I'm not sure how to title this. Maya's teacher called me aside this morning and suggested that I get her evaluated by a communication therapist (sort of a cross between speech therapy and early intervention I guess).
As I stood there with my mouth hanging open things started to fall into place a bit. She had some concerns about how Maya communicates, and some of the difficulties she has in doing so, that mirror those of that quiet little voice inside of me. Maya can speak. Beautifully. In complex sentences. In two languages. But she often doesn't, particularly in a group setting. She needs to feel very comfortable or she just shuts down verbally. If she's stressed or unhappy she can't seem to get words out and just points. While she can repeat entire scenes from dvd's by heart, complete with mimicking the proper intonations, if you interrupt her to ask what they're about or talk to her about them she'll ignore you and keep right on going with her speech. She has the physical ability to speak, and the vocabulary, but she doesn't do a lot of imaginative storytelling. It's harder to engage her in an in-depth conversation than it was with Itai at this age (I know, I know, I'm trying not to compare.) Her teacher also said she's not engaging with other children as much as she should be at her age. She can see that she wants to, but something inside seems to be holding her back. She can't seem to get past that barrier and remains on her own, even when she wants to engage. She's worried that while Maya is doing well in her current preschool, where classes are small and she gets an abundance of love and personal attention, that she'll struggle later if we don't find a way to help her open up more.
Right now I'm not sure whether to be upset, relieved, grateful, or just stunned. All I know is that yes, I think they're right that there is a concern here and I need to be as proactive as possible in getting my daughter whatever help she needs. I know that in the grand scheme of things this does not look to be huge, no one is talking about something truly awful, like god forbid a life-threatening disease, or something that would hold Maya back forever, but I just can't shake that sick, scared feeling in the pit of my stomach. I spoke this morning with a friend who's a developmental psychologist, who explained to me that this evaluation is the first step, and that depending on what they find they may continue there or recommend a psychological evaluation. I am trying to schedule her for a dr's appointment as soon as possible so that I can get the referral, and then I want to move ahead with this as fast as I can, so that Maya can start getting whatever help she needs.
I just wish I knew whether we were talking about some kind of minor "tweaking" that needs to be done to help Maya progress or about some kind of major issue. I KNOW that she is still the same wonderful, sweet, intelligent, physically daring, full of personality girl that she always was, the same girl who's been so very fun to live with these past few months, but I can't help feeling thrown for a very large, uncertain loop here. I'm sure once I know what we're up against it won't seem so frightening, at least I sure as hell hope so.
And I can't help but ask myself if somehow *I* did this to her. Did I not nurture her enough? Not correctly? Not give her some kind of tool that she needs to find her place in the world? Does she not get enough attention? Does she get too much? Have we been seeing her as too young and holding her back, or have we been expecting too much? So many unanswered questions...
I took Maya to the ped this afternoon to get a referral. He said that a communication therapist is completely inappropriate given the level of her speech. He did say that she seems to have issues with self-confidence and security (she shut down completely when asked to draw circles with a pencil, but 5 minutes later filled up the entire paper with circles, happy faces, bananas, etc., then stuck it in the dr's face to get his agreement that she'd done a very nice job. By the time we left she'd given it to him for a present.). He did say that she's on the late end of the continuum for developing social relationships and said that was worth looking into. He recommended either a psychological evaluation or a private preschool teacher to work with her one on one at home for a bit and then sit in on her class to help "facilitate" and "be a catalyst" for her to develop interpersonal relationships :confused. If we wanted to go the psychologist route, he told me to exaggerate her condition so as to be eligible for more treatment hours from the health fund (a suggestion that I REALLY don't like, because it will skew the results and I still won't know what's really going on!)
After we left there we went to a playdate I'd arranged last week, and for the next 2.5 hours I watched as Maya and this other little girl played BEAUTIFULLY TOGETHER - not in parallel, together. And the whole time she was talking up a storm. I mean this girl did not stop talking or interacting for 2.5 hours! The other girl's mother watched her and thought we were insane for being concerned. All I can think of is that the problem is more with larger groups or places where she feels insecure.
I decided that given all of this, I would rather pay for a private evaluation by a child psychologist, so that I could at least get an objective opinion and have some idea of what's going on here (and save the issue of HMO-funded hours for a later time, if it becomes necessary). I also spoke this evening with the head of a psychological institute in Tel Aviv who takes my insurance. He agreed that there was no need for a communication specialist, but that it couldn't hurt to get a psych evaluation by a qualified child psychologist, either there or elsewhere to find out whether these are physical or psychological issues, and to recommend a course of action. I'll call his secretary tomorrow and see what the story is with my coverage, but we'll probably do that.
So, that's where we are. I'm still confused, probably more than before, but am feeling a lot more relieved after seeing Maya and her friend interact this evening. There is probably still and issue with how she handles group settings, and I'm sure that if she were better able to use her voice as a tool of expression we'd have fewer meltdowns, but I think I'm now able to at least view this as a "something" that may need to be dealt with without spending hours googling frightening syndromes on the internet.
I'll update of course as we learn more.
I wanted to update this again for those of you who are finding this page through a google search. It's about 9 months later now. Over the summer, Maya completed a full evaluation with the Child Development Authority (Machon LaHitpatchut HaYeled for those of you here in Israel). While they did manage to rule out the scariest scenarios and have reassured me that Maya is likely to do just fine over the long-term, they did recommend both speech and psychological therapy for her. Her speech evaluation, conducted in both English and Hebrew, showed that while she was on track for English her Hebrew showed a 6-8 month lag, and she has difficulty with actually *using* her language (expressive language). She's been seeing a ST for a few months now and is making great strides in both of these areas. We've still got a ways to go, but now that she's progressing we can really see the difference from where she started. At the same time, she's also continuing to receive psychological therapy from the same developmental psychologist we spoke to in the very beginning (privately - the funded option the health fund offered us was not acceptable). L works with her (together with a parent - my husband and I switch off) on interpersonal skills and relationships, among other things. Progress there is slower, but visible.
If you found this page by searching for "communications evaluation" or something similar, I suspect it's because you too are now facing some of the questions we were. If that's the case and you're feeling as unsure and bewildered as I was (and sometimes still am) I hope that this update has helped. Feel free to e-mail me if you're the parent of a child facing similar issues and you're looking for someone to share the walk with you. My e-mail is robintlv AT gmail DOT com.