Speech therapy

[Rachel]

How do I know if my 5 year old needs speech therapy or if the way he speaks is something he will outgrow?

 

He is very articulate and has a big vocabulary but he sounds like he's from Boston (no offense Bostonians!) and we don't live there. He especially struggles with r sounds at the middle or end of words, including his name. Car is caw, bird is bahd, hurt is well I can't even phonetically write how he says that. When we don't understand him he pronounces the word the same way with more emphasis but it sounds even less like the word he was trying to say than before. I don't think he is capable of saying certain words correctly or hearing that he says them differently than other people. When my older kids mispronounced words they could usually pronounce them correctly when I would say the right pronunciation and have them repeat it.

 

Up until now I've assumed he too would outgrow the mispronounciations but he recently turned 5 and I've started wondering if maybe speech therapy would be appropriate. If we do go that route should we pursue it through the school system or privately? We do homeschool if that makes a difference.

 

For added information, he kind of has a lazy personality. He has been months behind my other kids in terms of physical, fine motor, and speech development but about the time I start to get concerned, he suddenly catches up. For example my other kids took their first steps well before age 1, he was 15 months. My older kids were very talkative at age one (one had about 200 words), at his 15 or 18 month checkup (can't remember which) my youngest only said a couple words and that was including momma. He was about to be referred for speech and then suddenly started taking. My oldest was reading a few words and writing very short stories at the same age, this child can write the first two letters of his name but they aren't really recognizable.

 

It's hard for me to see if this is just another example of how he develops more slowly than his siblings did and know if intervention is necessary. I'm not worried, but if speech therapy would be helpful, then I'd like to get started.

[Random]

I've usually checked with our pediatrician when I've wondered about stuff like this. 

 

In my area, when a child is pre-school aged, the county will pay for developmental testing when the pediatrician orders it.  If the child is school-aged, the school pays (regardless if the student is enrolled or is homeschooled) for testing when the teacher or the pediatrician thinks it's necessary.

 

Our ped is a super-smart mom with kids my own kids' ages, so I feel extremely fortunate.  She is awesome and trusts me to know if my kid is developing outside of 'normal' for our family.  :thumbup:

 

 

 

ETA: There are lots of fun exercises you can do at home if you think your child just needs to strengthen oral muscles... like, eating grapes, drinking thick liquids through a straw, tongue-twisters, etc.

Edited July 19, 2017 by Random

[Crimson Wife]

According to The Late Eight by Ken Bleile, only 50% of children acquire consonantal /r/ by 5y0m and 75% by 6y0m. Vocalic /r/ has 50% by 3y6m and 75% by 5y6m. So in the absence of other speech or language issues, your child is unlikely to qualify for SLP services at this time.

 

Now if he hasn't acquired them in another year, I would definitely recommend requesting an articulation evaluation.

[Rachel]

According to The Late Eight by Ken Bleile, only 50% of children acquire consonantal /r/ by 5y0m and 75% by 6y0m. Vocalic /r/ has 50% by 3y6m and 75% by 5y6m. So in the absence of other speech or language issues, your child is unlikely to qualify for SLP services at this time.

 

Now if he hasn't acquired them in another year, I would definitely recommend requesting an articulation evaluation.

That is helpful! Even if he didn't qualify for services through the school, would a few sessions of private therapy be beneficial so that I can help him work on that sound or would it be overkill?

 

He does have a physical scheduled for August so I can talk to his pediatrician at that time.

[EKT]

Hi! We homeschool and both my daughters did stints in (private) speech therapy. Is /r/ the only sound your son struggles with? That is one of the hardest sounds for kids to get and IIRC, it's not considered "late" until about age 7/8.

 

For reference, my younger daughter struggled with /k/, /g/, /l/, and /r/. We did an evaluation at age 4 when I realized that my 3-year-old niece was able to make sounds that my 4-year-old couldn't. It turned out that /k/ and /g/ were indeed "late" for my 4-year-old, so she got into therapy. We did weekly (private, but largely insurance-covered) sessions for about a year and a half and all of her sounds but /r/ were mastered by around age 6. Now, she will turn 8 in the fall and her /r/ is almost perfect. (It is still just slightly "soft" in certain words, but she can absolutely make the sound when we correct her, so I know she is fine and it will continue to "come in" as she rounds the corner to 8.

