We had our speech evaluation

[twins r fun]

And I must say I am shocked at how behind it showed Jacob and Caleb are. For receptive language, Jacob has solid skills at 4-5 months and Caleb has solid skills at 5-6 months. They both have scattered skills up to 7-8 months. For expressive language, they both have solid skills at 5-6 months. Jacob has scattered skills up to 10-11 months with a gap at 8-9 months and Caleb has scattered skills up to 7-8 months. I am baffled at how this is possible. How can they have been exposed to language for 16 months and only understand what a 5 month old does?

I wasn't very impressed with the evaluation. It really could have been done over the phone, since all they did was ask me questions about their language skills-the therapists really didn't observe or interact with the boys much at all. Their reccomedation is that we get services through the county early intervention program so that they can be seen in the home environment.

I'm pretty upset about this, which is somewhat ridicuous. It's not like they have some life threatening illness or something. I guess I just didn't expect them to be so low and I'm frustrated about what we are supposed to do with them. It seems like we are doing the right things. From the suggestions I've gotten so far, I have yet to think "Oh I had no idea I should be doing that." or "That's a good idea-why haven't we tried that?" And if we are doing the right things, why aren't they getting it? I either come up with the conclusion that we HAVEN'T been doing the right things and are depriving them of language or that there is something wrong with Jacob and Caleb (like a learning disability or low IQs or autism or...). I haven't been too concerened until now because I just kept thinking they are just a little slow in language development and they would get it when they were ready. But they aren't just a little slow-they are way behind! Anyway, just thought I'd share since I had originally posted here about a possible language delay. I welcome any thoughts on this latest news.

[COElizabeth]

Nicole,

I am sorry to hear the evaluation didn't go well. I don't know what a good evaluation looks like, but it seems to me that it would certainly include the therapist making his or her own observations rather than relying on the parent's recall. A parent is hardly an unbiased observer, and while some parents might tend to exaggerate their children's skills, I know some would probably be very conservative in describing those skills. I for one find it very stressful to be asked questions about James' development by the ped. Some things I can clearly answer, but others I puzzle, "Does he do that? I don't know!" I definitely think you should get another evaluation to compare. I will ask my sister what her son's speech evaluation was like - I know he saw a couple of different people. Finally, did the therapists say anything about them being twins? As people mentioned earlier, it's pretty well accepted that language delays are more common among multiples, just like they are among bilingual households. I hope you get some more helpful information!

Elizabeth
Mom to James
9-20-02

[ddmarsh]

Although I know little about the process of an evaluation, I do know from having had my Alexander assessed when he was around 2.5 that it was definately one on one and their was extensive interaction and it involved things like getting him to respond to pictures, cues by the therapists, etc. I honestly find it hard to imagine that anyone can give you a developmental estimate based on a phone interview with you.

One thing to keep in mind in the event that you do receive a full assessment that indicates intervention is warranted is that you are doing such a great job doing all of this so soon - intervention can be so effective when done early. So many parents struggle and deny obtaining assessments in various areas much to the detriment of their children - you have done a great job just by initiating the process.

As it so happens I still think that Alexander does have some degree of delay, although the intital one we had done found no problems. He just talks very differently than other children his age, so I am going to have him reassessed as soon as possible.

Keep your chin up - you're doing a great thing for your children.

Debbie

[cara1]

Early intervention is important, too. I agree, you might consider a second opinion, but a referall to early intervention isn't a bad idea. I'm worried myself that I'll be in your position soon. DS still hasn't said a single word yet at 13 mos. Although there are a few things he understands, they are few and far between. Our ped told us she'd reassess as his 15 mos check-up, and refer out if necessary. I don't know what else to say...

