New to EI for speech. Is this normal?--updated

[naismama]

Hi all. I am new to this particular forum, and I'd love some feedback from those of you moms who are familiar with speech therapy.

My son is 30 months old and has been pretty behind in speech, I think. I called early intervention, he was initialy evaluated by a developmental specialist and a speech therapist. They found that he had neither a developmental delay nor a speech delay, but that his articulation was so lacking that they made him eligible for services. He is very hard to understand and almost always leaves the end off words. He has vowel sounds but not as many consonants as he should; he can neither make an "s" sound nor a "k" sound. They also referred him to an OT who came to the house last week to evaluate him, and I have not heard back from her yet.

Today was ds's first therapy session. The therapist says she wants to come to the house weekly for about a month to get him ready for the phonological program (2-5 times a week at a therapy center). While she was here she admitted she was "really tough on him" (her words) to see "where he is and how much he can take." DS did okay, but I feel that he is lacking in receptive language and was not getting all of her instructions. She kept directing him to sit criss-cross applesauce and put his hands in his lap, saying that his trunk is weak because he is always wanting to lean on his hands. DS went along with the exercises and rewards fine, but started to get frustrated with her continually positioning him. At one point she had him sit on a little stool and reach for the rewards (little coins to put in a singing piggy bank). She said he was moving too much and needed to be still. I felt like he was just being an active toddler, and I do not understand why he needs to be cross-legged and still to do speech therapy--Do any of you know? I know, I should have asked her...I do not know where my mind was. Anyway, ds got really frustrated with her moving him and eventually he hit her. DH and I have been working with him on hitting; he does it when someone says something he doesn't like. The therapist said we should remind him to "use his words." In a manner of speaking, that is what I have been doing. I was so embarassed, and she said she "wasn't mad at him, it's ok" but she wants to get a behavioral therapist over for an evaluation. She and I both agreed that he is hitting out of frustration, and we need to work on his speech so that he can respond with word and not hitting. So why call a behavior specialist? When I questioned it and asked isn't it normal for a 2yo to get frustrated like that, she said that his behavior is "not normal." And please don't lecture me about how bad and horrible hitting is and how I shouldn't make excuses for my son. I don't condone the hitting at all, and my confusion is not just about that... But I've gone from being mildly concerned about a delay (I say mildly bc my older dc is very verbal, and I haven't wanted to compare him to her. Also, my mil said my dh did not talk until he was 3) to having all these specialists called and coming to my house and worrying that my child has all these issues. The session today upset me because I feel that ds was uncharacteristically quiet and withdrawn after the therapist left. Near the end of her visit he crawled into my lap and started rooting around at my shirt (he nurses), which is what he does to soothe himself.

I guess I'm trying to understand whether this is how it's going to be with speech therapy. Is it reasonable to expect a 2.5 yo boy to sit without squirming (I mean, he was sitting on his bottom, just very mildly wiggly). And is there a reason he has to sit without support from his hands for speech therapy? Does a behavior specialist sound warranted here?

Thanks in advance,
naismama

[Fay]

It sounds like the therapist is trying to rule out autism. Many autistic kids have a weak upper body (hypotonia) and behavior issues that need the support of a specialist.

In answer to your questions, most 2.5 year old boys are pretty darn squirmy. The issue of hand support may indicate a need for occupational therapy, but it won't impede speech therapy. I think the therapist was testing his receptive language and seeing what his limits were. It's OK to ask the therapist what she is trying to accomplish during the session and to find out what methodology she is using -- many speech therapists who work with toddlers follow MacDonald's "Play to Talk" methods, which are attachment-based and backed up by solid research. You can get the Play to Talk book at many libraries because it's so widely used and easy to put into practice at home.

BTW, your DS's speech sounds like my DS2 at that age. DS2's speech developed spontaneously at age 32 months, out of the blue while his speech therapist was on vacation. Keep encouraging your DS -- you understand his needs best, and you are the key to his development.

[Linda on the move]

Originally Posted by Fay

It's OK to ask the therapist what she is trying to accomplish during the session and to find out what methodology she is using --

agreed. It's been a decade since my DD was 3 and in speech therapy, but her therapist tried to make it playful. She did push Dd to go past her comfort Zone, but she tried to make it as fun as possible.

