Imagine sitting in the pediatrician's office. It is your child's 18 month doctor's visit. The pediatrician is going through the communication checklist. He or she nods as you describe the different examples of the milestones. The doctor is asking questions such as 1). Is your child talking in two word phrases? 2). Does your child have 20 or more words? 3). How does your child make requests?
You pause and try to recall examples. You begin to realize that your child may not have 20 words and does not produce two word phrases. Nonetheless, you know they still communicate with you. The pediatrician asks more questions to gain more insight. Then he or she thinks for a second and makes the suggestion. The pediatrician says, "I think you should consider a speech evaluation."
As the parent, your mind begins to race. Your mind goes to multiple narratives. The following questions and thoughts begin to develop:
What does the pediatrician mean that my child needs a speech evaluation?!
How long will my child need speech?
Am I too late?
How did I miss it?
I think my child communicates just fine. I know what he or she needs.
He or she is just a kid. They don't need to know so many words.
As a Speech Language Pathologist, who has navigated this space with families, I want to first and foremost reassure you that your concerns, questions, and emotions are VALID. Your goal is to protect and advocate for your child; therefore, anything that could present as a possible label or concern for your child causes high alert. This is typical.
What does the checklist even mean?
Let's unpack what occurred at the pediatrician. The pediatrician has a basic communication checklist. (see below for an example of some checklists from https://www.asha.org/public/speech/development/12/ The checklist helps them to get an idea for how your child is developing. The pediatrician and the SLP understand and acknowledge that the checklist is not a one size fits all or is a complete representation of your child. It purely helps the pediatrician identify anything that could present as a concern earlier than later.
Hearing and UnderstandingTalking
Birth–3 Months
Startles at loud sounds.
Quiets or smiles when you talk.
Seems to recognize your voice. Quiets if crying.
Birth–3 Months
Makes cooing sounds.
Cries change for different needs.
Smiles at people.
4–6 Months
Moves her eyes in the direction of sounds.
Responds to changes in your tone of voice.
Notices toys that make sounds.
Pays attention to music.
4–6 Months
Coos and babbles when playing alone or with you.
Makes speech-like babbling sounds, like pa, ba, and mi.
Giggles and laughs.
Makes sounds when happy or upset.
7 Months–1 Year
Turns and looks in the direction of sounds.
Looks when you point.
Turns when you call her name.
Understands words for common items and people—words like cup, truck, juice, and daddy.
Starts to respond to simple words and phrases, like “No,” “Come here,” and “Want more?”
Plays games with you, like peek-a-boo and pat-a-cake.
Listens to songs and stories for a short time.
7 Months–1 Year
Babbles long strings of sounds, like mimi upup babababa.
Uses sounds and gestures to get and keep attention.
Points to objects and shows them to others.
Uses gestures like waving bye, reaching for “up,” and shaking his head no.
Imitates different speech sounds.
Says 1 or 2 words, like hi, dog, dada, mama, or uh-oh. This will happen around his first birthday, but sounds may not be clear.
1 Year-2 Years
Hearing and UnderstandingTalking
Points to a few body parts when you ask.
Follows 1-part directions, like "Roll the ball" or "Kiss the baby."
Responds to simple questions, like “Who’s that?” or “Where’s your shoe?”
Listens to simple stories, songs, and rhymes.
Points to pictures in a book when you name them.
Uses a lot of new words.
Uses p, b, m, h, and w in words.
Starts to name pictures in books.
Asks questions, like “What's that?”, “Who’s that?”, and “Where’s kitty?”
Puts 2 words together, like "more apple," "no bed," and "mommy book."
(find more milestones at https://www.asha.org/public/speech/development/12/ )
As challenging as it maybe to hear those words, as an SLP I celebrate when pediatricians do not take the wait and see approach. A proactive doctor is trying to ensure that small problems are addressed earlier, so that they do not become bigger problems.
Waiting to see if a child "grows out" of a possible speech or language disorder can be compared to ignoring a hole in your favorite sweater. At first you noticed the small hole; however, you did not attempt to fix it. Then you wash the sweater, and the hole that was once the size of a quarter is now the size of a baseball. You still give the sweater time. After another load of laundry the sweater now has a hole that could fit your head. This once small hole has gotten bigger, and could have been fixed while it was a smaller hole.
Similarly, a speech or language disorder that is not targeted while a child is younger can result in the child having increased difficulties in school as the academic and social demand increases.
What does a Speech Evaluation Referral Mean?
The referral is your pediatrician suggesting that you allow a certified SLP to complete assessments and explore if your child would benefit from speech and language services. A referral is not a label. A referral is not suggesting severity. A referral is pediatrician noticing possibly area needing improvement. Think of the referral as the check engine soon light. It is not the check engine light, that warrants heightened concern. It is the proactive and precautionary warning light.
What to expect at a Speech Evaluation?
For young children, toys, interviews, observations, and some assessments. Whenever I conduct evaluations, I call the parents ahead of time to inquire about the child's favorite shows, snacks, and activities. I try to prepare the experience and make it as inviting for the child as possible. I strive to make sure the parent and child feels comfortable. I will ask the parent several questions to gain a better picture of the child because the scores on the assessment are part of the bigger picture. Then I observe the child during play and transition to the assessments.
What could the end results be?
At the end of the evaluation there are two more than likely possible options:
Option 1: Your child presents with areas in his or her communication that could benefit from extra assistance. Remember it is better to work on skills earlier than later. Choosing to allow your child to receive services at a younger age will greatly benefit them when they are older.
Option 2: Your child presents with typical communication skills and maybe the day at the pediatrician was an off for the child or you had a hard time remembering all the examples of your child's communication. You received a second opinion to confirm that your child is progressing typically. You did not run the risk of ignoring the referral and your child actually needing extra support.
Take Aways:
A speech and language referral and evaluation are similar to the check engine soon light. When that light comes on, most people take their car to the mechanic to check and see how the car is performing. A speech and language referral as well as evaluation is you taking your child to a professional to see how he or she is performing. As an SLP, I want to help not hinder or label your child unnecessarily.
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