I’ve Just Settled In for a Long Winter’s Rant

First the back story, of course.

I haven’t talked much about Quinn lately.  I’m not even sure I want to be talking about this on the blog right now, except I want to talk about what happened this morning, and if I don’t tell you a bit about Quinn that I’ve not been telling you, then none of what happened this morning could really be told.

So, Quinn.  Shortly after he came home from Vietnam he started saying English words:  Mamma, Dadda, hi, hello, more, all done, amen, and maybe a couple others.  For a while he would throw himself at Matt’s legs and say, “Hi Dadda!” when Matt would come home from work.  His enunciation was always crystal clear the first time he would say a word, but pretty garbled thereafter.  And then?  He just stopped talking.  Well, not entirely.  He still says, “more.”  He stopped signing, too, except for “more.”  Though, a week or so ago, he started saying, “that.”  But now he’s stopped.

If he hadn’t said any words up to this point I would probably only be mildly concerned.  However, the fact that he was saying words and has stopped, has left me just slightly more than mildly concerned.  I’m being serious there.  I’m not all in a tizzy about this, just slightly more than mildly concerned.  When I took him to his 18 month appointment two weeks ago or so (I was a few weeks behind on that, naturally), I casually mentioned the concern to the nurse practitioner.  I didn’t know we weren’t actually seeing the doctor that day.  For future appointments I will make sure we do, because I wasn’t really fond of the snippy nurse practitioner who seems to think I’ve sentenced my children to certain death by not having them vaccinated against chickenpox and the flu.  Anyway, she referred us for a hearing test.

Specifically, she referred us to our county health department.  Why?  Why?  Why not refer us to a private audiologist of some sort?  I don’t know, but this morning we went off to the county health department for Quinn’s hearing test.

Except when we got there?  The audiologist told us that after she was finished we would be seeing “Dave” and then seeing the doctor.  Umm . . . okay then.

So she did two tests and said he passed them both.  One was the hearing test they do in the hospital on newborns.  I don’t know what the other was, but it involved sticking something in his ears for a second.  Then she put the little beepy headphones on him, but said she knew he wouldn’t get it and she wouldn’t be able to actually test his hearing that way, so, though he passed the first two tests, she couldn’t rule out possible mild hearing impairment.

Fine.  Whatever.  I can fully accept the fact that he could have mild hearing impairment, but that wouldn’t explain why he was talking a bit and now almost never talks.  I know he hears.  If I hand him the diaper I just took off of him and tell him to put it in the trash can, he does.  If he opens the basement door and I tell him to close it, he stands there ignoring me.  But when I tell him to close the door or have a time out, and then I start counting to three, he slams that door shut.  So he hears, and he understand.  Whatever is going on with his speech, I really don’t think it has a lot to do with his hearing.

After the audiologist we go to Dave’s exam room.  I still have no idea who Dave is, technically speaking.  I only know that he is two years older than God and thinks it is odd that my son was talking but then stopped.  You think, Dave?!?!?  He then asks me if I can have Quinn take the sippy cup out of his mouth for a second.  When I do that, I hear Dave muttering to himself, “No signs of cleft lip or palate.”

For the love of all that’s holy, Dave!  You couldn’t have asked me about that?  I mean, it is no big deal to take the sippy cup away from a child who was only sucking on it because he was feeling insecure about his surroundings, but still!  Anyway, after that brilliant observation, Dave gives me an article on how to talk to your baby and a list of “Things to DO,” and “Things NOT to do” to encourage language development.  Because, you know, obviously the other four children who were with me, the children who I had to keep telling to stop talking, are all blithering, mute idiots.

Not to disparage Dave too much, but I am the mother of five children.  FIVE.  I may not be two years older than God, and I may not have a background in whatever it is that man actually does for a living, but I know how to talk to children in a way that encourages speech development.  For the love of God, I wish some of them would freaking shut up every now and then, because I did such a damn good job of helping them learn to talk.

It’s not rocket science.

But Dave didn’t really tick me off that badly.  No, what really got me was the meeting with the doctor.

