Eliza Grace was born on March 15, 2006, at 26 weeks, 4 days, weighing 1 pound 4 ounces and measuring just 11.5 inches long. She is the light of my soul and this is the story of our life in the big city.

Sunday, October 4, 2009

Informal Three and a Half Year Evaluation

Before you get your knickers in an uproar and accuse me of pretending to be a developmental pediatrician or an OT, PT or SLP, I did use the word "informal" in the post title. But really, after 3 years of evaluations a reasonably observant parent can figure out the highlights of some of the testing.

Block stacking is a perennial favorite at evaluations. I think it is fair to say that Eliza has mastered that skill:





She even admires her own work:



Eliza continues to fail the "let's pretend" test with the wooden cake and babydoll. Personally I think Eliza should be exempt from this one since not only would she never consider eating a birthday cake, she certainly is smart enough to figure out that this one is tasteless:



Which brings us to the dreaded speech evaluation. As I suspected, my playground observations confirm that virtually every neurotypical 3 to 3.5 year old can converse with the basic "who, what, where, when why and how" questions. Typical playground conversations involve parents yelling: "who's truck is that and where did you get it?" with the 3 year old answering: "it's Sally's and she gave it to me." The second part of this answer may well be a lie since very few three year olds part with their trucks in the sandbox. And we all know that every three old worth her salt has asked "why" enough times to make her mother head to the wine cellar.

Not so at Casa de Eliza. Eliza is sorely lacking in pragmatic speech or what is also called social language.

Eliza has a large vocabulary and for example, can identify many dozens of animals, can tell the difference between a crane, eagle, flamingo, scarlet macaw, dove and lovebird. But ask her if she went to school or what her teacher's name is and you get a big blank stare. Eliza can answer questions, but you quickly realize many of those answers are simply parroting the question. For example, "did you color at school?" gets the answer "I color at school." By the same token "did you go parachuting at school?" gets the answer "I parachute at school."

How do you teach a child to communicate and not just recite words? How do you get a child to converse in even basic ways? And if the child can't really do that, how do they ever learn to socialize with their peers? Feel free to post any pearls of wisdom.

15 comments:

Tasha said...

I am not exactly sure. Would she engage in social play with you? Maybe you could model it for her? (however, that may result in parroting back to you). Hmmm..I'll have to think.

Jenny G said...

We have the same ongoing in our home. Verbal Behavior has done wonders. I'd love to give you more info if you'd like. Not sure how to contact you other than through comments.

Jenny G said...

Also, check out Hanen's Program, More than words. www.Hanen.org I believe it is. Short course about ASD, but great for working with speech issues realated to social language and pragmatics.

isaiah's mama said...

These are the same issues I am running into with language developement with my child, it is so frustrating!

Anne, Eliza Grace's mom said...

Hi Jenny,

I try to incorporate a lot of the Hanen approach/philosophy when communicating with Eliza. I think she limits her conversational engagement with people other than me since she has poor articulation and has to keep repeating herself to be understood. Even at 3.5 years old, that becomes exhausting.

I would like to get some more info from you. My email is ealizagracesmom@yahoo.com. How old is your son/daughter?

Thanks,

Anne

Jenny G said...

Anne,
I'll email you, so you have my email. Do you facebook, too?

My daughter just turned 3. My daughter is verbal with mostly pragmatic issues causing social impairments. My son, is 20 months..my preemie. Which is how I came to find you and the blog while he was in NICU. He's progressing well, but we're never "in the clear" right? So, we have him in early intervention therapies to make sure we don't miss something he needs.

Hanen is like a cliff notes version of it all. I still glance at the manuals occasionally, but the admit I've been stuck with my nose in a few books while glazed over my computer screen to keep up with any info on how to keep her (and him too of course) progressing well. I agree with you about how hard it can be when they are trying to communicate with others. Especially since their style of communication is not "typical" to a stranger. Our family and close friends have learned how to understand her "scripts" and we are able to encourage more spontaneous language while modeling a variety ways to say whatever she is trying to tell us. The pronouns are so hard I admit. So much, I probably cling too much to using our names instead of pronouns..trying to get better at this so she can be exposed to how to use them.


The Question words are coming along ok. Still much work needed here, but she is asking questions..that's good.

The best 2 interventions for her language development (outside of what we do at home with her) has been working one on one with a verbal behavior therapist (until she turned 3..early intervention services) and then we started her at a school that incorporates VB into a preschool setting (known as the "clinical classroom") She comes home with a report each day and I'm amazed at what she is saying/learning there. You are in NY..I think one of the "best" places with great programs. We're in Florida and sometimes it's a challenge.

