Wyatt's Speech...

[Robin0472]

Hello Ladies. I thought I'd introduce myself. I maybe spending more time in here.
Wyatt is a Feb 09 Baby and I just got him tested for speech. He's 21 months and still not talking, never babbles and never babbled as a baby.
I'm not even sure what to post. I guess I was just hoping that getting his speech evaluated, they'd tell me he was fine and he'd start talking ever day. But now I'm a little worried there is something more going on. Everyone has been super-upber wonderful that I have worked with at our County.
But here the the link to the whole thread.
My breaking point was about a month ago after a few weeks of KinderMusic and Wyatt not wanting to participate and instead run the hallway. He was pulling my hand and pointing and grunting and some woman told him he needed to use his words and then told me, I really need to make him use his words and I should teach him sign language. Then the next day at the Library, Wyatt didn't want to participate again and the woman reading goes.. "Oh he must be having a rough day". I totally lost it. I was so upset and so angry. He's never participated in a group, This had been 4 weeks of KinderMusic and Story Time. Than, that afternoon, I called about part-time daycare and getting him evaluated. My DH is deployed for awhile and I felt like I'm losing my sanity and temper.
He was tested the week before Halloween and the follow up with the Case Manager was at our house today.....

[Robin0472]

X posted from our DD room. From today.So... Our Case manager came to the house today. They did the Battelle Development Inventory for testing at his originall testing (in case your interested to know that test they used) His scores weren't as great as I had originally thought. No.. I do take that back.. He was tested Advanced Development (31 months) for Motor Skills (Gross Motor & Fine Motor)
He scored at 15 Months for Self-concept and Social role, 16 Months for Receptive Communication, 14 months for Expressive Communication and 15 Months for Attention and Memory. And Delayed with Speech Sound Production with Limited variety of speech sounds in words.
Our Case manager did say this isn't our fault and we did nothing to cause this. She did say a lack in his baby babble was a good indicator that there was an issue early on. She also did note that he barely makes eye contact - which will hopefully improve with communication skills.
The eye contact does have me worried, I didn't realize it was such an issue.
We will start play-therapy as soon as they find a therapist that accepts our insurance. So our insurance will be billed and what they don't cover is going to be covered by the state since we make under some magic amount.
She suggested putting him in a program with more kids of his own age. But she is going to check out his Day-care. I told her Wyatt's provider wanted to know right away what skills to use to work with him, and our Case Manager said she was happy to hear our Provider is already in the game and might be okay for him to stay there. She did say he will learn more and faster around other/more kids his own age, since he will try to communicate and mimic what they are doing.
So now, I am to write down every sound he makes, as a form of communication. I'm to try take those sounds he's already making and expand on them. I'm suppose to create a stricter daily routine and incorporate more nursery rhymes and repetition songs, like Farmer and the Dell, Old McDonald.. etc.
We did make short term goals of him, parroting what we say, attempting to use sounds to name body parts, and trying to parrot simple nursery rhyme songs.
If he doesn't improve after 4 months with play therapy, day care and parent involvement, he'll be tested/evaluated again and we'll change the "treatment" (can't think of the right word). I got MORE handouts.
She also has to go back to his initial speech evaluator because she didn't put in his file she wanted him to have a second hearing test.

[Gwenn]

Robin. I can't imagine the stress of dealing with this and all the unknowns that go along with it while your husband is deployed. I think I'd lose my mind (if I haven't already).

You did the right thing by getting him evaluated. She is right, lack of babbling is a big red flag and so is lack of eye contact.

Since I'm an SLP I always ask nosy questions ... it's a habit so hope it doesn't bother you ... so was the speech evaluator an SLP or just a general child development person? You mentioned he is starting play therapy. Will he be receiving speech-language therapy?

Please let me know if you have any questions or would like some resources. We're all happy to help in here.

