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#1 of 19 Old 05-18-2013, 08:21 AM - Thread Starter
 
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My 22 month old (third child) needs speech therapy and we're getting started with Early Intervention.  I'm just starting to learn about the system, but I understand that there are goals written in to an IFSP, which is the next step in the process for us.  My daughter didn't meet the minimum criteria for services (2 standard deviations below the mean in one area, or 1.5 in two areas) but was qualified for services based on the discretion of the screener because of the discrepancy between her speech and other abilities (she scored in the 4th percentile for expressive language and 98th for receptive language).  

 
Do I need to be concerned about having the IFSP written so that she'll continue to be eligible for services until her speech catches up to her other skill areas rather than when it reaches some other arbitrary number?  
 
(cross posted in Special Needs)

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#2 of 19 Old 05-18-2013, 01:44 PM
 
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I have no idea, being in rural Canada where there are no such things as IFSPs, whatever those are. But I did want to lend some possible reassurance that even if things don't keep working out for Early Intervention she may be perfectly okay. My two eldest kids had less than half a dozen words at 27 months, and were off the the charts for receptive language and other skills. They got no intervention at all due to a lengthy wait-list situation, and over a period of six months their expressive language caught up to their receptive. My dd finally got to the top of the waitlist and had her assessment at 33 months, at which point her expressive language skills were considered equivalent to age 4.5-5.0. She went from way below normal to way above average in the space of half a year.

 

We almost got laughed right out of the office. No, actually, we didn't get laughed out, though the therapist did see some humour in it. She was humble enough to point out that kids like mine remind her that the miraculous acquisition of speech skills for kids in therapy is often attributable not to the therapy but just to time and maturity.

 

Of course not every child will catch up without intervention, but many do. So don't panic if you can't be guaranteed ongoing services. 

 

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#3 of 19 Old 05-18-2013, 06:56 PM
 
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Getting the qualification is the hardest part, so good that you're past that. You have a huge split. I'm glad you're getting services asap.

My DD is on an IEP in public school in which her specific learning disability qualification is based on her differential performance between cognitive and performance.

I'm not sure if your documents are assembled the same way as an IEP, but in the IEP you have a goal for each disability. Before writing the goal, there's a spot for outlining the present levels of performance. This is where we've outlined the cognitive potential and the achievement. The goals must be drawn from the present levels section, and must be quantifiable.

We've often used different goals (and with higher targets) than the run of the mill goals for these disabilities because of her predicted abilities. Happily, she's routinely met and exceded her goals. DD exited the first goal after 3.5 mo because the performance met the predicted performance off the cognitive. We've upped the goals big time for the other disability, again, tied to the predicted expectations based on cognitive.

My DS had private speech when he was 3, having failed to qualify through the school (expressive, artic, and phonology) partly because his receptive brought up the total score in a year. Private therapy got him up to average, but he continued to struggle and we saw obvious gaps. We carried on at home just following the model of the speech therapists. He was Retested this year and his receptive and expressive match. He's still struggling, but the root cause appears more complicated than "just" speech development. So we're still chasing down diagnoses. Alas. Dealing with some of these issues seems to be a process of "solutions for right now.". Use the services she can get now, do the therapy at home and keep asking questions. You might find that this is the right thing for a while, you get discharged,and then you'll need to revisit from a different angle later.

Good luck. You've cleared the biggest hurdle,
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#4 of 19 Old 05-20-2013, 07:06 AM - Thread Starter
 
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Thanks, mommas!  

moominmamma, that's horrible that there was such a long wait for your kiddos, but wonderful that they were able to catch up without intervention.

 

Geofizz, do you know of a resource where I can find examples of goals?  It's my understanding that IEPs & IFSPs are basically equivalent.


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#5 of 19 Old 05-20-2013, 07:35 AM
 
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google the diagnosis + IEP goal to get thousands of examples. 

 

I just found this one for you:

http://www.speakingofspeech.com/IEP_Goal_Bank.html

 

I have no idea how complete this one would be.  It gives you an idea, and hopefully you can keep googling.  The person writing the goals will be used to a certain wording and will likely start with "well, this is the goal for kids with expressive speech needs."  You can suggest different goals as long as they are realistic (tied to present levels) and quantifiable.

