Case in Progress
Riley - Year 2
At Riley's first birthday on August 16th, he was receiving therapy from both a physical and a speech/language therapist. His parents had already seen a developmental pediatrician through their local Regional Center. But, apart from a "failure to thrive" diagnosis, there were no clear-cut answers for them regarding Riley's developmental delay. Following this birthday, it was recommended that they travel to see a geneticist.
While waiting for this appointment, Riley continued to make steady progress. He walked for the first time right before Christmas, at the age of 15 1/2 months. It was the present his parents had been hoping for. Following Christmas, it was decided that since he was now walking the physical therapy side of his program would progress to a monitor status.
The focus of his program would be educational services to address his global development. At the beginning of this time, Riley had a hard time settling down in one place to work - he was so happy and excited to be walking that that was all he wanted to do! After several weeks, he was able to sit and focus - even to the point of greeting the therapist at the door, helping her carry in her bag, and insisting she sit in the same spot for each therapy.
He quickly learned to do different cognitive functions, such as stacking blocks, placing toys in and out of a container, and placing puzzle pieces. Prior to this time Riley had been clingy with his Mom, and during this time he became more independent and secure.
Riley and his family finally were able to go to Fresno in the spring and meet with Dr. Susan Winter, the geneticist. She researched a few diagnoses, such as Russell-Silver Syndrome, and suggested further testing be completed prior to any definitive diagnosis. Riley did not really fit any specific profile. It was recommended that he begin taking L-Carnitine to aid in his digestion and absorption of food, which his parents began right away. It was clear almost immediately that the L-Carnitine was a great benefit to Riley. He began eating more, and putting on some weight. Riley at this time was still on a bottle to make sure he consumed sufficient calories and nourishment. He could drink from a cup well.
In early summer Riley began speech/language therapy again. The therapist and Riley immediately clicked with each other and everyone was pleased with his response. He almost immediately began to make more sounds and imitation, and word attempts.
Best of all, his mother reported that he was acting "like a two-year-old", (which he almost was!). As his birthday approached, Riley's favorite pastimes were playing outside with his wagon and on the swing set, and having stories read. Over this past year he had become very charming and outgoing, with a big smile for everyone.
At Riley's annual IFSP (for his second birthday), it was noted that he had made 6 months progress in six months time. This was very exciting for Riley, his family, and his therapists. At this time Mother expressed her desire to increase Riley's speech. She also wanted to encourage more and more independence from her, as she was going to begin working on a weekly basis at Riley's older sister's school.
While still delayed, particularly in the area of expressive communication, we were all pleased with Riley's progress. In expressive language he was now approaching 18 months, with 20 words in his vocabulary. His receptive skills are close to 21 months. He is able to point to more than 6 body parts, points to objects when named and follows simple directions. His articulation had many errors and sounds similar to a 12-18 month old. Over the past 6 months his imitation skills have dramatically improved, imitation of specific vowel consonant repetitions is not a strong area for him. He is at a point where he can communicate what he really want and needs. The speech therapist recommended continued weekly speech therapy.
In the other areas of development Riley was continuing at a good developmental pace also. In the areas of fine motor, cognitive, and gross motor his skills were solid at 18 months. He could imitate a block train, imitate a crayon stroke, complete a 3 piece puzzle eventually. Riley would walk up stairs holding on with one hand, kick a ball, and climb into an adult size chair to reach something.
At the time of his second birthday, in the area of self care Riley was solid at 21 months, and social skills were his strength at 24 months. He put toys away upon request, pushed a toy with good steering, tried to comfort others when they were upset. He was eating with a fork, drinking from a straw, washing his own hands and able to zip and unzip.
Over the past year, Riley has come a long way. In our final year together, Riley had some difficult times and some good advancement. Come back next month to see what Riley is doing when he turns 3 years old.
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