Pediatric Services Pediatric Services: An intervention team serving children with developmental delays.

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Case in Progress

Danny at 3

Danny was now receiving weekly speech and language therapy, and weekly child education. We had seen good gains in the past 18 months of early start services. He continued to lag behind his age group but was making regular and consistent developmental progress.

Danny entered into his third year with a bang. A month after his second birthday he contracted asthmatic bronchitis, and was hospitalized for a week. He was very ill, exhibited some seizure activity, and gave his family quite a scare.

Immediately after his release from the hospital he was seen by the neurologist, and she increased his daily Tegretol. This served to make him more groggy in the beginning, but soon he was able to overcome it. The neurologist was considering referring him to a metabolic specialist in the future, and in the meantime was testing him for a chemical imbalance in the blood.

At this time Danny also become a big brother, when his mom gave birth to his little sister.

The focus of parent education at this time was about services for Danny once he has his third birthday. There were many long discussions with his mom and dad about school settings After quite a bit of thought, his Mom felt that it would be best for him to go into a preschool that was run at the local community college and that has a special education component. She wants Danny included in everything that the school has to offer. This location only has 6 slots available so we began the paperwork to see if this could be accomplished.

Danny continued having intense speech therapy 1-2 times a week, and child education. His mother continued to provide parental support at all times.

Danny was re-assessed in May, due to time constraints with the local school district. At that time his age was 28.5 months, and his skill levels were:

  • Gross Motors: skills are solid at 27 months, scattered to 30 months.
  • Cognitive: skills are solid at 24 months, scattered to 30 months.
  • Fine Motor: skills are solid at 24 months, scattered to 27 months.
  • Self-Care: solid at 24 months, scattered to 27 months.
  • Social-Emotional: solid at 27 months.
  • Communication: 24 months (receptive), 18 months (expressive).

Danny had made incredible gains in communication and was using many, many more words. His speech therapist was encouraging his mother to have him use his words and giving her many ideas for games that they could play to encourage speech. Danny's lack of eruption of teeth still remained a worry. A pediatric dentist was consulted and he said that Danny may actually be missing some teeth that will not come in at all. The therapist and his mother worked hard to make allowance for this, without it hindering his progress.

We began to target Danny's therapy to address his ability to have skills for school attendance. This included attention to task and verbal commands, ability to use crayons, cut with scissors, and play with clay.

Another area of concern was Danny's feeding. His family had not yet introduced the fork and were reliant on a straw for drinking. His mother was encourage begin to use a for and cup without a straw at mealtimes. He had also shown an interest in potty training, just before his sister was born, and potty training was encouraged if at all possible,.

At 30 months of age, a meeting was held with the local school district representatives and Danny's family. It was discussed at that time that there were no openings at the community college preschool that Danny's mother preferred when he turns three. However, a preschool specialist would see Danny weekly to address his continued developmental progress. He would also participate weekly in the small group speech preschool at the district, so he could increase his socialization skills and continue to work on speech.

At 35 months of age, Danny was seen by the regional center pediatrician. He was 38 inches tall, which is near the 75th % on the growth chart, and 33 pounds, which is at the 60th %. He is still considered mildly hypotonic, with his seizures being controlled adequately with medication. At that time his skills were assessed as follows:

Motor overall development is coming along at 80-85% of age expectation with Gross Motors skills near 28 months and Fine Motor skills scattering from 27-30 months.

Self-Care skills cluster at 28-32 months, (80-85% of age). He is not yet toilet trained and still requires assistance to wash his hands and get a drink.

Communication skills are receptive language at 25-27 months (71-77% of age), and expressive language skills at 18-20 months (50-57% of age). The pediatrician felt that Danny has signs of an element of oral apraxia or possibly an element of expressive aphasia.

Cognitive skills are at 25-30 months, with fine motor and visual perceptual skills ahead of verbal skills. Overall, Danny's abilities were placed in the lower part of average range.

Danny and his family have been with our program for over two years, receiving services and support to guide them on their way. It is now time for him to graduate onto a new program, that will be able to continue this journey with them. We are excited and happy for him and for his family, and look forward to hearing about all the progress he will continue to make.

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Last modified: January 26, 2013