 

Mostly what we've done is increase the accuracy rate in DD's goals.  One of DD's SLD's is writing, and the standard goals are for accuracy on the revised draft.  Because of her specific profile, we have two goals, the normal one for the revised draft (though with higher accuracy -- I think the school shoots for 90-95%, and DD's is 98% accuracy), but also one for the first draft but with lower initial accuracy.  Our thinking was to give her few errors to ultimately find on the final draft.  She's unqualified for a SLD for reading, having started out with a sub-first grade level of phonological skills despite a high school reading level.  The standard goal is to have her decoding with a certain accuracy at grade level.  Because there were no words at grade level reading she does not know on sight, her goals were on nonsense words and on words at a 12th grade level.

 

This isn't speech, but hopefully it gives you an example of the kind of things we've done with the goals.
 

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#6 of 19 Old 05-20-2013, 09:43 AM - Thread Starter
 
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thank you!


-Shannon, momma to H reading.gif 8/03, N heartbeat.gif 9/06, & P homebirth.jpg 8/11, missing S brokenheart.gif born at 11 wks 1/09 

 


 
   

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#7 of 19 Old 05-20-2013, 10:37 AM
 
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moominmamma, that's horrible that there was such a long wait for your kiddos, but wonderful that they were able to catch up without intervention.

 

Actually I didn't mind. I wasn't worried. I was pretty sure they were just wired to be late talkers. They were intense, bright, highly introverted, understood everything and were clearly very perfectionistic. I figured they'd talk when they were sure they could do it well. And speech therapy would have entailed a three hour drive to get to and from every session.

 

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#8 of 19 Old 05-24-2013, 06:03 AM
 
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Originally Posted by moominmamma View Post

 

Actually I didn't mind. I wasn't worried. I was pretty sure they were just wired to be late talkers. They were intense, bright, highly introverted, understood everything and were clearly very perfectionistic. I figured they'd talk when they were sure they could do it well. 

 

I want to echo this as some possible reassurance.  My DD1 was a silent little one.  She rarely spoke until she was around 25 months, had only a handful of words but rarely used them, wouldn't mimic words, etc., was only interested in saying the alphabet eyesroll.gif   But it was clear she understood everything, was following very detailed requests, was highly independant and bright so I wasn't worried even though everyone else (*cough* grandmothers *cough* ) were wringing their hands and suggesting speech therapy. Then she just...started talking.  VERY WELL. And eloquently. About her feelings and ideas she had and how things worked.  It was awesome.  Now, at 4, from what I observe, she is far ahead of her peers in vocabulary and expression and is discussing hard science in casual conversation, so I'm glad I didn't worry 

 

Anyway, I m not saying your child doesn't need speech therapy, obviously I have no idea...I just wanted to say that I think that this is one of those ways our kids can be so different...something that could be a real cause for concern in another child might not be in a very bright/gifted child.

 

I hope it all works out!  coolshine.gif


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#9 of 19 Old 05-28-2013, 08:29 PM
 
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I'm curious about the logic of qualifying a child for speech and language services based on a discrepancy between speech and other abilities.  Wouldn't this be an example of asynchronous development? OP - making no judgement about your child's need for therapy since I obviously don't know her. Questioning the reasoning - not the outcome....

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#10 of 19 Old 05-29-2013, 03:45 AM
 
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This is a child whose speaking abilitily places her in the 4th percentile. That alone should qualify her as it is 2 standard deviations below the mean (despite what the OP's been told) However, her ability to understand language is in the 98th percentile, which is more than 2 standard deviations above the mean. That huge split is indicative of an issue, as most diagnoses are based on the difference between ability and performance.

How amazingly frustrating it must be to be this child.

Asychronous generally refers to differential development between areas, not within them. So expressive speech should track receptive speech, but at the same time emotional regulation or gross motor skills might lag. In an older child, verbal IQ should be a predictor of reading ability assuming the child's been given access to an appropriate education. When these two diverge, then it's an indicator of a learning disability, generally taken as a difference of more than two standard deviations.

My child has an amazing ability to form hypotheses and devise experiments. Her asynchronous development comes in when you realize she lacks the organizational ability to execute the experiments, so we help out and provide the organzational skills until this catches up. She also has a 3 sigma difference in the verbal IQ and writing ability. That's why she receives services for dysgraphia.

