Speech Therapy Q

ArmyWife114 · April 2014

I mostly lurk on this board, so I'll give DS's background.

DS is a late term preemie whose been in physical therapy since 4 months old because of a torticollis diagnosis (now resolved). For awhile he was in private PT, but our insurance capped out on therapies for the year, so he's just continued in EI since then (last July). He also had a helmet for positional plagiocephaly for 4.5 months.

Orally hes always been delayed. He just started eating solids chunks at all at 13 months, eats them decently now. He still uses a bottle 2-3 times a day, and he's starting to figure out the sippy cup, but that's been a long road and I don't think he'll switch to it completely for a while. He makes some noises (da, ga, go, du) but no words. He doesn't cry when he needs something (usually) but makes noises (I don't know what else to call them). He even makes a string of sounds that sounds like a jibberish sentence.

All things considered, at his 15 month appointment, the provider wanted us to put him in speech therapy and gave us a referral for audiology (he's had fluid in his ears for months and his pediatrician won't do anything about it, so when we saw a different provider in the clinic this time, I seized the opportunity to ask for it again). I declined a private therapy referral in lieu of using EI for now. He saw audiology last week, and his right ear is completely clear and hearing is normal. His left ear has some fluid in it, so he'll see the ENT in May to take another look and then explore our options if the fluid is still there.

His PT from EI is going to bring out the SLP in the next couple of weeks, we've had her come out before (at around 12 months because he had NO babbling type noises) and she said to give him until about 18 months to see if his speech gets better, which, at the time, I agreed with her. I guess, the insistence on speech therapy we got from the provider has me questioning whether we should do speech now or wait. Thoughts?

algalphys · April 2014

I'm not all that familiar with the EI system cause I'm in canada but if seeing an slp for an evaluation won't hurt his chances down the road of getting ST if he needs it, I'd say go ahead and get the eval. I don't see the harm.

MaxandRuby · April 2014

No harm, no foul in getting an eval. The only thing it really costs is an hour or so of your time. The insistence on the provider's part could just be that they are more of a pro-active provider vs a laid back wait and see type of provider.

Unknown · April 2014

This content has been removed.

kcisthebombdotcom · April 2014

I'm going to be the lone voice of dissent and tell you to proceed with caution. In a lot of cases ei will evaluate, the child will not have scores to qualify and the parents have to wait 3-6 months for another Eval. The expectations are a little higher at 18 months vs 16. In our case, dd was tested at 17 months and technically didn't qualify based on scores but they took her in because of the failed hearing test plus a strong family history of delayed speech. I would inquire since you don't want to make your wait for a slp longer.

ArmyWife114 · April 2014

KC_13 said:

I'm going to be the lone voice of dissent and tell you to proceed with caution. In a lot of cases ei will evaluate, the child will not have scores to qualify and the parents have to wait 3-6 months for another Eval. The expectations are a little higher at 18 months vs 16. In our case, dd was tested at 17 months and technically didn't qualify based on scores but they took her in because of the failed hearing test plus a strong family history of delayed speech. I would inquire since you don't want to make your wait for a slp longer.

This is my biggest concern. I don't think he's going to qualify right now, and we have no history of failed hearing test or speech delays in the family (as far as I know), so I don't know if the SLP would want to continue seeing him until another eval. The only thing he has going for him in that case is that he's already in their system and he's already being seen.

Thanks everyone! I think deep down I know he needs this eval, I just needed some outside input that it wasn't too early for a speech eval.

CaptainSerious · April 2014

A child can have perfect hearing and still have a significant speech delay, and even an auditory processing disorder. Also, speech delays do not have to be hereditary. Possibly not qualifying is not a reason to not be evaluated.

annibes · April 2014

Middle ear fluid and the sounds you are describing (d and g sounds but not p, b, m, w) would make me want to evaluate further. Many SLPs would not take a kid for speech itself at 15 months, but then there is the whole receptive side to things, too. Did the first SLP do an actual eval or did she just observe and recommend? Do you remember how receptive language compared to expressive?

Early speech therapy will not be harmful to a child's development. Waiting could be. I would get the evaluation. If you don't qualify, then there's some peace of mind that things aren't that bad and always have the option to revisit in a few months.

kcisthebombdotcom · April 2014

CaptainSerious said:

A child can have perfect hearing and still have a significant speech delay, and even an auditory processing disorder. Also, speech delays do not have to be hereditary. Possibly not qualifying is not a reason to not be evaluated.

