Speech


Here are some strategies for language development between the ages of 3-5 years.

Remember that in typically developing children, 80% of your child’s language has been developed by age 3. This means that from age 3 through adulthood your child is refining their language skills and learning higher level language concepts.

Some of these strategies may overlap with the 0-3 Strategies and others are new.

1. Create a necesity for your child to communicate.

2. Expand your child’s phrases by adding 1 word to what he/she says.

3. Provide choices or ask open ended questions rather than asking yes/no questions.

4. Decrease use of non-specific language (i.e it).

5. Talk to your child about their day.  Ask questions.

6. Dedicate time to playing with your child.

7. Create opportunities for socializing with other children and adults.

8. Encourage your child to use words in his repertoire.

9. Allow your child to do things for himself that he knows how to do. (i.e putting on shoes)

10.  Read books, talk about the pictures, and ask questions about the books.

The more you talk to your child; the more your child will pick up on language.  Children imitate their parents/caregivers.  Make sure to include them in on family conversations (during dinner and other times) in your daily routines.

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This has really been bothering me and I thought I would blog about it today…

It seems that a mom poured her heart out to other moms (whom she doesn’t know) through a website and these moms lashed out at her…

They pointed the finger stating that she should be at home with her son in order to solve all their problems. Some were nice about it and some were out right mean.

Some said things like do you really have to work? Maybe you just need to stay home instead of placing your child in daycare…

I found these messages so inappropriate and mean… just so cruel… I mean if the parent does stay home with the child, the problems aren’t going to go away.

I asked myself… how ignorant can a mom be? these moms were just plain ignorant…

they replied and judged her without taking into consideration their knowledge about children with special needs or developmental delays/disorders/ or even the fact that this mom was just so anxious and so out of her element…

I mean these moms didn’t even think for a moment that this mom could be at her wits end… if she wasn’t depressed… they sure pushed her over the edge…

Did these moms even think to put themselves in her shoes? Nobody is the perfect parent and just because your child is considered “normal” doesn’t mean you are doing it right…

If and when the child goes to school, the problems will return and may have escalated or even be more apparent since schools are so strict and rigid. Schools are very demanding in all areas of development… academics, socially, emotionally, etc…

Working mothers do not cause developmental delays, disorders, or differences…

The one thing Stay at home moms never seem to figure out is that the more you hover over your child the less independent they are…

Stay at home moms aren’t always in the know regarding redflags in development… and guess what… your pediatrician isn’t either…

If they are… they don’t spend enough time with them to figure it out and if they aren’t then they don’t know what questions to ask the parents or how to probe the parents to get a better picture of the child’s development…

Development is not just about growth in their bodies and muscles and brains… but it also includes the subjective areas of social-emotional behaviors, speech and language skills and/or communicative behaviors, and of course adaptive behavior…

These subjective behaviors are behaviors that involve analysis and observation… they are not just seen in an xray…

So when your children are always around you and you are always adapting their environment to them… Redflags in development may not be apparent to you… OR… you just might find it normal for your child…

Many moms, regardless if they are working or stay at home, don’t know or understand what redflags to look for to catch developmental delays, disorders, etc before they send their children to school…

So it’s the teachers or the outside people who begin to ask questions and have doubts about the child’s development…

and let me tell you it is not easy to approach any parent and say “I have some concerns with your child’s behavior… I would like to recommend you to explore the idea of having your child evaluated…”

That is one of the hardest things to tell a parent and it’s incredibly stressful because of the uncertainty of how the parent will react…

You are trying to help someone and their family but you are also breaking someone’s heart… and making them feel incompetent…. without even wanting to…

This is where my doubt comes in about supportive moms… I think the only supportive moms you may find are those that have been through some difficult times with their children…

and even then, are they going to judge you about what steps you decide to take for your child’s intervention???

I don’t see other moms as supportive… I see them as critical… as judgmental… as inconsiderate… as uncompassionate… and always looking for one thing to use to put you down as a mother…

Do you cook? do you go to the gym? do you work? how do you discipline? do you follow the standard pediatrician recommendations for feeding, sleep training…. who’s your pediatrician? how do you dress your child? you name it…

It’s like moms are vultures and their waiting and watching and when you least expect it they are going to throw a knife at your heart and make you feel guilty for the decisions you’ve made as a parent with the greatest intentions you can possibly have for the well-being of your children…

Every parent does the best they can in the situation they are in at that moment in time…

That does not mean that parents don’t make mistakes…

That means that parents have strengths and they have weaknesses in their skills for raising their children and many factors play into how you as a parent will react at that moment when your child needs you the most…

I would only spill my guts to moms who are considered safe… and only, you, as a mom can determine if that parent is a safe and supportive person to have as an advocate for you…

So if you feel defensive when you are talking to another mom, that’s not a safe and supportive advocate for YOU!

