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Navigating Insurance Authorization for ABA Therapy in Florida
Insurance coverage for ABA therapy in Florida can feel like a maze to families who have just received an autism diagnosis for their child. Applied behavior analysis, or ABA, is one of the most widely used therapies for children with autism spectrum disorder. But before therapy can begin, most families must work through an insurance authorization process that involves diagnoses, prescriptions, assessments, treatment plans, and waiting periods.
Understanding how the process works helps families move through it with fewer surprises. While every insurance plan has its own rules, the general steps follow a similar path.
What Florida Law Requires
Florida has had an autism insurance mandate since 2009. The law, known as the Steven A. Geller Autism Coverage Act, appears in section 627.6686 of the Florida Statutes. It requires certain health insurance plans to cover screening for autism spectrum disorder and treatment of autism and Down syndrome through speech therapy, occupational therapy, physical therapy, and applied behavior analysis.
The law covers eligible individuals under 18, along with individuals 18 or older who are still in high school and were diagnosed with a developmental disability at age 8 or younger. It requires that ABA services be provided by an individual certified under Florida law or licensed under the state’s psychology or mental health counseling chapters.
The mandate has limits that families should understand. It applies to group health insurance plans offered by licensed insurers, including the state group insurance program. It does not apply to plans offered in the individual market, individually underwritten plans, or plans provided to small employers. Coverage under the statute is capped at $36,000 per year and $200,000 in lifetime benefits, with the maximum adjusted annually for medical inflation. The statute also allows insurers to apply general plan rules, including participating provider requirements and utilization review for medical necessity.
Families with plans outside the mandate may still have ABA coverage under their plan’s own terms. The only way to know for sure is to check with the insurer.
Florida Medicaid and ABA
Children enrolled in Florida Medicaid follow a separate path. According to the Florida Agency for Health Care Administration, Florida Medicaid covers behavior analysis services for eligible recipients under age 21 who require medically necessary services. Beginning February 1, 2025, those services are reimbursed through Statewide Medicaid Managed Care plans.
A Sensory-Friendly Halloween: Costumes, Crowds, and Trick-or-Treating
Fort Myers occupational therapy teams know that Halloween can be one of the hardest nights of the year for a child with sensory differences. Itchy costumes, rubber masks, flashing decorations, doorbells, barking dogs, strangers in disguise, and a routine turned upside down all arrive at once, after dark. For many of our FOCUS families, the holiday brings a cautious optimism.
The good news is that some planning, most children can enjoy Halloween on their own terms. October is also Sensory Awareness Month, recognized each year by the STAR Institute for Sensory Processing, which makes this a good time to look at the holiday through a sensory lens. Halloween falls on a Saturday this year, which gives families more flexibility on timing.
The strategies below draw on occupational therapy, ABA therapy, and speech therapy. That reflects how FOCUS Therapy works with children every day, and how Halloween challenges a child: the body, the routine, and communication all at once.
Why Halloween Overwhelms
Halloween asks a lot of the sensory system. A costume presses on the skin in unfamiliar places. A mask covers the face, muffles hearing, and narrows vision. Decorations flash and cackle. Crowds move unpredictably. The night is dark, loud, and full of surprises, which are exactly what many children with sensory processing differences or autism find hardest to manage.
Halloween also breaks the rules children have learned. Children are taught not to take candy from strangers, not to walk up to unfamiliar houses, and not to go out after dark. On one night a year, all of that reverses. A child who relies on predictable routines has good reason to find that confusing.
Understanding the source of the stress is the first step toward planning around it.
Costumes: Start With Comfort
The costume is often the first battle, and it is usually a sensory one. Occupational therapists look at costumes the way they look at clothing in general: texture, seams, tags, tightness, and temperature.
The most successful costumes often start with clothing a child already wears comfortably. A favorite pair of soft pajamas, a hoodie, or a sweatsuit can become a cat, a dinosaur, or a superhero with a few additions. Store-bought costumes made of stiff polyester, scratchy netting, or elastic bands are frequent trouble spots. Removing tags, wearing a soft layer underneath, or cutting out the most irritating pieces can turn a rejected costume into a tolerable one.
Masks deserve special caution. Many children cannot tolerate something on their face, and masks also limit vision on a dark night. Face paint, a hat, or a simple headband with ears can create the look without the pressure. Southwest Florida adds another factor. Halloween evenings here are often still warm and humid, and heavy costumes can make a child overheated and irritable quickly.
