Severe speech delay in 3 year olds - Mothering Forums

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#1 of 26 Old 03-22-2009, 02:26 PM - Thread Starter
 
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My twin boys are 3.5 years old now and both have speech delays. They were born premature. They were mostly in daycare during ages 1 to 3 though to my knowledge, never evaluated by EI(though I was promised they would be! )

They are not on the same levels either. One is doing much better and often points to things asking "what's that?" and then often repeating the name of whatever he pointed to. Even still, he rarely uses more than one word at a time and never more than two.

I'm more worried about my other son, who only parrots or uses one word or sound to communicate. He was also a late walker(first steps at 15 months, walking/running well about 20-22 months). He understands things I say often, such as "Do you want to have a bath?" but he parrots it like gibberish "Budla budla baaah?" Or "Do you want to eat?" = "Eee-eat?" He is making some progress, but obviously extremely speech delayed.

I am worried now that these delays are going to limit them even later in life. I used the choro-mega supplements for awhile with no changes at all.

They are on medicaid -- would they qualify for speech through it? I know they are now too old for EI They don't do well in all-day daycare or preschool.. they wind up getting very sick, due to the stress IMO. A short program 2-3 hours a couple times per week would be much more ideal.. but not sure if any such thing exists?

Also, other ideas on maybe a video or book set I could purchase that might help, or ways I can help them at home? TIA
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#2 of 26 Old 03-22-2009, 02:36 PM
 
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What state are you in?

At this point, I think the best thing you can do to help them is to have them evaluated by your local school district for special education services. They might receive preschool, speech therapy at school, speech therapy at home, or other services at home or at school.

There are definitely things you can do at home to help them, but with this much of a delay, I think it's important to first seek an evaluation and consultation with experts, who can give you ideas of what to do at home. Many of my students have had speech therapy that involved the parents, or the therapists would give the parents specific activities or things to do at home that would help.

Your son who talks less, does he have other delays? You mentioned physical and speech delays - how is his social interaction? He might have global developmental delays due to the prematurity and he might qualify for some physical therapy as well, depending on where he is now.

Generally, if you want something like an EI evaluation done, you need to request it, and then stay on top of it until you receive the results and have a meeting. There are many students receiving special education services and you really have to be assertive and remind the agency/school if something isn't being done when they said it would be.

So at this point, you'd need to call and ask for an evaluation for an IEP (individualized education program) for your boys, probably based on "OHI - other health impairment" which their prematurity would fall under.

Early intervention specialist and parent consultant since 2002.
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#3 of 26 Old 03-22-2009, 02:40 PM
 
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Insurance and speech therapy is a tricky situation, and I'm not sure with Medicaid.

You can refer the boys to your local school district at any time. There should be a preschool team in place to assess them and provide therapy - it depends on your district what they tend to offer. The assessment would be free and take place at the school, and then you would have a meeting (not the same day, they would schedule it) with everyone. You can bring anyone you want, and they will bring the school team members, including at least one teacher and the speech pathologist.

If they get therapy through school it will be with an Individual Education Plan (IEP) which outlines their goals and services. Most schools don't offer full-time school programs to kids unless they have multiple areas of delay or extremely severe delays. Some like to offer preschool with less therapy, some tend towards appointment therapy and preschool only for kids with more significant needs. This could mean a two or three hour program three days a week, or group speech therapy you bring them to for half an hour two times a week - it all depends on their needs and your district. You are free to disagree with anything they offer, accept it, or accept part of it (like accepting speech and turning down preschool) depending on what you feel comfortable with. You are also legally allowed to observe the classroom they would be in prior to placement if you want to.

As far as at home strategies - I would try a lot of focusing on a few words at a time. So in the middle of an activity choose a word or two and use it to death, in fairly short sentences. It helps understanding, and imitation or use. So like "Blocks go up. Go blocks! My blocks up! Crash blocks. Oh no blocks!" I'm not saying to use this kind of speech all day, just for a short period to focus on words you want to help them with. It's easier to imitate one word at a time, and also easier to learn a word you hear in context, with lots of intense stimulation.

To help with putting two words together, you could try modeling two words, especially when giving them choices. If they repeat back one word, just say the two again.

"Drink milk or eat apple?'" "apple" "Oh, eat apple!"

You can also expand what they are saying. So after your ds uses one word, repeat it but add to it just a little. If he says car, you can say 'go car' or 'my car' or whatever makes sense at the time. This helps them figure out the whole sentence thing, especially since it's just a step above where they are, and close enough to try. They might not imitate it at first, but just keep modeling!

