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Thread: Speech Therapy Questions

  1. #1

    Default Speech Therapy Questions

    I need thoughts/opinions etc and I will try to keep it short.

    I have two girls and my youngest is a boy. He is a very late talker and has always been. For example, if at a year the standard was 1-3 words (just an example, I don't remember), he would be at 1; if at 18 months the standard was 8-20 words, he would be at 8 (again, just an example). So, he has always been in the range but barely. My pediatrician flat out told me to wait and not go see a speech therapist because she said they would say he needs therapy when he is very likely to catch up.

    Fast forward... He is 22 months right now. He understands everything, has great eye contact, follow directions, responds to his name, can point to all his body parts, points to all the colors, loves playing with other children, is extremely bright, etc etc but he is still barely talking. He doesn't have complete words. For example, the cows says "mmm" not "mooo" and nose is "no" etc. He has little noises and sounds for a lot of things so I always understand what he is asking for. He can say the sound "b", "d", "n", "u" and "m". No "h", "c", "s", etc so he can say "nose", "no", "nut", "neck" but not "car" or "cat". He does have quite a few words and animal noises that he uses very consistently and every day. He points to what he wants, uses an appropriate name if he has one, answers "yes" and "no", nods so it's not like he is non-verbal. And he babbles all. day. long. He just mastered the sound "n" last week and has probably 5-10 n words in his vocabulary already. Once the sound is mastered, his vocabulary increases drastically - it's just that he is only proficient with the four sounds I indicated above so his vocabulary is rather limited and his words are incomplete.

    I went to my girls' school today for my daughter's gifted education recap meeting and 5 minutes into the meeting the gifted coordinator asks me how old Ben is. Followed by: "Is he in speech therapy?". Funny enough, I have an appointment with a pedestrian for next week to discuss his speech. Apparently, she is a speech pathologist and noticed that his speech was mostly babbling (a lot of it), inaudible (no one can understand him for the most part but me) and he doesn't finish his words like "no" for nose, so his words are incomplete.

    She said she offered private speech sessions and her price is very reasonable and only $5 more what my co-pay would be through insurance. I don't know her that well, but I have met her a few times and obviously, I will be seeing her around at school. She said I could wait because he very well can take off within the next month (my daughter did) or start speech now.

    So, my wwyd questions are:
    • Would you still see a pediatrician or just start speech? It wouldn't hurt him obviously but it's expensive.
    • Would you start now or wait a month considering I have a child in my household who very much was in the same boat and her vocabulary exploded in one month where the doctor said she no longer needed speech therapy (just never actually did any therapy sessions but the doctor at 2 told me that they were giving her a month and sending her to therapy; she came back with 50 words after that month)
    • If we were to start therapy now, would you go with this lady? If so, is it appropriate to ask for credentials or references? I am not sure what is the proper "speech therapy etiquette"


    I kind of know what we are going to do but I don't want to necessarily state my opinion as I would like unbiased and potentially fundamentally different responses to perhaps show me the other side I am currently not thinking about. Thanks so much if you made it this far!

  2. #2

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    Just to add... I read cheeksy's article posted and he was on track at 18 months and currently only has 2 out of 4 for 2 years (but he is not 2 yet). I also read Gwenn's article and he doesn't have any of the early warning signs listed there.

  3. #3
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    I would wait and talk to the pedi and go through the proper channels because if he qualifies for speech therapy it should not cost you anything as far as I understand. If he does not qualify and you are still concerned then I would consider this person although I would ask around to other moms for recommendations.

    I would always worry about my older 2 kids' speech and within a week or 2 things would change. Both my older 2 stuttered for a while. With DD1 it only lasted a few weeks. With DD2 it was really bad but by the time I went through the channels to get her evaluated she stopped! She still qualified for therapy for articulation so she got a year of therapy for that and it really helped her. She was 3 at the time.

    He will likely be fine but in your shoes I would talk to the pedi and go from there. Things may even change by the time he is evaluated if it comes to that.
    Thing 1 (7), Thing 2 (5), Thing 3 (2)

  4. #4

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    Quote Originally Posted by macksmom View Post
    I would wait and talk to the pedi and go through the proper channels because if he qualifies for speech therapy it should not cost you anything as far as I understand. If he does not qualify and you are still concerned then I would consider this person although I would ask around to other moms for recommendations.

