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04/08/2006

Raisin redux

A few weeks ago Charlie had a follow-up developmental evaluation.  Upon initial examination several months ago, he was found to be utterly average, performing the limited set of observable activities satisfactorily.  This time, with a wider array of motor and verbal behaviors in play, we had a little bit more to work with.

Charlie was at his most charming.  He grinned.  He babbled.  He crawled.  He pulled up.  He cruised.  He gamely attempted to eat a toy telephone.  He even — o, my proudly pounding heart! — dumped raisin.  Yes, he dumped that desiccated raisin like a sonofabitch.  Why, the dumping of this raisin will be celebrated in legend and in song for generations to come.  Never has an ossified raisin been so well and truly dumped as —

Well.  Enough of that.  The upshot?  I was not wrong to be concerned.  Charlie is somewhat delayed. 

For gross motor development — crawling, rolling, sitting, standing, walking, et cetera — Charlie ranks among the 25th percentile for his adjusted age.  The evaluating doctor expressed no major concern on this score, since he observed that all the prerequisite skills for standing unassisted and walking are already in evidence.

Charlie's auditory expressive skills — the spoken language he uses to communicate with others — fall into the 80-90th percentile for adjusted age.  This is gratifying, but it is not especially surprising, on reflection, that a child of his mouthy mother should be predisposed to getting a word in edgewise.

However, his auditory receptive skills — his response to verbal cues — are only in the 15-20th percentile.  He did not readily follow a command ("give Mama the ball") without an accompanying gesture ([furious hand jive of a pantomime, wild gesticulation, spastic pointing, exaggerated facial grimaces]).  He does, however, "inhibit to change in tone of voice."  That means basically that his face crumples adorably when he's told no in a warning tone.  (Yes, I can make my kid cry by speaking a single ungentle word.  This motherhood thing rocks.)

Spideydance His visual language skills — involvement of vision and facial expression in communication — are, alas, way behind, falling at about the 5th percentile for adjusted age.  He can give Mama the ball as long as she's doing an accompanying Macarena as detailed above; he can, when the mood strikes him, play peek-a-boo or "There's Something on Your Head" (a household favorite involving a head and a...something), but he does not initiate these games.  He doesn't point to objects with a single finger, though he'll do an alarming full-body lunge to indicate a desire, usually on the staircase, usually without warning, usually towards the terrified cat.

As for sensory motor development, which is just a fancy name for how well he learns through playing, he's currently testing at about a 9-13 month level, just at his adjusted age or below. 

In terms of object permanence ("I know your expensive cell phone still exists and I will find it.  You have to sleep sometime, after all..."), which the doctor tested by playing an intricate game of three-card Monte that confused even me, he's showing the understanding of a 9-10-month-old.  I have observed this myself: no matter how often I've told Charlie that you just can't win that game, the poor kid insists on betting his stuffed duck every goddamn time.

For the development of schemes for relating to objects, or, more plainly, recognizing how to play with objects — and this next part is a quote — "he drops objects and watches them go out of location at a 10-month level."  My beloved son is behind in dropping things.  His attendant "uh-oh," however, is the "uh-oh" of a baby of rare savoir faire, so I choose not to be discouraged.  If I'm teaching him nothing else, and I am not, I hope I'm showing him how to still look good while secretly being, deep down inside, as big a jerk as everyone else.

For social actions — bringing a book when he wants to be read to, or indicating a desire to share our food or drink, or insisting that I put a thoroughly spit-soggy, disintegrating graham cracker in my horrified mouth — he scores appropriately for his adjusted age.  I pass with flying colors, too, because you know what?  No matter how disgusting his offering is, I gamely nibble it every...single...time.

What can I say?  I love that preambulatory hyperverbal request-ignoring Hokey Pokey-requiring non-gesturing easily-bilked slow-dropping cracker-shoving boy.

So here is what this all boils down to, from the report:

Charlie was somewhat atypical in that he has better expressive language skills than he has visual or gestural or receptive communication.  For this reason, we felt that a referral at this time to the Family, Infant, and Toddler program to provide both early intervention and speech language follow-up makes some sense in terms of both tracking his development and providing ideas and supports for communication and play development in general.

We would like to see Charlie back for another visit when he is about 2 years of corrected age.  At that time we will evaluate the updates given by the Family, Infant, and Toddler program on their ongoing assessments and monitoring visits.

It was a pleasure to see Charlie today and to meet with his parents.  We did ask that they consider a follow-up hearing evaluation through the Hearing Outreach Project in their area.

(Sorry, what was that last bit again? Something about a lactation consultant?

Hahahaha.  Ohhhhh.)

How do I feel about all this?  Strangely, I don't.  It just is, a neutral, like his blue eyes, like the gap between his front teeth.  All of a sudden I'm not worried.  I'm not preoccupied by it.  If anything, I'm relieved to know what Charlie's status is so that we can proceed accordingly.

And, if I'm scrupulously honest, just a little bit jazzed to know I was right all along.

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