developmental delays/EI options

  1. You have chosen to ignore posts from stefani2. Show stefani2's posts

    developmental delays/EI options

    hi all - i have 1YO b/g twins as some of you know.  at our 1Y appt we raised some concerns about DS b/c compared to DD he's delayed.  he is just starting to crawl, took a lot longer to get the pincer grasp but now does it, just recently started clapping, gets up to his knees but does not pull himself to standing, sometimes responds to his name but often does not, and likes to eat finger foods but rarely swallows them - just about always spits them out (but will swallow purees, though he's starting to not want us to feed him).  he is also less vocal than DD - doesn't really babble or repeat words.  because we brought it up, the doctor said he would refer us to EI.  i guess my question is threefold:

    1) what do you all think, do i have something to worry about (interested in YOUR experience, not "ask the doctor!" - our pedi practice (MGH) is pretty much useless but i'm not interested in switching b/c we live so close and it's temporary)? 

    2)  are there any options besides going thru the standard EI process - i would almost rather a single-time consultation from a private company with specialists just to see where we stand but not sure if this is an option?

    3)  any other tips/EI specialists you'd recommend/etc.?

    thanks!
     
  2. You have chosen to ignore posts from medfordcc. Show medfordcc's posts

    Re: developmental delays/EI options

    Hi there,
    I don't have any insight about the specific issues with the LO you mention, but we recently entered EI and I have info about that!

    (2) EI starts out as a one time appointment.  They set up a time for an evaluation, and a couple of people come to your house.  So you're not committing to anything to start.  The evaluation will determine whether or not your LO will even qualify for EI.  If he *does* qualify, you could then worry about a course of action.
    In my (personal) experience, the evaluation was very helpful.  The EI specialists see a wide variety of kids and they have standard "tools" they use to assess.  It was fun.
    If, at or after the evaluation, and particularly if he does not qualify, you feel that you still want a medical specialist, you could ask the EI people what they would recommend.  For example, a physical therapist, a speech therapist, et cetera...

    (3) There are different EI service providers depending on what town you live in.  Some towns have more than one provider.  The list is here:
    http://www.massfamilyties.org/ei/eicity.php
    You can contact the provider's office directly.

    I know that's kind of confusing; I assumed it was a central agency.  There is information on the program as a whole here: http://www.mass.gov/dph/earlyintervention

    I guess my general advice is to definitely do the evaluation.  He may not qualify, but you'll learn a lot about the overall picture.  The people spend so much more time with the LO than a pediatrician can... for us, it was worth it.



     
  3. You have chosen to ignore posts from kiwigal. Show kiwigal's posts

    Re: developmental delays/EI options

    I agree with medford that it cant hurt to have an evaluation. When we mentioned some of our concerns at DS' 1 year appointment, the NP wasn't overly concerned but had the attitude that an evaluation wouldn't hurt if we had some worries. As medford said, there's no guarantee your son would even qualify (there has to be at least a 30% delay) or, if he does qualify, there's no requirement that you have to go forward with EI. After our evalutaion we had two meetings with SLPs to make sure the services felt like a good match and that we were comfortable with the assigned SLP before making the 6-month commitment. That's the other thing, it's not a forever kind of thing. At his re-evaluation, DS was measuring at or above age-level, so no longer qualified for services.

    The other thing that's great is that EI specialists see LOTS of kids and have a much better sense of what's in the normal range of development which is much harder for most of us parents to recognize when we only see our own kid(s).
     
  4. You have chosen to ignore posts from dz76. Show dz76's posts

    Re: developmental delays/EI options

    I would be mildly concerned about the eating and not responding to name/verbalizing while chocking the physical stuff more up to kids doing everything on their own time (you might not have even noticed if you didn't have someone to compare DS to).

    Do the EI evaluation.  They are specialist and will be able to tell you what to really be concerned by.  And it's free.

    DD2 has been having EI services since 7 months (my b/g twins are just a could weeks older than your's).  She has 2 sessions a week , 1 with a physical therapist focus and one with a development specialist focus (they are very similar).  Every other week she has a third session with an actually PT.  She also meets with an OT (occupational therapist) once a month to address eating concerns.  She is a very busy beaver!