Don’t forget… many people, friends, neighbors,etc will turn on you in the event of a crisis…

How do SLPs and other therapists determine the amount of therapy a child needs to significantly improve his skills?

Well… it should involve lots of analysis and thinking outside the box to tailor each treatment plan to your patient.

However, most SLPs will recommend the standard 2x/week for anywhere between 30-60 minutes… most of the time 30-45 minutes is what’s given…

Many Doctors like to prescribe this also… even if they have not evaluated the patient in terms of communication… That is mind boggling…

I believe that less is more…

Therapy can be anywhere from 1x/mo to 2x-3x per week depending on the patient…

I rarely see a patient more than 1x/wk and generally see my patients 2x/mo… They all receive a home exercise program which is expected to be implemented into daily routines…

See… I like to empower my parents and caregivers… I feel like you see greater improvement and more parent satisfaction with less is more.

Here’s what I look at:

age, type of delay/disorder, severity of delay/disorder, delay vs disorder, patient motivation, family support, prognosis, environmental factors, behavioral factors, concurrent diagnoses, maturity level, cognitive functioning levels, etc…

(Must take graduate level diagnosis/treatment courses to get more valuable information about treatment plans)

Lots of things to consider when recommending therapy… Less is more in order to empower families… because the more therapy you give the more your families depend on you…

In essence, you are encouraging dependence rather than independence with more therapy, better outcomes…

Ultimately, therapies are given to increase their skills in communication and obtain the highest level of independence the patient can attain (prognosis). So less is more…

Having said that… Family support is a valuable tool to supplement therapy services…

See… I can see my patients every single day for an hour… but if the families are not following through with strategies and home exercise programs… little change will be noted…

Here are some things to think about:

If you see your patients every day for an hour:

1. How much change will you see from 1 day to the next?
2. Will your recommendations change from 1 day to the next?
3. Are you empowering your families or are you fostering dependence?
4. Is the patient receiving enough time to process and assimilate strategies learned?
5. Have you given the families and your patients enough time to implement and practice?
6. Are you incorporating parent education and prevention in your therapies? (important for families who are still growing)

Now ask yourself the same questions regarding the standard 2x/wk 30-45 minutes…

Now… Some patients may need the standard 2x/wk 30-45 minutes… but most do not… especially the younger ones…

Try it… 2x/mo 45 min to hour… include direct tx time and indirect tx time via the parent

Again… relying heavily on parent follow through is key…

if you want to see significant changes in your patient’s communications… your families must follow through with strategies…

Here’s an example:

If your patient goes to the doctor and the doctor prescribes antibiotics. (This is considered the MD’s recommendation and strategy). The patient does not take the antibiotics as prescribed and comes back to the doctor 1 week later and then continues to come back everyday with the same complaints…

Who is doing their job? Who is not doing their job? What can the doctor do to improve the patient’s health, if the patient is not following through with the strategies?

Nothing… A doctor is no miracle worker… and if you don’t get the surgery or take the medication or do your exercise and eat a balanced diet as prescribed by the doctor… you will die…

because ultimately their job is to maintain your health in order for you to live as long as possible through recommendations…

So if the patient doesn’t take the medication then the doctor can’t help them… This is why the phrase “against medical advise” exists.

Well… Our job as SLPs is to facilitate communication for our patients… but we are not miracle workers… if our families do not follow through with our prescribed recommendations and/or strategies… an increase in frequency will not cure the problem…

Here’s another tidbit… make sure that the patient and their family understands that you are using the phrase “against therapist advise” or “limited family follow through” or “against therapist recommendations”… Use it outloud and in your paperwork…

document, document, document… 🙂

Most people don’t realize that there is a subspecialty of Pediatricians who specialize in development.

These pediatricians are called developmental pediatrician.

It’s no wonder why many pediatricians do not refer their patients out to specialists. Regular pediatricians focus on health vs illness and on the child globally. They have an overall understanding of development.

Regular pediatricians do not spend enough time with their patients to determine if there are delays in areas of development which are more subjective such as social-emotional development and speech and language development.

These areas of developments cannot be measured by a blood test, weight, circumference, and whether they are walking or running. These milestone measures are very concrete…

Social – emotional development and speech and language development are areas of development which are very abstract and difficult to judge when you have only been with the child for a few minutes over a sporadic period of time.

This is why if you have concerns regarding your child’s speech and language skills have a speech pathologist evaluate them.

