E/I E/I Oh.
On Friday, I took L to get her evaluation with Early Intervention (EI). I know that many parents seem to have a bias against getting evaluated when L is so recently home (with us for about 5.5 weeks at this point). I have seen some knock-down drag out “discussions” online by people who firmly believe that post-institutionalized kids should be with their family for a minimum of three months before an EI evaluation. To me, that just seems crazy.
As I have said before, it was my opinion that L isn’t too significantly delayed, given her history of living in an orphanage. She can do a lot of the big ticket items on those developmental charts: she can sit, crawl and stand. But sitting, crawling, and standing are not the whole canoli as far as development is concerned. I had talked to my genious friend (and former EI worker) Paige about some things I should keep my eye on once we met L, and that is exactly what I did.
While she hit a number of the bigger milestones, there were some less sexy milestones that she seemed to have problems with. For example, I noticed that once L gets ahold of something, she rarely lets it go. At first I thought maybe this was some kind of orphanage-influenced greediness. After watching her, though, I was more inclined to believe that she didn’t know HOW to let things go. She seems much more skilled at closing her fist than opening it. Another odd thing is that L is an expert stander. She can pull herself up to a stand and stand steadily holding on to something for very long periods of time. Unfortunately, she doesn’t know now to sit down. Poor kiddo pulls herself up and stands there crying until either she falls over or someone comes and helps her down (or walks her around). These issues are not huge, but they are a manifestation of some delays in L’s development.
I started wondering if there were more delays I wasn’t noticing. I also didn’t know exactly how I should go about helping L gain these skils. I am not an expert in child development, nor am I a physical therapist or occupational therapist. So, with the support of the International Adoption clinic staff, I requested an EI evaluation.
The EI evaluation was really educational. The EI person asked me a bunch of questions about what things L can and can’t do, in a wide range of different areas (fine motor, large motor, cognitive development, speech, personal care, etc.). The EI lady also had a bunch of toys and games for L to play. Because L turns one tomorrow, we looked at both the 8-12 month and 12-18 month ranges. The whole shebang took about an hour and a half.
As we talked about what things L can and can’t do, we discussed why she might not be able to do them. There were a lot of things on the list that would never have occured to me. We talked about ways to position L while she is playing to help her gain the strength she needs for some skills. We talked about games I can play with her, toys we can use and what skills will build on skills she has already mastered. We talked about how damn cute and charming L is.
The next step is that our evaluation will be reviewed by an EI team who will decide if L qualifies for services. It is my guess that she probably won’t, because she scored at least 60% in all areas. The team consists of an Occupational Therapist, Physical Therapist, Speech Pathologist (?), nutritionist, and developmental specialist. Even if we don’t qualify, they are going to send me copies of the results and suggestions and resources for the areas where L is still lagging. They also encouraged me to have her reevaluated after some time has passed to make sure she is making good progress (particularly in speech and language acquisition, since we couldn’t fairly evaluate that this soon).
I am so pleased with our experiences thus far with EI. I learned things in the evaluation that I could put to use right away. When it was confirmed that L is doing pretty well, it was a relief. I would much rather know where she stands than wait another two months wondering if she was making the kind of progress she should. I don’t understand why people would advocate waiting to get evaluated. Mark me up as one person voting to do it as soon as possible.
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A few other notes:
-I think Paige said that they expected institutionalized kids to be accomplishing tasks of a baby .5 x (lenth of institutionalization). For example, they might expect a one year old who had been in an orphanage since birth to do the milestones of a 6 month old baby. She also said that they expect kids to recover two months of development in each month after they are placed with their family. I wasn’t too worried because I knew that L was much more developed than an average 6 month old and I could see her making progress since she has been with us. For example, she had no pincher grasp when we met her and now she has a lovely one (though she can’t seem to let go of the cheerrio very well). If I am mis-quoting her, Paige can let me know, but since she is off in another country adopting her baby right now, you will just have to depend on my memory.
-Just today, L started working on two things she couldn’t do yesterday: she started dropping things over and over (yay! opening her hand on purpose!) and she started working on lowering herself from a stand to sitting. I supposed one could argue if I had never had the evaluation, she would have done those things anyway so I should have been patient. I am partial to believing that she realized she COULD do those things after the evaluator demonstrated the skills and helped her do them a few times.