    Our pedi is still concerned by DD2's delay in things so at our 9 month she referred us to a neurologist, which we were able to meet with the week before DD turned 1 (long wait).  The neurologist had DD do a hearing screening to rule out any hearing issues (she was concerned about DD's verbalization but it wasn't one of our concerns.  We did the screening though to rule anything out) and DD is having an MRI next month on her spine (she has an asymmetrical sacral dimple) to rule out any spinal issues not seen on the ultrasound that was done at 5 months and since she'll already be under they will scan her brain to make sure there are no structural issues.

    Ask your pedi about getting a referral for a hearing screen and ,if YOU are really concerned about the delays, to a neurologist. All in addition to having the EI eval.
     
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  6. You have chosen to ignore posts from medfordcc. Show medfordcc's posts

    Re: developmental delays/EI options

    Some-guy makes a really good point about worry about stigma.
    I have to say, when I first heard the term EI in reference to my own child, I was pretty nervous/upset.
    It's actually through these boards and hearing about it from kiwi and dz and others that I got really comfortable with the idea.  Now the more I talk about it, the better I feel about it.
     
  7. You have chosen to ignore posts from dz76. Show dz76's posts

    Re: developmental delays/EI options

    It's funny I never once worried about there being a stigma about having DD have EI.  They are SO little and no one needs to know unless you tell them.

    EI actually made me less concerned bacause the specialist were able to reassure me that some of the things that concerned me the most originally, the lack of eye head control and self soothing ability, would most likely be grown out of.  And that's what happened.
     
  8. You have chosen to ignore posts from MichelleandtheBoys. Show MichelleandtheBoys's posts

    Re: developmental delays/EI options

    He's probably fine, but it can't hurt to check him out.  It it were me, I'd get him checked by Early Intervention first.  If they say he's fine, you probably have nothing to worry about.  If they have any recommendations for their services, I'd see how qualified they seem, then look into private specialist options.

    My sister has a 21 month old that doesn't say one word, and will not get him checked out yet.  It's frustrating me.

    In the meantime, try not to worry.  Everyone really does develop differently. When my son was six months old the doctor wanted me to get him checked because he had low muscle tone. He was kind of floppy and didn't sit up so well. The early intervention people said he seemed perfectly fine. By 10 months he was literally running, and now at 9 years old is the most coordinated, athletic kid in his class!  (Just ran a 7.16 minute mile today, as a matter of fact. :) )
     
  9. You have chosen to ignore posts from misslily. Show misslily's posts

    Re: developmental delays/EI options

    Hi Stefani - as you know I have b/g twins too.  Mine have hearing loss so they qualify for EI automatically.  But my DH didn't want them to have it at first.  He wanted me to take them to the SLP at Mass. Eye and Ear instead.  I did it for a year and then said, "Enough - I'm calling EI."  I love it.  They come to the house...it's so much easier.
    Get the evaluation.  If you don't qualify then Hooray! - your DS is just taking his time getting to these milestones.  If you do - great - you can get EI to come to you and see him as often as necessary.

    And if you think he might have a hearing problem - get a referral to Mass Eye and Ear.  A hearing test (even at this age) is easy.
    They distract the kids with toys and play tones in their ears.

    Good luck!

     
  10. You have chosen to ignore posts from momofatoddler. Show momofatoddler's posts

    Re: developmental delays/EI options

    My 3-year old is on the autism spectrum, which was diagnosed around her third birthday.  We had her evaluated for EI after her 2.5-year appointment and I wish we had done it at 2 years because their services were so helpful and user friendly.  As others have said, the evaluation itself is fun for the child and everyone I have interacted with in the EI system has been high energy and great with kids.  Your insurance is mandated to pay for all services other than an annual fee. 

    Frankly, trying to figure it all out on your own is not easy.  The EI folks helped us understand the process for getting a medical diagnosis (we went through Children's) and facilitated the transition to the public school system.
     
  11. You have chosen to ignore posts from IPWBride. Show IPWBride's posts

    Re: developmental delays/EI options

    Not sure about insurance being mandated to cover.  I just scheduled our intake and evaluation appointments yesterday and she told me it is based on income.  I need to bring my tax returns or multiple copies of paychecks so they can determine our portion.  I hope I am not being scammed.
     
