speech and IUGR

[jules1973]

my dd was iugr, not strictly prem. Only 10 days early. She is now 3.5yrs and does not talk much. She can say 30-40 words but not sentences. The speech therapost believes she may have selective mutism. We are seeing a specialist ped in two weeks. Apparently she has not uttered a word in 9 months at nursery although has no probs there mixing and loves it. Just wondering if anyone has had similar problems with prem and IUGR.

[cathyw]

Hi. My son who was born at 32 weeks, 3 days has selective mutism. Check out the website, www.selectivemutism.org which has a wealth of information. I will write more later but right now we are heading out to the YMCA for a little swim. :-)

Cathy 38
DH 40
John 3 1/2 years (born at 32 weeks, 3 days due to Severe Pre-E)
Katrina, 22 months (born at 36 weeks, 6 days due to Mild Pre-E)

[deerhart]

Alex was born 37.5 weeks at 5lbs 10 0z (5%) and has a mixed expressive-receptive speech delay, but we think that the cause is more the 5 months of constant ear infections then his prematurity or lack of gorwing in utero (since academically he's way way ahead).

As for selective mutism (though its one catagory I do not know much about) I was always under the impression that speech was fairly normal and the child would not use it for one reason or another, verses langauge being abnormal and not using it (which could stem from discomfort at knowing she is behind, inability to understand what's going on verbally to follow along and add things etc.. or simply an inability to express herself in words).

We do know that Alex will refuse to use words if he doesn't understand whats going on (receptive issues) or if we aren't getting what he's trying to say (expressive issues). He then resorts to grunts, screams, sighs or just telling us to forget it. When he was 3.5 it was almost entirely just breaking down into tantrums.

Does she use nonverbal cues at all? Does she use grunts or noises? Does she make any sounds at all outside of the home?

[jules1973]

Thanks for replies. I am a bit sceptical about the selective mutism (sm) diagnosis. We will see what ped says next week. I always thought that a child with sm would talk well at home and not in certain situations. I find it difficult to see how you can diagnose a child with sm if they have a speech delay. However I am not an expert and stand to be corrected. My friend is a highly qualified speech therapist and although she has not seen Em for ages,she thinks it is unlikely from what I tell her.

[amiejo]

I would think that Selective Mutism would be difficult to diagnose at this point. I typically will diagnose that type of disorder if the child is using thier language (speech delayed or not) regularly with people and in a setting that she is comfortable with and does not use it in other settings for reasons that cannot be explained by other reasons. Like someone else said, many children choose not to speak due to knowing they are behind others. With my experience with Selective Mutism, it is typically a control and anxiety disorder that comes when children enter preschool or elementary school, so I would watch her language use in nursery school and make sure she is showing some communication with the verbal language that she does have. Let us know how the dr appointment goes.

[cathyw]

Hi. I just wanted to chime in with some more information on Selective Mutism. Basically, selective mutism is a Social Anxiety Disorder. The child feels anxiety so much that his vocal cords literally become paralyzed preventing any sound from being uttered. The child will speak in some environments or with certain people but not others. It is not willful behavior on the child's part nor is it an attempt on the child's part to control others. He is not CHOOSING not to speak; he literally is unable to do so due to the anxiety. The child will be mute in settings where he feels the EXPECTATION to speak. The mutism is the only strategy the child has to deal with the anxiety about speaking. There are associated behaviours too. Some kids with SM will not participate in activities at school (i.e. doing motor movements during circle time etc.), basically anything that calls attention to themselves. Contributing factors include: genetic predisposition (severe shyness/anxiety in family history), speech and language impairment (MILD typically), sensory processing disorders and prematurity. I attended a conference on SM given by Dr. Elisa Shipon-Blum, a physician whose own daughter suffered from SM. She explained that we need to focus less on the actual lack of speech and instead focus on improving the child's communication in its entirety, including non-verbal communication, social skills etc. Dr. Shipon-Blum is one of the leading experts in the world on this condition. To educate people about SM has become her life's mission. She adamantly wants people to understand that the child does not CHOOSE this behavior, nor is it an attempt to control others etc. Many children have been kicked out of school and basically emotionally abused by teachers and therapists who have this opinion. The child actually wants desperately to speak but the anxiety shuts his vocal cords down. Only by decreasing the anxiety, removing the pressure on the child to speak, and providing the child with social and communication skills will the child eventually speak. The child needs to change his perception of himself too. If the mutism continues over a matter of years, it will be much more difficult to overcome.