As I said, I thought we were going out for a hearing test, plain and simple.  I had no idea we would be meeting with a doctor who would want to check Quinn’s ears.  I mean, why?  I just had him in for a well check and they looked in his ears then and didn’t seem to see anything wrong, but whatever.

So we go into the exam room and the doctor looks in his ears and declares, “I can’t see anything.  There is too much wax and junk in there.”

Umm . . . okay.  Then he goes on to say that I’ll have to bring Quinn back, but he’d prefer that we not wait until he’s back in our county, he’d prefer that we bring him to the actual office in the closest Thinks Its a Big City.  Right.  And why didn’t the pediatrician just give us a referral to do that to begin with?

Then the doctor goes on to explain that, yes, bringing him in to the office would be best since they couldn’t do a hearing test on Quinn today because, you know, this county health department isn’t set up for that.

Excuse me?  He just had two tests done by the audiologist.

Right, the doctor said, but those weren’t hearing tests.  If they had been able to test his “actual” hearing, they wouldn’t have sent us to see the doctor.  Then I explain to him that from the moment we first met the audiologist she told us we would also be meeting with the doctor.  So what was the point of telling me we were coming here for a hearing test if, in fact, everybody knew from the beginning that they wouldn’t be able to test his “actual” hearing?

And . . . AND????  If his ears are so freaking filled with wax, why didn’t the nurse practitioner mention this to me at the well check?

The doctor said perhaps there wasn’t wax then.

“Two weeks ago?  You’re saying this all developed in two weeks?”

“Umm . . . well . . . umm . . . I don’t know . . . “

Translation:  Country doctors/nurse practitioners suck.

To summarize:  I spent the morning getting five kids ready and schlepped them out in the rain to a COUNTY HEALTH DEPARTMENT, and we lost an entire morning of school time so that Quinn could have a “hearing test” that doesn’t test his “actual” hearing in order for an ENT, whose office is an hour away, to refer himself to me and tell me to clean my kid’s ears out in the meantime.

Gah!

Also, because I am slightly more than mildly concerned about Quinn’s speech development, I had called the county’s early intervention folks and scheduled an evaluation for this Friday.  I was absolutely loathe to do this because I don’t want to be “in the system” and because (sorry, I know I’m about to offend some people here, but my feelings are what they are and this is my blog) county early intervention programs, like the county health department, are microcosms of socialized medicine/services.  It is to their advantage to find something wrong with my son because they need children with “delays” to justify their jobs and expand the socialized system.  I am glad they are there for the children who really do need them, I am; but in a case like Quinn’s I am afraid there is too much wiggle room and fear that they would err on the side of justifying their jobs.  See, if there really is a problem, I want to know.  But if it’s just a kid not wanting to bother with talking because he has four older siblings and two parents who know what he wants anyway, I don’t want somebody to slap a label on him just to make themselves feel needed.

Despite these feelings, I scheduled an evaluation because, if my son really does need help, I want to get it for him (though after the evaluation I’d find private providers if needed and pay out the nose if I had to, because I feel that strongly about socialized medicine).

So I asked the doctor who had just referred himself to me if doing the evaluation this Friday would be wasting even more of my time since we still haven’t ruled out a hearing issue.  He hemmed and hawed about how he’s not sure what all they screen for in those evaluations and it probably doesn’t all have to do with his speech development and . . .

I interrupted him to explain as clearly and politely as I could that my only concern with my son is his speech development and I’m none to happy that the early intervention folks plan to screen for other things as well since there are no concerns there, and I only scheduled the appointment for speech purposes (even though I know they will screen his motor skills and heaven knows what else).

The doctor then ‘fessed up that doing the evaluation this Friday, before hearing issues could be ruled out, would be premature given the concerns I have.  So I have cancelled that.

And now . . . now I want to call the pediatrician’s office and find out what exactly they saw or didn’t see in my son’s ears two weeks ago.  I also want to know why they didn’t just refer me to the ENT to begin with.  I also want to know who my girls are scheduled to see on Monday and who Tank Boy is scheduled to see the following Monday.

