| The Quiet Child |
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| Written by Sue Mahar | |
| Thursday, 14 December 2006 | |
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Speech and Language Milestones Not To Be Taken For Granted. One evening, last year, my spouse and I were chatting during a weeknight dinner. We raised the topic of our second child's upcoming 2nd birthday. Our 5 year-old son was so verbally proficient that, honestly, it was a bit of a relief to have a quiet child for a second child!. We hadn’t even thought of issues with it at all. Like many families with a ‘quiet', or 'shy' child’, we never suspected anything until now. The first call I made the next morning was to my trusted pediatrician. She recommended a speech and hearing evaluation. The second call I made was to the Dr.'s recommended Speech and Audiology Center. I cleared it with our insurance carrier. The preliminary testing would be covered. Because I called when I did, I was given an appointment that had just become available later that same week.
Six weeks earlier, our son had an ear infection, which burst his eardrum. After recovering from the ear infection, he resumed normal activity. The Audiologist tested and concluded there was hearing loss and further suggested a neuro-sensory issue. The Speech Pathologist, during a 40 minute consultation in her office, had suggested I count his words. He had about a dozen words (and a few of those were a stretch). For the age he was at, 23 months, he should have mastered about fifty to seventy five words and begin to form sentences. It became apparent, he was far from that target. He couldn’t even say his own name. He used the same sounds to mean many things. “Dee” and “Cee” were used for multiple things. It was clear, though, that he understood everything just fine for his age, but he couldn’t verbally express himself far beyond that of a one-year old. The Speech Pathologist suggested the ‘Early Intervention Program’ and gave me the contact information. The Early Intervention Program is a state funded program open to children under the age of three. Insurance is not needed for the services they provide, though services vary from case to case. Family income determines shared costs, if any. Their service providers are extremely qualified and experienced. Upon returning home, I called the office of my county's Early Intervention Program as suggested. We arranged a preliminary standard meeting in my home to evaluate my son. Based on the Early Intervention meeting and the reports from the Speech and Audiology Center, it was evident he would need a hearing impaired teacher and a speech pathologist to get him on track. The Early Intervention Program Manager recommended my son to a specialized school for hearing impaired children. Again, time was on our side due to an unexpected opening and he was scheduled for the following week. In order to place my son in their program, the Speech School conducted a thorough evaluation with their team of professionals. I had no idea, really, what to expect from this evaluation. I didn’t even ask my husband to attend. I treated it like a doctor appointment. I took both my sons with me, in fact. I was mostly excited and honored that my son was to receive this kind of treatment so quickly. My emotions were not yet involved. My sons and I were led into an observation playroom and introduced to several professionals; a Physical Therapist, an Occupational Therapist and two Speech-Language Pathologists. Two of the school administrators then went into the adjoining room with a two-way mirror to observe the evaluation. Each professional had specific tasks for my son to perform. By way of play, he was tested for gross motor, fine motor, oral motor, communication, cognition, self-help and social/emotional. My kids had a good time with their play tasks as I tried to answer a barrage of questions by the study team. Some of the questions took me off guard. “Does he drool?” “Does he prefer smooth or crunchy textured food?” “Does he shove food into his mouth?” “Does he make eye contact?” I hadn’t even thought of these things as something to look for. I couldn’t answer all of their questions fully. It started to overwhelm me. During the ninety-minute evaluation they determined that he was 25–33% developmentally delayed in three areas. By the end of the session, they had consulted each other and informed me that he qualified for their program and would be accepted into their parents participation group for 2 hours a week until his third birthday. So, the good news was that he was to have highly specialized teachers, but I couldn't believe that he had to. I became numb. I remained numb and overcome for several days. It all progressed so fast that I hadn’t really discussed it with most of my family or friends. Within a period of just about three weeks, we went from suspecting nothing, to several evaluations, and classifying our son as a 'Special Needs' child. One afternoon, a few days later, it hit me. The house was quiet during nap time. I stared at the pile of reading material given to me by all the specialists we had seen. I stretched out on the floor to release some tension. A minute later, I just started sobbing. In fact, I could barely stop for 2 days. “What was I crying about?” I would ask myself, “After all, a developmental and speech