early intervention: getting started (part 2)

Last night I posted a bit about Phoebe’s initial assessment for Early Intervention services. This is part 2. (If you are interested, you might also want to look back at what I wrote back at the end of November, and how we ended up getting the assessment.)

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As I mentioned, because of the time of year, it was several weeks after the assessment before our services got started.

In early January, we heard from the person who would be taking on our case. (I’m actually not sure what her specific qualifications were. And actually, I never thought to ask. But we’ll call her a speech pathologist.) She set up an appointment to come to our house for a first meeting to talk to us about goals, and to write up our ISP (Individual Service Plan).

At that time, our main concern was that, while she used quite a large number of different words to label things at her own discretion, and would occasionally produce longer utterances of her observations, Phoebe didn’t often use language to communicate her needs and wants. What was most difficult was that she would typically only ask for things by pointing, or sometimes just by becoming unhappy, and we would have the job of trying to figure out what was wanted. Most of the time, we were able to do this, largely through playing what was a lot like a game of 20 questions. Are you hungry? Do you want milk? Do you want the toy? Are you hurting? Those times when we didn’t come up with the right question, Phoebe would get frustrated. She would sometimes start making that sort of grunting/groaning toddler noise, and occasionally break down crying. Mind you, these times were few and far between, but we wanted to get past them. We knew, for example, that she could say the word (and in some cases the sign) for many of things that she wanted. But somehow, she was never willing to say them as a request.

This was the main goal written on her ISP: for Phoebe to make simple requests, using single words.

We also worked at that first meeting on getting a schedule for services. The speech pathologist would meet with Phoebe once a week, either at our home or at Phoebe’s daycare. Phoebe could also attend a weekly group at one of the program offices (either a parent-child group, or a “drop off” group). Since I wanted to be involved in the process, we got signed up for a parent-child group. I also wanted to be around for the one-on-one meetings, rather than have them take place at daycare. As it turned out, because of my tight schedule, we ended up scheduling our one-on-one meetings right after the play group, at the program building, rather than having a separate meeting at our home on a different day.

We did have one more home visit from the speech pathologist before starting the regular schedule. She came over with a bag of toys, and sat down to play with Phoebe. Because that was just what it seemed like. As they played, the speech pathologist used very short, simple sentences and repeated single words often. I was very impressed with how engaged Phoebe was right from the start.

The speech pathologist also left us with some suggestions for encouraging Phoebe to make requests. The main suggestion was to frequently give Phoebe a choice of two things. For example, when offering a crayon, we should ask “Do you want green or blue?” When she’d point to one or the other, we should use the single word, repeating it clearly a couple of times. I was a bit skeptical about how much difference this could make, but having seen how engaged Phoebe was during the meeting, I decided to work this into our daily routine.

It may well have been a total coincidence of timing, but we had a breakthrough shortly after. I wrote a post about it on my old “Phoebe blog” (which I used mostly to post updates for family and friends) on January 19th. Since that site seems to be broken just now, I’ll copy the whole thing here:

We’ve been working on trying to get Phoebe to express her wants to us more clearly. Phoebe uses a lot of words, but usually just to name things. She’s quite good at responding to questions, like “what does a dog say?” (“woof”) or “what color is this?” (“gee!”) or “do you want milk?” (“yup.”)

She has started asking for things that are just out of her reach. She will, for example, point to where we keep her beads and say “bee?” There has also been at least one time when she has wanted us to get her Bunny out of her crib, and she’s pointed towards her room and said her version of “Bunny.” However, she has been reluctant about making requests for things that she can’t see.

Today, though, we had an exciting moment. We were in the car heading home from a meeting in Boston, and having a snack of graham crackers. I asked Phoebe if she wanted some water. To which she replied. “No. Milk, yeah!”

(Unfortunately, we didn’t actually have any milk in the car with us. But we were at least able to acknowledge her request by saying that we would get milk later.)

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Okay, I’ll have to continue this again later. (It’s late at night once more.) Next time, I’ll write about going to the play group.