Early intervention for late speaking child

[Penny_P]

DS23mo. is a late talker. The ped. recommended that I have him evaluated just to get into the "system", but wasn't particularly alarmed. DS10 didn't talk much until 2.5 or even 3. He has dyslexia and has speech therapy. I didn't even know about early intervention. Little DS speaks maybe 20 words/phrases inconsistently and unclearly.

 

After an evaluation it appears that my son does "need" therapy. The state will pay for a portion, but because of our income we don't qualify for a very high percentage. Our insurance won't cover any. Sigh. How important is speech therapy for a toddler? Will it help prevent some of the speech issues that DS1 has, really? What say the hive?

[Murmer]

I personally think that early intervention is important....but isn't there a way you can get it free? I know our early intervention is all free regardless of income or insurance...Getting the help now while they are little means that they may not need it when they are older. It can also catch other problems before they become a big deal. Good luck with the decision its hard when it ends up costing money.

[wonderchica]

Have you asked the exact cost? I work for our state's early intervention program. Each program is different and in some states you may pay a percentage due to your income. In our state (and I believe all), the therapy agencies are only allowed to charge the Medicaid rate which is generally $40-50 lower than their typical rate. Then you would pay the percentage of that rate assigned by the state if insurance doesn't cover. For example, in NC speech therapy is $68.25 per unit (Medicaid rate). A family with a 20% sliding fee scale would pay $13 and some change.

 

How often did they recommend therapy?

[PeterPan]

You asked if it's important and if it would actually help or change the course of things. Well that depends on what kind of therapy you get and whether you get the right diagnosis. Sometimes EI and SLP's will label it as a delay when it's actually apraxia (motor control, read about it). Apraxia is totally different and doesn't always respond well to regular speech therapy. So you'll meet people in your shoes who do the speech therapy (regular therapy) and get minimal results, and the problem was wrong therapy, wrong diagnosis.

 

My ds started PROMPT for speech therapy with a certified PROMPT therapist http://www.promptinstitute.com when he was newly 2. At that time he had one word (mama) and two sounds (m, a). That was it. He is diagnosed with moderate verbal apraxia. A year later he blends in with his peers and is generally intelligible. He'll continue speech therapy till at least 5, but it has RADICALLY changed the course of where he would have been. Some apraxic children come through it fine. Some begin to speak but are more reserved or have articulation problems. Or they'll talk really, really fast and be unintelligible. Or, like mine, they simple won't learn to talk.

 

So I wouldn't hestitate to get speech therapy at this age if you have the right diagnosis and know what's going on. But when you start saying late talkers, dyslexia, you're looking at apraxia, not a developmental delay. And if it's apraxia, no, I'd keep looking beyond a regular speech therapist. PROMPT is amazing, because its goal is to teach *you* how to carry it over at home. It's less about what the therapist does in the session and more about empowering you to help him at home. Homeschoolers are all over that. :)

[Penny_P]

In the ideal situation (read: if we can afford it), they recommend therapy once a week. The cost is $80/hr, but you pay a percentage based on your income. Unfortunately, I think that percentage based on our income could be high. They did say that if only one W2 is submitted to show income from the lower income (mine) that they never do any follow-up to check out the facts (but of course I didn't hear it from them- wink, wink). The paper work specifically asks for all W2 forms, so I have a real ethical issue with that. We have a lot of costs coming up- renters moving out of our now semi-trashed house, baby coming, big trip coming that we've planned for 6 months...

 

Anyway, THAT's why I was wondering how important early intervention for speech really is for a normally developing kiddo. The pathologist, although not warm and fuzzy, was chalk full of good information for me, so maybe just a few sessions that would help teach ME how to teach HIM better.

 

ETA: It USED to be free I guess, but with state budget cuts, etc.....

Edited October 28, 2011 by Penny_P

[sbgrace]

You might be surprised. A friend whose husband is in the six figure range paid the maximum and it was still cheap.

