Speech Update: Four Years, Three Months

I received the written report from his most recent speech evaluation. (A post on last year's evaluation here.)

Bad News First: Overall, his expressive communication was pegged at two years nine months. Over the twelve months from May 2009, he only progressed five months. He scored a 63 on the expressive language portion of the Reynell Developmental Language Scale, a test in which the mean for his age is 100 plus or minus 15. So that's discouraging.

His deficits appear to stem from four types of issues: verbal/visual association errors, paragraph comprehension, semantic errors and rigidity. The examiner also observed "as expressive language tasks became more complicated and Brad was ask to describe pictures or re-tell narratives, he began to resist." Go figure. He's four years old!

Excerpted from the report, for your information and amusement:

Although Brad responded accurately with regard to production of grammatical skills, errors were noted in semantic abilities. For example, when asked to label an illustration of a group of men, Brad responded, "children." When shown a picture of several people trying to escape the rain and asked, "What's happening," Brad responded, "It's not raining." The examiner continued "It is raining. And the people are getting ____" and Brad responded, "frozen." He provided definitions for concrete or abstract concepts with inconsistent accuracy. When asked, "what's an apple - what do you do with an apple?" Brad responded correctly by showing the examiner eating. Error responses were predominantly reiterations of the targeted concept. For example when asked, "What does cold mean, "Brad responded, "I'm cold." Brad's motivation waned when asked to describe a group of illustrations depicting a family engaged in various tasks. He fell out of his chair and told the examiner that the task was "so so hard. It might take a very long time." With encouragement, Brad provided short sentences that in general described the pictures. For example, in response to a picture of a family washing the dishes, Brad responded, "She's making a recipe." In response to a picture of the same family setting the table, Brad provided, "He's making dinner." Brad substituted "he" and "she" pronouns thoughout.

The picture card sequence probe outlined in the language comprehension section of this report was used to assess Brad's formulation skills for sequenced activities. Brad experienced difficulty on this task. He repeatedly pointed out numbers on the cards that existed outside the illustrations. He appeared to focus on pictured details and neglected salient features of the illustrations. For example in the sequence that depicted a girl making her bed, the line that the sheet's border had created intrigued Brad. He ran his finger along this line and asked the examiner about the "rope."

That's Brad in a nutshell. Marching to the beat of his own drum. Falling behind in communication but getting ahead in numeracy.

As a parent reading the report, it was hard for me to figure out how much was attributable visual/verbal association problems versus semantics versus he's four years old and the exam was taxing on his attention.

The good news: The perpetual tough grader wrote:

In contrast to previous testing, Brad made several improvements in nonverbal and verbal pragmatic skills. During current assessment, Brad followed the examiner's gaze and engaged in joint attention.

He also did very well with object identification, sentence completion, syntax construction and pragmatic judgment, scoring within the average range for each of those assessments.

Quick Hit

Psychology today muses: Not Quite Autism - At the Borderland of ASD. (Hat tip or...er....belly rub...to GoodFountain.)

It's all there: intersecting spheres, blurry lines and a slew of vaguely defined conditions. I've resigned myself that this is all there is until and unless epigenetics makes a quantum leap.

Have a great holiday!

Epilogue.

Thanks for the well-wishes and the insight.

Brad actually passed his depth perception test. Imagine that. One result one day, and a different result six months later. Well that never happens! Except when it does.

At the end of the day, I've learned to place less stock in two-dimensional medical opinions, positive or negative, good or bad. The truth most likely lies somewhere in the middle.

Annual Physical.

Like most kids, Brad gets an annual check up around his birthday, which is in January. Two notable aspects of his most recent appointment:

• He failed the depth perception test. He passed the eye exam, meaning his eyesight, in the conventional sense, is fine. The nurse practioner administers a test with multi-directional Es and special glasses aimed testing depth perception, and he failed. Which means he wasn't trying, he didn't understand or, what I suspect, he has issues with ocular musle control and visual perception that interfere with depth perception.
  
• I unbundled one of his vaxes. Since, for better or worse, there is a "vaccine debate" (although I don't think the debate is debatable, meaning, I think it's well-settled that vaccines don't cause autism), I thought I'd share my views. Although I don't buy into the vax-autism link and I'm very pro-vax, I don't have a problem with a modified schedule, so I unbundled varicella from the other shots he received at his 4 year appointment. I don't follow the Dr. Sears modified schedule; I just follow my intuition, but in any event, I make sure he is fully vaxed - it just takes an extra appointment. I'm happy with my decision.

Why am I posting now? Because Brad goes for his varicella shot this upcoming week, and I'm going to have him re-tested for depth perception. I'll post the results. Wish him luck!

I'm Back.

Sorry for the prolonged absence. I'd provide a good reason but I don't have one. I just needed to focus on all of the rest of life's demands. I missed you all!

We're still here, and we're doing well.

Brad is coming along nicely. Still ever the joy to parent, mellow and happy as ever. I wish I knew what makes him so perpetually happy. I'd bottle it up and drink it myself.

On the cognitive front, he's reading now - not too shabby for a 4.5 year old. At this stage, it's beginner reading, mostly three letter words, but not just sight words or rote learning. He's legitimately sounding things out and reading new words. From a parenting perspective, our goodnight ritual is pure joy, with Jeremy and Brad taking turns reading kiddie books.

So I suppose I've been smelling the roses lately.

But all sun and no rain makes for a desert, doesn't it? On the speech/communication front, he was recently reevaluated by his private speech therapist (not the public school), and the results were not great. (Click here for his evaluation from a year ago.) His delay is still in the "severe" category for expressive communication. The SLP had expected him to progress to the "mild" category by now. But there were gains. The perpetually tough grader said he is showing a budding imagination. For those of you who want to understand how this is evaluated: "typical" children narrate a play scheme while they play. The first time Brad was evaluated, he didn't do this, but during the most recent evaluation, he did. But according to the SLP, he still isn't getting the big picture, choosing to focus on details and losing out on concepts and meaning.

On the motor front, he's progressing, I suppose. A big milestone: he can take off a shirt effortlessly now. He's pedaling, just on his big wheel. But he's as floppy as ever, and continues to be unmotivated to move, characteristic of hypotonia. He's been in a big boy bed for a year now, and he has never attempted to leave the bed on his own. Not once. He just waits for us to show up and tell him to get up. Maybe that's in part a routine issue. But still. The good news: he's overnight potty trained. Weird, right? He doesn't get up overnight to go potty; he just holds it in all night. This is me, not complaining.

On the physical front, his pigeon toed-ness seems to be getting worse, not better. His natural standing posture is with his feet twisted inward, a lot.

So what's new with you and yours?