Sam's Speech, 30 months

If you were to take a peek into Sam's world these days, you'd find a boy that is more vocal than ever! He may not be making discernible words, but when we sit back and look at where we started and the growth he's shown over the last year, he's really come a long way. I really feel like he's starting to blossom these days, in new and wonderful ways. In fact, his speech pathologist commented that he seemed more comfortable in his own skin at his last appointment. I love that. I love that other people are seeing that, too. Maybe he's figuring it all out.

When he's not thinking about it, he's actually quite chatty. Common babbling includes the repetition of sounds such as ab-a, on-a, neh, good (remember that one?), da, uh, duh, ma, ba, pa, deh, tuk, guh, ott and more. This is more sounds than he's ever made, and he's even starting to combine sounds. On rare but exciting occasions he'll actually say a real word, and it's so unexpected that it really stuns and thrills me. Like his speech pathologist says, we think the words are in there; he just has trouble getting them out when he's thinking about it. She's heard him say her name (Amy), wash, rawr (what a lion says), and pop. Gramma has heard Grampa, and I have heard down, on, hush, good and mama (but he'll only say mama if you say it first; he won't call for me with it. For Dada he does the sign for Dada (open hand with thumb on forehead), but instead with both hands on his temples... apparently Daddy is a reindeer. Ha!) Technically, he has no consistent words but all promising sounds.
We continue to give him all the resources available to him and have really appreciated how our behavior therapist through the Help Me Grow program works so closely with our speech pathologist at the children's hospital. She will also bring along another HMG Occupational Therapist or Speech Therapist on occasion, who offer different observation and perspective on therapies.

This is what we've done for him the last 6+ months: Weekly social group. The Department of Disabilities offers an 8-week social group with other children his age. We started the first session in January and he was the youngest one in the class. By the end of the winter session he started to catch on to the routine so we enrolled him in the Spring session, which just wrapped up. We're considering taking a break from the summer session since Adam will be home for the summer with him. A quick visit to an ENT last fall to check to see if his frenulum (the tissue connecting the tongue to the mouth floor) was too tight and restricting speech. His was clipped at his newborn appointment but it can supposedly grow back, but the doctor didn't see it as a problem, nor did he believe it would affect not talking, just pronunciation. Strike that off the list. Follow-up evaluation at the Department of Developmental and Behavioral Pediatrics (DDBP) in December. This report was basically a compilation of his past ELAP exam and recent speech therapy reports, plus new observations. Nothing new to report, just that he's showing some progress but still has the deficits.  Started The Play Project (www.playproject.org) through the Help Me Grow program. This involves more hands-on training for Michael and I with two behavioral therapists. It's done in our house, often with video recording of our interactions with Sam, which are evaluated by other specialists trained in the program and then reviewed with us. The feedback is valuable to helping Michael and I make the most of our interactions with Sam. They really help coach/guide us to get more engagement from him. Through the program we've also learned a lot about sensory processing -- how Sam prefers to only eat dry or crunchy foods or foods that he recognizes, hates to have his hair washed, and dislikes getting his hands dirty. He also seeks vestibular stimulation through swinging, jumping, being squeezed/hugged, chewing on board books or clothing (for oral stimulation), opening and closing doors (particularly automated sliding doors), aligning objects in a row, and pacing along horizontal planes or picking up a linear option and moving it horizontally across his line of vision.  He becomes fixated on doors, and at his social group the organizer began covering the classroom windows because Sam just wanted to watch the automatic lobby doors the whole time. Twice a month speech therapy sessions. We felt for several months that he was really stagnant in development, but since the new year he has really shown progress. His play imitation is better than ever and his receptive language is much improved. Amy can now get sounds out of him where just a couple of months ago she couldn't get anything. It's always exciting to go to his sessions and see his progress. Weekly music therapy. We've been doing this about a month, and he does really great with it. Our therapist is also Adam's piano teacher, so she comes to the house for a half hour session with each of them. She carries in a keyboard, a guitar, and a bag full of scarves, toys, bells, drums, etc. I could do a whole post on the various techniques used, but all the songs require Sam to move, to make a sound, to make a prompt, to mimic, etc. This is another great way to engage and develop him. He particularly loves the songs using gross motor movement. ADOS-2 evaluation in April. This is an Autism Spectrum evaluation and was given with the general idea of ruling out ASD as a cause for the speech delay. Sam has a couple of "red flags" that his behavioral therapists were concerned about. These include the initial loss of language (he had babbling at 12mos but lost all verbal for awhile), obvious speech delay, and some sensory processing issues, as described above (which are exacerbated in unfamiliar settings, such as where the testing took place.) Results showed a "moderate to severe" concern that he may have ASD. The developmental specialist who conducted the evaluation said that "based on the impressions from the ADOS testing, autism spectrum disorder could be one explanation for Samuel's deficits in social affect, communication skills and functional play skills", but then acknowledged verbally that she wasn't convinced he has ASD. On paper, Sam was flagged as having ASD characteristics, but often his responses to certain stimuli didn't hold across the board for a typical ASD child. And the test didn't account for his many "green flags" of good eye contact, nonverbal communication, social interactions, etc. He seems to confuse the experts. We've been referred back to the Children's Hospital Department of Developmental and Behavioral Pediatrics, who just said for us to continue our therapies and they'll reassess when he's 3. Upcoming evaluation with the local school district. The school district offers a preschool program for 3 and 4 year olds, and if Sam qualifies for an IEP (individualized education plan, which he should for his speech), he would be able to attend for free when he turns 3. This would be 4 days a week, half days, and would include speech therapy, which he wouldn't get at a private daycare. Plus, he and Adam would be at the same school. I'm really excited about this opportunity for him, as I think being around more children his age every day will be really beneficial. They also help with feeding and potty training, as well. We'll know more after August. Annual Help Me Grow evaluation. His behavior specialist came to the house with a tackle box of objects, and like his initial exam last year, she asked him to perform various tasks like stacking blocks, finding the object, etc. We'll get a full report, but immediate results showed good fine motor, gross motor, adaptive and personal/social skills, with delays in receptive and expressive communication and cognition.