 

I do think appropriate therapy, especially given his family history, started early is best. If what you get through EI is quality it would be well worth it I'd think. If it were just delay I'd suggest material for you to work on it yourself but given his family history it really sounds like this is very likely motor/articulation type things that probably need expert intervention.

 

When does EI in your state transfer over to the school system for therapy? That's another thing to think about. Being in the EI system may help you get services in a more timely manner from the school system. Typically schools take over at three years but a child in the EI system will often start the process around 2.5. At least that has been my experience.

[wonderchica]

If you can afford it, even on a temporary basis, I would do it. As I'm sure you already know, the 30 minutes a week with the SLP isn't what's going to "make him talk". Early intervention SHOULD be all about teaching the parent effective ways to work with their child in the natural environment. That's what makes a huge difference.

 

And to add to the previous poster, county schools take over services at age 3 (Part B) for all children who qualify. Early intervention (Part C) usually begins that process around 2.5. If you wait and want services after the child turns 3, it won't be automatic and can take up to 3 months (in our state anyway). If you start now with EI and decide to continue you won't lose any therapy time during the transition.

 

ETA: Not to add any pressure, but if he's only saying 20 words/phrases his speech isn't "normally developing". He may be developing normally in other areas, but that's definitely a delay. A 24 month old child with normal speech development says at least 50-70 words and can use 2-3 word phrases.

Edited October 28, 2011 by wonderchica
to add

[Renee in NC]

Yes, do it! If I had gotten early help with my boys, they would be better off for it now. My 2yo is in speech therapy now because I was *not* going to repeat that mistake. I heard a lot of, "Boys mature later, don't worry he will talk eventually, etc." Don't believe it! Language issues are real and can continue even into the teen years and beyond. I can't get back all those years of low vocabulary acquisition.

[Murmer]

Also if you let them know your situation they may work even more with you...we are getting some therapy for dd that is covered if you have medicaid but if not it is a sliding scale...we make way more than the sliding scale but the therapist saw how much we needed and knows about our financial needs and made a special arrangement...it is still a pinch to the budget but my dd needs it and it is helping her

[AmyinMD]

Yes, do it! If I had gotten early help with my boys, they would be better off for it now. My 2yo is in speech therapy now because I was *not* going to repeat that mistake. I heard a lot of, "Boys mature later, don't worry he will talk eventually, etc." Don't believe it! Language issues are real and can continue even into the teen years and beyond. I can't get back all those years of low vocabulary acquisition.

 

I bought into this and I really regret it. My older son actually was a late talker. I assumed my second son was as well and held off way longer than I should have getting him services.

 

That being said there is a huge difference between a great speech therapist and a mediocre speech therapist. We've worked with 4 different ones and 2 were fabulous. With those sessions I was usually amazed at all the stuff the speech therapist could get my ds to say.

[historically accurate]

We used EI for my middle dd. She has apraxia (very mild now 4 years later). We still use the same therapist we were assigned when she turned 2; we kept her after dd aged out. We talked to the school district, EI automatically sets up the appts. to transfer the child to the school district. After the comment one of the school testers said "Your dd is the most well-behaved speech delayed child I've ever seen", I really couldn't see putting her in a class 5x a week with 20+ speech delayed child. That, and the school district wouldn't provide any physical therapy for her. They work to get the child up to a level where they could function in a classroom; she was already there.

 

As far as the sliding scale, dd qualified for PT & ST both 1x per week; although I fought for 2x per week speech, they only did 1x per week. Our payment out of pocket was supposed to be $20 per week -- $10 a session. However, because of their bureaucracy, I guess, we only paid about $50 for the year. They just forgot (?) to bill us.

 

I'm a big fan of early intervention when it comes to speech. Although dd is still missing some sounds at age 6, she's almost able to be understood by everyone. Some people have trouble, but most people are able to understand most of her speech.

 

Since your older child has speech difficulties, I would definitely try to swing the price for therapy. You could keep looking to see if you could find a PROMPT therapist, but they are few & far between in my area. Dyslexia may mean it's apraxia rather than just a phonological delay. It's easier to resolve any issues the younger the child is.

