Wednesday, February 10, 2010

Therapy Services from Age 2 to 3

How would we know what to ask for if we don't know what we are missing?

I recently received emails from a mom in Richmond, VA who had a few questions about the therapy services we currently receive and the skills we are currently working on. With her permission, I am sharing our email exchange as it could be helpful to others. Here are excerpts from her emails (in green text):
I'm writing because I struggle in my county with therapy services. We only receive infant education 2-3 times per month. The IE is a PT, ST and OT all rolled into one person.

Obviously in that one hour, we can't cover all the skills so we talk about them and I am given "homework" to do in between our sessions. We probably have one therapy session for one hour each week. As you can imagine, this puts a lot of pressure on us to make sure we (parents) are working on all these skills with him and doing them correctly. However, on the positive side, we don't have a lot of therapies to occupy our days and can spend plenty of time playing and enjoying other activities. This parent-centered approach leaves me struggling on whether we are getting good advice and whether our therapy sessions are similar to others. I realize all kids learn differently and at different speeds but it does help to have some insight into what others are getting.

I really respect your perspective and would be curious as to the following: what type of services and frequency are you receiving at age 2-3 yrs old? What did you feel were the most important skills that you are working on (now that walking is mastered)? Did you have home therapy, office therapies or group therapies?
I think many parents who have kids that are the same age as or younger than Matthew (he is now 28 months old) have these same questions. Many would be interested in insights and ideas that others have to offer. I invite everyone to share their experiences by answering any or all of the above questions.

Ways to share (if you are willing):
1) Leave a comment below....OR...
2) Write your own post in your blog (if you have your own blog) and share the link in a comment below...OR...
3) If you have already written on this topic, please share the link in a comment below.

My Reply
(reformatted for easier reading with additional links to previous posts)

It's interesting to see how early intervention services can vary so much. I suppose every state/ county does what it can do given the demand and available resources. What matters the most is if you feel like you're getting all the services you are should be getting. I understand the need to ask other families about their experiences with EI in order to compare and see if you might be missing something. Of course, keep in mind that every child's needs are different so what one child may be receiving and benefiting from may not necessarily work for another.

What type of services and frequency are you receiving at age 2-3 yrs old?
In our case, at age 2-3, Matthew sees 4 different people who come to our home. We are receiving physical therapy (PT) every 2 weeks, developmental therapy (DT) every 2 weeks, occupational therapy (OT) twice a month, and speech therapy (ST) once a week via the early intervention provider in Missouri called First Steps. The frequency "every 2 weeks" is different from "twice a month" to accomodate a 3rd session during long months (based on how the dates fall).

We used to only get ST twice a month but since Matthew's annual evaluation in October, I requested for an increase to once a week. I'm glad we did it because we've seen more progress in the area of speech in the past couple of months. Granted, Matthew's not saying whole words yet with clarity (he started approximating words last week) but we definitely hear him babble and experiment with sounds and inflections more and more, along with the words that he knows how to sign.

Did you have home therapy, office therapies or group therapies?
I have no experience with group or center-based therapies. But I supplement by taking him to preschool gym at the YMCA, the Parents as Teachers playgroups, and tot time at the library. I used to take him to swim classes (in 2008 and 2009) for kids with special needs at the Y too but it got harder for me to do being pregnant. I view these as opportunities for Matthew to socialize and just be around other kids since he does not have any siblings yet. That will change soon though with his sister due towards the end of April. :-)

Other families also get music therapy. We don't as it is not available in our area. If it were available, I would probably request for it too. So instead, I enrolled Matthew in a Kindermusik class last summer and last semester because he enjoys music so much. It's probably not the same as a one-on-one music therapy session with more specific and individualized goals but it was still an opportunity to expose Matthew to music and kid interaction.

