a very timely manner.

I never thought I'd be so happy over a piece of equipment. Without that little machine, Nolan would only hear a lot of mumbling during circle time. With that little machine, he will hear his teacher read the story, ask questions, and give directions. He'll be able to hear his teacher, even when she's outside of his 5' hearing bubble.

He'll be able to hear the music the other kids are dancing to.

Here's to a whole new world of sound- in the classroom!

IEP Meeting: A Complete Success

Team Nolan

We had Nolan's Individualized Educational Plan (IEP) meeting this morning with the Committee for Preschool Special Education (CPSE). It was a resounding success!

We went over Nolan's history and current hearing situation, under-amplification, and desired goals/accommodations. We had placed a picture of Nolan on the front of the report to help make the meeting more personal. I couldn't find childcare for Nolan this morning, so the picture was a moot point since he was sitting at the table. Still, it put a face to all of the nameless data in the reports.

A draft of his psychological testing was present, and he is functioning above age level with regard to cognition. This is great news: while it is always wonderful to hear you have a bright kid, it also means that any delays Nolan is experiencing are a direct result of his hearing loss and not any other cognitive issue.

It was decided that Nolan's speech and language services would continue, with a mixture of services provided in the home and at the preschool. In addition, his need for an FM system was written into the IEP under "assistive technology."

We did hit a roadblock when we mentioned the FM system, with regard to funding. We managed to bring the conversation back to the point by reminding everyone that we simply need to place the fact that he needs an FM on the IEP now. We're worried about the "what," not the "how." The school district and county can determine the funding for the FM system at a later date.

We also obtained consultations services from a Teacher of the Deaf (TOD), for one hour per month. This is primarily to monitor Nolan's progress in both the social and language arenas.

We did discuss Nolan's potential sensory integration issues and problems dealing with large groups and noise. One fortunate aspect of his attendance at the meeting was that he had a meltdown from the noise/people- demonstrating behaviors we see when he is overwhelmed. Seeing as how there were only six adults in the room and not the sixteen children he will have in his preschool class, it was easy to see why we are concerned.

After watching his behavior and inconsolable nature, then mentioning that he has (very) mild hypotonia in his hands/arms, the team thought an evaluation by an occupational therapist (OT) would be a good idea. I doubt Nolan really needs services in this area, but an evaluation can't hurt. We added the OT evaluation into his IEP at the end of the meeting.

Everything is signed, and Nolan will have all of the services he needs to excel.

Today is a good day!

IEP Booklets

When a parent goes to an IEP meeting, it is good to have all of the proverbial ducks in a row. Know what the necessary goals and accommodations are, and have the data supporting the requested goals/accommodations at hand.

To accomplish this, we made informational booklets about Nolan's particular situation and his needs in an educational setting. The books consisted of:

1. Nolan's name and picture, to personalize the report.
2. Future Planning Statement.
3. History.
   
4. Audiology: all reports from birth to present.
5. FM Systems: letter of support from our audiologist and research on personal FM systems
6. Language testing: Testing from John Tracy and from our home Speech Language Pathologist.
7. IEP References: this included the IEP checklist, deaf student policy guidance, essential aspects of an IEP, and Did You Know?

We made a booklet for each person present at the meeting, so everyone could have their own reference during certain discussions. These were extremely valuable during our IEP meeting- a big thank you goes out to the John Tracy Clinic and to Drew's Mom.

Still Preparing for the IEP

Nolan dearly misses the John Tracy Clinic

Once completed, I will post a complete description of the booklets we are preparing for Nolan's IEP meeting. The information is nearly complete, thanks to help from Drew's blog and from the John Tracy Clinic.

The reason we are providing this information to the IEP team is twofold: one is to educate the team on the needs of children with hearing loss (the needs vary by the child, but Nolan's particular concerns deal with social difficulties, language holes, access to auditory information, and articulation). The other reason is to provide the necessary data to back up our requests for services and accommodations. At our pre-CPSE meeting, we were told that personal FM systems and TOD services are not typically offered until Kindergarten. With Nolan's under-amplification, fluctuant hearing loss, and articulation delay, the FM system is necessary. Every professional (from our own audiologist to the audiologist, TOD, and speech language teacher at John Tracy) has stated that Nolan's access to sound is compromised without the use of a personal FM system. Please note that ear-level FM systems are not universally required among deaf or hard-of-hearing preschoolers (they can even be detrimental to toddlers with cochlear implants, who are unable to report on the functionality of the device). For Nolan's specific hearing situation, however, the personal FM system is vital.

