Progress Report

Kymee has made so much progress in her speech this last semester. A week before she began speech she had her ear tubes replaced. I believe that the combination of hearing clearly, speech therapy, and age appropriate behavior has made all the difference. For those of you who are fascinated by technicalities of evaluations and therapy, like I am, this post is for you. This is a summery of Kymee's latest evaluation.










Before
Language:
1. Lack of verbal reasoning
2. Little to no knowledge of animals or household objects
3. Little use of social behaviors such as greetings or sharing
4. Identifies colors but unable to verbalize names
5. Unable to produce names of immediate family
6. Struggles with bilabial sounds, fricatives and glottal stops
(Googling this helped me understand Kymee could not make sounds which used both lips, or make sounds in which the airflow must be stopped to produce the sound)

Behavior:
1. Adapted to being with therapist away from Mom
2. 3 minute attention span
3. If more than one toy available for play - she struggles to choose and becomes upset
4. Is upset when asked to share (isn't this normal for a 2 1/2 year old?)
5. Throws toys when finished
6. Throws things at therapist instead of verbalizing her needs
7. Noises outside room distract her
8. Strikes the therapist wen doesn't want to participate in planned activity (I can vouch for this one personally)

Therapy Goals 
1. Repeat verbal commands 80% of time
Initial: 20%
Final: 100%
2. Verbally request items to play when prompted 80% of time
Initial: 40%
Final:90%
3. Verbally request items to play without prompting 80% of time in 2 sessions
Initial:40%
Final:90%
4. Repeat animal names 80% of time
Initial: 20%
Final:85%
5. Use 2 word phrases in structured play by modeling
Initial:25%
Final:90%
6. Repeat family names
Initial: 25%
Final: 85%
7. Repeat common household item names
Initial: 20%
Final:80%
8. verbally identify household objects
Initial:25%
Final: 75%

After
1. Says "all done" when finished with toys instead of throwing them
2. Verbalizes names of colors, animals and family member most of the time without prompting
3. Could play for 10 minutes without frustration
4. Could greet and share more age appropriately
5. Kymee no longer hits her therapist (now if we could figure out how to make her stop hitting Elijah)

Recommendations

1. Increse 2 word phrases

2. Increase age-appropriate vocabulary

3. Improve verbal identification of family members

4. Monitor Kymee's articulation production for further assessment and remediation 

(I'm ready to move on to this part - but it may be a while)

Flower Fairy Kymee and the Evil Speech Stealing Monster

Once upon a time there was a Flower Fairy named Kymee.

An evil speech monster stole all Kymee's words. Kymee couldn't use her words to name all the beautiful flowers around her. 

Then all of a sudden, a Fairy Speech-mother appeared. She played and sang to Fairy Kymee and tried to help her find the words which the monster had stolen. But she couldn't do it alone. 

So the Fairy Speech-mother placed a spell on each of those Kymee loved. She shrunk the Fairy Family down and turned them into a village of beautiful popcycle people. The Fairy Speech-mother hoped that if the Flower Fairy could hold them then the power of their love could overcome the monster's spell. 

Each pop-cycle person, agreed to give Kymee one word or two. 

Kymee dressed Grandma popcycle person on her magnetic puzzle, and Grandma gave  her the words "shirt" and "skirt" and "shoes"

As the popcylcle people rested on lily pads, magical frogs transported Kymee from pad to pad.  And each gave her a new word.
She hopped from Grandpa and Grandma, Abuelo and Abuela to Daddy, Mommy and Yaya. She rode on the frogs back as she visited the lily pad of Baba, Mimi and Eli. She leaped to Carlos, Lydia, and J then to Kenny, Sissy and Trent, and finally she came to land on the pad of Uncle Mark and Auntie Kim.
With each new hop, the magic of the monster began to wear out and the Flower Fairy began to find her words.

 The Fairy Speech-mother put Kymee into a deep sleep, and returned the popcycle people to their rightful place among the flowers. The monster was overcome for another day.

When Flower Fairy Kymee awoke, she had new words to use and was happier then ever before.

The end, until the Speech Monster roars again.