What did you feel were the most important skills that you are working on (now that walking is mastered)?
Now that walking is mastered, we are working on walking up and down the stairs. He can climb/crawl up and down the stairs but he doesn't have the strength and balance necessary to be able to walk up or down. We also worked on walking while holding one of my hands - very important when we are in a place where I don't want him to wander off alone such as a parking lot. Last year, we also started on the concept of jumping, which he now gets, except he still doesn't have lift-off. It's funny to see him count to 3 (he says "oo, oo, oo") and then bend his knees and straighten up to jump. Learning to kick a ball independently was also important for developing balance and coordination. Other gross motor skills we worked on after his 2nd birthday (and he has already achieved) included backing into a kid's chair (one low enough to the ground) to sit, climbing on the sofa to sit (requires more upper strength and coordination to pull himself up without assistance and sit safely on the sofa, facing the right direction), and carrying a big, heavy (for him) object while walking (trains him to adjust to the change in center of balance).

In fine motor development, we are currently working on rolling play doh into balls and with a rolling pin, squeezing playdoh, coloring with crayons, stringing beads, using a spoon and fork, and other similar activities that help develop finger dexterity. We had to work on pointing for a while too because he wouldn't point with his index finger with his other fingers and thumb tucked in (proper finger isolation). He used to, and sometimes still does, point with his thumb but he has started isolating his index/ pointer finger in December when I had my Hallmark Christmas decor with buttons out for him. He enjoyed listening and dancing to the music everytime he pressed the button and it would only work when he used his index finger. Now our next goal is for him to point on request, for example when asked to point at a specific picture in a book. Our OT also helps us with feeding issues.

Sessions with his developmental therapist are focused on cognitive skills such as problem solving and learning to focus and attend to a task for longer periods of time. The activities usually require using fine motor skills and a lot of thinking on Matthew's part especially when working on activities such as matching pictures, sorting shapes or learning colors.

Our speech therapist gives me suggestions for jaw strengthening and feeding, which I implement whenever possible with Matthew. So during the speech therapy session, activities currently are centered on articulating the b, d, m, and p sounds merely based on imitation and prompting. I recently learned of a method called PROMPT wherein a PROMPT-certified speech pathologist is trained to physically manipulate the child's mouth muscles in order to make a specific sound. Moms and fellow bloggers, MaggieMae, who blogs at Take a Walk on the Happy Side, and Jennie, who blogs at A Little Something Extra For Us, have highly recommended the PROMPT method to me based on their sons' progress when their speech therapists used it. I've asked our speech therapist about PROMPT and she said she had been looking into it and was interested in getting certified. I was encouraging her to do so based on other kids' success with it but it will ultimately be her decision whether to pursue it or not. I'm keeping my fingers crossed. Another method I was made aware of is the Hanen Program for Parents - It Takes Two to Talk. I haven't had a chance to research this yet but I know another blogger who took the course. You can find her at Cathal's Big Adventure.

Additional Thoughts
What I like about the services we get is that all four therapists exchange information amongst themselves about Matthew. They joke that kids will sometimes speak for the physical therapist, demonstrate fine motor skills for the speech therapist, and show off gross motor skills for the occupational therapist and developmental therapist. Keeping communication lines open between them helps them come up with a more unified and targeted approach for each of their therapy sessions, overlapping where they should and reinforcing learned skills. This is evident during our annual and semi-annual evaluations.

Matthew will start school when he turns 3 in October 2010. This is when we transition out of our early intervention program and into the Early Childhood Special Education program, which is where Matthew will receive the therapy services that he may still need. I know another mom who sent her daughter to school before she turned 3 to receive services and I believe she was very pleased with how that worked out. If you want her experience on that, you can find her at Just RK.

I have simple detailed lists of developmental milestones that are organized by area of development and age range. (Contact me if you would like a copy). I got these lists from one of Matthew's therapists. While they are not modified for kids with Down syndrome, I have been using these lists to help me keep my eye on the horizon and see what we can work on next. I ignore the age ranges because if I focus on that then I'd look at the lists as a gauge for Matthew's delays instead of the progress he's making.


Jill said...

Hi Ria!
Great post. I just wrote about a little speech therapy post today myself! A little trick I've learned along the way from our speech therapist. You or any other readers can check it out if you want! Nate has speech therapy every other Tuesday, and physical therapy every other Thursday. We do not do OT. I am getting ready to begin swim therapy soon, and am looking into equestrian therapy for the spring! Thank you for all of the good advice you give...your blog is great!

To Love Endlessly said...

