I'm worried about my little boy. He's almost 18 months old and he's not saying any words yet. We've tried to teach him some sign language but he's not really using it. He didn't really babble all that much when he was a baby either. I'm going to talk to my pediatrician at his check up next week, but I was wondering if you could tell me what to expect after that. What will happen if my pediatrician is concerned, too? Will he recommend speech therapy? If so, how can you do speech therapy with an 18 month old??
Great question! First of all, I think you are on the right track. Your pediatrician is an excellent source of information for you and your child. Hopefully she will listen to your concerns, set your mind at ease about what is to come, and get you going in the right direction. Having said that, I'm happy to give you my thoughts on how things might flow if your pediatrician does recommend that you look into speech and language therapy services for your son.
Here's the scoop. Each state is required by the federal government to have an early intervention program for children under the age of three years. Although each state's program is different, each must serve young children who either have delays in a specific area of development (a speech and language delay, for example) or who have a diagnosis that puts them at risk to have a delay (a cleft palate, for example). The state is given federal grants to provide early intervention services to young children and their families at minimal to no cost to the family. An early intervention program is made up of a group of professionals who work with young children with delays and their families to help them grow into their highest potential. Typically this group is made up of a wide variety of professionals such as (but not limited to): speech-language therapists, physical therapists, occupational therapists, early education teachers, social workers, nurses, and/or psychologists.
If your pediatrician suspects your child has a delay or is at risk to have a delay, he'll probably refer you to your state's early intervention program, which is usually run at the county level. Once you've been referred to early intervention, someone from your local program will probably* call you to gather some basic information and explain the program to you. That person will generally schedule a meeting with you to gather even more information about your family, your child, and your concerns. Early intervention services are mandated to be provided in a child's natural environment, so it's likely that this meeting will take place in your home (and no, we do not care if your house is clean!). During that initial meeting, you will help decide what areas of your child's development should be evaluated.
(*If you're noticing that I'm saying probably and generally a lot in this post, it's because every county's program is a little different. Although there are broad guidelines for early intervention programs, there's no universal process by which early intervention is delivered.)
Next, usually on a different day, your child will be evaluated by a couple of different professionals from the early intervention program. The word "evaluation" sounds so much more formal than it really is, though. An evaluation for a child in an early intervention program generally looks a lot like a bunch of adults sitting around and playing and talking. We sit on the floor with you and your child, play, observe, and ask you lots of questions. We completely understand that, with us there, your infant or toddler might not do all the things he'd normally do around just you, so you please don't worry about your child being shy or nervous or not himself. When I do an evaluation, I usually talk to the family as much as, or more than, I interact with the child. The overall goal of the evaluation is to get a good picture of what the child is doing so that we can determine if he has a delay that would qualify him to receive treatment services through the early intervention program. Again, the word "delay" sounds much more worrisome than it often is. Finding out your child has a speech and language delay does not mean that he'll be delayed for the rest of his life or that he'll carry that label forever. It just means that, right now, he struggles a bit to communicate with others and that, because he does, he and your family are eligible to receive support from an early intervention professional.
After the evaluations are completed, you and your early intervention team will have a meeting to decide what you'd like to do. If your child does qualify for services, you'll come up with a plan. The plan, formally called an IFSP or an Individualized Family Service Plan, will lay out what goals you have for your child and family and what professionals are going help you to meet those goals. This is where things get really different depending on the state in which you live. Some states typically have only one professional work directly with your family and child, while other states might have multiple professionals working in the home of just one family. You can find out more about the early intervention program in your state by finding their website here.
No matter what your state's model for providing early intervention services, though, I can tell you this: All early intervention professionals want to help your family and your child, and we almost always try to find ways to help you and your child in the context of child-based activities. This might mean that we work with you and your child while he is playing with toys in the living room or while he is eating lunch in the kitchen, or while he is running around outside. Our visits with you and your child often look much less like "speech therapy" or "physical therapy" and much more like playtime or lunchtime or bathtime. We do this because we know that young children learn best from interacting with loving caregivers inside of routine, motivating activities that occur on a daily basis. It's our job to help figure out how what we know about child development fits with what you know about your own child. To do this, we join you and your child in play or another daily routine, try out some strategies, see how they work, and then teach you to do the same. And together, we take joy in watching your child grow.
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