When to worry about speech delay? (sorry long)

[maestramommy]

Okay, I guess I should preface this by saying that Dh and I aren't really worried, but I wonder sometimes if we should be. Dora isn't saying any words yet. She says "nanana" for banana, but that is literally it. She knows about 5-6 signs, and uses them very well and constantly. Someone posted a link to ASHA or something like that a couple of days ago, so I went to look at it. In reading it I see that as far as the talking column goes, Dora has been consistently a few months later than all of her peers. For example, she said "hamamam" on her 6th month birthday, but hardly every babbled after that. There was the occasional "adada" but the constant repetive babble never really took off until 12 months. At 15 months, the ped was concerned that she didn't even say mama or dada yet, but since Dora seemed to be trying to communicate during the appt. and was already using signs she said it was fine. Well, her 18 month appt is coming up in one month (we got a little behind) and I have almost nothing new to add. In the 1-2 years column for speaking I ended up answering no for every milestone.

One thing I did notice at the ASHA link was that in the 1-2 years column for hearing that Dora's listening comprehension is much more complex that what was described. In fact, she seems to have no trouble understanding what we say to her. Beyond the simple commands, she understands longer statements, suggestions, and requests that go beyond the "put the ball away," or "go get....". Here's an example: one day she brings a Pooh pullout book for me to read. The first pullout has become detached from too much pulling and often gets separated from the book. I noticed that it wasn't there when she brought the book and said, "Oh, the front cover is missing. Where is it? Can you find the front cover?" and I show her the book. She stands there for a second then leaves the room. 30 seconds later, she comes running back all excited with the first pullout. So I know there's A) nothing wrong with her hearing, or B) her receptive language. Lately she also points to things, and says "dah!" and I can no longer just imitate or say "oh really?" it pisses her off. I have to either name the object, or say something about it, even though I know she knows what it is. Reading to her is no longer a passive activity. She wants to point to pictures and have a conversation about it, even though all she says is "dah!"

So I know from this forum that many kids don't start talking until age 2. By that do you mean, no discernable words at all? Do they have their own words for objects like the "nanana", or just nothing? Dora has been a pretty quiet kid from day one, so Dh thinks it's just inherited (we're both introverts and our house is pretty quiet, considering). If we go to our next well check and the ped start nattering about her lack of speech again, my initial game plan was to say I wanted to wait until age 2 to see what happens. Is that too long?

[LarsMal]

Landon had his 18 month appointment a couple weeks ago. He was hardly saying anything at the time. The ped even gave him credit for "ouch" (more like "oww") because he actually used it (once) when he fell down! She told me if his receptive language seems to be on par then he is just fine. She also told me there isn't any need to worry until he is 2, but if he isn't saying more by 21 months, and I become concerned, she'll give me the name of an SLP to meet with. My undergrad is in Hearing & Speech and I've talked to a friend who is still in the field- we both agreed that if he is understanding what we say and is able to communicate in some way (a few signs, grunts, points, whatever) then he is fine. The speech will come soon enough. I'm not concerned at this point.

Landon is like Dora in that he understands *everything*. He can follow more extensive directions, and we are always amazed at what he remembers from day to day. He can say "mama", and he'll point to me if someone says, "Where's Mommy?" but he has still not *called* me Mama". He communicates mostly through grunting, pointing, and a few signs. If we are looking at a book, he will point to a picture and says, "uhh" (I think it's a cross between Tim Allen from "Tool Time" and Astro from "The Jetsons"!!). If we ask him to name a picture it always comes out "Moo", but to him he really just said "ball" or "cup"! (Oh...someone told me that animal sounds count- FYI)

I would definitely talk to you ped about it, but know that you are not alone. Most of the kids I know that are in this age range aren't saying 20 words (I think that's what the guideline is for 18 months).

Good luck!

[almostamom]

Personally, I would go ahead and see if you can have a speech/lang eval done before she turns 2. Please know, it's not because I think that Dora is incredibly behind. Her expressive speech sounds much the same as my DS' was at that age. He was identified as delayed, but his receptive speech was nowhere near Dora's at that time. Here's why I think you should have it checked out now though. My DS' eval was done last May. We are still on waiting lists for speech therapy through Early Intervention. Yes, 10 months later, we are still waiting! Early Intervention covers ages 0-3. Just in case your DD could use a little help, I would hate for you to have to wait as long as we have and not receive any services she qualifies for before she turns 3. I know we're in different state (I'm in AZ), so the situation could be quite different where you are (CA, right?) I just don't think it would hurt to have it checked out sooner. BTW, We have had DS in private practice speech therapy since last June and he's showing some definite progress.

