My Son's Speech Therapy and School Mask Mandate Conundrum

As an infant and toddler, my youngest son had frequent ear infections. The infections were indicative of fluid retention in his middle ear. The fluid prevented his eardrums from vibrating properly, thus causing conductive hearing loss. The doctor placed ear tubes in his ears two years ago so his middle ear can drain since his Eustachian tubes weren’t draining properly.

My son’s expressive language is stuck in the babbling and one-word stage, which is the spoken language level of a one-year-old. He says a few words like tickle, no, ma, and da. Mostly, he babbles. Occasionally, his intonation sounds like a word or phrase. Overall, we have to repeat sounds many times before he imitates them. He responds better when he imitates his brothers or the sound is linked with an action.

His receptive language is much higher. He can point to objects or follow one-step commands. For example, when I say “Where’s the ball?” with a book, he will point to it. And he will throw trash away if I ask him to as a one-step command.

Because my son is stuck in the one-word/babbling stage, seeing is important to his language development.

What role does sight play in learning language?

From the moment children are born, they are imitating our facial expressions. Psychologists believe this imitation derives from our “mirror neurons.” One such imitation and expression is when an infant smiles around eight weeks old. They also imitate the manner of articulation from what they see and hear their parents say. The imitations carry through an infant’s cooing and babbling stages. Babies will take conversational turns of smiles, coos, gestures, babbling, and other actions. For example, if you stick your tongue out, a baby will copy that, but usually at a slower pace.

The School Mask Mandate

Ever since Utah Governor Gary Herbert ordered that all students should wear masks (or face shields), I have wondered how this would affect my toddler in special ed preschool and speech therapy. He would probably be covered under the disability category, but I didn’t know. I figured I could do a face shield for my son and the teacher would be wearing only a face shield. I discussed this with the preschool speech therapist when she visited for extended school year visits. She hoped that it would only be face shields.

On August 14, Gov. Herbert ordered that teachers must wear a mask with the face shield. All students must wear a mask unless they have a doctor sign a medical exemption form. Section (3)(e) of the mandate states a communication exemption:

an individual engaged in an activity where the ability to see the mouth is
essential for communication, including an individual who is deaf or hard of
hearing while communicating with others, an individual who is
communicating with an individual who is deaf or hard of hearing, or a
teachers-student dyad participating in speech therapy, in which case the
individual shall wear a face shield without a mask or use alternative
protection, including a plexiglass or similar barrier;

I tried to get some clarification from my son’s previous preschool teacher during our extended school year conversations about this. She stated students and teachers must wear masks from the last update. She didn’t seem to know anything about the exceptions for speech therapy. It seems there is a lack of communication about the exceptions.

Overall, I am very confused; some teachers are confused too. Because the rules change frequently, parents and teachers are both scrambling to figure this out. Preschool starts next week, so the kinks are yet to be determined.

Last week, I made five masks for each of my four sons to last a school week. I included my toddler because I don’t know exactly what is going on. Amid the confusion, my older children have adjusted to school with masks. Maybe my youngest will adjust well too.

On Monday, I read that deaf BYU students were considering clear face masks for themselves and their interpreters. Some read lips and also want to see the facial cues in ASL. I had an epiphany that they would work well for my son and his teacher.

I asked my son’s new preschool teacher if she would wear a clear mask. She said she’d try it out. I will be purchasing one for her most likely. This will all cost more money, but I don’t know what to do. My son needs to see the teacher’s mouth in order to imitate speech sounds better. I believe he could copy some sounds, but not as accurately.

What can I learn from blind babies’ language development?

While writing this post, I realized that sight is not absolutely critical to learning language. For example, blind babies learn how to talk. I wondered how they learn to communicate. I found some answers on Family Connect. A blind baby learns more through touch and sound. An adult can put a baby's hands on their lips or hands.

So masks will not stop my son from learning to talk but may make the process longer.

However, children are very resilient. Their plastic neurons forge new connections to adapt to the different learning circumstances.

This school year may be different, but children will still learn.

A Year Later

I witnessed how the mask exemption at my third son’s grade school worked when I substituted his special education class. The speech therapist, special education staff, and students wore face shields during therapy sessions. Otherwise, they wore masks. The face shield exception only applied when my third son attended therapy. My son could take off the face mask during recess, P.E., and lunch. I noticed he pulled it down to suck his thumb occasionally. For more details on masks and my substitute experience go here.

My third son also had frequent ear infections. After ear tube placement, his language returned to normal except for his “s/sh”. He first backed his tongue placement as an “h” and glottal stop. Now his “s” usually sounds like “s” or “sh”. Over the last year, my third son’s reading level improved one grade level (he is still one level behind). His “s” improved a significant percentage, mostly in the initial and final syllable slots. His “s” blends are still lagging behind.