  12. You have chosen to ignore posts from momofatoddler. Show momofatoddler's posts

    Re: developmental delays/EI options

    There is an annual fee is based on income that is on top of the cost paid by your insurance company.  I don't recall the full range of the annual fee. It can be a few hundred dollars if you are in the top income tier.  (By comparison, if you paid out of pocket, you'd be looking at $50-100 per hour of speech therapy, PT, etc.) 

    This is from the web site of one of the Boston providers (each EI provider serves a specific geography):

    Who Pays for EI?

    Early Intervention is a State and Federally mandated service paid for by the MA Department of Public Health (DPH), Medicaid, MA Health Insurance and Health Maintenance Organizations (HMOs). There are no direct costs to families for the following Early Intervention services:

    • Screening
    • Service Coordination
    • Eligibility Evaluation and Assessments

    Participating families are assessed a modest, one time per year fee based on annual family income for all other Early Intervention services. This fee does not apply to families earning less than 200% of Federal Poverty Guidelines. Family health insurance, Medicaid and/or the MA Department of Public Health will pay all other Early Intervention costs. No family will be denied Early Intervention services based on ability to pay the fee.

     
  13. You have chosen to ignore posts from clc51510. Show clc51510's posts

    Re: developmental delays/EI options

    IPW here's the full link that Momofatoddler refered to above:

    Who pays for EI?
     
  14. You have chosen to ignore posts from dz76. Show dz76's posts

    Re: developmental delays/EI options

    The eval is always free, your heath insurance/the state pays. 

    There is an fee for services based on your income and the number of people in your family.  The low side of the income range for a family of 5 was more than we made even before DH was laid off.  And the upper range was like $100,000.  And even if we had fit into the range, the cost was so only ~$250.
     
  15. You have chosen to ignore posts from kargiver. Show kargiver's posts

    Re: developmental delays/EI options

    If you're concerned about DS's development, of course you are doing the right thing getting him evaluated.

    At the same time, though, I think it's often the case that boys develop slower than girls in many respects, and the fact that they are b/g twins could just be making the disparity more obvious. 

    Best to you - it must be scary to be considering how to handle things like this in the best possible way.
     
  16. You have chosen to ignore posts from kiwigal. Show kiwigal's posts

    Re: developmental delays/EI options

    I just want to respond to the comment that has appeared a few times in this thread. As a mother to two boys, I am particularly sensitive to it and I admit it. Every child develops differently and SOME boys do things more slowly than SOME girls seem to. Sometimes they are developing in other areas more quickly (I've posted before about how DS#1 was at age for expressive language, but way above age for pattern recognition--much harder for me to observe or understand what it means.) Anyway, I spoke at length about this with my EI specialist and they do NOT evaluate boys and girls differently. They use the exact same benchmarks for children of each sex. They expect the same range of development for boys and girls. So, they don't subscribe to the idea that boys develop more "slowly" than girls.
     
  17. You have chosen to ignore posts from Micromom. Show Micromom's posts

    Re: developmental delays/EI options

    My son got some EI services due to concerns around a potential speech delay. 

    I've had good and bad experiences with EI.  I think they can provide helpful insights, but they can also make mountains out of molehills.  I'd say do the evaluation, to have a clinical perspective, but also place value on your observations as a mother.  You know your children best, and your instincts are very valid.

    Kids develop in all sorts of quirky ways.  It's good to let them evolve at their own pace, while giving them as much support as you can.  In some cases that means active play, in others that means special services.  Gather information from credible sources (pedi, EI etc, NOT your opinionated mother in law etc.) and go from there.

    I gave my son until age 2 for his speech to shake out, at 24 months, his first word was a full sentance and he hasn't stopped yapping since. 
      
    We participated in a program at Children's Hospital called Early Infant Follow up, they do regular evaluations of physical, speech, and motor development.  If your kids were early, you may want to give them a call.  You might have better luck with insurance coverage if you go through them.
     