Medical doctor referrals are not needed for speech pathology evaluations. Speech language pathologists are trained to refer their patients out for further evaluations if they deem necessary.

Social emotional development can be measured by Early Childhood specialists, psychologists, and developmental pediatricians.

Developmental Pediatricians work with a team who evaluate child globally in terms of development.

For more information check out the American Academy of Pediatrics for more information.

It is sad to me to think that SLPs in the schools do not defend their professions or behave on a different level than teachers.

I find that difficult to understand. Why is that in schools, SLPs are prohibited from recommending further evaluations from specialists outside the school district? More troubling than that, is why SLPs don’t stick up for their profession.

We are an allied health field… we take courses in the medical sciences… we are not teachers. We are not glorified tutors. We have been trained to analyze, observe, make professional judgments, and determine if our patients require further evaluations by any other kind of therapist and/or medical professional.

We, SLPs, are held responsible for HIPPA Compliance and are considered to be part of the medical field.

It is under our scope of practice to recommend further evaluation from psychologists, neurologists, etc…

So, again, I would believe it would be unethical to evade recommendations for further evaluations from specialists outside the school district if we believed through our professional training that a child would benefit from further evaluations from developmental pediatricians, neurologists, psychologists, OTs, PTs, or any other sort of specialty regardless if they qualify for services under the school service delivery method.

Here’s the thing… Why aren’t we educating doctors, other therapists, and educational staff about our profession? Why aren’t we standing up for ourselves and explaining that our scope of practice involves communication and how it impacts academics and social interactions. Then again, communication overlaps every aspect of one’s life.

We do not tutor… Once communication is functional, then the learning disability or other disability is not covered under our scope of practice… So basically, we work with LD students to organize their language… so that they can functionally understand and express their desires, wants and needs. We do not teach them or tutor them just because they are low academically… We cannot change a learning disability… which means a child has difficulty learning… so basically the child is going to be behind academically which is why there are resource programs and special ed programs which will help move the child along.

We should not be working on social skills with children who are emotionally disturbed… ED must be targeted to improve social skills. Targeting communication will not improve social skills for a child with ED or anxiety since the communication is not negatively impacting his social skills. If ED or anxiety is negatively impacting his social skills, then the emotional disorder should be targeted to improve social skills.

I can understand teachers not being able to recommend evaluations from other medical professionals… They have not been trained in the medical sciences or taken courses in neuroanatomy…

Why is a professional from an allied health field (SLPs) who works in a school district unable to recommend evaluations from other medical professionals outside of school districts? That’s part of the reason we are trained in neuroanatomy and arteriosclerosis, Traumatic Brain Injury, and other neurological language delays/disorders.

Speech Pathologists are not teachers unless they have been dually certified in education…

SLPs are governed by the state licensing board and by ASHA… Teachers are governed by the TEA…

Communication is the SLP’s expertise… Education is the Teacher’s expertise… there is a significant difference, especially in how they are trained and the backbone that each profession is given in order to be successful in their career.

SLPs should always think of themselves as allied healthcare professionals regardless of the setting they work in… this would help get the respect we deserve in the school districts…

SLPs would be able to stand out and demonstrate their expertise in their fields if they do not allow others to treat them as teachers or glorified tutors…

SLPs need to put boundaries in place in order for them to be seen as experts in their fields… They need to put up a tough act and fight for their scope of practice and their rights as allied health professionals.

Ironically, in the medical service delivery method… we do not need a referral from medical doctors to evaluate our patients… In fact, we obtain MD referrals for payment purposes…

So SLPs in medical service delivery method settings are maintaining their independence and have set up a boundary… yet, those in the education fields are just sitting back and watching while others treat them as teachers.

1. Private Speech Language Pathologists

a. Some may have an actual office where they see their patients
b. Some may have an in home office
c. Some treat patients in the patients home
d. Many school SLPs treat patients privately during summer vacation to augment their income. Some may even see children after school hours.

Please remember to ask about payment options since SLPs can vary greatly. Some may or not bill insurance.

Visit the American Speech Hearing and Language Association to search for speech pathologists in your area.

2. Early Childhood Intervention

A national program which treats patients 0-3 years. They are funded and have a sliding scale to determine if and what you are required to pay for services. Most accept Medicaid and private insurance.

Services offered: Nutritionists, Speech therapy, Occupational therapy, counseling, and any other area the team determines will help the child and the family succeed. This program serves children in their homes and empowers parents and caregivers by teaching them to use the child’s strengths to improve their weaknesses.

Call 1-800-628-5115 to find a program in your area.

3. School Districts i.e. Child Find.

School districts evaluate and treat children ages 0-21 who have communication delays/disorders which will impact or are impacting their learning. This program is free since it is considered part of your child’s academics. The children must show a significant delay or disorder which is significantly impacting their academics. It is open to children who attend private schools.

