anyone a speech therapist or IE evaluator?

Littlejen22

What do you look for in order to determine if a 25mo is on target for speaking (communication not receptive).  Or speech therapist does not want to re-evaluate DS just yet.  I cannot tell from what she writes on her forms if what she sees is age appropriate or not.  I feel like he is more than caught up and actually ahead but that might just be because I can understand most of what he says but I know that many times other people need him to say it more than once or I translate.  That said, he has way more than 200 words (I used to keep track) and is speaking in sentences, usually 2 and 3 words but daily he has long sentences like, "I bring Shep snack downstairs" and other longer sentences.  I can understand most of what he says and I think others can understand about 1/2.  That said, she seems to mostly be concerned about trying to get him to open up because he is shy around strangers (finally opening up to her and talking without being prompted although usually 1 and 2 word phrases) and she wants to see more of what he can do since he will have to talk to strangers in the world.  But I was deathly shy.  Oh, and he will go to McDonalds and walk up an quietly say "Chicken nuggets, apples"...although too quite to be heard.  What are your thoughts?

championmama

I'm a speech therapist.  His expressive language is wonderful, based on what youv'e said here.  Receptive language sounds on target - can he follow directives pretty well, and understands many vocab terms, etc?

Are you concerned about actualy speech sound production and speech intelligibility?

championmama

OK, I reread.  It sounds like you are more concerned with his intelligibility.  Blaire still does not use all sounds appropriately, and it bothers me to no end that she is currently lisping her initial /s/ sound.  I haven't even drawn attention to correct it yet, b/c I think she'll eventually get it.  She also leaves some end sounds off of certain words, but that's just developmental as well. 

As parents, we do understand what our child says, moreso than strangers, b/c we learn their patterns and substitutions and all.  But, that's all two years old.  I haven't worked with EI, the youngest I've done is age 3 in preschool.  But, it would all depend on their sounds.  If the child had some sort of muscle weakness in the facial and cheek and mouth muscles that kept them from correctly making sounds then I would def. qualify.  Many sounds aren't considered dev. in error until certain ages.  Do you know what test she gave him or what the criteria was for the dismissal?

Littlejen22

at 22 months he tested at 26 months for receptive but expressive (I could not think of the word) tested at only 13 months...but he had a huge explosion before he started therapy and had 100+ words at that time although they were not all very clear.  I really think that most of his pronunciation is age appropriate - like blends, th, etc.  And I do not think that the other kids his age in our play group are any more clear to me than DS is to the other Moms...maybe I am wrong.  But she mostly seems to be just trying to see more of what he can do even though she believes what we are telling her.  Is that typical?  I am just trying to figure out when I should push for another eval.  I would hate for him to test again and get kicked out and them say he is behind at all but it just seems to me like he is ahead.  And I think it was all due to a word explosion at 2 instead of our therapists word...but don't get me wrong, I love her and think she's good but I just think that most of his improvement is just age and time.

championmama

I agree with that last statement.  some kids just need that experience and time and everything just sort of comes together.  If he's 25 months, you probably won't see the dr. again till age 3 for a well-baby visit, but if he's sick, you can talk to pedi about your concersn then.  Just from your descriptions, his exp. language is really good.  Lengthy sentences and all. 200 word vocab is great!

If you feel he is still behind in a few months, I'd ask for another one.  You can also get a second opinion. 

Littlejen22

I should clarify, he is still in therapy through EI.  She does not want to re-evaluation him yet because she wants to continue but I am questioning if I should push to have him re-evaluated to get him officially kicked out.  I would not quit unless he tests out.  And thanks for your info.  Oh, and he is not really even doing the leaving sounds out at the end but does substitute for some sounds and some just get garbled.  But I think her biggest concern is that he needs to talk more in front of strangers...less about speaking clearly and more about wanting longer phrases/sentences.  That seems advanced for me especially with a shy kid.

championmama

sorry I've been in and out...

this makes more sense, b/c I still had some confusion when rereading the OP.  Here's my thing... speech therapists are not guidance counselors or behavior specialists in the sense that we should treat children for shyness.  Shyness is not a communication disorder and ASHA def. does not rec. it as one.  Longer sentences would def. be advanced for him at that age (IMO). 

I've had parents and school officials mad at me in the past b/c I do dismiss kids who absolutely don't say a word b/c of their choice.  Not b/c they have any type of language delay or speech disorder.  But, geez, if I placed/kept every kid in speech that didn't talk to strangers then I'd have tons of kids and be over caseload.  That's something that will come with maturity. 

I have to get going.  Blaire is crying at my feet saying "night-night".  Email me ifyou have any other questions or concerns...I'll recheck this post tomorrow too, in case something else comes up.  GL

lbhslp2003@yahoo.com

Littlejen22

Thanks!  So it sounds like you agree that he is advanced for his age at this point.  I have been asking for a while to have him retested and she is the one not wanting to.  Next week I am going to ask her point blank what else she thinks he is behind on that he should continue.  I am all for getting him help but the sessions are hard on him b/c they are right after his nap time and he start cranky and while I think he is getting something out of it I just do not think it justifies it.  And while I would spend any amount of money to help my children, we are paying a decent co-pay for services and if he is advanced I do not get the point.  Oh, and my friend is a pre-k teacher in a preschool and her son is in the 2yo room and she thinks my DS speaks better than any of the younger 2yos in the class too.

championmama

One more thing I am VERY cautious to add here... and I could be totally wrong.  When I was working, I worked in the schools (plan to return this August) and I was there from 8-3 and paid based on the teacher's salary scale for my education and experience.

People who do home health, outpatient, rehab etc, are there for the duration of appointments and are paid hourly.  That being said - if you want to get paid, you have to maintain that caseload and show that youare efficient doing it.  Compaines that I have done PRN work for require about 75% efficiency. 

What I'm getting at is there are some people out there (not just speech, but PT, and OT, too) that will carry a caseload just b/c things are slow and they need that caseload in order to get paid.  I'm not saying that's what your SLP is doing, but I question her motives for wanting to keep your DS for shyness and for not wanting to reevaluate at this time (again, I'm not familiar w/ EI guidelines, either, so there may be a required wait between test giving and HPT coding and all). 

Just something I had thought of and didn't know if I should mention it or not.  i know my first year out of school I worked for a ocmpany where my boss would leave me post it notes saying to "hold off on Mr. B's d/c until such and such date".  It's all about money and reimbursement and it's very unethical. 

And, I agree, those copays need to be justified if you are paying them.  Plus, I don't know how your insurance is, but ours only allows so many visits per year for ST,PT,OT and what if someting comes up later in the eyar that he really needs  services for and there are none left on the insurance plan?