DS speech eval - kinda upset

[JulieL]

Ok, now I know I'm gonna be a little sensitive when I hear someone say your child is below average - but I just can't help it.

So I finally got Anthony's evaluation today. It's just a preliminary eval and not a complete one. Here is what she wrote:

Object Identification below average
articulation w/in average range
language comprehension below average
language production below average


I haven't spoken to her yet and hope to do so today but here is what upsets me. First she didn't even spell my son's name right, she wrote Anothy (WHAT???) I mean come on your evaluating my son and you can't spell his very common name correctly? And she wants to eval my son??? Second I really don't think he has a problem with object identification nor language comprehension. He went in for the eval cause his preschool teachers had a hard time understanding him so I expected his articulation to be below average yet she said it was in the normal range. Her letter said Sshe wants to do a complete eval on him, but I don't feel like she's a good person to go to. I am faxing the e-val over to my son's ped so he can tell me what he thinks of her credentials and if we should get help elsewhere.

For those who have been through this her credentials are M.A., CCC-SLP: does that mean much? Anyway I'm really upset about this and really ticked off about his name written wrong.

[jayali]

Try not to be upset. I know easier said then done!

Remember it is just this person's evaluation. Go with your gut and find someone else to do another eval. Who cares what her credentials are - you have to be comfortable with the person. Sounds to me like she is unprofessional which would totally turn me off. Hopefully your Ped will be able to make another recommendation.

Good luck,

[kathsmom]

Julie,

I know how you feel. Andrew is being tested for autism right now and I got the speech evaluation and it was not a good experience to read the speech report. It's just so weird to read about your child in such clinical terms. Definitely send the copy to your pediatrician and if you feel uncomfortable with her evaluating your child, you can always see someone else.

I am a speech pathologist (although I haven't practiced in several years). The designation is that she has a Master of Arts degree and the CCC-SLP means that she has passed the national test and kept up with all the requirements put forth by our governing body, ASHA (American Speech-Language Hearing Association). CCC stands for Certificate of Clinical Competency and the SLP stands for Speech Language Pathologist (my designation is MSP, CCC-SLP. I received a Master of Speech Pathology. You might also see M.S., CCC-SLP). You can visit ASHA's website at www.asha.org .

Please feel free to e-mail me if you have any questions, but I have not worked in years and am on inactive status and I worked with adults (just my friendly disclaimer so I don't get in trouble! ).

Take care!

[redhookmom]

My ds has gone through some testing and it is so hard. I always felt like I was somehow responsible for his "below averages." But, we needed "below average" ratings in order for him to qualify for services. He qualified for occupational therapy and I think in the future will qualify for speech therapy. We really like our OT and she is the one we deal with.

If you can choose to go to someone else, GO! You want to have confidence that someone truly understands your ds's strengths and weaknesses.

Were you there for the eval? How did they test for object identification? I remember my ds not pointing to the "polka dotted ball," I never say "polka dotted."

[brittone2]

It is very hard to hear your child is "below average," but from the other side of the coin working as a pediatric physical therapist in early intervention, it is tough to be in a position as an evaluator. I spent a lot of time doing evaluations for the early intervention system before my DS was born, and it is difficult to explain to parents that their child may need some help to catch up. Of course, a therapist should always try their best to display sensitivity toward the family and be tactful in their approach. In the counties I've worked in we were always discouraged from using "clinical terms" as much as possible in the birth to three year old evaluation reports in particular. When it is necessary to use such terms, I usually try to define the term in layman's terms in paretheses afterward so that it is more readable for the parent. Early intervention is meant to be "family-centered."

