23 month old speech concerns

[Krisrich]

I m afraid this is going to be a long post... I am wondering if I should be concerned about my daughter's speech and whether or not I should pursue therapy. She had multiple ear infections as an infant and had tubes placed at 15 months. She was also a bit slow with her gross motor development- she walked a 16 months. (However, her older sister walked at 14 months and they were both huge babies!) She seems to be fine with her gross motor and fine motor now. And she understands everything and is playful and interactive. Her speech, however, is much less clear than her older sister's was at her age. A couple of months ago, I was a bit concerned about her acquisition of new words but that seems to have exploded now. I have counted 175 words and 4 word combinations, like "I want snack, please." However, it sounds like " Ah wah sna peese." I know her speech should be 50% understandable by strangers. I'd guess it is about 75% understandable by ME, 25% by strangers. Another example, "table" is "baebuh." A couple of months ago, I think she might have had more words than I realized- I just couldn't understand them! And I obviously still have trouble. She is a finger sucker. She also still holds her mouth open at rest quite a bit and sometimes drools. Although, this has improved quite a bit in the past month. (They no longer have to change her shirt at daycare. :))

So, with that background, I had her evaluated by a speech pathologist last week who recommends speech therapy for 1/2 hour once weekly. But, I don't think she really got an adequate evaluation of my daughter. She initially said that she saw an expressive speech delay because I report 175 words and a 2 year old should have 200 (she is not yet two, just 23 months) and she did not observe any word combinations during the 45 minute evaluation. Of course, as we were leaving, my daughter put on her coat herself and said "I did it" ("I dee dee") and then picked up a doll and said "wake up, baby) ("way up, beebee".) So, then she agreed that maybe she didn't get an adequate sense of her abilities. But, she did see her drool and suck her fingers and thinks she has poor muscle tone. She was not concerned about a lot of the articulation problems- she said substituting "goggie" for "doggie" and "dump" for "jump" like my daughter does is fine. But she heard a lisp, which I do not hear.

Anyway, now I am wondering if I actually need to pursue therapy at this time or if I could just work on mouth strengthening exercises at home and then see where we are in the spring. I certainly do not want to do a disservice to my daughter. Nor do I want to stick my head in the sand if there may be an issue. I just wonder how atypical this really is for a 23 month old. And, if I pursue therapy, I will have to travel 35 minutes each way for a half hour session, dragging my 3 year old along, in the middle of winter. I work part- time so I only have two days alone at home with them...

Any opinions are very welcome! Thanks!

[brittone2]

Was she evaluated through EI? At under 3, that's one option. It sounds like you are doing private outpatient therapy?

Has her hearing been tested by an audiologist?

Low tone and or hearing issues could possibly coincide with what you are seeing (I'll leave that to the SLPs on the board, but I worked in EI as a PT, and screened for speech and other domains).

Given the history, for my own child, I might have her hearing tested or an ENT consult.

200 words at that age is waaaay beyond what I've heard most SLPs look for. Typically I've heard 20 words by 20 months as a benchmark for when services are warranted, and combining 2 words by 2 years old.

Articulation and lisping aren't usually a concern until school age (speaking in generalities here of course), but if the articulation issues are the result of fluid or not hearing well, then it would be something to address.

Hopefully one of the SLPs can chime in with their thoughts, but the benchmark of 200 words by 2 years old is IMO not typical. BUt the drooling, possible low oral muscle tone, history of tubes, etc. may be worth pursuing.

[indigo99]

My son was saying less than ten words at that age. We got a referral to start speech therapy, but they've dropped the ball (and I've been busy with the new baby) so it hasn't even started yet. He is slowly catching up, but I'm still not overly concerned. Maybe that's just me, but I personally wouldn't be worried about your daughter.

[jenfromnj]

I second brittone's suggestion of an EI evaluation, if that's available where you are. If nothing else, it would give you a second opinion, and all the services are in your home, which would take away the travel/time factor.

[Krisrich]

Thanks for the responses so far!

I should have mentioned that I did have her hearing testing about a week before the speech evaluation. She passed as far as could be determined but, of course, she wasn't entirely cooperative. :). The audiologist told me verbally that she did fine but her report recommends a repeat evaluation in 6 months to be sure.

This testing was done privately. I doubt that she would qualify for EI. I also thought that the expectations were a bit high for a 23 month old and was somewhat upset to hear that she thinks she has an expressive speech delay. I was prepared for the low muscle tone.

[Krisrich]

Hopefully one of the SLPs can chime in with their thoughts, but the benchmark of 200 words by 2 years old is IMO not typical. BUt the drooling, possible low oral muscle tone, history of tubes, etc. may be worth pursuing.

Brittone, can I ask what you mean by "worth pursuing?" Do you think that there could be some other underlying diagnosis or that I should indeed pursue therapy? She does have an ENT. We had a follow-up visit for her tubes when she was 22 months and I expressed my concerns about her articulation and drooling but he kind of blew me off because he said she is still very young.

I am just wondering if I am making a mountain out of a molehill especially because she has improved so much in the past month...

Oh, and thanks again for your response! :)

[brittone2]

I'm just thinking that mouth breathing, drooling, etc. sometimes have a medical issue underlying them (whether low tone, oral motor muscle weakness, or adenoid issues (I think?) or similar. Not my area of expertise).

