Speech and Social Dev. in 20mo

[mlkmnsgrl]

I know a toddler doesn't really fall under homeschool, per se, but I consider you all better parenting experts than the average. So here's my situation:

 

My son wasn't using any words besides Mama, Dadda, and Yah (and that often incorrectly) at 18 mos, so the pediatrician recommended a speech pathologist. She came to our home to assess him and determined that he was delayed not only verbally but also socially. He spends the majority of his time playing happily on his own and becomes frustrated if we try to play with him (unless he initiates it, which he does periodically for 5-10 minutes).

 

So we're a couple months in to 2x/week home visits in which the pathologist brings different toys to try and encourage him to interact. We're also upping our sign language use and making a very concerted effort to provide over-the-top encouragement and feedback when he uses words, or even babbles.

 

Is this just my ds taking his time starting to talk and being an independent soul or have others used very early intervention speech pathology with success? As long as it's worthwhile, we'll keep doing it, but after this many weeks, I don't feel like he's responding to her at all and I'm not sure I'm learning anything new about working with him myself.

 

Thanks for suggestions/experiences!

[Parrothead]

I have absolutely no experience with therapists in general or for children specifically. So if I'm out of line kindly let me know.

 

I find it odd that the person who evaluated your kiddo is the same person getting paid for the therapy. Shouldn't there be an independent evaluation? Then if need be a therapist found to help your son.

[Zuzu822]

I have absolutely no experience with therapists in general or for children specifically. So if I'm out of line kindly let me know.

 

I find it odd that the person who evaluated your kiddo is the same person getting paid for the therapy. Shouldn't there be an independent evaluation? Then if need be a therapist found to help your son.

 

The OP didn't specify, but generally these things are covered by Early Intervention through the county/state. Sometimes the evaluator is also the person providing services, sometimes not. So that doesn't sem odd to me.

 

What does seem odd is the diagnosis that an 18-20 month old is socially delayed because he doesn't play much with others. Parallel play IS developmentally appropriate until sometime between 2-3. Depending on the kid, I'd say even longer. My boys play together, but faced with a group, my 3 yo still generally prefers to play alone or with his brothers.

 

As for the effectiveness of speech, I'm on the fence myself. I think some children are just slower to develop speech, especially boys, and speech is playtime, but not really speeding anything along. I say this as a mother with two children who have qualified for EI speech services, and have still developed at their own pace, and were caught up by three (although the 3 yo is still working on articulation, but he's also THREE, so some sounds are still primitive).

[jplain]

Was he evaluated by your local Early Intervention? If not, try that now, to get a second opinion. It shouldn't cost anything, and should include hearing and vision screens if those haven't already been done.

 

It'll take months to know whether sign language and therapy are making a difference. Definitely don't expect him to be using new signs anytime soon. Though he may understand them sooner, it often takes several months before a child will spontaneously produce a new sign.

 

What does seem odd is the diagnosis that an 18-20 month old is socially delayed because he doesn't play much with others. Parallel play IS developmentally appropriate until sometime between 2-3. Depending on the kid, I'd say even longer.

Yep, definitely agree with this.

 

My older daughter engaged in mostly parallel/associative play until she was 3.5. Even at 4.5 years old she often preferred parallel and associative play. That was just her way of being in the world. With introverts for parents, it surprised no one, including her preschool teachers. Fast forward to 8 years old: she greatly enjoys cooperative play, and rarely chooses to play alone when there are other kids around.

Edited September 12, 2011 by jplain

[Ann@thebeach]

I know there are "averages" for development but all kids are different.

I'm sure many moms here with more than 1 child will tell you that each developed at different rates.

 

My 3rd child was not talking "at age level" when he was 2 or even 3! But he WAS developing, just slower so we never got any assistance.

 

He was totally "normal" with his speech by the time he was 5.

