JTsMom
10-14-2008, 12:44 PM
Two original threads are here:
http://www.windsorpeak.com/vbulletin/showthread.php?t=295950&highlight=speech
http://www.windsorpeak.com/vbulletin/showthread.php?t=299164&highlight=speech
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Today we finally had Jason's eval through the school board. It went really well, and basically, they decided he does not need any type of intervention at all. Instead, they suggested a few really little things to do at home.
Just to recap and expand a little on the previous threads, we also had him evaluated through are local children's hospital, and their findings were somewhat different.
First, we did a speech eval. I was not very happy with the SLP, and I felt like she was more focused on my parenting than Jason's speech. He did not want to work with her at all b/c she was very harsh and yelled at him during the first few minutes, and then he shut down. Her eval was not complete, but she concluded that he had some minor speech issues which would likely resolve once we took care of his sensory issues. In person, she told me she would hold off on speech therapy, but in her written report, she rec'd it once a week.
According to her report, she placed him 1.5 standard deviations below average. Some of the specifics she included in the report were understanding pronouns, understanding lengthy linguistic info, categorical info, rotely learned language skills, and a few phonological process errors.
Since then, his speech has improved dramatically. He is using a lot more unique phrases, and has toned down the echolalia quite a bit. His understanding of Wh questions is improving as well.
Next, we did the OT eval for the sensory issues we were concerned about. The SLP felt strongly this was the main issue. I never did post about the OT eval, but it went much better than the speech one. The OT was great. Jason really enjoyed the experience, and I felt like the OT really understood my concerns, and ofered some really helpful suggestions such as signing him up for gymnastics.
Her (typo/grammatical error laden, so insert your own sics) report states "Jason is demonstrating mild to moderate sensory processing difficulties demonstrated by vestibular and tactile defensiveness... Jason also demonstrates being functioning within the poor performance in fine motor skills. Jason appears to have self-Regulation/Arousal deficits...Per the Peabody Developmental Motor Scales-2 (PDMS-2) standardized test, Jason is demonstrating below average grasping skills (standard score: 4) and below aveage visual motor integration skills (standard score: 6). It is recommended that Jason to receive short term hospital based skilled occupational therapy services to address the concerns."
(Yes, those errors really are in there) I cut out a lot of the paragraph that just explalined what each of those things mean.
In the second part of the report, she goes into more detail- I'm just going to summarize.
Tactile- dmonstated symptoms typically seen in children w/mild to moderate tactile sensitivity or over-responsive to tactile input (tactile defensiveness)
Proprioception-Jason was observed to crave proprioceptive input.
Vestibular-Jason appears to demonstrate mild vestibular sensitivity-postural insecurity. A lot of this observation had to do with his dislike of being tipped backwars.
Self-Regulation/Arousal System-Jason appears to demonstrate mild to moderate difficulties with self-regulation.
Motor planning- Questionable
Auditory-Mild to moderate, but this is iffy, b/c she inserted another child's info into his report. The major concern with Jason imo is that he seeks out loud noises, and has a hard time tuning out irrelavent sounds.
Visual-No concerns
Then there is the Peabody Developmental Motor Scales info:
Grasping Raw Score=40, Age Equivalent=14 months, Standard Scores=4.
Visual-Motor Integration Raw Score=103, Age Equivalent=29 Months, Standard Scores=6
Fine Motor Quotient=70
6-7= below average, 4-5 is poor.
70-79=poor
Some of the things he could not do were imitating a bridge design, copying a circle (he can draw circles, but he doesn't stop at one if that makes sense), imitating a 4 block design, and cutting paper in half- he can cut a little, but not totally unassisted, and not an entire paper)
She recommended OT once a week for 3-6 months, along with the gymnastics lessons, and a strong home program. She also rec'd "a Therapeutic Listening Threapy Program by a certified occupational therapist to enhance attention, self-regulation, motor planning and body coordination".
So, today everything checked out- he scored very well on the motor portion of the eval. This really threw me, so I shared the reports, and the special ed people were pretty shocked by the differences. I'm not sure if all school systems use the same testing, but their form says Batelle Developmental Inventory, and here are his scores:
Adaptive Raw=22, Cut Score=21
Personal-Social Raw=28, Cut=21
Communication-25/22
Motor-26/20
Cognitive-20/20 (the lower score here was attributed to attention. He really wanted to play with some of the toys they had, I have no concerns with his cognitive abilities, and neither did the evaluator)
Each evaluator we worked with commented on how well he pays attention when something interests him, and how he absolutely refused to pay attention if he wasn't interested.
*************************************
So, there's my mini novel. LOL
My question now is what do I do next, if anything? Is there something I'm missing? Should we see a developmental ped or neurologist? The major thing that I believe everything is pointing to is the self regulation/arousal issues mentioned in the OT's report, and really, that is the thing that has been, and continues to, make life at home difficult.
There is new research showing that kids who have open heart surgery at a very young age often exhibit behavioral issues (and speech issues FWIW). These things are attributed to the time they spend on the heart-lung machine. Several cardiologists have told me they just don't know what that time on the machine does to children's brains, and frankly, until recently, these kids did not live long enough to figure it out. Anyway, I really do believe that the surgery likely had some effect on the challenging behavior issues that we have, and if it's due to something neurological, and there's anything we can do about it, I definitely want to know.
Another factor to keep in mind is that DH had pretty severe ADHD issues as a child.
I guess I'm just concerned that I'm missing something, and that I don't know enough to know what that something is.
I'm planning on maxxing out our 20 visits per year with OT. The SLP from today's eval strongly rec'd not doing speech at this point- she felt like it would be a waste of time. Honestly, I trust her opinion more than the original SLP b/c I think she got a better sense of Jason's abilities.
