Another speach question

[Nooknookmom]

Can you guys explain what an EI eval. is? I didn't want to hijack the other thread.

My friend has a daughter that will be 2 in about 3 weeks. I'll call her DB. My 21 mo old & DB play about 3 times a week. They have played together from the time they were 5 & 7 months old, so I have seen the development of each child from the get go.

The 23 mo old hardly speaks at all. Seriously, I've heard her say, maybe, 3 words total.

Her mom has 3 kids total and when it comes to this baby's development she kind of says "oh well". She usually just lets her watch TV and feeds her to keep her busy. I normally, don't dare stick my nose in others business, but I am really concerned for her. She's always making comments on how my DD can carry on conversations, plays pretend, etc. & her daughter can't. Makes me feel very uncomfortable being around them.

DB's tounge is tied (has that little thingy that prevents it from going outward completely), would that keep her from forming letters? She had no problems latching on.

Also, I'm not sure how to approach her (if I do find some place she could be tested) b/c I don't want to come off as insinuating that her baby has issues, KWIM? I just want to help in a discreet way.

Maybe I should just let sleeping dogs lie, and not say anything at all. WWYD?

[AnnieW625]

As being a mom who is very open minded to my daughter's care esp. concerning her speech delay issues (at 25 mos. on a good day or around me, DH, or daycare she was equal to a 15 mos old; on a bad day or when she was around new people she spoke as little as a 13 mos old) I might have taken a suggestion well, but truthfully sometimes I think that it's best that you just leave it alone and let the parents assess what their DC need. Now if you are very close to this person I might suggest that they have their child evaluated.

I am not sure what an EI eval is; different places call evals different things.

[brittone2]

It is very hard to even gently suggest to someone else that their child might have a delay and it may harm your friendship. Parents often have to come around to it in their own time. The difficult thing is in many states, early intervention for 0-3 year olds is very different than the system for 3+. For 0-3 it is much more family focused and easier to obtain services IME. Once they turn 3, it can become more challenging to get services.

Basically in most states you can self-refer for an evaluation by calling the local office for early intervention in your county. In many cases a physician will refer toe family to EI if they have concerns, but parents can also self refer as I mentioned. Typically someone will ask some questions to get some info for the intake form and give you an idea of how long of a wait you are looking at.

In many states, a "team" will come out to evaluate the child. When I worked as a pediatric PT for EI in PA, the team was an early education teacher or speech therapist, and then either an OT or a PT. In some states depending on the concern they may only send one of those professionals out vs. a team depending on the concerns.

The evaluation typically lasts around an hour or so. It generally involves a lot of what looks like play and many kids actually somewhat enjoy the evaluation.

The evaluators then score their testing and can usually tell the family if the child qualifies for services. In some states certain diagnoses can qualify a child even without a delay (like a diagnosis of torticollis for example, putting a child at risk of delay). In many states kids need a 25% delay to qualify for services through EI (the % delay can vary state to state. I think in some states it may be 33%?). So for example, a 24 month old child would need to be functioning at the level of an 18 month old to qualify for services in a specific area (speech, fine motor skills, gross motor skills, cognitive, self-help, etc.). Again, this may vary somewhat depending on the state you are in. (eta: even if a child does not qualify for services, in many instances the evaluation team may give the family pointers or tips on things to work on, or may give the parent an idea of "red flags" to watch out for in coming months or milestones they'd expect the child to meet in coming months, with the suggestion that they call for another evaluation if the child is missing those milestones or having some of the "red flag" issues come up)

If a child qualifies, EI services for 0-3 are frequently free regardless of family income. In some states there are sliding scales, etc. based on income, so it does vary somewhat. Services for 0-3 are generally provided in the child's most "natural setting" which is daycare if the child attends, or in the home.

Children are periodically reassessed once they enter the system, and if they catch up services are discontinued (eta: famlies sometimes opt for private outpatient therapy if their child has some delays but no longer significant enough to qualify them for early intervention services). If the child continues to need services and continues to demonstrate enough of a delay, services will continue.

If you are going to bring it up, it is sometimes easier on the other parent if you mention knowing someone else's child (friend, family member, etc.) who received services through early intervention to "catch up" but not mention the concerns about the actual child of the friend you are speaking to, kwim? There is much less stigma associated w/ services today (fortunately) and soooo many kids receive a little help through early intervention. Many will catch up with their peers by the time school begins. However, many times parents feel hesitant to make that first call to schedule an evaluation. Sometimes it is denial, sometimes their pediatricians/family physicians brush off their concerns, sometimes they don't recognize a delay or are convinced their child will catch up without help (which is sometimes true, but even seasoned therapists can't always tell which children will catch up and which won't). It is certainly a difficult topic to tread...you know your relationship with this person best, but just know that is can be hard to raise concerns without upsetting your friend.

