Friday, March 18, 2011

Early Intervention: What To Expect

A reader sent me the following question:

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.

Got Questions? I've got answers. E-mail me at childtalk01@yahoo.com 
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More information on Early Intervention 

14 comments:

  1. As a mom of a recent graduate of early intervention services, I can say this is a wonderful service. My daughter started speech therapy, occupational therapy, and physical therapy with early intervention at 6 months old. She has progressed extensively with their help. We love my daughter's therapists and teachers, all of them.

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  2. YAY, Mom on a Line, I'm so glad you had a positive experience! :) I love working with families and children and watching as children grow. :)

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  3. We have my daughter in speech therapy through our early intervention service right now and it has been a very helpful experience. We started her just after her second birthday and have seen a lot of improvement but there is still a lot of work to do as well. I am a little concerned about what happens when she turns three and no longer qualifies for this program but we have still have about 6 months before we have to worry about that.

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  4. Thanks for visiting my blog today. I know that speech therapy will be a big help for my boys- I look forward to seeing their development in this area.

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  5. Angela, I'm glad speech is going well for your daughter! And yes...so many of the families we work with worry about that transition...but it usually all works out. It's just hard to let go of the people you've gotten to know (just like it's hard for us to let go of the kids and families!)

    Liz, Good luck! Hope to hear more about how it goes with your boys.

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  6. We stopped services from our early intervention program because we weren't happy with them. My daughter has a genetic condition that includes developmental delays (hypotonia, feeding difficulties, and now apraxia) and I found ECI just didn't meet her needs. Forty five minutes twice a month was just not sufficient. We moved to private therapy (speech twice a week) and my daughter has made great progress! I love the idea of home based early intervention, but our provider just wasn't what we needed.

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  7. Thanks for the perspective, Shannon. You're right, an early intervention program can often be less intense than private therapies (although this does depend on the state). The focus of early intervention is as much on teaching families as it is on working directly with kids...with the idea that families spend waaaaay more quality time than we (therapists) ever could with their children, so that we (therapists) have way more of an impact by working with the family and the child together than we ever could by working with the child alone. BUT some families certainly feel this isn't enough. And I am so glad when families have a variety of options from which to choose so that they can get what they feel is best for their child. I'm glad that you have found a fit for you. (I'm actually in a unique situation where I work in both early intervention and a clinic, and I really love the work in both!).

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  8. (Although, I'll also add, that my own early intervention program tends to see children one time a week, not two times a month-- another difference that is based in location of your EI program!)

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  9. this was a very detailed and informative post about EI! :) Great job!

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  10. Thanks, Jess! It's nice to know that it fits what many people have experienced. :)

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  11. Thanks for explaining the process to a newbie.

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  12. My kid is 3yrs old having the same issue..our 1st part of evaluation process is done...but i am very much worried and depressed abt this.will he be a normal kid after undergoing this EIP.I want him to be like other kids.

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  13. I am a pediatric occupational therapist and practicing for over 37 years. I am consumed with concern that kids are not being referred for services soon enough (or not at all) by their pediatricians. What I understand, in speaking with pediatricians, is that pediatricians may not be schooled enough or are not feeling confident enough in their observational skills for the early signs of autism. they are therefore reluctant to discuss the subject with families or make referrals/recommendations to families (not wanting to unnecessarily frighten new parents). Are you aware of brand new tools available to pediatricians to help them be more confident in observing signs of autism and making referrals for young infants (2-6 month olds)? In my own practice, I have been fortunate to treat a few very young babies (under 6 months) who were showing signs of autism by 2 months. The outcome for these babies has been nothing short of miraculous, with me having no concern at all for these young children's future.

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  14. I have had our county's program over, & the lady doing the evaluation (for about 45 mins) was concerned...but I got a letter basically saying that nothing was bad enough for further intervention for my two yr old. I know she would benefit from sime of these programs but am a loss of what to do next. Some of her issues include a speech delay, about 20 words at 28 months; social issues which do not include eye contact, but she does have a problem with communicating what she wants which ends up in no pointing or talking ...just screaming. She runs off a lot and will not respond to her name. She hits her twin sister often and just smiles. The twin sister will react to my fake crying over a hit, she just smiles. She definitely has sensory issues which involve drooling and preferring certain rough textures. She prefers to be either fully clothed always with a jacket, or stark naked and she'll pull on her nipples. She can't stand having her hands dirty or a dirty diaper either...but does not seem to be willing to use thepotty. Any suggestions???? Please email me in case I can't find this site again! :) amyknowsitworks@gmail.com

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