I don’t know if I’m going to, though.  Should I?  And is it acceptable to ask them to put a notation in my records not to refer us to the health department, but rather send us straight to an actual doctor’s office, assuming there is an actual doctor in this God-forsaken section of the world, because we do have insurance (even though it’s pretty crappy – yeah, the big three aren’t going down because they take care of their salaried folks)?

Right.  So I’m just royally p.o.ed about all this.  I’m p.o.’ed that they wasted my time.  I’m p.o.ed that my pediatrician/nurse couldn’t mention the developing wax problem.  I’m p.o.ed that they all scheduled a hearing test for a 19-month-old knowing full damn well that they weren’t equipped to do what needed done.  I’m p.o.ed that they shuffled us around to three different people after leading me to believe we were only going for a hearing test.  And I’m p.o.ed because now I know my tax dollars go in part to pay Dave, the man of indeterminate expertise who may already be dead due to causes incident to age, to hand out photocopies of common sense crap to mothers who obviously know how to talk to their children. (Could I have fit even one more preposition into that sentence?  I think not.)

My current plan is to spend the weeks between now and Christmas making sure my son’s ears are good and clean.  I will pay close attention to see if there are any improvements/changes in his speech during this time.  If things improve I will chalk it up to ear wax.  If things don’t improve I will make an appointment with the ENT/audiology office after the first of the year.  If all that shows that his hearing is fine I will find a private early intervention specialist to do an evaluation.  If such a thing exists around here.  Hell, maybe I’ll just take him to the veterinarian.  I’m sure the care can’t be much worse.

I’m still not sure what to do about the pediatric practice we go to.  Maybe his ears were clean two weeks ago?  What are the chances?

And George, you don’t have the password anyway.

17 thoughts on “I’ve Just Settled In for a Long Winter’s Rant

  1. I’m sorry. I really am. I don’t know why she didn’t refer you to an ENT up here in the Thinks It’s a City. I have the name of the ENT who did Gabe’s hearing evaluation and his tonsil/adenoid/ear drum surgery if you want it.

    I’m assuming that since Dave works at the County Health Department he probably encounters mothers all day long who are really struggling with the basics. It really sounds like it was a total waste of your time.

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  2. They totally wasted your time. I agree that they are not used to dealing with knowledgeable parents. You need to talk to your ped about what happened and how to handle future referrals. Good Luck.

    christy

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  3. A friends little girl did the same thing as Quinn. She was adopted from China at 9months & seemed to pick up English fairly quickly. Then she stopped talking. She understood everything that was said to her but didn’t do much other than point & grunt for months. I forget how long it lasted – I think she was about 20 months before her speech picked up again. My friend said it was as if R~ took a break from talking to really listen. When she started up again she was speaking in full sentences.

    As for the various incompetent health care people you encountered – I’d complain. The next time you’re in the dr’s office, I’d mention that your experience at the health dept was less than stellar & in the future you’d rather skip that step. I thought I lived in a backwater! Sorry you wasted your time.

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  4. Ugh…your wasted time totally reminded me of the “pregnancy and child birth” class we went to at the hospital when I was expecting. It was geared towards women who had never read one iota of information about being pregnant or delivering a baby–come to find out it was being taught by the “educators” at the free clinic and they were teaching LIES! i.e. “If you eat a lot of sugar while you’re pregnant your child won’t be able to pay attention in school.” “If you get an epidural it will hurt your child’s brain” etc etc etc. We were livid and at my next midwife appointment told her about it. She picked up her cell phone and called to yell at the hospital while we listened. It was lovely.

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  5. Blech, I avoid our county health dept at all costs. We only use it for immunizations and sparingly at that. I always leave shaking my head at all the “liturature” they give me about making sure to keep your children clothed and fed and suggestions for further “services.”

    I have a cousin who did something like Quinn is doing. He talked at an average age and then stopped. Turned out that his three older siblings were talking for him. They figured this out when he was nearing two after doctors found nothing wrong with him. Might be another thing to look for.

