Doubting Speech Therapy

[Raidra]

I know we have a few moms here whose kids who are doing speech therapy, so hopefully you guys can give me some advice. Colwyn has been doing speech therapy for about two months now for an expressive language delay. I'm not very happy with the therapy he's getting, though, but I'm conflicted about whether to cancel services or not.

Basically, we started services for two things - not stringing words together, and a lack of clarity (mostly because he leaves off the endings of words, like ba instead of ball, ma instead of man, tray instead of train). He has made big improvements in the last two months, which I don't think has anything to do with the therapy. He's really increased his vocabulary by quite a lot, strings 2-3 words all the time (sometimes 4 words, but not often), is always copying us (he never really did that until very recently), and has been making a small amount of progress with his clarity - he used to just make a T sound for train, like "tuh, tuh" but now it's "tray". He's also moved from calling planes "pay" to "play" and even "airplay". He really hasn't made much progress with marking the ends of his words, though. She showed me a chart of what sounds they should be able to make and when, and we talked about how kids normally switch R sounds for W sounds (wabbit instead of rabbit), but Colwyn does it with Ls (labbit). He just learned how to make L sounds in the last two-three weeks, though.. and he doesn't really make W sounds.

What I don't like about speech therapy is the way she sometimes forces him to try to say things. If he turns away from her to look in her bag of toys, she'll physically turn him towards her (she's not rough about it, but it bothers me) and make him watch her mouth as she says something. The therapist is really nice, and I don't think another therapist would be much different. I just don't like the idea of making him do something he doesn't want to. He enjoys therapy somewhat, but there are definite times (at least once or twice during a session) when he tries to go do something else, and she won't let him. She's made comments when he does that about how he knows what she wants him to do is hard work, and that's why he's walking away.

So, my concern about canceling services is that I'm worried his problem with clarity won't resolve on its own. If he truly needs professional help with that, then fine.. but I wonder if since he's made so much progress on his own in other areas, does he really need help for clarity, too? The speech therapist told me how we should put emphasis on the endings of words when talking to him, and as I started doing that, I realized how unemphatically we normally end words. I'm wondering if it's unreasonable to expect him to end words completely when we don't always. Does that make sense?

I'm also worried that I'm fabricating these concerns because I'm generally a shy person, and don't like getting "advice" from other people about my kids--of course, online advice doesn't seem to bother me. ;)

Anyway.. any advice or thoughts you guys could give me would be great!

Thanks!

[o_mom]

Are you going through your local Birth to Three program? It might be worth discussing with your service coordinator. He or she can give you options, such as a re-evaluation, a different therapist, or ways to approach the current therapist. You can talk to the current therapist and tell her that her motivational approaches some times make you uncomfortable.


HTH!

[searchdog]

I agree with the PP, I would talk to your service coordinator about it. I know there are different approaches. Like with my daughter we often work with food and it is a real positive motivator for her. Now my SC her son gets ST but not the same therapist and that therapist brings a booster and straps the child in it to keep the focus on her. So different strokes for different folks. I would maybe look into a therapist with a different approach that you might be more comfortable with.

[Elilly]

Our speech therapist is very strict too. I understand your dilemma. That said, we are staying with our speech therapist. Why? Graham does need to be pushed. Left to his own devices, he would not be making the progress that he is. Is this the right choice for everyone? Maybe not. But we have decided to stick with our person because, long term, this is what Graham needs. Maybe not what he, or even I, want for the sixty minutes that she is there, but I know he needs it. So, we're implementing tough love on this one.
If you're uncomfortable with your ST, ITA, talk to your coordinator.
I'm so glad to hear that Colwyn is making progress!

[cara1]

We had DS evaluated for ST 3 times until he qualified for services. Before the 3rd, family were bugging me to do it earlier, or pay out of pocket. I always understood everything he said, and he always made progress, so I thought things were fine. When he turned 3, the 3rd evaluation allowed him to qualify for services (not EI, but CPSE), primarily for articulation. Similar to your DS, dropping endings, etc. He's been getting ST since March, and it's like night and day. I have NO idea if it is secondary to the therapy, or if he's just getting better on his own, and there's no way to know. The therapist sees DS in daycare, so I don't really see what happens. But I saw her last week because she came to the house when he was sick. I was amazed. She handled him so well. Thirty minutes is a long time for him to stay attentive. When he got distracted, or lied down on the floor, she told him he had to sit up and finish. She always managed to redirect him. That's what she's there for, so I think it's reasonable for your therapist to redirect him. It's not forcing him to do what he doesn't want to do. It's getting him to do what you want him to do. A trick she told me she does is when he refuses to say a word for her, and wants to be negative and resistent, she says, fine, "Don't say chipmunk, say NO chipmunk", and he does it, thinking he "won", but in reality, she did. Before he entered therapy, I was skeptical. What could she do that I can't? Did he really need it? Is there a stigma? Well, I couldn't have been more wrong, and I'm sooo thankful we've continued. She gets him to work on words all the time through play, and I NEVER could do that.