I am unsure how the staff enforced the mask mandate in my youngest son’s preschool. I sent a mask in his backpack, usually a mask with a clear center. I offered the teacher adult masks with a clear plastic middle, which she accepted. I don’t know if she ever wore it. Those masks were harder to breathe and talk through when I wore one once substituting. I believe the speech therapist used a face shield during therapy. I don’t know what my son wore. I suspect he rarely wore the mask correctly or at all considering my fourth son usually wore it under his chin, over his eyes, or not at all during church service.

Over the last year, he increased his word count with banana ‘nana’, shoe, water, and possibly a few others. The speech therapist implemented a communication board, which he uses at home for more, want, and help. He signed more before the pandemic, then stopped. He increased his sign usage this year to more, help, stop, go, all done, and water. His “t” no longer sounds like “d”.

2021 School Year Mask Recommendations

This school year, Utah rescinded the school mask mandate because the legislature restricted the emergency powers of the governor and health departments. Grand County reimplemented the mandate because their county government approved it for 30 days. The Salt Lake County Council overturned Salt Lake County’s health department mask mandate for children under 12. Mayor Erin Mendenhall is looking to overturn that decision. President Biden may challenge Utah’s and other states’ lack of a school mask mandate. All Utah mandates still have the same exceptions as before. Other schools across the nation vary with their mask mandates despite the CDC’s school mask recommendations. 

The American Academy of Pediatrics states:

“While this is a natural concern, there is no evidence that use of face masks prevents or delays speech and language development.”

Their article addresses parents’ concerns, contains tips to work around the mask, and work with speech therapists.

On the other hand, the UK, Sweden, and Holland largely do not require masks for children 12 and under. UNICEF recommends children under 5 not wear masks, and children 5–11 only wear them under certain circumstances. The website states for 5–11:

“You should also consider the potential impact that wearing a mask could have on your individual child’s learning and psychosocial development. Decide this in consultation with your child’s teachers and/or medical providers.”

Obviously, mask recommendations vary for children and those with speech delays. 

With my background in linguistics and my parental intuition, I believe children learn language better without masks. But I know they can learn in masked settings too. For now, I send my children to school without masks because I “consider the potential impact that wearing a mask could have on [my]individual child’s learning and psychosocial development.” If a mask mandate comes, I will mask my children.

This I know, children are resilient.

Medications that Interfere with Bipolar 2

 

Via Public Domain Photos

I have learned over the past 16 years what medications, beverage additives, and herbs tend to exacerbate my bipolar symptoms. Some of these through talking with doctors and others through trial and error, unfortunately. I share my experience hoping that others with bipolar, and their loved ones, can work with their doctors to discuss options when taking similar medications. So take this with a grain of salt. It is for informational purposes. Your body, or your loved one’s body, may react differently.

St. John’s Wort

My senior year of high school, I experienced a depressive episode. My mom talked with me and we discussed that I probably had depression. We weren’t sure of the severity yet. I started taking St. John’s Wart at the end of my senior year and through my freshman year at a junior college. My depression went away during that time, but I over-involved myself in college and activities. I stayed up late on weekends and was a bit louder than my reserved self. I worked a part-time job, attended my religious organization’s Institute and choir all while taking 16 credits fall semester, 21.5 college credits winter semester, and then 18.5 college credits the summer semester. I was hypomanic for a year, which was probably exacerbated by St. John’s Wort. I had small crashes where I quit my class and quit my job during the summer semester.

I stopped taking St. John’s Wart when I left for Brigham Young University and I fell into a depressive episode several months later. This time I sought for help only for my depression.

St. John’s Wort can cause mania and hypomania in bipolar patients. It is also not in normal dosages that can be relied on from company to company. St. John’s Wort is still a drug like any other pharmaceutical. If you have any mood symptoms, I would consult with a psychiatrist or a doctor and therapist combo.

Antidepressants Alone

At BYU, I related to the regular doctor that I was depressed and having suicidal ideation. The doctor prescribed an antidepressant and I went home to the APRN with that diagnosis. He kept prescribing an antidepressant. I felt happy with no complaints. My previous energy from a year ago returned. But the hypomania wouldn’t last forever.

I burned out serving a mission for the Church of Jesus Christ of Latter-day Saints. I felt the beginning when I was in a strict schedule at the Missionary Training Center, but the “mission field” in San Antonio felt more restrictive. I was tired in the morning and awake at night. I cycled through emotions quickly. I became suicidal the last two days. Then I went to the mission home. The mission psychiatry department asked if I wanted to stay or go home. I chose to go home.

My mission companion suggested I had bipolar. I considered that and talked it over with my mom and dad. My mom and I were really convinced as we looked at symptoms online. We then met with the APRN. He was convinced when I had displayed “psychobabble.” I talked hurriedly and had to make my point.

Antidepressants alone act similar to St. John’s Wort where they can cause mania or hypomania. Bipolar patients need a mood stabilizer in addition to an antidepressant to counteract this problem. Occasionally, a doctor will only have a bipolar person on an antidepressant if they are experiencing only depression and being closely monitored.

