Four Year Old Speech

[Trelawney]

My four year old's speech therapist plans to graduate him in the next couple of weeks. I've heard a lot of improvement in his speech since he began, but unfortunately, a lot of people still struggle understanding him. His therapist says that he has very advanced syntax and vocabulary for his age, and combined with his age appropriate errors, this is what is continuing to cause his reduced intelligibility, and that this will likely resolve naturally as he matures. I feel nervous about ending speech therapy while others struggle to understand him. Should I get a second opinion? Has anyone else been in this situation, and if so, did it naturally resolve? 

[PeterPan]

Google for the charts on intelligibility. The charts I'm seeing are that he should be 90-100% intelligible. My ds has apraxia, a motor planning problem, and we always tracked his intelligibility carefully. You're definitely right to be concerned, and he should be almost completely intelligible at this point. You usually look at intelligibility in conversations with strangers, grocery line stuff, and that's not usually very complex. My ds has always had very high vocab, but that's not what drives intelligibility. Intelligibility is a combo of a whole bunch of factors (prosody, how the words are connecting, etc. etc.) that all together result in him being understood even if some of the letters aren't there yet. So say he doesn't have his /r/ sound. No biggee, he's STILL supposed to be intelligible. And our SLP never blew that off just because he has a gifted level vocabulary. It was still the goal.

[PeterPan]

Have you read about apraxia to make sure that's not the issue? It's not in the majority of cases. I'm just saying it is a potential explanation for continued intelligibility issues and would explain why the SLP wants to toss him. 

The SLPs are taught not to go way beyond typical development. It's kind of awkward because they don't have charts that say how kids of IQ similar to his would sound. You KNOW they would typically sound pretty good. But for speech, yes, they just look at one set of charts.

So she can be totally legit saying his articulation is age-appropriate. I just don't think that vocab is causing him issues in the grocery store line with strangers, kwim? That's just chit chat.

[sweet2ndchance]

My 5.5yo son has apraxia and has been in therapy since he was almost 2 years old. The SLP is talking about graduating him in about 6 mos, probably around his 6th birthday. His errors are absolutely age appropriate now and he only falls back into old habits when he tries to talk too fast. We include a lot of speech work in teaching him how to read as well. He also corrects himself often when he hears himself struggle to get a sound correct. He will stop, slow down and go sound by sound in the word. Is your son doing any of these things? If my son weren't, I would be concerned about possible graduation as well.

Is this a private SLP you are seeing? Is it possible that she thinks his issues are not severe enough to warrant private speech and speech at school and she believes he will be starting school in the fall? Can you ask the SLP or has she shown you her goals for him and how she assesses how he is doing moving toward those goals? We get a speech progress report 4 times a year that shows her current speech goals for our son, for example right now one of his goals is to produce s-blends with 90% accuracy, which is age appropriate for a 5 year old to make a few mistakes still with s-blends. Then each quarter, she puts a percentage score that represents his accuracy rating according to the speech assessment she gave him to get that percentage. Since our son has apraxia, when he meets one goal, she replaces that goal with another since his speech needed so much work in the beginning.

And graduation isn't always the end of speech. Our son will probably graduate just after his 6th birthday but if his speech falls behind again, for example he turns 8yo and is still making 5yo speech mistakes, we can have him evaluated again and start speech again. If your son really is age appropriate right now but doesn't make age appropriate progress as he gets older, you can put him in speech again.

And yes, if your son isn't intelligible to say, maybe a preschool teacher friend of yours or someone you know who works with preschoolers and kindergarteners daily, I would find a new SLP and get a second opinion.

[Trelawney]

I never thought that maybe he's graduating because she expects the schools to pick this up next year. He is starting to read: just little bits like, "The cat is on the hill." He uses his emerging sounds (L and TH, mostly) more when he reads than when he speaks. He has definitely met his speech goals (substituting d/t for g/c and omitting the s in s blends). When I brought up the continuing intelligibility issue to his current SLP, she had another SLP in the practice take a listen to him and she reported that the other SLP found him completely intelligible. But then we'll go to the park and meet up with other parents, and I'll notice the other parents not understanding him consistently. I don't know if I know anyone who works with this age range daily. ?