[Robin0472]

When he was evaluated he was evaluated by a man I think he was Child Development (not sure what he was) and a Speech Therapist. Two people in the room. The man asked the questions on the Battelle Test and the Speech Therapist tried to engage him in play and observed him. Then after the man finished asking me questions, The female Speech Therapist did some play things for him. The final report was what the Case manager brought to my house today. And we went over services and which agencies are contracted that accept our insurance.
Since he is not making any sounds in a parroting fashion/mimicking/or babbling not sure the right word to use. They are going to start him in play therapy to get him to make sounds on command. 4 months of that, they will re-evaluate and see how he's doing. THey are hoping that will jump start him to realize he can use his voice to communicate. Then.. if they feel services are further required (which they think he probably will), if he is parroting/mimicking sounds they can bring a speech therapist in. He does make animal noises on command.
So they feel, a speech therapist would be too advanced for him right now and he wouldn't cooperate (based on testing). So start him with a play therapist and work their way from there.
I copied the sheet with his scores on it, but will get a copy of all the paperwork today after she changes a few notes on his paperwork.
DH and I got to talk on Skype about it, and he seemed pretty upset by the whole thing. I don't know what to tell him, cause I'm kinda worried too. Sorry that seemed a little rambled.

[Gwenn]

Since he is not making any sounds in a parroting fashion/mimicking/or babbling not sure the right word to use. They are going to start him in play therapy to get him to make sounds on command. 4 months of that, they will re-evaluate and see how he's doing. THey are hoping that will jump start him to realize he can use his voice to communicate. Then.. if they feel services are further required (which they think he probably will), if he is parroting/mimicking sounds they can bring a speech therapist in. He does make animal noises on command.
So they feel, a speech therapist would be too advanced for him right now and he wouldn't cooperate (based on testing). So start him with a play therapist and work their way from there.

I have to admit this confuses me. I work with several children who make few to no sounds to develop their communication, and I don't focus on getting them to produce sounds at all. I work through play to develop spontaneous communication including gestures, sign, and symbol use as well as vocalizations if possible. So I don't understand why they are telling you a speech therapist would be too advanced. We haven't been "speech correctionists" who simply drilled sounds for a very, very long time. In fact, that's one of the reasons we no longer call ourselves Speech Therapists and have switched to Speech-Language Pathologists. If that is how they view my profession they are simply out of touch ... I suspect this has to do with wanting to save themselves some money on qualified personnel.

Do you know if Tricare covers Speech Therapy? I might seek a second opinion through Tricare if possible considering they are telling you he does not qualify because speech therapy would be "too advanced." Seriously, I work with 10 year olds who have NO spontaneous communication and degenerative diseases - if Wyatt can make animal sounds on command then he is far ahead of them skill wise.

[Gwenn]

DH and I got to talk on Skype about it, and he seemed pretty upset by the whole thing. I don't know what to tell him, cause I'm kinda worried too. Sorry that seemed a little rambled.

It's not easy any way you deal with it, but it must be really hard for your DH being so far away.

[Robin0472]

Hum.... These people are coming from Therapy Contracted Businesses. I might have the terminology wrong. When I get a copy of the forms, I'll see what the real title of the therapists is. Tricare will be billed, if they don't cover all, the state pays the difference. I don't know if this is because of a shortage of SLP in the area or it is more for cooperation. She said the Play Therapists were really good at what they do and getting the non-vocal kids to vocalize. There were 3 companies on their list that accepted new patients on our insurance and about 14 companies total on their list.

[swannie]

First,

Secondly, your state's EI program goes through private insurance?? Ours is totally separate from insurance. The providers are all contracted/paid by the state, with families paying a share based on income.

Elliott also has an expressive language delay. Here, they will generally only send out an actual SLP to provide services if expressive language is the only delay—if there are cognitive or receptive language delays (or social/emotional, etc), they send a DI (developmental interventionist/teacher/play therapist) to work with the child.

It Takes Two to Talk is a great starting point, IMO (it's a book/DVD set from The Hanen Centre). Your local library might have it, or be able to get it on loan for you.

[Robin0472]

First,

Secondly, your state's EI program goes through private insurance?? Ours is totally separate from insurance. The providers are all contracted/paid by the state, with families paying a share based on income.

Elliott also has an expressive language delay. Here, they will generally only send out an actual SLP to provide services if expressive language is the only delay—if there are cognitive or receptive language delays (or social/emotional, etc), they send a DI (developmental interventionist/teacher/play therapist) to work with the child.

It Takes Two to Talk is a great starting point, IMO (it's a book/DVD set from The Hanen Centre). Your local library might have it, or be able to get it on loan for you.

Thank you for the info. If you have private insurance, they bill the first and then if you make below a certain amount, the State covers. Not sure is this is normal. If your insurance refuses to pay, you don't have to pay anything if you make under a certain amount of $$ Our state doesn't have the same amount of money as bigger states.