[emilyf]

I think I would get a second opinion too-I also have heard that twins tend to develop language a little later, and yours are still quite young! I have a good friend who has a two year old. She was almost silent until right around her second birthday, and now she chatters non-stop. My brother was late with language too-he couldn't say much until he was almost 3, and then it was non-stop and he is one of the most hilarious, verbally skilled people I know. I guess it's hard to tell, but do YOU feel like they understand more than an average 5 month old? The 5 month old babies I've been around don't seem to understand much. You're around them all the time, if this seems off to you (and it sounds like it does) than it probably is.
Emily
mom of Charlie born 11/02

[flagger]

I know my response may not be the most popular in the world, but it is just my humble opinion. Please do not take my response to mean I do not empathise with your concerns. I do, but I just wanted to add another perspective.

You are around your children for much longer periods of time than those doing the assessing. I know there is great pressure to get children with a learning disability help at the earliest possible point, but I seem to remember "slower kids" in my elementary school classes suddenly excelling in later years. They were taking AP classes in high school.

I think it is possible that there comes a point where there is too much information available to read and peruse. So much so that we start to second guess our own very powerful millenia old parental instincts. IMHO, it is difficult to get an accurate assessment at this young of an age.

FWIW, my good friend's daughter didn't start "talking" until she was five. Now she cannot shut her daughter up and she is doing extremely well in school. ;) For another perspective, you might want to look up Albert Einstein and see how he was classified at a very young age.

[Rachels]

Okay, granted I didn't train in sppech specifically, but ALL the developmental assessment stuff I observed or trained in involved intensive activity WITH THE BABY. So I do question the evaluation. I agree that early intervention is probably a good idea, and I also agree that twins are often slower initially with language. How's their development otherwise?

I know this must be really difficult. These don't sound to me like developmentally disordered kids, though (having seen more than a few). Get whatever support you can on the speech, but try not to panic. I think they'll be fine.

-Rachel
Mom to Abigail Rose
5/18/02

[Kate888]

>I wasn't very impressed with the evaluation. It really
>could have been done over the phone, since all they did was
>ask me questions about their language skills-the therapists
>really didn't observe or interact with the boys much at all.


I'd recommend getting a second opinion. I'm a licenced speech-language pathologist (now a SAHM) and I would not reach such conclusions without observing and interacting with the children. A full evaluation should include interviewing the caregiver and interacting with the child (as well as observing how the child interacts with the caregiver). Like Emily has already mentioned, twins tend to develop language a little late (they communicate to each other in a special way), so I won't be too stressed about it until I have a "thorough" evaluation.

>I either come up
>with the conclusion that we HAVEN'T been doing the right
>things and are depriving them of language or that there is
>something wrong with Jacob and Caleb (like a learning
>disability or low IQs or autism or...).

Please don't feel guilty about their language development. You're a terrific mom to Jacob and Caleb and they're so lucky to have a mom like you. It sure is WAY too early to think negative thoughts (although as moms, we tend to do so). Hang in there!

Kate :)
Mom to Maya 2-17-02

[twins r fun]

Thank you for all your input and reassurance. Like you guys I have come to the conclusion that the evaluation was TERRIBLE. They basically assessed my knowledge, not Jacob and Caleb's. And though I try to pay attention to what they can do, who knows what I miss. Plus my standards are pretty high for giving them credit for being able to do something-they've got to prove it many times to me. And there were some things they can do that I didn't even get to tell the thersapists about. I have no doubt that Jacob and Caleb are delayed, but to be at a 5-6 month level seems a little extreme. I just can't picture a baby that age being able to do the things my boys can do. I mean really what language skills does a child that age have? Obviously recalling what J & C were like at that age doesn't help me because they weren;t doing what they are supposed to, but I've seen quite a few 6 months old and they don't do much as far as language. Anyway, the whole assessment was a waste of time since they just referred me back to the county who I was already in touch with to get services! The county is going to be the second opinion you guys reccomend.

And Flagger, I agree with your idea about getting too much information. A large part of me believes that if I just leave Jacob and Caleb alone and do what we are doing naturally, they will be fine. This is why I thought twice about getting the evaluations done in the first place. However there's enough doubt to make me get them done and accept the offered services!

