Speech Pathologist

After more than half a year of being bugged by doctors, therapists, etc. we finally had James' speech appointment yesterday. Ever since James was about 18 months old we have been pushed about seeing a speech pathologist. We managed to hold off for several months before we gave in and decided we'd at least see the pathologist so they would stop bugging us and that way we'd get him into the speech system so that if he indeed did actually have a problem he would be in the system and we wouldn't have to wait at that time.

In December we had James' hearing tested, which came back normal, and the following week were suppose to have an appointment with Early Words, but we received a call changing the appointment time and date. What we didn't realize was that they had actually changed him from the Early Words program to the Infant-Parent Program, which is much like Early Words, but broader, having a wide variety of other developmental programs and connections to various help in these areas. So in December we had an appointment with the Infant-Parent Therapist to determine what James needed. At this time we stressed that we were not interested in their other programs and assesments but only in seeing a speech pathologist.

We spent about two hours at yesterday's appointment and it went much as I had expected. I had already said before we left that I knew he would not do anything that they ask since he does not like to be put on the spot. The appointment was done in a big play/toy room. We sat on the floor and discussed James while he walked around and played with all the wonderful toys ... and there were lots of nice ones there. If left alone, James plays excellent, and I was happy to hear that he was actually babbling and "talking" while he played. It's amazing what a good ear the pathologist has also. She would ask me questions about what James can or cannot do, his health history, etc ... but meantime she was also able to listen to his babbling. Every now and then she would stop to say what she had heard so far ...eg. "I've heard the g, h, t sounds". After James had had a chance to warm up she brought out her "tools" ... a spoon, a cup, a ball, and a crayon. She lay them out and then asked James to give her the spoon, a task that James can very easily follow. He looked at her and then walked the other way to play with some other toys. She tried several other approaches and asked me to try ... no luck, just as I figured. Just as we were leaving James got Teddy out of his diaper bag, who is his faithful friend who goes everywhere ... and surprising spent the whole time in the diaper bag, if that tells you how much fun he was having. I decided to take a new approach to show he could easily follow simple directions. I told James Teddy was hunger, could he please get the spoon and feed Teddy. No problem. Easily done. Teddy is now thirsty and needs a drink, could you please give Teddy the cup ... no problem. See ... he has no trouble following instructions.

The pathologist advised she had to do her calculation and would call me the next day to let me know the results. From what she could see he was not meeting the 2 year standard number of words, which is 200, and he would score low on the receptive section as he did not follow the requests/instructions that she asked him to do.

Currently James has 45 words in his vocab. I already knew that he would not meet their requirements as I had reviewed their criteria before hand. To look at the differences you can click the links to check between 18 months and 2 years. I knew that James met the 18 month requirements. I also have different developmental sheets from various other sources that only required a child to know 50 words by age two. According to the pathologist, 50 words is from a few years ago and now they have decided 200 is more accurate. Although I do not argue that it is very possible for a 2 year old to have 200 words, I also know that it is just as common that they do not ... especially boys, who most people will tell me are slower then their girls. Marietta certainly had 200 words by age two...she never stopped talking, and has yet to do so. Rebecca on the other hand was a very quiet child, more to herself, like James ... she didn't talk much, but she had no speech problems. James has just started in the past week to put together two words. We will not argue with the fact that James is on the slow side, but we also know that he has been slow with other important milestones ... he crawled at 11 1/2 months, walked at 20 months ... but when he does it he does fine. James just started to talk in the fall ... after being home and stable for a decent period of time. He is learning along the same lines as the girls did, he just started a few months late and at this time we still feel it will all come in due time.

The pathologist wanted James to see a developmental specialist (can't remember the fancy name) who would review all of James' development skills in a play setting and determine how he is doing, and thus they would be better able to tell where his speech fits into the big picture. This has actually already been suggested to us when the Therapist came for the original appointment, at which time we politely told them "no thanks." There is definitely nothing wrong with James' motor and fine motor skills! I spoke to my pediatrician about this and she also did not feel this was necessary. So I once again turned down this option as she said it would not help them in regards to his speech; it would just create a bigger picture. At this time all we want is some guidance on what to watch for and how to encourage and help him in a subtle way. She gave me some information on how to do this.

Today the pathologist called back to give me a more detailed report of what she found after she did all her calculations. She has determined that in the Expressive area (talking) James is in the 10th percentile (20th is normal) and at the level of an 18 month ... yup we knew that. In the Receptive area (following instructions) he is also in the 10th percentile and about the level of a 16 1/2 month old. This is definitely inaccurate as we know he has no problems with comprehesion. The bottom line is that he is considered mildly delayed. She has suggested that we get a referral to the Communications Support Team. This involves individuals with Early Childhold Education (ECE) coming out to our home to work with James on some of the techniques that she told me about yesterday. These individuals are under the supervision of a speech pathologist. There is currently a three month wait for this. I decided to just go ahead with it, as it will be easier to pull him out then to get him in later. The pathologist herself will also be coming to our home in April to do another assessment and see how James is progressing.

So for now we've bought ourselves another two months of time ... by then I think we may have a clearer idea if there really is any reason to be concerned.