[PeterPan]

That seems like a reasonable plan to get speech into his IEP for fall. You could go ahead and write the letter now. He'll be in K5? You can write a letter to the school now, stating that he has been receiving services and has intelligibility issues in the community, when talking with adults, when talking with other children, and that you would like his speech eval'd to see if he would be eligible for services. 

If the SLP is graduating him, you could have a gap of a month or so between service and the evals. Since the IEP process takes time, you'd have that gap anyway.

Hold it, are you planning on homeschooling him or enrolling him? If you're homeschooling him, what are the laws about providing services in your state? If they're not required to provide service, then the evals wouldn't be worth much to you right now.

You might wait a month or two, see how it goes, and then start with a new private SLP. I'm with you that the 2nd opinion within the office seems tacky. Like what, she walks up and says hey I think this kid is intelligible and the mom is whining... She probably didn't say it that way, but still. And yes it's like dentists understanding talk while they're drilling, lol. Our SLP never went by her own opinion, because she saw him too much. She always asked how he was doing in the community, with strangers. That's the gauge.

[sweet2ndchance]

How does he do with other kids? Do the other kids understand him? Does he express frustration or anxiety from not being understood? Is there any way you could record him having a conversation with a neighbor or another parent to show the SLP that you don't think his speech progress is making the jump to spontaneous speech yet and what can be done about that? Does he ever have group therapy sessions with other children so the SLP can evaluate spontaneous speech?

Does your son see a pediatrician or a family doctor? If it's a ped or a family doctor that sees lots of kids, that might be someone you can ask to listen to your son and see if they agree with the SLP that his speech is age appropriate. You could also ask for an evaluation by the SPED department of your local school district. 

[Trelawney]

I will ask about group sessions. Other kids don't seem to mind not understanding what he says. He doesn't seem to mind others not understanding him. He plays a lot of games with other kids where any speech is secondary to movement (knights, Star Wars, etc...). Recording the conversations sound like a good idea. I will have to try to find an unfamiliar adult willing to let me record them. We plan to homeschool him, like his older siblings, and even if we didn't, he has a birthday that misses the kindy cut-off in our area: he'd have another year of pre-K. The schools are legally required to provide services if we can prove educational impact, but in our experience with an older sibling with the local public school, it's hard for homeschoolers to show educational impact for kids who read and write well (which I feel like he is for his age). He had a well-child a couple months ago: his pediatrician actually commented on how much his speech has improved since his last one, but I didn't think to ask the pediatrician if he thought his speech was okay. We will see the ped again soon though, with the constant baby well visits - I will ask next time we bring the baby in if he'd give an opinion. 

[sweet2ndchance]

Since he is still 4 years old, you might be able to get Birth to Five in your area to help prove educational impact. Birth To Five programs go under many different names but every state has a Birth To Five program. You would need to ask at your local health department what agency does develmental evaluations for children under age five in your area to find out the name of the program in your state.But even if they can't help him because he is about to turn 5, they might be able to give you the backing you need to prove to the school district that there is or will be educational impact and he requires services.

Did you talk to the local school or the special education cooridinator for the school district? Often the individuals at the local school have no idea what all special education services can and will do but give their biased opinion anyway, to the detriment of private school and homeschool students who would otherwise qualify for services. Your best bet is to start with the special education cooridinator for the entire school district, don't even worry about the local school just yet. Submit a request, in writing, for an evaluation for services to the district SPED cooridinator. They usually have to respond to all requests within a certain time frame during the school year but I don't know if they do during the summer or if all requests during the summer roll forward to the beginning of the school year. But if they are required to provide services to all students, I would look up the specific law in your state and speak to the district until it is decided whether or not your child will receive services. Individual schools are notorious for giving false information about special education services to parents who ask about having their child evaluated but the child does not attend public school. Sometimes the individuals are simply misinformed themselves and other times they just think they are doing their school a financial favor by detering parents of children who do not attend public school from pursuing their child's legal right to services. Either way, it's just best to cut out all the middle men and deal with those who actually deal with these kinds of cases and know what they are talking about.