If you don't feel comfortable with this therapist, by all means, request another one! However, I do want to say that the system is tough on us as therapists at times. We usually only have a set amount of time to drive to the evaluation (assuming yours was done in-home), complete the evaluation and write it up on site, drive to the next one, etc. and sometimes the case workers schedule them very tightly as the parents don't have flexibility time-wise, etc. Children aren't always able to cooperate fully, as we are strangers, they may be shy, etc. and we only have a limited amount of time (unfortunately!) in which to develop a picture of the child's abilities. So...sometimes names get written incorrectly, etc. It is a shame, but it is the reality of our job sometimes. It does sound like the therapist lacked some sensitivity though. Also, we have to rely on what we actually "see" during the evaluation. Sometimes I strongly suspect that the child can do a particular skill , but they just aren't doing it in the evaluation...however, in many cases, we are unable to go by parental report because the "requirements" for actually "completing" the skill according to the evaluation tool are **very** specific. On some things we can take parental report, but sometimes we can't. That is frustrating for a parent who knows their child can do the skill, but for us as therapists, we have to stick to the very specific test criteria, etc. in many cases. Believe me, sometimes we'd like to have a little more flexibility, but it isn't always possible when using a standardized test.

Also, sometimes if a child is on the borderline of qualifying for services, we are in a bit of a conundrum. The county doesn't always want to pay for services for kids, but sometimes our gut instinct as therapists tells us a child really does need services or would really benefit from a little help...and as a result we try to make our report reflect that need. It is an ethical deliemma for sure. So...sometimes the report may come across more strongly worded if it will help us to help the child...does that make sense? I'm trying to write this with DS tugging in my leg ;) I'm not a speech therapist in early intervention obviously, but I think sometimes articulation alone isn't enough to qualify a child for services, (usually articulation isn't given a lot of weight until the child is over 3...), so having a few areas slightly below average may help get the articulation covered in therapy. Obviously I don't know your child, but that is a possibility.

In terms of using "below average" etc,...usually at least on the evaluation tools we use we tend to give an age range where the child is developmentally in all areas. Also, I think it is important to realize that much of what happens from birth to three in terms of speech, gross motor skills, etc. is not predictive of your child's future performance. Therapy can help catch them up and give them a boost, but it doesn't mean your child is going to struggle w/ lifelong issues provided there aren't other problems going on.

I haven't worked since my DS was born (he's 9 months) but now that I have a child, I have even more empathy for families. I know it is so hard to hear that your child isn't where you want them to be developmentally. But please...do not think it is any fault of yours!! It certainly isn't. The point of the early intervention system is to catch problems early so that kids can be given a little boost to help them out and get them back on track. It is better to catch something early, and maybe even be a bit "picky" about what you are seeing, in order to help the child get a boost. Most times it isn't a predictor of future learning or ability :)

I hope that post made sense, as I'm trying to think with DS jabbering away, but I wanted to give you some perspective from the other side. I certainly think your therapist could have been more tactful, and if you aren't comfortable with her, by all means request a different therapist. Particularly if you are going to receive early intervention services and the person is coming into your home...you want to make sure that you feel confident in and comfortable w/ the therapist.

Okay...enough from me ;)

[pritchettzoo]

Although credentials are important, they don't mean everything. I mean, it's hard to graduate from law school and pass the Bar, but there are TONS of big furry idiot attorneys out there. If you don't like her and don't feel she's qualified, find someone else. It's your child, and the evaluation and the results are important to his life.

I'd be ticked off about the name thing too.

Hugs,
Anna
Mama to Gracie (Sept '03)

[egoldber]

As I recall, your DS's evaluation was done at preschool by the visiting SLP yes? If so, it may have been hard for her to get him to respond to her requests if you were not present at the evaluation. I am sure this is why she is recommending the complete evaluation.

It also sounds like she did some kind of "quickie" evaluation form as opposed to one of the more comprehensive scales of speech. That may be also why she is recommending the complete evlauation, since hers was a more cursory overview.

Just remember that when she writes "below average", what she really means is "below age level". She also does not indicate how much below age level. So he could be just barely behind of months behind. Again, another reason to do a more complete evaluation.

And it stinks that she got his name wrong. But my experience with several early intervention SLPs is that they are overworked, underpaid, dedicated public servants. I would forgive a misspelling here and there.

But I well remember the shock and dismay at being told that DD was below her peers in her speech. It was very distressing to me as a parent, and I felt like that somehow made me a bad parent. And that of course is not the case.