HTH,
Linda

[sidmand]

I would second Linda's statements...if you are *at all* concerned, it doesn't hurt to get an evaluation. Once they "age out" of the system at 3-years-old, it does become more difficult to get the services they need. Under age 3, not only is it easier (for the most part), but they have more time to work with them, if necessary.

It's very hard to hear and very hard to think about, but I was in a similar position a few months ago, and as people said to me, it doesn't hurt and it might help. An evaluation is mainly a game to the little ones and it can either put your mind at ease, or help get Dora started if she needs any help.

I've wondered about people saying their DCs didn't start talking at age 2 as well (whether it was no words at all, or just a couple, but not a lot until age 2?). We had many people tell us not to worry since DS was a boy and boys are later/slower blah blah blah. At one point I wasn't sure he was ever going to talk! Now I'm thinking he probably will around age 2. Would he have anyway? Maybe, maybe not. We've been in Early Intervention for almost six months. Can I say with certainty that it has helped...no, but I can't say that it didn't. He thinks it's fun. After the initial shock to my own system, it's all been good. And it's nice to have the reinforcement of our EI group as well as concrete things to do with him to help him along.

Debbie
http://b2.lilypie.com/BI7Tm5.png

[masha12]

I think you have to trust your instinct. If you just "feel" like something isn't right, pursue it with your doctor.

That said, your description of your daughter's language and comprehension doesn't really alarm me. I don't know much about it, but I always view the age guidelines as a range; some kids will be ahead of curve and some will be behind.

My 16 month old really has no words except mamamamamamama when she is really upset. I am not concerned because it is apparent she understands me and she makes the "preverbal" noices (where it appears she thinks she is actually saying something but nothing that comes out makes any sense).

But, if in your gut you feel like something isn't quite right, follow through with an evaluation.

[lizajane]

dylan only said a few words at 18 months, and nothing clearly. the ped counts signs as words. and our ped wasn't concerned AT ALL. he hit the marks just AFTER the check ups. so at 18 months, they asked if he said however many words... by a month later, he did and more. at his 2 year, they asked if he used verb-noun sentences and refered to himself as "dylan" or "me." he didn't. within a month, he was using 3 word sentences and recognizing himself as dylan in photos and the mirror. (or really, dih-un.)

i wouldn't worry one bit, honestly.

[maestramommy]

Thanks for all the replies so far! I guess in my gut I would have to say I'm not alarmed. Mainly because in her own ways, she manages to communicate with us quite easily. She has her own vocab of syllables and inflections ("dah" could mean daddy, that, yes, Dora or backpack, depending on the inflection and what she's pointing to) to tell us something. She just doesn't have "words" they way they are defined as such. The other thing is that even though all of her peers have many words, they still have a lot of tantrums, due to frustration I guess (that's what their moms say, and that's the conventional wisdom, right?,, and Dora doesn't have tantrums yet, so either she's super mellow (she's not THAT mellow) or she manages to communicate well enough to satisfy herself. Does that make sense? The reason I wonder if I should be concerned is mainly because her peers are talking now, some of them have hit the word explosion, and I don't want to bury my head in the sand if there's actually a problem.

[gatorsmom]

My son's speech behavior was very similar to your daughter's. Minnesota has a fantastic state- funded program that my pediatrician told us to contact and I'm so glad I did. DS was babbling but not saying any words by 2.5 years. When I contacted the state program coordinator, they sent someone to test him and they started sending a speech therapist to work with him for one hour/week. The speech therapist worked with him for 6 months until he started a pre-school-like program geared toward children with speech delays that the therapist recommended. I can honestly say, that starting him working with a speech therapist was the best thing to do. I wasn't entirely convinced he needed help, but it has been fantastic for him. He used to get so frustrated when he couldn't make himself understood. And he loved playing with the other kids in the program and he LOVED the one-on-one attention from the therapists.

Often, it's hard to tell what the problem is IF there is in fact a problem until they are much older, and by then the problem has progressed so much they need much more help. Starting with therapy at this age means it doesn't need to be quite as intense. Anyway, it's just a good idea to have a specialist see her.

