2 years and 3 months - HV concerned about 'development'

[cjn27b]

We have just had our son's 2 year check (which is done at 2 years and 3 months in our area). The health visitor has said she is concerned that he is:

• unable to identify familiar picture objects (he can identify a tractor, and make animal noises in response to pictures of the animals)

• has poor concentration

• does not respond to questions

She also said she was concerned about his speech, language and hearing. We have got a referal to speech and language specialists and for audiology testing but this will take at least 3 months. Meanwhile, I've organised to go and see a private paediatrician (sp?) to get a general overview of the situation.

I am really worried and trying hard not to look at everything my son does and start asking myself 'is this normal'. Has anyone else been told these kinds of things at their two year review? Is it normal for boys to be very late in speech and language development?

Any thoughts / advice would be much appreciated.

Chloe

Boys are later.

The pictures and figures they use in these tests are very dated so much so in fact I bought my old health visitor a plastic tree because hers from her 'standard set' was unidentifiable.

The hearing tests arent much cop imo bcos children grow up with all sorts of noise- the sound of a swooshing washing machine doesnt make them turn their head immediately as our dc are constantly entertained with flashing lights and musical toys.

Speech is often later in only children and its very rare that a child has no communication even very disabled children find a way to communicate.

Poor concentration to me at that age equates to unexciting - children are fascinated by things they shouldnt have and these outdated tests use really uninspiring equipment.

I think you can gather Ive had this experience myself?

He can identify a tractor and make animal noises... so he is developing...

Did they ask him to do things he hasn't done before? Does he do these things when not under the focus? He may have been abit bemused at some woman coming into his home wanting him to do things.

I think these days many HV's err on the side of caution and get everything checked out. Which has a good point of getting into the system if help is required but it does leave you worried.

My boy has been reviewed since 3 months old about his development. He is now 2yrs and 4 months.

I don't know if your child is a nursery or day care but some ( not all) kids jump up a few levels when in an environment like that. I work part-time and my son who was not talking in August now goes to a nursery and does not shut up. His language all came on at once.

There's a theory that boys may have a lazy streak - mummy knows what they want and gets it. Why should they bother themselves!

I would make a note of what your son can do ( don't focus on what he cannot do) and take that with you to the assessments. Don't worry - he's not a failure at 2. Best to get things checked out though so if there is anything he needs a hand to sort out - then it's done early in his life.

Thank you Nickschick. I'm feeling rather stumped by the whole thing.

It is true our son is rather slower than others we know at this age. No one was worried before this 2 year assessment we just thought he'd catch up soon. I guess it's a case of trying not to worry and getting to see the paediatrician ASAP.

Does your ds understand you when you talk to him? At this age they would usually have fairly good comprehension skills even if they don't say very much.

I found it helped to:

1. Make sure I had ds' attention first, usually by touching him on the shoulder.

2. Break sentences down into very simple language. So instead of saying "Lets's go to the park today" you would say "

My DS1 'failed' practically every test on the 2 year check (which they didn't even do until he was 2.4). His vocab was v limited, couldn't or wouldn't point out any animals in the book or even point at all, wouldn't build tower etc, couldn't really run or jump, climb stairs 'properly'. Couldn't have a proper conversation (i.e. respond to a question) even with me. He just used to say the last word anyone said to him.

He was referred to community paediatrician and speech therapy assessment and had blood tests for muscular dystrophy - the works. Now he is 3 he is the same as all his peers and good at counting, shapes, colours. He stuttered for 3 weeks and then after that could talk normally - it was weird. Looking back he met all his milestones late so I don't know why I was worried.

Your DS is still the same little boy you had before these checks. The only difference is if he needs any help with language he will be getting it now. I bet he's a late starter like mine, hang out with other mums with, er, laid back toddlers it really helped me not to constantly compare.

What does he play with at home?

Thanks everyone. We don't compare, though being told our son had 'development concerns' did cause something of a panic reaction. We're now just trying adjust our communication accordingly, and be more interactive.

He plays with paints, crayons, play doh (love art all in all). Also likes building blocks, railway tracks, big foam letter / number jigsaw type squares, tractors, farm animals and so on. We also read to him every night, and he does watch some DVDs (shaun the sheep, pingu). He goes to the park a lot and swimming.

Since our second baby arrived when he was 18 months his development has slowed a lot (hindsight here). Also we have had au-pairs help out since then and their English isn't always great. Our new one has wonderful English and her mum is a pre-school teacher so she's doing brilliantly with him.