    I would always worry about my older 2 kids' speech and within a week or 2 things would change. Both my older 2 stuttered for a while. With DD1 it only lasted a few weeks. With DD2 it was really bad but by the time I went through the channels to get her evaluated she stopped! She still qualified for therapy for articulation so she got a year of therapy for that and it really helped her. She was 3 at the time.

    He will likely be fine but in your shoes I would talk to the pedi and go from there. Things may even change by the time he is evaluated if it comes to that.
    ^ This is true. Cody had speech therapy from 18 months to 3 years. We didn't pay anything because we didn't make enough money for a co-pay we went through a First Steps Program with him. Something I didn't know until I got with First Step is they thanked me for asking my pediatrician for help. In the case of speech development the sooner the better for it. Talk to your pediatrician ASAP and they should give you a referral if they think there is room for concern. There is new criteria all the time for things like this. They came out to the house the usually like to see a child at home but, they do accommodate working parents to visit a child at daycare if need be.

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    I'm having mixed feelings about this.

    SOME of what you wrote concerns me, and some of what you wrote is very much age-appropriate and wouldn't concern me at all. I really would not want to venture an opinion without seeing him. My gut feeling is that an SLP did see him and raise concerns, so given that I do think it's valid to consider there might be issues.

    But ... I feel like professionally she is jumping the gun talking to you about her hourly rate. First step is an evaluation and determine whether or not he qualifies. She shouldn't be signing anyone up for therapy without an evaluation (I'd be willing to say she screened him and judged that an evaluation is warranted) so she's way ahead of herself. I also question whether it is a conflict of interest for her to work with him seeing that she works at your daughter's school - it would be in my case and I wouldn't touch him. People have been fired for situations that were somewhat similar. So I am not sure I would go with her to be honest.

    But - I do think you've had a screening and have cause to worry. I wouldn't bother with the pediatrician because I can promise you s/he will tell you to wait given what you went through in the past. I think it is worth a call to Early Intervention (which is always free for an evaluation and in some states therapy is free, and in others it is not - but private speech therapy, unlike EI, is never free unless the therapist is doing it out of charity). EI can't qualify just any kid who walks through the door, unlike a private therapist who can take anyone willing to pay. So if he does qualify for EI, you will know he needs it.

    And yes, ALWAYS ask for credentials and references if you have any concerns. There are people in my city who have passed themselves off as SLPs when they did not have the proper license or certification. And there are others who I would not give a good reference for.
    Last edited by Gwenn; 05-14-2014 at 08:01 PM.
    Me (39) DH (46) & furbabies * m/c 7/08 4/12 11/12

  6. #6

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    Gwenn, wouldn't EI take about 6 months to get him in?
    Also, it is a new pediatrician so this one is a lot less judgmental so she may just let me go with my gut on this one.

    Also, may I ask which parts concerned you and which parts are age-appropriate?

  7. #7

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    This wouldn't be nearly as formal but we were also around another SLP a couple of weeks ago at a friend's house and she didn't seem concerned at all and I specifically asked her. Now, this woman barely knew me so may be she didn't want to tell me. I wonder if I can get a private evaluation independent of anyone and how I would go about doing so. I don't mind paying but I want someone who is not after my money and can honestly put me on the right track and is good at what they do. I am not asking for too much, am I?

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    I'm concerned because it seems from that way you wrote it that his speech sounds appear to be limiting the words he is attempting. In my experience, kids will attempt words but just substitute sounds that he is able to make for sounds he isn't. Perhaps he is doing that and it just didn't translate well in your paragraph ... that's why I would want to see him.

    The specific sounds, though, usually k (or c - same sound) and s are later developing sounds. /k/ usually comes in around 3.5 and /s/ is a tricky one but definitely not before 3 years old. p, b, m, t, and d are usually the first sounds to develop, and sometimes n, h, w - but before two there are no absolute "must have by this age" sounds. Leaving off the end of words is 100% normal but should disappear again before the age of 3. So I would definitely not work on any of the sounds you listed - I would just focus on increasing his vocabulary if he were on my caseload.

