Speech therapy eval - advice please (long)

[niccig]

I am confused. DS is 6 in December

DS was at a friend's house when a SLP was there for my friend's DS. She noticed some things with DS's speech and suggested an evaluation - specifically tongue thrusting and some sounds.

Our dentist didn't think DS was tongue thrusting of if he is, it's minimall. She sees nothing with his dentition or bite, and to take conservative approach.

The school SLP did an evaluation and is not recommending services. She says he isn't tongue thrusting. He isn't saying L as in yellow. If he follows you he can put the tip of his tongue behind his teeth and say low, but he doesn't do it on his own. He is saying his Rs as in chair sometimes but half the time he isn't saying his Rs either. The school SLP says to give it another year. The school's position is that DS is still within range of developing the sounds and he might get there on his own. But if he's 6.5 years old and still not saying L and R, to take him in. He can't do s, or z or th either, but I was told that's normal at this age.

I pass all this on to my friend, and she tells her SLP, the one that first noticed something with DS's speech. She feels the school's evaluation is too conservative and that DS is close to the age where he should be making those sounds, and if he hasn't done it by now, then he probably won't on his own. She also said that not all SLPs are great at diagnosing tongue thrusting. And the schools criteria for offering services are higher than other evaluations because of budget - our DR. told me to do the school eval. but they might not give services if didn't affect learning.

On the opposite side, the school SLP says that private therapists often recommend services earlier than the school does and that the child might get there on their own anyways, so they wait and see. Our Dr. said this as well.

DS probably won't qualify for any school services as we're in a private school and apparently they're stopping services to private school kids from this year. We would have to go to private if he needs speech therapy.

My dilemma is do I wait or do I go see someone privately - I can go to a 3rd place, it's a clinic near DS's school, and get another opinion. DS does get frustrated with me sometimes if I can't understand him. Eg. in the car he was asking me if today was three day of school. He meant 3rd, but said three. For the life I've me I could not work out "three day" and he got really frustrated. Then a few minutes later he asks me why there was a cup on the road - an in-n-out cup, and I thought he said cop, so I start talking about policeman and he tells me I'm not listening to him, and it's from the restaurant, we had just driven by in-n-out, so I figured it out. Just now he can say cup and cop and I can tell the difference. I can understand him most of the time, but there are moments when the word he says is not intelligible.

So, advice. What do I do? Wait and see, or go see someone privately.
Thanks

[karstmama]

if it's frustrating him, have him seen.

yeah, the school system's gonna be on the wait & see side - it would be out of their budget. but it's not their kid that's frustrated at not being understood.

if he didn't care, then 'wait & see for another 6 months or so' would be an appropriate response, too, but it's bothering him & your mama radar is going off or you wouldn't be asking.

[Indianamom2]

Well, this is just my opinion as the mom of an almost 6 year old who's been in speech therapy since 18 months of age, but I think I would go with a private eval. I'm less concerned about "l" and "r", because they are later developing sounds and he is still within the range. I'd be more inclined to take a wait and see approach, but the other sounds are things that he probably should be closer to doing (s, z, and th).

The biggest red flag though, is his (and therefore your) level of frustration with not being able to communicate clearly. If you are having trouble understanding him, and this causes him frustration, it's definitely happening at school as well, and I would be concerned. And believe me, we have definitely been there, done that. It still happens on rare occasion, but not nearly as often.

I will say that I tend to agree with the private SLP that schools tend to take the wait and see approach and that the child has to have a higher percentage of delay to receive services. I will also say that from our personal experience (having done private and school therapy), private therapy will probably be far more beneficial that school therapy. We saw tremendous gains when DD was seeing a private therapist, but nothing like that with school. In fact, we have just about decided that this year, we will take the wait and see approach, and take a break from therapy because we don't really think the school's therapy program has been all that effective. (The only sound DD doesn't say now is "r", so we are pretty age-appropriate at this point anyhow.)

I know that having to pay for private therapy stinks. It's expensive, but it can make a huge difference, provided you find a highly recommended therapist. Also, look into whether your insurance co. covers speech. Ours covered 40 sessions per year, which worked out great. we had to pay 20%, IIR, and we had to submit the claim forms, but it was better than paying full price.

Good luck with whatever you decide. It's not an easy decision sometimes.

[n2ou]

Hope this helps.

http://tiny.cc/mtnsj

Do you have concerns about his speech affecting his academic abilities? Like sounding out words and spelling them wrong? I think that would be a good angle to approach it.

[bubbaray]

Hmmm, I would wait.

DD#1 was in speech therapy for a couple of years in what would in the US be "private" (though we d/n have to pay). She still had a lisp when she started K, but the SLP said it was age-appropriate and not to worry. I told the K teacher so that the school SLP could assess, but the teacher said it wasn't even close to what they refer to in the schools. She told me not to worry.

