Knowing Someone Has My Back

Part I: Speech Therapy for Someone Who Can Speak Quite Clearly?

What do train whistles, chocolate pudding, a nose flute, mango nectar, mini marshmallows, peanut butter, and tongue depressors have in common? At times all of these items and a laundry list of others have been required for Zoe’s speech therapy homework. Next week she will wrap up four months of weekly sessions to correct tongue thrust, a problem we didn’t even realize she had until we started the rounds of visiting prospective orthodontists last winter. When one of them suggested speech therapy for tongue thrust, I was skeptical until I talked with a speech therapist who said that kids with tongue thrust often had to have braces twice because their thrusting tongue pushed their teeth right back out where they were to begin with. And I know this to be true because it happened to me. I had braces in middle school and again in college, but I never knew that tongue thrust was something I could correct. So in an effort to save Zoe the aggravation of extended orthodontia and save us money in the long run, we have invested money and time in speech therapy now. (Zoe just completed her course of treatment with Andi Fisher at Chain Bridge Speech and Language Therapy, a practice owned and operated by our good friend Kristin Keller Daus.)

And despite the fun foods and accessories involved, it is not always at the top of a 10-year-old’s list of activities to do speech therapy homework, especially after school homework, martial arts, soccer practice, chores, or whatever else is going on.

Fortunately or unfortunately, Zoe is no stranger to therapeutic homework. For a while she did eye exercises every night to address convergence insufficiency. Way back when she was in preschool and struggling to overcome a bladder disorder, she had pelvic therapy and other exercises to help her strengthen her pelvic floor muscles. None of this has been easy. But who said it would be, right?

Part II: Causing a Nosebleed, Lying Down on the Rug, and Ignoring Personal Space

Luckily for Zeke, his occupational therapy sessions start off with time to bounce on a big trampoline, climb onto swinging platforms hanging from the ceiling, and jump from a fluffy cloud suspended from ropes into a ball pit. He loves going to Miss Mary’s for OT. (Miss Mary being Mary Craver, who practices occupational therapy in Cabin John, Maryland.)

I never expected he would need occupational therapy. He’s always been strong, athletic, coordinated, and capable of sustained attention playing with Legos and doing puzzles. I never imagined anything was off kilter.

Then last spring, his preschool teacher mentioned on three different occasions that Zeke had thrown something on the playground that hit another kid in the face, including one occasion where the other kid got a nosebleed (I apologized later to his mom and she was gracious and not the least bit concerned, thankfully). In every case, he wasn’t trying to hurt anyone. He’s not malicious (although he does occasionally punch his sister, I admit), but just had no control over his body. He would also bump into his classmates a lot in line, and whack them with his jacket while swinging it around. Zeke was also frequently causing frustration in the classroom by lying down when it was time to go outside, or refusing to get his coat on to head to the playground.

I understood his teacher’s concerns and didn’t want Zeke’s behavior to be disruptive. I also figured that those behaviors were probably typical for a three-year-old or something he would outgrow. Meanwhile, I happened to interview occupational therapist Mary Craver (who we know now as Miss Mary) for a client project. My client had been asking about how Zeke was doing, and when I shared some of these issues, she asked if I wanted to complete a sensory profile for Zeke–basically an assessment from the parents’ point of view of how a child seeks or responds to different kinds of sensory stimulation. We did this and Mary agreed to look at it. I talked with her and she suggested Zeke’s teachers fill out a profile of their observations of his behaviors at school, which they thoughtfully did. I was surprised to read some of their notes about how much effort it sometimes took to get Zeke to do what he was supposed to do in class. Especially because I’d been in his class, many times, and I never felt like he was any more or less challenging than any other kid in the class. They were three years old, after all.

Mary decided it would be best for her to observe Zeke at school to get a complete picture of what was going on. As her time with the class was coming to an end, the kids were preparing to go outside. Zeke was refusing. Apparently his classmates were lined up in the hall on their way to the playground, and he was lying down on the rug, unwilling to get his coat on despite the co-opers cajoling. Although she doesn’t typically intervene during an observation, Mary decided to help out the desperate co-oper. “Zeke!” she said. “You have one minute to get your coat on!” “OK!” he said, and jumped up and got his coat on and was ready to go outside in about 10 seconds. It turns out that Zeke just needed some parameters. She later explained to me that “get your coat on” was surprisingly too abstract for him, as if he had until the end of time to get his coat on. But I have since learned that he responds really well to time limits. On her advice, we’ve bought a time timer, just like the one she uses in her office, for our house. It’s hugely helpful in letting Zeke feel like he is in control of how he spends his time and he can clearly see how long he has to do an activity.