Gwenn, is this something I need to bring to EFMP? Our Primary is a civilian Physician. I did a self refer to get testing. Our primary was more concerned I staggered vaccinations, than y concern with his speech.

[Gwenn]

Insurance can be tricky. Services can be provided for three reasons - medical, educational, and (I think) habilitative. The schools actually bill medicaid for children who qualify to get services reimbursed and it turns out they bill private insurance, wait for it to be rejected, and then bill medicaid. There was a lot of confusion about this but it was explained to me that private insurance will only cover medical services, so it won't pay for educational services, so those claims will always be denied. Likewise, services through EI are considered habilitative so won't be reimbursed through those who cover medical or educational services. I actually got curious and googled Tricare and Speech Therapy, and it stated they only cover medical. So it might be that they will deny coverage and the state will pay it all. But any time you go through the state for anything they attempt to bill the private insurance just on the off chance they will accept the claim.

In Arizona, I see many children transitioning out of EI who received services from an SLP and some with pretty severe needs but I guess like most other things it depends on the state. Still, professionally I'm insulted by the statement that he isn't far enough advanced for speech therapy. We work with infants, sometimes in the NICU. The youngest child I have worked with was 14 months and had just received a cochlear implant. She had only been "hearing" for a couple of weeks and I started from the ground up - that's what I am trained to do. Overall, I feel strongly that an SLP with expertise in that area (many don't have that expertise) will be better than a teacher or developmental specialist. We do cost more money than teachers. But, I will say that being in North Carolina the level of training for the interventionists should be very good. The program I use as a guideline in my practice was developed and implemented in North Carolina.

I will say, though ... if they are only focusing on getting him to repeat sounds they aren't providing him with the services he needs. Just watch that.

Robin, I can't advise on EFMP because since we're National Guard I really don't know all the ins and outs of military insurance. I have insurance through my work so I just haven't navigated the systems and I have to confess I don't know the acronym. But if you're asking whether you should ask your doctor, many people in our little forum here pursue private therapy in addition to what they receive through their state or county. Sometimes they are covered by insurance, sometimes not. Your call whether you want to seek additional services if they are available. They might be, as it did say Tricare covered medically necessary speech therapy but you'd need to check with your doctor. They might not cover it if it's offered through EI or if they're paying part of that bill.

[Gwenn]

Okay, I know I'm beating a dead horse and there's not much Robin can do anyway, but this is my profession's position statement on early intervention (italics mine).

Position Statement

It is the position of the American Speech-Language-Hearing Association (ASHA) that speech-language pathologists have a central role in providing services and supports for families and their infants or toddlers with disabilities as members of the early intervention team. Furthermore, the appropriately certified and licensed (as applicable) speech-language pathologist is qualified to address delays and disabilities in communication, language, speech, emergent literacy, and feeding/swallowing. Effective communication is fundamental to all aspects of human functioning, particularly learning and social interaction. The development of communication skills begins at birth. Families with infants and toddlers (birth–36 months) who are at risk for or have disabilities should receive developmentally supportive care that addresses a broad spectrum of priorities and concerns (Individuals with Disabilities Education Improvement Act, 2004; National Association for the Education of Young Children, 2005; National Research Council & Institute of Medicine, 2000; Sandall, Hemmeter, Smith, & McLean, 2005).

Speech-language pathologists, as autonomous professionals, assume various roles in addressing the concerns and priorities of families and their infants or toddlers, and should be included on any early intervention team for children who are at risk for or have communication, language, speech, emergent literacy, or feeding/swallowing impairments. These roles are implemented in collaboration with families, caregivers, and other professionals, and include but are not limited to (a) prevention; (b) screening, evaluation, and assessment; (c) planning, implementing, and monitoring intervention; (d) consultation with and education for team members, including families and other professionals; (e) service coordination; (f) transition planning; (g) advocacy; and (h) awareness and advancement of the knowledge base in early intervention. These roles should be implemented in accord with the following guiding principles:

1. Services are family centered and culturally and linguistically responsive.
2. Services are developmentally supportive and promote children's participation in their natural environments.
3. Services are comprehensive, coordinated, and team based.
4. Services are based on the highest quality evidence that is available.