We are making a massive effort to join lots of toddler groups with him now, and also because we recently moved and don't know many people here - basically we all need to meet people and socialise more in our new neighbourhood.

It is true that if there's a problem, the sooner identified, the better. I'm just a bit amazed by the whole approach taken, and am very much appreciative of everyone's reassurance on here. Many thanks all.

Two boys with delays here, one overcame them by himself, the other needed more help, you don't know which camp your lad is in yet....

I strongly suggest you buy this book, It Takes Two to Talk, published by Hanen, which you will see has been recommended on another thread this morning and is the best manual for helping you perfect your communication techniques with him.

www.winslow-cat.com/cgi-bin/winslow.filereader?4d2c27a401c05a9c273f0a022f0305b5+EN/products/52731

It is entirely non-scary and jargon free. you can show it to any family member without freaking people out. It will not make you panic. But doctors/therapists will be very happy for you to use it too.

Another preliminary step will be to organise a hearing test - you may get better value out of your private paediatrician if s/he can see the results of a hearing test at your appointment....glue ear could be the issue.

Lastly, start observing his reactions to what people say to him - how much does he understand? If he has an issue understanding language then that is a key thing to address. And as he's so visual, try to make your communications very visual - get some photos of everyday destinations up on your wall and take a camera out with you and take snaps then show them at bedtime.....

good luck, don't panic (and I'd go easy on the toddler groups to be honest ....)

I agree some of those tests the HV's do are awful. DD was asked to identify a cat from a black and white line drawing and explain what was going on in the picture - erm she was 20 months and obviously less than interested!

I also think that the birth of a sibling sometimes causes a slowing down of development in some older children. I definitely noticed this in DS when DD was born.

Sounds like you are doing all the right things and you have some great advice here too!

Some of the tests that they do are really outdated and seem to be a tick the box exercise for HVs rather than a proper check to reassure parents. For example if they rephrased the request to draw a circle to draw a wheel they might get more children to co-operate. Same goes with the "familiar objects". My child knows what a mobile phone is but wouldn't know what a 1950s one complete with twisty cord was from a photo.

When I took ds1 to his 2 year check he shook his head at every request. He had no interest in writing or drawing so he rightly wouldn't "perform" for the HV. If the test was more geared to his interests and personality "Please can I have the red car" rather than "Which colour on his page is red" then she might discover that he knew what that meant.
Personally I've never met an HV who I'd like to stay and chat with so I'm not surprised that my children didn't feel like performing for them either.

They were far more interested in her broefcase, the posters on the wall, the blood pressure machine on her table and looking in her cupboards than talking to her!!

I found that my children regressed when younger siblings were born too. My daughter who had dressed herself for over a year suddenly couldn't do it when she became a big sister at 3.5 years old.

I hope that the paed can reassure you.

Where we live the two year check consists of being sent a birthday card with a few lines saying what they should be able to do.....we don't get any official contact other than that with a HV after 8 months.....so the whole two year check is a bit of a strange concept to me!! Do I just live in a very odd area??

We found a local speech and language therapy drop in clinic that happened to be open today. The therapist feels he is behind too, and with a family history of deafness we've organised some audiology testing too. Hopefully we can find out what the issue is ASAP and get on with dealing with it. Thank you again for all your advice and help.

Just a thought - the dvd's he watches, Pingu and Shaun the Sheep - neither of them have any language in at all iirc - maybe try and get him into fireman sam or thomas the tank engine and you may be amazed at the difference that makes!

He has a new sibling, he has had several au pairs who didn't speak much English and now he's just moved, all in the space of a few months, and that is a lot of change and upheaval for someone small to cope with, actually non-stop change for a huge proportion of his life if you think about it.

I would actually be inclined to spend some time just 'nesting' with him at home enjoying his quiet arty pursuits and playing and talking and singing together as much as possible - and avoid the toddler groups altogether.

He loves to pretend he's on the phone - I've got through 3 mobiles due to his constant playing with them! He occassionally points, and sometimes wants to put things in peoples hands (usually a scrap of his dinner).

We moved 5 weeks after his sibling was born, so we've been at the new house quite a while (7 months). The changing au-pairs has been tricky, but now we have a lovely one who's staying for at least 6 more months.

We are also getting more DVDs, one specifically for language development.

I've read a little about autism, and it's hard to say if he has any early signs - he's clumsy and a bit 'lost in space' at times, but these are also signs of hearing impairment.

