What exactly is supposed to be accomplished? I know that's a broad question, but after observing my daughter's speech and occupational therapists for several months now, they don't do anything different from what I do on a daily basis. I don't see how we're making any progress with these weekly visits.

A little history: Catherine was evaluated by Early Intervention at 17 months using the Hawaii something-or-other evaluation. She measured between 9 and 30 months across all skill sets. Receptive language was way ahead; expressive language was way behind. She has some sensory issues as well. The outcome was that she was to have speech and OT every other week, but they alternate weeks so she sees someone every week. I'm really struggling to see what the point is. At 20 months, Catherine now has a 7 word vocabulary, which is a significant improvement, but I imagined that would have happened anyway through our daily interaction with her and her maturity. However, she screams all the time. All the time. ALL the time. The therapies have not helped with this; if anything, she's much worse than she was three months ago.

What I need help with, in a nutshell, is to see how these very nice ladies are helping, because I'm not convinced they are. Thanks.

Hi Lesley:

Your question is a good one. Your therapists should have made short/long term goals from the results of the Hawaii and after Catherine’s initial evaluation. In making her goals, hopefully they have incorporated what you realistically would like Catherine to accomplish in treatment. Take in mind too, that you see Catherine every day. It is often difficult to assess a child’s overall progress when you are with her/him all of the time. Most therapists see patients less frequently, and therefore observe progression perhaps more objectively than a parent might. However, if a patient is not making progress with therapeutic goals over time, that patient should ethically be discharged from therapy. You should ask to review Catherine’s therapy goals with each therapist. This will really tell you if she is making any progress, perhaps some progress slowly, or no progress at all.

Was Catherine a term baby? I see from her medication list that she is on non-stop antibiotics. Has a physician placed her on continuous low does antibiotics for a reason or is she always sick? Does she always have reactive airway issues or just occasional asthma? Is she on thickened liquids or has she ever had a modified barium swallow study performed? Knowing a little more about Catherine’s big picture would help me with your question.

Looking at the results from the Hawaii, Catherine’s developmental skills appear to be very “splintered” or scattered. There is also a large discrepancy between her expressive and receptive language. The sensory issues are very common in little ones who have reflux. It is par for the course as they say. Is the therapist giving you a sensory diet (activities) for the home environment? I have a question regarding Catherine’s OT. Is he/she focusing on sensory integration therapy only or is the therapist working on gross/fine and developmental motor skills in addition to activities of daily living?

Lesley, I know you are frustrated that Catherine has a 7 word vocabulary. You will see a huge change in her expressive language between 24 and 36 months. The other thing you need to know as well is one a child progresses in one developmental area, many of the other developmental areas lag behind. They too, will catch up in time. Please write back with questions.

THANK YOU!!!!!

Your therapists should have made short/long term goals from the results of the Hawaii and after Catherine’s initial evaluation.

They did. Her speech goal is 10 consistently and correctly used words by the time she's 2 (in January). She will likely make this goal. My other goal for her was less screaming, which I know is totally subjective and a result of her general frustration with her ability to communicate. She has no coping skills.

Was Catherine a term baby? I see from her medication list that she is on non-stop antibiotics. Has a physician placed her on continuous low does antibiotics for a reason or is she always sick? Does she always have reactive airway issues or just occasional asthma? Is she on thickened liquids or has she ever had a modified barium swallow study performed? Knowing a little more about Catherine’s big picture would help me with your question.

Catherine was delivered by scheduled c-section at 36 weeks. I have a blood clotting problem so she needed to be delivered as soon as she was ready. An amnio the day before delivery confirmed adequate lung development. She is not on prophylactic antibiotics. She is always sick and is now antibiotic-resistant to the point of requiring 30-day courses to treat her recurrent sinus infections. Just occasional asthma flares. She takes Singular daily as a preventative. Never on thickened liquids ... the few times we tried to thicked her bottles as a young infant resulted in projectile vomiting so nothing to be gained there. She's had an upper GI, abdominal ultrasound and regular x-rays (all at about 10-14 days of age) and an upper endoscopy/flexible sigmoidoscopy at 12 months. The scopes came back clean except for a marker for celiac, which turned out to be negative after a follow-up blood test. More than you wanted to know, huh? :toothy10:


Looking at the results from the Hawaii, Catherine’s developmental skills appear to be very “splintered” or scattered. There is also a large discrepancy between her expressive and receptive language. It is par for the course as they say. Is the therapist giving you a sensory diet (activities) for the home environment? I have a question regarding Catherine’s OT. Is he/she focusing on sensory integration therapy only or is the therapist working on gross/fine and developmental motor skills in addition to activities of daily living?

Yes, she actually had NO scores in her age range; they were all below or above. The ST did note the enormous gap between receptive and expressive language, and that was one of her qualifiers for the ECI program. Having a delay is not enough, apparently. Her fine motor skills were way ahead. For example, one of the tests was putting pegs in holes so they'd stand up. She not only put the pegs into the holes but she sorted them by color first (unasked, and the pegs were red and brown). dh and I laugh about her OCD tendencies, but there's a lot of truth there. The OT wants her to play outside, which we try to do every evening. She will now touch things outside but immediately wants her hands wiped off if dirt gets on them. She still will not put her hands down in the grass to get back up if she falls. Gross motor was on the low end of "normal" as she's still a wobbly walker but they weren't concerned about that, and I'm not either. Her lowest scores were on self-help because at the time she was eating hardly any table food and wouldn't touch with her hands/feed herself anything that wasn't hard and dry (like a cheerio or cracker). She's actually gotten quite adept now at using a fork and spoon although her diet is still extremely limited.

I guess she has made more progress than I realized ...

Thanks again, Robynne!

Lesley:

It does sound like Catherine is making some good progress. Quite a few of her behaviors are most likely her lack of expressive language as you mentioned in addition to some obvious sensory issues. Is she receiving ECI services or are you taking her to private OT and speech? It is difficult for ECI therapists to provide true sensory integration (SI) therapy in the home environment because of the set up. Catherine may benefit from seeing a private OT who specializes in SI. This kind of therapy may assist in getting her behaviors more under control.If you haven't read The Out of Sync Child by Carol Cranowitz, I highly recommend it. It is a quick read and will answer many of your questions. Most of our SI patients are extremely bright like your precious Catherine.

I do question the frequent sinus infections. The Prevacid will give her clear scopes. I know you have not thickened her liquids since early infancy and it made her throw up. Did you use cereal? It often backs my infants up and can cause increased emesis. Catherine is much older now and there are wonderful commercial thickeners that do not have any taste. Something to consider for at least a trial. It sure beats having repeat sinus infections and asthma flare ups.

Robynne