Extensive information and references about these guiding principles and roles and responsibilities of speech-language pathologists in early intervention can be found in the companion ASHA technical report, guidelines, and knowledge and skills documents (ASHA, 2008a, 2008b, 2008c).

[swannie]

Overall, I feel strongly that an SLP with expertise in that area (many don't have that expertise) will be better than a teacher or developmental specialist. We do cost more money than teachers.

There's the rub, here at least. Comes down to $$.

[Gwenn]

There's the rub, here at least. Comes down to $$.

I know - that's why it bothers me. In general, you get what you pay for.

[swannie]

I know - that's why it bothers me. In general, you get what you pay for.

I think part of the rationale is that if a kid has more issues than just language going on, the DI can address those through more general play-based therapy to see if the language improves. But I hear you. Preaching to the choir here.

[Gwenn]

I understand what you're saying, too ... but if a child has MORE severe needs, shouldn't they be more likely to be entitled to a specialist? I could teach almost any teacher's aide I've worked with to do simple articulation therapy, so long as I oversaw the program. It's teaching the concept of communication and building on that that's the difficult part!

[Robin0472]

Gwenn, let me find out first what the official title of the person coming to the house. As you said NC is a different being. The big things seem to be speech and social. With Social being effected because of speech. With a slight worry about eye contact. If you try to communicate with him in "Animal Noises", he'll make eye contact and smile. But you have to almost force the eye contact.

Here is some BASIC information for EFMP. I think it will also effect Tricare and put an EFMP status on your insurance. It qualified you for more needs.. That is called Tricare ECHO (we don't qualify for Echo as of now)
I'm reading some conflicting reports on EFMP being just for PCS purposes and doesn't help you with anything else. Ex... If your child has Spina Bifida or Autism then they will only move you to another base where there is a guarantee your family members can/will recieve treatment, or transfer you to another base that would be closer to a Specializing Hospital/Clinic. This can effect overseas orders if your overseas assignment doesn't have a people in place for that issue. Tricare ECHO looks to be an "ADD ON" to your Tricare that provides a greater level of services, with people with Life long issues.
I might call EFMP and find out... Here is our Base EFMP information on the MWR site.

[Robin0472]

I dont' know... I've been so borderline upset today... I hate to admit it but these last 3 weeks of him being in Child care has been AMAZING for me (1st time for me being alone (w/o my husband) and with my own body and not having a baby inside or glued to me for almost 3 years). I've been given time to "think", and get things done I can't get done without Wyatt.
I hate not being able to talk to my DH when I need to.

[Gwenn]

Hmmm ... still a little confused because I don't know the ins and outs of the program. Tell you what, I actually have a couple of students on my caseload who have a parent who is active duty Air Force. We live near the Air Force Base (a very large one) and although there is a school on base, the school where I work is the closest one with a self-contained Autism classroom so they are bussed over here. I can ask one of the mothers for her experiences if you'd like, although her daughter is severely special needs and older so not exactly comparable but they did just return from living overseas.

[Gwenn]

I dont' know... I've been so borderline upset today... I hate to admit it but these last 3 weeks of him being in Child care has been AMAZING for me (1st time for me being alone (w/o my husband) and with my own body and not having a baby inside or glued to me for almost 3 years). I've been given time to "think", and get things done I can't get done without Wyatt.
I hate not being able to talk to my DH when I need to.

Right with you there. I may have mentioned the issues I had earlier this fall with my house vandalized. It was very difficult for both of us having him so far away when we really needed each other.

But I'm glad you have some time and space. I think it's necessary, and it must be something very hard to come by when you're alone with Wyatt. I'm glad you have child care available.

[Robin0472]

Yea.. ask her if EFMP should be notified about a current speech delay, that is about to start SLP therapy, or it they would be beneficial for anything.
Sorry if we are confusing the rest of the world there with our acronym talk. It gets to be a pain in the butt for us too.
Wyatt's Child Care Provider, is an in-home provider, she use to be a military, in-home/on-base provider in TX. She also worked as a Spanish Translator for the Early Intervention program in TX. She mentioned me getting him tested after his first day at her house, and I already had the appointment set up by that time. She already wants to be on board with the everyone involved so she can learn more skills to work with Wyatt and use with the other Children. She allows for part-time hours and full-time hours, with a fee that works into our current budget without me working.