Great post! We were 1st offered developmental therapy all rolled into one therapist. I didn't agree so I fought and fought and fought. Marissa now gets feeding therapy, PT, OT, and play therapy. I say fight for your baby. Someone will eventually break and decide to fork over the money to pay for intervention services.

RK said...

It sounds like your new friend is a part of a PSP model for EI. I just did a quick(ish) bit about it on the blog.

Kristin said...

It is intereting to see what services our little ones are receiving. Dominic will be turning 4 in a few weeks. From birth to 3 OT,PT & ST came to our home. Frequency was similar to Matthew's (every other week). In Sept., he started going to school in the EC program,so we no longer receive home services. Speech is Dominic's weak area. He now receives speech 3x's/wk. We love his therapists, but in all honesty, I think the best therapy comes from being surrounded by his siblings(Dominic is the youngest of 4), relatives and daycare friends. A few weeks ago my oldest daughter had a group of her friends over. Dominic wanted to sit and eat at the table with them. After asking for a drink in his usual manner, "ink, ink", he pulled my hand to the room where the girls were eating, pointed to the table and said, "ut, up, ear, Monny- (put cup here, Mommy!)" His first 4 word senetence-everyone was so excited.
as far as gross motor-Dominic has very loose joints. He started wearing braces, shortly after his first birthday. This past June, I brought him to a specialist at Children's Hospital in Milwaukee, who didn't seem to think he needed to wear them anymore. He seems to be doing fine- runs 100 &, started to ski black dimond hills with a harness at age 2=)
Fine motor skills are coming along. He's currently working on drawing horizontal lines, vertical lines and making circles.
I look forward to reading comments from all of your followers.

Karen said...

don't have much time to post, so I won't elaborate too much. Caleb receives 4 different types of therapies a week-PT, OT, ST and ITDS (infant toddler development specialit). Additionally, we see a computer tutor once a week. We are about to age out of Early Steps next month and services will be in-school, but will pay for private PT and ST (Hanen).
Hoping to include music somewhere-either as a therapy itself or Kindermusic and ISR (swimming). Would LOVE to do the Hippotherapy, but we have to wait on the neck xray.
Take care!

Anonymous said...

Great blog! Nate stopped PT and OT at 18 months of age. He had a developmental teacher come out once a month or less. She honestly was not very good. I so wanted to drop her but Nate's pediatrician told me that he has Down syndrome and he should have this EI. Speech therapy had been focused on feeding and very sporatic and limited. We had had 3 differenct SLP. Each gave up on getting Nate to eat. No therapy was ever given from SLP for language till the very end of EI services which stopped 3 months before he tuned 3. He had 3 sessions for language development which were awesome following a Hanen Course I had attended. Pam Marshalla's book Becoming Verbal with Childhood Speech Apraxia was also very helpful along with Dr James MacDonalds website--Communicating partners.

Nate and I enjoyed taking mommy and me gym classes as well as music classes.

Anonymous said...

Wow - Great post with lots of detail. My son is 34mos and like a previous post we are in Wisconsin. Our Birth-3 program is delivered through the county so each county is a little different. I recieve whats called a medical model. The professionals come to my home to first work with my son and then second to advise me on things we can do ourselves. Our county had been known for exceptional services but has recently made cuts where parents will recieve the teaching model unless they specifically request or have a script. This sounds like your posted friend. I am concerned for the reasons you mention. How do you know what you need? I'm an educated and and experienced mom and I wonder what I am missing.

Currently we have four services in our home. We recieve PT, and ST 1x/week and OT and Sped every other week. Overall I'm pleased with my services and happy to be where I am. He just started walking and is taking off in that area. Like many he is behind in speech and I wish I could up the frequency of those visits. 18mos ago he would have qualified for 2x/week (before the cuts).

He will transfer into a school district funded early childhood program in April and will recieve all of his services there. I have yet to find out what frequency and types he will qualify for. During the summer we will have to pay privately for therapies.

I hope to do a gym class soon as he is now walking and will consider other activities like swim, music and hippo as they come.

I would advise all new parents to ask a lot of questions, my therpists tell me they are restricted in what info they can volunteer but if we ask they can answer truthfully and offer advise if ask. So no question is out of line!