Last thing, does anyone have any reliable sources on the twin language delay? I've read that it's true and that it's a myth. The people at the county think it's a factor, the people who did the evaluation today think it isn't. It makes sence in some ways to me, but then again it also makes a convenient cover for all language problems in twins and may prevent people (myself included) from searching for the true reasons.

Thanks all of you guys!
Nicole

[COElizabeth]

I found this review of literature on the subject:

http://web.mit.edu/afs/athena/user/j/g/jganger/Public/delaylit.html

I sort of skimmed it, but I did read that the author's conclusion is that while some of the studies are flawed, it does appear that twins are more prone to language delays for both biological and environmental reasons. I did a quick search on google and also saw an article from the UK called, "When baby keeps mum." I didn't really read it, but I love the title. :) British expressions are just great. By the way, was the evaluation going by the boys' adjusted age or actual age? I know they catch up, but I wonder if that is a little bit of a factor.

Elizabeth
Mom to James
9-20-02

[atlbaby]

Hi Nicole,

I'm sorry you had such a disappointing assessment!! Given what you have told me about Jacob and Caleb, I too am shocked at the therapists' report! Of course a 5-6 month old understands way less than your boys do! Plus, they have a few words too, which is above a 5-6 or even 8-9 month range! I have worked with speech pathologists before, as well as with county intervention programs in the home, and I am amazed that they didn't spend time interacting with the boys!

It's normal to have doubts, since you are with them every day, and it's hard *not* to notice what other childen are doing. But I do believe they are just a bit delayed and will be big talkers soon. Just to look at some generalities (which I'm sure you've thought of), but for one thing they are boys, and boys tend to speak later. And they are premiees too, so everything might take a bit longer. As for twin language delay, I'll be interested to see if anyone here has any information as to its reliability. Have you spoken with any of the parents of twins you see at groups?

I know you are doing *all* the right things (and then some!) so please don't think it's something you aren't doing with the boys! You are a wonderful mother, who does her research too! :)

-Rachel
Mom to Arielle Jill, 10/30/01
#2:) EDD 10/24/03

[egoldber]

Ah, Nicole, I feel your pain. I find it surprising that she didn't interact with the boys at all. Sarah's assessment is tomorrow, and even though our concern is walking, she is supposed to get a "full" assessment, so I'll let you know what mine was like.

But I have read that therapists do rely a lot on parental assessments at this age. It can be VERY difficult to evaluate a toddler, who may clam up and be silent in an unfamiliar setting, but be a chatter box at home.

But I know what you mean about wondering what you could do differently. When the ped referred me, she was like, "oh they'll show you things to do with her and recommend toys..." And I think to myself, do they think I have my child shut up in a box all day and NEVER interact with her? Do they think she has no age appropriate walking toys? What on EARTH could I have done differently?

The reality is that there is a WIDE range of normal development. Our society puts a lot of stock on achieving milestones and doing them early. As parents we get a lot of pressure for our children to perform on a time table and this is not something I really buy.

BUT if a child is delayed for whatever reason, early intervention can be CRITICAL for putting a child on track. And I really wouldn't mess around with language. A lot of language is acquired early in life (I read somewhere that most of our daily spoken vocabulary is developed by age 3!). It sounds like your assessment was poor, but I would probably get a second opinion if I were you. Just in case, heaven forbid, there is an issue, getting early help would be really important.

Hang in there!!! I know how tough it is! Just today, I was at a birthday party for a two year old who lives across the street, and I can't even tell you how many moms in the neighborhood said to me, "OH MY GOODNESS, she's STILL not walking!!!!" GRRRRRRRRRRRR!!!!!!