[PeterPan]

If it's any consolation, we pay $100 an hour. I'd be concerned about what you're saying, that you didn't really like the SLP as a person. She's going to be spending a lot of time with your dc, trying to get him to do things that make him tired. Our SLP turns on the charm big time. They play games, she tickles him, she does a really high-pitched voice. It's just very engaging and kid-appropriate.

 

Someone else suggested they can't "make" the dc talk. When you have a late talker, you're trying to sort through whether the dc has a developmental delay or a motor control problem (apraxia). If it's apraxia, in fact the right therapy CAN help the dc talk immediately. In my ds' first therapy session he said multiple, multiple words (put, on, me, more, do, etc.) over and over and over again. This the child who had NO words in general interaction, only one word if you really pried it out of him. If it's motor control, then it's all inside, wanting to come out. Read some books about it. PROMPT is amazing and totally different from regular therapy. We put our hands on the articulators, making the sensory connections. It literally unlocks him to talk. No flashcards or "communication" junk like the regular speech therapist was going to do.

 

We took a vacation to Alaska for two weeks for my dh's 40th birthday before we started speech therapy. I understand what you're saying there about wanting to go, but I would consider spending a little *less* and saving some to be able to do the speech. The other thing is to find unusual sources of money. Do you use any credit cards with cash rewards? If you do, those can add up and be another way to pay for the speech therapy.

[PeterPan]

Since your older child has speech difficulties, I would definitely try to swing the price for therapy. You could keep looking to see if you could find a PROMPT therapist, but they are few & far between in my area. Dyslexia may mean it's apraxia rather than just a phonological delay. It's easier to resolve any issues the younger the child is.

 

The PROMPT website now has an interactive map to help people find the therapists. If the op is going on vacation, what she might do is coordinate that with seeing someone. It is true that our therapist is the only person certified in the technique for a multi-state drive. People come from very far to use her. They'll come in for a week, do intensive therapy, then go home and have the parent implement things.

 

It's *worth* the effort to find someone like that and to get the right diagnosis. In the south btw there were a lot more options. You just never know what you'll find till you (the op) look at the map.

 

http://www.youtube.com/watch?v=oa9KOMtY-N0 Here's a video about PROMPT. I know I keep harping on that, but it has been *amazing* for us. The right diagnosis and the right therapy make a radical difference. At this point we only go every other week (because I work with him at home), and starting in December we may trim that back to once a month. She's going to be testing him to see where he's at, but that's just astonishing to me that someone with moderate apraxia could go from nothing to almost age-appropriate in a year, appropriate enough that, with lots of work at home and monthly sessions, he can continue to develop speech and be normal by age 5 (which is what she has said he's on track for). So we're not talking once a week for 6 years. With PROMPT it was once a week for several months, backing off to every other week with lots of work at home, and soon backing off to once a month.

 

BTW, if it is apraxia, books like "The Late Talker" also have recommendations on supplements. We find food and the proper oils make a BIG difference in his speech. We also started some enzyme supplements with him on the advice of the SLP.

[wonderchica]

 

Someone else suggested they can't "make" the dc talk.

I said the 30 minutes per week is not what's going to "make him talk". Just to clarify, my point was that the work you do with your child daily, using the suggestions provided by the SLP, is what's going to make the biggest difference in your child's speech. You have to put in the work at home to get the results. I have known lots of parents who took their child to speech therapy 30 minutes a week and didn't implement the strategies at home, and then wondered why their child wasn't making progress. Not suggesting this is what OP would do, just given a suggestion to possibly help stretch the budget further. Do the sessions for as long as you can afford and really push him at home at the same time. That's how progress is made.

[Penny_P]

Well, I submitted the paperwork, and I will keep my fingers crossed that the cost won't be too bad. The speech pathologist was adament that their job was primarily to teach me. I'll check out your link, OhElizabeth.