  18. You have chosen to ignore posts from misslily. Show misslily's posts

    Re: developmental delays/EI options

    Yes - IPW - there is an annual fee based on income.  It's not a scam.  The scale is income vs number of family members.  And for us, the second child was 1/2 price.
    So even though I could get insurance to pay for my visits to the SLP at Mass eye and ear, I'd still have a $20 copay for each visit.  If I take my twins once a month that's $480 in copays annually.  I only paid $375.00 to EI. The SLP is coming every other week for my DS and once a month for DD.  I've also had a developmental specialist for DS (they thought he had low attention span) who came every week for a while.  I'm phasing her out. She's been really great, but he's more attentive now and talking more so she's going to come less often. Imagine - that's equal to $140 in co-pays a month if I took them somewhere private!
    And they come to the house!
     
  19. You have chosen to ignore posts from SarahInActon. Show SarahInActon's posts

    Re: developmental delays/EI options

    Just wanted to correct the insurance comments.  Your insurance company is not necessarily mandated to cover EI.  EI will bill your insurance company and pray that they get some sort of reimbursement.  If the insurance co doesn't, the state pays.  Yes, this is a social service.

    You pay fee based on your family income and it maxes out at around $950 which is charged in 6 month increments as services are needed.  There is another out of pocket max per family so if you have three kids, you don't have to pay three entire fees.

    And don't wait.  It can take time for the correct specialist to become availible and its need based rathe than first come first serve.
     
  20. You have chosen to ignore posts from kargiver. Show kargiver's posts

    Re: developmental delays/EI options

    kiwi, I didn't mean to be offensive.  This excerpt from an Early Childhood News article contains the information I was referring to, and it goes on to talk about more than early language (bold added).  My mom taught kindergarten, and she believed that boys should be closer to 6 when they started than 5 so that the whole class would be more homogenous with respect to readiness.

    ETA:  If parents are offended by this it might be easier for specialists to downplay or even dismiss the differences.  If they don't subscribe to the chemical brain differences and resulting developmental differences between boys and girls I'd probably ask them why they don't.

    The Needs of Boys

    Gender differences are biological and not just cultural: the biological foundation for gender differences includes hormonal influences on the brain (Berger, 2003). These differences begin in the fetal stage of development, when the sex hormones begin to influence brain development, which continues to develop throughout childhood. These gender differences in brain maturation produces different overall development, such as the fact that infant girls tend to talk earlier than boys, and their language development continues to be more advanced than boys throughout early childhood (Fenson et al., 1994; Leaper, Anderson and Sanders, 1998).


    The Differences Between Boys and Girls

    In the United States a newborn boy’s odds of dying accidentally before age 15 are about one in 500; for girls it is one in 800 (National Center of Health Statistics, 2000). Generally, male embryos and fetuses are at greater risk than females. In addition, newborn boys have more birth defects, and older boys have more learning disabilities and other problems (Berger, 2003). For example, about four times as many boys as girls are autistic. And, as infant and toddler caregivers will tell you, male toddlers bite more than female toddlers (Gerrard, Leland & Smith, 1988). Further, three to nine times more boys than girls are diagnosed with ADHD (Berk, 2002).

     

    Any learning disability or other impairment to normal brain growth can jeopardize all development, including academic achievement and social behaviors, because almost all basic skills and accomplishments require the use of many parts of the brain working together (Berger, 2003). Girls are not only more advanced than boys in vocabulary, language, memory and perception, but also in sustained attending and self-control (Cornoyer, Solomon and Trudel, 1998; Rothbart, 1989). Finally, girls prefer dramatic play more than do boys, and tend to engage in fewer aggressive and violent themes in their play (Berger, 2003).

     
  21. You have chosen to ignore posts from tbracer39. Show tbracer39's posts

    Re: developmental delays/EI options

    I also say don't wait!! I waited until 2 1/2 for my youngest son. I kept telling myself the speech would come...it didn't. I also was concerned about the stigma. I forget what site I had first visited, but they made it seem like only neglectful parents needed children in EI. Whatever blurb they had really made me feel like an awful parent.
    When I finally did get him eveluated and talked to people about it, I realized how many kids out there do need the service, even if it's only for awhile.
    My son is 5 now and there are still days that are a struggle, however he continues to make great progress. He's in a Communication Enhancement Program at the public preschool. So if your child does need services after the EI cutoff (3 yrs. old), the public preschool does need to take your child (even if they miss the enrollment age cutoff and isn't potty trained)...I know that is still a few years away, but something to also keep in mind!
     