It sounds like a tough situation, it's so hard to watch our children struggle. Hopefully you can find the help for them you are looking for.
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#4 of 26 Old 03-22-2009, 02:48 PM
 
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Only time for a quick reply, but I recommend getting the book The Late Talker. What you're describing may well be simply a delay reflective of their prematurity, but it's worth looking into the possibility of apraxia.

Wendy ~ mom to VeeGee (6/05), who has PRS, Apraxia, SPD, VPI, a G-Tube, 14q duplication, and is a delightful little pistol! I'm an English professor and a writer.
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#5 of 26 Old 03-22-2009, 02:50 PM
 
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If going through the school district is not something you're interested in you can also contact local therapy centers to see who accepts medicaid and then go from there. Often times the children's hospital outpatient therapy places will accept medicaid but there may also be other centers who take it as well.

My daughter's also 3yrs old and still primarily non-verbal, accept for a handful of words, mainly word approximations. She uses sign language as her primary means of communication. We've not done the school district thing and don't plan to any time in the near future. Instead she's been receiving private therapy for the last 2.5yrs, paid for by our private insurance and medicaid.
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#6 of 26 Old 03-22-2009, 02:51 PM
 
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I agree with calling the school to set up an evaluation (after 3 years old, it's too late for EI, and the public school system takes over). My DD is also 3.5 and her speech is probably somewhere in between your boys. What we get from the school is two days of 3 hour preschool, 15 minutes of speech on the days she's in class, and two 30 minute sessions on days she doesn't have preschool. I'm looking in to getting her more private therapy again- it can be difficult to get as much as they need from the school alone.
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Also, other ideas on maybe a video or book set I could purchase that might help, or ways I can help them at home? TIA
I recommend Signing Times DVDs. They are a quick and easy way to learn some basic sign language which helps develop vocabulary and in the meantime, helps them express themselves with signs as well as speech.

You're doing the right thing by trying to find help for them- the earlier the better with speech delays.

DD1 7/13/05 DD2 9/20/10
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#7 of 26 Old 03-22-2009, 02:56 PM
 
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Considering your childs age and the range of expressive language you've mentioned I would say that you definitely need to get them evaluated ASAP. By law each state must have a setup to evaluate special needs in children, on the large part is thru your individual school district or EI (usually before age 3 varies sometimes by state) You would most likely need to contact your local school district and ask them who you would need to talk to for your children to evaluated. Be proactive and stay on top of it, taking down names and #'s. By law they must evaluate your child within a reasonable time frame. You mentioned you had medicaid? Is it possible to get a referral from your pediatrician to a developmental pediatrician? They specialize in assessing delays in children and would be a great place to start.
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#8 of 26 Old 03-22-2009, 03:01 PM
 
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Originally Posted by bri276;13411834}
I recommend Signing Times DVDs. They are a quick and easy way to learn some basic sign language which helps develop vocabulary and in the meantime, helps them express themselves with signs as well as speech.
Yes! I completely forgot to mention Signing Time.
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#9 of 26 Old 03-22-2009, 03:02 PM - Thread Starter
 
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I'm in Louisiana.

I'm feeling a lot of guilt over this, during their daycare years, I was the sole provider not receiving any CS etc so I was working long hours and just hoping their education based daycares would help them out. Sucky excuse I know, but keeping a roof over our heads sort of put everything else on the back burner. I know I don't *have* to explain, but I feel I should.

The past 9 months I was dealing with a very difficult pregnancy including months of bedrest, and now I have a newborn baby boy... so more reasons I haven't tried to really do 'something'... they seem intelligent, good eye contact, playing 'normally', singing along with videos etc. Socially there are some off behaviors such as some tantrums and such but I usually equate those with frustration in not being able to properly communicate.

Wait, so if I'm reading right, I could have them evaluated by the school district and then elect to do only the therapy and not preschool itself? I was under the impression that it was all or nothing. I just know they aren't going to do well in all day school at this point.