And just because she recommended a complete eval does not mean that she will be the one doing the eval. I am assuming that means she wants you (or maybe she) will contact the EI program and set up an official evaluation.

HTH,

[jk3]

First of all, just because this evaluator claims that your child's language skills are average or below average, this does not mean that your child is average or below average. Intelligence is complex and language is only one component. If you are uncomfortable, definiely use someone else. I think it's bizarre that you were given the results of an evaluation, preliminary or not, without any discussion. She should go over the tests with you in detail.

Jenn
DS 6/03

http://lilypie.com/baby2/030603/2/5/1/-5/.png

[JulieL]

Thanks for all of your input. I know Beth it must be hard to eval someones child knowing it's going to be a touchy subject. But I think the way she handled it is not professional. I didn't meet her, she came to the school and sat with him for 15 mintues. So I personally think since it was such an informal and short eval if she thought there was a possible problem and he should be given a full evaluation then she should have written inconclusive not below average. My DH and I think we should go with whomever our ped recommends and go from there. I'm trying not to let this put a damper on me but it's hard. If he has problems I want to help him but as the mom I KNOW identifying objects and language comprehension is not a problem...sigh now to go have some coffee and chill...

[JulieL]

Thanks for all of your input. I know Beth it must be hard to eval someones child knowing it's going to be a touchy subject. But I think the way she handled it is not professional. I didn't meet her, she came to the school and sat with him for 15 mintues. So I personally think since it was such an informal and short eval if she thought there was a possible problem and he should be given a full evaluation then she should have written inconclusive not below average. My DH and I think we should go with whomever our ped recommends and go from there. I'm trying not to let this put a damper on me but it's hard. If he has problems I want to help him but as the mom I KNOW identifying objects and language comprehension is not a problem...sigh now to go have some coffee and chill...

[JulieL]

She wrote on the evaluation that she wants to talk to me and get more info. So I did leave her a message today so we'll see what she has to say. But something else that bothered me was it took 2 weeks for her to get this very short evaluation to me. That is something else I was not impressed with.

Beth I know you're right about them being overworked and underpaid, but her not spelling my sons name wrong meant either she rushed the evaluation or her interest in my son is not there. This is the first contact I've had with her and it looks bad. Anyway not saying she is a bad therapist I just don't feel comfortable with her.

[JulieL]

She wrote on the evaluation that she wants to talk to me and get more info. So I did leave her a message today so we'll see what she has to say. But something else that bothered me was it took 2 weeks for her to get this very short evaluation to me. That is something else I was not impressed with.

Beth I know you're right about them being overworked and underpaid, but her not spelling my sons name wrong meant either she rushed the evaluation or her interest in my son is not there. This is the first contact I've had with her and it looks bad. Anyway not saying she is a bad therapist I just don't feel comfortable with her.

[jubilee]

My son Jacob was tested for speech delays when he was a toddler and he scored below average on some things too. Partly their system was flawed. I was there for the testing and a lot of it involved him doing activities with different toys: stack the red blocks, put the green balls in the hole, etc. Well, my son didn't do very well with those because he is colorblind. We didn't know he was colorblind when he did the speech testing, so we thought he didn't understand what he was being asked to do because he'd put both red and green blocks in the stack when she only wanted the red ones, etc. So, their system was flawed. But, also my son just picked up some skills a bit later than other kids. Now Jacob is almost 13, in seventh grade, and in the "talented and gifted" programs, and always gets A's in every subject. I hope you will end up with a similar success story for your son,

[brittone2]

I didn't have all the info about your scenario with your son when I first posted, but with your additional explanation, I absolutely can see why you'd be upset. A 15 min eval with a skimpy report arriving well after the evaluation isn't adequate in my professional opinion. She must have just done a quick screen on him, but if that were the case I'm not sure I personally would have written up something saying his skills in the tested areas were "below average" without elaborating more. Did she call it an "eval" or did you just figure she'd do a full evaluation? If her intention was to do a cursory screen to see if a more lengthy eval was needed, she should have explained that to you up front.

