Wednesday Beth and I had our annual meeting with Justin's battery of teachers over at the pre-school, as part of the review of his IEP (individual education plan) and planning for next year. The big question to be decided was where to put him next year, since he's technically eligible for Kindergaten but his birthday is only two weeks before the cutoff. Since he was born, we'd never intended to send him to kindergarten this year, but Beth wasn't sure if the preschool would be able to give him enough next year that was different from this year. But they were all in agreement that the preschool was a better place to have him, since there' s smaller classes and fewer kids per teacher in the special ed programs especially. They did agree that he could have more of his individual instruction before or after school, thereby maximizing the amount of time he spends in the regular classroom, so that will make for a slightly longer day for him and hopefully give him some more time to do everything so he doesn't start feeling like a lab rat (assuming he doesn't feel that way already).



What struck me about this meeting is that for the first time in the three years or so all this has been going on I'm starting to get a sense of what exactly we're dealing with. When we met last year, he was just finishing up his first year at the preschool with one individual speech class a week and one PT class a week, and there didn't seem to be much to show for it. I had been kind of hoping when he started there that after a year of this comparatively intense instruction all his speech problems would be fixed, but that was not only not the case but it was hard to point at much progress that couldn't just be attributed to the fact that he was a year older. This time around, his progress is much more obvious and, more importantly, seems to have directly benefited from the extra therapy session, with not only speech and PT but now with OT as well.



To my mind, speech is the whole reason we're there at all. Justin was a little late to start talking, but when he did he had the odd habit of dropping the beginning consonants off of words, and by the time he was two he was barely stringing more than a few words together, and it was very difficult to know what he was talking about. As he's gotten older, he talks all the time now, and those of us who spend a fair amount of time around him can understand him most of the time, but strangers and particularly kids his own age still don't get 90% of what he says in most situations. The major progress he's made this year has been in putting those beginning consonants on words, sometimes the wrong one but usually the right one. Stringing words together makes them harder to understand, as substitutions of one sound for another make it harder to figure out what he's saying, particularly if he comes up with something out of context or as a non sequitur, which is quite often. So this coming year, while continuing to work on intelligibility, the ability to say individual sounds and words, they also want to work on fluency, the ability to string those words together into sentences and still be understood. You can tell when he talks now that he can be conscious of speaking very deliberately, of how to position his mouth to say certain things, and without the speech instruction he wouldn't be doing that.



Since he was already in the pre-school program, he was also evaluated for physical therapy and turned out to be deficient there, also, in that he's fairly uncoordinated and doesn't have much upper body strength. This has gotten better, too, but by itself I don't know if it would be enough to warrant special services. Same thing with the occupational therapy, where the test they did for the annual review had him actually ahead of his age group in many categories, but still lagging in others. The OT teacher calls him a "kinesthetic learner", meaning he needs to experience what something feels like several times before he can do it himself. In drawing copies of shapes on a page, it helped him to trace over the shape first before drawing it himself, for instance. Some of those kind of tricks he's figured out on his own. The OT teacher also kind of pulled it all together, that the fact that Justin needs help in speech and OT and PT is not coincidental, but is all interrelated to some neurlogical wiring problem for which there is no medical cause or cure, but which can be fixed gradually by a coordinated effort on these several fronts, such that conditioning in PT or OT may actually help him in speech and vice versa, which is very interesting and very enlightening. Beth has spent a fair amount of time looking for The Answer, but nobody can find anything medically wrong, no evidence of seizures or any other neurological disorder which could be treated with medication. So you're left with the more abstract and more long-term approach of addressing all these issues separately but at the same time, in the belief that gains in one area will hasten gains in another area. For this past year, at least, that seems to have been borne out. As long as Justin is still a cooperative subject, and hopefully sees his own progress while not feeling set apart from other kids, it should remain so.



Since the preschool teacher has a hand in this too, she wants to focus on his socialization skills, which again by themselves don't warrant an IEP and can't even necessarily be attributed to his other disabilities, although I'm sure they don't help. He tends to be fairly private, not that interested in playing with other kids, not spontaneously social in group situations, but he's by no means acts sullen or violent or anything like that. I was shy and antisocial at that age and I didn't have any speech problems, so it may just be genetic in this case. They want him to be able to interact more with other kids, and being able to talk better would of course help that, and the preschool teacher sees progress in those areas, and thinks the smaller class size and individual attention of his current school will continue to better serve Justin next year too, and I would tend to agree. He definitely manifests all the standard boy characteristics, likes to play with trucks and trains, likes to play tricks on people and tell jokes, doesn't seem to be phased by scary tv imagery, etc.



You can only do everything you reasonably can to take advantage of what's out there to help him along, and Beth certainly has that well in hand. She wants a roadmap, or a crystal ball, or a magic bullet that will tell her exactly when and how everything will be fixed, and of course there isn't one, but I tend to to take the approach that as long as you see definite progress and it seems to be enhanced by all this extra help, then its worth doing, but as far what happens next year or the year after that there's no sense worrying about it now. The good news to take away from this year's annual review was just that progress is being made, and there's the expectation of more to come.