However, this summer we did a "take home" evaluation to determine if her speech was progressing normally, since she has been a pro at gross motor (our little monkey!). Due to funding cut-backs, our coordinator was trying to move us to "mail-in" evaluations so she wouldn't have to come out to our house for meetings. My sister (who has a degree in speech therapy) administered the test in August while Jon & I were on vacation and noticed some delays, especially in the areas of speech and problem-solving. We thought Hannah might have a bit of a speech delay because she didn't say many words but would babble a great deal, and Karen was pretty sure she could use some help. After the test was mailed in, we were contacted for a follow-up evaluation at our house by a certified therapist. This therapist spent well over an hour playing with Hannah and trying to get her to talk. He determined that she definitely had some delays and recommended that she receive home-based speech therapy.
Unfortunately, there is a waiting list for those services, and my sister who does this stuff for a living lives too far away!!!!! While we are waiting to be placed with a home therapist, Hannah is eligible for the "Bridge Program," which is offered after a referral but before a placement with a therapist. Due to my work schedule, it would have been difficult to get Hannah in much sooner -- but I took Thanksgiving week off and made an appointment for her Tuesday morning (they are only available for 4 or 5 hours on Tuesday & Thursdays of each week). I wasn't really sure what the appointment would be like...but figured it didn't hurt to use a free service.
Boy was I surprised when we weren't just met by our Help Me Grow coordinator and one therapist....but FOUR therapists all at once! We had an Early Intervention Specialist, a Speech Language Therapist, an Occupational Therapist, and a Physical Therapist. Wow!!
One of the most interesting things about having all of the therapists evaluate her at once was how they were able to tie certain "issues" together. For example, Hannah sometimes walks on her tip-toes. She also will stuff her mouth too full of food (but fortunately doesn't choke!). Then there is not using many words and also not sticking to any one activity for long. Now, many of you reading will think "well, all kids are like that," but the one thing about preemies is that they're tracked so much because doctors are still trying to piece together all of the issues that result from early birth. Some of her issues may be normal, but they'll be watched closer. Of course, none of these issues seem related to her speech. However, what the therapists pieced together is that Hannah has "sensory issues." She walks on her tip-toes to make her body work harder and get more impact when she walks. She stuffs her mouth to really feel the food, and her speech difficulties come from her needing all of her senses to learn.
Basically, Hannah needs input from a variety of sources to learn -- for example, she'd say the word "airplane" when she hears one flying above, but not when you point to a picture. I had actually thought the therapy session wouldn't produce much in the way of information because between our initial evaluation and the Bridge appointment Hannah started to use a lot more words. However, the therapists pointed out the way she learns and how that may be problematic with future schooling if we don't work to help her now. When she was challenged by the therapists in any way, she'd shut down her learning and become less receptive to information. She also moved from activity to activity much faster than typical for her age until the therapists used deep pressure on her to get her to calm down.
What I found interesting about the pressure was that when she was in the NICU we got all of these handouts about NOT using light touch because it aggravates preemies. Instead, we were only to use firm touch when we handled her in any way. No light stroking of her back or hands was allowed. Now, as a toddler, we're being told that same thing to help her concentrate on tasks. Either putting pressure on her shoulders, stroking her back, or even sitting "indian-style" and squeezing my legs together when holding her on my lap for storytime...It really helped her concentrate and focus on tasks.
I thought the therapy sessions were really interesting and I thought it was great to get tips on how to help Hannah learn in the best way for her. We just have to be deliberate about some of the things we do, but the therapists think she'll eventually work through her problems. In July, our school district will follow-up with us to see if Hannah meets the criteria for 3-year old preschool. Although it seems WAY early to me (since she's not even 2 yet!), they've found that sometimes the extra year of pre-school helps kids with sensory and other learning issues to prepare for pre-school so they are better prepared to succeed. If she doesn't qualify, then she'll just be on tap for regular pre-school at 4 and kindergarten at 5. Hard to believe that is even on the horizon!!
Because I know some people might be interested in the types of things the therapists suggested we do to help Hannah, here are a smattering of the activities to help that the therapists gave:
- Have a large box of sensory materials for pretend play & dump and fill
- Encourage imitation of action words
- Try to get her to complete tasks and add more time spent at tasks (especially unfamiliar ones)
- Attend Toddler Storytime at the public library
- Use simple sign language along with verbal words
- Use gestures as much as possible to give her more information
- Use fun sounds with exaggerated facial gestures as much as possible to make her more likely to imitate
- Try facial massage before tooth brushing and eating
- Use "heavy work" activities (i.e., carrying bags with stuff in them, pushing or pulling wagons, etc., moving chairs or books, obstacle courses, moving like animals, using large gym balls, etc.) along with movement to help Hannah's need for increased input - to help with regulation of her attention, affect, and activity level
- Use tactile exploration at times to help her work on processing tactile information
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