Lisa
Mom to Gator July 2003
And Cha-Cha July 2005

[brittone2]

Off to get the kiddos in bed but wanted to respond...

It does generally concern me when people don't become concerned about speech delays until a child is 2, for reasons the PP cited. EI services for 0-3 are generally much easier to obtain, and the system as a whole is a lot more warm and cozy than it is after 3. There are definitely benefits to getting an eval (and services if needed) before age 3. Waiting lists are quite common these days w/ the number of kids receiving speech services because of things like the epidemic of autism, etc.

The fact that Dora has great receptive language and is signing is wonderful. Both are really good signs. I will say that personally I don't think it is reason enough to skip doing an eval if a child has receptive language skills but not expressive language that is age appropriate. I've heard that argument often from parents, physicians, etc. but there are many diagnoses in speech that can manifest with a delay in expressive language w/ normal receptive language.

I'm not an SLP but I think things like oral motor issues can result in a delay in expressive language with normal receptive language. Lots of coordination issues w/ the mouth, etc. can result in delays in only the expressive domain. I think what is promising in a child w/ good receptive language is that it is less likely there is any cognitive stuff going on for example. I also think the fact that she can produce signs shows that the pathways in her brain are able to produce speech output, even if it is coming out as signing. Again, not an SLP, but from working w/ lots of speech people that's my general impression. The fact that you haven't noticed much of a change in recent months is a sign to me that it might be worth looking into more extensively. Also, the fact that you are describing her as generally pretty quiet. If she was making a huge variety of sounds, etc. I'd say there might be less concern about expressive language, but those things to me are signs that an eval might be helpful.

The thing with EI is that IMO, getting an eval at this point is helpful because most parents can't detect something like an oral motor issue on their own for example. Getting an eval gives you information to work with. SLPs certainly have tons of business these days in EI, so they certainly aren't going to see a child that doesn't need services. By getting the eval, you get a professional's opinion of what is going on. From there, you can decide whether or not to pursue services, assuming she'd even qualify in the first place. But you are making that decision based on the expertise that the evaluator can provide. If she doesn't qualify, the SLP will likely be able to provide you with suggestions on things to encourage her speech. The eval (and sessions) are largely play-based, and honestly, most kids really enjoy it. It tends to be emotionally tough on parents because they have anxiety about the results and the child's performance, but really, most kids like seeing the new toys the therapist brings along and they tend to like interacting during the eval.

If she does qualify, since her receptive language is excellent, there's a good chance that she'll only need therapy for a short period of time, so it isn't like you are committing to therapy indefinitely or anything. She may not even qualify in the first place.

Not sure if that makes sense since I'm rushing here, but I think it is beneficial to get a professional's opinion, and then go from there in making your decision about whether or not to pursue therapy. Getting an eval now stacks the deck in everyone's favor IMO.

[maestramommy]

This is really good to know. I think what I can do is if the ped brings it up again at her well check, to ask for an EI. As you and other pp said, it can't hurt, and at this point could be fun for her. Dora is making a much bigger variety of sounds these days, but it's all relative, so what I consider to be more sounds may still not "be enough."

[Wife_and_mommy]

You've gotten some great advice/info.

I never realized how close in age Dora and my ds were. He says maybe a couple words and signs only one word.

DH thinks something might be wrong. I fluctuate back and forth but after your thread, I'm definitely going to take him in. I thought waiting until age 2 would be okay. Glad to know now earlier is better.

Thanks for bringing this up, M.


http://www.gynosaur.com/assets/ribbons/ribbon_gold_12m.gif[/img][/url] http://www.gynosaur.com/assets/ribbons/ribbon_gold_12m.gif[/img][/url]

I love them most when they are sleeping.--Me
http://b3.lilypie.com/QaHxm5.png
http://b2.lilypie.com/UgAXm5.png

[janeybwild]

Just wanted to add our story. Dana is around 20 months now, and I could have written your post. Her receptive language is amazing, but almost nothing verbal. Except in the past 2 weeks she has exploded with words. New ones every day. She says words now I didn't know she even knew. Our ped had said if not 30 words by 21 months then he would be concerned and would recommend an eval, but he said don't be surprised if she suddenly exploded, and here we are. At her 18 month appt she had 2 words (mama and dada) and one or 2 funny sounding words like baba for bunny. HTH.