Sure enough, as the year went on, DD#1's speech improved. She still has a slight lisp on certain sounds, but its WAAAAY better.

So, based on our experience, I would wait and see. If you need to get on a wait list for reassessment, do that, but I don't think I'd do private pay if the other SLP is saying he's fine.

JMHO

[bnme]

Your DS's issues sound very similar to my 6yo DS. My main concern has always been about his overall intelligibility and not just his ability to produce certain sounds. He was getting so frustrated and it really affects him in social situations, especially with other kids. My experience with the school system is that they try to reserve speech therapy for only the more severe cases and require you to prove it affects their learning. I think there is a big difference between a child not being able to say their 's's correctly and them being very difficult to understand. Most kids who just mispronounce certain letters are not unintelligible. I was pulling my hair out of my head and going in circles trying to get the school to re-evaluate him.

Prior to kindy he had qualified through the district for 'preschool services'. But he tested out, according to my districts standards, prior to entering kindegarten. I was able to challenge their decision and force a re-evaluation and he started getting services in January. Thankfully his teacher and the SLP were on my side.

My advice would be to go with your gut. If it is affecting him socially it will affect his learning. See if you can challenge the schools decision. I know in my state having a private evaluation can be an issue if you desire another school evaluation at a later date so I would really look into all the rules. For my DS, his break in services (and even having the summer off) really makes a difference in the progress he had made so I know that the sessions really do something. I work with him at home, but it is just not the same. My DS can produce many of the sounds if prompted and in isolation but has issues with doing it spontaneously and in conversation.

Good luck. I know it is a hard to go through something like this. Especially when you are getting different advice from the specialists.

[niccig]

Hope this helps.

http://tiny.cc/mtnsj

Do you have concerns about his speech affecting his academic abilities? Like sounding out words and spelling them wrong? I think that would be a good angle to approach it.

Well based on that, and thanks for posting it, DS should be saying L sounds by 6 years old. He's 5 3/4 and isn't saying them, unless you prompt him. He can do a proper L with tip behind his teeth if you have him model you. The school SLP felt that as he can do it, he eventually will. The private SLP, who didn't give him a full evaluation, but talked to him for some time, thinks that 5 3/4 is close to 6.

The other sounds like r, s,z, th aren't until 7-8 - so we could still have problems with saying three until 7.

I don't think it's affecting his academics. I do wonder if he's not being understood at school, he says everyone else understands him and it's just me. I might have a word with his new K teacher and ask them if they're having trouble. It can't just be me.

[niccig]

Sure enough, as the year went on, DD#1's speech improved. She still has a slight lisp on certain sounds, but its WAAAAY better.



I know this is possible, and why it's one of those do I wait, or do I go ahead. We have friends that were told to wait on speech, and they did, and they now regret it as their DS was the one that did not improve on his own, and they feel they wasted time. But other kids did improve on their own.

[AngelaS]

If you can't understand him, get another opinion. My almost 6 year old has been in therapy for 2 years and has learned to say all the sounds your son cannot say yet. They've also spent some time unlearning her bad habits. I'm finding now that I'm teaching her to read that there are still a few things to work on--like the difference between short A and short E sounds.

[bubbaray]

But the examples you give re understanding him are contextual, not speech, correct? As in, the "cup" he referred to actually was a cup, right and you thought he meant something else? And the three day/third day is a word choice issue, not a speech formation issue, no?

That chart isn't hard and fast. For example, some sounds are easier to say at the beginning of a word (the L in love for example) or end (the L in well) as opposed to in the middle of a word (the L in world). I think that is what our SLP said. And I think it depended on the sound too -- some like R were easier to learn at the end and middle, but harder at the beginning.

Its all a bit of a blur, frankly.

Anyway, my post was more to give you some home that some kids do improve by just being in the school setting. The sounds that my DD#1 had problems with were not even worked on by her private SLP b/c they weren't yet age appropriate when she stopped working with her. I wouldn't say her speech is perfect, but its much better and more "big girl" sounding as each month passes.

[niccig]

Your DS's issues sound very similar to my 6yo DS. My main concern has always been about his overall intelligibility and not just his ability to produce certain sounds. He was getting so frustrated and it really affects him in social situations, especially with other kids. My experience with the school system is that they try to reserve speech therapy for only the more severe cases and require you to prove it affects their learning. I think there is a big difference between a child not being able to say their 's's correctly and them being very difficult to understand. Most kids who just mispronounce certain letters are not unintelligible. I was pulling my hair out of my head and going in circles trying to get the school to re-evaluate him.

Prior to kindy he had qualified through the district for 'preschool services'. But he tested out, according to my districts standards, prior to entering kindegarten. I was able to challenge their decision and force a re-evaluation and he started getting services in January. Thankfully his teacher and the SLP were on my side.