More thorough testing through the Early Intervention system done in your home if possible sounds like it might be the way to go. Whatever test is used, the evaluating therapist(s) should provide you with actual age levels on receptive and expressive communication, etc. As someone else mentioned, "below average" is very vague and could indicate a very mild delay or a more extensive delay. It isn't really all that helpful of a thing to write, frankly. In order to qualify for Early Intervention, you generally need to demonstrate a 25% delay in skills. So for example, 24 month old would have to be functioning at an 18 month level or lower to get services (through early intervention...you could always seek private therapy). So a vague "below average' doesn't really even tell you if he qualifies for services, etc.

An early intervention report should be written in parent friendly language, and if it isn't, I wouldn't feel badly at all about calling the therapist and asking her to explain it to you. When I was working, our evaluation teams always went over the child's levels with the parent(s) and case worker at the time of the evaluation, and we also wrote up a short report on site for the parent. As I was leaving my job, several counties were in the process of requiring therapists write up the entire eval on-site (I wasn't fond of this BTW, as I like to have the opportunity to take my time and write up a nice thorough report, and as long as the parent was given a brief write up and explanation at the time of the eval, I thought that was more than adequate. The full report still arrived within less than 2 weeks in most cases). In any case, before we left the parent always knew whether or not the child qualified for services and what their "levels" were, and had the opportunity to ask questions. We generally provided a few ideas on how to get started while they waited for therapy to begin (the evaluators generally are not the therapists who end up treating the child as this would technically be a financial conflict of interest).

Okay, that was really wordy, but I now understand more about why you were upset. It doesn't seem like this therapist is the one for you. I'd call EI and get an eval through them, in your home. Sorry that you had a negative experience, and hopefully the next eval will give you more answers. Hopefully the next evaluation will be a more positive and helpful experience.

[JulieL]

Thanks for your reply Beth. I'm looking into getting more info from the ped and waiting to go from there. The therapist is to call me, and if we get a chance to talk I am going to tell her that I don't think she is very professional - hey you can't improve if someone doesn't tell you.

Also the test used was the Fluharty Preschool Speech/Language Screening Test. My DH looked it up and the on report he could get access to said it's be around for 30 years and it brings in about 50% of incorrectly asessed children. We did realize this was a short eval screening to see if he looked like he needed more help. But I think assessing a child as below average sounds more like a conclusion than a need for concern and more info. So he could need help but I just don't think she is the one for us. Thanks for your time. :-)

[brittone2]

No problem! With a screen, the intention is to bring more kids in than you think have a problem. It likely would have a high false positive rate so that you don't "miss" any kids that need further services. So your goal would be to pick up on MORE kids rather than fewer kids...so that you wouldn't miss any that need therapy. The mentality would be that it is better to pick up on too many than to miss the kids that need help.

But if it was a screen, she should have presented to you as such, and explained the steps in the process to you (let's do this little screen, if based on that I think there is a need for further evaluation, we can complete that in my office and that will be more in depth, etc. etc.). I agree with you, had this been a physical therapy situation and I was the therapist, I probably would have phrased it differently. I would have explained the purpose of a screen, that they do have high "false positive" rates and that that just means that we recommend further testing. I'm not familiar with the speech screen she used, but is it possible that the test is graded on an "above average," "below average," and "average" basis? If that is how that particular test is scored, then maybe she just wrote down "below average" without realizing the impact that can have on a parent. But that might be exactly how that test is scored. However, she perhaps could have explained to you that it doesn't give age levels, etc. and that "below average" just means she'd like your DS to have some additional testing. Sometimes we get so wrapped up in the test and the clinical aspect that we forget that using a term like "below average" looks like to someone who isn't familiar with the test.

In any case, I'm sure there were ways she could have made her report more parent-friendly for sure. I don't like second guessing another therapist, but if you aren't comfortable, definitely get in with early intervention for an eval and hopefully it will be a much more positive experience. Let us know what happens.

