Tuesday, August 20, 2013

Early Intervention, Part Four

If you missed the first three installments, you can find them here, here and here.

Ryan was tested for early intervention for the second time at 28 months old after a PEDS screening at his preschool. Since we had already gone through a specific agency with his first screening at 15 months and they seemed competent, we went through them again for this second screening. Ryan did not qualify for services, again.

At the urging of the speech pathologist who had conducted the second screening, we scheduled an appointment with a pediatric ENT to have Ryan’s tonsils and adenoids evaluated to see if they were enlarged and possibly contributing to his speech delays. The recommendation was to then have him screened again after 30 months for qualification into an early intervention program that is managed by our school district, as opposed to the county, and run by a group called the Committee on Preschool Education (CPSE). The idea being that if his adenoids or tonsils were the issue, he would have surgery and then we could see if his speech improved. Or if he did not have an issue with his tonsils or adenoids and still didn't make progress, he'd be more likely to qualify after he was 30 months old.

In the meantime, I hired a private speech therapist to come to our home. This was only marginally more expensive than my insurance copay. This also avoided the babysitter/childcare/managing schedules for three kids dance that came with going to a private agency wherein you have to bring your child to an office for services.

Ryan’s appointment with the pediatric ENT was on June 17. They looked at his tonsils and adenoids with the mouth flashlight that pediatricians use and also with a camera that was put down his nasal passage. As a sidenote to this, our insurance company considered this “surgery” and we were charged a ridiculous amount for this procedure out of pocket because we haven’t met our surgical deductible for the year. Insurance reform is so badly needed, but I digress.

Ryan was also seen by an audiologist (which is a medical doctor for hearing, please forgive me if you knew that, I had no idea what the hell an audiologist was before this appointment). They put Ryan and I in a sound booth and she sat behind a semi-opaque mirror and played noises in various speakers placed around the room. The point of which was to get him to turn toward the noise, no matter how soft it was. It was hard not to turn to the noise with him sitting on my lap, thereby tipping him off to something inadvertently. It was even harder to sit with him there on my lap and hear the noises and anticipate him turning, and know that there were noises that he was obviously missing.

After being screened in the booth, the audiologist tried to conduct an advanced hearing test on him by sticking these rubber things in his ears that would play sounds. Ryan would not let her anywhere near him or his face and his behavior was some of the more outlandish that I had ever seen.

I was told that Ryan's hearing is on the lowest end of "normal" and that his ear drums were retracted, which is a sign that they were either recently filled with fluid or they were about to be filled with fluid. The fluid is what causes kids to have ear infections. Now, Ry has never had ear infections. But apparently you can have ear fluid without it progressing to an ear infection wherein you get very sick, have a fever, etc. I had no idea.

They suggested we come back in three months -- October -- to have his ears looked at again. In the meantime the audiologist made some comment about how they would be monitoring him for some developmental things that she noted. I kept pushing her to tell me what she had seen, but she wouldn't give me more information other than to say that they would be monitoring him. Having been a teacher I knew in my heart what she was hinting at and it lit a fire under my ass so big that I went right into action as soon as we got back into the car.

I called the Early Intervention caseworker and I think she was less than thrilled to hear from me again. I think she thought I was crazy. I told her if they missed diagnosing my son with autism for budgetary reasons that this wouldn't be the last angry phone call I made to her office (!) and what do you know? She scheduled a new evaluation for Ryan.

* p.s. we are still successfully paci-free, and it has helped with his clarity of speech immensely. Some of these are just old pictures. 

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