[2boyzmama]

A few things jump out at me in your post.

1. Get his hearing checked! A booth test, not just at the ped's office. Not saying certain consonant sounds and leaving off the end of words is a big red flag for hearing loss.

2. Read up on Apraxia. Apraxia is a motor planning disorder that often manifests in speech issues and hypotonia. If he is slightly hypotonic, it could be from Apraxia.

I think that it sounds like the therapist was testing him aggressively, and it sounds like he did really well actually! Yes, 2 year olds often don't listen, or hit out of frustration. So it's probably pretty normal. But she was pushing his limits a little to see whether it was necessary to bring in any other specialists. In my experience, Early Intervention has a very low threshold for testing/referrals, meaning that they will call in a specialist much quicker than a pediatrician might. That isn't necessarily bad, although you're right that it can feel like they're controlling your life quickly!!! Remember that it's always okay for you to ask them to slow down!! You can always say "Can we just focus on speech for right now, he and I are stressed and need to ease into this." A local friend of mine recently scaled back her EI services for her son, and although her case manager was confused about why she did it, they did re-write their service plan and scale things back.

Also, your son is close to age 3, which is when most kids transition from early intervention to public school. So EI might be pushing hard to get a bunch of referrals/evals done quickly before he has to transition. And yes, at public school at age 3, he will be expected to sit criss-cross with his hands in his lap (my son's class has a whole morning song about it). So I wonder if she was testing his preschool readiness a bit also.

Oops...gotta run!!

[Fay]

Originally Posted by 2boyzmama

Get his hearing checked! A booth test, not just at the ped's office. Not saying certain consonant sounds and leaving off the end of words is a big red flag for hearing loss.

Yes, I forgot to mention this. I got hearing tests for both of my kids last summer because of their speech issues. Find an audiology lab with a special testing room for toddlers. It is usually covered by insurance with a referral from the ped.

[anj_rn]

My DD is yournger than your son, but I truly feel the EI therapists were not the best for us. Fortunately our insurance covers therapy, so we have home health PT, and we go out for Speech and OT. Currently we have 1 individual session of speech and ot a week, and one co-treat.

As for ability to sit still, that varies from child to child. My DS and nephew are 5 days apart, my son is able to sit quietly and self entertain better, but I do not think either are abnormal.

Remember EI services are voluntary, so you can say no to anything.

[naismama]

Originally Posted by Fay

It sounds like the therapist is trying to rule out autism. Many autistic kids have a weak upper body (hypotonia) and behavior issues that need the support of a specialist.

In answer to your questions, most 2.5 year old boys are pretty darn squirmy. The issue of hand support may indicate a need for occupational therapy, but it won't impede speech therapy. I think the therapist was testing his receptive language and seeing what his limits were. It's OK to ask the therapist what she is trying to accomplish during the session and to find out what methodology she is using -- many speech therapists who work with toddlers follow MacDonald's "Play to Talk" methods, which are attachment-based and backed up by solid research. You can get the Play to Talk book at many libraries because it's so widely used and easy to put into practice at home.

BTW, your DS's speech sounds like my DS2 at that age. DS2's speech developed spontaneously at age 32 months, out of the blue while his speech therapist was on vacation. Keep encouraging your DS -- you understand his needs best, and you are the key to his development.

Wouldn't the developmental specialist have ruled out autism or is that more the speech therapists area? Please forgive my ignorance.

Also, that's great about your son's language development. I still believe that ds's langage will really take off. I feel that he's actually gained a lot of language in the couple of weeks between the initial assessment and his first session yesterday!

Originally Posted by Linda on the move

agreed. It's been a decade since my DD was 3 and in speech therapy, but her therapist tried to make it playful. She did push Dd to go past her comfort Zone, but she tried to make it as fun as possible.

Thanks. This is helpful. I think the therapist tried to make it fun...I just felt she was more focused on the sitting than the speech and her way stressed ds.

Originally Posted by 2boyzmama

A few things jump out at me in your post.

