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The Right Language Test and Therapist

Submitted by kim on Wed, 04/02/2014 - 15:20 in Augmented Communication, Nathaniel's Story

I have been kindling a dislike of speech therapists for months.

If I were perfectly honest I have been kindling a dislike of speech therapists since I was in elementary when I had to sit in a hot little rectangular room with four boys practicing my "s" and "r" sounds.

But my weariness of speech therapists has started to change.

Nathaniel's new weekly speech therapist suggested we start with an evaluation tool so we both understand what is expected of an average child with no delays or medical issues: The Rossetti Infant-Toddler Language Scale. Repeated testing of children irks me, and Nathaniel just had a language test a few months ago. But I was curious, so I agreed.

The Rossetti measures Nathaniel in six areas: Interaction-Attachment, Pragmatics, Gesture, Play, Language Comprehension, and Language Expression. This offers a much broader understanding of Nathaniel's language use than the developmental test he had at his one-year check up. The previous test looked at two areas only. He scored at sixteen days old in expressive language and six months old in receptive language. It was discouraging news.

Next the new therapist suggested we evaluate the communicative function of each developmental goal. This happened sitting on my living room floor amidst papers and toys and thinking together aloud. I like to think together aloud with people. Even strangers like new speech therapists.

Third, she asked, "Can Nathaniel physically do this?" If the answer was no, she did not count it against him but rather marked it such.

She explained, "If a child doesn't have arms, we would never count it against him that he can't clap. We would decide if clapping has an important communicative function. Some might argue yes, clapping is an important skill. It conveys approval and support. We would then find a way to help this child with no arms covey approval and support. Perhaps stomping his or her foot. If we decided no, clapping is not an important skill for this child, we would simply eliminate clapping from the child's list of expected developmental milestones."

I seriously wanted to hug her right in the middle of our appointment yesterday.

So we looked at the goal; we looked at Nathaniel's limitations; then we looked at how and if Nathaniel has already met the communicative function of the goal in his own unique way.

For example, a typical language expression of an average three month old is to vocalize to express pleasure. Nathaniel can't vocalize, but he does alter the rate and intensity of his breathing which creates noise in his trach tube. He tends to breath rapidly and loud when he is excited. So in his own unique way, Nathaniel vocalizes to express pleasure. We checked that box!

And a lot more boxes!  We found a couple things to work on in the nine-twelve month list. But we also checked off numerous boxes in the twelve-fifteen month list. As she was leaving the therapist told me that if Nathaniel did not have a trach, he probably would not qualify for speech therapy.  His overall language delays are not grossly significant for a sixteen month old. Granted, sixteen months is when children start talking and without speech therapy he is going to fall drastically behind fast. But rethinking the starting line is huge. He's not at sixteen days old in language expression! He's a slightly delayed sixteen month old on the verge of talking.