I've no knowledge of deafness but have hung out with people who do have, IYSWIM.

I think you need to hit the possible hearing problem hard and focus right in on that. So before you have the hearing test, find out what kind of test they will do and make sure it's appropriate for his stage(we wasted time because DS2 repeatedly had a hearing test that required him to follow instructions he didn't understand....).

and as mathananxiety says, I don't think toddler groups are the answer. If you want to work on playskills (and it's a bit early to expect real communication with other peers) get one gentle child round to the house regularly and let them get familiar by sharing a bowl of popcorn - in front of a DVD if necessary.

If you visit the teachmetotalk.com site, there are very high quality dvds available there, including (unusually but importantly) one on helping your child understand language. It is misleadingly called "teach me to listen and obey" but don't let that put you off - it is excellent (and her accent is rather beautiful Deep South....)

I agree that at this age it can be difficult to tell whether it could be autism or a hearing impairment. I had similar concerns about ds1 and we too had a family history of deafness.

One thing I noticed was that ds1 would ignore most noises but would respond to very quiet sounds. I could call his name repeatedly and get no response at all but the very quiet rustling of paper would immediately make him turn around. The problem was that his hearing was actually too good. Noise hurt his ears so he blocked them out. He was diagnosed with autism when he was 3.

The issue of pointing was also confusing for me. I assumed it meant that a child just physically pointed at something. What I didn't realise was that the important bit is whether they are actually trying to share whatever it is with you. So a child should be physically pointing but also looking back at you to see if you are looking too etc.

We had his audiology test today and his hearing is perfect... Next we've been recommended to see a speech and language therapist for a more detailed assessment, then it's off to a paediatritian if need be.

Hello!

I work with children with special educational needs and I think he sounds like his just a bit delayed in certain areas. I I have worked with some children who don't talk and then suddenly start rambling one day. I also worked with a child who couldn't count or say their ABCs but could name every animal at the zoo, including some that I couldn't! Some kids just get there sooner than others.

My best friend is a speech and language therapist and her son is 3 and up until last week hadn't said a word or even babbled, his first word?...
...crocodile, clear as day.

From a speech and language point of view that's the last thing you'd expect to come out first!

Please try not to worry. My friend says speech and language therapist can vary so it might be worth getting a second opinion if you're not happy with what they say.

Cjn - that's good news.

I think he's just had a busy life :) To me he sounds well within the 'normal' range - the range is huge.

I wont bore you with lots of stories - but my friends 4 year old, wouldn't have 'passed' any of that stuff either when he was your sons age - he'd ignore a lot of 'noises', concentration - yeah right... about 10 seconds - naming stuff - nope (not speaking so a bit tough), pointing - if he felt like it, but not if he didn't, recognising animals, shapes - not the HV weird ones.... at 3 he started talking and now doesn't shut up, he's revealed an enormous knowledge that he's silently built up and entertains his teacher with his general knowledge - his speach is still difficult to undestand at times but the ST says not to worry, it will come. He's lovely, he's bright, he's funny, he's caring.... yet he would have 'failed' the 2 year old test!

Fingers crossed he's just being a little stubborn and has decided to talk in his own sweet time(with a very stubborn mum and dad that would hardly be suprising...).

The whole thing has brought out some pretty weird thoughts / reactions / behaviours in me. Whilst my partner is being super cool and just saying 'we'll deal with it, whatever it is', there's a large part of me wondering how we'd do that if the news was that he had a serious learning difficulty of some sort.

Also, it's the way things are when you're in the 'there are concerns but we're not sure what they might be' phase that is stressful. Amateur analysis of all behaviour seems to have taken over half my brain space. For example, now I know about the pointing being a possible sign of ASD I am putting tempting yogurts in random spots to see if he'll point and at and look at me saying 'dowie' (his made up word that he's been using for 'I want' for 6 months). I realise this is getting a little nutty on my part and am thinking it's time for a glass of wine, TV and off to bed ready to start another day afresh with a better frame on mind on all this.

Cjn - your reaction is normal.

It's not helpful - but it's normal :)

You are doing all the right things (getting things checked out) but I think the best thing you can do is try to relax and see that he's probably on the low side of normal and it doesn't mean he'll be there forever.

There's the odd child that gets 'picked up' by the 2 year old tests - but on the whole it's the method of testing that is the problem, not the child. I think they should be changed to 3 year old tests - much more useful and they should be done by people better qualified than your average HV if they are to be of any real use.