How do I choose a speech therapist/center...

[ZeeMommy]

Last week my kids and I were at a bagel shop for lunch.  Another boy the same age as my son came over when he saw my toddler playing with my phone.  They all made friends with each other quickly.  I was bothered but not surprised when the other boy kept saying to my son, "I can't understand what you're saying."  This was the first obvious encounter where someone has said that my son's speech is hard to understand.  One grandpa has trouble, but he also wears hearing aids.  Others ask my son to repeat what he says, but they usually figure it out.  We know that he has trouble with saying Rs and Ls (all sound like Ws).  He whacked one of his front top teeth when he was two; tooth died and eventually had to be pulled, so he's spent most of his life with a gap there.  So, his dad and I are thinking that speech therapy is probably needed.  Now I need to pick a therapist, and I have no clue what to look for.  Pediatric would be an obvious choice - what else do I need to know, expect, ask about?      

[Jean in Newcastle]

Your son is 5?  Most speech therapists will not work on r's yet at that age because it is a developmentally late sound.  

[ZeeMommy]

I'm more concerned that the tooth loss is causing him to mispronounce words/sounds, and that it will become a habit that would continue even after he gets that permanent front tooth in.  I showed him the other day how to pronounce the L sound by putting tongue to front top teeth - he could make the sound correctly that way, but when I asked him to say "lemon" it came out "l-wemon". 

[redsquirrel]

I agree that 'r' is a late sound, but sound replacement (w for r) is a really common problem and they deal with it all the time. If it is just the sound replacement then it might go away on it's own. But, you could get him evaluated just to make sure. There might be other issues a therapist can hear. At 5, most people should be able to understand what he says. It might be an ineligibility issue such as speed, breath control etc.

 

And my son lost his two front teeth at a very young age (naturally) and then it took a year for new teeth to begin to come in. After over 6 months without front teeth he began to develop a slight lisp and I got worried. My younger son had in home speech therapy from early intervention and the therapist said that it could be a concern. She listened to him and agreed it was very slight, but said if it didn't go away quickly once the teeth started coming in to have him evaluated. Mostly what I am trying say, badly, is that speech problems due to tooth loss can be an issue, but it might also resolve. It was important to her that he never had a lisp before he lost the teeth. She believed that made it likely it would resolve. So, did your son have the sound replacement before he lost his teeth?

 

If your son is 5 then it is likely that your local public school is in charge of evaluations. you should also look into the rules around speech therapy and homeschooled kids. My state has full and equal access, but I know other folks aren't so lucky.

[praisefor3]

If you live near a university you might start there. Our oldest is in grad school to become an SLP and they have a full program for helping kids...especially if you aren't sure if he needs treatment our not.

[kwg]

My son started when he was 5 at our local school.  I called them, explained I was a homeschooler and they tested him.  He gets a certain number of sessions a year (and they made sure to tell me that he would have unlimited if he went to school..lol).  

 

I started with my pediatrician who referred me to the school.

[theYoungerMrsWarde]

We're getting speech therapy at the local school for free, even as homeschoolers.

[PeterPan]

My ds, newly 5, has been in ST since he was newly 2 because he has moderate verbal apraxia.  It's a motor control problem and not a developmental delay or timing issue.  He pulled a chair on himself a few months after we started ST and knocked out his 2 front, top teeth. How is your ds' /t/?  You need a dental stop for /t/ and the voiced /d/, so sometimes you'll get tongue protrusion there when the teeth are missing.  The SLP wanted him to get a flipper, but I opted to do more of a manual approach, placing my thumb in the space to physically create the stop.  At this point we just watch it to make sure the tongue is not protruding and he can focus on bringing his tongue in.

 

The /l/ and /r/ sounds are formative for him at this stage.  They do not use the front teeth, so there shouldn't be a correlation there.  The tongue has to go up in the mouth a particular way.  She has said if he hits them 60% or more of the time in speech, she's happy that he's on track developmentally.  So perfect, 100% at newly 5 isn't necessary.  We've actually backed off on our ST, because she's feels he's on-track and hitting developmental limits.  As the others said, you don't just do therapy, do therapy.  There's a sense of what's developmentally appropriate.

 

Does he attempt /th/ or let it degrade to another sound?  Because my ds is missing both front upper teeth, he essentially can't hit /th/.  She has worked on the motor control for it a bit, because it is developmentally appropriate, but she has decided not to work on it intensely till his teeth come in, which we assume won't be till he's 6-ish, a full year or more.  So you're going to hit some limits.

 

Does he have any sensory symptoms?  Have you inventoried all his sounds to see what he's not hitting?  To whom is he unintelligible and to what degree?  What percentage of his speech do people in the store or new acquaintances understand?  Does he speak rapidly, have trouble blowing bubbles or making faces?  Did he miss any developmental milestones?  These are all things that can help you put the things you're seeing into a larger context and figure out if it's an isolated letter thing or part of a bigger issue.

 

SLPs definitely vary.  Around here, the EI SLP was an utter newbie and certainly not trained in the current best techniques for apraxia.  The school SLPs around here are not trained in it either.  Only about 10% of kids with speech delays have apraxia, but it's dastardly hard to treat.  That means there's a whole segment of kids not getting optimally treated.  With apraxia, you basically have to strongly suspect the diagnosis and find the right ST to start with, before you can even get the correct person to diagnose at treat it.  Crazy.  Unintelligibility can be a flag for apraxia.  Slim chance, but possible.  My experience looking for SLPs to treat my ds has left me pretty skeptical.  I'd be very careful to determine the degree of what you've got going on.  Results are what matters, and it really depends on the situation as to whether the free ST services through the school system will be adequate or not.

[ZeeMommy]

A belated thanks to everyone who answered!  OhElizabeth, yours was especially helpful.  It turns out that another homeschooling mom friend has a friend who is a speech therapist, so a conversation with her is in the near future, if she's willing to do that.  Otherwise I've decided to get him evaluated; its just a matter of picking a therapy center/therapist.  I'd rather not go through the local school system, even if it is free.  Our health insurance does cover speech therapy - might as well use all the money we pay into it to pay for something we need.