 

Long story short, if /r/ is his only problematic sound, you're probably fine because he is so young still. At the same time, the earlier you start therapy, the better, so it might be worth it to schedule an evaluation with a speech language pathologist. (If nothing else, it will definitely put your mind at ease and you won't have to worry once you get their feedback.) We lucked out with our insurance (our sessions were 80% covered, with no cap on number of sessions), so we never considered trying to go through the public schools. We were very happy doing private sessions, so I would recommend that route, just based on my experience. Above all, don't worry! I was so distraught when I found out my kids needed speech therapy and I totally panicked that they would struggle for life or something, but the therapy completely worked (we did weekly professional therapy sessions with daily 20-minute "homework" between sessions), and all the issues were resolved. My children speak completely normally now and are outstanding readers, reading far above grade level. (Just wanted to throw that out there, because I know how much I panicked when I first dealt with the issue!) :-) 

[EKT]

That is helpful! Even if he didn't qualify for services through the school, would a few sessions of private therapy be beneficial so that I can help him work on that sound or would it be overkill?

 

He does have a physical scheduled for August so I can talk to his pediatrician at that time.

 

Jumping in with my big mouth. :-) 

 

I don't think it would be overkill. Maybe wait until your pedi appointment in August, to see what they say, but if it were me, I would do the professional eval just to get a specialist's input. They'll either tell you everything is fine (developmentally appropriate) as-is, in which case, Great! You don't have to worry at all and you don't have to think about it anymore! Or, they'll tell you he needs a little therapy, in which case, Great! You now know what your child needs! I do think even a few sessions could be beneficial; your therapist will give you exercises you can do at home to practice and encourage the sound to "come in."

 

Speech therapy is sometimes a tricky balance because on the one hand, you don't want to invent problems where there aren't any. On the other hand, you don't want a child to establish bad habits that have to be undone later. (As I said in my previous post, I'm pretty sure 5 is very young for /r/, so I'm betting you have absolutely nothing to worry about. But I'm just a person who would rather check on something than worry about it. For me...better safe than sorry.) Good luck! :-)

[Rachel]

Thanks for your input. I think he struggles with more than just the /r/ sound but I can't pinpoint other letters. I need to pay better attention. For the longest time I just thought he sounded cute but he is starting to be frustrated when other people can't understand him. We get the comment on him sounding like he's from Boston a lot!

 

I'm usually a wait and see person but if getting help early would be better, I'd go that route. I can't say that I'm worried, more just don't want to ignore it if I could do something for him.

 

Jumping in with my big mouth. :-)

 

I don't think it would be overkill. Maybe wait until your pedi appointment in August, to see what they say, but if it were me, I would do the professional eval just to get a specialist's input. They'll either tell you everything is fine (developmentally appropriate) as-is, in which case, Great! You don't have to worry at all and you don't have to think about it anymore! Or, they'll tell you he needs a little therapy, in which case, Great! You now know what your child needs! I do think even a few sessions could be beneficial; your therapist will give you exercises you can do at home to practice and encourage the sound to "come in."

 

Speech therapy is sometimes a tricky balance because on the one hand, you don't want to invent problems where there aren't any. On the other hand, you don't want a child to establish bad habits that have to be undone later. (As I said in my previous post, I'm pretty sure 5 is very young for /r/, so I'm betting you have absolutely nothing to worry about. But I'm just a person who would rather check on something than worry about it. For me...better safe than sorry.) Good luck! :-)

[nixpix5]

Speech therapy would bring his speech along more quickly but what you describe is still within normal limits for his age.

[debi21]

Hi. My son turned 5 in April, we had him evaluated through our public schools in May, and he will qualify for speech services this fall in K. They measured him in the 7th percentile. So this is some of our info in case you find it helpful. He is missing r, l, and every consonant blend, where he either just says one of the letter or says 'f' (so, stick is 'tick', while truck is totally inappropriate). His j was also marked as not quite right (kind of like a french 'j' - 'zhj'). He also frequently drops the first syllable of 3 syllable + words. For example "destroyed" is "foyed." For the IEP, they have prioritized getting the "sh" sound. Our public school evaluation took less than 30 minutes and involved him looking at pictures and saying what they were. Also of interest, since they said there is nothing phsyical preventing him from developing the sound, they said that even with no therapy, he would eventually come to gain all of them naturally.

 

[CTVKath]

My 5 3/4 yo son is in speech therapy for "r", "l" and "sh". He can't say "th" either but the therapist says that is a 7/8 yo sound. I had a heads up that we might need a speech evaluation because my sister-in-law (a first grade teacher) had already mentioned that he might have a tongue thrust. Then the pediatric dentist asked me if he had a tongue thrust and said that she saw the results of it in his mouth structure. Then when we started phonics and he couldn't say any words starting with "r" or "l", I decided to get the evaluation. 

 

We chose to go with private speech therapy because we could start that immediately while it could take months to get an evaluation and start therapy through the school system.

[lovinmyboys]

If r is the only one he isn't saying, I doubt he will qualify for therapy.