1. Get his hearing checked! A booth test, not just at the ped's office. Not saying certain consonant sounds and leaving off the end of words is a big red flag for hearing loss.

2. Read up on Apraxia. Apraxia is a motor planning disorder that often manifests in speech issues and hypotonia. If he is slightly hypotonic, it could be from Apraxia.

I think that it sounds like the therapist was testing him aggressively, and it sounds like he did really well actually! Yes, 2 year olds often don't listen, or hit out of frustration. So it's probably pretty normal. But she was pushing his limits a little to see whether it was necessary to bring in any other specialists. In my experience, Early Intervention has a very low threshold for testing/referrals, meaning that they will call in a specialist much quicker than a pediatrician might. That isn't necessarily bad, although you're right that it can feel like they're controlling your life quickly!!! Remember that it's always okay for you to ask them to slow down!! You can always say "Can we just focus on speech for right now, he and I are stressed and need to ease into this." A local friend of mine recently scaled back her EI services for her son, and although her case manager was confused about why she did it, they did re-write their service plan and scale things back.

Also, your son is close to age 3, which is when most kids transition from early intervention to public school. So EI might be pushing hard to get a bunch of referrals/evals done quickly before he has to transition. And yes, at public school at age 3, he will be expected to sit criss-cross with his hands in his lap (my son's class has a whole morning song about it). So I wonder if she was testing his preschool readiness a bit also.

Oops...gotta run!!

Thanks so much. I guess I just feel like we had an initial eval, saw a developmental specialist and an OT, so why wouldn't she just focus on speech? But the preschool thing makes sense. Right now ds is enrolled 2 mornings a week at a small private preschool where his sister will be attending kindergarten. We definitely have some work to do to get him ready.


You mamas are great. It is helpful to hear about your experiences, as this is so new for us. I think the therapist just rubbed me the wrong way, even questioning the word we use for "poop" .

Would a hearing test likely be covered by EI or do I need to have it done privately? Maybe I should call my case manager and talk to her about our service plan--which only lays out a plan to prepare ds for the phonology program then have him do it for 14 weeks, then re-assess? I don't feel comfortable moving so fast. But I will get started on a hearing test TODAY!

If anyone else has experiences/ insights/ suggestions, please share. It is very helpful to me!

[Marsupialmom]

Originally Posted by naismama

Wouldn't the developmental specialist have ruled out autism or is that more the speech therapists area? Please forgive my ignorance.

Also, that's great about your son's language development. I still believe that ds's langage will really take off. I feel that he's actually gained a lot of language in the couple of weeks between the initial assessment and his first session yesterday!



Thanks. This is helpful. I think the therapist tried to make it fun...I just felt she was more focused on the sitting than the speech and her way stressed ds.



Thanks so much. I guess I just feel like we had an initial eval, saw a developmental specialist and an OT, so why wouldn't she just focus on speech? But the preschool thing makes sense. Right now ds is enrolled 2 mornings a week at a small private preschool where his sister will be attending kindergarten. We definitely have some work to do to get him ready.


You mamas are great. It is helpful to hear about your experiences, as this is so new for us. I think the therapist just rubbed me the wrong way, even questioning the word we use for "poop" .

Would a hearing test likely be covered by EI or do I need to have it done privately? Maybe I should call my case manager and talk to her about our service plan--which only lays out a plan to prepare ds for the phonology program then have him do it for 14 weeks, then re-assess? I don't feel comfortable moving so fast. But I will get started on a hearing test TODAY!

If anyone else has experiences/ insights/ suggestions, please share. It is very helpful to me!

For the hearing test, find out how EI does it. If it is not in a booth by people that specialize in children care pay for it! St. Louis special school district was awesome but not all EI offer the best.

This rush can be to get your child in the system. Once you are in and he transfer to the next level it will get easier.

I am bothered by some of the testers behavior, but ask her.

Dropping the last sounds worry me about hearing. The needing a hand to hold up also worries me because muscle development. Speech is a motor skill issues.

