Encompass Evaluation

On Tuesday last week was Hayden's evaluation by an organization called Encompass, referred to us by our pediatrician after I mentioned some concerns I had with Hayden's speech development at his 2 year check-up. When the pediatrician asked if Hayden had at least a 50 word vocabulary, I couldn't definitively say yes. If you count the words Phil and I understand, then yes. But a stranger would recognize? I wasn't so sure. So Encompass has a special program for 0-3 year-olds that helps with any developmental concerns parents have (paid for 100% by insurance, state grants, and other grants). So I thought better to get it all evaluated now.

Between the time I scheduled the evaluation and the actual date the 2 evaluators (a speech therapist and an occupational therapist) came over for the 1.5 hour in-home evaluation, is when Hayden's vocabulary suddenly exploded! Of course. Prior to the appointment, I filled out a huge packet of questions and could already tell that there were only a few small areas that Hayden might be a little behind.

I actually called a few days before and said I really wasn't having concerns anymore, but they insisted on following through with the evaluation. To qualify for therapy services, the child has to be scored in the bottom 25th percentile in one or more categories: Cognitive, Fine Motor, Gross Motor, Social-Emotional, Adaptive Behavior, Receptive Language and Expressive Language. The only category I had any concerns with was the "Expressive Language" area. Within about 5 minutes, they both said they could tell Hayden would not qualify. But they still were very helpful in giving me some suggestions on helping Hayden with some of the words he pronounces unusually, and also eased my worries that some of the sound substitutions he was making were very common. For example, he says, "Ba" for "Fan" and the speech therapist said the "B" for an "F" sound is a very common substitution. And also that picking up on the last sounds, almost speaking "Backwards" like he does sometimes is also very common as children learn to connect their hearing with verbal communication.

While the occupational therapist brought out an assortment of toys, puzzles, and books to administer "The Bayley Scales of Infant and Toddler Development", the speech therapist observed his language and asked me questions about what he says and how he communicates. The first puzzle the OT presented was a simple wood board with 3 pieces: circle, square, and triangle. She dumped the 3 pieces out in front of Hayden and put the board in front of him. She turned to grab her stop-watch and a pencil and as she turned back to Hayden, he was just putting the last piece in the puzzle. She and the Speech Therapist both laughed and were like, "OK, clearly no problems here." The next puzzle had 9 shapes in a 3x3 grid and as Hayden put them all in their proper place, he also counted 1-9 ("one, two, free, fah, figh, sixess, neneven, eight, nine". Again, the therapists were pretty stunned. And I apologized for wasting their time! But they said it was helpful and encouraging for them to see children at the other end of the spectrum since they are so used to seeing children with developmental delays.

It was actually really fun to see Hayden do some of the tasks so well, even impressing me with things I didn't think he'd understand or know how to do, like sort colored pegs into different clear cups, and mimic unusual hand gestures. At one point the OT asked him to match her hand, which was the "OK" sign, and Hayden not only did it, but said "F" because that is also the sign for the letter "F". I explained to the her that he knows almost the whole sign language alphabet and when I showed them, as I did the hand signs, Hayden said almost all the letters correctly. Noting that he makes a connection with visual and verbal communication, the speech therapist suggested I use more signs with words and try to do them closer to my face as I say the word out loud, so he is watching both my hands and mouth. She was able to get him to say "Trailer" much more clearly than I've ever heard before just by motioning her fingers by her face a few times as she said the word (and it doesn't matter if it's true American Sign Language, as long as there is a hand gesture with the word that helps him see it together with the word.)

Another trick the Speech Therapist suggested to work with Hayden on the words he says unusually, is to print out some pictures from the Internet and hold the pictures up near my face, saying the word with very intentional mouth movements. "FFFloWer"

By the end of the evaluation the Speech Therapist scored Hayden in the 70th percentile for receptive language (Age equivalent = 32 months), and 30th percentile for expressive language (Age equivalent = 22 months). So he didn't qualify for any therapy. The therapist said that if the issues he is having with expressive language (consonant substitution and deleting the beginning or ending or words) are not resolved by age 3, to get him evaluated again. Just as I have been working with him over the past week with the suggestions she recommended, I am already noticing a lot of improvements.

The final summary of the evaluation was:

"Hayden is a charming 25-month old boy. Based on today's testing, Hayden demonstrated age-appropriate skills in all areas of development. Encompass's Birth-to-Three services are not recommended at this time."