How do I know if my child has a communication delay?

 

Knowing for sure if your child has a communication delay is often difficult, especially if he or she is the first born and you have no other child to compare his development, too.   If you are unsure, mention your concerns to your pediatrician.  Remember a good pediatrician is not just concerned about your child’s health, but also about how your child is developing across all domains.  This would include assessing his or her cognitive growth, communicative and social functioning and motor abilities.  During your visits, you should be asked very specific questions regarding your child’s present abilities. 

 

In addition to the pediatrician, you can self-evaluate, too.   Look around when you are in situations with other children of the same age group.  How is your child interacting?  Is he or she engaged?  Is he or she speaking to his or her peers?  Does he or she seem able to communicate his needs and wants?  Is he or she frustrated?  Does he or she use gestures more than words, or resort to hitting and pulling when he or she wants something? Is it extremely difficult to understand what your child is saying?

 

Lastly, if your child is in school or a toddler program, mention your concerns to the teacher.  Typically, many times, the educator is often the first person to identify a potential problem.  If you want to know for sure, however, the absolute best way is to reach out to a state-licensed speech-language pathologist to complete a thorough evaluation of your child.

 

Will insurance cover speech therapy?

 

Every insurance contract is unique, so there is no way of knowing for sure until you call the plan.  Keep in mind that many companies, especially if they are a smaller company, will place exclusions of therapy benefits to keep costs down.  They will also have higher co-pays or deductibles.  Key phrases to look out for are: “medical necessity”, “restorative benefit” or “short-term rehabilitation”. This would mean typically that more chronic, developmental conditions like a speech or language delay without a primary medical cause are excluded.  The best practice is to write to your plan (called a predetermination) and explain the issue in detail (include the codes which you can get from a provider) to determine if the plan will cover. If you come in for an evaluation, our office will do this for you if your plan requires it.  Our office will always call and do a check over the phone in a similar way prior to your evaluation; however, no plan will ever guarantee payment until the actual claim is received and reviewed. This is why it is so very important to understand your insurance contract before making a commitment to move forward with treatment.  If the language of your contract is vague, unclear, or contradictory (which sometimes happens), we will discuss this with you prior to moving forward so that you are making an informed decision.  The last thing we want is anyone to be surprised by an unexpected bill.  If you decide to call your plan, too, (which is always recommended) insurance companies are required to document what was discussed.  Ask for a tracking number just so you have something to reference, most especially if an unexpected denial comes through.  Always get the name and ID number of the representative with whom you spoke to.  Also do not forget to write down the date.

 

How long can I estimate that my child will need therapy?

 

The answer to this question will also vary based on several factors.  This would include the nature and severity of the problem, how consistent attendance is in therapy, whether or not home carryover activities are completed, and how well your child responds to treatment in general.   Usually, at the time of the evaluation, our office will assess “stimulability” to determine how well your child responds to cues during the course of the assessment.  Additionally, all other factors mentioned will be considered to come up with a treatment plan outlining the frequency and estimated duration.  Keep in mind though that this is just an estimate, and there is no possible way to know exactly how many sessions will be needed to resolve the issue.

 

What is the difference between a “picky” eater and a real problem with feeding?

 

This is one of the most commonly asked questions of parents with children who have communication and/or feeding issues. Research shows that children who have disabilities have a greater chance of developing feeding issues, so paying close attention to eating habits is very important especially if your child has a known speech and language delay.    This does not mean, however, that all children with speech and language issues who are also "picky" eaters have a feeding disorder.  There are many clinical indicators that a trained professional would look for before making a definite diagnosis.  Your practitioner will likely ask you many probing questions upon your initial consultation to determine even the need for an assessment.  This is to identify the presence of any "red flags".  Has your child been dropping foods from his or her diet without replacing them with new ones? Is your child losing weight?  Does your child eat less than 10 foods in total or refuse food when it is changed even ever so slightly?  If the issue at hand is becoming so disruptive to your child or family’s life, then seeking out the advice of a professional is probably best.    Remember, not all SLPs are trained or clinically experienced in swallowing/feeding, so do not assume that your EI therapist or school-based therapist could address this issue.  This is why it is crucial to understand the level of experience and training of the provider that you are working with.

 

Is there a difference between school-based speech therapy and private treatment?

 

School-based speech therapy is provided by a school district or county when it is determined that your child's communication delay or impairment is having an adverse effect on his or her ability to succeed academically.  In most cases, therapy in school employs an educational model of delivery, as opposed to a clinical one.  This is why in many cases, the school district will not address certain areas of intervention that they believe bear no "educational relevance".  Keep in mind that what is educationally relevant for one child may not be for another, depending upon the child's educational setting, abilities, and nature/severity of his or her impairment.  Since speech therapy in a school setting most often has a "qualification criteria", in some cases a child may not qualify for the service even if he or she presents with a communication impairment.  This does not mean that therapy is not warranted.  It just means that the degree of impairment or implication on education is not severe enough to warrant the service under an IEP or Speech Improvement Plan. If your child gets approved for services, you will also come to realize that therapy in school is often within a group setting or that the sessions may only be provided one time per week. Conversely, when you seek out private therapy, the intensity of therapy is greater simply because your child is being seen individually and the frequency of the sessions are usually more than once a week.  Consistency in treatment is also greater since therapy time is not lost due to school recesses or closures, summer vacation, testing days, school trips or any other special event that would prevent your child from being seen on a particular day.  When therapy is consistent, outcomes are greater and achieved faster.  Lastly, the greatest difference between private treatment and school treatment is the level of involvement that you will have with your child's therapy experience. There is no substitute for having weekly face-to-face contact with your child's private provider to discuss your child's session performance and review home carryover suggestions, which unfortunately is typically not possible when you have school-based services. 

 

What are the qualifications of a Speech-Language Pathologist and is there a difference between a Speech-Language Pathologist and a Speech Correctionist or Speech Improvement Teacher?

 

All speech-language pathologists must be state-licensed to practice in the state where they are working.  They are required to renew their license regularly. In order to maintain licensure, they are required to complete a designated amount of Continuing Education Units during each registration period.  If they fail to do this, they will jeopardize their licensure status.  It is illegal to practice with a revoked, suspended, or expired license. 

 

A speech-language pathologist can also obtain a Certificate of Clinical Competency from the American Speech-Language-Hearing Association (ASHA), which is an additional certification granted once the SLP satisfactorily completes a supervised fellowship and meets the clinical requirements set forth by ASHA.  Although this certification is not required by the state, it is preferred and in some job settings required. 

 

There is a significant difference between a state-licensed speech-language pathologist (SLP) and a speech correctionist or speech improvement teacher.  Unlike SLPs, the latter two professionals are only authorized to work in a school setting and have not completed the necessary clinical training required to obtain an SLP license.  This prevents them from working in private practice, hospital, or clinic settings.  Their scope of practice is limited to treating communication impairments within the educational realm only.  In recent years though, most school districts have decided to make the SLP license a requirement for all newly hired therapists practicing in the schools.