It is never too soon to see a professional if you think your child is delayed in communication. Many parents consult their pediatrician first, and some pediatricians readily refer to a speech pathologist while others are less aggressive and choose to “wait and see”. When parents have a feeling that something is not right, they should pursue until they get answers that they are satisfied with.
Speech and language develop on a continuum. “Normal” describes a wide range of skills. Comparing your child to another child is not always the best way to judge what is “normal”. Typically, girls develop language faster than boys. Boys usually do not start talking until they have mastered walking and running. Second of third children of verbal older siblings are often late talkers. Children in bilingual households are able to learn two languages simultaneously, but will at a slower rate. Children who, as infants, have trouble with feeding, reflux or recurrent ear infections may develop language at a slower rate.
Listed below are behaviors that may be considered red flags for communication delays:
6 months
• no response to loud sounds
• limited response to familiar voices or faces
• unresolved feeding difficulties
• lack of babble
9 months
• babbling and vocal sounds that disappear
• no efforts at nonverbal communication (waving bye-bye, reaching to be taken)
• no interest in games such as peek-a-boo
• a lack of interest in toys
12 months
• no noticeable increase in babble or vocalizations since 9 months
• no interest in pictures or books
• an inability to follow simple commands (stop, come, sit)
• eats only pureed foods
• limited imitation
18 months
• a vocabulary of less than 15 words
• no attempt to imitate words or gestures
• repetitive behaviors
• unusual response to particular sounds, textures, movements or foods
24 months
• does not use two-word phrases
• a vocabulary of less than 50 words
• unable to retrieve familiar items on request
• lack of social interaction and interaction with toys
• a loss of skills
3 years
• does not talk in sentences, does not string sentences together
• does not use the sounds /p, m, h, n, w/
• does not play appropriately with a variety of toys
• does not eat a variety of foods
• becomes easily over stimulated or under stimulated
4 years
• cannot tell a story or relay information
• does not know first and last name, age
• does not use the sounds /b, k, g, d, f, y/
• cannot name 4 colors or count to 10
The speech therapist process in Richmond, VA:
If your child is 0-2 years of age and you want an evaluation, contact the Early Intervention Programs for your area. These programs provide evaluation and therapeutic services for speech therapy, occupational therapy, physical therapy and education/cognitive development. When you make your appointment, a case manager will help determine what evaluations your child will need and assist you with scheduling. You may work with an early intervention team or you may be given a list of providers from which you choose.
If your child is found eligible, you’ll work with the therapists to develop and Individual Family Services Plan (ISFP). This plan describes your child’s strengths and weaknesses and outlines specific goals to be addressed in therapy. Early intervention services are typically rendered in the home of the child, and the parents are financially responsible for these services, though medical insurance and government funds can offset the cost.
If your child is 3 or over, but not yet in kindergarten, then you should call your neighborhood school to request an evaluation. This request may be handled by the staff at your home school, or you may be referred to a preschool assessment team. After your referral, an evaluation will be scheduled. If your child demonstrates at 20 or 25% delay (this varies by county) then he or she will be found eligible for services. If there is a delay in more than one area (communication, motor, cognitive, social), then he or she may qualify for preschool special education services. An Individual Education Plan (IEP) will be written to record strengths, weaknesses and goals to be addressed in therapy.
Preschool special education services are offered in a variety of ways including part-time or full-time classrooms specially designed for preschoolers with disabilities, enrollment in regular preschool classrooms with support from special education educators, or consultative support. Program options vary from county to county and from school to school. Inquire about all options before placing your child.
If your child qualifies for speech therapy only, then that service is provided free of charge by the school system. Parents are responsible for transportation to and from therapy and there is no guarantee that the therapy can be provided at the child’s neighborhood school.
If your child is enrolled in school and you have concerns about his or her communication skills, you should first consult with the teacher. Request a child study meeting (in writing). By law, a school has to honor a request for child study. A child study team consisting of you, your child’s teacher, an administrative staff member and any other staff who may potentially be involved (i.e. the speech pathologist) will meet to discuss your concerns. The team will decide if an evaluation is warranted. After the evaluation, the team will reconvene to review the testing results and decide if your child qualifies for services. If your child qualifies there will be another meeting to write an IEP.
Be forewarned, the process to acquire services in the school can take several months. The services are free of charge, however. For more information about parents’ legal rights for special education, consult www.wrightslaw.com.
For various reasons, many parents choose to seek services privately for their children. The services can be in addition to or in lieu of what the school offers. Large facilities such as Children’s Hospital, and MCV, and The Childhood Language Center offer a variety of services in a variety of settings.
There are other smaller private practices that offer services as well, such as this list. Fees for services vary depending on the provider; health insurance may cover some or all of the cost. When choosing a private provider, inquire about fees, billing practices and insurance coverage. Your provider should be licensed by the state of Virginia and have a Certificate of Clinical Competence from ASHA (the American Speech and Hearing Association).
This article was written by Lisa Wright M.S. CCC-SLP. Lisa has worked as a pediatric speech pathologist in a variety of settings including schools, clinics and hospitals for 20 years. She currently has a private practice in Glen Allen, VA. Lisa can be reached at [email protected].