 

A friend of mine got the same assessment for her son at about the same age you did of 18 mos. I encouraged her to wait awhile but she went ahead with the same therapy you're getting. After 3 mos she saw no improvement and felt like her son was just needing his own time. She quit therapy and now at age 5 he's also "normal."

 

If you were seeing lots of improvement then I might think it was an area needing help but without any results it sounds like he's fine.

 

So while I think there is a time and place for therapy, I don't think many children at age 18 mos need it. I would need to see some big delays in many areas to deem it a problem needing therapy rather than just slower than "normal" development. Just my .02

[mlkmnsgrl]

I'm not suspicious about her diagnosis--we had already noted that he's really not interested in interaction. That said, it does appear to be more than just typical parallel play. He's fine with playing regardless of the number of children around and does so pretty typically. The issue is that another kid can come up and throw him down but he won't even acknowledge he's been touched. Or, we'll sit on the floor with him and play with his toys next to him, but we can talk to him, say his name, offer him a toy, etc and he won't even acknowledge our existence. I have to shout his name in a very loud, shocking voice to get him to even glance at me (and yes, his hearing is fine--if he hears a plane or a car outside, he runs to the window from the other side of the room and if he's in the mood, he'll babble back and forth matching sounds I whisper without him looking at my mouth). He just refuses to do anything that he hasn't initiated.

[mlkmnsgrl]

I know there are "averages" for development but all kids are different.

I'm sure many moms here with more than 1 child will tell you that each developed at different rates.

 

My 3rd child was not talking "at age level" when he was 2 or even 3! But he WAS developing, just slower so we never got any assistance.

 

He was totally "normal" with his speech by the time he was 5.

 

A friend of mine got the same assessment for her son at about the same age you did of 18 mos. I encouraged her to wait awhile but she went ahead with the same therapy you're getting. After 3 mos she saw no improvement and felt like her son was just needing his own time. She quit therapy and now at age 5 he's also "normal."

 

If you were seeing lots of improvement then I might think it was an area needing help but without any results it sounds like he's fine.

 

So while I think there is a time and place for therapy, I don't think many children at age 18 mos need it. I would need to see some big delays in many areas to deem it a problem needing therapy rather than just slower than "normal" development. Just my .02

 

That's kind of my feeling--since he's not interested in the learning activities she does with him, maybe he's just not ready. He loves to learn things, but likes to figure it out himself rather than being pushed.

[mlkmnsgrl]

It'll take months to know whether sign language and therapy are making a difference. Definitely don't expect him to be using new signs anytime soon. Though he may understand them sooner, it often takes several months before a child will spontaneously produce a new sign.

 

 

He's picked signs up really quickly, actually and does sometimes use them out of the blue and without prompting to show us he wants food/milk/water/diaper, etc. That right there should probably say that he's just taking his time vocalizing, shouldn't it?

[hmvaughan4]

DS is now 5, but I'll share his story. At age 2, his pedi referred us to First Steps (Indiana's early intervention program). He qualified for speech and also had a social delay. The therapist said that basically every child with a speech delay also qualifies for social delay because they can't communicate with others, hindering their social behavior. I tried one therapist and she told me that I was more qualified than her to provide services and that I could provide better therapy than she could (I have a BS in Early Childhood Education and taught special needs preschool at the time). We found another therapist and she visited him at his daycare. The only feedback I received on his weekly progress report was about his bad behavior. We did put him in speech therapy at our hospital during the summer while I was home from school. That therapist taught him more signs to use, which helped both of us, but didn't necessarily help him with his verbal skills. A few months before he turned three, we took him out of the program. He progressed some, but I honestly do not think it had anything to do with the therapy.

DS2 is following exactly in his footsteps. He understands everything, has excellent receptive language skills, but his expressive is delayed. I know when I take him for his two year check-up that the pedi will want to refer him, but we're not going to pursue it.

How are his receptive skills? I'm sure you do it, but just be sure to talk to him all the time. About everything.

Good luck!

