I’ve been concerned about Charlie’s speech and language development for a while. So, we scheduled an evaluation with the state Early Intervention team. They sent a Speech Pathologist and an Occupational Therapist, and did a test called the Infant-Toddler Developmental Assessment. The results indicated that his cognitive skills, social/emotional development, and “self-help” skills were all age-appropriate (in the 22-25 month range.) His communication skills and gross-motor skills were delayed (in the 18-21 month range.) I would have been more comfortable with tests that yield a standard score and percentiles, but this is what they use initially. The important thing is putting together some specific, measurable, appropriate goals for treatment, and if they can do that with this test, that’s fine. If not, I’ll push for more testing until we get enough information to work with.
The SLP observed that he definitely has communicative intent, but that his imitation skills are very weak. His vocabulary is limited (he uses maybe 25 words, when he should be using at least 50), and he isn’t putting words together in short phrases and sentences yet. In addition, he doesn’t use the words that he has consistently, and never ever on request. She is leaning toward a diagnosis of apraxia. They are going to recommend therapy at least once a week, and hopefully we can get that rolling within the month.
I was really happy to have a second opinion, and couldn’t believe that apraxia never crossed my mind before. I was convinced he was a late talker because I wasn’t playing with him enough or talking to him enough. Even though he showed some hallmark signs of motor speech problems, I totally missed it, thinking it had to be all my fault. I’m sure if he was someone else’s kid, I would have picked up on it - strange the things you miss…
Anyway, he also showed delays in gross motor skills. They noted that his running isn’t really running, but more of a bouncy, fast walking. He’s generally low-tone, and he has a lot of unnecessary rotation in his trunk when running. He also had trouble standing on one foot, and the way that he manages stairs is immature. They recommended more time at the playground, etc. I don’t know that they are willing to recommend therapy, but I’m going to push them and see if I can get it for him. In the meantime, I’m scouring the local area for some kind of tumbling/gymnastics class that we can attend. More on that later…
The OT said that he technically passed the items on the fine motor portion of the test, but she has qualitative concerns about his development in this area. She said that at this age, he should be favoring either the left or right hand, and he really isn’t. His crayon/pencil grasp is immature, his ability to stack blocks is somewhat limited, and his little hands still have that chubby-baby look - all of these things indicate low muscle tone, weakness and poor coordination. She wants to have another look at him in 3-4 months, and in the meantime she recommended some activities to improve his fine-motor strength and coordination (play-doh, etc.)
So, we’ve been really happy about the mild weather lately, because that means we can spend more time at the playground. And to reassure whoever might be wondering, none of these things are serious or permanent - a little therapy and some focused attention and he’ll be caught up in no time. 
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