Speech therapy is a service provided under Special Education. Special Education is a federally funded program which is open to the public. This allows all children ages 0-21 who reside in the school district to receive services regardless of where they attend school (private, homeschool, etc).

All children must qualify for services as outlined in the school districts speech language pathology handbooks.

4. Hospitals: Out patient and in patient programs.

All hospitals have speech language pathologists who treat in patients. Most have outpatient programs where your child may receive speech and language services.

5. University

Universities who offer a degree in Communication Disorders or Speech Pathology usually have a university clinic and/or programs which offer speech language pathology services. Services maybe provided by student clinicians who are graduate students in their programs. All student clinicians are supervised by a certified/licensed SLP.

Go to the ASHA website to find university programs.

6. Student Clinicians in Speech Pathology (Communication Disorders) Graduate Programs

Many families will go to the university looking for student clinicians to work informally with their special needs child. Children who have a certified/licensed speech pathologist and who have been diagnosed and being treated by this speech language pathologist may benefit from extra help given by a Student Clinician.

Please keep in mind student clinicians should not and cannot take the place of a certified and licensed speech language pathologist. I am not recommending your child to be treated by a student clinician.

Student Clinicians can serve as facilitators and love the opportunity to practice their emerging skills. For example, a graduate student can babysit your child and while he/she babysits provide opportunities to practice communication and language. The student clinician will provide the same opportunities a parent/caregiver can provide. The Student Clinician will be able to follow the strategies and home exercise programs provided by the child’s speech pathologist. Student Clinicians can be good mother’s helpers or just come to help implement the home exercise programs in your home.

7. Home Health Agencies

Home health agencies provide speech services to children in their homes after school or during the day for those children who are not in school.

Home health agencies typically accept all insurance, private pay, and Medicaid programs.

They usually have related services as well such as Physical therapy, Occupational therapy, etc.

Good Luck finding your SLP. Communication is complex and personal. Look for someone you feel comfortable with and make sure that person is willing to give you all your options. All SLPs are different. Treat this search as if you are searching for a doctor.

If your family is bilingual, be sure to ask for a bilingual speech language pathologist preferably one who speaks the language spoken in your home.

Interpreters are not recommended. However, due to a shortage of speech pathologists in general and a greater shortage of bilingual speech pathologists some agencies are forced to use interpreters as a last resort option.

A school speech language pathologist diagnoses and treats communication disorders.

School SLPs improve communication skills to facilitate academics. In order for a school slp to qualify a student for services, the student must exhibit a true communication disorder with an academic need.

This means that it is possible for a student to have a communication disorder and not qualify for school speech services… It all goes back to… does this child have an academic need? or Are this student’s communication skills impacting their academics? If the answer is no, then the child cannot qualify for services.

School SLPs are there to improve communication skills. They are not there to teach a language, academic concepts or tutor any students who are behind in their academics. Therefore, students should not be evaluated for speech services just because they are behind in school.

It would be more appropriate for an educational diagnostician to evaluate the students. The reason, again, being that speech language pathologists focus on communication and the functionality of communication for learning.

Just because a child receives special education services does not mean the child requires speech services. The speech services fall under special education services but speech services are meant to improve communication skills.

Speech services in the school are not meant to tutor or improve academic grades. Students who improve their communication skills have shown an increase in their academic skills but only for those whose communication skills are impacting their academics.

A child who is ADHD does not typically qualify for speech services. A decrease in attention does not constitute a true language disorder. If the child is able to answer successfully with repetition, cueing, and frequent breaks, the child does not qualify for speech services… he does not have a true communication disorder. The child’s behavioral difficulties are impacting his communication skills.

If a child’s communication skills are negatively impacting his behavioral skills, then the child should qualify for services.

If a child’s behavior is negatively impacting his communication skills, then the child’s behavior should be targeted for services. He, therefore, does not qualify for speech services because what is causing a communication breakdown is his behavior. If the child did not present with the behavioral issues, then the child would not exhibit difficulties in communication.

This goes for all socio-emotional difficulties… Just because a child is diagnosed with Emotional disturbance and exhibits difficulty with social interactions does not mean the child should qualify for speech services. Again, the child’s diagnosis of ED is negatively impacting his communication skills via social interactions. Therefore, ED needs to be addressed to improve social skills.

School SLPs have exhibited an increase in their caseloads. High caseloads can be attributed to misunderstanding of what SLP’s do in schools, uneducated school staff, misdiagnosis of true communication disorders, and the pressure for children to receive services because their academics are failing.

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