[Gwenn]

Yea.. ask her if EFMP should be notified about a current speech delay, that is about to start SLP therapy, or it they would be beneficial for anything.
Sorry if we are confusing the rest of the world there with our acronym talk. It gets to be a pain in the butt for us too.
Wyatt's Child Care Provider, is an in-home provider, she use to be a military, in-home/on-base provider in TX. She also worked as a Spanish Translator for the Early Intervention program in TX. She mentioned me getting him tested after his first day at her house, and I already had the appointment set up by that time. She already wants to be on board with the everyone involved so she can learn more skills to work with Wyatt and use with the other Children. She allows for part-time hours and full-time hours, with a fee that works into our current budget without me working.

That's amazing!

[Robin0472]

HI everyone! Well things are getting moving, sort of. They are doing CBRS Community Based Rehab Services. Basically some woman comes into our house and shows Wyatt a ball and as he reaches it puts it to her lips and says, Ba Ba Ball.... The owner of the company was actually quite engaging and Wyatt was interested to interact. But the second lady that came who is going to be his therapist, isn't as engaging. He has no other issues, He understands, he can follow simple directions, his small motor Skills and gross motor skill are fine.
He's only met with her once. What Gwenn said before about why is he not in speech. Even his Home Center Day-Care Provider doesn't know why CBRS is there and she thinks he should go straight to speech. And she was a Spanish Interpreter for Early-In in TX.
He's really learning a lot in the Daycare and she is working so hard with him. She gets the younger kids who talk more to count and Wyatt goes along with them with Dooo, Dooo, Dooo (With the One, Two, Three). She's working really hard to have the other kids do things to help Wyatt Mimic what they do.
We've also started going to Church and he seems to love the Nursery. So now he is around kids 5 days a week 1/2 day for Day-care and Sunday Morning at the Nursery.
Meanwhile he still makes animal noises, "Moo", "Mee" - Cat,, signs for Dog, Signs Fish says "ish", Says "Ma" but not "MaMa", His newest signs are Bubbles, Milk, Cat, Fish, He's perfected Dog and he's perfected Bird (well if you count doing by your nose with your middle finger)... He's picking up the signs FAST! And I need to learn more. We've started Baby Babble together and Letter Factory together and he can say "Ssss" now. Because that is what a Snake says.
He knows what you're saying, he just WON'T TALK!
Is it too early for me to be upset about the CRBS, should I push for Speech? I honestly think my $65 a week for him to be in the Home Day-Care is worth 10x more than the lady coming for an hour and going B-B-B Ball. And she's probably being paid to drive the 40 mins here too!
They (His Case manager) want me to enroll Wyatt into Smart Start at 2 years old, I've been told a lot of those classes depend on the teacher and I'm tempted to check the Montessori School since they have smaller classes of ages 2-5 together. He would have to learn to communicate with the older kids if he wanted to interact anything. So far being around other kids has been the best help and Mrs. Tania that is working really hard with him.
Sorry if I'm rambling in circles.
Should I look into private Speech Therapy for him? Talk to his Dr? I went to Early In before talking to his Dr.
I just don't know....

[Gwenn]

Obviously I'm biased, but I think he needs to be in speech!!!!

Is she doing ANYTHING to give him ways to communicate other than trying to get him to mimic her?

[Robin0472]

Obviously I'm biased, but I think he needs to be in speech!!!!

Is she doing ANYTHING to give him ways to communicate other than trying to get him to mimic her?

They are making him sign "more", if he wants something she takes away. They are telling me signs to do that he already knows. I don't really know what you mean by above, what are other ways to communicate? I don't know what to tell you.
They want me to not respond to his desire for 2 mins while I try to encourage him to "SAY with his mouth" what he wants. He's a really quiet kid and only squeals when I'm chasing him through the house and even then his squeals aren't LOUD. I bought a microphone/DJ toy and he holds it to his lips, I've showed him how it works and he won't make a sound. He gets a really excited look on his face as if he wants to do it to, but he seems as if he doesn't realize he has a voice.

[Luna]

They are making him sign "more", if he wants something she takes away. They are telling me signs to do that he already knows. I don't really know what you mean by above, what are other ways to communicate? I don't know what to tell you.
They want me to not respond to his desire for 2 mins while I try to encourage him to "SAY with his mouth" what he wants. He's a really quiet kid and only squeals when I'm chasing him through the house and even then his squeals aren't LOUD. I bought a microphone/DJ toy and he holds it to his lips, I've showed him how it works and he won't make a sound. He gets a really excited look on his face as if he wants to do it to, but he seems as if he doesn't realize he has a voice.

