Speech Therapy and Pacifier Banishment

Henry finally started speech therapy the beginning of December. He is doing very well so far and we are already noticing improvements. He really responded well to Gwyn, the therapist that came to our home twice a week. The sad part is, it took us so long to get him in the system that he had to transition to a new therapist when he turned 3. Now he only gets one 30-min session a week with Mr. Martin. But he seems to do well in a "clinical" setting, meaning fewer distractions and he focuses well. And we finally quit the pacifier just after Christmas. It was rough for a few nights but we got through it. And naps are hit and miss now so that's less of an issue that it was before.

It's been an interesting few months learning where Henry stands and what he needs.

For those of you not intimately familiar with our little man, here's his back story. And maybe our small adventure can help another family in a similar situation.

When Henry was an infant, he had a strong interest in the pacifier and would want to have it in his mouth, but he couldn't hold it in no matter what tricks we tried. At all his early well-baby check ups I mentioned this to the ped and they would check out his mouth and say he was fine or that they'd never heard of that scenario before and say he'd grow out of it, etc. Finally around 7-9 months he could keep the paci in without us having to prop it. After that, he would keep it in his mouth whenever he could and we were pretty lax with trying to save it only for naps/bedtime. Maybe this had something to do with it, maybe not. My gut says yes.

He is a very smart sweet boy and had fun learning baby signs around a year old and continued with the dozen or so that we introduced. He wasn't saying a whole lot of comprehensible words by 18 months, but because he was a boy we weren't overly concerned. We also moved around that time and had a new baby in our family so he got more time with the paci during the day than he would've otherwise.

At his 2nd year well-child exam I expressed concern about his lack of coherent speech with our new pediatrician. Her answer was to get rid of the pacifier and that boys can often take longer. But I felt like there was something more to his delay and wished there was something else to do besides wait and see. In hindsight, I wish she would've said, "If you're really concerned, talk to the Early Education Office through the county schools or Far Northern Regional Center to have him evaluated." But she didn't. Most likely because she didn't know.

A few more months passed and I finally got around to emailing a couple friends about resources to try and they both suggested going through the local school system. By the time I got around to contacting them, the school year was just ending and whatever request I submitted didn't seem to get to the right place. Finally in September I called back and was given the name and number of the coordinator for the under 3 kids. Within a week of calling her, she was at our door and evaluated Henry on all his abilities. His speech score was extremely low, as was expected. She mentioned that his strong pacifier use wasn't necessarily the cause for his oral motor delay, but often is a compensation for something else that isn't doing right. Something about regulating. This made us feel a little bit better! We also had his hearing checked by an audiologist so it was on record that his hearing was perfect and not a contributing factor.

Finally he was evaluated by the speech therapist and she was able to zero in on his lack of muscle tone in his tongue and lips: flacid is the technical term. Plus the open bite from the pacifier usage. : ( The first test she did with him she couldn't even get a score because nothing he said matched up with what she was asking him. He also drooled frequently and had developed many compensation techniques for getting what he wanted. The most obvious: forcefully pulling on our hand/finger/sleeve until we followed him and we tried guessing what he wanted.

By the time this report was submitted, it was another few weeks before we met to discuss an IFSP so he could start therapy. All the while, his window of time for at home therapy dwindled to a couple of months. In hindsight, it's not the end of the world that he didn't get therapy sooner, but I'm sure he'd be saying more coherent words by now if he'd started at 2 years instead of 2 years 10 months!

It's hard to convey a kids personality and abilities in writing like this. Henry is a smart bright boy. He hears the smallest sounds and looks for tiny airplanes in the sky and loves finding bugs and watching them (or dragging me by the hand to show me what he found). He's always saying things and getting excited about things around him. But his inabilty to make more than vowel and B, N, T, etc sounds and not be able to connect them kinda limits his communication.

He really enjoyed working with Gwyn and getting to play with bubbles, balloons, blowing toys and other therapy exercises. And of course he loved the fun toys she brought that he'd get to play with as a reward after the exercises. (The girls liked this part too because they got to join in at the end!) Now he goes to the speech therapy room at the Early Education Offices by the county schools. I think the setting is good for him since there's not "home" distractions and he gets to go do something fun away from the house, just like Evalyn gets to go to preschool. I just wish he could get two sessions in a week but the county is really short on therapists/tume. If you know any speech therapist out there looking for a job, let me know!

Just before Henry turned 3 we met with the county to do his ISP. Gwyn had coached me a bit going into it and answered a lot of questions for me. So when I was concerned that he didn't qualify for any preschool services (because we don't qualifiy fininancially for the state prechool program and his only impairment is speech) I asked for them to put that in the notes. And again when I was concerned about the small amount of time he would have for therapy each week, I made sure they put that in the notes as well. Depending on how well he does in the next 5 months, maybe those issues won't matter. But I wanted to have them in the notes so that IF by June he's not improving with his plan, I have grounds to say "Look! I think he needs more therapy time. Or: It might help him to be in a preschool environment a couple days a week to learn how to communicate with people outside his family or be more stimulated with language."

The thing that Matt and I both felt coming out of that meeting was: the middle class really gets screwed sometimes. We weren't poor enough for Henry to get free preschool. But we are a single income family that doesn't have gobs of money to throw around and pay for two kids to be in preschool. One is enough of a stretch (which is mostly why Evalyn is in 2 half-days a week and for only half of the school year). Not that preschool is the most amazing thing in the world. In some ways it just seems like glorfied day-care and I'm glad Evalyn gets to come home at lunch and be with us. While there are definitely social skills and rules that kids learn in that environement, I don't think not going to preschool will sentence your child to poor academia for their entire lives. That's a "whole nother" topic entirely though.

The other thing that we felt was that Henry is one of those kids who might easily fall through the cracks of the Early Ed/Special Ed system. If his speech delays weren't so significant and in so many areas, the results of his evaluation might have been "He'll grow out of it". And what if he didn't? When I was 7 or 8 I took speech therapy for my r's that sounded like w's. After the IEP meeting Gwyn mentioned that they're being told to not qualify kids who have only one articulation delays. That's really sad that a lot of kids won't get that help. I still feel sensitive about the way I talk even though I know I talk "normally" now. Imagine being a kid who knows they talk "wrong" and nobody will give them the help they need?

Another area that Matt and I are concerned about: Henry doesn't have a lot of friends his age. Is this because he's a middle sibling and he just plays with Evalyn's friends? Or that the kids in his social group at church are in the next class up because of birthdays, etc? I keep comparing him to Evalyn and remembering that she had at least 3 or 4 kids her age that she'd request to play with or invite over, etc. Is it because he's a boy? Or because he isn't understood by his peers? I notice that I get pretty protective of him in different situations where he's being excluded. When we were planning his birthday party this really dawned on me. Who were his friends? We couldn't think of more than 1 or 2 kids that he'd probably ask to invite if he was more vocal about it.

At this point I want to make myself feel better and say: because I AM home with my children I can provide the things they need that Head Start programs attempt to give to lower income children that their family's often don't or can't provide. I should count my blessings. While a really amazing Montessori hands-on preschool environment would be something most kids would enjoy going to, I can also provide a lot of that environment in my own home if I made that my priority. Add to this that having a very verbal big sister as a "speech mentor" and stimulator for conversations is a huge help for him. In these ways, he doesn't need preschool because he gets alot of whathe in his home environemnt.

I should also be grateful that an oral motor delay is Henry's only developmental obstacle at this point and that he IS getting help for it and in all likelihood by the time he starts kindergarten he'll talk just like any other 5 year old there. Or, at the very least, they'll be able to understand him!

The end. Thanks for listening. :)