  22. You have chosen to ignore posts from lemonmelon. Show lemonmelon's posts

    Re: developmental delays/EI options

    Personally I don't see any reason NOT to get an EI evaluation. The kids think EI is fun and the parents enjoy it to. It's free or close to it. It teaches you how to better respond to your child's needs, and it gives your child the advantage of private instruction. It's like having a free, highly trained private tutor come to your house with a fun lesson plan geared specifically to your child's needs. What's not to like? As for the stigma, I don't think there is one. My nephew and niece were both in EI, as were a lot of kids they know. What, you didn't hear about them? That's because nobody cares if my sister's kids were in EI or not. It's a total non-issue. Parents would get a baseball or ballet coach for a kid in a second and not think twice about it.
     
  23. You have chosen to ignore posts from kiwigal. Show kiwigal's posts

    Re: developmental delays/EI options

    This will be my last post on the subject of boys' development because it's really not central to the thread, but I need to respond to Kar's last post:

     "If parents are offended by this it might be easier for specialists to downplay or even dismiss the differences.  If they don't subscribe to the chemical brain differences and resulting developmental differences between boys and girls I'd probably ask them why they don't."

    My EI case worker, who is a trained professional with years of experience did not say what she said to me because I might take "offense" and she wanted to make the conversation "easier". That's just ridiculous. (For your information, I have a master's degree in education, have studied child development, and have almost 20 years of classroom experience, most of it in single-sex environments, so there'd be no need to beat around the bush with me.) There are differences between boys and girls--I never said there weren't and neither did our SLP. It's the judgment that boys develop "more slowly" that's the problem. That's a huge disservice to boys in general (and to stefani's original question about her DS) to dismiss a concern about a child with a misinformed generalization. While there may be some gender differences as well as individual differences, professionals do indeed expect all children to be on a similar continuum of development, boy or girl. 

    As for the comment that boys should be closer to 6 for kindergarten (again, another gross generalization), I just hope and pray that my sons will have kindergarten teachers who are well-versed in their five year-old learning styles and development and are able to make them feel supported and challenged, not deficient in any way. Isn't it the teachers' job to meet ALL students where they are? That's how it is in my classroom anyway.

    Like I said, I am very sensitive to this!
     
  24. You have chosen to ignore posts from lemonmelon. Show lemonmelon's posts

    Re: developmental delays/EI options

    I'm not a trained anything, but I'd also point out that even if boys did develop speech or whatever more slowly than girls there's no reason not to help them along with it. My daughter was a late walker, but once I mentioned my concern to our babysitter she took it upon herself to train our daughter to walk and accomplished it in a single day. We teach kids how to do things all the time, from nursing to sleeping to speaking. And when we don't know how to help our little ones along, and they're getting frustrated because they can't communicate, there's no reason we shouldn't get help from someone who  has experience with this sort of thing. Should I still be waiting for my daughter to teach herself to walk? No, I'm glad our very skilled sitter knew how to help her when we did not.
     
  25. You have chosen to ignore posts from misslily. Show misslily's posts

    Re: developmental delays/EI options

    I agree totally with Lemon and Kiwi on this.  I've just heard that in my town up to 85% of boys born in the summer are being "red shirted" and held out of kindergarten until they are 6.  Up to 50% of the girls are too. Parents seem to think it will give their kids an edge.  I have summer babies and it never occured to me to keep my twins out of kindergarten when they turn 5.
    What the heck would I do with them anyway? Send them to a private kindergarten somewhere and then send them again?
    Anyway - back to EI...I had both my twins evaluated and they used the exact same testing methods. DS was ahead of DD in some areas and behind in others.  They are two people who one would expect to develop at their own rate.
    Good luck Stefani.  I'm sure you'll do whatever you need to for your DS.

     
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