Many visitors to Children's Speech Care Center are “first-timer parents” in the world of pediatric speech and language issues. Accordingly, they know very little and are just starting to get educated in these matters. Additionally, we do receive calls from families that are further along in the process, and are quite well educated on the subject.
In the interest of this chronological gap in family involvement with speech and language issues, it will perhaps be easier for everyone if we start at the beginning.
The identification, or at least the suspicion, that your child has a speech and language (S/L) difficulty can become apparent via a number of individuals in your child’s life. .
It is not unusual for parents or other family members, (Grandma, Uncle Joe or brother David) to notice that your child is showing difficulty in speech and language development.
Often you, or that other person, may not know how to put these suspicions into words—but you or they know something is out of the ordinary. We have found that this “intuition” is often very accurate.
Concerns may also come from people outside the family. Examples include baby-sitters, friends, preschool teachers, elementary school teachers, middle or high school teachers, your pediatrician, a hearing specialist (audiologist) or a dentist may bring your child’s speech to your attention.
Since language development begins very early in life and can best be treated when the problem is identified at the earliest possible moment, it is always wise to follow up any indication from any source regarding your child’s possible speech and language challenges.
If a non-clinical person (not a medical or allied health professional) suspects a problem, one of the first places to visit is your pediatrician’s office. Express your concerns by describing in your own words what you feel is the problem. If there is a problem, your doctor will most likely write a prescription (or “referral”) for an evaluation by a certified Speech Pathologist. If your pediatrician does not do this, and you are still concerned, ask your pediatrician to make a referral for an evaluation.
Sometimes children can exhibit a condition known as “delayed” speech and/or language. This means that they are not following the general “norms” (http://www.speechdelay.com/testrosemilestones1.htm) in terms of the timing and sequence by which children typically develop speech and language skills. This sequence and timing of skills is carried out from birth over many years, with bulk of it occurring relatively early in childhood. The following link may be helpful: http://www.worldbank.org/children/what/.
When children’s performances do not fit the typical developmental norms, they may be viewed as Speech/Language Delayed. Since the “typical child” is hypothetical (meaning that children’s development is highly variable across individuals), a variance may not be a problem at all. This is why most, if not all, insurance companies do not cover “delayed speech.” Their view is that children will grow out of it—and in fact, depending on the type and degree of variance, many children do. However, a speech and language evaluation (for our purposes, an “evaluation” and an “assessment” are the same) will uncover more detailed information, which will help clarify this issue. It should be remembered that although many children “outgrow” their developmental “lag,” many also do not. A speech/language pathologist can help you determine the nature and severity of the discrepancy and whether intervention is warranted.
There are basically three avenues for obtaining an evaluation. However, in each case, an evaluation must be administered and interpreted by a qualified Speech and Language Pathologist (also called a Speech Therapist).
Private clinics, of course, must charge for their evaluations. Prices and scopes of evaluations vary from clinic to clinic, and you should investigate these issues to suit your own personal needs. Private evaluations are sometimes more costly, although this is not necessarily the case at every private clinic, as stated above. Make sure to ask a speech/language pathologist about the scope and cost of an evaluation.
If your child is a preschooler (between 3-5 years) or school-aged, you are entitled to an evaluation by the California Department of Education. Contact your local school district for help.
If your child is below three years of age, you may seek assistance from one of the Regional Centers in your state. These are non-profit, privately owned centers that work with state governments under the Lanterman Act. The Lanterman Act ensures that each state citizen can receive assistance for disabilities.
You may also have your child evaluated at a private clinic—as your first choice or as a second opinion. Private evaluations tend to be very comprehensive. These private clinics are working only for you and your child and many tend to be family-centered. Also, they do not have the same rules and restrictions that other agencies may have. For example, ability to qualify for a service may be different. However, each setting has its advantages. The other alternatives are viable and qualified means for the provision of services, and you should investigate all options available to you.
A person can have multiple ICD codes. This is not uncommon with speech and language disorders.
If your child is diagnosed with a speech and language disorder, you must decide where to have him/her treated. Our view on selecting a private speech and language clinic can be found in section Selecting a speech and language clinic that is right for you. We will also talk a little bit about other options later on.
The evaluation has indicated that your child definitely needs treatment, that he/she may be “at risk” for a problem and needs to be re-evaluated at a later date, or that he/she does not need treatment.
You will receive a copy of the evaluation, and you should provide your pediatrician with a copy for him/her to review, discuss with you (and the speech pathologist, at your request), and place in your child’s medical file.
Should your child need treatment, you will next decide where to take him/her. We address this issue in Selecting a speech and language clinic that is right for you.
We suggest at this point that you begin the process of your own education before you enroll your child in treatment, so you can more fully understand his/her difficulties and the challenges that these may present to the whole family. This discussion is covered in the next section “Getting educated and keeping up to date.”