[egoldber]

What Beth describes is pretty much exactly the issue we had with Sarah. At 18 months she only had 1-2 words, but was babbling and had GREAT receptive language and *I* thought she was fine, just a late talker. I took her in for an EI evaluation (because she was also not walking yet) and it turns out that she had oral motor delay as well as overall low muscle tone. They weren't concerned so much about her lack of words as they were her overall sound repertoire. There were whole sound groups that she wasn't making that I had really never noticed. The SLPs were terrific, came to the house, and gave us tons of strategies for working with her. All free. :)

Fast forward to age 4, her speech is now fine, but she is still having low muscle tone and gross motor delays and what I suspect are some sensory issues. I want another eval done, but now the school won't even talk to me because of her age and her delays aren't severe enough. We did end up getting her services but had to go all private. Fortunately our insurance is covering most of it. But speech services, FYI, are generally not covered by most insurances.

Anyway, the upshot of that is I would have her evaluated sooner rather than later. It is SOOO much easier to get into the programs when they are younger.

[maestramommy]

Don't know if this differs from state to state (we're in CA), but how do you get an EI? Is it a recommendation made by the ped? Only one kid in my moms group got an evaulation, but the mom didn't say why he got one in the first place and how it came about. In his case they were diagnosing not only speech delay but possibly something on the autism spectrum.

[egoldber]

Ask your ped for the contact info. You don't need a ped referral, a parent can ask for a referral themselves. Sometimes having a ped referral can help, but it isn't required. The program is called different things in different states.

[sidmand]

I don't know how much it differs by state, but in MA anyone can call EI themselves. I think that for the most part that is the case, but I'm sure someone with better knowledge of CA can chime in.

For us, everything was right on target (some a little ahead, some a little behind), including receptive language, cognitive skills, etc. EXCEPT expressive language. And it turned out that DS has low oral muscle tone (and probably some sensory issues, although it can be very difficult to tell what is personality and what is a sensory issue sometimes!). I am very introverted and DS is very independent and does he get that from me? Or is it that he doesn't like the interaction with other kids. Hard to tell at this age.

But in our case the low oral muscle tone tied directly in to the lack of speech. And that makes total sense once they explained it, but it probably wasn't something I would have thought of. Also, when a speech therapist saw him, they noted that he wasn't moving his jaw to make sounds. No one had ever noticed that before. They definitely have an expertise that can be helpful. And it's amazing how many people I encounter who have used EI services for a wide range of delays.

This I know varies by state, but in MA the child needs to be delayed by at least 25% in one area to qualify for services (and I'm not sure how much it is if it's more than one area they are delayed in). At the time, DS was 66% delayed in expressive language, so he very definitely qualified! I was surprised, but like some of the PPs mentioned, I did have a gut feeling that there was more to it than just being a bit slow. I wasn't so worried at his 12-month checkup, and thought I wasn't at his 15-month, but then realized there were more things going on than I was consciously admitting to myself! That's when I called EI.

Debbie
http://b2.lilypie.com/BI7Tm5.png

[julieakc]

As Beth said you can ask your Ped. for a referral, but I don't think it's necessary (sorry, not 100% on this since our referral was done by the hospital due to DS's diagnosis).

Here in CA services (evaluations) are provided by your local Regional Center through the Department of Developmental Services:

Check out this link for eligibility information for infants/toddlers:

http://www.dds.ca.gov/general/elig_criteria.cfm

A speech delay alone does qualify, but it has to be "a significant difference between the expected level of development for their age and their current level of functioning. This determination shall be made by qualified personnel who are recognized by, or part of, a multidisciplinary team, including the parents."

At the bottom of the above link there is a link to "contact your local regional center" (there's an option to the right also: "directory of regional centers"), you can then search by County and zip code to find the one that would service you. Call them up and tell them your concerns.

HTH,

[julieakc]

On a positive note (for me), all of the responses have made me feel MUCH better about my own DS. Due to his syndrome (global low muscle tone being a major issue) delayed speech was pretty much a given, but hearing that many kids out there also were late bloomers makes me realize that although he certainly is delayed, the "real life" delay may not actually be as big as the "on paper" delay. His speech has EXPLODED in the last few months to the point where I am missing the days when he wasn't talking ;-)

[searchdog]

DD has been in EI since 12 months old. She had a year of PT and then also started getting ST at 18 months old. She still gets speech but is really close to age appropriate at this point.