My advice would be to go with your gut. If it is affecting him socially it will affect his learning. See if you can challenge the schools decision. I know in my state having a private evaluation can be an issue if you desire another school evaluation at a later date so I would really look into all the rules. For my DS, his break in services (and even having the summer off) really makes a difference in the progress he had made so I know that the sessions really do something. I work with him at home, but it is just not the same. My DS can produce many of the sounds if prompted and in isolation but has issues with doing it spontaneously and in conversation.

Good luck. I know it is a hard to go through something like this. Especially when you are getting different advice from the specialists.

Yes, this is DS. When I ask him to say one word, he often can, but not in a conversation hence why he can now say cop and cup but I couldn't understand him in the car when he said cup in a sentence.

I'm not sure if it's affecting him socially - he maintains it's only me that has trouble understanding him. And it's not all the time. Today, it was twice within a 10 minute drive, but that's not usual. But, it's enough that I notice.

I think the school is totally out as an option. It sounds like all private school children will no longer receive services through the public school SLPs. We would have to go to private SLP.

It is very frustrating that the specialists don't agree. Both SLPs have been doing this for 10+ years and they disagree on whether he is tongue thrusting and when to intervene. The school SLP said if he was tongue thrust + sounds, she would recommend services now, but as in her opinion it's just the sounds, then wait. The private SLP thinks he is tongue thrusting and close enough to end range of age for proper sound development to do something now.

I'll talk to DH and I might go to the private clinic near his school - they have some SLPs that specialise in tongue thrusting - surely they can say whether he is or he isn't.

I was fine with the school's wait and see suggestion, until today when DS got upset with me, and then I got my friend's phone call, so now I'm not sure...

[niccig]

But the examples you give re understanding him are contextual, not speech, correct? As in, the "cup" he referred to actually was a cup, right and you thought he meant something else? And the three day/third day is a word choice issue, not a speech formation issue, no?

That chart isn't hard and fast. For example, some sounds are easier to say at the beginning of a word (the L in love for example) or end (the L in well) as opposed to in the middle of a word (the L in world). I think that is what our SLP said. And I think it depended on the sound too -- some like R were easier to learn at the end and middle, but harder at the beginning.

Its all a bit of a blur, frankly.

Anyway, my post was more to give you some home that some kids do improve by just being in the school setting. The sounds that my DD#1 had problems with were not even worked on by her private SLP b/c they weren't yet age appropriate when she stopped working with her. I wouldn't say her speech is perfect, but its much better and more "big girl" sounding as each month passes.

The cup sentence was "mummy, why is there a cup back there?" He saw an In-N-Out cup on a low wall as we drove past In-n-Out burger. I thought he said "why is there a cop back there" thinking police officer. I start talking about the police and he gets upset as I didn't listen to him, so I ask him to say it again and then to use other words to tell me more. He then said "it's from that restaurant we just passed." I say "In-N-Out?" and he says "yes". I then put two and two together and say "did you see an In-N-Out CUP?" and he says "YES!!!!".

I couldn't understand the three at all. If it was clear, I would have worked out that he meant third. I got the "is today a" something "day at school?"

I know some sounds are easier to make depending on where it is in the word. DS can say a beautiful chair, but other r's he couldn't.

I know he could improve on his own, I just wish for a crystal ball to tell me if he definitely will or not...that crystal ball that we all want when it comes to our kids.

I'll talk more with DH and I have a SLP friend,although adults, to ask advice of too.

[mytwosons]

It sounds to me, since he can make the sound when prompted, he won't be in ST for very long. I would go the private route. They will be able to instruct you on how to help him practice and I bet you'll be done in no time.

FWIW, when DS1 was almost 6.5, he couldn't say \th\, even when prompted. I got the school involved because it was affecting his spelling. If we hadn't gone private, I think he would still be having problems; the schools are just too overwhelmed to work much on kids w/minor problems. It only took about six weeks of private ST to resolve the issue completely.

[mom2binsd]

I'll give my perspective from a school SLP (for 14 years) and someone who did private therapy as well, outpatient therapy too. Sorry if long...

The thing with schools, the speech disorder is technically supposed to impact learning to qualify a student, it's pretty clear in the IDEA law, but there were times that I had a parent who was able to present the case that the student was reluctant to answer in class due to embarrassment and that was impacting classroom participation.

For your DS, yes those sounds are within the range, but all of them together can make his speech somewhat difficult to understand possibly. If it was just L, or just R or just the S sounds, but all together.....

