Speech: week 2

Monica noted that Dominick seemed more organized yesterday. He made good eye contact, especially when signing "more" when he wanted more toys, and sometimes he signed it without being prompted first. He also helped clean up each toy when Monica asked him to. She said these improvements could have been because he knew her better this time, but she wonders if some of the OT might be starting to work. Again, Monica stressed that until the OT really gets going, progress in speech will be slow, so she recommended bombarding his sensory system with lots of messy play, swinging, bouncing, etc. Speechwise, we still need to try to get Dominick to start imitating sounds. So far, nothing.

I do think there is some progress being made with the sensory integration. The biggest change is in swinging. Dom has gone from hating it and fighting getting in the swing to swinging for 50 minutes nonstop today. He wanted to keep going, too. He also loves going down the slide on his new swingset. And I noticed that he's starting to play with his food more, which might not normally be a good thing (and admittedly, it's hard to think of it as a good thing when there's spaghetti all over the kitchen door). These are all signs of improvements, but Dom still hates having lotion put on--he cries when he sees the bottle--or his teeth brushed. I'm really curious to see how the brushing protocol affects these issues.

When Monica was here, I asked her if she thinks that Dom won't talk or can't talk. He can make the sounds but doesn't use any actual words. For example, why is it that he can say "daddy," and he knows Mike is Daddy, yet Dom doesn't put the two together and refer to Mike by that name? Monica said her take is that Dominick can't as a result of all the sensory problems. She said it's rare for toddlers to refuse to talk.

Occupational therapy

Today was our first OT session with Robin. The focus was really on meeting Dominick, observing him, asking questions, reviewing his OT evaluation with me, and coming up with a strategy. We decided to concentrate for the next week on the tactile issues that are bothering Dom. We need to make sure he has some form of messy play every day, using food, Play-doh, shaving cream, etc.

Following Robin's suggestions, I started this morning at snack time, by giving Dom some applesauce and repeatedly dropping his spoon into it so that he'd have to reach in for it. It wasn't a problem for him. I made the mistake of using a spoon that has a looped handle. Next time, I'll use a smaller, flat spoon and make sure it gets really covered in applesauce.

Then we did Play-doh. Robin had mentioned putting little objects in the Play-doh for Dom to pull out. I used a wooden sun from his bead-stringing kit, a small straw, and a broken bit of crayon. The sun is big enough that the Play-doh wouldn't completely cover it, but Dominick did not want to dig it out. The straw and crayon were much easier for him. Then I buried them completely, forcing him to unroll the dough to find them. At certain points, he got upset if he had to touch it too much, or if I tried to touch him with the Play-doh, but by the end he was handling it a little more than usual. He still won't mush it with his fingers or anything like that.

Robin also wants us to use cups with a straw as much as possible. I've noticed that Dom never drinks as much from these cups, so he could stand some more practice. Note: buy more cups!

Another technique we might use is brushing/joint compression. Sheree did this briefly during her evaluation. Using a small plastic brush, she rapidly and deeply stroked Dom's arms and legs. I think he was more puzzled than anything, but he put up with it. Robin is going to bring more information next week, but I did find this link that gives an explanation:

http://www.slc.sevier.org/sibrush.htm

It sounds strange, but apparently it works.

Next week we are going to have Dominick eat during our session, so that will be interesting. We'll try to get him used to getting a little messier before then. Before I go today, I will post a new link for some general information about OT, for those who, like myself, don't know much about it.

New link

I just posted the link to the First Steps web site, in case anyone would like more information about the program. This was a little tricky to do, because unlike MSN Spaces, you have to insert actual computer code into your template in order to add links to the sidebar. It was a little scary looking at all that code, but I was able to figure it out without having to call Mike, who is obviously the computer expert around here.

First session

Dom had his first speech therapy today. Monica, the therapist, was really good with him. At first, he hid in his play yard, but when she brought out the toys, he came out of hiding. First she had him stack some blocks, then knock them down (as if he needed any urging!) and put them away. Then she gave him a couple of puzzles to work, holding each piece at her mouth to make him watch her as she said the animal's name and sound. He wanted to grab all the pieces on his own, but she made him do it one at a time. They did the same thing with Mr. Potato Head and some picture cards. Eventually, Dom decided he'd rather wander around and play with his own toys.

Until the occupational therapy gets under way (more on that below), we're not going to see major progress in speech, so Monica wants us to work on getting Dominick to imitate sounds. Words can be broken down as much as necessary. For example, if he can't say "moo moo," we can try "mmm-ooo," and then "mmm-ah," because that sound is easier, and then just "mmm." Monica also wants him to do more signing. As it is, he can sign "more" and does so regularly, but he's shown no interest in other signs that I've tried to introduce. Even things like waving, giving high fives and copying finger play are good, if we can get him to do them.

