Navigating Speech Therapy: The Toddler Years
Navigating the early years of suspected speech delays.
While laying in bed this morning I started reminiscing in a way about the year we took the speech therapy journey with one of our kids. It occurred to me that someone might benefit from some element of our experience so I’m putting my thoughts together about how we sought out help for our child at around 17 months old and why.
You are told kids develop at such different rates and as a parent of multiple kids you start seeing the truth in that statement. I would label myself as more proactive than a wait and see kind of parent in general so with our toddler we were confused as to why she rambled and jibber jabbered all the time but only had a few intelligible words. We planned her entire second birthday party around puppies because doggy was one of her few words at the time!
If memory serves me well I think doggy, mama, dada, hi and maybe bye were her first words and the list just didn’t seem to grow. At some point we had 7. However many of her peers seemed so far ahead in their speech and language skills so after failing to add many more words to the mix we started reaching out to her pediatrician. The opinion there was that two was the age most pediatricians start referring but a parent’s gut instinct was important and she felt it was worth having her evaluated professionally. I have since read that two is waiting too late for many children and an unnecessary starting point if concerns are present. However, if resources are limited where you live and the funds to start an eval are completely out of reach, there is still a good chance by two you will see the progress you are hoping for!
The one thing I wish I had known was that Georgia has a Babies Can’t Wait program where children under three are evaluated for free for developmental delays. By the time I learned about that we had paid about $500 towards our deductible with insurance to have testing done on just the speech component and multiple hearing tests (one of which we failed due to a hidden ear infection). By the time we got our referral in to Babies Can’t Wait, we had spent a chunk of change and the testing they offered was more holistic looking at social, emotional, cognitive skills, etc. We scored quite poorly in enough categories to warrant inclusion in their in home therapy program for speech.
The challenge for us as we started this journey well before the age of two was figuring out the most affordable way forward. Speech therapy is often not covered by many insurances. The beautiful thing about Georgia and states with a similar program to BCW is if you qualify they provide sliding scale therapy sessions no matter your financial picture. For many, the services are free. The challenge we found was a huge demand and not enough therapists in our area during times that we could make work but we did get a time slot for a few months. For families who have multiple children and taking a child somewhere would be quite challenging this can be a huge resource! We found that our daughter could not focus at our house and the sessions were only 30 minutes so getting a lot accomplished could be a challenge. Our sweet therapist was often dealing with lunch time traffic and running late as well. I also felt guilt because we were taking a spot from someone else when arguably we could afford the copay from our insurance to go out of the house.
Thankfully our insurance did include speech therapy using a negotiated copay with our local children's hospital (CHOA for the Atlanta folks). We were incredibly fortunate that we lived nearby the location where the therapy center is located. While lugging my never sit still toddler through the large parking deck each week and up to check in while pregnant was not exactly relaxing, I found going to their office for her therapy sessions to be a better fit for her. Each session took place one on one in a small office meant for kids and I was allowed to be there and watch or I could leave to watch using a video monitor and headphones if she was distracted by me.
I was able to video activities to share with my husband and for my own recollection and watch as the therapist clued me in as to how to work with my daughter at home and what tips and tricks I may have never considered when helping her. The biggest takeaway for me at the time was asking my daughter to use her words. It had never occurred to me to do that simple thing when she was throwing a fit or using gestures. So instead of letting her grunt about wanting something off the counter, I had to push pause and ask her "Do you want this spoon?" and then she would nod so I would say "Tell mommy SPOON!" Once she would say spoon, she could finally have it. So simple but I used to just try to decipher her grunts! I also tried to teach my husband and the grandparents little tips that might help her when they were with her as well.
For someone who does not have insurance and cannot access Babies Can't Wait and is looking at the cost of therapy at upwards of $75/hour, I have a few thoughts about how to move forward once you determine your child needs help. If you cannot afford or access an evaluation to get a formal diagnosis or feel you may just be jumping the gun with your concerns, I recommend researching blogs and articles online that are written by therapists and that can tip you off to what is a reasonable expectations for your child's age. While parenting forums and Facebook groups can be rife with opinions, I have often found that there is one parent at least who has walked a similar walk and had similar concerns who provides useful advice. This is how I learned that we had Babies Can't Wait available to us in Georgia.