HTH,

[Annette_C]

Nicole,
I'm sorry about the negative experience you had with your boys' evaluation.
I agree with everyone else here, get a second evaluation done.
My older daughter didn't really say much until she was 2. Twenty years later, she has more awards/certificates of excellence, etc. than I have wall space in my entire house (and she never shuts up!LOL)!
My son, began talking at 3 1/2 months old but didn't walk until 15 months (more ran than walked after that!).
No two babies are alike in the way of development but, for peace of mind, I would get another opinion.
Good luck! I'll be thinking of you and keep us posted.
Annette
SAHM to Sabrina 6/24/02

[egoldber]

I just found this site and I found it to have some helpful info.

http://www.keepkidshealthy.com/welcome/conditions/developmentaldelays.html

[JulieL]

I have a bit of advice. I want to be a special education teacher someday. And as far as St. Louis goes I know we have a very good special ed district. If I were you for peace of mind I would go to your school district and find out your special ed district. These people live eat and breathe to help children. It is the highest turnover position for a teacher because it requires a lot of patience and knowledge. Don't think because you consult them that your children will ever even enter a special ed class but for their sake I would talk to these people. They will know support groups, other therapists, and all kinds of sources you won't to help you out. It is sooooo criticle at a young age to take signs seriously. Don't go crazy, but your attitude seems very healthy. I can't say enough about the teachers who dedicate themselves to those who need help. I admire them and aspire to be one. Hope this helps you out. Keep your chin up! A side note, did you see the posting about signing to children? I went to the website for Signing Time, and the couple who made the video's have a 2 year old who has medical problems, I don't remember the specific's but the signing helped her speech abilites. Check it out, may be helpful as well. -JulieL

[twins r fun]

That link is actually one of the ones I read. It does make some valid points about the twin language delay that I totally agree could be a factor. The funny thing is the woman that wrote it is in charge of or at least works on a twin language study at MIT that Jacob and Caleb are supposed to be in. I say supposed to be because I think they don't use kids with diagnosed speech issues so I'm pretty sure we're out now! I have to contact them to find out for sure. At the end of the study they will either pay you a small sum or pay to get the test done to find out if they are fraternal or identical. We were going to get the test done to put to rest any debate on the issue. Oh well, here's to many more years of hearing my mom and my DH try to convinve me that the boys are identical! Thanks for doing a search for me Elizabeth-that was sweet of you!

Nicole

[twins r fun]

Just wanted to thank everyone again for all your encouragement. I was able to talk to the people in the county infants and toddler program on Friday(which as you suggested JulieL, is run by the school system special ed. department). The private assessment we got done was able to speed up the process of getting county services so it wasn't a complete waste after all. The speech pathologist will come out and do a needs assessment on both boys in the next few weeks. She will make reccomendations to me and to two special ed teachers about what to do. The special ed teachers (one assigned to each child) will come out once a week to work with the boys and the speech pathologist will be out every 2-4 weeks to check on their progress and make new reccomendations. I've met the teachers already and they seem very nice and genuinely concerened. The program also runs a playgroup once a week that we can attend and the therapists and teachers stop by to work with the kids. I still have my reservations about what they are going to be able to tell me that we haven't tried, but I'm sure they must have something, right?

As a side note, I told my pediatrician how disappointed I was with the assessment so she's not going to refer anyone else there. The place we went was a pediatric clinic dealing with all kinds of developmental dealys and medical issues. And the ped. told us that was the only type of place that would take insurance - the good speech therapists just make you pay out of pocket and you can get reimbursed by your insurance. Good to know for the future!

Nicole

[COElizabeth]

My aunt was told that her twin girls were fraternal, but several years later, after reading an article about different ways to make the determination, she asked her OB which test had been done. He went back and checked her file and saw a note at the bottom of the result saying "inconclusive"! He asked if people thought they were identical and she said yes, so he said they probably are! LOL.

Elizabeth
Mom to James
9-20-02

[egoldber]

The therapist that did Sarah's assessment is a special ed teacher. She does private assessments and therapy on the weekends through my ped's office. She was really good. I am sure that they will be able to make a lot of recommendations for your boys.

I was surprised at some of the suggestions our therapist made. Since her concern with Sarah was over lip movement and particular sounds, she has us doing things to stimulate her lip muscles and sorting her toys into "sound groups" to make it easier to work with her on those sounds, etc. Things I certainly would have never known to do.