My son who has SM presents like this. He will chat non-stop, sing songs, bounce around the house with extreme exuberance, but the moment we park the car near school he becomes COMPLETELY mute. He can then only gesture or possibly grunt to communicate his needs. He has been attending a special needs pre-school through our school district five mornings per week for the past 6 months for children with speech and language impairment. He has yet to say one word in the classroom. He actually wants to speak and will attempt to speak to the teacher. When he does try, only strange garbled sounds come out of his open mouth. So sad! He is making signs of progress in that he has spoken to two aides and a few classmates outside of the classroom. He has also begun to speak to children when on one to one playdates. There is usually a warm up period first where he has to make wierd animal sounds etc. before actual words start flowing. He has also relaxed enough now to start doing the special dances during circle time etc. So speech is probably on the horizon. He has always LOVED going to school though and does not look physically anxious at all. He loves to be around and interact with other kids, but he just does not speak to them. You would never know he was anxious except for the mutism. My son has age level expressive and receptive speech.

It is a frustrating problem, one that takes a long time to overcome. There are numerous behavioral plans one can put into place to help encourage speech at school (pairing him up with a child he likes, allowing people he speaks with to come into the classroom environment, giving him one on one time with the teacher alone to build a relationship etc.). If these don't work, anti-anxiety meds given on short-term basis along with behavioral intervention are available too.

In my non-speech therapist opinion, I would not readily accept the SM diagnosis given the severity of your daughter's speech delay. You may have already done this, but I would encourage you to get her evaluated through your school district. It sounds to me like she would benefit from an INTENSIVE speech pre-school to help promote her language development. If you were in our district, your daughter would definitely be put in my son's classroom. He has some kids in his class who started at age three only saying 50 words or so and who then test at age level when being advanced to kindergarten. The low ratios of the speech and language pre-school rooms really help to decrease anxiety and promote speech. IF there is anything else I can do, please let me know. Best wishes to your daughter.

Cathy 38
DH 40
John, 3 1/2 years (born at 32 wks, 3 days due to Severe Pre-E)
Katrina, 22 months (born at 36 wks, 6 days due to Mild Pre-E)

[jules1973]

Thanks loads for your detailed replies. I am basically waiting to hear what the ped says. I think Em will be going to ordinary pre-school because here in the UK there are not many special needs schools. They tend to teach children in mainstream school with one-to-one input rather than put them in specially designated schools. She is saying about 2-3 new words every day at the mo and has started to repeat words said to her. I am hoping it is just maturation delay, but who knows. Whatever it is, she is still the same little girl she always was. I did not talk properly when I started school at 4,5yrs and they say it can be genetic and I too was a IUGR baby. Let's hope history repeats itself. I will let u know how we get on. Thanks again for the fab support!!!

[catherinemackinlay]

Hi Jules,

I know this is a very old thread but I was wondering whether you had any advice seeing our situations were very similar. ( IUGR/PE and c-section at 36 weeks delivering my little girl at 3lb 15). Georgia is fine in terms of gross and fine motor skills and has hit other milestones on time. However, at 20 months she isn't saying anything at all really. Her hearing is fine and she is as sharp as a pin. The language aspect of her development however is concerning me and there does not appear to be much information out there concerning IUGR and language development. I guess to some degree all situations are unique. Just wondering whether you came across any specific resources that you found particularly useful?

Best regards,

Catherine.

[catherinemackinlay]

Hi Jules,

I know this is a very old thread but I was wondering whether you had any advice seeing our situations were very similar. ( IUGR/PE and c-section at 36 weeks delivering my little girl at 3lb 15). Georgia is fine in terms of gross and fine motor skills and has hit other milestones on time. However, at 20 months she isn't saying anything at all really. Her hearing is fine and she is as sharp as a pin. The language aspect of her development however is concerning me and there does not appear to be much information out there concerning IUGR and language development. I guess to some degree all situations are unique. Just wondering whether you came across any specific resources that you found particularly useful?

Best regards,

Catherine.