Beyond the services the organization was providing to us at the time, BCW follows your child through the age of three and came to our preschool to do a final evaluation. If your child remains eligible for services at three, you then get fed into the local school system and start receiving services through your local school from 3-5. A big reason for getting into BCW even if you don't use their therapy services is to ensure a more seamless transition into school services as your eligibility is already proven and they already have a record of your child. Otherwise, you basically have to start from scratch if you have an older child and did not use Babies Can't Wait. The process is so exhausting when you start from scratch to get your child the help they need that I STRONGLY encourage any Georgia families to make use of Babies Can't Wait even if just for the ease of transitions into school services. If it takes a long wait to get an evaluation don't give up the spot even if you go a different route for an initial evaluation and therapy.
Also, note that if your child has had ear infections or often pulls at ears or seems fussy, ear infections and hearing issues can drastically delay a child's speech. This fact alone to me would warrant seeking out a physician for help with a referral. When we took our daughter for her first hearing test, she freaked out and they noted that she had fluid in her ears. Apparently she had double ear infections and was only bothered by them when someone tried to put something in her ear! Looking back my daughter's only real illnesses were ear infections that were hitting every few months starting around the end of her first year. So by the time we started getting concerned at 17 months, the poor thing had had numerous time periods of impaired hearing, something key to learning how to talk!!!
If speaking with your doctor, doing your own research from reputable sources and getting a pulse from other parents who may have had similar concerns leads you to the speech therapy journey, I highly recommend you take off with helping your child sooner than later. It turned out beyond speech my daughter had some other occupational therapy in her future. Because we were on the speech path, the other concerns were identified sooner and we have had teachers engaged and observing her since the beginning of her preschool experience. Now in Kindergarten, while we are blessed to be in an inclusive class, she has pretty much caught up on the big ticket concerns that stood out from the beginning. I truly do not believe she would be as far along as she is now without getting help so early. My husband and I are aware of what to watch for, dyslexia, for one and have our eyes open as she starts her elementary school days.
No matter how smart you may be or how many children you may have had, there is always something that will throw you off when raising kids. For instance, a third child may be the first child you have that doesn't talk early. Even having experience parenting two other children, the child in need of speech support may surprise and mystify. I hate that finances and access to help are often the reason children do not get the help they need. Below I list a few ideas I have for a parent who does not have insurance and is living in a state that lacks the resources for early intervention.
1. Shop around. If looking for an evaluation and the initial quote you get is hard to swallow, keep calling around. You may be able to find a practitioner that works on sliding scale. Also, make sure you research what resources your state or county provides for child development. I could have saved money if I had known from the beginning we had a program here!
2. Take a stab at YouTube videos from licensed practitioners or experts in the field. Work with your child at home doing activities you learn from these resources. Reading about speech development and borrowing books from your local library can be helpful as well.
3. If you feel a professional is needed and the hourly rates are beyond what you can afford, consider a few ways forward...I reached out on my NextDoor local network to see if anyone in my area had experience with speech or young children with learning disabilities. I found a teacher off for the summer that came and worked with my daughter for $15/hour. I was able to show babysitters and family members video from some of our therapy appointments so everyone could work with my daughter in an impactful way. So, say you can afford one therapy appointment per month even though weekly appointments are encouraged. I would ask the therapist for notes and handouts regarding activities or tips to use at home. Also try to video the activities they are doing in the office and replicate those at home in between appointments. A lot of therapy for us was replication but I was clueless as to what to do to help my child.
4. If your child attends preschool, ask if they offer screenings for vision and speech. Our preschool offered screenings for $35 twice per year. You may also find a preschool teacher available to work an extra 45 minutes or so with your child after school once per week. If you don't attend a preschool or daycare, consider calling a local one to see if they do screenings and you can bring your child in or if they have a staff member who offers tutoring that may have the experience to help your child on the side.
If the tips above still seem far out of reach for you from a resource perspective, I encourage you to reach out to a social worker at a local non-profit organization that helps children. From there, you can learn what other options may be available and what non-profit groups in your area offer support services.
Being several years out from this journey, I am sure things have changed and rules of thumb are always shifting when it comes to child development. However, I hope no one lets the cost of lack of access to a service keep them from getting help for their child. If you are determined to get the help you need for your family, I strongly believe you will find the resources in the end.