Oops, sorry I started this comment and just realized it was getting really long. I'd love to help answer any questions or just to "compare notes" with you. I have a great community (and family) locally that is well-verse in these types of issues. If you are interested, I'd love to add you to our family blog readers. Mostly day to day stuff, but I'm trying to add more helpful info about therapies and "home schooling" type activities that help promote and improve language and social behavior. I keep thinking I'll start up a seperate blog, but for now it's all in the same place :)

BTW, I love your blog!!

Anne, Eliza Grace's mom said...

Jenny,

I would really like an invite to read your blog! I am also on Facebook, but will admit to be singularly lame at actually locating people on FB! Since you have my email, see if you can find me on FB. Otherwise you can just email me at my yahoo account. Of course if I had ever taken typing in high school, you would have known my email is elizagracesmom@yahoo.com and not what I typed in my last comment.

Between Eliza's articulation and communication issues, I often feel like one of those United Nations simulataneous translators when we are at family functions just trying to get my very large extended family to understand what Eliza wants. :)

Sarah said...

Saba - that's my suggestion and I'm sticking to it.

Consequently, the neighbor girl came over today, 6 months younger than E, and:
A. Said "Hi Sarah, where's Emmy?"
B. I told her he was inside and she said, 'can I go get him to pway?"
c. I said "no, he's in a therapy session right now.'
D. She said "I can pway, too!"

Yeah, language sucks.

Anonymous said...

Hello Annie,

We have been searching for a therapist(ABA) more than an year but never found one. The place where we live is very small and not lot of opportunities here. I am very much frustrated about not getting any help for my daughter. I mentioned to you in your earlier post that my child in in the spectrum and LIFE IS SOOOO DIFFICULT!Thank you for giving the suggestions about feeding therapies but it's hard to get one. If you find any help for Eliza about her pragmatic language issues please write down in the blog. You are very helpful and we love your blog.
One good thing is Eliza has been answering the question even she is repeating but at least she is not staring but I have to ask hundred times to get any answer from my child. It's very frustrating!

Kathy.

Anonymous said...

Hello Anne,

I need to ask you something if you please don't mind. When Eliza had her brain MRI done how the doctors sedate her? My daughter has severe anxiety disorder and she can't breadth and gets stiff and totally pale if the doctors ever want to check her ear.The doctor has been saying for a long time to do the endoscopy but seeing her extreme fear and anxiety she doesn't want to take any risk. Is there any way she takes medicine and sleeps and then they do IV so she doesn't know what the doctors are going to do? How Eliza reacted and how long they had to put IV in her before they did MRI?Was it very painful?Do you know any medicine which can make her hungry or medicine for stomach emptying? I don't know many people who have children with feeding problems and some medical issues and that's why I wanted to ask you but it really depends if you think it's appropriate to answer or not.

Thank you.

Kathy

Anne, Eliza Grace's mom said...

Kathy,

Eliza is not a "fan" of getting blood drawm and the last time it took four people to hold her down.

With the MRI (and with her earlier endoscopy) she was sedated first with gas and then they placed her IVs (which she immediately ripped out once she woke up and realized they were there). When the anesthesiologist gave Eliza the gas, I simply held her in my lap and I don't think it took more than 3 breaths before she was sound asleep.

Hope this helps!

Anne

Alison said...

my daughter was born at 24 weeks in April'06, she is about the same age as Eliza. We have gone thru 2 rounds of neurological testing using the NEPSY II. My daughter has a very large vocabulary too but also fails in the answering question part. She also had a keen understanding of phonics and can spell almost all 3 letter words and many 4 and 5 letter words, without adult support. The results from the neuropsych evals came back stating the "Emergence of a Learning Disability, specifically Non-Verbal Learning (NVD or NVLD)." Her super strength in some areas matched with significant delays in other areas (social, spacial, coordination and vocab pragmatics) have led the docs to suspect something greater than a general delay. I was panicked when I first got this diagnosis but now I have embraced the possibility and am working with her school to respond to the "potential emergence" of NVLD. We are going test my daughter again at 5 1/2 when the test becomes valid. Until then the best I can do is to foster her strengths and begin to challenge her weaknesses. I have asked the school to create a small peer group for her so she is forced to answer questions and respond to children her own age. It has just begun so I can't tell how it's working just yet. I'll keep you posted. Hope this helps
Alison

Anonymous said...

Hi Anne,

Thanks a lot for your answer.

Kathy.

Anne, Eliza Grace's mom said...

Thanks Alison. I would be interested to hear how the small peer group at school works out. Sounds like it is a good idea.

Natalie and Abigail said...

Anne - I LOVE the picture of Eliza at the top of the page. It is just beautiful. I think her pictures show so much personality.