a diagnosis...finally

Back on Jan 11, we shared our concerns about Riley's speech delay and our hope for a diagnosis in April when he was scheduled for an evaluation with a Speech & Language Pathologist at Children's Hospital. There was a 4 month wait list, despite having 13 SLPs on staff. So when CH called me Tuesday afternoon with a cancellation, we were able to see his SLP the next day. Her name was Katherine and she used toys and play to assess his expressive and receptive language skills. Riley was his normal, friendly, curious, sometimes very focused self. He warmed up to her quickly and though he got distracted often, he was able to be redirected back to the task at hand.

After the assessment, she brought us back in to her office for a summary of her report. We were greatly relieved to hear that she did not think that he had a motor planning disorder, such as verbal dyspraxia. Rather, she diagnosed a phonological delay which was impacting speech production. This is a part of the expressive language delay in which the typical explosion of speech that occurs at around 18 months and again at 30 months hasn't happened yet. With 80 single words and a few 2-word combinations, he doesn't have the vocabulary of a child his age.

Phonological development is the gradual process of acquiring adult speech patterns. All children make pronunciation errors (called phonological processes) when they are learning to talk like adults. These predictable phonological deviations are the way that children simplify the articulation of words. Some examples would be deleting the final consonant (saying "boo" instead of "book") deleting syllables (saying "nana" instead of "banana") or substituting one sound for another (saying "wuv" instead of "love"). All children use phonological processes and these are usually eliminated between the ages of 3 to 5.

It was important to us that Katherine used the term delay instead of disorder when describing Riley's problems with speech production. Children who are delayed use speech patterns typical of a child who is younger. In other words, they continue to develop, but at a slower pace. A disorder would mean the use of speech sounds which are not appropriate for any aged child -- an atypical developmental pattern. At 2.75 yrs, Riley's using speech patterns that are typical of a child under the age of 2. Also, his intelligibility is quite a bit lower as he's using more phonological processes when he does speak.

Another related issue that had been identified by EI is oral hypo-sensitivity. Riley's not an extreme case, but he has exhibited some of the signs of decreased oral sensation such as:

• drooling and putting non-food objects in his mouth beyond teething age
• stuffing his mouth with food
• pocketing food in his cheeks
• biting on fork/spoon/straw when eating

When he was still drooling last November, we bought him an electric toothbrush to help increase his oral awareness and the drooling stopped within a month or so. The other symptoms still remain so this issue will affect his ability to articulate his sounds correctly too. An OT patient of Jonathan's recommended a couple more tips for us as well. One was to use a toothbrush to "wake up" his mouth prior to eating and another was to use a variety of oral massagers, vibration, and textured materials/objects for stimulation. We plan to incorporate these things into his "home therapy" in the coming weeks.

While no one can predict how successful speech therapy will be in overcoming Riley's speech issues, Katherine said there's reason to believe his prognosis is good. We left CH feeling very encouraged.

I can't close this out without saying how incredibly grateful we are that God has placed us in a city that is world renowned for it's medical research and expertise. One of my friends commented last week that had we lived elsewhere his arm seizure and stroke may not have been diagnosed so quickly, if ever. Because of that experienced NICU nurse who "happened" to be helping me with Riley's first nursing, we have had our son under watchful care since then. His neurologist recommended EI at 18 months and referred us to the SLP at 30 months. How many kids don't get the help they need because they lack the close observation that Riley has been so fortunate to have? We are blessed and lucky, thanks to our sovereign and loving God who gives us all that we need.

Shelby