Replacements

It was a long day at the hospital for James (and us).  In the morning, we had his three year visit for the Outcomes of Children with Hearing Loss study.  The assessments are focused on speech, so a lot of it was them showing him pictures and asking various questions about them (although he did also get to do a couple puzzles and play with play-doh).  For the most part, he was great and really cooperative, although it seemed like he did get tired of it after a while.  My sense was that he did pretty well on most of the test, and in particular, they did the articulation test (Goldman-Fristoe) that he had scored so poorly on with his hearing therapist -- and this time, he rocked it.  :)  I'm no expert, so I don't know how he actually scored, but he said all but two of the words (pretty clearly, to my ears at least) and whipped through it at a rapid pace.  (Last time he was just not in the mood and basically refused to say a lot of the words or said them very quietly.)  Amusingly, one of the words he didn't say without prompting was "flower" (or "flowers"), which was one of his early words.  Instead, he said, "plants" and then when they prompted him for something else, he said (correctly), "rose."  The examiner said informally that the sound substitutions James was making were all age-appropriate (I can't remember the example, but maybe substituting the "w" sound for the "l" sound.)

The one test that he did not do well on was for social uses of language, where they gave a scenario and wanted him to fill in what people would say in a given situation (for example, "the baby wants to get down from the high chair -- if she could talk, what would she say to her brother?").  These were mostly situations where he would say the right thing in the actual situation, but he just didn't have an answer or would say "I don't know" for almost all of them.  The examiner said that it's not uncommon for that to happen with three-year olds, where they don't translate everyday knowledge to these line drawings.  (Nonetheless, I'm guessing that Matthew would have had no trouble at all with it, so we might start practicing this kind of thing with James.)

The last part of the session was getting a language sample, where they left the room and I was supposed to look at some pictures on the wall with James and talk about them (while they were recording).  Well, he looked at the pictures briefly, and then turned to me and said (and I quote), "Let's get out of here."  (Followed soon after by, "I don't want to play here anymore.")  Okay then!!  :)

We met up with Mike for lunch and then went over to ENT for James's hearing test.  It's a behavioral test (he has to make a response when he hears a sound), and he was also a perfect delight for that test, very cheerful and enthusiastic. He did a great job identifying different words that sound alike (all one syllable-words starting with B).

His hearing profile was about the same as it's been, except for a decrease at the lower frequencies which is a common effect of getting ear tubes (as I understand it, the tubes slightly lessen the vibrations that get through).

But the problem came when they were programming his hearing aids -- even though the overall hearing profile is not much changed from what it was, apparently the change was enough to put it outside the limits for his current hearing aids in his left ear (right is okay).  This was very depressing news because *&%$, his hearing is so bad that his hearing aid can't even handle it?? Yikes.  (This was my reaction, not Mike's.  Mike does not see this part as any big deal.  He's probably right, especially since James seems to be doing well with his language.)

And it's also a bummer because they recommended that he get new hearing aids -- AND, since his FM system (remote microphone) is integrated into his hearing aids, that means we'd have to get new ones of those as well.  Insurance will cover some portion of the aids, which are expensive themselves, but not the FM system.  FM systems cost several thousand dollars.  We could use the transmitter part of ours so it would be less than the full system, but it will still be a hefty amount.  Ouch.  He's got a loaner aid for his left ear for now (which is black and dark blue, but oh well).  We're going to check with our audiologist to see if it makes sense to do one more hearing test before taking the leap to complete new aids -- we didn't think about this until we got home.