What to Bring to Your Child’s First Fort Myers IEP Meeting
Parents searching for Fort Myers IEP meeting tips often share the same feeling before their child’s first meeting: a mix of hope and nerves. An Individualized Education Program, or IEP, is a written plan that spells out the special education services and supports a child with a disability will receive at school. The first meeting sets the foundation for that plan. Parents who walk in prepared are better able to share what they know, ask the right questions, and help shape a plan that fits their child.
IEP meetings can feel intimidating. A table full of educators, specialists, and administrators may use terms and acronyms that sound like a foreign language. But federal law treats parents as full members of the IEP team, not observers. Bringing the right materials helps parents step into that role with confidence.
Parents Are Part of the Team – by Law
The Individuals with Disabilities Education Act, or IDEA, governs special education across the country, including in Florida. Under the federal regulation at 34 CFR 300.321, the IEP team for every child with a disability must include the child’s parents. The same regulation allows parents to bring other individuals who have knowledge or special expertise about the child. The person who invites that individual decides whether he or she has the relevant knowledge.
Schools must also tell parents about this right before the meeting. According to guidance from the U.S. Department of Education’s Office of Special Education Programs, the meeting notice must inform parents that they may bring individuals with knowledge or special expertise regarding their child. Parents should read that notice carefully. It lists the meeting’s purpose, time, and location, along with who will attend by title or position.
Preparing a Child With Developmental Delays for Kindergarten
A Fort Myers occupational therapist often meets families in the year before kindergarten, when parents start to wonder whether their child will be ready for a full school day. For children with developmental delays, that question carries extra weight. Kindergarten asks a lot of a 5-year-old. Children are expected to sit at a table, hold a pencil, open a lunch container, follow a routine, take turns, and manage big feelings, often all before lunch.
The good news is that many of these skills can be taught, practiced, and strengthened. Kindergarten readiness occupational therapy focuses on exactly that: the everyday abilities that let a child take part in the classroom with confidence.
What Kindergarten Readiness Really Means
Many parents think of readiness in academic terms. Can the child recognize letters? Count to 10? Write their name? Those skills matter, but they rest on a foundation that is easy to overlook.
The Centers for Disease Control and Prevention lists milestones that most children reach by age 5, defined as skills that at least 75 percent of children can do at that age. The list reaches well beyond academics. By 5, most children can button some buttons and hop on one foot. They follow rules or take turns when playing games with other children. They pay attention for 5 to 10 minutes during activities like story time or crafts. They write some letters in their name.
Those milestones cut across movement, attention, social skills, and early writing. A child who struggles in one area may find the whole school day harder than it needs to be.
Why the Transition Matters
The American Occupational Therapy Association describes the move to kindergarten as a critical milestone that lays the groundwork for later academic achievement. A smooth start can build a child’s confidence and enthusiasm for learning. A rocky one can leave a child frustrated before the year has truly begun.
In Florida, children are eligible for public kindergarten if they turn 5 on or before September 1 of the school year, under section 1003.21 of the Florida Statutes. For families of children with developmental delays, that date often marks the end of a planning window that should start well before the first day of school.
Fine Motor Skills for the Classroom
Fine motor skills involve the small muscles of the hands and fingers. In kindergarten, children use them constantly. They grip pencils and crayons, cut with scissors, glue paper, turn pages, and manage zippers and snaps.
Children with developmental delays may have weak hand strength, an immature grasp, or trouble coordinating both hands together. These challenges can make writing tiring and cutting frustrating. An occupational therapist evaluates the underlying causes and builds strength and coordination through play. Activities like squeezing putty, stringing beads, building with small blocks, and tearing paper target the same skills a child needs for handwriting, but in a way that feels like fun instead of work.
Gross Motor Skills and Body Awareness
Gross motor skills involve large muscle groups. They help a child sit upright at a desk, walk in a line, climb playground equipment, and keep up during recess and physical education.
A child with low muscle tone or poor balance may slump in a chair, fidget constantly, or tire quickly. Those behaviors can look like inattention when the root cause is physical. Occupational therapists help children build core strength, balance, and body awareness so they can stay seated, focused, and engaged.