[elvisfan]

First of all, I don't want to offend anyone here..but here is my opinion on "evaluations". Yes, there are kids out there who are behind and need help. But it seems like every kid out there is being evaluated and treated from something. Years ago it was hyperactivity. Then it was ADD.Then ADHD. Now it seems as if every kid out there has a speech delay or autism. Again, yes, some kids do...but sometimes I think the only purpose these evaluations serve is to get parents to be hypercompetitive and worrisome:( Yes, by all means, get an evaluation redone. And take what anyone says with a grain of salt. remember, this is how they make their money. A child without an "issue" = no paycheck for them

[brittone2]

I respectfully do take offense to that. I can tell you as a therapist who evaluated for the early intervention system that I had *NO* financial stake in qualifying a child for services. There are more than enough kids with significant developmental needs to keep therapists quite busy without us needing to add extra kids to the system to keep ourselves paid, believe me. In the birth to three system, the evaluating therapists generally come from a completely different county, from an agency that is contracted only for evaluations not for treatment to avoid any potential conflict of interest. As a treating therapist, I get a "referral" from the county saying that the child qualifies for services (which was determined by an independent team, separate from the agency I worked for).
As therapists, we often have waiting lists and would like to NOT have so many kids on our caseloads, believe me! While I agree that there has been a huge huge jump in diagnoses like ADHD, etc. that may not always be warranted, in most cases they are. In the past, these kids were just not diagnosed, they were stuck in a classroom or labeled as the "bad" kids. I look back to when I was in school 10-15 years ago and I can think of several kids who were often made fun of by teachers and students and were labeled as problem kids that almost certainly had ADD, autism, or other developmental problems. It was a disservice to these kids that they didn't have the help they needed available at the time. I think of the impact it must have had on their feelings of self-worth and the negative influence it had on their academic achievement and it is quite sad.
Autism is unfortunately far too common, and I'd love to have it any other way, but the reality is that it affects so many children. Some of this is just that physicians now have better criteria for how to diagnose it, but some is an actual rise for reasons no one fully understands. We as therapists don't diagnose things like autism, ADHD, etc. We know what to look for and often suspect it in our clients, but we don't diagnose it. We are there to help with the developmental aspects and may recommend an appointment w/ a developmental pediatrician, if the child hasn't yet seen one and we think there is something that needs to be looked at, but we don't make the actual diagnosis of conditions such as autism or ADD. We aren't to blame for the huge numbers of kids with developmental issues. We aren't padding our paychecks, or trying to nitpick problems. I love going to evals and telling parents that I don't see anything signficant to be concerned with, that the child is just a little behind and will catch up in their own time, and that if the child isn't walking, etc. in 3 more months to call early intervention back and request another evaluation. I love those appointments!! There is nothing like seeing that relief on a parent's face!
The whole point of early intervention is to catch things early so that there won't be problems down the road. Sometimes I see a child for 2-3 months (sometimes even less) and that is it...they are discharged as soon as they no longer exhibit a 25% delay in skills. They just needed a jump start, or the parents needed some ideas on how to help the child get going. Some kids I see for years. If we catch it early, in the end it is less costly to the "system." If we wait, the problems have a much larger impact and take much longer to treat. The 25% delay number is backed up by a standardized test. We aren't diagnosing kids with developmental delays in order to pad our paychecks. Most therapists are actually relatively underpaid in pediatrics. The agencies they work for make some $$ (not much!) but the therapist only gets a fraction of the total that the agency makes. The county audits our files to make sure that we aren't retaining children who don't still exhibit a 25% delay as it is very costly for them to continue to provide services to these families (especially in the case of a child receiving multiple therapies).

A self employed therapist in private practice may have a financial stake in theory, but I can't think of many incidents ever where I've come across that. Early intervention therapists certainly don't "qualify" a child to pad their paychecks. We have more than enough kids with serious needs to keep us very very busy. Trust me. I always recommend families go through early intervention if their child qualifies for this reason. If they want additional help or the child doesn't qualify through EI, only then should they go through private insurance. Why pay if you don't have to? EI is a free service regardless of income to those children who demonstrate a 25% delay.