Of course, but if a child is on the cusp, evaluated at 16 months, "passes" and has to wait six months to be reevaluated, they're not going to be receiving therapy until nearly two if not later if there's a wait for therapists. Giving a little more time could help make the difference because the standards are different between 16 and 18 months--it is why therapists recommend that age. It's definitely worth inquiring about.

ArmyWife114 · April 2014

annibes said:

Middle ear fluid and the sounds you are describing (d and g sounds but not p, b, m, w) would make me want to evaluate further. Many SLPs would not take a kid for speech itself at 15 months, but then there is the whole receptive side to things, too. Did the first SLP do an actual eval or did she just observe and recommend? Do you remember how receptive language compared to expressive? Early speech therapy will not be harmful to a child's development. Waiting could be. I would get the evaluation. If you don't qualify, then there's some peace of mind that things aren't that bad and always have the option to revisit in a few months.

When we had her out earlier, she observed and recommended mostly, she felt it was too early at 12 months to really evaluate. Off the top of my head, I don't remember how receptive compared to expressive, What I do remember is that it was obvious to her that he was understanding at least some of what we were saying to him, mostly his name, when we asked him to do simple things (like no touch, give that to me please, etc.). I remember she mentioned it, but I'll have to go look through our visit summaries and see if it says for that day.

ArmyWife114 · April 2014

KC_13 said:

CaptainSerious said:

A child can have perfect hearing and still have a significant speech delay, and even an auditory processing disorder. Also, speech delays do not have to be hereditary. Possibly not qualifying is not a reason to not be evaluated.

Of course, but if a child is on the cusp, evaluated at 16 months, "passes" and has to wait six months to be reevaluated, they're not going to be receiving therapy until nearly two if not later if there's a wait for therapists. Giving a little more time could help make the difference because the standards are different between 16 and 18 months--it is why therapists recommend that age. It's definitely worth inquiring about.

I am going to ask her when she comes out if she feels we should do the full eval that visit, or if she thinks we should wait. She can't come out for another two weeks since she's getting married this weekend, When we saw her last, she said she preferred to wait to eval most kids until 18 months because of the reasons KC mentioned, not qualifying when they really do need it. She also gives them until 18 months to have their first word.

The good thing is I know she'll come out and not do an eval unless I ask to proceed with one at the next visit, this visit she'll come out to discuss whether to eval or not, which I see the benefit in doing it now, but I also see the downside of doing it now and him truly needing speech and having to wait 3-6 months for an eval because we jumped the gun.

ArmyWife114 · April 2014

-auntie- said:

Adding to what KC_13 said:

The other piece is that even if a child qualifies for "speech", in many communities he will be assigned a developmental teacher/therapist in lieu of an SLP until he's 18 or 24 months. SLPs are harder to come by and many EI programs feel a DT is the appropriate professional for pre-speech/cognitive services.

Family hx doesn't place into most children qualifying for services. They look at the actual child.

Auditory processing is an emerging skill for all children until puberty. Clinicians don't explore this as a dx until the primary grades.

I think, I could be wrong, that all our EI has is 2 SLPs and no DTs (we live in a really small area). I'll ask his PT when she comes out next week, she'll know if they use DTs.

lemen99 · April 2014

I was told (with both of my kids) that you can't get an ST (at least not in indiana) until 18 months. Kids speech-wise vary so much even within the normal age until then and you'll get a DT, which I guess isn't all bad, but I guess I didn't see it as all bad to give them a little time. The other thing is if you do an eval, and you either get a DT or don't qualify, you have to wait a certain amount of time to try again.

With both of mine we started at 18 months with ST. My oldest (on the spectrum) is caught up or more (minus social skills) at 5 years old and has been caught up for a while. My youngest was only in it about a year. When my oldest started he had 1 word and 2 sounds "ga" and "ya". My youngest had 2 words I think. My oldest struggled with feeding too and didn't do any cup drinkign until we took his bottle away cold turkey at 15 months adjusted age.

Both of my kids were preemies too.

flerlgirl · April 2014

Your situation sounds almost identical to ours. FWIW, our PT told us she wouldn't worry about speech therapy until 18 months (actual, because our EI program doesn't adjust for speech, which is weird). We are going to reevaluate then (unofficially, with the pedi and PT) and see if we think he needs the additional therapy to proceed. Right now they are not concerned - he is still on 2nd foods and babbles but that's it, but that is fine with the therapist right now. DS does whatever he wants whenever he wants anyway

GL to you!

(sorry to bump an old thread; it was just something I thought I could help with!)

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