For us our Ped referred us since DD wasn't crawling correctly at 12 months. I know here in Indiana, the ped has to approve the evaluation, so it might be just as easy to have your ped refer you so that he/she will know your concerns and not have an issue approving of the evaluation. Ours is not free in Indiana anymore but they have a scale they use. We pay a copay basically to the state for each therapy session.

[o_mom]

I would call now because my experience was 3-4 weeks before an evaluation and then another 4-6 weeks to get a 'plan' which you need before therapy can start. The wait can be longer in some places and ST has more kids in it (we were doing OT). You don't need your ped to do the referral, you can self refer and they would only need permission from the ped if they wanted to do a PT eval (at least in my state).

You always have the option of discontinuing at any point with no penalty.

[lmintzer]

Melinda,
Just have 2 secs here--have to take Joshua to preschool. I wouldn't worry! Sounds like she is doing great. She's understanding tons which is really a good sign.

Joshua said all of 10 words at his 2nd birthday. Now, at 3 years and 4 months, he speaks in sentences (full sentences with some telegraphic ones mixed in). He also SPELLS 25 different words. Yep, he's been listening to big brother--he'll be reading before he's speaking 100% fluently.

I know it's hard not to be concerned, but honestly, I'd give it another couple of months. She'll get there!

[juliasmom05]

Melinda,

You've gotten some great advice already. I guess I'm in the camp of getting an eval done sooner rather than later for many of the reasons already mentioned.

DD was referred at her 12 month appointment since she had no words at the time and had had chronic fluid in the ears for many months. Our ped's advice was to just get the ball rolling on the EI eval just in case the speech delay wasn't due to the hearing issues. In some places in can take quite a while to get services. It took us almost 4 months to get a ST. There is no harm in getting the eval. Even if she qualifies, you don't have to have services. It is entirely optional and you can stop when ever you want. I guess to me there are no negatives in getting the eval. If she doesn't qualify, then you can stop worrying, or if she does, you can choose to get her services at an early stage or get helpful hints from the therapists to help her on your own.

As everyone said, the eval is actually quite fun for the kids. For me it was it was both educational to actually see how they do the evaluation, but it was also a very emotional experience. It was very difficult to hear someone actually say that DD was delayed. But, after the initial eval, we have had nothing but positive experiences.

Good luck with your decision.

Marci

[brittone2]

Just agreeing w/ the PPs that you can self refer as a parent. No need to wait until a ped refers you if you are still concerned. You can call their office and ask for EI's contact info.

I know in PA it was in the government pages under the office of mental health and mental retardation, which always sounds terrible and scary, but it just has to do w/ where the funding comes from for services.

You may be able to find it online too.

One other thing...in reading through these threads, I think what jumps out is so many people will tell you that their child took off at age 2, had a big explosion in speech, etc. That very often does happen, but the catch is that IMO most parents can't very well predict which kids are going to catch up on their own. As several PPs mentioned, it often takes a few weeks to get an eval, and then a few weeks until services begin, so if you wait until two, you are losing time there, kwim?

I know in PA, once they were no longer 25% delayed, we had to discharge them basically immediately. My point in mentioning that is that if you start services (assuming she qualifies), get therapy for say 2 months and she has a language explosion, the therapist may recommend discontinuing services if there are no underlying issues (low tone for example). So you can start, and then if Dora takes off on her own, great, kwim? Again, IMO, nothing to lose.

HTH.

[KBecks]

Don't worry about your daughter being behind on the tantrum spectrum! Enjoy it while it lasts! :P

We made it to almost 2.5 and now have had and survivied the public doozies. Not sure if he's peaked the tantrum curve yet or not. :)

Oh, I should add our tantrums have absolutely nothing to do with communication...

[lilycat88]

Do you actually get bills? We kept expecting to get billed for Susanna's PT through First Steps and never did. We were at the income level where we should have been paying the max amount. Never saw a bill.

