As parents, we are always concerned about our children meeting their milestones. We spend a lot of time worrying if their skills are up to par compared to their peers.
Both of my children received early intervention services. My son received physical therapy for a gross motor delay and my daughter saw an occupational therapist when she was a baby. My background is in speech-language pathology. I spent some of my early years in the field working with babies and toddlers.
Without a doubt, I’ve been on both sides of the table when it comes to early intervention.
In honor of May being Better Hearing and Speech month, I thought I would give you some insight into the early intervention process and some of the questions parents have for me when they find out I’m a speech-language pathologist.
1) What is early intervention?
Early intervention is a service provided to children, from birth until their 3rd birthday, whose skills are considered delayed or disordered, as defined by a state’s special education regulations.
2) When should I be concerned or try to have my child evaluated?
No matter the age of your child, whether they are infants or high schoolers, my answer to this is always, “When, as parents, your gut is telling you there’s something off.”
My son didn’t roll until he was about 8 months old. By 10.5 months, he still wasn’t sturdy while sitting up and he wasn’t crawling. I sat on the fence a bit wondering if I should just give him time. However, I watched him stare at toys two feet away from him, not sure how to get to them. He realized they were out of his reach and wasn’t even trying to move towards them. It was heartbreaking and he was missing out on a lot of important play because of his limited mobility. My gut told me it was time to call in someone who knew more than I did about the subject matter.
As for when you should refer a child for speech, if you’re looking at speech and language milestones, charts give you an average age that children typically acquire skills. It is okay if your child doesn’t have ten words the minute they turn a year old, despite what many people think. There is a normal range of development that many charts don’t really demonstrate.
That said, there are plenty of reasons my gut would tell me to refer my child for a speech and language evaluation.
There are things that are atypical or put up a red flag for me as a professional and would warrant an evaluation. Some examples of things that might concern me both as an SLP and a parent are:
- An unengaged baby. By 4-6 months, you should feel like your baby is paying attention to you. Not only do babies make eye contact with their caregivers, they will often move their little bodies (arms, legs, etc) in response to you talking to them. It is important to remember that communication does not have to be vocal.
- Babies who have not made any cooing noises by 5-7 months. My daughter was cooing by 3-4 months old before she decided that a high pitched scream was much more effective communication mode for a few months. After making sure I lost a little of my hearing, she decided to coo again and babble at about 9.5-10 months. She started imitating words and producing a couple of her own not long after. I didn’t so much worry while she was screaming because she was still a pretty social baby and I heard her coo before she entered that phase. In that case, I chose to give her time. But if I had not heard anything resembling cooing noises by 6 months, or if she stopped responding to my voice, I probably would have referred her for an evaluation.
- If an older baby (8-12 months) doesn’t seem to notice when the caregiver initiates a communicative act with them. Babies should be looking for you when they hear your voice even a bit before this age.
- If you haven’t heard your child produce any consonant sounds by 10-11 months. (/b/ and /d/ are usually very common even by 7-10 months). They don’t have to appear in words. A baby saying /ba ba ba/ is the type of utterance we want to hear.
- An 18-month-old who isn’t gesturing/pointing to indicate that he/she wants something and does not have the verbal language to express this either. Again, nonverbal communication development is very important.
- If your child only has a handful of words by 20 months. Yes, some children do catch up or have a random language explosion after the age of 2. But just because cousin Freddy, “Didn’t say anything until he was 30 months old,” doesn’t mean that it will be the same for your child. Other kids don’t catch up, whether there is a co-occurring medical diagnosis or not. As SLPs, we’d rather you refer your child to us earlier rather than later. There is lots of research that proves therapy outcomes are better for children who are provided with intervention sooner.
- If adults who do not spend time with your two-year-old on a regular basis understand less than 50% of what they say. Young children don’t need to pronounce everything perfectly. However, speech is a problem if they are producing too many or atypical errors for a child their age in conversation.
There are plenty of other reasons I would recommend a speech and language evaluation. These are just a few examples.
If you have a child care provider, they may also express concerns to you. In fact, there are many that are providing developmental screenings for the children they serve. If your childcare provider brings up concerns, you may also consider contacting early intervention for an evaluation to rule out any issues.
For an outside opinion, Vermont residents can contact a “Help Me Grow VT” child development specialist. To do this, call 2-1-1 x6. For more information, consult the additional resources section at the bottom of this article.
You should also consult your pediatrician if you have concerns about your child’s development in any area and listen to their opinion. But be aware that they do not know everything about the speech and language development of children. It is okay to call early intervention even if your doctor isn’t too concerned but you still feel there’s a problem. It is your right by law. As professionals, we do not look at you any differently as parents if you are making the referral versus having your pediatrician do it. You know your child better than anyone else.