We also have to pay out of pocket at each visit and hope that our insurance will re-imburse us. Since it is though ouw ped's office, hopefully they are pretty "insurance savvy" and will know how to get it re-imbursed.

Good luck!

[JulieL]

I am glad I can help. Having a circle of people around you who know where you are coming from is half of staying positive. Keep us posted. I have so much compasion for you. If it helps to know I will be praying for you and your whole family. You will get through this, sane!

All the best!
-JulieL
mama to Anthony 3/23/02

[kathsmom]

Nicole,

I am sorry that I am late getting on the boards for this.

I am a non-practicing speech therapist, and like I told Beth, it was hard for me to tell parents news like this (when I was working).

I am going to be e-mailing you a little later today. I have to make lunch for my hungry DH and DD (she is out of school today for a holiday).

Toni - mom to Katherine (5/19/96) and Andrew (9/23/02)

[nofeea]

Hi Nicole,

Last time you posted about this I e-mailed you back since I wasn't a member yet. Now I am so...

I'm a SAHM and an SLP- speech-language pathologist (just resigned, actually, but hope to work again when my 4 mo. old gets a little older!). Sorry you got a lousy eval. Remember, any evaluator only sees your kids for a short amount of time and it's unlikely they can get an accurate picture of their skills even by interacting with them for the one hour. (That being said, they should have at least tried- not depended entirely on parent interview!) I think that a second evaluation really isn't necessary- sounds like your boys have at least some level of delay even if the severity is not accurate. If you start them in therapy, the therapist will get to know them better than any evaluator and will be able to get a more accurate picture of their skills and needs. There ARE good therapists out there so I hope you get luckier than with the assessment! Sounds like you're doing a great job with your kids- You're trying to get them the best services you can! Don't worry, the therapist may just help focus on certain target areas and give you some tips about how to maximize their language learning when you interact with them (ie.-use gestures while you talk to help them understand more, etc.) Try to stay positive- remember that the age ranges they gave you reflect only specific skills within language areas. I'm sure your boys do a lot of other things at higher levels (if I remember correctly from your previous post).

[megsmom]

Beth,

On the insurance front, one thing that really helps with reimbursement is not to have the diagnosis that goes to the insurance company be "developmental delay." This is very frequently denied. It is much better for it to say, "hypotonia" or whatever. I would check on this. A lot of peds offices aren't aware of this.

Did you also know that Sarah may eligible for free services coming to your home from the county? If you want some more info, I can get it tomorrow from work.

Jen
mom to Meghan 7/13/01

[egoldber]

Any info is greatly appreciated!

[megsmom]

I'm sorry for not posting earlier and am glad you are getting a second assessment for the boys. I'm a physical therapist and cannot imagine making any huge conclusions without observing the children. Especially with kids it can be hard to get a true picture since they often do tons more at home in a comfortable environment with their parents, but an attempt should have been made. I wonder, were the boys tested separately or together? I would guess this would make a difference.

Incidentally, my cousin's twin boys were slower to speak than their older sister but are now totally fine and on track (they are 3 now). My dd is the opposite, very, very verbal for her age with very clear speech and understanding and has been speaking in complete sentences for awhile now. People make a lot of comments to us, too (the lady at the church nursery asked my husband on Sunday if we were trying to make her a "baby genius") and we have done absolutely nothing out of the ordinary as parents to make Meg the way she is. I just want to assure you that you certainly aren't doing anything wrong or have somehow not done something. My little sister didn't end up talking much until she was almost 3 and later needed to get speech therapy to work on her articulation. She's an artistic genius, took calculus in college for fun and graduated from college a couple of years ago summa cum laude. She does have learning disabilities and auditory comprehension problems but has really overcome a lot. I think your boys will definitely turn out great too and will certainly benefit from all of your love and concern. The services from the school system will just be icing on the cake.

Jen
mom to Meghan 7/13/01