    And yes, there would be a wait time for EI. I certainly hope it wouldn't take a full 6 months, though. It might take 6-8 weeks would be my guess, unless something got really backed up in the system, but they are run by the state so your experience might vary.
    Last edited by Gwenn; 05-14-2014 at 08:23 PM.
    Me (39) DH (46) & furbabies * m/c 7/08 4/12 11/12

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    Quote Originally Posted by martiniqus View Post
    This wouldn't be nearly as formal but we were also around another SLP a couple of weeks ago at a friend's house and she didn't seem concerned at all and I specifically asked her. Now, this woman barely knew me so may be she didn't want to tell me. I wonder if I can get a private evaluation independent of anyone and how I would go about doing so. I don't mind paying but I want someone who is not after my money and can honestly put me on the right track and is good at what they do. I am not asking for too much, am I?
    I do totally agree with this, and that would by my thought, too. In fact, tell them up front you want an independent evaluation and would look around to see who would provide services after they tell you whether or not he qualifies.
    Me (39) DH (46) & furbabies * m/c 7/08 4/12 11/12

  10. #10

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    Quote Originally Posted by Gwenn View Post
    I do totally agree with this, and that would by my thought, too. In fact, tell them up front you want an independent evaluation and would look around to see who would provide services after they tell you whether or not he qualifies.
    Ok, sorry... Who is "them"? Who should I tell that to - the pediatrician or the EI Evaluation?

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    If you go thru your school district they will certainly not be after your money because THEY have to pay for it! You'll know he really needs it if he qualifies. It can take a while to get it set up though.
    Thing 1 (7), Thing 2 (5), Thing 3 (2)

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    Sorry, that was confusing. I was thinking that if you hired a private SLP, tell "them" that you wouldn't necessarily use them for therapy. That will keep "them" objective, if that makes sense.

    EI wouldn't care, they would have strict criteria they have to follow (usually it's a % delay the child has to meet or other risk factors).
    Me (39) DH (46) & furbabies * m/c 7/08 4/12 11/12

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    Quote Originally Posted by macksmom View Post
    If you go thru your school district they will certainly not be after your money because THEY have to pay for it! You'll know he really needs it if he qualifies. It can take a while to get it set up though.
    He's too young for the school district ... they won't evaluate him until he is nearing three and he isn't two yet.
    Me (39) DH (46) & furbabies * m/c 7/08 4/12 11/12

  14. #14

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    I am a bit confused with the sound and substituting sounds to what he would say. If I ask him to say it, he would repeat things like sissy and shoe although it's far from a clear "s". If I asked him to say "cat", he would say "dada". He loves pointing to things in his books and call everything "dada" or "adada". But there is also "dad dad" "duh" and the rest of the variations. If I point to the shoe and say: "Ben, say shoe", he will actually say something really close to "shoe", but then turn around, point to it and call is "dada". However, he figured out the sound "n" comfortably last week or the week before and he wanted "nuts", so I said "nut", he repeated it and called it appropriately every single time since then.

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    I really do think it sounds like he is just learning.

    Is it possible the speech pathologist at school thinks he is older than he is?
    Me (39) DH (46) & furbabies * m/c 7/08 4/12 11/12

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    Quote Originally Posted by Gwenn View Post
    He's too young for the school district ... they won't evaluate him until he is nearing three and he isn't two yet.
    Sorry I thought the school was involved even with EI.
    Thing 1 (7), Thing 2 (5), Thing 3 (2)

  17. #17

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    Quote Originally Posted by Gwenn View Post
    Sorry, that was confusing. I was thinking that if you hired a private SLP, tell "them" that you wouldn't necessarily use them for therapy. That will keep "them" objective, if that makes sense.

    EI wouldn't care, they would have strict criteria they have to follow (usually it's a % delay the child has to meet or other risk factors).
    Yes, that makes sense - thanks!!

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    Quote Originally Posted by macksmom View Post
    Sorry I thought the school was involved even with EI.
    Maybe that is something that varies by state, too? Possibly. Birth to three is covered under a different part of the law, though, so it is usually separate from preschool. And in my state EI is a sliding fee scale and it is only free to families who are low income. Preschool is free to everyone.
    Me (39) DH (46) & furbabies * m/c 7/08 4/12 11/12

  19. #19

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    Quote Originally Posted by Gwenn View Post
    I really do think it sounds like he is just learning.