Self-Care and Independence
Kindergarten teachers manage a room full of children. They cannot help every child with every task. Children who can handle basic self-care on their own spend less time waiting and more time learning.
Self-care skills include using the bathroom independently, washing hands, putting on and taking off a jacket, opening food packages, and managing a backpack. The CDC suggests that parents let children do things for themselves, like buttoning a shirt or pouring water, even if the result is not perfect. Occupational therapists break these tasks into smaller steps and help children practice each one until it becomes routine.
Sensory Processing and Self-Regulation
A kindergarten classroom can be loud, bright, and busy. Some children with developmental delays process sensory information differently. A buzzing light, a crowded hallway, or the feel of a certain fabric can overwhelm them. Others seek out extra movement or touch and have trouble staying still.
Self-regulation is the ability to notice and manage those reactions. It helps a child transition between activities, wait for a turn, and recover after a disappointment. Occupational therapists help children recognize their sensory needs and learn strategies to stay calm and focused. Those tools can make the difference between a child who melts down at circle time and one who joins in.
Social Participation and Following Routines
Kindergarten runs on routines. Children line up, move between centers, clean up, and gather for group activities. They also learn to share materials, take turns, and play cooperatively.
Children with delays may need extra practice with these expectations. Therapy sessions that include structured games, turn-taking, and multi-step directions help children build skills they will use every day in the classroom. The CDC recommends playing simple board games, card games, or Simon Says to help children learn to follow rules.
How Families Can Help at Home
Parents play a central role in kindergarten readiness. Simple activities at home reinforce what children practice in therapy. Coloring, playing with modeling dough, building puzzles, and helping in the kitchen all strengthen fine motor skills. Playground time builds gross motor strength. Letting children dress themselves and pack their own snacks builds independence.
Families can also prepare children emotionally. The CDC suggests reading stories or role-playing to help children get ready for kindergarten and new people. Visiting the school, meeting the teacher, and practicing the morning routine can ease anxiety for both child and parent.
How FOCUS Therapy Supports Kindergarten Readiness
FOCUS Therapy in Fort Myers provides occupational therapy alongside speech, physical, feeding, and ABA therapy under one roof. That approach matters because kindergarten readiness skills overlap. A child working on handwriting may also need help with attention, communication, or regulation. Coordinated care lets therapists address the whole child.
Sessions at FOCUS are built around play, and parents receive a full report and the chance to ask questions at the end of every session. The clinic also offers IEP assistance and planning to help families prepare for conversations with their child’s school.
Start Preparing Early
Kindergarten readiness does not happen in a single summer. Skills like hand strength, self-regulation, and independence develop over months of steady practice. Families who begin working with a Fort Myers occupational therapist well before the school year give their children time to build those skills without pressure.
Every child develops at a different pace, and a developmental delay does not determine how a child will do in school. The earlier families identify where a child needs support, the more time that child has to grow into the classroom with confidence. To schedule an evaluation, contact FOCUS Therapy.
FOCUS Therapy offers Occupational Therapy in Fort Myers, Florida. Call (239) 313-5049 or Contact Us online.
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Questions to Ask When Choosing a Fort Myers Pediatric Therapy Clinic
Choosing a Fort Myers pediatric therapy clinic is one of the most important decisions a parent makes after learning a child needs speech, occupational, or behavioral therapy. The clinic a family picks will shape weekly routines for months or years. The therapists will become trusted partners in a child’s growth. And the right fit can make the difference between steady progress and frustration.
Many families face this decision. According to the Centers for Disease Control and Prevention, about 1 in 6 children ages 3 through 17 in the United States have one or more developmental disabilities. Behind that number are parents searching for help, often for the first time.
Asking the right questions up front helps parents compare clinics on what matters most. The questions below offer a starting point.
Are the Therapists Licensed and Credentialed?
Credentials come first. In Florida, speech-language pathologists, occupational therapists, and physical therapists must hold state licenses to practice. Reputable clinics can provide this information quickly on request, but parents can confirm a therapist’s license status and check for disciplinary history through the Florida Department of Health’s license verification portal.
Professional certifications offer another layer of assurance. Many speech-language pathologists hold the Certificate of Clinical Competence, known as the CCC-SLP. The American Speech-Language-Hearing Association describes the CCC as a nationally recognized credential, and certificate holders agree to follow ASHA’s Code of Ethics. The credential is voluntary, so its presence signals a clinician who chose to meet an additional national standard.