 

One of my kids couldn't say "s" and "f" at 4. He didn't qualify for therapy at first, but I called our local children's hospital and basically begged them to let him have therapy. His name starts with an s and he was four, so it really really bothered him that no one could understand his name or age. The therapist told me that therapy can backfire-a child can become self conscious and stop talking. My son was already self conscious and the therapy was the best thing for him. He only did 10 weeks but he improved so much. He was very motivated.

 

My current five year old also sounds like he is from Boston. He has talked like that ever since he started talking. We are gently starting to work on words like "hurt." I'm not sure what we will do. It is really cute now, but it won't be as cute when he gets older. I think we will wait until he is 6 to pursue anything. He is not self conscious about it.

[PeterPan]

Thanks for your input. I think he struggles with more than just the /r/ sound but I can't pinpoint other letters. I need to pay better attention. For the longest time I just thought he sounded cute but he is starting to be frustrated when other people can't understand him. We get the comment on him sounding like he's from Boston a lot!

 

I'm usually a wait and see person but if getting help early would be better, I'd go that route. I can't say that I'm worried, more just don't want to ignore it if I could do something for him.

 

 

Ok, I want to clarify something here. Articulation and intelligibility are not one in the same. A dc of that age should be 100% intelligible. So that means if a stranger in the grocery store makes conversation while you're in the check out line, they should understand him. Intelligibility is separate from articulation. Someone can be missing letters/sounds and still be intelligible. So the fact that you say he is not INTELLIGIBLE to an expected degree actually is concerning and something an SLP would want to quantify. Intelligibility is affected by multiple factors (that I don't know, because I'm not an SLP). We have monitored it diligently with my ds because he has apraxia. 

 

I agree in general they will not care much about the Rs. However the intelligibility matters, yes. So yeah, I'd put in the call. Your insurance will probably cover it, and it won't be express in the realm of things.

 

I'm also struck by your comment about him being overall late or seemingly behind a bit. That's actually concerning. He might benefit from an OT eval. It's something you could talk with your ped about. As far as whether his language was behind, sometimes when people inventory they don't realize animal sounds count. So your goal is (minimum, absolute positive minimum) 50 words by age 2. And words can include animal sounds. 

 

Anything involving regression or missing minimum developmental targets is concerning. There is the CELF they can run to see how his language acquisition (expressive and receptive) compares to peers. Your mother gut is usually very on, because you're with him the most. You're wise to listen to it.

[Rachel]

Ok, I want to clarify something here. Articulation and intelligibility are not one in the same. A dc of that age should be 100% intelligible. So that means if a stranger in the grocery store makes conversation while you're in the check out line, they should understand him. Intelligibility is separate from articulation. Someone can be missing letters/sounds and still be intelligible. So the fact that you say he is not INTELLIGIBLE to an expected degree actually is concerning and something an SLP would want to quantify. Intelligibility is affected by multiple factors (that I don't know, because I'm not an SLP). We have monitored it diligently with my ds because he has apraxia.

 

I agree in general they will not care much about the Rs. However the intelligibility matters, yes. So yeah, I'd put in the call. Your insurance will probably cover it, and it won't be express in the realm of things.

 

I'm also struck by your comment about him being overall late or seemingly behind a bit. That's actually concerning. He might benefit from an OT eval. It's something you could talk with your ped about. As far as whether his language was behind, sometimes when people inventory they don't realize animal sounds count. So your goal is (minimum, absolute positive minimum) 50 words by age 2. And words can include animal sounds.

 

Anything involving regression or missing minimum developmental targets is concerning. There is the CELF they can run to see how his language acquisition (expressive and receptive) compares to peers. Your mother gut is usually very on, because you're with him the most. You're wise to listen to it.

 

His name is definitely unintelligible to other people. Its 2 syllables and not difficult for other children to pronounce. Other than that he can carry quite the conversation with strangers with them only occasionally missing a word here and there. Even with mispronounced words, he is mostly understood by others. His vocabulary is fine now, I have no worries at all. My older two kids were pretty advanced with language so now having a child that is more average or below average it's hard for me to gauge if that's just how he is, or if it's a concern.

 

An OT evaluation is something I hadn't thought about. He hasn't been as interested in coloring or drawing like his brother and sister were so I've kind of chalked up his not writing well to lack of practice. I did in the last week find some activities for working on fine motor skills and we have been working on them.

 

You all have given me some good things to think about. I'll talk with his pediatrician at his upcoming appointment.

[Crimson Wife]

Ok, I want to clarify something here. Articulation and intelligibility are not one in the same. A dc of that age should be 100% intelligible. So that means if a stranger in the grocery store makes conversation while you're in the check out line, they should understand him. Intelligibility is separate from articulation. Someone can be missing letters/sounds and still be intelligible.