In defence of the school SLP, she may have over 60 kids on her caseload at one school and may just feel that he is not quite at the level to qualify. Private SLP's, well, they are running a business and do not have to follow any IDEA laws/policy etc. and if a parent feels their child needs services and if they see a need they will see them. Most private SLP's are very ethical and will not provide services if needed, it sounds like he'd really benefit. In the schools if you've got students who are struggling academically, student with significant special needs (autism, down syndrome, severe learning disabilities, etc) it is sometimes not possible to fit another in if they really don't qualify. In my day's as a school SLP as a favor to a parent who was very concerned and eager to follow through at home, I'd try to find a group to add the child to, yes it's one more IEP to write, meeting to schedule, report card to write etc but sometimes it doesn't take too much time for the child to achieve their goals. If a child absolutely qualifies, then you add them to your caseload and if your caseload become unmanageable you call the district and beg for more help!

With respect to L- although the charts give an age of almost 7, I believe most kids should have mastered it by age 5, it's a easy sound to work on, and very high frequency- my son is a perfect example, he's 4 (March birthday) and his name is Logan, and his fav thing to say to me is "look it".....we are really working on him self correcting his l's at this time, he's about 75% with the L in the word initial position (l in the middle and end is harder and will come). I really feel like at age 4 my DS can do it, like your DS he has shown he's "stimuable" meaning he can make the sound, he just needs practice.

Private therapy will give you much more practice and one on one time, school therapy will be in group and you won't have the contact with the SLP like you do with private therapy. If you can afford it, you might try it, or try the 3rd opinion.

PM me if you have any questions.

[bnme]

I think how often it is happening is really key. It was constant with DS. And I could/can understand him SO much better than others, even DH. And his frustration would sometimes reach the tantrum level. One time we were at a Chuck E. Cheese type place and the kids were picking their prizes. He only had enough tickets left to get a small top so we asked him which color. At first it was clear he was annoyed that was his only choice. We gave him a few chances to tell us which color and he didn't seem to be telling us (I don't remember what i thought he was saying). W ended up just leaving. Well once we were in the car he was so upset and screaming and I finally realized he had been saying he wanted the orange top all along (when I had thought he was saying he wanted something else). I remember being so sad for him. Having many momments like this is what drove me to really persue this. I also saw kids walk away from him or outright say "I don't understand you" because he was so hard to understand. It really became noticeable in the 4yo program at preschool when kids are really starting to interact one-on-one and not just playing along side each other. And thats when I noticed he was starting to hold back and avoid social interactions. It helped that his preschool was a co-op so I was in the classroom almost weekly. I knew it was something more then 'some kids don't produce that sound until they are 7-8'. He also has some language delays. Has your DS been evaluated for that?

I think getting some feedback from his teacher is a good idea. He may be one of those kids that just is late developing certain sounds and will have some minor issues from time-to-time being understood. Or not. I struggled with that too. But for me as he got older it became very clear their was a real issue.

[BeachBum]

I just skimmed the responses...but I wanted to respond because we are going through something similar.

My son just turned 5 this week. I was told by two therapists that at age 5, "the untrained ear should be able to understand all of what your child says".
He too has trouble with "l' and "r" and some blends (like th). But has a very good vocabulary in general.
I took my son to early intervention type service that works with schools and is state funded. She said he certainly didn't qualify, but if I was concerned take him to private. She did think he was a little behind where he should be.

When I mentioned to my friends several of them had "it's about time" type comments. (I was really surprised). I took him to a private eval this week. He scored a 97--where 100 is average. Her $.02 was since he is not yet in Kindy, give it until January so see if those few months help him develop on his own. If I don't notice a huge improvement plan on him starting therapy in Jan.

My Ped feels good about this plan of action. She definitely thought I would want to be working on this well before Kindy.

So from what I learned in going through this with my son, I would encourage you to seek out private therapy pronto.

[hillview]

Given the frustration level and that it seems like more than once in a while you struggle to understand, I'd get another opinion. DS2 did SLP via EI last year FWIW. DS1 is just 5 and I understand all of what he says however sometimes I don't get the context b/c he is talking about something very random/out of the blue (he has been thinking about it but it is not in the context of now). I understand the words but not what he means (if that makes sense).
/hillary

[gordo]

I am currently going through something similar with my 5 year old. I have noticed more and more that people are asking me what she is saying. It is the same sounds - l, r, s, th. Since she just started Kindergarten, I called the school speech path and asked her to have a listen to her. She called me today and said she did a screening process and would recommend starting speech services. She said that DD can make the correct sounds in isolation but she speaks fast and has established bad articulation habits. That while she is in the range where the sounds don't have to be mastered yet, she feels it is best to start correcting them now, before the bad habits become even more ingrained and that she feels with this approach she could probably be done with speech by the end of the school year.

So that is my long winded way of saying I would get another opinion, especially since he is getting frustrated and the articulation errors are effecting his intelligibility.