But I’m getting ahead of myself.

Part III: Why Would My Strong and Active Boy Who Can Do Puzzles and Play Legos for Hours Need Occupational Therapy?

After she reviewed the parent and teacher sensory profiles, the classroom observation, and an assessment in her office, Mary gave us a complete evaluation of Zeke’s issues. To be honest, this was a little overwhelming. Although I have several good friends whose children had done occupational therapy before and I knew they were all wonderful, fabulous, successful kids, my first thought was “what is wrong with my child?” On one level I realize this didn’t make sense. Nothing was wrong with Zeke. Yet, clearly according to this evaluation, there were areas where he struggled. He had trouble grasping and manipulating objects, balancing, and with hand-eye coordination. Truthfully I don’t fully understand the clinical vocabulary that describes Zeke’s diagnosis, but the therapist showed me exactly what he had trouble doing and I got it. I have slowly come to understand since then that the areas where he had deficits were where we saw him getting frequently frustrated at school and at home. I just didn’t realize at the time there was anything we could have done about it.

Many people (including me, to be honest) have wondered whether the behaviors Zeke is working on in OT are just typical for his age, or if he would simply outgrow them. The answer is maybe, but…I had those questions myself when we started this process and our amazing preschool director Susan Parker explained it this way–if there are things he’s struggling with that OT could help him master, that will reduce his frustration with daily activities, with school, and build his confidence, why not give him those tools? Why not, indeed?

Some of the tangible tools that Mary has given Zeke so far include a size of the problem worksheet/scale to help him assess whether something that bothers him is a small problem that he can handle, a larger problem that needs adult intervention, or a huge problem that is really serious, and a couple levels in between. There’s a little chart to help kids articulate their feelings about the size of their problem.

She also helped him create a speedometer for his engine–is it running low, high, or just right? And if it’s running low or high, how can he modulate it? She also gave him a (paper) remote control that he can use to control his own brain and body (and no one else’s). Using the remote he can pause to think about something, rewind if he made a mistake or hurt someone and try again to do better, fast forward to think about possible consequences of his actions before he takes them.

Mary also showed Zeke how to correctly hold a writing or drawing utensil, making those activities much more comfortable to him. I knew he wasn’t holding crayons properly, but I wasn’t sure how to correct him in a constructive way. She’s had him using special small scissors to make it easier for him to learn the proper way to hold and use scissors.

Mary helped me realize that Zeke (and most kids) needs clear parameters when he’s being asked to do something. My repeated requests for him to get his shoes on or clean up his toys might be ignored, but if I say, “Zeke, you have one minute to get your shoes on,” he (usually) jumps on it immediately. He loves for me to count to 10 (or 20 or more) when he’s trying to do a task. Part of me fervently wishes I could just make a request and he would do it, but if counting works for now, I will surely count.

Zeke also loves the movement breaks he gets during occupational therapy, which also enable him to work on gross motor skills. These are just a few of the cool pieces of equipment in Miss Mary’s office.

I’ve learned from Mary that OT is a lifespan activity, addressing any needs that anyone–from infant to senior–has to better be able to function in the world. OT can address issues such as eating, holding a writing utensil, self-regulation and self-control, emotional stability, social skills, fine and gross motor skills, and so much more. Zeke’s just been doing this for a couple months so I’m still learning every week what it means for him or others.

Part IV: Speech Therapy for Someone Who Actually CANNOT Speak Clearly

Meanwhile, we’ve known for a while that Zeke has some articulation issues when he speaks. He says T for K sounds, and frequently cannot correctly pronounce words containing R, L, or TH. I asked his preschool teacher when he was two about this and she showed me a graphic that illustrates when boys are supposed to have mastered certain sounds. She assured me that he would get it and not to spend money on speech therapy. Yet.

In his three-year-old class I told the teachers my concerns about his speech and they were listening for it. They noted that sometimes they couldn’t understand him, but mostly they could, and his articulation issues didn’t seem to interfere with his learning or social interaction, and he would likely outgrow them.