So what else? You all have been right on in all of your advice so far, so I'm all ears.
http://www.windsorpeak.com/vbulletin/showthread.php?t=295950&highlight=speech
http://www.windsorpeak.com/vbulletin/showthread.php?t=299164&highlight=speech
********************************************
Today we finally had Jason's eval through the school board. It went really well, and basically, they decided he does not need any type of intervention at all. Instead, they suggested a few really little things to do at home.
Just to recap and expand a little on the previous threads, we also had him evaluated through are local children's hospital, and their findings were somewhat different.
First, we did a speech eval. I was not very happy with the SLP, and I felt like she was more focused on my parenting than Jason's speech. He did not want to work with her at all b/c she was very harsh and yelled at him during the first few minutes, and then he shut down. Her eval was not complete, but she concluded that he had some minor speech issues which would likely resolve once we took care of his sensory issues. In person, she told me she would hold off on speech therapy, but in her written report, she rec'd it once a week.
According to her report, she placed him 1.5 standard deviations below average. Some of the specifics she included in the report were understanding pronouns, understanding lengthy linguistic info, categorical info, rotely learned language skills, and a few phonological process errors.
Since then, his speech has improved dramatically. He is using a lot more unique phrases, and has toned down the echolalia quite a bit. His understanding of Wh questions is improving as well.
Next, we did the OT eval for the sensory issues we were concerned about. The SLP felt strongly this was the main issue. I never did post about the OT eval, but it went much better than the speech one. The OT was great. Jason really enjoyed the experience, and I felt like the OT really understood my concerns, and ofered some really helpful suggestions such as signing him up for gymnastics.
Her (typo/grammatical error laden, so insert your own sics) report states "Jason is demonstrating mild to moderate sensory processing difficulties demonstrated by vestibular and tactile defensiveness... Jason also demonstrates being functioning within the poor performance in fine motor skills. Jason appears to have self-Regulation/Arousal deficits...Per the Peabody Developmental Motor Scales-2 (PDMS-2) standardized test, Jason is demonstrating below average grasping skills (standard score: 4) and below aveage visual motor integration skills (standard score: 6). It is recommended that Jason to receive short term hospital based skilled occupational therapy services to address the concerns."
(Yes, those errors really are in there) I cut out a lot of the paragraph that just explalined what each of those things mean.
In the second part of the report, she goes into more detail- I'm just going to summarize.
Tactile- dmonstated symptoms typically seen in children w/mild to moderate tactile sensitivity or over-responsive to tactile input (tactile defensiveness)
Proprioception-Jason was observed to crave proprioceptive input.
Vestibular-Jason appears to demonstrate mild vestibular sensitivity-postural insecurity. A lot of this observation had to do with his dislike of being tipped backwars.
Self-Regulation/Arousal System-Jason appears to demonstrate mild to moderate difficulties with self-regulation.
Motor planning- Questionable
Auditory-Mild to moderate, but this is iffy, b/c she inserted another child's info into his report. The major concern with Jason imo is that he seeks out loud noises, and has a hard time tuning out irrelavent sounds.
Visual-No concerns
Then there is the Peabody Developmental Motor Scales info:
Grasping Raw Score=40, Age Equivalent=14 months, Standard Scores=4.
Visual-Motor Integration Raw Score=103, Age Equivalent=29 Months, Standard Scores=6
Fine Motor Quotient=70
6-7= below average, 4-5 is poor.
70-79=poor
Some of the things he could not do were imitating a bridge design, copying a circle (he can draw circles, but he doesn't stop at one if that makes sense), imitating a 4 block design, and cutting paper in half- he can cut a little, but not totally unassisted, and not an entire paper)
She recommended OT once a week for 3-6 months, along with the gymnastics lessons, and a strong home program. She also rec'd "a Therapeutic Listening Threapy Program by a certified occupational therapist to enhance attention, self-regulation, motor planning and body coordination".
So, today everything checked out- he scored very well on the motor portion of the eval. This really threw me, so I shared the reports, and the special ed people were pretty shocked by the differences. I'm not sure if all school systems use the same testing, but their form says Batelle Developmental Inventory, and here are his scores:
Adaptive Raw=22, Cut Score=21
Personal-Social Raw=28, Cut=21
Communication-25/22
Motor-26/20
Cognitive-20/20 (the lower score here was attributed to attention. He really wanted to play with some of the toys they had, I have no concerns with his cognitive abilities, and neither did the evaluator)
Each evaluator we worked with commented on how well he pays attention when something interests him, and how he absolutely refused to pay attention if he wasn't interested.
*************************************
So, there's my mini novel. LOL
My question now is what do I do next, if anything? Is there something I'm missing? Should we see a developmental ped or neurologist? The major thing that I believe everything is pointing to is the self regulation/arousal issues mentioned in the OT's report, and really, that is the thing that has been, and continues to, make life at home difficult.
There is new research showing that kids who have open heart surgery at a very young age often exhibit behavioral issues (and speech issues FWIW). These things are attributed to the time they spend on the heart-lung machine. Several cardiologists have told me they just don't know what that time on the machine does to children's brains, and frankly, until recently, these kids did not live long enough to figure it out. Anyway, I really do believe that the surgery likely had some effect on the challenging behavior issues that we have, and if it's due to something neurological, and there's anything we can do about it, I definitely want to know.
Another factor to keep in mind is that DH had pretty severe ADHD issues as a child.
I guess I'm just concerned that I'm missing something, and that I don't know enough to know what that something is.
I'm planning on maxxing out our 20 visits per year with OT. The SLP from today's eval strongly rec'd not doing speech at this point- she felt like it would be a waste of time. Honestly, I trust her opinion more than the original SLP b/c I think she got a better sense of Jason's abilities.
So what else? You all have been right on in all of your advice so far, so I'm all ears.