I think that when an OP posts wanting to make sure that a child gets the services her daughter needs, it's dangerous to have people telling her that it's just asynchronous development or the kid will start talking eventually. The OP didn't post asking for reassurance. She asked for specific help in gaining services after a diagnosed disability. She's not questioning the diagnosis. I certainly kick myself on a daily basis for waiting so long to have my kids evaluated, and now having waited so long to find someone who doesn't just brush off my concerns on my son. Indeed, what I'm learning is that so very few people -parents, teachers, or experts- have much understanding of what it means to have such a disability until they've seen it.
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#11 of 19 Old 05-29-2013, 05:43 AM
 
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I apologize if I caused the OP any distress. I was not questioning the diagnosis or need for therapy. I totally can see that a score in the 4th percentile on a test might indicate a need for therapy. I also was not trying to tell the OP that her daughter just has asynchronous development.
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#12 of 19 Old 05-29-2013, 05:58 AM
 
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Actually, I gather from how the OP wrote things that she's quite confident in her path.

I was actually responding as much to the posters above you as I was to you and I wanted to give you a clear answer. I wasn't meant as an attack or anything. I understood it was a question of curiosity. Sorry if it came across as an attack. Often my posts respond to the general idea when it comes to issues like this, because there will likely be someone searching out information later on and bump into the thread. I didn't want those people to come away with "ahh, it's just ansychnronous development.". I stay up at night stewing that I didn't follow up on my instincts when my DS was 2. I assumed he was just a late talker, maybe some asynchronous development. Afterall, he could do 48 piece jigsaw puzzles picture side down. Surely the language would catch up. We're now at 7.5 and he's being held back in math -- an area of profound giftedness - because of some sort of undiagnosed and untreated language and oral - motor disability.

I also wanted to get into this thread other information about what asynchronicity is and what qualifies as a disability. Many schools won't qualify a child for services unless the skill is 2 sigma below average, whereas the clinical diagnosis is often 2 sigma between potential and ability. These are subtle things that come into play here as the OP goes forward in maintaining services for her child.
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#13 of 19 Old 05-31-2013, 10:41 AM - Thread Starter
 
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As I understand it, asynchronous development is my 6 yr old writing elaborate Harry Potter fan fiction in her free time but still using training wheels on her bike.  The 2E world is new to me, but as Geofizz says, looking at a child with scores on the opposite extremes of a bell curve in areas that "should" be related is indicative of something far beyond asynchronous development.  


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#14 of 19 Old 05-31-2013, 12:48 PM
 
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Yes, I think a discrepancy can be "just asynchronous" if, say the child is on the 99th percentile for one thing and on the 40th or 60th for another. Sometimes simple asynchronicity can be a problem, like when a child who writes at an age-appropriate level is being denied the advanced reading material she desperately needs and wants, because she can't create written answers on an evaluation intended for older kids reading at that level. Sometimes asynchronicity can be indicative of a masked learning disability, especially when the areas are closely related and usually (even in gifted kids) relatively synchronous, like in the classic case of an achievement-performance mismatch in IQ. 

 

In the case of the OPs dd, though, the asynchronicity is more that just advanced-vs-age-appropriate. It's advanced vs. lagging significantly behind agemates. So I think it definitely warrants concern.

 

By the way, in my first post I wasn't at all trying to talk the OP out of pursuing ongoing services. I was only saying that if, despite her best efforts, it is impossible to continue, it's possible things may work out okay anyway. I did state it that way, but I'm sorry if it came across as a suggestion that services be forgone. 

 

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#15 of 19 Old 05-31-2013, 08:33 PM
 
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So - I totally get that a score at the 4th percentile is indicative of something more than asynchronous development. IT was the wording "discrepancy between speech and other abilities" that I was thinking would be an example of asynchronous development - not the OP child's performance. I guess what I don't get is why the best justification for therapy requires a comparison between the 2 scores.  To begin with 2SD below the mean seems like pretty strict criteria for qualification.  But given that is what it is - I would think there would be additional information that could be cited as to why the child should qualify for services.  Behavioral information about how the child is frustrated by not being able to communicate for just one example.  Because I would think that even if a child scored at the 50th percentile for receptive language a score at the 4th percentile could be a cause for concern.  OR - moving forward - when the child begins to make progress when do you determine that they are "caught up?"  And I think this line of thinking is what led me to bring up asynchronous development (which I admittedly do not fully grasp....).  When the expressive language score is at the 20th percentile do they still qualify for services because of the discrepancy?  At the 50th percentile?  VS I would think providing more qualitative information about what the child is (or is not) doing expressively would provide more information about why the child is receiving therapy and therefore when therapy might no longer be considered necessary?