Nolan had his cognitive testing this morning, and did well. He did manage to look like a prodigy on the receptive language portion of the test, pointing to the correct pictures for "horizontal," "parallel," and "equivalent." He doesn't actually know these words (testing officials don't do any evidence gaining- if the child happens to point to the correct picture, they get the point). He's age appropriate (or a little above age level) for his receptive language, but he's not a savant! Still, the test will show that he does not have a cognitive disability and any speech or language gaps are due specifically to his hearing loss.

He did miss the question, "Point to the doll," consistently pointing to the ball. His compromised hearing definitely comes into play, even in a quiet environment. We really need to get his hearing situation figured out and get his amplification set to the correct levels!

We will be running to Office Max tonight to make copies of our little booklets- full of research articles on FM systems, Nolan's history, and audiological/language testing results. Our IEP meeting is at 11:20am tomorrow- wish us luck!

Speaking of preschool, I mentioned the start of the school year to both of our boys. They LOVE school, and the conversation went something like this:

Matthew: "I can't wait to go to Preschool."

Nolan: "You go preschool. Nolan go JOHN TRACY!"

Every conversation ends with Nolan insisting that he is attending John Tracy in a few weeks. I'm not quite sure how to get the concept through to him, though I suspect a few experience books will help him through the transition. He is still in love with his John Tracy teachers and misses his friends dearly.

IEP Part 2: Future Planning Statement

A future planning statement will be included in Nolan's IEP booklet, to share our vision of Nolan's successful future:

We see the first five years of Nolan’s life as a critical window where he needs intensive intervention to establish his communication and listening skills that he will need in all future educational and life experiences.

In the short term, we see Nolan attending First Covenant Preschool in Jamestown, New York. This is a mainstream program, designed for three year old children. As Nolan will be attending a mainstream preschool, a personal FM System is vital to allow him equal access to the curriculum. Weekly sessions by a licensed Speech Language Pathologist are required to maintain Nolan's current language levels, and to address his difficulties with articulation. Regular monitoring by a certified Teacher of the Deaf (TOD) are necessary to verify that Nolan is functioning socially in the classroom, in addition to monitoring language, equipment (FM System) usage, and Nolan’s ability to hear and communicate in a mainstream classroom setting. The goal for these preschool years is to establish an appropriate foundation of communication, language, listening and literacy that will hopefully allow him to integrate into a mainstream Kindergarten class in Southwestern School District with minimal or no speech and language delays.

If Nolan receives the appropriate accommodations and services, we see Nolan graduating from High School and attending college or post-secondary education, should he choose to do so. We see Nolan as a positive, contributing member of society, who will be successful in life, without letting his deafness define him.

IEP Booklet, Part I: History

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

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

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

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

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

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

Potential Problems

1) Equipment Maintenance

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

2) Ear Infections

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

3) Moisture

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

4) Hearing In Noise and Sound Localization

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

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

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

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

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).

Updated Language Scores and TB Test Scheduled

I received Nolan's language scores today. He is holding steady with his expressive and receptive language scores, with results nearly identical to his former scores (by percentile rank-there was a very slight/insignificant decrease in scores). He is currently 2 years, 8 months old and his expressive language score is at 2 years, 11 months. His receptive language is at 3 years, 6 months, so his receptive language is definitely his strong suit!

His articulation scores, however, have taken a bit of a dive. He has lost sounds that he used to have, so I was afraid this might be a "problem area." With his pesky conductive hearing issues and amplification that hasn't been adjusted since last June, his hearing level and amplification level aren't exactly well matched.

Nolan used to test with a very mild articulation delay (bordering on normal), and now has a moderate articulation delay.

The upshot of the regression in skills is that we shouldn't have any problem qualifying for an IEP and maintaining our speech therapy services. Though his language scores are well ahead of his chronological age, he is barely maintaining his expressive/receptive language score percentiles. His articulation scores have decreased, likely a product of chronic hearing fluctuation in conjunction with his permanent hearing loss. Hopefully the articulation scores will improve once the conductive component either disappears or we can adjust his hearing aids to suit his loss (he is currently aided for a 30dB loss in the high frequencies, even though his hearing level is 60dB with the conductive component). We have a hearing test on May 20 to get a better idea on the status of his current hearing levels.

I also scheduled Nolan's TB test for the John Tracy Clinic Summer Session today. We'll have the test performed tomorrow afternoon and read on Thursday afternoon. I have a call into our "grown-up" doctor to have the same test performed on Dennis and me. I hope to have the health forms completed and mailed into John Tracy by the first week of May.

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.