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What Every Parent Needs to Know About Early Intervention

This article is an excellent starting point for Speech & Outreach since it explains “who, what, and why” of Early Intervention which is our passion. 

What is a Speech Language Pathologist?

A speech-language pathologist (SLP) is a licensed and certified professional that specializes in providing evaluation and therapeutic intervention to individuals with various speech, language, and voice needs. A speech language pathologist can also be referred to as a speech pathologist, speech therapist, and even a language speech and hearing specialist. A fully qualified SLP has obtained their certificate of clinical competence (CCC’s) from the American Speech Language Hearing Association (ASHA).

What is Early Intervention for a Communication Delay or Disorder?

Early intervention is the process of early identification, evaluation, and treatment of developmental delays or disorders in infants through preschool years (0-5). Research indicates that early intervention is a key factor in successfully overcoming or reducing communication challenges so your child can reach their full potential. Immediate action is critical to prevent these challenges from turning into major developmental problems, future learning disabilities, and reducing self-esteem.

The first step in early identification for speech or language concerns is a referral. A referral can be generated from a parent, teacher, or a child’s pediatrician. At times, parents will hear “don’t worry, he/she will grow out of it” or “let’s wait and see” from family members, friends, and even their child’s pediatrician. Although they mean well, I encourage you not to listen. Often parents tell me that they have a gut feeling that something does not seem right. I advise all parents to listen to that feeling and not delay in seeking a professional to see if their child needs help. Research has indicated that the first 5 years of the development of the brain are fundamentally important in laying the foundation for future learning and academic potential. This critical period for learning begins with a solid foundation in verbal and non-verbal communication.

There are two avenues in which a parent could seek help: the public sector or the private sector. I will briefly describe each and explain how a child may obtain services.

In regards to the public sector there are two separate programs depending on the child’s age. If a child is between the ages of 0-3, a parent would seek out the early intervention program in their county; in Virginia this program is called the Infant and Toddler Connection. A child qualifies for this program if they demonstrate a 25% delay or atypical development/behavior in one or more areas of cognitive, language or communication, physical, social, emotional, or adaptive. Loudoun, Fairfax/Falls Church, Prince William, Alexandria, and Arlington Counties all have this program. 

If a child is between the ages of 3-5, a parent would seek out their local public school district to inquire about services. Each case is unique and qualification is based on the assessment team’s consensus that a child’s delay will adversely affect his/her academic performance. For example, a child demonstrates low language skills that he/she is unable to ask or answer questions presented by the teacher or his/her classmates. This child then refuses to participate due to the inability to effectively communicate which adversely affects academic performance.

Both of the programs in the public sector are excellent resources and the fees for these services may be reduced or provided for free. However, the disadvantages of the public sector services according to many families are the longer waiting periods for the evaluation process or being told after an extended waiting period that the child does not demonstrate “enough of a problem” to qualify for the services. 

The other avenue available is the private sector, which consists of a private practice; much like your pediatrician’s office. There is no qualification for a child to receive therapy other than demonstrating a difficulty or delay in language skills. A parent would seek a therapist by referral from their pediatrician or insurance company. I also recommend asking friends, local moms groups, or even other health professionals that work with the child. There may be a wait list at a particular private practice but that should not deter you. There are many private practices and ultimately the choice is yours in regards to where you want your child to receive services. As a professional and fellow parent, I urge you to go to the practice with the shortest wait but most importantly the one that you feel is the best fit for your child.

The majority of pediatricians should be able to refer a parent to a speech-language pathologist in your area. If not, the best place to search for a certified speech language pathologist is through the American Speech and Hearing Association’s website. I recommend a parent write down at least 3 names of SLPs in their area and research them. The therapist one ultimately chooses should have extensive experience and/or knowledge in treating the particular delay the child has. On a less technical note, a child should enjoy spending time in speech therapy and work well with that therapist in order to achieve progress.

The second step is a screening or evaluation. A screening is done to determine if an evaluation of the child’s communication skills is warranted. Prior to seeing a child, I speak to parents to find out what their particular concerns are and then make a determination if a screening or evaluation is appropriate. Most private practices offer screenings for free or small fee. An evaluation consists of formal (standardized) and/or informal (language sample, parent report) testing. A full evaluation will look at each area of communication: what the child says (expressive language), what the child understands (receptive language), how the child pronouncing sounds (articulation), social language (pragmatics), voice quality, and fluency. An evaluation will state your child’s skill level in each of the above areas, recommendations from the SLP, goals to address the delay or disorder, and frequency of visits for services, if necessary.  

The third step would be services. The frequency of services is determined by the therapist’s clinical and professional opinion. Services are customized to each child’s needs and may focus solely on the individual child or a family centered approach. In my practice, our integrated approach includes the child, family, and the child’s environment. My particular experience has shown that all three areas need to be addressed to yield the best results. Additionally, parental education and training should be an integral part of therapy so the parent can incorporate the strategies into the child’s daily routine.

When will a parent see results?

It is extremely difficult to determine a timeframe for when your child will “graduate” from therapy. There are so many variables that affect a child’s progress and it can be an easy, slow, fast, and even frustrating process. However, parents should always remember that the more a child practices the new skills taught in speech therapy, the easier it will be for the child to apply the skills in their day to day life. It is important for parents to be patient with this process and encourage your child like you would for anything else.

What are “red flags?”

No babbling by 9 months.
No first words by 15 months.
No consistent words by 18 months.
No word combinations by 24 months.
Slowed or stagnant speech development.
Problems understanding your child’s speech at 24 months of age; strangers having problems understanding your child’s speech by 36 months of age.
Not showing an interest in communicating.

Also, talk to your health professional anytime you or another caregiver has concerns about your child’s speech and language development or other problem that affects your child’s speech or understanding of language, such as:

Excessive drooling.
Problems sucking, chewing, or swallowing.
Problems with control and coordination of lips, tongue, and jaw.
Stuttering that causes a child embarrassment, frustration, or difficulty with peers.
Poor memory skills by the time your child reaches kindergarten age (5 to 6 years). He or she may have difficulty learning colors, numbers, shapes, or the alphabet.

Other “red flags” include:

Failure to respond normally, such as not responding when spoken to. This may include signs that the child does not hear well, such as not reacting to loud noises.
A sudden loss of speech and language skills. Loss of abilities at any age should be addressed immediately.
Not speaking clearly or well by age 3.

Developed by Healthwise Staff. Primary Medical Review: Susan C Kim, MD-Pediatrics. Specialist Medical Reviewer: Louis Pellegrino, MD- Developmental Pediatrics. 12/2010. http://www.webmd.com/parenting/tc/speech-and-language-development-red-flags-topic-overview

It is important to know that each child is unique and may develop skills at different rates. If you have any concerns, it is recommended you talk to your pediatrician and contact a professional speech-language pathologist.

One last note…

Parent(s)- You are your child’s best advocate and do not let anyone tell you to wait when you have the slightest concern. As a parent of two young boys myself I initially felt foolish voicing “concerns” over the smallest thing, but never enough to prevent me from asking. After all if a parent doesn’t look out for their child, who will?