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#16 of 19 Old 06-01-2013, 05:44 AM - Thread Starter
 
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That is what I'm wondering about.  With a 2E child, should the goal be to reach an average skill level or an above average skill level?  

 

My perception of my child is that she "should" be able to communicate at a level far above average.

 

Will Speech-Language Pathologists see it the same way?  Will the Early Intervention program see it the same way?  Will our insurance provider see it the same way?  

 

I realize that only time will tell.  But I hope to learn more about what other parents have found in similar situations & be better prepared to advocate for my daughter.


-Shannon, momma to H reading.gif 8/03, N heartbeat.gif 9/06, & P homebirth.jpg 8/11, missing S brokenheart.gif born at 11 wks 1/09 

 


 
   

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#17 of 19 Old 06-01-2013, 08:14 AM
 
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Quote:
Originally Posted by MovingMomma View Post

That is what I'm wondering about.  With a 2E child, should the goal be to reach an average skill level or an above average skill level?  

 

My perception of my child is that she "should" be able to communicate at a level far above average.

 

Will Speech-Language Pathologists see it the same way?  Will the Early Intervention program see it the same way?  Will our insurance provider see it the same way?  

 

 

Since your DD is only 22 months old, it's impossible for anyone to say what how she "should" be able to communicate. It really depends on what is causing the delay.

 

As far as what level she should reach before services are terminated, that really depends on the provider and the payer of those services. It sounds like you plan on having her receive services both through the public system and through the private insurance, and it may be a very different deal. Also, her ability to receive speech services through school once she is school age could yet again be a different deal.

 

Personally, I think that a child who has average speech abilities doesn't need speech therapy, regardless of what else is going on with them. Neither my DD or I enjoyed therapies enough to continue them when there wasn't a true need. Getting into the system is more difficult than staying in the system.

 

The thing is, if something truly significant is going on with your DD's speech, this may never be an issue because she may not ever fully catch up. If nothing significant is going on, she may need help for awhile to get over a hump, and then take off in spades. After all, kids are working on speech skills ALL THE TIME, and once you guys get into therapy, you'll learn ways to work in a more targeted way with her.


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#18 of 19 Old 06-01-2013, 08:33 AM
 
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Originally Posted by MovingMomma View Post

That is what I'm wondering about.  With a 2E child, should the goal be to reach an average skill level or an above average skill level?  

 

My perception of my child is that she "should" be able to communicate at a level far above average.

 

Will Speech-Language Pathologists see it the same way?  Will the Early Intervention program see it the same way?  Will our insurance provider see it the same way?  

 

I realize that only time will tell.  But I hope to learn more about what other parents have found in similar situations & be better prepared to advocate for my daughter.

 

Hmm, has she been evaluated? I guess I was assuming she had been but sounds like maybe not? My youngest didn't speak until 2. His doctor mentioned we could look into therapy at 18 months but I just didn't see it as a problem yet and this doc is pretty high on the "reactive" scale (great for some things, premature for others.) I wanted to give him a little time and sure enough, at 2 we were having trouble with something and he blurted out "what a quandary" lol. He hasn't been quiet since.... seriously, it's the family joke because he talks non-stop. Oh, and he skipped all the baby talk stuff... straight to sentences with advanced vocabulary.

 

My eldest was speaking well at 7 months so DS was different for sure. However, we had a friend whose child was REALLY not speaking. I mean, she was all grunts, pointing and tantrums. My DS wasn't using words but he had expressive babble and always seemed to know how to get his thoughts across. It was clear his receptive language was advanced and he would hum melodies.

 

Our school district doesn't test and accept kids into speech therapy before age 2 and most of the kids graduate out of it long before they start kindergarten. If you really feel it's a problem, I'd check with your local school district and see what they offer. 


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#19 of 19 Old 06-01-2013, 09:19 AM - Thread Starter
 
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She has not yet been evaluated by a SLP.  She has been through screening with EI, including a couple of full scale but not speech specific assessments.  
 

Right now we're 1.5 months into this & are only at the point where we are waiting for appointments with SLPs.  


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