For applied behavior analysis, families should ask whether a Board Certified Behavior Analyst designs and oversees the child’s program. The Behavior Analyst Certification Board publishes a public registry that lets anyone look up a certificant’s status.
What Does the Evaluation Process Involve?
Down Syndrome and Speech: How a Fort Myers Speech Therapist Builds Communication From Infancy
A Fort Myers speech therapist for Down syndrome often meets families long before a child says a first word, and that timing is deliberate. Communication starts in the first months of life, well before speech. It starts with eye contact, cooing, turn-taking, and the first gestures. For children with Down syndrome, the foundation for talking is built in infancy. The families who start early give their children the most time to build it.
October is Down Syndrome Awareness Month, recognized each year by the National Down Syndrome Society. It is a good moment to look at what the research says about speech and language in Down syndrome, why hearing deserves special attention, and why signs and communication devices help children talk rather than holding them back.
A Common Condition With a Distinct Communication Profile
Down syndrome is the most common chromosomal condition in the United States. According to CDC estimates, about 1 in every 640 babies is born with Down syndrome, roughly 5,700 births each year.
Every child with Down syndrome is an individual. Still, researchers have documented a communication profile that shows up across many children. Babbling often begins later. And a gap tends to open between what a child understands and what a child can say. A study published in Frontiers in Psychology described the most striking finding in the research this way: children with Down syndrome often have relatively strong receptive language, the ability to understand, alongside more significant delays in expressive language, the ability to produce words and sentences.
That gap matters. A child who understands far more than he or she can say may become frustrated. Adults may also underestimate the child. Researchers writing in Language, Speech, and Hearing Services in Schools noted that poor speech intelligibility can mask what a child with Down syndrome actually knows, which can lead to serious misconceptions about overall ability. Fort Myers speech therapy for a child with Down syndrome works to close that gap, so the child can show what he or she knows.
Why Speech Is Physically Harder
Pacifiers, Sippy Cups, and Speech: Why Fort Myers Speech Therapists Recommends Phasing Them Out Early
Most Fort Myers speech therapists are of the mind that once a child starts to talk, the pacifier and the sippy cup should be on their way out. A toddler needs a free mouth to babble, experiment with sounds, and try out new words. Heavy pacifier use is linked to smaller vocabularies, more ear infections, and dental changes that can make some sounds harder to produce. The sippy cup was designed as a short stop on the way to an open cup, not a permanent fixture. Neither one dooms a child’s speech. Both are worth retiring sooner rather than later.
Pacifiers Have a Place in Infancy
The case for phasing out pacifiers is about timing, not about whether pacifiers are good or bad. In the first months of life, they can serve real purposes. A 2025 review in American Family Physician found that pacifier use reduces the risk of sudden infant death syndrome, decreases discomfort during air travel, and helps control pain during shots and blood draws. The American Academy of Pediatrics recommends offering a pacifier when putting an infant to sleep, once breastfeeding is well established.
That window closes quickly. The AAP recommends weaning pacifier use during the second six months of life. The same review found that the health risks of pacifier use appear to increase after 12 months of age. Yet about half of children still use a pacifier at their first birthday, according to the review. For many families, the pacifier stays long after its benefits have run out.
What the Research Shows About Speech Sounds
The most careful study on pacifiers and speech sounds was published in 2021 in the International Journal of Language & Communication Disorders. Researchers Charlie Strutt, Ghada Khattab, and Joe Willoughby examined whether the duration and frequency of pacifier use affected how children’s speech developed.
Most speech outcomes in the study were not tied to pacifier use. The pattern that did emerge points straight at daytime habits. Frequent pacifier use during the day was associated with more atypical speech errors, the kind not usually seen in typical development. Nighttime use did not show the same effect. The authors noted that the evidence base is small and that the errors may resolve over time. Even so, the takeaway for parents is clear. A pacifier at bedtime is one thing. A pacifier in the mouth for hours of the day is a different matter.
Heavy Use and Smaller Vocabularies
A 2024 study took the question a step further. Researchers at the University of Oslo, Luis Muñoz, Natalia Kartushina, and Julien Mayor, published a study in Developmental Science examining pacifier use and vocabulary size.