Kymee the Guinea Pig: A Play

The Cast

The Child: Cute as a Button. Runs around the office pulling all the duckies off the shelves, opening every drawer to find what’s in it, and screaming when she doesn't get her way 

The Doctor: An eccentric geneticist. A self-defined “quake” who has decorated her entire office in duckies to accentuate the point. She arrives to see the patient with a basket-full of goodies, which rival Mary Poppins bag.  Writes every detail of question and answer session with mom, as well as medical information obtained, and observation of the child.

The Mom: Presents a calm astute persona while stress and turmoil are boiling up under the skin. Sings, "Put on a Happy Face" under her breath. 

Props:

The Book: Thicker than the Bible, with descriptions and characteristics of every genetically diagnosis, except Fetal Valproate Syndrome

Doctor's Goodie Bag

Stethoscope - First time it hasn't taken 2 nurses to hold the child down when listening to her heart

Reflex Hammer - the child laughed when the doctor told her the giraffe wanted to "kiss her knees" 

 Flashlight - for counting nasty, crooked, out of place and backwards teeth - The child showed the doctor her amazing talent of roaring like a tiger

Stickers- to make child very,very happy

Script:

Dr (to Child): Lets see your fingers. Can I tickle your toes? (to Mom) Yep – Fetal Valproate Syndrome, see how long they are and how they overlap?

Dr: Is she always this active?

Mom: Mostly

Dr: She will most likely be labeled ADHD, but I’m not ready to make that diagnosis yet. There’s nothing you can do about it at this stage of life anyway.

Mom thinking: She’s two – that’s normal – she is NOT HYPER.

Mom (to child): Let’s put your shoes on.

Child: Nooooooooooooooooo! (throws huge fit)

Dr: She most likely has sensory integration issues.

Mom: What can we do about it?

Dr: Nothing. Next year at your appointment I can recommend her to a behavioral specialist. But we can’t do that until she is 3.

Dr: What’s this under her chin?

Mom: A birthmark. It has changed some since she was born. It now has texture as well as color.

Dr: I believe it’s nevus sebaceous. It’s nothing to worry about, but it should be removed. I’ll give you the name of a pediatric dermatologist.

Mom thinks: just what she needs another specialist, and another surgery.

Dr: Lets look it up in the Big Black Book. Fetal Valproate Syndrome. See here are pictures of kids who look just like her: eyes too wide apart, forehead too large, upper lip too thin.

Mom thinks: A syndrome which creates beautiful children

Dr: Just what I thought. Nothing in here. Nothing about possible behavior effects. Nothing about related medical effects. Nothing about learning challenges. The syndrome is too new. That’s why I write everything down. Someday the information I compile about this child will be compared with the information other geneticists write down about other children, and they will be added to this here book.

Mom thinks: Good thing future children will benefit from my child’s behavior problems.

Dr: With my recommendation, she should qualify to go to preschool next year.

Mom: I’ve homeschooled my other kids. I plan to homeschool her as well, unless there are resources available that she needs and I can’t provide for her.

Dr (contemplates for a minute before responding): I think the best thing for this child would be to be homeschooled while receiving private therapy. Most teachers are trained and able to handle academic challenges in children, but not as well trained in dealing with behavioral problem. This child will benefit most from having one on one attention and using behavior modification Technics. You are doing the right thing.

Mom thinks: Wow – this is the first time I’ve heard a doctor say this. This makes me feel good. I like this doctor.

Dr: She looks good and healthy, and we’ll deal with the behavioral problems in the future. See you next year.

Mom thinks: I hate the term “behavioral problems.” When referring to “unreasonable phobias” “night terrors” “sensory issues” and “overly-active” (notice I didn’t say “hyperactive”) -shouldn't there be a term other then “behavioral problems?” Something, kinder, gentler – something that doesn't make my child sound like “Chucky” and me sound like I have the parenting skills of Casey Anthony. 

Bubbles for Babbling

“Bubbles, bubbles, bubbles
Bubbles, bubbles, bubbles
Bubbles, bubbles, bubbles
Bubbles, bubbles, POP!”

Turns out blowing bubbles is good for developing speech.

“Bubbles” is one of the few words Kymee says which a stranger can understand. Of course “Baba” 

and “Bubbles” end up sounding the same, so one must taking into context whether she is hugging her “Baba” Stephan, or wanting to chase pop-able spheres around. Her therapist is also using bubbles to try and get her to say, “Pop” and “More.” (She does say "more" - Amanda just hasn't heard it yet)

If you listen real closely in this video you can catch the word "bubbles" or more like "bubu."