[naismama]

Originally Posted by anj_rn

My DD is yournger than your son, but I truly feel the EI therapists were not the best for us. Fortunately our insurance covers therapy, so we have home health PT, and we go out for Speech and OT. Currently we have 1 individual session of speech and ot a week, and one co-treat.

As for ability to sit still, that varies from child to child. My DS and nephew are 5 days apart, my son is able to sit quietly and self entertain better, but I do not think either are abnormal.

Remember EI services are voluntary, so you can say no to anything.

If this doesn't work out, we'll have to go private, but I've been trying to avoid it. We have good insurance, but I get scared because my dd has a "pre-existing condition" and I feel that they are always trying to deny or drop us.

And my son is sooooo laid back, calm and not usually wiggly. If she had just let him sit as he was comfortable and stop repositioning him to sit up straight with his legs at 90 degrees, he would have been fine. But I understand that she had her reasons for doing that.

[naismama]

Originally Posted by Marsupialmom

For the hearing test, find out how EI does it. If it is not in a booth by people that specialize in children care pay for it! St. Louis special school district was awesome but not all EI offer the best.

This rush can be to get your child in the system. Once you are in and he transfer to the next level it will get easier.

I am bothered by some of the testers behavior, but ask her.

Dropping the last sounds worry me about hearing. The needing a hand to hold up also worries me because muscle development. Speech is a motor skill issues.

But if we've had evals by the developmental specialist and the ot, we have a service plan, and we've started speech therapy, aren't we already in the system?

[Pyrodjm]

Just wanted to mentioned that the therapist was probably working on establishing attending skills (the stuff we do when we make a point to be still and listen). These generally include sitting still and maintaining eye contact. Its important for speech therapists to make sure their students have these skills because most kids have a much harder time listening, following directions and answering questions when they are moving around. Cross-legged on the floor on in a chair with both feet on the floor are common positions for a child to be in during an EI session. If a child is constantly wiggling and figeting, it makes it hard to know if they missed a direction because of keeping a beat with his foot or because he really doesn't understand. Sitting still may be new for your son so that's might be why she wanted to work on that first. As far as calling in the behavioral therapist, I feel she did the right thing. If your son displays agression when frustrated or challenged, it is absolutely appropiate for him to be evaluate dby a behavioral therapist in addition to the speech therapy he is receiving. I hope everything works out for your DS.

[APToddlerMama]

No time to read the posts...

But, whoa! That speech therapist's behavior was completely inappropriate in my opinion. My son is in speech through EI, and I used to work for EI in another county myself. We have had a similar experience in which our SLP thought her job was behavior modification, not speech therapy. I get the whole tone thing and wanting to check this out, but really... the hitting sounds totally normal to me. She shouldn't be surprised or alarmed that she pushes a kid to their limit and then, lacking the communication skills to tell her to back off, lashes out by hitting instead. What other means does he really have? If it were me, I'd welcome the other evaluations just to see what everyone else says in case she is legitimately seeing something you're not. But--I'd also get rid of her and get a new SLP. You do have the right to call her EI supervisor, tell her you're not happy with the services and request someone else. I had to "fire" my son's first SLP because she clearly did not understand what her role was. Once she came with her huge bag of toys, put it in plain view, and didn't allow him to play with them (which he had every other time) because she thought it was "good for him." That was my last straw with her. Apparently she was trying to teach him "patience" and that he "can't have everything he wants" when her job was to teach him to communicate.

Speech therapy is supposed to be *fun* for kids...not stressful. I wouldn't tolerate any SLP stressing my kid out. He deserves better and you do too. I just thought to myself when I fired DS's first SLP...if the point of speech therapy is for him to learn to speak, how is he going to learn that if this lady is focusing on sitting, patience, and him not having a sense of entitlement to her toys at 22 months old? It was really ridiculous. I am sooo glad we switched. Good luck Mama.

[APToddlerMama]

Originally Posted by Pyrodjm

As far as calling in the behavioral therapist, I feel she did the right thing. If your son displays agression when frustrated or challenged, it is absolutely appropiate for him to be evaluate dby a behavioral therapist in addition to the speech therapy he is receiving.

eeek. This would mean nearly all of the two year olds I know would need a behavioral therapist.