[mlkmnsgrl]

How are his receptive skills? I'm sure you do it, but just be sure to talk to him all the time. About everything.

Good luck!

 

He makes it clear that he understands everything and we do talk to him and around him all the time. Taking that straight from TWTM--I talk about everything we do together and sometimes he babbles back.

 

Thank you all for your quick feedback! I think I'll talk to my dh about maybe setting a date that we'll stop therapy unless something changes (like end of the month or something). I've pulled up our state's Early Intervention program, too, to see if it seems like a second opinion could be helpful.

[TheReader]

It's funny....my youngest had ECI services practically from birth to 2.5 years, for various things. When he started speech therapy (somewhere in there; I forget the actual time line now) he was so stubborn/strong willed/independent/etc... that he would not "learn" any of the things the speech therapist actually worked on.

 

For instance, she really wanted me to work with him on saying "Up!" when he wanted to be picked up (her theory with him being the youngest and me at home all the time was that he didn't have much need to talk, because we knew what he wanted and met his needs w/o him verbalizing them). So, from the very first appointment, we worked on "up" as a word.

 

For the duration of the appts, six months or more (ending when we moved to Brazil), he gained a decent amount in speech. But he would.not.ever. say the word "up." Ever.

 

It was like that the whole time, with everything she started working on. He'd gain words, we'd see improvement, but if she started working on one specific thing, he would.not.do it.

 

All that to say....maybe your little guy is just independent and stubborn, but the absolute refusal to engage if he doesn't initiate would be a red flag for me and I would stick with the therapy. The speech itself wouldn't worry me as much, and if the person coming to work with him is strictly speech I'd maybe ask for an Occupational Therapist instead/also to work on the social delays. But I think a couple of months isn't really long enough to see results, so yes, stick with it. Give at least six months to see improvement and reevaluate then.

[Zuzu822]

He's picked signs up really quickly, actually and does sometimes use them out of the blue and without prompting to show us he wants food/milk/water/diaper, etc. That right there should probably say that he's just taking his time vocalizing, shouldn't it?

 

That sounds like my boys. They didn't babble much as babies, knew sign language, and had very high receptive language skills (years above their ages). They just weren't ready to talk for whatever reason. The youngest babbles much more, so I'm interested to see how his language progresses.

 

DS is now 5, but I'll share his story. At age 2, his pedi referred us to First Steps (Indiana's early intervention program). He qualified for speech and also had a social delay. The therapist said that basically every child with a speech delay also qualifies for social delay because they can't communicate with others, hindering their social behavior. I tried one therapist and she told me that I was more qualified than her to provide services and that I could provide better therapy than she could (I have a BS in Early Childhood Education and taught special needs preschool at the time). We found another therapist and she visited him at his daycare. The only feedback I received on his weekly progress report was about his bad behavior. We did put him in speech therapy at our hospital during the summer while I was home from school. That therapist taught him more signs to use, which helped both of us, but didn't necessarily help him with his verbal skills. A few months before he turned three, we took him out of the program. He progressed some, but I honestly do not think it had anything to do with the therapy.

DS2 is following exactly in his footsteps. He understands everything, has excellent receptive language skills, but his expressive is delayed. I know when I take him for his two year check-up that the pedi will want to refer him, but we're not going to pursue it.

How are his receptive skills? I'm sure you do it, but just be sure to talk to him all the time. About everything.

Good luck!

 

The bolded is interesting to me. Our evaluators and therapists have never indicated that, and it certainly wasn't reflected in scores when the boys were evaluated.

[SKL]

Some kids just take their time to talk. My dd2 didn't say much well past age 2, but I always considered her a good communicator, because she had no trouble letting everyone know what she wanted us to know. My dd1 had more words at an earlier age, but her overall communication was not as good. Today, dd2's speech (age 4.5) is advanced (though not always perfectly clear), while dd1 (almost 5) is still working on some speech issues.

 

My feeling is, if the child is physically able to speak and communicates well in some way, there is nothing to worry about.

