early intervention (part 4): getting up to speed

This is part of my series about our experiences in getting Early Intervention services for Phoebe’s expressive language delay. Phoebe started receiving services in January of this year, which consisted of one-on-one meetings with a speech pathologist, and weekly attendance of a parent-toddler group. For background, you can refer back to parts 1, 2 and 3. This post is a bit about the course of Phoebe’s language progress, and a bit more about what went on during the services she received.

(I should make it clear that the rapidity of Phoebe’s progress is not typical, and most likely not due solely to the EI services she received. I also can’t say how the service she received compare to those of other locations, and other kids. But here is what we experienced, for what it’s worth.)

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When Phoebe started EI services in January, she would primarily use single word utterances, with occasional utterances of 2 words or longer. Through the next couple months, we would get plenty of the 2 word utterances, like “eat cake” or “candles hot”, with more and more 3-word strings.

She was getting more and more comfortable making requests (which became more and more like demands). We tried to encourage her to request using a sentence, such as “I want X,” like the more advanced speakers at the playgroup would do, but she would only produce this reluctantly. She must have been giving this a lot of thought, though, as there was one early morning in March when she was apparently practicing in her sleep. I was startled (and amused) to hear the words “I want a cookie” ringing out loudly and clearly from the baby monitor. (And then she went back to sleep.)

By April, 3- and 4-word sentences were the norm, with more and more of the adult-like grammatical elements showing up. (She would regularly produce plurals and articles, for example.) More helpful to us, though, was that we were getting to the point where Phoebe could really communicate. She could tell us not only her wants and needs, but more information about her state of being. After she had been sick, it was really thrilling for us to hear her produce the sentence “tummy feel better now.”

In spite of all this progress, it was like she was a different child at the playgroup. She would often not say a peep for the first half hour of free play, aside from occasional single word responses to questions. Then at snacktime, she would only whisper her request, which was often only a single word even after she could make longer requests at home. Over the months, she would more and more often make the full-sentence requests that she’d make so readily at home, but very very quietly. Whenever Phoebe was particularly tired, such as after we’d returned from a weekend trip, she’d get even more quiet. Likewise when a new child (and accompanying adult) started in the group, or when a substitute group leader took the place of our regular person.

Things were different with the speech pathologist, J, when we’d meet with her for our one-on-one sessions immediately after the group. Phoebe would need a few minutes to warm up, but would gladly respond to questions and use her words. Our meetings continued to be play sessions, centered around various toys, and Phoebe showed no signs of believing them to be anything other than sitting around and playing with J. I’d sit with them and watch, and play, and sometime encourage Phoebe to tell J about something we’d done since our last visit. Phoebe tended not to speak in quite as complex ways as she did at home, but even so, J never failed to hear evidence of Phoebe’s rapid progress. Each week, I’d have some new bit of language development to report, and Phoebe would usually obligingly produce that construction, if not during that session, within the next one or two. Plurals. Articles. A range of negatives. Multi-word constructions. Past tense. Then full sentences with all the right bits in place. And then, suddenly, complex sentences with subordinate clauses.

Each week, J would write up a report for us of her observations of Phoebe’s progress, and recommendations for things to work on. She’d include a few samples of Phoebe’s longer utterances, which will be nice for me to look back at. She also would give me various handouts about activities we could do to encourage speech, and information about development stages. After the first few weeks, J said that Phoebe’s progress was steady enough that weekly one-on-one sessions were no longer considered necessary. However, seeing as Phoebe enjoyed these sessions so much, and I got a chance to observe the process in action, I asked if we could keep up the weekly meetings. J was happy to continue. (I also got her assurance that there wasn’t some other child waiting in the wings for an opening in the schedule, though.)

I don’t remember when it came up first, but the speech pathologist let me know that come our next assessment, which would be scheduled 6 months from the date we started services, Phoebe would no longer qualify for services.

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I’m still not done with this yet, though it’s getting closer. Next time, I’ll talk a bit more about Phoebe’s progress in the playgroup setting, and perhaps also about our 6-month assessment. I’d also like to share more about what I think that Phoebe got out of the Early Intervention services, and how it may or may not have affected her language development.

early intervention: starting to get into it (part 3)

Last week I started writing about our experiences with Phoebe and Early Intervention for a language delay. Part 1 was about the original assessment, and part 2 was about starting to work with a speech pathologist. (If you are interested, you may also want to see what I wrote before the original assessment back in November.)