[sbgrace]

I believe most insurance covers hearing tests.

I had an experience with a therapist who was plain mean to my son. It was an anomoly I know now but it caught me off guard. It's ok to switch therapists. You probably don't have long with EI anyway though unfortunately (I say that because usually the quality and time given to therapy is much better than what you'll get in most school systems at three years old).

All my son's therapists talked about criss-cross apple sauce. We haven't mentioned it in at least two years but last night I actually asked him to sit criss cross apple sauce and he did it--it's engrained in his memory I think. It sounds like she was saying your son shows signs of hypotonia (mine was/is mildly hypotonic) and that is significant in that it might well be responsible for his speech issues.

[aspeechthx]

OK, so I have been reading posts here for a long time ('lurking' as they say!) because, as an EI speech therapist, I want to be in touch with how parents of my special needs kids think, feel... All of you on this site have been very helpful to me professionally. This is the first time I felt such a strong need to respond to a post!

First of all, it is normal for a 2 1/2 year old to leave the final sound off of words. Not all toddlers do this but it usually goes away around age 3 years 3 months. Up until then, it is considered normal. Could it be a sign of something else (hearing loss, apraxia...)? Yes. But in and of itself, it is normal.

Articulation therapy for a toddler is not based on sitting still. It is play-based, fun and engaging! As a PP mentioned, Dr. James MacDonald is a great resource for appropriate EI speech therapy. You definitely can request another therapist or at least challenge her to explain why her expectations are so high for a 2 year old!

And a Behavior Specialist? Hummm...

Good luck!

[Marsupialmom]

Originally Posted by naismama

But if we've had evals by the developmental specialist and the ot, we have a service plan, and we've started speech therapy, aren't we already in the system?

Yes, an no. If you are not actively receiving a service you have to start a new process it can be a PITA.

Example: My dd was evaluated. It was 1 month before her 3 rd b-day. If she did not receive 1 season of speech we would have had to have her reevaluated when the new agency took over. The paper work would have transfered but they would have wanted to do a new eval. Yes the system is THAT contrary.

Also, one thing we rain into is the range of normal. If your son is on the low end of normal he can still pass through until he becomes much further behind. So still watch carefully.

[Linda on the move]

Originally Posted by naismama

Wouldn't the developmental specialist have ruled out autism or is that more the speech therapists area?

For some children who end up at the high functioning end of the spectrum ( like mine) 2.5 isn't old enough to rule out autism. At 3 her eval said "autism like behavoirs" but now she is "on the autism spectrum."

Nothing in your posts jumps out at me as big red flags for autism.

[~cassie]

My ds has similar issues--the speech and the hypotonia(mild) and we always tell him "criss cross applesauce" during therapy and throughout the day. For us it is getting him used to sitting that way all the time. He doesn't have issue sitting still, he could sit for his therapy for hours, lol. To me she sounds like she was very aggressive and I know my son would have shut down completely with that.

I would get a hearing test if you haven't already and I wouldn't wait for EI to get that put together. Just call and ENT/audiologist and request one to be done.

[APToddlerMama]

You know, the more I think about this, the more annoyed I get about how aggressive she was with your son. Maybe you should suggest a behavioral therapist for her too...

[naismama]

Originally Posted by APToddlerMama

You know, the more I think about this, the more annoyed I get about how aggressive she was with your son. Maybe you should suggest a behavioral therapist for her too...

Yeah, I am feeling the same way. I guess what bugs me is that my son was so agreeable until about 30 minutes into the session after she had physically repositioned him at least 15+ times. She talked a little fast (even my super-articulate and verbal 4.5 yo dd did not understand when the therapist greeted her with "Remind me your name again?") and I know my son is lacking in receptive language skills, so I think he was very tired and frustrated. She was making him work for his rewards, so that even after he made the sound she wanted, she would hold the reward toy just out of reach so he would have to reach for it to "work his core."

I got a message from the therapist wanting to switch our time with another child to make it more convenient for that child. I almost feel like using this opportunity to request a different therapist or "time slot" altogether. *sigh*