 

I'm not a speech expert, just a mom who had a gut feeling that was right.

[sbgrace]

You're noting significant social issues (the lack of response to name and lack of responsive interaction generally being paramount) in addition to the speech delay. A typical 18 month old is usually paying attention to his parents playing next to him, looking back and forth for reactions, showing things to the parent, and responding to attempts at interaction.

 

Is he pointing to show you things of interest? Pointing at all? Waving? I think it's very encouraging that he's taking to signs! Non-verbal is a foundation of communication. That's more important than speech at this point. If he's pointing to show you things and waving that's very encouraging.

 

I'd hesitate to stop therapy with a kid who has issues outside of speech delay and it seems your son does. You don't have enough at this age to know what those other things might mean but they are there and are, in my mind, something that needs addressed. But it also sounds like the therapy might not be effective.

 

The other stuff being delayed is more important than the speech right now. Don't over-focus on speech. Hanen programs might give you tools to make your interactions more effective. I'd actually look at the More Than Words program. As a warning this is geared to autism and he's too young to make that assumption so don't go there--I'm not suggesting that--but this program will cover those social things you've noted and teach you ways to draw him in and engage as well as speech. You want the focus on that stuff. It comes first. It's the motivation for communication and a big part of communication even after speech comes in.

[MeaganS]

I think that in cases like this, Mommy's intuition is worth a thousand words, so go with your gut. It's hard to express my daughter's issues online, and often even with people who have been around her for a few hours don't see them, but they are definitely there. If you think there is something wrong, then continue therapy. If you think more is wrong than they see, search out more channels. Therapy won't hurt him. My daughter loves going to therapy, even though they make her work, so all you're really risking is your time.

 

That said, speech therapy has never really helped my daughter. It did help me when I was seven and couldn't say my "r's" correctly, but my daughter's speech issues aren't pronunciation (well they are, but pronunciation is the least of our worries). I'm not sure how much speech therapy helps little children, but I won't say that it doesn't. I just haven't really seen it in my life personally.

[Momof3littles]

I worked in EI previously as a physical therapist. I was on eval teams and screened speech in my profession. I am not a speech therapist, but agree w/ the PP that the social aspect is a bit of a concern. Obviously, without seeing your DS it is difficult to say how much of a concern, but what you describe falls outside what I would consider typical development.

 

The SLP can help keep an eye on his social development, work on interaction, etc. while working on some of the language as well. For that reason, I would continue. Again, I think the social concerns are the bigger concern from what you are describing.

 

I agree w/ sbgrace.

 

eta: he may mature out of what you are seeing, or may not...it is too early to tell most likely. However, starting now, in case there *are* concerns that there is more going on, can only help. Parents can't always predict which children will mature out of certain behaviors/delays, and even experienced therapists sometimes can't predict which kids will catch up on their own vs. need therapy to catch up. EI tends to cast a wide net in hope of helping as many kids as possible. Many would likely catch up fine on their own, but we can't always tell. IMO it is always more of a concern when you see more than one domain impacted (speech delay *with* the social concern would concern me more than speech delay without concern about social interaction).

Edited September 12, 2011 by Momof3littles

[mlkmnsgrl]

I just wanted to say thanks again for everyone's words of advice and encouragement.

 

DS is just over 2, still testing delayed in speech, but thanks to therapy and increased parental work/know-how he's testing spot on in his social interaction. Of course, now he's also a toddler who likes to throw tantrums if we don't have Mater on 24/7, but then that's a whole different challenge! :001_smile: So, we're continuing therapy, but only once a week so it's not such a scheduling stress for his naps and based on the leaps he takes between each session, I'm confident he'll be caught up within the year. Hurray! Even if that means he was just a late bloomer, I still think the therapy has been worthwhile, if only to help dh and I know what to do to help each of our kids learn and progress in a timely fashion.

 

So thanks again, all!!!!