Context/Background
Liam is a 17 month old male. He is a little big for his age, with a full head of strawberry blond hair and a sturdy body frame. Liam is an only child conceived through in vitro fertilization. His mother (Mom) is a 37 year old speech pathologist who runs her own practice and his father (Dad) is 49 and works in the finance industry.
Liam was observed in his home, on a Friday, from 10 am to 12 pm. Mom takes Fridays off from her practice to spend the day with Liam. Monday through Wednesday Liam is cared for by a stay at home mother, with one young child at home (20 months) and a special needs child in school. On Thursdays, Liam is cared for in his own home by a grandmotherly caregiver.
Mom was the only parent home at the time of the observation. She has excellent articulation and speaks in clear, simple sentences with Liam and makes frequent observations about his actions. I observed Liam on the main floor of his home which has clearly been baby proofed, with gates at the stairs, closed doors to bathrooms, latches on all cabinets and all fragile items are either above the 5 foot mark or removed. There is an overflowing toy box, and a book case with childrens’ books on it. It is worth noting that Liam had “tubes” put in his ears a month ago due to frequent ear infections and Mom’s concern about possible language delays.
Observation
Liam’s mom met me at the door holding Liam in her arms. She was also trying to hold back the family’s large Newfoundland, whom Liam was reaching down to grab. She told Liam to say hello to me and he hid his face in Mom’s shoulder for a second. Mom then asked me to hold Liam while she put away the dog. I held my hands up for Liam to come to me and asked Liam if he could come. Liam put out his arms and I was able to hold Liam for a minute while Mom opened the gate and removed the dog.
“Hi Liam! How are you?” Liam looked at me and played with the necklace I was wearing. When Mom came back in, he squirmed down to walk to her. I mentioned I thought he might need a diaper change.
Mom asked, “Did you go poop? Liam, did you go poop? Come over and let me check.” However, she was walking to Liam and looked, and yes, he did need a diaper change. “Can you get me a diaper? Go get and diaper and let’s change you.” Liam and Mom walked to the changing station in the living room and Liam took a diaper from the hanging storage unit. He handed it to Mom and lay down on the floor. Mom sort of narrated the process of cleaning Liam up to him, while simultaneously talking to me and looking at Liam. He looked at Mom and when she said “All done!” he scrambled over to his toy chest.
While Liam pulled toys from the toy chest, I asked Mom about how many words she thought Liam might have. She thought he had about 20 clearly enough to be understood, but often sang, spoke and replied in unclear language. However, as Liam pulled out toys, he clearly wanted us to be his audience and would hold up items and Mom would question him about it or give another direction.
“Is that a car? I know you like cars. Can you show us the blue car?” Liam rooted through the toy box and pulled out a similar car in blue. “Cuh!” “That’s right, that’s the blue carrrr!” Liam then sort of threw the car at us (we were on the couch). Mom got up, kneeled in front of Liam and said firmly, “No! We do not throw the cars. No throwing cars!” Liam picked up the red car he had before and watching Mom very carefully, pulled his arm back slowly as if to throw it again. “Oh, no thank you. We cannot have cars now. All done with cars.” Mom signed all done and took the red car from Liam’s hand and put the cars on a shelf.
This prompted a melt down from Liam who clearly wanted the cars. He cried and pointed to the cars. He jumped a little and made like he was going to climb the wall to get the car. “Cah, cuh,” was repeated with other words (sounds?) I couldn’t decipher. Mom scooped up Liam and asked, “Are you hungry? Do you think you need snack?” Mom signed the word for hungry. Liam’s tears evaporated as he shook his head yes.
Mom put Liam in his highchair, gave him a sippy cup with milk, and put a few Cheerios on his tray while she cut up a banana. He kind of sang or hummed happily as he ate, shoving the cereal in his mouth. When he ate those he signed “more”. “More?” Mom asked. “Good signing! Can you say mmmooorrreee?” Liam made the “mmmmm” sound, still signing more, and Mom put Cheerios on his tray. Then she gave him banana. “Banana!” She said. I started to sing, “banana fana mo mana, me mi mo mana banana!” Liam looked at me and smiled and bounced in his seat, so I sang the name game song with the words Mom, Liam and my name. Liam continued to eat and bounce happily in his seat looking at me while I sang and chair danced for him.
After snack, Mom took Liam to the bathroom to get cleaned up (he had banana in his hair). She narrated the whole time what she was going to do and Liam would murmur in reply, although I couldn’t make out the words. Liam came back cleaned up and went again to the toy box to pull out toys. Mom and I sat on the floor with him and named the toys. He would show us the toys, “talk” about them ( I didn’t understand him) and play on the floor. One thing he did do clearly was some of the animal noises with a Little People farm set. He clearly said “moo”, “baa” and sort of “meow”. Mom would say, “Yes, that’s right, the cow says Moo!” and so forth. I just copied him with the animal sounds. He would look at whomever was speaking to him and I think he thought my animal noises were funny because he was giggling. He would pretend the animals were eating and made sort of “nom, nom, nom” munch sounds.
Liam went to the couch and pulled down his “blankie” and rubbed his face on it. “Uh-oh, someone is getting tired,” Mom commented. She asked Liam if he wanted a story and he nodded yes. There was a small bookcase of children’s books and they cuddled on the couch as Mom read Are You My Mother? Clearly, they had read it before, because Liam would point to things as she read them. At each page Mom would ask, “Is that baby bird’s Mother?” and Liam would quietly say, “nnnnoooooo”. At the end when they find the bird’s mother, Liam said “Yay!” I don’t know if that was yes, or hooray, but either one worked in the situation.
Impressions
It is clear Liam communicates even if his expressive language still has a long way to go. His receptive language is good, as he would hand Mom the toys she asked for, or item requested. (The exception being the cars he wanted to throw.) He and Mom make good eye contact, are close physically and exhibit turn taking in conversation. Mom uses simple language and tends to demonstrate what she is saying. She narrates everything. The home is clearly child centered and there is a wide range of toys, particularly “learning toys” (stacking blocks, puzzles, toddler friendly musical instruments, sorting toys) on display. There are also a number of children’s books, with many “classics” (Dr. Seuss, Where the Wild Things Are, The Carrot Seed).
Recommendations
It feels arrogant to make recommendations to a speech pathologist who clearly adores her child and is doing everything possible to encourage communication. I love that they were using sign language and Mom was on top of his getting tubes in Liam’s ears. I might suggest that she not anticipate so much of what he wants, to encourage him to ask for it. For example, instead of just giving him his milk, he could be made to ask for milk. Also, Mom doesn’t do much singing (she admitted this). Liam clearly enjoys music and that might be fun for him and break up some of the narration she does. Liam does attend activities at the library where he sees other children his age. In addition, Mom and Dad take him to children’s museums, stores, family visits, his Grandparents’ farm and restaurants on the weekends. He is definitely seeing the world around him. Liam is an adorable, delightful little boy whom is clearly the center of his parents’ world. They are doing a lot correctly.
