Expert: Christine D. DeLoatch, MA CCC-SLP - 9/30/2007

Question
Hi Christine,
I have a four year old son.  He was adopted at birth.  Both of his birth parents were developmentally delayed but there was no evidence that it was genetic.  My son had plagiocephaly and had to wear a helmet to correct that condition when he was a small baby.  He wore it for almost four months.  

At that time he began in the ECI program (early childhood intervention).  The main focus was on physical therapy to strenghthen his neck muscles and help him with rolling over.
As he became stronger the focus was more on balance, pulling up, and later walking.  

When he was about a year and a half of age physical therapy was phased out and occupational therapy became the main focus.  My son was still only able to say a few words so they eventually added speech therapy.  His speech therapist felt that he might have some kind of oral sensitivity.... because he hardly ate at all and did not like the way many things felt in his mouth.  He also did not like the way tags felt on his clothing.  They felt like he might not be able to learn to talk I guess so they wanted to focus on teaching him sign language.  I didn't mind him learning SOME sign language but I didn't want them to stop working on trying to teach him to say the words either...so I kind of limited how much time was spent on sign language...which didn't necessarily make me popular.

When my son was 2 and a half years old he had some extensive oral surgery.  Almost within the week his vocabulary doubled!!!!  His speech therapist had been insisting that he go immediately into Head Start but I had been a little nervous about him going five days a week because he wasn't potty trained 100% and still needed help sometimes.  Because his speech improved so dramatically,
the therapist agreed that he would be okay in a two day a week program I had him in.

Now...my son is older...his speech is very much improved but he is very disruptive in class.  A big part of it is that he cannot focus long enough to listen to the teacher so that he can learn what he needs to do.  He does not know how to act around other children....he is an only child and there are no other small children in the family...so he acts silly or makes noises to get attention.  He has also hit other little kids...not hard...but STILL!

I have tried to talk with him and give him some ideas for positive things to say...."Hey, how ya doin?" "What kinds of things do you like to play?" etc...and have suggested giving people "five" instead of hitting.  But sometimes just getting him to listen to suggestions is a challenge.

His teachers at the daycare are VERY nice...they realize he needs more one on one attention than they can give and are trying to help me get him into some kind of program in Head Start or in the public schools.  One minute I think we are making progress but the next all I hear is that his speech problem is not severe enough and we aren't poor enough.  

I would appreciate it if you could give me some guidance on what to say or do so that I am not just shut down and my child is given the chance he needs.  I only want the best for him.  He is a very smart little boy in many ways but I think that maybe different methods might work better for him.  You seem very knowledgeable....if you don't know...maybe you can point me in the right direction!!!
Thanks in advance!!! Shelia :)

PS....sorry for the long post!!

Answer
Dear Shelia,  

Thanks for asking me your question.  I apologize for the delay in my response to your questions I had a death in the family.  

When is the last time he had a speech language evaluation?  Has he had a hearing evaluation?  
When will he turn 5?  What are your feelings about medication?  Has your son visited a child psychologist?  Have you discussed these issues with your son's medical doctor?  Does your son still have an occupational therapist?

If you have not done so, you might want to fill out a screening test at www.amenclinic.com to see if these concerns seem to be related to attention deficit disorder.  Usually ADHD is treated with medication and behavioral treatment, but medication only seems to work 50% of the time for kids who are under 5, so they often like to wait until then to look at medication.

You may want to look into a program called 1,2,3, Magic for behavior challenges - but this may not address the impulsivity I think you were alluding to.  You didn't say whether you son is able to tell you the rules or seems to just say 'I don't know' if he is asked, "Should you hit?"  

If he is impulsive then medication may be the best option. If he is also not remembering the information, then you may need to see how the speech therapist can work with him in pragmatics (the social rules of language) - doing some role playing and such.  A child psychologist can also help with this too.  

You do want early intervention - the sooner you address these things the sooner your son will be 'available' for learning.  It sounds like right now he may be too distracted to learn effectively.  

An occupational therapist may also be able to suggest some sensory strategies for calming and alerting so that he is more attentive.  Ask about a sensory diet.  If he is not still receiving OT, ask for a re-evaluation.

You may also be interested in a book called - The Out-of-sync Child.  It is very good.  

If you want to write back to me again with more specifics - the answers to the first set of questions, I may be able to be of more assistance.  

One last suggestion - A website called do2learn it is very good.  Using some schedules might also help your son finish tasks if this is also a challenge.  

Thanks again for your question & your patience.

Christine