I had trouble understanding him sometimes as well, although my husband and our daughter and I could probably decipher his language best out of anyone. But still, his vocabulary and expressiveness were so developed that the articulation didn’t seem to get in the way. Much.

Then, when Mary Craver evaluated Zeke for occupational therapy, she said his speech was something to think about. Understanding that it would be just a wee bit overwhelming for Zeke (and our calendar and wallet) to take Zeke to OT and speech simultaneously, she encouraged us to begin the process of getting Zeke evaluated through Child Find for speech therapy services that would be provided at no cost to us by Arlington County. This was welcome news.

We started this process in May. I called the Child Find office to find out how to apply and received a packet in the mail. I completed the application and had to ask one of Zeke’s wonderful teachers to fill out yet another form about him, which she graciously did. I found Zeke’s birth certificate and medical records and a mortgage statement (to prove we live in Arlington) and headed over to the Child Find office to submit the application. Turns out the mortgage statement didn’t work, and I needed the deed to our house. Although we have that in a file cabinet, I had no idea which pages were the right ones, so I went to the Arlington County Courthouse and paid $9 for them to copy the 16 pages needed to prove we live here, and took them back to Child Find. Once I was back there, the fantastic administrative assistant Elizabeth pointed out that the hearing test box on Zeke’s physical form was checked but there was no indication of whether he had passed or failed the screening. Hearing tests are required for speech therapy evaluations. So I took Zeke to the pediatrician the next day to get a hearing test, which it turned out he hadn’t had at all during his last check-up but the nurse had accidentally checked the box that he had. At the pediatrician’s office a young nurse did a hearing test which I observed and wondered if she was doing it correctly. She said he failed. So…I made an appointment with our ENT to have Zeke do a more comprehensive hearing screening. Which he passed with flying colors. Whew! But what was interesting about the more extensive test, which involved the audiologist asking Zeke, through headphones, to repeat certain words, was I realized there were a LOT of words I couldn’t understand Zeke saying when they were out of context. I suddenly understood that my ability to converse with Zeke depended a lot on the context of his sentences, and that many individual words were indecipherable.

So we took the successful hearing screening results to Child Find and our application was complete! Meanwhile, on June 1 we had an initial meeting with a team there, including the Child Find Coordinator, a psychologist, and a social worker. They talked with me about the background of Zeke’s speech issues, his occupational therapy issues, and what my concerns were. The social worker played with Zeke with a bunch of toys in the office. Everyone was incredibly friendly. They determined that Zeke should have a speech evaluation and said a speech therapist would be calling us to schedule an appointment.

Apparently it took a while for the speech therapists to wrap up school year appointments and do whatever else they had to do, and I ended up calling the Child Find office four or five times to ensure our appointment was still forthcoming. Finally, in mid-July, we heard from the person who would be doing Zeke’s assessment, and will be meeting her on August 2. Then, after a couple more calls, we have an appointment on August 25 for Zeke’s final eligibility meeting, where the Child Find team talks with me about the speech therapist’s evaluation, and determines what’s next for Zeke. Again, whew. I have to reiterate that even though all this has taken a while, everyone who I’ve spoken with at Child Find has been extremely kind and helpful. Especially Elizabeth the admin. She rocks.

The Child Find coordinator said if Zeke is deemed eligible to receive speech therapy services, they will take place at our neighborhood elementary school. This sounded great to me because it’s less than a 10-minute walk from our house, and would give Zeke a familiarity with the school he will attend a year from now for kindergarten. And best of all, it’s free. From what I understand from all the therapists and educators I’ve talked with this year, it’s so much easier for the kids and the school system if these kinds of issues are caught and corrected before elementary school starts. So that’s our goal.

Part V: The Moral of the Story

No doubt this saga is far from over for everyone in our family. There will always be more appointments and more therapies and more issues. But I am so thankful that we have these wonderful resources at hand to help our kids overcome frustration, improve their social skills, prevent future orthodontic catastrophe, and so much more. Sometimes it’s hard to know when to intervene and when to let it go, but it’s gratifying when you see that something you’ve done is helping your kid thrive. Parenting is hard enough as it is. Thank goodness for all of these teachers and therapists and helpers who have my kids’ backs.