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  6. Yeah, I agree; I’d tell your ped office exactly what you want (or don’t). My family are all docs, and my dad always says that you have to aggressively advocate for yourself in the health care system…demand what you want (politely, if only at first).

    For what it’s worth, we did an EIC evaluation when Lu was 12 months old and they DIDN’T think she qualified for services at that point…although now she certainly would. So ours, at least, is discriminating.

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  7. Oh man, that is just nuts. Believe it or not, I really share your feelings on early intervention/health department although I will say I have actually been part of EI programs that totally ruled out any issues for the kids we were having tested. So maybe they aren’t so bad. But I would def. want to see a doc.

    If it helps at all, though, we took Addy to a top of the line audiologist and they simply could not test her adequately. They said it is SUPER hard to accurate assess hearing in toddlers. They just are not cooperative in the ways they need to be. I highly doubt they could have possibly done the real newborn hearing screening on Quinn because he’d have to basically be asleep for it. They told us to bring Addy back when she was older but of course by then she was speaking and, like you, we were always fairly sure that her hearing was just fine.

    I don’t think it’s unusual for kids to regress in speech, especially if they are suddenly jumping ahead in other skills (large motor, small motor, etc). It also does seem like adopted kids tend to do the two steps forward one step back speech thing more frequently. Addy seemed like she’d be an early talker, like Quinn, but then just simply stopped progressing. She didn’t stop talking per se but she talked less and she definitely stopped moving forwarding or adding words. She didn’t really move forward again until closer to 2.

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  8. Can you call the school system? I’ve been really impressed with our school district’s EI stuff. They don’t do anything to treat until age 3, but they did evaluate and then referred us to the local Parents as Teachers group, which actually has social workers who evaluate and come out for play dates. Holler if you have any questions! 🙂

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  9. I am very suspicious of county health departments, socialized medicine and “current trends” evaluations. I am worried that one of these people will remember a pamphlet he or she read and pronounce your child autistic. IMO, autism is a bucket that lots of kids are dumped in, similar to depression. Both conditions are real, but vague and over diagnosed.
    I would tell the pediatrician to refer you somewhere else the next time, no more county intervention!
    Bon chance!

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  10. Elaine, my educated guess (as a second language learner myself and a former ESL teacher) is that Quinn is in the classic ‘silent period’ of second language acquisition. Language begins to map right away and the proof comes quickly with parroting. There is a level of comprehension that comes with the parroting, but it’s always followed by a silent period whether it’s short and unnoticeable or longer like Quinn’s. The silent stage looks like regression and occurs in all language learners just before early production begins. The length of each stage is unique for all learners, but they all follow the same stages to fluency. I know it’s odd to think of Quinn as a second language learner at such a young age, but he’d been mapping VNese since birth and started all over in March.

    I agree that you should rule out possible physical reasons for Quinn’s silence, but I’d also be careful if you decide to look into early intervention. Make sure your specialist understands second language learning and is able to tell the difference between normal acquisition and a language processing disorder.

    I hope some of this made sense. I’m ridiculous tired and really have no business commenting past 8 pm.

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  11. Sounds like you’ve gotten lots of great advice and have a good plan about going forward. It does seem like something to be slightly more than mildly concerned about, but as you and many others said hopefully it’s just as simple as Quinn learning that as the youngest in a good-sized family he can kick back a bit now. But does seem like something that is pretty important to keep on top of, if there is something going on you certainly want to tackle it earlier rather than later, it just stinks that you have to deal with so much incompetence to get there. Keep us updated (and boy, does that experience really not sound like what you needed this week!)

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  12. All I know is that the audiologist said it was the hearing test they do on newborns. But who knows? It’s not like the people there seemed highly competent.

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  13. I can imagine how frustrated you are. I had Binh evaluated by EI almost a month ago and have been trying to get a hold of them since. My husband feels the exact same way you do about the socialized health care, but our doctor said this was really the only referral for children under three in our area. Don’t I miss Boston? I would agree with what someone said earlier about a “silent period”. I taught ESL and have heard of this but never had actual experience with it. As long as his other skills haven’t taken a step backward, I would think he’s really starting to learn the language composition in his mind and not just repeating what he heard others say.
    Good luck to you guys. And, oh, I don’t think it would be bad to tell your ped. not to refer you to the county health dep. Maybe they do that b/c other people’s insurance wouldn’t cover somewhere else or something like that.