[o_mom]

Not Meg, but also used First Steps. We got bills for DS2's therapy, but it did take some time - a couple months or so after the sessions to get bills. For PT they may be able to get reimbursement from your health insurance, but you should still get an EOB. Also, the billing comes from a third party, so make sure you didn't overlook them. :-)

[o_mom]

The ped approval is only for PT, BTW, ST and OT can be evaluated and treated without the ped. (also in IN and didn't need ped for the ST/OT eval) :-)

[hobokenmom]

This is exactly how my kids have all been. They all said very little at 2, but by 3 were speaking in complete very understandable sentences.

My youngest is over 2 1/2, and just in the last month has he really started talking in that he repeats back everything you say, and he asks my husband "What are you doing?" about 100 times a day.

My older two were also like this, and are now straight A students in school.

[maestramommy]

Thanks Julie! I will look into this.

[tarahsolazy]

Similar story here. At 2 years old, Forrest could say maybe 5 words, and he never babbled or really made many sounds besides crying. A few animal noises, maybe, but no imitation, nothing like appropriate pre-speech stuff.

We had him evaluated at 25 months, and his expressive speech was at a 14month level. His expressive was fine, and he had around 50 signs. The ST was concerned that he had apraxia of speech, and he started therapy.

He then suddenly learned to talk over about 5-6 weeks. From 5 words to 5 word sentences. At 30 months, his expressive speech was at the 3.5yr level, so we were discharged from therapy. At 3, he speaks in paragraphs and will explain how Jupiter and Saturn are different from each other for you, and what asteroids are. So its all good.

I was glad for the evals, though, because if he had needed long term services for apraxia, being in the system around 2 would have been essential.

[BeachBum]

"At her 18 month appt she had 2 words (mama and dada) and one or 2 funny sounding words like baba for bunny. "


Just wanted to mention that my ped said that all "words" that your child consistently uses for things count as words, even if they aren't the real word. If he points at animals in the books and makes the sounds, those count as words etc.
My child is 18 mo, and probably has 60 "words", but I would say that only a few of those would be understandable to a stranger.





If my child had not met one of the guidelines/markers I would be beating down the door to get EI services. The way I see it you have nothing to loose, but potentially a lot to gain. I would need the peace of mind to know that I done everything I could to help my child. Particularly if there is a possibility of a long wait list, I would want to get a head start.

Having a delay is not a reflection of poor parenting, or of your child not being "smart". There is a whole lot more to a person than being "smart" anyway. If you feel like you or your child would be judged for seeking EI services then don't tell anyone.

My comments aren't directed at anyone person--I just feel like this issue of "should I or shouldn't I" comes up a lot. I just wanted to put my opinion out there. :)

[lilycat88]

You know...we never got a thing. I'm 100%% sure our insurance didn't pay either. We're pretty neurotic about keeping track of those things and look at every EOB and any medical statement. Working in the business end of healthcare, I know how many errors are made. Susanna's been out of PT since late Summer '05. Hmmm...

[brittone2]

ITA about the worries about a child receiving services...you would not believe how many kids get services. When I was working, often times in almost every development within a huge radius, *some* child was receiving some sort of service. I often had multiple kids in the same neighborhood, or knew of other kids receiving services in the same development (so I may have been providing PT to one kid, but the neighbor down the road was getting speech therapy). We were but one of several agencies that provided EI services in that area, so there were probably more. EI is of course all confidential, and in the agencies I've worked for the therapists drive their own cars, so there is no sign on the vehicles or anything like that. Many of the parents probably didn't even realize other kids in their neighborhood were getting services (unless they chose to talk about it) since it is all confidential info.

For many kids, I think EI simply provides a little jump start. Sure, they may get there on their own anyway, but EI is a little bit of an insurance policy that they won't slip through the cracks in case that doesn't happen. It can be tough to tell which kids will get there on their own, and which kids won't, even for a professional. It isn't a reflection that the parents somehow didn't "do something right" or that their child isn't smart :)

It is also nice that in the 0-3 population, the kids really do tend to enjoy the one-on-one attention from the therapist, it is play-based, the therapist brings new, fun toys and activities, and kids that age really IMO have no idea that it is actually "therapy" most times. It really looks more like an adult-child play date, to tell you the truth. Kids in the 0-3 group aren't self-conscious about it, and don't feel "different" because they get therapy.

Parents tend to sometimes feel like there's some sort of stigma, but truly, if they knew how common it was for kids to receive services today, they really would feel reassured :) Many kids just need a little jump start to get them caught up.