With EI, usually the evaluating therapist is independent from the treating therapist. There is no financial incentive to qualify kids for services that don't need them. That said, with the financial cutbacks, etc. in many states children need a 25, 33, or 50% delay in order to qualify, which is quite substantial. (eta: and depending on what the underlying issue is, articulation at that age is probably not going to be covered. From what you describe, she seems pretty age appropriate based on # words and combining two words, so it may come down to their thoughts on what the underlying cause is and whether she'd benefit from therapy to address low muscle tone and oral motor strength, for ex. In some areas of the country, it may be difficult to qualify if it isn't impacting her vocabulary, etc. yet.) The upside is that the therapy is free in many states or on a sliding scale in other states if the child qualifies. I would worry about someone feeling 200 words are necessary for a not yet 2 yo. It sounds like she's combining some words into 2 word phrases as well. (eta: and the evaluating therapist may be able to give you their thoughts on whether she would benefit from private therapy even if she doesn't qualify for EI. They may be able to tease out whether there's an underlying physical/medical issue, low tone, oral motor strength and coordination issues, etc.)

It is good her hearing was tested.

[crl]

I'd get an EI evaluation. It's a free second opinion, so why not? If she qualifies, you can decide whether to pursue therapy; and if you decide to pursue therapy whether to do it privately or through EI. For us it was a wash financially, except for the evaluation being free. But the nice thing about EI for us was that they came to our house. So much easier than having to drive somewhere and wait in a waiting room (cause I'm always early everywhere) and so on.

DS drooled a ton and had horrible articulation. When he was finally discharged from speech therapy altogether at age 7 (his problems included expressive and pragmatic delays as well as articulation issues) he STILL had "poor oral motor skills" but he has learned to compensate and he has zero articulation issues.

Catherine

[zag95]

I agree with PP that having an EI eval done is totally the way to go. DD had a expressive language delay due to cleft lip and palate. They tested her in all areas. I think it would be good because several evaluators can observe her (slp, OT, etc) at once and get a better idea of how she is doing. DD qualified at has been receiving services for speech at 22-23 mos old. She'll be 4 next month, and we are still getting services in addition to private speech therapy.

Also- 1/2 hr per week of speech seems kind of short to me. DD does a 50 minute session with both EI and private. so basically 100 minutes of speech per week. I would say that being aggressive at an early age is going to pay off later....

Agree that a second opinion is a good idea........

[BeachBum]

That said, with the financial cutbacks, etc. in many states children need a 25, 33, or 50% delay in order to qualify, which is quite substantial. (eta: and depending on what the underlying issue is, articulation at that age is probably not going to be covered.

In my state, I was told that they were so underfunded that if my kid has any words at age two not to bother bringing them in for testing it was a waste of time for everyone. My boys were having trouble with the "c" and "g" sounds. The woman I spoke with on the phone encouraged me to go private and I'm so glad I did.

My twins having been in speech for several months. I've seen LOTS of progress and am so thankful I took them in. Habits are really hard to break.

If I were in your situation I would take my child without a hesitation or second thought.

[mom2binsd]

I'm just thinking that mouth breathing, drooling, etc. sometimes have a medical issue underlying them (whether low tone, oral motor muscle weakness, or adenoid issues (I think?) or similar. Not my area of expertise).

With EI, usually the evaluating therapist is independent from the treating therapist. There is no financial incentive to qualify kids for services that don't need them. That said, with the financial cutbacks, etc. in many states children need a 25, 33, or 50% delay in order to qualify, which is quite substantial. (eta: and depending on what the underlying issue is, articulation at that age is probably not going to be covered. From what you describe, she seems pretty age appropriate based on # words and combining two words, so it may come down to their thoughts on what the underlying cause is and whether she'd benefit from therapy to address low muscle tone and oral motor strength, for ex. In some areas of the country, it may be difficult to qualify if it isn't impacting her vocabulary, etc. yet.) The upside is that the therapy is free in many states or on a sliding scale in other states if the child qualifies. I would worry about someone feeling 200 words are necessary for a not yet 2 yo. It sounds like she's combining some words into 2 word phrases as well. (eta: and the evaluating therapist may be able to give you their thoughts on whether she would benefit from private therapy even if she doesn't qualify for EI. They may be able to tease out whether there's an underlying physical/medical issue, low tone, oral motor strength and coordination issues, etc.)

It is good her hearing was tested.

I'm an SLP and it sounds like she is using a lot of words, at at just about 24months and saying the words she's saying (even though not perfect articulation) she is on target and most likely would not qualify for speech therapy through EI (my son had 5 words at age 2 and he didn't qualify based on his higher receptive scores and other factors, he was a late talker!).

I agree that looking at her overall development, like EI does, might be helpful, and maybe asking for a pediatric audiological eval/recheck to make sure the tubes are still in place.

Some of there errors seem to be hard consonant sounds at the ends, which she may not be hearing, or she may not be getting proper placement or what is known as velopharyngeal closure for some nasal sounds, again a pediatric ENT might be helpful.

Do you live in a large city with a university clinic (a large school with a graduate program for SLP's).