Pediatric Speech and Language Initial Evaluation
Matthew Burnett, age 27 months, was seen for a speech and language evaluation with the following results:

Symbolic Play Skills: 24-27 months - within normal limits.
Receptive Language Skills: 24-27 months - within normal limits.
Expressive Language Skills: 15-16 months - 42% delay.
Speech Production Skills: 12-13 months - 53% delay.

Diagnostic Impressions: Moderate expressive language delay. Severe speech production impairment. Spirited child who likes to be in control and who appeared to be well and warmly bonded with his mother. Normal receptive language and symbolic play skills. Good potential for learning.

Recommendations: Speech/Language Therapy with caregiver involvement, 1 visit/week to start (may up visits to 2x/week when ready verbal repeating is established). Duration: 6 months, then re-evaluate skills. Referral to audiological assessment scheduled, contact regional center for client assessment.

Short-Term Goals: 1-2 months
1. Establish rapport with child and establish levels of 50% compliance by child with clinician-initiated activities that involve play.
2. Target x 10 1 syllable vowel-initiated or /h/-initiated words and establish 80% ability to imitate these words with correct vowel use in play.
3. Target x 10 bilabial-initiated 1 syllable words and establish 80% ability to imitate correct CV structure of these words in play.

Long-Term Discharge Goals: 6 months
1. Increase expressive language skills to a solid 24 month level.
2. Increase speech production skills to a solid 18 month level.

Other
Sweet, active little boy. Good play skills, but attention span appeared short in today’s new setting. It was a pleasure to work today with Matthew and his lovely mother.

Evidence of oral apraxia: Unable to rule out. Too young to reliably assess.
Evidence of developmental apraxia of speech: Unable to rule out. Paucity of intelligible vocal/verbal output.

(amusing note: for “Feeding Skills” - “Caregiver reports normal eating.” Did I ever! Ha!)

My right leg feels like it’s headed for Mexico and my left leg is aiming for Vancouver while the rest of my body stays put. In the phase of pregnancy now where all muscles relax and bones migrate to prepare for childbirth, and for some reason my body doesn’t realize how inconvenient this is when one rides a bumpy MUNI bus every day. OW.

First, I have officially switched over to UCSF for the rest of my prenatal care. I felt much more at home with them, and it’s really nice that they will actually evaluate me more tightly at the end before making a recommendation for induction (because of insulin degrading the placenta and such earlier) versus just recommending it based on dates (CPMC wanted to induce at 39 weeks if I hadn’t gone already). The midwife actually encouraged me to push back and demand to have reasons for procedures. “This is your birth - you take charge!” So nice. I am down another 2 lbs., which makes me down a total of 10. Great diet!

Second, I am kind of enamored with my sewing machine. By kind of I mean really. REALLY REALLY REALLY. I made a couple of key fobs, and am tickled pink. My next projects are Christmas stockings for the kids (!! WTF ) and I bought stuff to make a quilt for Matthew for Christmas. I forgot the booklet with the pattern at work, but I will bring that back tomorrow so I can get started. I think the toughest part of that will be cutting out all of the pieces. It is oddly satisfying and calming.

Third, I am one week away from turning 32. This weekend we celebrated, but nothing went according to plan! We had plans to go to the California Academy of Sciences but our plans were thwarted when we had a hard time finding parking (Josh’s grandmother drove us). Alas. We ran around a playground for awhile, though, before heading off to dinner, at a Vietnamese restaurant near the end of the N-Judah line near the beach. The wait was too long (about an hour!) and by that point both Matthew and I were about to melt into puddles so we went to a Mexican place for dinner, which was decidedly lackluster. Alas. It was nice to spend time with family, though, and it made for a lovely weekend nonetheless.

Fourth, Josh, Matthew and I are sick. Joy. Matthew and Josh seem to have the worst of it, and I fear I am not far behind.

Fifth, last weekend I was in Dallas for a conference and ate marvelously. The conference wasn’t too shabby, I got to meet the lovely Nicole/(lj - elusion) for sushi, and bought a lot of fabric for aforementioned projects. I don’t know where I’m going to get the TIME to do all of this, but I am not going to think too hard about it. While in Dallas, a vendor took a group of us out to eat and I had the most MARVELOUS filet mignon. The waiter asked how I would like it and I said, “Rare!” (if you are going to comment about how I will kill the baby if I eat rare meat, don’t bother, and don’t read the next sentences either).

Then the waiter asked, “Do you want it a little cold in the middle?” I nearly squealed as I shouted in the affirmative. The thing was singed on the outside and mooing on the inside - it was very much like heaven. So nice. And baby loved every bite of it.

Sixth, to end things off on an even number, we have a name picked out for the baby. I think. I thought we had one before but I hedged and I’m sure Josh wanted to toss me out of the window. So we have another and now I am fearing that I am bullying Josh into accepting my will. Which I probably am, so that’s why things don’t feel as resolved as they probably ought. This child will be coming home named “Baby Girl” and she will probably have to name herself one day.

I thought this particularly poignant.

(link)

Dear white voter, it’s time for a decision.

This November, will you support the candidate who assumes the worst about your character and motivations?

Or will you vote for the candidate who has never stopped believing in and championing your capacity for greatness?