with his behavior therapist Mindy from the parent camera at Speech watching the lobby doors staring at the lobby doors through the gym door

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So, yes! A whole lot going on with our Sweet Sam! He's 2 1/2 now, and I'm constantly surprised at how independent he's becoming (and how big he's getting)! Here are some of his recent antics and fascinations:

• Loves to RUN! Our neighbors often get to watch us chasing Sam down to the cul-de-sac because he's taken off on an impromptu run once again. A couple of them have helped "catch" him for us. On the plus side, it's been a great way to get to know the neighbors!

• Loves opening doors, often opening and slamming them over and over, sometimes at 6:30 in the morning. If the door swings closed by itself, it's even more fun (until he's stuck in the closed garage in the dark). He is also getting skilled at unlocking doors, which is a problem around the house, and we're having to get smarter about locking the front and back doors because he will escape. (Then see point 1.) He loves automatic sliding doors, and when we go anywhere that has them (which is most stores) he will wriggle out of my arms and race for them. Once I manage to pull him away from them he's constantly watching for them throughout the store.

• Recently he's discovered he can open the refrigerator and freezer. We store our milk in the door, at his level, and he'll sometimes come to me lugging the carton, which is really cute. What is not cute is finding refrigerator contents sitting out on the kitchen floor.

• Has started using sign language without prompting. (This is really exciting!) Typically he'll sign more or all done when he wants to continue or stop an activity. It used to be he'd do this only if we ask him but now he'll do this on his own. Most often he'll use more and all done when he's strapped into a swing or his high chair.

• Blows kisses with the "mmm-ah" sound! And the other day Michael said, "I love you!" and Sam blew him a kiss in response. He is a great cuddle and each morning he comes into our room, climbs up on our bed and lays right on top of me.

• Sometimes changes the intonation of sounds to sound like words. He may say a high-low sound for Thank You or a "uh-huh" sound for yes, without actually saying words. For a while, his No was a definite, firm (and rather rude!) grunt, but he only uses this occasionally now.

• When you ask him to say something specifically he has trouble but he can prompt us verbally. It's usually "pah" or "bah" whispered. Hopefully he'll begin to realize he can tell us things or that a verbal response is expected. 

• Is much more aware of his environment and responds. If he hears someone say Mama (and not to him as a directive to repeat it) he'll repeat it. If he hears a song that he knows he'll stop what he's doing and do the motions.

• Loves to throw rocks in the river, which has progressed to throwing mulch on the patio. He recently tried to throw decorative river rocks into a friend's swimming pool. He giggles the whole time. (See video below.)

• Typically does most fine motor skills left handed and more often than not, points to objects with his left thumb.

• His biggest passions, I think, are running, doors and the swing. He will swing until you get tired and he recently discovered the rocking chair is similar movement. Lately he wants to sit on my lap to swing and I love this cuddle time! (I usually get tired long before he does.)

• Loves to play baseball. He'll place a ball on the tee and then swing a bat to hit it. Over and over again. Or he'll chase down Adam's fly balls.

• Loves music -- Wheels on the Bus, Monkeys in a Tree, Monkeys Jumping on the Bed, Speckled Frogs, Ring Around the Rosie, Itsy Bitsy Spider, Happy and You Know It, Row Row Row Your Boat, Wiggly Jiggly Car Song, Head Shoulders Knees Toes -- all songs that are interactive and involve gross motor.

• Loves playing with his brother and is starting to play along side him more. They particularly love to rough-house (ka-boom, hammer down and jump/throw on the couch) or chase each other. When playing alone he's typically lining up objects (shoes, cars) in a row or realigning my picture frames to the front edge of the table.

• No more pacifier! He chewed holes in his and they became less desirable. I tossed them and he hasn't seemed to notice. He still likes his little blanket-giraffe for bedtime and will often suck on it or his shirt front instead. We're trying to break that habit next.

• He may not be able to say it, but he sure knows how to show us what he wants by bringing us objects, or leading us to something, or placing our hands on an object he wants or needs help with... particularly shoes. He'll bring you his shoes as indication he wants to go out and he'll bring us each of ours to put on, too. If in the garage he'll stand by the car door as indication he wants to get in and go anywhere you'll take him.

I read a book called Late Talking Children, which profiles other families who have had their child in evaluations, speech therapy, specialists, etc., and all to say the child is completely normal, just speech delayed. Many of these children don't really talk until 3 or 4 or even 5 but otherwise excel in all other areas of development, sometimes beyond typical development for their age. It's been comforting to know that, while uncommon, his behavior is not necessarily abnormal. Likewise, when we had Adam IQ tested I mentioned to the psychologist that Sam was speech delayed, and he interrupted me to say that some of the delayed children he works with are extremely bright and don't start talking until 3 or later and often in full sentences. As our therapist put it, we're hoping he's just speech delayed and not language delayed, which would have longer lasting impact.

I know we are headed in the right direction, and I'm so excited to watch him on this journey. Here's a couple videos of him in action. He has the best laugh!