Shoe last sculpture

Shoe Last Sculpture

Last week a mom called to ask me about working with her 21 month-old little girl who had been tested by birth-Three Services twice since July and did not qualify for services. The mom reported that both she and her pediatrician were concerned with her daughter’s apparent delay in expressive language since she was only saying a few words and not able to imitate. Little Charlotte scored right at her age level for receptive language (understanding) but 2 standard deviations below the mean for her age in expressive language (talking). Unfortunately, this is a common scenario that parents come to me with, frustrated that because their child can understand, it is assumed that don’t need help expressing themselves verbally, using words.

I thought it would be helpful if I gave parents some of my tips for navigating the process to bring about the greatest success in terms of receiving speech and language services for their child. Let me preface this list by saying that although I have great respect for the professionals serving the Birth to Three Program, I do feel a parent’s advocacy can be important at several steps:

  • Be informed. Find out as much as you can about the early intervention program in your state–what scores qualify a child for services, the cost, who provides the therapy etc. In Connecticut’s Birth to Three Program, a child is eligible for services when testing reveals a standard deviation of -2.0 in one area of development or -1.5 in two areas of development.  Standard deviations between -1.0 and +1.0 indicate age appropriate development in an area (Self Help/Adaptive, Social/Emotional, Physical-Gross Motor, Fine Motor, Communication–Receptive Language and Expressive Language and Cognitive).
  • Be prepared. I always ask parents for a list of what words a child is saying before I come to test them. Write them out phonetically by sounds such as uppa/up, da/cup, or ju/juice. First of all, it’s been my experience that kids have more words than their parents think they do and when asked to listen and observe, parents find the list sometimes goes from less than 10 to 20 or more. Quite a difference. By giving this list to the testing professional, you are helping a stranger catch up on your child’s capabilities quickly and make a more accurate assessment.
  • Request the most specialized therapist to test your child in the area of concern. If you are worried about your child’s language development, ask for a speech language pathologist to be part of the team to do the testing. Seems obvious, right? I consulted with a parent today whose only concern and reason for evaluation was her child’s language delay and the Early Intervention services sent out an occupational and physical therapist to test. Mom asked questions about tongue function, based on other input and the testers said, “I’ve never heard of that.” I have great respect for all these professions but I wouldn’t want to be the the expert testing children in their fields of expertise.
  • Speak up. If you disagree with the assessment of your child (you know them the best) speak up. You want an accurate picture of your child’s abilities. If his scores are borderline, offer other information that might speak to the need for services such as behavior issues as a result of not being understood. If you disagree with the eligibility decision, ask to talk with a supervisor. This also holds true concerning how often therapy is recommended. Weekly is always better than twice a month for consistency.
  • When therapy starts, again, request that the therapist be in the specific field of your child’s deficit. Again, this sounds obvious, but I have counseled parents to get a speech therapist for speech therapy!
  • Get involved. Watch, listen, and learn how to carryover and implement the strategies that the therapist is using with your child. Continuing to engage with your child in these specific ways will bring faster progress and satisfaction in being part of the process.