Jennie said...

Micah (age 25mos) receives the following through Early Childhood (which is done through the school districts in the state of MN... in WI it was done through the counties):

PT - weekly - Micah is not yet walking

OT - 2 per month - he needs more, but I haven't requested it because I don't know when to fit it in my schedule (in addition to Down syndrome, Micah has amniotic banding syndrome on his left hand, which cut off all four fingers before the first joint... this alone would warrant his OT, let alone the fact that he is 25mos old and still not pointing, which is most likely due primarily to his lack of eating so no need to work on pincer grasp early on)

ST - 3 per month - BIG issue because Micah has a feeding tube and is significantly behind on speech, eating, etc.

DT - 2 per month - LOVE his DT and he will also be his teacher when Micah enters school at age 3 - huge bonus for Micah!

Now that we are in a major metro area, we have opted to go the private route for speech and feeding. Micah has had a feeding tube since he checked out of the NICU. He started eating pureed baby food last August(?) and hasn't progressed beyond that yet. He does not allow anything by his mouth except the rubber-coated spoons.

Anyway... Micah sees his private SLP twice each week and we've also added private OT to that (she co-treats for feeding issues with the private SLP).

Whew. I get tired just thinking about all of that!

Leslie said...

Interesting the differences, isn't it.

Here is what Eliana had from age 2 to 3 through our early intervention program.

OT - once per week out of the home in a clinic. This started as feeding therapy and we continued to go there. Had to get permission to go out of the home, but we needed a specialist and weren't happy with the one that came to our home.

PT - once per week

Speech - twice per week. We moved this up once she began talking and it was very helpful.

Music - She just had this for about 4 months and it fell under DT. It was a lot of fun and a great motivator for her too.


heidi marie said...

henry receive ot, pt, st twice a week. his sessions are an half hour long and they are back to back, so we got to therapy place twice a week. we do private therapy because our local eci program sucks. we couldn't get henry approved for certain therapies and i felt the people associated with the state early intervention program weren't that great. some were down right terrible and a waste of time.

i wasn't going to fight for poor therapists. there are some other reasons why we chose private as well. he concentrates more. at home he is distracted and if i'm there he won't "work." in private therapy he is alone with his therapists. after each session they brief me on what they did and give me ideas to use at home.

our main focus at this time is speech. he is very delayed in speech and it is something he will need to work on his entirely life. jumping, running, kicking, etc...all that will come with time. i'm not concerned about it. but we work on building his core which also relates to speech, and we work on words/sounds.

Jennifer said...

Our Little J is 18 months. I posted a fairly detailed bit of information about his therapy services at my

Bethany said...

I am also in VA and I find it interesting that this family is only getting an infant educator right now. How old is the child? In VA, you really need to push and know how to work the system. I'd love to chat with this mom. :)

Services that people get vary so much from state to state. Virginia's approach is the furthest from a medical model that you can get. The point is that they only come in as often as they need to to teach the parents how to conduct therapy with their child. However, getting only an infant educator is not ideal.

Kelli said...

Hi Ria!

I really enjoyed reading this post! Thanks for providing so much great information!

Through Early Intervention in New Jersey, Colin receives in the home:

PT once per week. Right now, Colin can sit independently, so we are working on the skills necessary to get him to get OUT of sitting. He won't "prop" yet to the sides either by manipulating him or by getting him to react to "falling" out of sitting. We are also working on building strength so that he can support himself on all fours and hopefully get him mobile soon. Months ago, he was rolling both ways, but he seems to have "lost" the skill to roll from back to his tummy so we are trying to work on that as well.

DT once per week. Most of the skills we are working on right now involve imitation (clapping, pointing, waving, mouth movements, sounds, specific manipulations with toys, etc.). We are also working on object permanence with games like peek a boo, hiding the toy and having him "find" it, etc.

Colin's year IFSP will be in June and by then I really want to get him Speech and OT. His DT and I are currently writing a list for our arguments of why he needs these things. I honestly feel that these are therapies he SHOULD receive automatically (wish it was sooner than later) but apparently we have to "fight" for them.

Thanks for the great advice!