2) What does an early intervention evaluation look like?
Usually, a provider or two (depending on the referral) come(s) to your house or see your child at daycare. All evaluations are going to look a bit different. It depends on what the concerns are, how old the child is, and the evaluator’s style.
Generally, the provider will play and engage with your child no matter how young they are. Written reports are great. However, seeing children in action often reveals much more about what is going on than words on a page. Professionals totally understand if your child is shy or unwilling to interact. It happens frequently. The evaluators do the best they can.
Specific standardized testing is also used when culturally appropriate. Some of these tests come in the form of parent interview. Other tests require the professional to con your children into performing tasks demonstrating target skills.
The evaluator will fill in gaps that weren’t revealed during play and/or testing by asking the caregiver more questions.
Before the professionals leave, they may, but don’t always, give you an idea of what their initial thoughts are.
Prior to my own children’s evaluations, I wasn’t too nervous. I already had a good idea of what would happen and was able to mentally prepare. I think parent nerves are perfectly normal, though. You wonder what questions they are going to ask, and if you can answer them with enough detail. You worry about professionals judging your parenting skills or ways of doing things. Maybe you’re worried about how clean your house isn’t because… children.
In response to those concerns, RELAX! As I said before, you know your child best. Professionals won’t judge your parenting skills as long as you’re taking care of your kids. If your house is a mess (yet sanitary), no worries! If you only have time to clear one little spot on the floor that’s comfy enough for an adult and a child, that’s fine. Therapists work with children because they like them. They understand what life with one child or more is like. The evaluation is about helping your child and that’s what the evaluator(s) will focus on.
Then there is the major fear: what will they say might be wrong with my child?
It’s a valid fear. Maybe there is a problem and maybe there isn’t. Maybe the doctor made the referral but you see nothing amiss. Whatever the case, the feeling of unease is normal.
As a parent and a therapist, I hate labels. Even labels as general as “developmental delay” (which is the label they tend to use in children this young). Labels tell me nothing about what an individual child is like or even what their particular strengths and weaknesses are. They don’t define children or their personalities. But, they are real and they help evaluators to justify services.
When this fear rears its ugly head, and it will, remember that you are doing the best thing you can for your child at the current moment as a parent. If your child needs early intervention, it is best to start when they are small. Their brains are little sponges just soaking up all kinds of new information and gaining skills at a more rapid pace than they will when they are older.
3) What does early intervention look like?
Once you get through the evaluation, if your child needs services, the team will start by putting together an Individualized Family Service Plan (IFSP). In Vermont, this is called a One Plan. In a nutshell, it is a flexible document that lays out what services your child and family will receive how services will be provided, and defines your child’s current goals. One Plans are formulated after the evaluation and revised by the team (a coordinator, therapists, and the parents) periodically to make sure everything your child is working toward is appropriate.
As far as early intervention services, whether it be speech therapy, physical therapy, or occupational therapy, a provider will work with the child as specified on the One Plan at a location determined by you and the provider. Like the evaluation, there is going to be lots of play involved. Children, especially younger children, learn best by playing.
I know some parents are often taken aback when the speech-language pathologist comes. They might think, “But they’re just playing with my child,” or “What are they doing that I am not?” I assure you, this play is well thought out. Therapists do have specific goals and targets in mind when playing or helping the child participate in their daily routines.
Only a select few children can sit for flash cards or drills and the like. Skills learned in these situations do not allow the child to transfer their learning into everyday situations right away. By targeting skills in play or in routines, it sets children up to learn to use the skills at home from the beginning.
A large part of the therapist’s job to educate you on how you can work on and improve your child’s skills at home, whether it be in play or within your regular routine.
It is in your child’s best interest for you to participate in therapy as much as possible.
For some, an interventionist comes once per week. For others, it’s once per month. No matter what the schedule, you, as the parent are with your child a lot more than the therapist is. When you use the strategies your therapists provide you with during sessions, that is what will make the largest difference in helping your child.
So, whenever you’re thinking about early intervention, remember to trust your gut when making a referral but don’t panic if your child isn’t reaching the milestones on a chart exactly when it says so. Remember that the evaluation process isn’t meant to label your child. It’s meant as a means to see what help you and your child need for them to be successful in the here and now, and to set them up for success in the future. Finally, know that your participation in therapy is the most important thing to help your child meet their goals.
Speech and Language Milestones:
If you have questions about your child’s development:
Help Me Grow VT or dial 2-1-1 x6 to talk to a Help Me Grow VT child development specialist (M-F 9am-6pm)
Information about Early Intervention in Vermont