-Finally, EI is totally FREE in my state. If it isn’t free in some other states, or if there is a huge waitlist, I can see why people might be reluctant to look into their services.
it is FREE In every state and everyone should do it adopted or not
EI is a federally mandated program and is free in every state. BUT, each state can determine what they will and won’t do as far as the mandate is concerned. I know that Ohio, for example, only does referrals, but doesn’t do the actual therapy, while in MA, where I live, everything including the therapy is free. Both of my kids were in EI and I think it’s a remarkable program. I am very glad you decided to take L right away instead of waiting. Waiting can only make a child lag even further behind, and you already missed a year of EI, so you only have a precious amount of time left to have her brain retrain. 18 months is supposidly the cutoff for language, 3 years for physical stuff. I started my kids at 4 months and I got chastised because ‘it was too early’ but you know what? They needed every single second of their time in EI. Good for you for taking control of what works for your family.
I’m piping up with a hearty Right On – My older daughter has been in OT for various delays for a few months now, and I feel awful that I didn’t take get her an EI eval when I first started wondering what was going on, instead of following others’ advice to wait and see…I agree with Mer & Margalit – EI is important for *everyone*, and every day counts.
Early Intervention is NOT free in every state. A few other states besides mine charge, I know.
NJ, so I’m told anyway, has been the most expensive for a long time. The price (excuse me, “family participation / cost sharing”) has just gone up – a lot. Our EI person just told me that with the new regs, (thank you, Governor Corzine) a family with an income of $60,000 could pay up to about $600 a month for services, depending how many hours a week their child receives. That’s an immense sum for a family at that income level in this rather expensive state.
Amber, I don’t know what the rules are where you live, but here in order to get services the rule is
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http://www.cnjmchc.org/women-families-detail.asp?ID=102#whatis
Who is eligible Early Intervention Services?
In New Jersey, infants and toddlers are eligible for Early Intervention Services if they are under 3 years of age and meet the following criteria:
* Developmental delay of 25% in two or more areas of development
* Developmental delay of 33% in one area of development
* Medically diagnosed physical or mental condition that has a high probability of resulting in developmental delay (for example, Down Syndrome, Autism, Cerebral Palsy, etc.)
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So actually L may qualify.
Just to play devil’s advocate, I want to give the case for waiting for EI, especially for families in states where there is a cost. Say your child is very young, 10 months old. For what they can measure at that age, your child falls outside EI guidelines – even though the child is at risk, even though you feel that they are delayed, even though they fell at the low end of normal or within cutoff of 33%.
Here in NJ, you then have a substantial wait until the next time the child can be evaluated. By that time, the child is much older, the delay is very easy to document but you have lost a lot of precious time. (Though, I do not think there are “cutoff” ages, and the ages I have heard for approximate end of the critical periods are a bit older than cited above.)
The world is very unfair, and especially so for developmentally disabled children.
If you can afford *private* evaluations, in this state, yes, there is no reason to wait a moment. You can repeat evaluations as you see fit, and you can use them as ammunition with EI if you like. But for a financially strapped family, unfortunate and, in my opinion, morally wrong as the situation may be, I do think there can be good reason to wait.
In case anybody cares, the reason I’ve thought about this is that my child has very severe speech delays, though she is fine in everything else. She would never have been caught by EI had we gone right away. Also, my experience was that EI tried very hard to minimize her issues once it was apparent that she would qualify for services. It would be wonderful to think that EI is run purely for the benefit of delayed children, but at least here that doesn’t seem to be so.
Thank you for writing about this, everyone. Very important and fascinating.
Happy birthday L!
Take care, Lin
Even if she *had* done those two new things without your having had her evaluated, you still learned so much more about her, how to interact with her, and the things to look for. I don’t think getting an evaluation is just about getting them new skills. I think it’s about feeling on top of your child’s development as much as possible, so of course you did it now.
You’re a super tiger mama, Amber.
First, happy 1st birthday to L! Second, kudos for getting L evaluated asap. I am a big fan of EI evaluations whether you are worried about your child or not. From what I understand, EI evaluations are free in every state under federal law, but depending on the state, there may be costs to EI therapy and services if they are deemed necessary. You are free to reject the services if you cannot afford or want them, and just having the evaluations done is so incredibly informative.
I can see why some parents would want to wait at least a little while before having an evaluation. My daughter, would have totally shut-down at an evaluation if it was done shortly and even probably three months after we returned home. She definitely needed a bit of time and space to become comfortable and allow strangers to be around her. No doubt some children could handle an evaluation immediately, but not every child.
I am with you — we had our daughter evaluated right after coming home and she only needed 3 months of physical therapy for gross motor skills — one of her big issues was not knowing how to sit from a stand, she would just keel over backward right onto her head. (FYI, I was told it was from not having enough on her feet time in the crib or on someone’s lap so her thigh muscles were way underdeveloped) but the activities we learned were GREAT and she developed very swiftly and is now right on target for a 2 1/2 year old.
DS-L