Health, Verbal, and Behavioral Assessments

Caroline just finished her in-home health, verbal, and behavioral assessments and I thought I better write this all down before I forget. The nurse, speech pathologist, and behavioral developmental expert are with Kids on the Move. It is a federal and state funded precursor to Early Intervention designed for kids under 3 years of age. We were referred to them by her pediatrician, ENT, and orthopedist (I didn’t even ask her opinion, she just gave it).


2 Year Well-Baby Checkup:
Her weight has actually dropped even further off the chart. Blood work was redone to compare to her tests a year ago. Small improvement in her numbers, still worrisome to the pediatrician. She needs to be kept on whole milk and take iron and Vitamin D supplements along with her normal daily vitamins. Dr assumes her constipation has to do with her body trying to hold on to everything for as long as it can in order to get as many nutrients as possible out of it. Even on daily full doses of laxatives, she poops approx. once every 3 days. For a few weeks she had many fissures because of this and became so itchy that she would claw at herself down there until she bled. Luckily, the fissures and itching have subsided.

Health Assessment:
The nurse thought everything looked good except the concerns with her constant bowel problems (spit up as a baby, diarrhea, constipation). The nurse recommended we have her visit a pediatric gastroenterologist. I tend to agree. We wonder if she has a milk or wheat sensitivity or if she is unable to absorb the nutrients she needs. The doctors are only located at Primary Children’s and are booked through the end of the year so Cara is waitlisted.

Verbal Assessment:
Caroline is in the 47th percentile for verbal comprehension (I think it’s higher, she just loses interest or focuses on other tasks) and 8th percentile for speech. The cutoff for the program is the 7th percentile unless they give a clinical recommendation for her, which they did because of some of the other things I mention below.

Behavioral Assessment:
Caroline is in the 70th percentile for motor development. After an hour and a half discussion and observation, there is some concern with her, especially in 3 areas. 1) Her borderline obsession with stuffing her mouth overly full and chewing on everything she shouldn’t including crayons, erasers, pencil lead, markers, peanut shells, etc; 2) Her disconnect in behavior between how she acts at home around her family and how she acts in other social situations. She has a seemingly quiet, conscientious nature but she is actually a dare devil and has disregard for safety of self. Usually kids this age are who they are regardless of setting; 3) As intelligent as she is, she has made very little progress with speech in the last year.

There are also a few other minor things they saw and will be watching to make sure they don’t develop into bigger issues, namely, her short span of compliance is only 5- 10 minutes and then she breaks down (for example, while shopping, in sacrament meeting, eating dinner with the family). She shuts down when pressured to do anything she doesn’t want to do. Also, she noted that Cara wiggles all her fingers when she is concentrating or listening or working on something. Now that it was brought up, I realize that she does do it sometimes but I hadn’t consciously taken note of that before. May mean nothing, but they took note as it being something to watch.

What’s Next:
So, like I said, they have accepted her into their therapy program. Our initial goals are to get her to expand her vocabulary so that she can express herself and also to increase her short compliance span. They will be putting together an individualized plan for Caroline. In the meantime, the family  will be working with her on basic sign language. They also suggest I attend a set of 3 classes for parents of speech delayed children. She will start weekly 1/2 hour, in-home speech therapy sessions and maybe something else with behavior. I’m not sure yet. She will be reassessed in 6 months.


Sheesh. That’s a lot of information. I was actually quite impressed by the whole thing. The women were all very professional and knowledgeable and have a lot of experience. They took their time, listened to me, and I felt they really got a good idea of who Caroline is. They don’t know yet if there is an underlying issue causing some of this. Cara is still so young and they haven’t had enough time with her yet, but they are taking a lot of notes and know what to be watching for. I’m hopeful that with their help we’ll be able to make some progress in the areas of difficulty.

The point of this whole thing is that delays, when taken care of early, decrease the chances of bigger issues down the road, especially in school. Speech delays increase the chance of other learning delays. It also affects behavior and social skills.

In case anyone thinks I’m just being overly zealous and worrisome about this, there is a reason. I know first hand the effects of a speech impediment. I actually really hate talking about it because it negatively affected me so much. Many kids have it for a little while but grow out of it. I didn’t. I finally conquered it at 17 years old, but it had lasting affects. I am normally an introverted, somewhat shy person but the impediment made me much more so. I was tough at the time, but even now that it’s been 14 years since, I still sometimes tear up when I think about all the embarrassment I had growing up. Lots of making fun. Most of it was good-natured, some it was ill-natured. In 2nd grade I told peers that the accent was because I was from Canada. People looked at me strangely when I spoke and I had to repeat myself so, so many times. I didn’t like all the eyes on me as I walked out in the middle of class so that I could attend Speech. I hated that Speech focused on rhyming and categorizing words rather than the real issue of not being able to get my tongue to do what it was supposed to do. It really came to a head when I was 16 and one of my friends told me that her mom thought I was “retarded”. My friend thought it was funny. I was devastated. I was always one of the smarter kids in class and had never realized that people may have thought that about me my whole life. Not that there is anything wrong with that, but I’m not. That was the last straw. My parents decided to invest a couple thousand dollars into a real speech pathologist. She worked with me for a couple of months, couldn’t help me, and we had her stop coming. Finally, a couple of weeks or months after that (I don’t remember exactly), a miracle happened and something clicked. All of a sudden, I could speak. Finally! Not long after that I made many new friends and started dating a lot more. Gosh. I’m so thankful for that miracle!

Anyway, yeah, I really don’t like admitting this about myself but thought it would give insight as to why I’m so concerned with Caroline’s speech. I don’t want her to go through even a little of what I did. I don’t blame my parents and I don’t blame the Speech teachers. There wasn’t anything my parents could have done differently and therapy has come a long way since then. Thankfully.

Here’s to Cara learning how to speak!


…I must be crazy to publish this about myself…I could’ve left it safely in the past where no one knew it existed…

6 thoughts on “Health, Verbal, and Behavioral Assessments

  1. Julie, you are amazing and a wonderful mother! Cara is a sweet, adorable girl. I can't believe what you are going (and have gone) through. We will be praying for your family.

  2. This all sounds so familiar to me, Wade worked with kids on the move from 13 months to 3 years. He is not currently in early intervention. He worked with three different therapists for gross motor, fine motor (including feeding) and behavioral wellness.
    At times it was overwhelming and discouraging, I felt like everyone else around me had these perfect babies (most of my friends had just one child at this point), while wade couldn't do a pincer grasp for food at 11-months and didn't even crawl until he was 14-months. Among many other things.
    I loved working with kids on the move. They will love her and come up with very creative ways to solve concerns. My biggest takeaway is that YOU are her biggest advocate. If you feel she could be better served with more therapy, less therapy or that she needs to be in play groups at KOTM–speak up. Find out what they offer and voice your opinion.
    Please let me know if you have any questions or need to talk. Wishing Caroline much success in the months ahead!

  3. I didn't know what “speech” was when I was younger, and just thought it was some exclusive club that the cool kids got to leave school to go to.

    This all sounds incredibly difficult to deal with. I'm glad she is getting the early intervention, and hope that you will have some answers and that it will help her. 2 year olds are already tricky to deal with, but add on these kind of extra things to worry about and work through, and I imagine it is quite taxing. We love you guys!

  4. We've got the baby signing time videos if you'd like them. I think they really helped Maya and the twins not only with signing but also with general vocabulary development

  5. And you are not overreacting! You are a mom. You love your babies. All of them. You and your family will get through this. I have faith that Cara will be able to learn as fast if not faster then all of the kids in her class. Keep your chin up.

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