The system does pull in a percentage of kids that would probably catch up on their own time, but I think it is better to do that than to neglect kids that need a little boost. Our job as therapists in EI is really to guide the parents on activities they can do at home with the child. We are more teachers for the family than anything. I usually tell parents my one visit per week for one hour isn't going to have much impact in all honesty, but what they do the rest of the week with their child certainly is. So we spend a large amount of time instructing the family on how they can best help their child.

We spend a great deal of unpaid time completing paperwork at home, making phone calls, dropping equipment off at homes on our own time, etc. When I was working part time I couldn't bill for travel time between appointments or for indirect time like paperwork. Only for my hour long visit. And that hour often lasted an hour and 15 mins, or an hour and a half sometimes if the parent had a lot of questions, etc. The time over an hour was on my time...I never got paid for it. Most therapists I know do the very same thing. Our clients come first, money second, or we wouldn't have chosen this profession.

Okay, enough from me. I had to get that off my chest as I definitely did take offense to the comment above. I don't think the pediatricians have any financial stake in "diagnosing" kids with ADD, autism, etc. and as therapists, we certainly don't make those diagnoses and we certainly don't need to add kids to our caseload who don't qualify for or need services. Believe me.

[ddmarsh]

"I don't think the pediatricians have any financial stake in "diagnosing" kids with ADD, autism, etc. and as therapists, we certainly don't make those diagnoses and we certainly don't need to add kids to our caseload who don't qualify for or need services."


ITA and find the post to which you responded a rather unfortunate view.

In general it seems that many people do not seem to appreciate the advances in diagnostic and treatment capabilities and the great advantages that has brought to myriad children.

[amp]

Julie - I just wanted to send hugs your way. You sound so frustrated and I'm sure this whole process is a bit unnerving. I hope that you are able to get a successful and accurate eval for Anthony.

[brittone2]

Thanks for the support Debbie. I was bothered by the assumption that therapists and pediatricians have something to gain by diagnosing children with developmental issues.

Julie-sorry to have hijacked your post, but as you can tell the topic hits home for me and I felt obligated to respond. I hope you don't mind.

[starrynight]

The way insurance companies pay now it's not much of a paycheck anymore! My son had a $500 medical test, the insurance paid $189 and we were responsible for nothing, so it was considered paid in full.

And as a child with a lot of symptoms of being on the autism spectrum and definitly with adhd, I highly doubt it's all about hypercompetitiveness but yes it does come with worry. I would give anything for a "normal" son. I don't want to compete in the "special" circus for anything in the world. I highly doubt many other parents of child with these disorders do either, honestly who wants to wear the "parent of a child with ASD" ribbon so badly that they put their kid through unnecessary evaluations!!?? It's no walk in the park believe me.

OP, good luck I'm sure there is nothing wrong, it's just to make sure he is looked at incase of a problem instead of skipping over a child that needs help.

[Rachels]

Ugh. The big bucks-- that's why I borrowed a mortgage's worth to get through six years of graduate school and why I worked without pay for all those years in community mental health. I'm rolling in it now.

What a sad viewpoint.

-Rachel
Mom to Abigail Rose
5/18/02


"When you know better, you do better."
Maya Angelou

http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Two years and counting!

[calebsmama03]

ITA, and being someone who works in the DD system - though with adults and not kids - I can tell you that with the early intervention system where I work, they SLP's, OT's, etc are all paid on salary and get paid whether they are working with 1 kid or 50 kids so if you take that viewpoint, they "benefit" more from NOT finding kiddos eligible for services! While it does seem like there's always a certain "buzz word"/diagnosis in the field, I think perhaps that it reflects that we are simply better at diagnosing the disorder rather than some synister plot to overdiagnose.
Lynne
Mommy to Caleb 3/3/03
http://www.gynosaur.com/assets/ribbons/ribbon_emerald_18m.gif[/img][/url]
Oh my!! #2 5/05