They found that greater pacifier use over an infant’s life was associated with smaller vocabularies at 12 and 24 months. Later use mattered more than early use. Heavy pacifier use in the two months before a child’s second birthday was associated with a higher likelihood of scoring in the low range for vocabulary.
The study shows an association, not proof of cause, and the lead author said so directly. Fussier babies may use pacifiers more, and something about those babies could explain part of the difference. But the mechanism researchers propose is easy to understand. Babies learn to talk by babbling, playing with sounds, and imitating the people around them. A pacifier limits all three. Earlier experimental work found that infants holding a teething toy that restricted tongue movement temporarily had more difficulty telling certain speech sounds apart. A baby’s own mouth appears to help the brain process the sounds it hears.
A toddler with a pacifier in during most waking hours, at the age when vocabulary is exploding, is getting less practice than a toddler without one. That alone is a reason to cut back.
The Ear and Tooth Problems
The clearest risks of prolonged pacifier use affect speech indirectly, and they add to the case for weaning early.
The first is ear infections. The AAP’s recommendation to wean during the second six months of life is aimed at reducing the risk of otitis media, or middle ear infection. Repeated ear infections can leave fluid behind the eardrum and muffle hearing during the years when children are building their sound systems. FOCUS Therapy has written in more detail about how chronic ear infections can delay speech.
The second is teeth. Prolonged pacifier use is linked to dental malocclusion, including an open bite, where the front teeth do not meet. The American Academy of Pediatric Dentistry’s policy on pacifiers addresses these effects. An open bite changes where the tongue rests and moves, which can make sounds like /s/ and /z/ harder to produce cleanly. For more on how those sounds develop, see FOCUS’s sound-by-age timeline.
Sippy Cups: A Stepping Stone, Not a Fixture
The research on sippy cups is thinner than the research on pacifiers. Few studies test whether sippy cups affect speech directly. The concern rests mostly on how the mouth works.
A hard-spouted sippy cup with a spill-proof valve requires a sucking motion similar to a bottle. Drinking from an open cup or a straw requires more mature movements of the lips and tongue. The Minnesota Department of Health’s WIC guidance on cup transitions notes that sucking on a bottle or hard-spouted sippy cup frequently throughout the day can restrict the tongue’s range of movement. The guidance recommends open cups and straw cups without spill-proof valves.
What a BCBA Does: How a Fort Myers ABA Therapy Team Is Built
A Fort Myers ABA therapist is rarely working alone. Behind every session a child receives is a team with distinct roles, credentials, and responsibilities. Many parents meet the person who works with their child day to day without ever learning who designed the program, who reviews the data, or how often that person actually watches the sessions. Those questions matter more in Florida this fall than they have in years. Families who understand how Fort Myers ABA therapy teams are built can judge the quality of their child’s care for themselves.
Why Credentials Are in the Spotlight
Florida spends more on applied behavior analysis than any other state. According to reporting by the Florida Phoenix, Florida Medicaid spent $6.57 billion on ABA services between 2023 and 2025.
That spending prompted the Legislature to create an Applied Behavior Analysis Task Force within the Agency for Health Care Administration. The task force is examining clinical care models, quality metrics, service-authorization limits, potential caps on how long services last, and provider enrollment and billing standards. Its recommendations are due to the Governor and legislative leaders by December 31, 2026.
Whatever the task force recommends, one fact will not change: the highest quality of care and dedication brought by our Fort Myers ABA therapy team at FOCUS Therapy.
The BCBA: The Clinician in Charge
A Board Certified Behavior Analyst, or BCBA, is the clinician responsible for a child’s ABA program. The credential is issued by the Behavior Analyst Certification Board, an independent nonprofit that sets the standards for the profession.
Becoming a BCBA takes years. Candidates need a master’s degree or higher, graduate-level coursework in behavior analysis, and supervised fieldwork, which requires 2,000 hours under the standard pathway or 1,500 hours under a more intensive concentrated pathway. Then they must pass the BCBA certification exam. The BACB is tightening the eligibility pathways starting January 1, 2027. Under its 2027 BCBA requirements, applicants will qualify through either a degree from an accredited behavior-analysis program or a defined sequence of behavior-analytic coursework.
In practice, the BCBA does the work that shapes a child’s therapy. The BCBA conducts the initial assessment, identifies the skills a child needs to build and the behaviors that are getting in the way, and writes the treatment plan. The BCBA reviews session data to see whether the plan is working and changes it when it is not. The BCBA trains and supervises the registered behavior technicians who deliver much of the therapy, and leads parent training, which is often where progress at home begins.