Yes, tongue tie can impact speech somewhat, but in many cases I'm guessing (speech isn't my specialty, but I've screened many kids for speech issues) that the child would still be making quite a few sounds. The tongue tie might impact the variety of sounds, but not speaking much at all by 2 would definitely be a concern that *may* extend beyond a tongue tie alone...no way of saying for sure without evaluating that child, of course.

:hug: I hope the child can get help if needed, but it is such a difficult issue to raise without offending a friend.

[egoldber]

A 23 month old with only 3 words is pretty concerning, but I'm not sure what you can do. You could always play the "talking about a friend's kid who went to EI" game. That often works well. :)

[mom2binsd]

My DS was 26 months and only had about 4 words and I requested an EI eval. I'm an even an SLP and am very aware that many kiddo's can really vary, but I didn't want my role as mom and SLP to be interfering with each other. DS DID not qualify for speech services, his comprehension and other skills were all fine and he was a little expressively behind but not enough to qualify for services which I was fine with, I really felt he was a typical late talker, a busy boy who clearly understood lots of language and demonstrated age appropriate social and developmental skills.

What is considered "normal" takes into so many factors other than just the number of words a child can use. A child's entire communication system as well as developmental skills and social skills are also important factors. Again, many children don't often say much until around 2.

So at 23 months DB may very well be just a late talker and like the others have said it's really very difficult to bring it up to someone. I'm often asked by friends for my opinion on their DC's speech and language skills and I always tell them to request an eval if they're really concerned so a complete assessment can take place (I never like to give a "quickie diagnosis", but I often tell them that not saying "r" correctly at age 4 is just fine!)

Oh and now, if we could have 2 minutes of peace and quite and no talking from DS it would be heaven!

[JTsMom]

She's always making comments on how my DD can carry on conversations, plays pretend, etc. & her daughter can't.

Personally, I would take that and run with it. She may be fishing to see what you think. A lot of times people will just say, "Oh, I'm sure she's fine! You worry too much!" and make the concerned parent feel like they are overreacting. The next time she says something, maybe say something along the lines of, "Hmmm. Well, speech delays are really common. If you're at all concerned, I know you can get a free evaluation through EI. Some of the moms I chat with online have gone that route, and they all say it's wonderful! I know they stop the service at 3, and there is often a waiting list, so it probably couldn't hurt to check into it soon.".

[maestramommy]

I probably wouldn't suggest an EI eval out of the blue, but the next time your friend comments on the different between your DD and hers, you might ask whether that concerns her, and gently lead that to looking into an eval. In CA it's very easy to get evaluated. At least that was our experience. The people at the regional centers are great to work with. And if DB's tongue tie has anything to do with it, they would pick up on that and give suggestions for what to do about it. In CA you have to show a 33% delay in a single area to qualify for services. But they always do a complete eval, so don't be alarmed if you look up a regional center in online and it says stuff about autism.

Our particular regional center (Harbor) found that Dora just barely qualified on paper. But they wanted to make sure she got the services because they could easily see she wasn't talking at all. So they did a different screen and she qualified without question. I'm always grateful for that because we were at a standstill with her and wouldn't have known what to do next if she didnt get the services. It's always harder (for me as a parent) to know what's normal when your kid is so quiet, which Dora was.

I believe there is a regional center in the San Gabriel Valley. One of my GF's friends took her son to get evaluated there. You can also pm me if you have more questions about the process.

[Nooknookmom]

Hey everyone, thanks for the suggestions. I feel a little better now, we got together to play today and SHE brought it up out of the blue.

I just tiptoed around it by shooting her some of the info you all shared. Perhaps, DB IS a late talker. DB walked at 8 months and learned to climb very early. So I suggested that maybe DB is just a more physical baby and the language skills will come in time and the more she works w/ her the easier it will be. She asked me what the age for concern was and I said that I thought it was around 2 and if she had any concerns after that to check it out.

Sidenote: DB is very much a loner as well, when we go over, she will go sit on the couch and cover up and just sit there for a long time or go back in the bedroom and sit on the floor, kinda strange.

Whew. So, we'll see how it goes.

Thanks Melinda for the SGV tip, since that's where we are that could be a great resource!