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Some time in January, our speech pathologist told us of an opening in a parent-toddler group that we could attend on Mondays. I wasn’t sure what to expect from the play group. I hadn’t had a whole lot of interaction with groups of parents and toddlers.

The group leader, N., was a very friendly young woman who welcomed us warmly. The other parents were generally quite friendly as well, and all were supportive of all the kids in the group. There were about 8 kids in the group (each accompanied by a parent or other family member), with the number fluctuating a bit week by week. The first week we were there, Phoebe was the only girl at the group. Apparently boys are flagged for Early Intervention services much more frequently than girls. However, our group did have quite a few girls re-appear and join the group over time, as well. (In fact, at the last group we attended, there were more girls than boys. However, this was considered remarkable.) All kids were under 3, as services only cover kids up to 3. The youngest child was 18 months when we started, though I later learned that he was a “community child,” meaning a child not receiving EI services, and attending the group as a “model.” Most children were closer to 2. (Phoebe was almost 2 when she started.)

While I know groups vary quite a bit, here’s an overview of what went on during the group.

The group met for 2 hours, from 9 to 11 in the morning. Things started off with some unstructured time where kids could ease into things, and play with various toys set up in stations around the room. This gave adults a bit of time to chat (and thankfully, time to run late). The group leader, N, would also move around the room and chat with each child, and also with the adults to get progress updates. Other activities then followed, in a more-or-less fixed order: clean-up from the free play, snack time, playground time (indoor or outdoor, depending on weather), craft time, “circle time” (with songs) and then the good-bye. Each activity had it’s own routine and sometimes associated songs.

Because the group was geared towards working on expressive language and communication skills, the routines typically involved getting the kids to participate and communicate. For example, for the snack, there was always a choice of 2 snack items, and the child was encouraged to express their choice. “Do you want crackers or raisins?” N might ask, showing both options. And depending on the individual’s abilities and level, different answers would be encouraged. For most of the kids, a single word or sign was encouraged. (Some of the kids weren’t speaking, though all in the group were hearing.) Sometimes a “please” would be encouraged. For some kids, such as those just entering the group, pointing to the desired snack was enough. For more advanced speakers, a whole-sentence request was elicited: “I want crackers.” I remember being impressed by one little boy, who was almost 3 and had been attending the group and getting EI services for at least a year, because he could sometimes be prompted to ask: “Can I have crackers, please?”

Our own goal for Phoebe was to get Phoebe to make requests using single words. Even after she started making such requests with us, she was still very reluctant to speak in front of others. She would sometimes manage only to point, or only to whisper her choice in a single word. What was nice was that every attempt was greeted with encouragement and praise, and there was little pressure. If a child wasn’t up to making a request, a choice would be made for them and they would still get encouragement.

I swear that Phoebe loved every bit of the play group time. She was probably fondest of circle time, where we’d all sit in a circle and sing songs. Each child would get a turn, in the order of our seating arrangement, to pick between two toys representing songs: a spider, a fish, a boat, a bus, etc. Most of the songs (or at least the tunes) were familiar to me (and some to Phoebe), and a subset of the same group of songs would be chosen each week. All the songs had some sort of movement or gestures, so that kids could participate with their hands and feet. (Mostly the kids did not sing along, but the adults all did.)

Phoebe behaved quite wonderfully during the group, staying in her seat, following instructions, and observing everything going on around her. I think it helped that she had already been attending daycare, which also had a bit more structure than our time together at home. (I think Phoebe is also rather on the mellow side, as toddlers go.) The kids in the group varied in how well they could focus. A few kids would have trouble sitting still, especially by the end of the 2 hours. But for the most part, all the kids seemed tuned in for at least most of the group time.

While I was worried that I would find the whole thing painfully hokey, seeing Phoebe so engaged was really gratifying. And while she continued to be quiet during the group time itself, she started to show a lot of signs early on that she was really taking in the lessons of the group.

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Okay, I’m still not done. Next time, I’ll write more about Phoebe’s progress. And maybe about the one-on-one sessions. If anyone out there has questions about particular aspects of the EI services we received, please feel free to leave a comment or email me. (See the “contact alejna” page in the sidebar.)