Florida Medicaid builds its program around this role. Under the state’s Behavior Analysis Services Coverage Policy, services must be overseen by a Lead Analyst, and a BCBA credentialed by the BACB qualifies for that position.
Fort Myers OT Explains Why Bedtime Resistance May be a Sensory Problem
When bedtime falls apart every single night, a Fort Myers occupational therapist is not often the professional families think to call. Parents try earlier bedtimes, later bedtimes, sticker charts, and every routine a friend swears by. For some children, those things will help. But when a child’s nervous system is the thing standing between them and sleep, no schedule adjustment will resolve bedtime resistance.
Why Sleep and Sensory Processing Are Linked to Bedtime Resistance
Falling asleep requires a nervous system to move from alert to calm. For most children that shift happens quietly in the background. For children with sensory processing differences, it can be the hardest transition of the day.
Consider what bedtime actually asks. A child must stop moving after hours of accumulated input, tolerate the feel of pajamas and sheets, filter out household sound, accept darkness, and lie still without the movement their body may be actively requesting. Every one of those is a sensory demand, and they all arrive at once, at the end of a day when the child has the least regulation left to spend.
A Fort Myers occupational therapist may encourage that instead of asking why a child will not go to sleep, our occupational therapists at FOCUS Therapy ask what is happening in that room and in that body that makes sleep hard to reach.
What a Sensory Sleep Problem Looks Like
There are a few patterns worth noticing. A child who cannot settle without movement may rock, kick the wall, roll continuously, or ask to be squeezed. Their body is seeking proprioceptive input, the deep pressure information that comes from muscles and joints, because that input is organizing and calming.
A child who is overwhelmed rather than under-stimulated looks different. Pajama seams and tags become unbearable. The sheet feels wrong. The hum of the air conditioner, the ceiling fan, the light under the door, or the smell of dinner in the house all register at full volume. This child is not stalling. They are being asked to relax inside an environment their system is still actively processing.
Speech Sound Errors and Reading: Why a Kindergarten Concern Can Become a First-Grade One
Parents often ask their child’s Fort Myers speech therapist whether a preschooler’s speech errors will follow them into the classroom. The honest answer is the majority of children with speech sound differences learn to read without much difficulty. But a smaller group of kids may have a measurable risk into first grade — and researchers now understand fairly well which children those are. This knowledge can transform vague concerns into something a family can actually act on.
The Bridge Between Talking and Reading
Reading requires a child to break a spoken word into its individual sounds and match those sounds to letters. The skill that makes this possible is called phonological awareness, and it develops before formal reading instruction begins.
Phonological awareness follows a rough order. Children first notice rhyme and the beat of syllables, then isolate the first sound in a word, then blend sounds into a word, and finally segment a whole word into its parts. A kindergartner who can tell you that “cat” starts with /k/ and ends with /t/ is doing the work that decoding will require in a few months.
Note that children does not analyze words using the sounds in the air. They analyze words using the sound representations stored in their own mind. If those stored representations are fuzzy or organized in an unusual way, the analysis gets harder, no matter how bright the child is or how much they love books.
Not All Speech Errors Carry the Same Weight
Clinicians distinguish between articulation errors and phonological errors. An articulation error involves difficulty producing a particular sound, like a lisped /s/ or a /w/ substituted for /r/. The child’s underlying sound system is intact. The mouth simply has not caught up.
A phonological error is rule based and affects whole categories of sounds. A child who drops every final consonant, so that “cat,” “cap,” and “can” all come out as “ca,” is not struggling with individual muscles. They are operating on a pattern that simplifies the sound system itself.
Research published in the Journal of Speech, Language, and Hearing Research followed 123 children and analyzed their speech errors at ages five and six against their literacy at ages seven to nine. Phonological errors, but not articulation errors, predicted phonological awareness, letter knowledge, and later literacy, even after accounting for the children’s language skills. Sequencing difficulty, meaning trouble organizing sounds in order, showed the strongest relationship of all.
For a family whose kindergartner has a charming lisp and nothing else, that finding is genuine reassurance. For a family whose child simplifies whole patterns of sounds, it is a reason to look closely at preliteracy skills now rather than waiting.