Caffeine

When I drink caffeinated soda or have dark chocolate and chocolate in the late afternoon or evening, it can keep me up at night. I feel restless and have racing thoughts for several hours. Some nights I am still wide awake late in the evening. I review what I ate: usually I had caffeine in some form. I especially forget about the effect of chocolate, especially dark chocolate. Basically, caffeine can cause a brief hypomanic episode in bipolar patients.

Caffeine comes in so many forms, sometimes it is hard to know if I had caffeine. For example, I found little treats when my family was briefly going to the food pantry that tasted like lemons. The gummy boasted it contained yerba mate. I was suspicious it might cause problems, but I tried it anyway. Well, I couldn’t fall asleep that night. I had racing thoughts. I searched for yerba mate online, and sure enough, it has lots of caffeine. It is the same mate that citizens in several South American countries drink. My husband saw many Uruguayans drink mate (with lots of sugar) on his LDS mission in Uruguay.

I have learned I need to look at labels carefully for caffeine. Sodas are especially tricky to know about. I avoid dark chocolate now because it has more caffeine than milk chocolate. Overall, I only consume caffeinated beverages early in the day, unless I need to stay awake driving.

Coffee and some teas contain caffeine, but I avoid those for religious and health reasons.

Sudafed (Pseudophedrine)

I was always congested as a child. When I had strep throat in seventh grade, my family doctor prescribed Claritin-D. We figured I had allergies. I took it in the morning and I could finally breathe. I had fewer colds and only had occasional sinus infections. After worse congestion during my third pregnancy, I started taking Mucinex-D. Six months after I delivered my baby, I had an allergy test: I was allergic to nothing. So they looked at my nose. I had large turbinates and a Haller cell, an extra sinus cavity. I had surgery and could breathe again without any decongestant. Occasionally, I still get sinus infections. During those times, I tried Mucinex-D and Sudafed. Sometimes I took them at night. And I couldn’t fall asleep for hours.

I discovered that pseudophedrine is a stimulant similar to caffeine. It can cause hypomania in bipolar patients. I have learned that I can only take it in the morning. I have switched to phenylephrine as a decongestant. It isn’t as effective, but it helps. Nasal irrigators or netty pots help the most.

Prescription Steroids

I had a severe sinus infection and my ENT prescribed steroids to reduce the inflammation in my nasal cavities. I could breathe within hours. But I went into hypomanic episode. I wasn’t sure if it was related to the steroid, but I learned that it was.

A few years ago, I had another severe sinus infection, but my throat constricted to the point I struggled to breathe through my mouth. I went to my family doctor for relief. We debated over using a steroid because of the possibility of hypomania. I took the steroid for one or two days just so I could breathe. I felt so much relief, but I was wired until six in the morning. I stopped taking it the next day. I followed my doctor’s other advice to take 800 mg of ibuprofen. The ibuprofen reduced the inflammation so I could breathe better. But steroids are the most effective. If only there were no side effects.

Overall, I have learned that Mucinex, ibuprofen, phenylephrine, and nasal rinses combat my sinus infections without causing hypomania.

My relative with Multiple Sclerosis takes steroids and she has remained fairly stable. So there is a balance that people with bipolar can find between prescription steroids and bipolar medications.

Hormonal birth control

After my fourth baby, I bled for five months. I was baffled by this. I had an IUD placed when I was still bleeding. I figured it was just my period. The bleeding continued. My doctor prescribed a birth control pill in an effort to keep in the IUD. The bleeding lessened. However, I felt suicidal and depressed almost every day on it. I tried for two weeks, but it was too much. I believe we tried another form of birth control pill. I had an x-ray or ultrasound that showed no afterbirth remained in my uterus. Finally, my doctor referred me to a gynecologist. The gynecologist noted I had a thick endometrium. We settled on a D & C, which stopped the bleeding. The gynecologist suggested higher doses of hormonal birth control. I refused since a low dose already caused so much emotional havoc.

I had the birth control patch for the first nine months of our marriage. I figured that it didn’t affect my moods, but that other circumstances caused my problems. After all my bleeding, I wondered if the patch had exacerbated my symptoms.

I know that my body does better with only low levels of progesterone (like in Mirena). I am never going to use hormonal birth control again. I will stick with an IUD. However, my relative doesn’t have issues with her birth control, so who knows.

Overall, any female with bipolar needs to consult carefully with a gynecologist and psychiatrist on the best birth control method.

Conclusion

Different medications and substances can interfere with bipolar. I have learned through trial and error what works for me. Sometimes, I have had to find alternative ways to deal with frequent congestion, menstrual bleeding, and birth control. I am glad that my doctors have worked with me to resolve any mood disturbances. So much is observation. What works for one bipolar person may not work for another. But if any of my experiences help other people with bipolar, I am glad to share.