It feels like forever since I posted and I've been trying to find a few spare minutes to write ever since Monday. Alas, it's now Friday, but mercifully, Hallie is down for a nap (she woke up way too early today, at around 7:15, and had a very hard time going to sleep last night since she had one of her bottle-refund episodes and then couldn't settle back down easily, so I am not surprised that she was begging, in her own wordless way, for a nap by 10:30am). So I'll try to make this quick, since one can never predict whether a nap will last an hour (which it already has) or three hours.
So, bright and early on Monday morning (at 8am--not an hour that Hallie normally is up by), we had an appointment for a speech assessment over at CHOP. Given the earliness of the hour and the fact that our girl (like her mommy) takes a long time to wake up in the morning, we were surprised at how cooperative she was. The very nice speech therapist started out by asking Hallie to point to various familiar objects in a book (a ball, a dog, shoes, and stuff of that nature) and then kept going for several pages, finally maxing out Hallie's capacities when it came to identifying actions (not something that she really quite understands). She then asked Hallie to do various things with toys, watched Hallie turn around on command (she taught this trick to herself--we were not aware that she knew the word 'around') and go through her ever-expanding repertoire of signs. Finally, she listened to the various (and few) speech sounds that Hallie produced during the session (we got her to say her favorite word, 'kitty', but not much else). We'll be getting a formal written assessment at some point, but after all the tallying up of scores, it turns out that Hallie is at the 21 month level in terms of her receptive speech (which places her a bit BEYOND her actual age in this respect) and at the 12 month level in her expressive speech (4+ months delayed for her adjusted age, and about 9 months delayed for her actual age). Despite this wide gap, it's too soon to say that Hallie is officially apraxic. So the therapist gave us a bunch of tactics to use to help Hallie communicate expressively (making up a book or photo album of important pictures in her life, so she can point to what she wants and perhaps practice naming these things) and creating letter-boxes (boxes of cards that begin with a specific letter) with which we can practice Hallie's words. And she will give us the contact numbers of several speech therapists, but it's not clear whether insurance will cover this because the way scores are computed means that the two numbers--the receptive and expressive--are added together and then halved, at which point Hallie comes out looking like she is at about the 16 month level, which is totally fine. It's a pretty bad system, if you ask me, and designed to work against early-enough intervention for Apraxia. But it is in keeping with the very crappy health care system we have that favors intervention only once a problem has gotten out of hand and denies any assistance on prophylaxis to prevent a problem in the first place. That's bass ackwards, if you ask me, and even from a purely cost-control perspective (since it would be naive to assert that insurance companies are interested in people--lord knows that money is the number one priority), it makes no sense. It's precisely like all those situations where tens of thousands of dollars worth of surgery and g-tube maintenance is covered, but feeding therapy is not.
OK; I'm done with my rant here.
Anyway, we'll be working with Hallie and if need be train ourselves in the potentially useful therapy tactics (PROMPT, Kaufman praxis, what have you) to see if those things cannot help our kid find her voice.
Meanwhile, Hallie has definitely experienced an expressive signing explosion this week. She's picked up the following: dog (which she signed when she wanted her stuffed doggie), hot, cold, potty (which she used today to indicate that she had pooped in her diaper!), hat, cookie, apple, bear, help (which she is also using correctly), car, go, stop, and a bunch of others that I am now forgetting. She knows at least 20 signs and possibly many more than that---what happens is that she hears a word and signs it and that's how we realize she knows the sign. A few times this week, she signed 'yes' when the word 'yes' came up on the video but before Rachel had produced or spoken the word. I am not sure that this indicates that our girl can read, but what it does indicate is that she is familiar with sequencing and has a great memory.
On top of this, she is also experiencing a surge in her fine motor skills. I bought her a puzzle with shapes on it--it's one of those wooden ones with small pegs, and it contains a square, pentagon, rectangle, oval, circle, and triangle. We unwrapped it for her on Monday night and she took out all the pieces and put them all back in correctly, several times in a row. She is also using her stacking rings (she never used to do that), sorting her blocks like a champ now, and pretend feeding me (from one of the plastic Margarita cups she found in the sideboard and claimed as her own--apparently she's interested in hosting a cocktail party at some point soon). Anyway, she's a really cool kid and very smart and even if she doesn't ever talk in a conventional way, it's clear to us that she has a lot going on in that little head of hers and that she's finding ways of letting us know all about it.
We really do need to teach Ami sign, though: Hallie was signing all day for her doggie (which was upstairs) and Ami had no idea what she was doing or what the kid wanted. Sharon and I have both learned a lot of sign so far (Sharon is MUCH better than I am) and cousins Adam and Megan are learning a ton, and the rest of the Levy family (Sharon's sister, brother in law, and the other kids) have expressed a great deal of interest in learning, too. And regardless of what happens speech-wise, we really want Hallie to keep up with her signing. I think that a second language, whatever that language is, opens up new parts of the brain and opens up new worlds to whoever masters (or attempts to master) the language. It's a good thing all around. We had always planned to raise bilingual kids (we thought maybe Russian, Spanish, or after Karina was born, Chinese) but if it's ASL, that's fine too.
Hallie still has a bit of a cold and is still snarfly as a consequence (hence last night's refund episode), so there's been more vomit this week than any week in the recent past, but we are hoping she gets over this soon. We've taken to trying to get 6 ounces of baby food in her at every meal (up from four) and this is going well (for the most part, though the second or third time around after an upchucking session she's not nearly as cooperative as the first). And we're also working on getting her to drink out of an open cup (plastic, or the nosey cups), which she is enjoying, likely as not due to the novelty of the experience. We're not sure what her weight is right now, but will have to check this out pretty darned soon.
Finally, both of Hallie's 'stomach teeth' (canines) have broken through now, and we are still waiting on the two eye teeth. We know that at least two and maybe all of the first-year molars are through the gums (though not entirely in), but she wouldn't let me check today (which was probably a good thing for my poor fingers), so I can't say for sure what is going on with them.
Blogger is giving me one of its oh-so-fun-super-hard-times with uploading images, so I'll have to do these separately. I'm also busy downloading software to back up a (broken) RAZR to my hard drive (let's hope it works, because otherwise all of you whom I know IRL will never hear from me again because I've lost your phone numbers...). So more later...I promise!