delay was not a life threatening condition”, and, “I should be handling this better.” Seeing the other kids at the school, observing him in an entirely new way, the symptoms that were overlooked till now, the possibility of autism, the challenges ahead, that’s what made me cry. Finally, after letting it all out, I was done sobbing. I still cry about it from time to time, but that was a cleansing kind of cry. I needed it. So, I brushed myself off and accepted the challenge. Basing everything on 'what is right' and 'what is good', we forged ahead with the help being recommended and offered to us. I set up a schedule with the speech school for group and individual therapy. Four hours a week, every week until he is three years old. In addition to setting up his group and in-home sessions, I had him checked by an Eye Doctor and ENT (ears, nose, throat Doctor) as recommended by the study team. The eye doctor gave him a clean bill of visual health. The ENT, however, recommended tubes in his ears. We wasted no time and had them done. Almost instantly, we noticed a difference in our son’s ability to hear. The tubes helped clear the fluid in his ears and immediately improved his hearing. Until the tubes come out (about a year) he has to wear earplugs every time he is near water. Water play and regular baths with earplugs are manageable, with my son's cooperation. My close friend, who lives out of state, asked if I knew about Apraxia. I knew nothing. She had been dealing with apraxia in her second child. She knew the signs to look for in a 'quiet child'. She began to tell me more about Verbal Apraxia. Open to multiple theories from friends and relatives, I replayed that conversation in my thoughts for several days. After a while, just dismissed it because I knew I wanted a name for what we were dealing with. I felt like I was looking too hard for a diagnosis. I just didn’t think it was ‘Verbal Apraxia’. Three months later, a Speech Therapist was included in the weekly sessions. She said "He is ‘Verbal Apraxic’'. I was stunned. My close friend (who lives out of state) was right! I wasted no time in emailing my friend with the news. She really was not as surprised as I was, then pointed me in the direction of an informational website. She knew the first thing I needed to do was learn more about it. I learned that my son indeed fits the description of the verbally apraxic child. This recalls the Audiologists' suggestion of a neuro sensory issue. Apraxia is, in short, a condition where the brain is working properly, the oratory muscles are working properly, but the message from the brain to the muscles gets jumbled and words don’t come out as they should. The child becomes withdrawn because they are aware of their struggle and requires special training to speak and communicate properly. We are not to insist our child say words. This can be tormenting for him. We prompt him by simple sign language and sounds (ppp for please, mmm for more, etc.) until it becomes more natural for him. It is our goal to get our son ready for Kindergarten in time. By starting speech and language therapy with the Early Intervention Program, he will have the confidence he needs for his primary school years. There are specialists in the field of teaching apraxic children to speak. The Prompt Institute is one such institution. Certain professionals are Prompt certified on level one, two, three four and five. Five is the highest qualification. (Please refer to www.Apraxia-kids.org , www.Promptinstitute.com and to www.Cherab.org for complete information) Many families with a quiet child just accept their child as they are, with love and concern. They are mostly unaware this treatable condition. They may experience more yelling, hitting, frustration and shyness from their child because of an expressive language deficiency. You may hear lots of people say, “my brother didn’t talk until he was 4!” or “Einstein didn’t talk until he was 5!”, implying you have nothing to worry about. With an understanding of my son’s condition, at this early age, I am able to help bypass the frustration and failures that many kids experience simply because they are misunderstood by their expressive language. Quiet kids often struggle in school and social situations. Being quiet is commonly considered a personality trait. Though it may simply be a personality trait in some kids, it could be an indication of a child’s personal struggle. Whatever the explanation, it’s worth exploring. Now my husband and I are looking forward to our son’s third birthday in a few months. It has been quite a year of frustration, worry, learning, discovery and understanding, but because of our proactive measures, we are also on track with his development and growth.
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After dinner, the conversation got serious. We looked at our adorable, strong little tike and realized that he had been struggling to communicate. He was, in fact using sounds, not words, to speak. He used made up words like, 'dee' and 'cee' and used them universally for 'house', 'car', 'yes', 'cat', etc. He would pull and point when he wanted something. We realized together that he wasn't meeting his verbal milestone. What seemed like nothing more than baby talk, suddenly got our attention. | < Prev | Next > |
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