Another idea she mentioned was using an electric toothbrush or vibrating toy to stimulate his mouth and cheeks. He'll love that! Part of the sensory integration issue is that he absolutely hates having anyone mess with his mouth or face, so toothbrushing, nose wiping, face washing, and the like are major ordeals for us.

Also today, I heard from Robin, the occupational therapist. We arranged to have OT sessions on Monday mornings at 8:30, beginning next week. Dom's going to be a busy guy, with therapy twice a week in addition to playgroup. The great thing about First Steps is that everything is done here at our house: the initial meeting with the intake coordinator, both evaluations, the IFSP meeting, and ongoing services.

In closing, I have to share something funny Dominick did at playgroup yesterday. He had gone into a separate playroom off the main space where we were all hanging out, and I went in to check on him and found him sitting in Reilly's Exersaucer. I have no idea how he got in there by himself! He's never had one, and it seems that climbing up into the center and getting your legs through the holes without falling over would be really difficult for a toddler to do, but he did. Quite impressive.

Today's milestones

Three things happened today:

1. Dominick copied horizontal and vertical lines, something he didn't do during his OT evaluation. I was very proud.

2. He shook his head for "no." Previously, he's done this weird thing where he jerks his head and says "da!" for no, but this was the first actual head shake. Again, I was very proud.

3. He tried to jump off a book. This was something we'd tried to get him to do before, but he never even showed any interest. This time, he did, though he really just stepped off quickly, one foot at a time. It was very cute, and I was proud of him for trying.

Also, we went to the park, and after much struggling and fussing on his part and much forcing on my part, I succeeded in getting him into the swing for 11 minutes. He just hung there, leaning against the front of the swing, legs dangling straight down, as he was swinging. I wish he could enjoy it. Last week some other little kid about his age was riding in the swing, and he was laughing and smiling the whole time. I want Dom to have as much fun.

First session scheduled

Dominick's speech therapy sessions are set for Wednesday mornings at 10:30, starting next week. We are still trying to arrange for an occupational therapist. The one we really wanted (based on a recommendation from a friend--thanks anyway, Jenny!) is not available, so Carol is working on finding another.

After finding out that "W" sitting (with the knees in front and feet to the sides) is a sign of low muscle tone, I went back through the digital photos of Dom that we have on our computer. He's been doing this for a long time, at least a year. He sat on his own at seven months, and those earliest pictures show him sitting with his legs in front, but by a year, he's starting to sit in a W. He does it almost all the time now, unless he's in a highchair or playing with his Leap Pad on his lap.

Something else we realized after the OT evaluation is that Dom is really not very active. He prefers to sit or lie down and play quietly than to run around. When I take him to open play, he spends most of his time lying around or hanging on me. One thing we are supposed to do is swing him 10-15 minutes a day. He's never liked swinging. At best, he tolerates it, and at worst, he hates it, but I did get 11 minutes out of him on Friday at the park. As I write today, Mike and his friend Greg are building a swingset in the backyard. We had planned to get one anyway, but suddenly it became more important to do so. Dominick had better play on the thing! Other suggestions for getting him moving were roughhousing and bouncing on a large exercise ball, so we've been doing those things, too. I'm really curious to see how the OT sessions go. This is all very new to me.

Our journey begins

It occurred to me that a blog might be the easiest way to update friends and family on Dominick's speech and occupational therapy, so here it is! I'll try to post at least every week.

On Friday we learned that Dominick had been found eligible for First Steps, which is Missouri's early intervention program for children up to age three. Today we had our IFSP (Individual Family Service Plan) meeting. In attendance were Carol, our intake service coordinator at First Steps; Sheree, the occupational therapist who evaluated Dominick; and Brandie, our Parents as Teachers educator; and of course Mike and I. Bridget, the speech evaluator, was out of town but sent some written comments. Dominick was there too but spent most of the time quietly hiding in his play yard.

We went over the evaluations and discussed all of our concerns regarding Dominick's lack of speech, which is what prompted us to contact First Steps. Only during the eligibility process did we learn of his oral motor development and sensory integration issues. When these were brought to our attention, the signs became much more obvious to us. We had to state our goals and priorities for the treatment, which can only go until the day before Dom turns three, at which point he will transfer to the special school district if necessary. The speech and OT evaluators each recommended one session of therapy per week.

The next step is to choose therapists from the First Steps provider directory. I am working on this now, hoping to give Carol some names as early as tomorrow so that we can start services as soon as possible. I'm excited to think that we may soon be hearing some actual words from our very brilliant two-year-old.