    Is it possible the speech pathologist at school thinks he is older than he is?
    Well, that's the catch.. She isn't a school pathologist at the school, she is a gifted coordinator, although it's possible she does speech as well. I looked up her LinkedIn profile and it looks like she had her own SLP business for 9 years 1990-1999 and has just been taking private clients since she joined the disctrict. She said language is her passion but I can't say she spent a long time evaluating him before asking about his speech and throwing out potential diagnosis. She watched his babbling for a couple of minutes and then went right into talking about his speech. I asked her about her rates, she didn't necessarily offer her services so I am torn. This has been bothering me for quite some time so I better get an independent evaluation done, put this to rest one way or the other. I need to perhaps google and see what I can find in terms of independent evaluators.

  20. #20

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    Quote Originally Posted by macksmom View Post
    Sorry I thought the school was involved even with EI.
    For us if Cody wasn't up to par by age 3 he would have qualified for help with the school so it can sometimes depending on where you live.

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    I think that's a good idea.
    Me (39) DH (46) & furbabies * m/c 7/08 4/12 11/12

  22. #22

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    Thank you all... You all have been SO extremely helpful! And Gwenn, with all the advice you have given me over the last year, I feel like you should charge me a consult fee or something THANK YOU!!!!!

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    Hahahaha...maybe I should take you up on that!
    Me (39) DH (46) & furbabies * m/c 7/08 4/12 11/12

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    My son is 19 months and was just evaluated by EI for speech therapy. He doesn't have any words at all, but has a good understanding of what we say to him and follows most commands. He did qualify. His pediatrician did recommend I call EI, but I did it on my own. From the time I first called, I had an appointment with the social worker two weeks later, and the SLP did her evaluation a week after that. It's been another two weeks now, and I've meet with the SW again to get his official results and have another meeting with her on Friday to set goals and a schedule. So all in all, about a month and a half from first phone call to first session of therapy (next week). EI covers up til age 3, and then the school picks it up from there if therapy is still necessary, and we don't pay anything for it. I definitely think it is work getting you son evaluated and go from there. If you have any questions about it all, let me know!
    Jennifer


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    I think that if you are concerned, you should have him evaluated. I wish I had pushed for speech therapy earlier but I was relying on our pedi that everything was normal (my DS was like yours - always at the bottom for the normal range for the age - e.g. 8 words for 18 months, etc.). But I was also going to ask if you think he may have trouble hearing. My DS had ear infections and fluid in the ears from about 18 to 27 months (when had got ear tubes). He passed all hearing tests but within 24 hours of getting ear tubes he went from not putting 2 words together to 5-6 word sentences. He also started saying complete words (such as cantaloupe instead of "lope").

    I think it took 6-8 weeks to get an eval with the EI (It was called Early Steps in Lake County but I am not sure if it is county or state name.) But this time of the year, you will probably run into the summer break - i.e. they may not evaluate him until next school year or evaluate him now but not start speech until August/September (assuming he qualified). I felt that Early Steps had pretty low standard for what a child should be saying (they did not find anything concerning about the specifics I brought I up). I had DS evaluated in April or May just before he turned 3 - the report I got was that everything was perfect, no concerns at all. I requested another eval by the school system (we got on the schedule for October) and DS qualified for speech therapy (there was no huge regression in the months between the two evals, he actually made really good progress in between).

    Good luck! I hope that helps.

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    Are you bilingual at all at home? If so, he may still have language confusion. Our children are about the same in speech. As I remember from my university speech development courses sounds that they aren't saying now are not really an alarming sign. He is not even 2. My older didn't speak more than 8-9 words till 23 months. Also many of my friends with both boys and girls said their boys were later than girls in developing speech.
    Of course , as said above - if your mommy gut keeps telling you "evaluate", do so. But honestly I don't see him having anything super alarming at this point of time. What you CAN do is perhaps spend a little more time talking to him, reading to him and ask your girls for help with communicating with him. I noticed when my older one actually reads for A or role plays with dolls (speaking for her dolls and A's dolls), A is more willing to say things and put 2-3 words together. She also mixes up 3 languages so she seems to be choosing what is easier for her to say plus babbling 90% of stuff. She won't say thank you or spasiba, but will say xie xie which is same for Chinese even if we ask her to say either of former ones. She doesn't say S. It is more like sh or sch and her name she says as Ayischa. And so on. Also unfinished words but it doesn't bother me really as I've seen this is so many children in my 16+ years of teaching.
    Miss T (10.17.2008) Miss A(06.30.2012) Flipper #3 due 06.2014
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