But the real therapy isn’t in the words associated with bubbles themselves, but the ability to blow them. 120 toddlers were studied by Lancaster University, it was found that the ability to perform complex mouth movements, like blowing bubbles, sucking through a straw and kissing, were strongly linked with the ability to develop language.

Kymee’s language challenges stem from a lack of control over her mouth muscles, due to her cleft lip and palate. Blowing bubbles exercises for the lips, breathe control, and mouth positions.

When blowing bubbles, the therapist is looking for a round shape of the lips. 

As you can see from this photo, Kymee can not yet  round her lips completely. 

 “Pucker up” and blow is the lip position for the sounds /w/, oo, and /o/.

Blowing bubbles also positions and strengthens the tongue for sounds that are made in the back of the mouth like /k/, /g/, and ng.  Funny, these were the first sounds that Kymee made after her palate repair surgery, but she has stopped making them for some reason.

So, I’ll get Kymee to blow some bubbles and work out those lip muscles. I’m hopeful that a byproduct of this therapy is that she’ll learn to give round, closed mouthed kisses instead of slobbering all over my face. 

Say "Moooo"

Amanda, "What does the cow say?"

 "The cow says moooo"
"Say 'moooo'"

 "What does the lion say"

Kymee, "Grrrrrrrr"

Amanda, "Grr, good"

                                              

I watched on a TV monitor from a cubby-hole in the video observation room as Kymee and her new speech therapist played alone in a therapy room. I realized I was paying $25/hr for a graduate student to sit on the floor and name objects, a task I perform daily for free.

I have no idea why, but watching Kymee interact with the therapist, was spell-binding. Best TV I've seen for a while. Don't ask me why it was entertaining to watch when she shook her head and said "no" when asked to exchange her plastic lion for a red fire truck, but it was. Even Andres couldn't keep his eyes off the monitor and read his book, and laughed out loud as Kymee loaded her baskets with the four-legged creatures instead of willingly being redirected by Amanda. She enjoyed loading and unloading these small critters into the baskets, and when forced to play with the "red fire truck" and "yellow school bus" (as Amanda labeled them) she insisted on lining the vehicles up perfectly on the table. Slightly OCD, or maybe just a melancholy.

I prided myself on the fact that she never once threw a fit, or screamed in frustration, and only hit Amanda twice. I almost feel sorry for Amanda, after one hour of Kymee time, she believes her to be a "quiet" little girl whose one true love in life is manufactured barnyard animals. But, as far as first impressions go, Kymee made a good one. Hope the graduate student isn't too disillusioned when the real Kymee shows up.

Scream and Point

Kymee was evaluated by ECI (a state funded program run by the school district for kids too young to go to school) to see if she qualified for Speech Therapy.

This is what 19 month-olds are supposed to be saying:

"The vocabulary of a typical 19-month-old toddler may consist of as few as ten words or as many as 50. Yours may be able to link two or more words together, and is starting to use more "action" words. Verbs like "go" and "jump" are common, and so is linking a verb with her name (or pronoun), as in "Come me," meaning "Come with me." (It will be some months before she inserts the preposition.) Many 19-month-olds are also well-versed in direction words such as "up," "down," "under," "out," and "in."

http://www.babycenter.com/0_your-19-month-olds-language-and-cognitive-development-versed_1214071.bc

This is what Kymee is doing at 19 months: 

"Kymberlee is waving bye-bye and uses signs and gestures to request what she wants. She is imitating several sounds: h,m,n and vowels. She can vary her voice to use inflections, and uses 5 verbal words and 4 signs consistently. Her sound repertoire is still limited related to her cleft palate. She is not eligible for therapy." 

This is what they really mean:

Kymberlee uses signs and gestures to request what she wants = She smacks you to get your attention

She is imitating several sounds = she growls like a lion, and barks like a dog

She can vary her voice = she screams loudly

She uses 5 verbal words = that are only understood by over-compensation, over-zealous loved ones

Her sound repertoire is still limited = she can't speak

She is not eligible for therapy = Because she can point and scream, we don't have to spend money on her therapy, you do!