I'm sorry for how ignorant I am on all this, but where should I start calling? The public preschool in our district?
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#10 of 26 Old 03-22-2009, 03:07 PM - Thread Starter
 
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wow TY for all the quick responses and suggestions. The options are sounding better than I imagined re: preschool and private therapy. I will also look into the signing time DVDs
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#11 of 26 Old 03-22-2009, 03:23 PM - Thread Starter
 
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I think I'm going to get that late talker book from amazon... have any of you tried this: http://www.amazon.com/Baby-Babble-Sp...d_bxgy_b_img_b
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#12 of 26 Old 03-22-2009, 03:28 PM
 
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As far as what the treatment options available will be, that varies widely. Here, when my twin boys were 3 (and neither one had any words at all - ZERO - and that's after having been through EI), the school district offered us only special ed preschool (the way the program was set up, my guess is it was less expensive for them that way) even though the possibility of other treatment, such as speech group, existed. But every school district is a little different. The more all-encompassing the delays, the more likely it may be that the offer is for special ed preschool. But I'd guess there's school districts out there that don't even have that. When you set up the eval with the school district, you can ask about the types of services typically provided, and then you'll have a chance to argue for whatever it is that you would prefer. My advice would be to let them know, in a casual but direct way, what you would prefer when you're at the evaluation stage (say, when you're sitting there in the room with the evaluators chatting) so that they're aware of this before your IEP meeting and are not taken completely by surprise. (Also, FWIW, special ed preschool in my district was 2.5 hrs per day, and the number of days per week varied according to the child's needs - my kids got 2 or 3 days, I can't remember because I ended up going the private route instead with preschool and private speech therapy - but that's a story for another day).

As long as you get them the help they need, this is not a time to worry about what happens to them later in life. Lots of kids are late bloomers. (want some examples? now my boys are in kindergarten, and just turned 6. The teacher of one of them - the one who had head-banging tantrums at 2 y.o. and silently lined up cars all day - told me a couple days ago that he is the best reader in his montessori K class. The other one still has an IEP for speech, but has come a long long way and we just dropped OT for fine motor and additional learning services because he's now age appropriate with fine motor and at or above grade level in reading; two years after I heard from the psychologist about how developmentally delayed he was at 3 y.o., by 5 y.o. he was counting to 1000 and doing triple digit addition in spite of his speech delay. He just had a big assessment done for his new IEP, and his achievement scores, even for reading, are all above average or in the superior range.) That's not to say that they won't need help for the immediate future - the goal is to support their weaknesses so that they can develop their strengths. Getting help for them now does not mean you give up faith in your children regarding their long-term potential.
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#13 of 26 Old 03-22-2009, 03:41 PM
 
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Originally Posted by elephantine View Post
I think I'm going to get that late talker book from amazon... have any of you tried this: http://www.amazon.com/Baby-Babble-Sp...d_bxgy_b_img_b
I'm not familiar with that book, but about late talking in general, you might find this web page helpful for working with your kids (read down through the whole page)
http://www.geocities.com/speppera/Speechenrichment.htm
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#14 of 26 Old 03-22-2009, 03:45 PM
 
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First of all, mama, please don't feel guilty. There's no reason. It's sometimes hard to "see the forest for the trees" when you're so intensely focused on just the day to day survival for your family. It will be okay!

Here is the agency for Louisiana, Early Steps, that handles early intervention. Even though LA only provides EI through age three, they should be able to help you out with the "what's next?" stuff. Your local school system, also, should have a division, frequently called "Exceptional Children," that will help out. Most school systems do offer speech, even for kiddos in typical environments. Good luck.

Wendy ~ mom to VeeGee (6/05), who has PRS, Apraxia, SPD, VPI, a G-Tube, 14q duplication, and is a delightful little pistol! I'm an English professor and a writer.
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#15 of 26 Old 03-22-2009, 07:31 PM - Thread Starter
 
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Oh... I forgot to add that neither is PL'd! My better talker has been on the verge for months now(I let him go bottomless and he sometimes pees in the potty, but if not, always asks for a diaper when he needs to go).

My slower talker seems to have no control or awareness over going potty. After a bath I have to get a dipe on him super quick or he just lets it fly and watches with a mildly surprised amusement as he pees on the carpet. He watches me go potty, has watched his brother go and my DP and we let him flush the toilet for us sometimes... we also have the Elmo potty video that they've seen 100 times.

I know to do headstart they have to be potty trained right? What about for SN preschool? Would I be able to stick around in case they needed changed... or are we SOL until they PL?

Thanks again for the help and support, I am going to start calling tomorrow.
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#16 of 26 Old 03-22-2009, 08:21 PM
 
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My DS2 was like your twins when he was three. We went through the local school system and he got preschool two days a week and speech on those two days he was in school. The preschool was increased to five days this past fall and OT was added. We will be decreasing to four afternoons a week in the fall (not sure how much of that was my request (I had put in his paperwork that five mornings was tiring him out) in his eval paperwork or the TEAM decision on how he was doing). He also gets services two days a week during the summer.