Sorry so long. Summary: Stick with the therapy!

[brittone2]

Hmmmm....hard to say. It may just be a case where you'd be more comfortable with a different therapist's approach to things, but then you have the trade-off of having the new therapist having to establish a repoire w/ Colwyn.

It sounds as if he's making some nice progress, whether due to therapy or just his own timeline. That is encouraging!! 2 months really isn't a lot of time to expect therapy to be really effective. The first few sessions are taken up w/ the therapist getting to know the child and vice versa. As a therapist, you have to figure out what motivates the child, what exactly the issues are (the eval gives you info but therapists are continually sort of re-evaluating in their minds what is going on...), what toys and games the child likes, etc. It definitely takes some time for therapy to really make a substantial difference, although sometimes the effects can be seen rather quickly.

Having worked in EI, I don't think her "making him" attempt to say a word and look at her is unusual. I can understand how that would be annoying (now that I have a child of my own), but at the same time, the therapist's time with him is so short and therefore the therapist is just trying to maximize what he gets out of the session. As long as Colwyn isn't upset by her attempts to make him focus on her, I wouldn't worry a whole lot about it, but if it truly bothers you (I can understand that) you might either just directly address it with your therapist (which is hard I'm sure but it might help your relationship) or talk to the service coordinator. As a therapist it is hard because some families would be upset if you would "allow" the child to walk away and play during a session, as they feel their child isn't getting their full hour's worth of therapy, but then you also have families that don't want to see their child be pushed too hard. Families and kids and therapists are soooo individual...it is hard to please everyone as a therapist. But, as a parent, I can see where you are coming from.

It is hard because as a PT, sometimes I had to do range of motion/stretching exercises on kids. Babies generally aren't big fans of having their heads turned this way and that way on a relative stranger's lap. I had toddlers who needed stretching, and that can be uncomfortable. But...that's what I was there for, and it was necessary. I tried as hard as possible to make it fun, and more times than not it went okay, but there are days there are tears and resistance and it is tough on the family as well. Some days you just let it go and let them play a little more, hoping the next week would be better, but that isn't always possible. So from a therapist's perspective, it is a tough balancing act. Teaching a toddler to walk with a walker isn't always fun for them. Again, you try your best to be *really* fun and *really* motivate them with fun things, but sometimes they just don't want to do something and you have to, for lack of a better word, sort of *make* them do it.

As a PT I sort of had the child try to focus hard on something and then gave them some "breathing out" time with an easier activity or even just some free play. I was okay with them taking a break and walking off if I knew I could then reel them back in, but there are also kids that once they walk away, they aren't coming back to work on something ;) They are gone...and the session is essentially over whether you want that to be the case or not.

Kids will attempt at times to avoid an activity that they struggle with, so her trying to make him stay focused isn't unusual IMO. Of course, it sort of depends on her attitude about it (is she treating it as though he's trying to be "difficult," or just sort of playfully redirecting him back to the session for example?). Most therapists would not let a child just wander off and play during a session, or at least not for more than a few mins. It is nice at those times if they can sort of join in with the child's play and shape it into something therapeutic, but that isn't always practical or possible.

As far as him not finishing his words, that IMO is not at all unusual. I worked as a PT but screened for speech and worked on eval teams with speech therapists regularly. Usually they specify that articulation (basically pronunciation/clarity) isn't a concern until they are over 3. It doesn't hurt to work on it now if she's there to help him expand his sentences, etc. but at the same time it isn't usually considered a big deal (as long as it isn't terribly frustrating for you or him). Of course, I don't know Colwyn personally and i'm not a speech therapist, so take that fwiw ;)

Anyway, I'm not sure what I'm trying to say. What you describe the therapist doing does not at all sound unusual to me, but as a parent if that makes you uncomfortable (and having a child of my own now I can see how it might), you can ask her to take a different approach, you could ask the service coordinator to talk to the therapist, or you could request a new therapist. None of those are unreasonable. I think your concerns are legit, and sometimes there is just a difference of personality that doesn't mesh. I saw therapists trade cases here and there because one therapist just was a better fit for a family than another. It doesn't happen often but it does happen.

Do they do a quarterly meeting with the service coordinator and speech therapist both present? If so, that would be a good time to bring some of these issues up if it is approaching anytime soon. You could also ask her to give you his levels on expressive and receptive language to see where he is now since he's made some progress and decide whether or not you feel it is worth continuing.

HTH

[lilycat88]

To keep it on topic...I would recommend trying another therapist before you decide to ditch altogether. I think that's the gist of the other replies.

I just wanted to comment on the Indianapolis contingent answering your post. I think we need to write an EI manual! :-)


Jamelin
Mom to Susanna born 6/29/2004