I'm not Gwenn, but. . . .it sounds like they're not helping you in any other way than by having him repeat and imitate. Gestures (sign) and pictures are other ways to help facilitate communication. My blood boils that they want you to not respond for 2 minutes! Ridiculous. If he's pointing or gesturing to something--that's communication! Just waiting is going to frustrate him and encourage him to NOT communicate. Honestly, I wouldn't continue with that at all. I would definitely check out Swannie's suggestion "It takes two to talk".

I think I'd complain about them not having an SLP, because that's what he needs. I don't know what your options are where you live, but I think I'd go private therapy over this, if it's the early intervention (sorry, didn't have time to read all of it in detail with all the acronyms you guys were using, lol!).

[Gwenn]

I'm not Gwenn, but. . . .it sounds like they're not helping you in any other way than by having him repeat and imitate. Gestures (sign) and pictures are other ways to help facilitate communication. My blood boils that they want you to not respond for 2 minutes! Ridiculous. If he's pointing or gesturing to something--that's communication! Just waiting is going to frustrate him and encourage him to NOT communicate. Honestly, I wouldn't continue with that at all. I would definitely check out Swannie's suggestion "It takes two to talk".

I think I'd complain about them not having an SLP, because that's what he needs. I don't know what your options are where you live, but I think I'd go private therapy over this, if it's the early intervention (sorry, didn't have time to read all of it in detail with all the acronyms you guys were using, lol!).

I'm so glad you posted, Kate, and that you agree with me. This makes me angry. He needs the services of a speech-language pathologist. This person is not trained in developing communication skills.

Children do not begin to learn how to communicate when they begin talking. Their whole first year, they are learning give and take and how their own actions (cries, gestures, etc.) are interpreted by you as communicating. Reaching for a toy, showing you something of interest, is all communication and it's the foundation. Speech is just speech - it's one way to communicate. There are many other ways, including reading, signing, pictures, and gestures. The idea is in the brain and it is communicated to someone else in a form that the communicator is comfortable using (i.e. Deaf individuals often prefer signing or writing to speech). Wyatt needs to learn the back-and-forth concept of communication, which is a completely separate thing than speaking words.

I agree with Kate that she is giving you bad advice and I would also agree that you should not wait 2 minutes for him to "speak" a request. That's terrible advice, and as she said, it will not help him learn the cause-and-effect nature of his actions having an effect on others, which is the foundation for communication to happen.

Even if she does teach him to say "ball", where does that get him? He'll learn to walk around and repeat things other people have said to him. I have actually worked with children who have been "programmed" in a similar manner and they are like robots. I have to try to un-do everything that has been done already and it isn't easy.

[Robin0472]

I'm going to Call our Insurance and Talk/ask them what they cover in terms of Speech Therapy. I'm going to order the book now. I don't care how much it costs. I'm hearing the same thing and not just from you ladies. Basically everyone is telling me he should be in Speech. I hate that I went to an Org that was suppose to help, and they've just made things seem more complicated.

[Robin0472]

Gwenn what is a pervasive developmental disorder?

Speech Therapy

TRICARE covers speech therapy when prescribed and provided or supervised by a physician to treat speech, language and voice dysfunctions resulting from birth defects, disease, injury, hearing loss and pervasive developmental disorders.

TRICARE does not cover services for:

* Disorders resulting from occupational or educational deficits
* Myofunctional or tongue thrust therapy
* Videofluroscopy evaluation
* Maintenance therapy that does not require a skilled level after a therapy program has been designed
* Special education services from a public educational agency to beneficiaries age 3-21

[swannie]

Brief rundown about PDD

Basically autism and related disorders. There has to be a broader congentical/developmental issue at play (or an injury) for them to cover the services, basically. Our insurance has the same restrictions. I am likely going to have to go to battle with them to have E's speech covered as medically necessary.

[Robin0472]

I talked just got off the phone with one of our Only local (w/in 30 miles) Speech Therapists and they are backed up for initial evaluations for 4-6 months. Which Wyatt should be transferred to Speech by that time. So now I'm thinking about just pushing talking to his Physician and talking to his Case Manager.