 

Yes, this. My child who is in speech therapy has delayed articulation but is mostly intelligible. The speech goals are targeted towards the sounds that affect intelligibility (substituting /w/ for both /l/ and /r/) rather than the ones that don't hamper her intelligibility (/f/ for voiceless /th/ and /d/ for voiced /th/).

[PeterPan]

His name is definitely unintelligible to other people. Its 2 syllables and not difficult for other children to pronounce. Other than that he can carry quite the conversation with strangers with them only occasionally missing a word here and there. Even with mispronounced words, he is mostly understood by others. 

 

What you're describing, to me, sounds like he's 75-80% intelligible. And I hate to say this, but the charts say he should be 100% intelligible by age 4. 

 

Table 1 - Intelligibility - Caroline Bowen

 

Intelligibility Intelligibility to familiar listeners Intelligibility to unfamiliar ...

 

Yes, talking with your ped would be good. He can give you referrals. It's better to have the evals than not.

[JudoMom]

You might want to check out Super Star Speech. I bought it from (currclick?) somewhere several years ago and had success remediating one of my boys.

[Black-eyed Suzan]

Although I was told that /r/ is a sound some kids don't acquire until 7, you might consider getting an evaluation now to allay any concerns. My oldest has been in speech therapy for articulation for 3 years. I waited to get him evaluated until he was 7. Now I wish we would have started earlier.

[coastalfam]

At age 5 your still good, even six, and then somewhere in the 7 age range I would get an evaluation.

[happypamama]

I took my first son to speech therapy at 7 because he still had some sounds that hadn't come in. I then took my second son at 4 because I loved the therapist and because he had a different issue (could make the sounds but put them in the wrong place). She said that for my little guys, they should be about 75% intelligible to non-family by age 4. Third son spoke very clearly. Fourth son is about to be 4 and isn't 75% intelligible to non-family, so I will be asking for a referral to the therapist for him as well. If you're unsure, ask your child's doctor for a referral and let the speech therapist decide.

[heartlikealion]

My personal experience... when I was a kid apparently there was a neighbor that would come over that did this with her r's. My parents said I started copying her. So supposedly I started talking like Elmer Fudd ("wabbit"). I had some speech in school to address this. No speech since. Honestly I question if that's what really happened but the way my parents describe it, I didn't initially have issues.

 

Now recently I had concerns with my toddler's speech. The ped said she may or may not have a speech issue, but to investigate it just in case (she was frustrated, having trouble communicating and doing a lot of pointing instead of trying to say words. Not saying as many words as they would like for her age). Okay so I contacted Early Intervention (she's 2). It took forever. First we did an intake form where I had to answer a million questions about developmental milestones. Then I was told to come back when the evaluation team was present. Then one of the people couldn't even make it to the appt but they had already made me reschedule twice. Alright so at least the person present was a speech pathologist. Thing is, she just asked me a bunch of questions from a check off list and had dd demonstrate some skills. Most of which had NOTHING to do with speech. In the end they said she didn't qualify for speech and I should call the school district when she turns 3 to see if she needs speech articulation help. Um ok? The speech pathologist didn't seem very concerned, but she also didn't hear dd talk a lot or look inside her mouth. Spoke to two other moms who live in different counties and they both said they took their kids to speech therapists and were told their kid was fine. At least one was still concerned so I suggested she go through the school system since last time she had gone through somewhere else.

 

All this to say I would pursue it but not have high expectations.

[luuknam]

OP, if you want to go through the school district, I'd put in a written request for evals *now*, because the timeline for that is kind of slow, and they'll typically only provide services during the school year, so you'd want any therapy to start as soon as possible after school starts in the fall. 

[...................]

Well I will just say if you live in a state where you can get it at the PS do it. Nowadays they make speech therapy so positive, very fun and for my son it was a wonderful experience! I taught him his r's myself but it was not very fun for either of us and his s-lisp was so bad I finally went to the PS (this was in FL) and they were so kind and welcoming, not judgmental about the homeschooling and he loved the entire experience. They received the state funding for the IEP and we received free speech therapy from a kind and loving teacher. It was a great experience and much better than doing it ourselves. He did all his homework and practice and I also bribed him and his speech was corrected in 6 months :)

 

It's totally possible to fix the Rs yourself at home, there a videos on the internet and special things you can buy at Super Duper publisvatkons ..but having the teacher really helped!

[...................]

Oh yes but it did take a squeaky wheel to get in!!! In had to call the front desk about 6-7 times IN SUMMER, then go back and forth several times with the Special Ed coordinator, just getting an appointment with her took a month, then he had to have the Eval, them the IEP meeting, and finally his first day of class. I started the process in late July and he was not in the class

Until several weeks after school Began.

 

So start calling now!! And of course Always honey never vinegar :)