As far as potty training... In our school system, they actually don't expect the "special needs" students coming in to be potty trained. They change diapers and everything for the kids (NT kids are expected to be potty trained, though). Beyond that I don't have much knowledge on the potty/diapers in school. My DS was very potty trained when he went in (had been trained since he was 2.5 years) and they extremely excited.
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#17 of 26 Old 03-22-2009, 08:26 PM
 
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As a PP said, they don't have to be potty trained to go to SN preschool if they are there to receive services.

Don't spend too much time beating yourself up over this - we do what we can when we can. It sounds like you were working and trying as hard as you could to keep things going, and you did it, and now you have the space and opportunity to look at things differently and you are doing that.

Good luck in this journey with your boys.
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#18 of 26 Old 03-22-2009, 09:24 PM
 
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I do NOT recommend that Baby Babble DVD. Total waste of money. I don't know why I bought it. I hope your library has the Signing Time DVDs! Much better stuff.

DD1 = 8 yrs *** DD2 = 6 yrs
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#19 of 26 Old 03-22-2009, 11:36 PM
 
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Medicaid, at least where I live, covers speech services. My now almost 4 year old (like 3 days away) has been in speech therapy since he was about 27-28 months old. We go 1 time a week for 30 mins.

You also need to contact your local public school district. At the age of 3, they are eligible to receive services for any delays from your public school (this is in addition to what Medicaid will provide). My son attends our local EICP (Early Intervention Childhood Preschool I believe) through our public school. From that he receives a group speech therapy for 20-30 mins a week.
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#20 of 26 Old 03-23-2009, 02:24 PM
 
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Request an eval through your local school district and take your boys to your Ped and have him/her give you a referral for a speech eval from a private speech therapist. Medicaid should cover ST but they will most likely want a referral from a Ped then the Eval gets sent to them and they approve X amount of ST sessions.
Start both at the same time, then you have the option of choosing the one you like better or use both.
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#21 of 26 Old 03-23-2009, 02:36 PM
 
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My son was evaluated with the school district right before he turned 3 and qualified for st,ot,and pt. He goes to a class 2 times per week for 3 hrs, At 3 years old he was mostly only speaking in 2 word utterances.

He loves his class at school and I have had a wonderful experience with it also. As far as being potty trained, he was not potty trained when he started there and it was never an issue, they never expected any of the kids to be and we never had a problem.

He is 4 now and continues to go to the school and will go again next year.

Busy Mom raising 5 kiddos, 7, 6, 5, 2  and a brand new bundle!! (5/15/11)  cd.gifribbonpb.gifnovaxnoIRC.gif

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#22 of 26 Old 03-23-2009, 03:31 PM
 
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I second what other posters are saying. Don't be afraid of your local school eval. I really don't understand the allure of private clinics that most parents seem to have. I find that school evals are almost always more complete (because they are not getting paid a flat rate for the eval and can take as much time as they need to complete it, whereas in private clinics you get what you can get in an hour period). A school has a built in set of peers to assist your child with communication skills (whereas a private clinic is often one on one with a therapist in a room that is unfamiliar with the child). The schools offer a myriad of services for free if your child qualifies. Most private clinics would be 1 hr per week of speech (if that) and its quite expensive. Medicaid does pay much better than insurance, so that works in your advantage. Also the schools are not under the rule of "medically necessary" so they often write more functional and useful communication goals, whereas the private clinics have a lot of oral motor goals and other "medical" goals that are in reality not useful and not research based, but insurance/medicaid will approve. I find a lot of the work being done in private clinics is very decontextualized from a child's daily communication needs. Of course, some clinics are very good. But in general, the pressure from insurance companies to have "medical" services is really putting a strain on private practice and I see it in the goals that they write.

I think people's fear is getting a child "labeled" but quite honestly, we aren't living in the 1950s anymore. Special Education has vastly improved and the move to mainstream children and get them in the least restrictive environment possible etc. is huge. If your child does not get the help and comes into school with an obvious communication impairment, they will be "labeled" by their peers as different because of it. Its not something that can be hidden, nor should it. Again I'm not accusing any parents of this, but just saying I feel the fear of a label is unjustified in most cases. And even if that fear was valid, the parent has a right to refuse service and have the label dropped at any time, so its possible to terminate that and not have it follow your child anyhow.

Getting therapy at your local school also gives you the added bonus of familiarizing your child with the school before they enter school. Even if that isn't the school they end up attending, its nice from the standpoint that they see kids with backpacks, classrooms, teachers, routines etc. of school. It makes for a much easier transition. Children with language impairments often have a harder time getting into a new routine, and if they've been coming for therapy for years prior, its an easier one.