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  14. I believe all mothers have a right as to who should treat their children. You should call the doctors office and request a certain doctor if that’s what you want. Don’t be afraid to take charge of you child’s heath care. So many mothers don’t and go home with the wrong information.

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  15. I was all set to give advice but then I read your plan in the last paragraph and now all I have to say is, “Yeah, Do that.” Because I tend to think he’s hearing fine and apparently most Asians have lots of ear wax and it doesn’t really impede their hearing. (Zeeb’s is so thick the ear thermometer doesn’t work right, but he hears just fine). And I’m like you – I don’t trust tax-funded evaluations or the so called “specialists” either for that matter. Which is weird because my mom worked for the county her whole career and she’s a Phd and knows a lot. But then I also think she was enthusiastic about programs because she knew where her bread was buttered… anyway, I definitely think the private evaluation is the way to go.

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  16. UGH! How incredibly frustrating! I, too, tend to stay away from health departments as much as possible. They’re just too frustrating! But as someone else pointed out, they are used to dealing with people who really struggle to cover the basics of parenting. Too sad.
    As far as the hearing tests are concerned…the first two tests are pretty basic. They pretty much just tell the doctor if the ear drums are responding to sound waves. The things they put in his ears sent sound waves to the ear drum. If the drums vibrate, the doctors know the ears work at some capacity, but there is no way to tell how much Quinn is actually hearing. It basically just indicates whether he’s hearing anything at all.
    She couldn’t do the earphone test because he was too young to make the results accurate. He wouldn’t be able to raise his hand every time he heard a sound.
    There is a much more specialized test for toddlers and preschoolers (which Anya and Maddie have both gone through) that uses some visual stimuli along with the sound to help determine if their level of hearing.
    The child is placed in a sound proof booth and sounds are played through animal speakers on wall. When the child turns to look at the animal in response to the sound the child is rewarded by the animal doing a special trick. The great thing about this test is you are able to determine that the child is able to hear sounds at specific decibals.
    Does any of this make sense? I hope so. I just wanted to explain the tests they want Quinn to have. But YES they should have just scheduled those tests instead of sending you to the health department. And YES I would have them put it in Quinn’s record…and all of the rest of the kids, that you don’t want to be referred to the health department in the future.
    As far as Early Intervention is concerned…I would encourage you not to throw the baby out with the bath water. (Pun totally intended)
    Yes, there are some out there who are just trying to pad their numbers…our last town was exactly like that. But there are some great programs out there to help these kids. And you as the parent, are totally in control of which services your child receives.
    Maddie is in the developmental preschool in our town because of her hearing issues, but she is also getting help for gross and fine motor issues. They’re not so much issues as they are deficits because of things she wasn’t exposed to in the orphanage. Things like learning to skip, using scissors and sensory integration issues.
    Shad and I are working with her on these at home, and I have every confidence she can learn how to do these kinds of things, but the extra attention she is getting at preschool is helping her to catch up at a faster rate than we can provide on our own.
    All of our kids have speech issues and have been getting speech and language help. But its not a forever kind of thing. Alek is getting ready to graduate out of speech this year and Anya should also be done with it this year. At every step along the way, every one of these providers has reminded us we can pull the kids out at any time.
    And I’ve thought about it.
    All of this to say…
    I bet Quinn IS experiencing the ‘silent period’ Gina talked about. It makes total sense to me. BUT if it turns out to be anything more than that, don’t be afraid to look into EI. You will be the one in control of how much help Quinn gets.
    Boy…that was a book. ;>)

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  17. I’m glad Gina helped you out. If it is helpful, they can do a hearing test on young children b/c they did an ABR test on Ben to be sure he was hearing and they did this while he was completely sedated following his MRI. They put microbes on his head and the audiologist registers if the different parts of his brain “light up” when stimulated by sound.

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