XOXO
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#23 of 26 Old 03-23-2009, 11:56 PM
 
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[QUOTE=BethSLP;13417549 The schools offer a myriad of services for free if your child qualifies. Most private clinics would be 1 hr per week of speech (if that) and its quite expensive. <snip> the schools are not under the rule of "medically necessary" so they often write more functional and useful communication goals, whereas the private clinics have a lot of oral motor goals and other "medical" goals that are in reality not useful and not research based, but insurance/medicaid will approve. I find a lot of the work being done in private clinics is very decontextualized from a child's daily communication needs. [/QUOTE]

I have HUGE respect for Beth and her viewpoint, but some of this, I think may not be a universal. In the school system where we are, the goals are really really really narrow in the school system's ST evaluation/case plan, where they are MUCH more fluid and responsive in our private therapy. The school ST can only work within what is "presently an education-based goal" and does not even take ANY note (and she's a good therapist as far as I can tell) of her issues of apraxia and tactile stuff that affects her speech. This is what she's told me directly. The private therapists are able to work with dd as she is developing and seem less tied to a "curriculum" (for lack of a better word). I was even told, at an evaluation in the fall, that they weren't going to focus on the "k" sound because that wasn't a sound that was in the "plan" for dd's age. Problem is, it's a sound she "had" but was using inappropriately. I wanted them to kind of harness that sound with/for her. But that wasn't in the agenda.

DD is adopted out of our state's foster care system and therefore still qualifies for our state's version of Medicaid, so we are in the same "payer" boat as OP. I've chosen to get both private and school system ST for dd, though I don't know how much she's actually benefiting from the school system's 30 min/twice a week (and, if I actually took her to the SN preschool, it would be that same 30 min, but in a large group context). I do it, though, to keep our "foot in the door" with the system, because, at some point she'll be there.

I'm not trying to "poo-poo" the school system's methodology, I'm just saying that they must subserviate themselves to a very particular agenda that is very specifically goal-oriented, while the private SLPs and STs are able to modify their treatment in a much more responsive and fluid manner.

Wendy ~ mom to VeeGee (6/05), who has PRS, Apraxia, SPD, VPI, a G-Tube, 14q duplication, and is a delightful little pistol! I'm an English professor and a writer.
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#24 of 26 Old 03-24-2009, 07:32 PM
 
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I'm going to agree with BethSLP on this.

I have a 9 year old with an articulation delay, which when he was 3 was severe. He has received speech therapy through our local school district since he was 3 1/2. Until he started kindergarten, he was receiving an hour of speech therapy once a week. From kindergarten to now (5 years) he's been receiving 30 minutes of speech therapy twice a week.

Since we knew then that our child would be attending the local public school, it's actually made things easier. Having a speech IEP in place actually made getting him Resource services A LOT easier (he has some kind of processing disorder... I learn more about it Friday).

My child's experience with school based speech therapy has been a lot different than AndVeeGeeMakes3's. His SLP's generally have started the years with the things that he's "almost there" on, and then once he masters that they move him on.
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#25 of 26 Old 03-27-2009, 05:47 PM
 
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Kinda Late, but I would urge you to make sure you get your child's hearing tested. My daughter was a NICU baby (not a preemie though) and we discovered she had a moderate hearing loss at 18 months. She had begun to lose her hearing at 12 months and the only reason we found out so quickly was because we thought she needed speech therapy. Not all kids with a hearing loss are deaf so many of them hear lots but not good enough to learn full language. They often are able to parrot, especially one on one, but they just aren't hearing well enough to learn enough language to express in words.

How is hi receptive language? Can he follow a two step direction given to him if the steps are related?
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#26 of 26 Old 03-27-2009, 06:54 PM
 
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i wouldn't dismiss preschool out of hand until you explore your options. in my area, we have a preschool that is considered community based, but one of the best programs in the country. we had to fight for this placement, but we got it and it has been a very good program for our son. he's 3.5 and he goes there monday through friday for a full school day - and he LOVES it. we did explore the other options in our area and this was the only option we considered appropriate for our son. but you just never know what is available to you until you ask and look (and definitely take a tour of all your options).

as far as potty training - our son is not yet ready and he wasn't expected to be. in fact, it is written into his IEP that he follows a potty routine every day (basically, they go through the potty routine with him everyday, without any expectations of him becoming potty trained - it's an ideal situation to me).

finally - i would recommend finding an IEP advocate for your little boys. that person will know what your boys have due to them by law and will help you fight for it. i wouldn't attend and IEP meeting without one.
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