Evaluations are an important step in the process of securing speech, occupational, physical, and/or ABA therapy for your child. But parents and caregivers should be wary of facilities that offer these evaluations while lacking capacity to immediately treat the child.
FOCUS Therapy Owner/Founder Jennifer Voltz-Ronco explains that unless her team is being called on for a second opinion of an initial evaluation, they refrain from conducting formal assessments if unable to promptly provide treatment once the evaluation is complete.
“A standardized assessment is only a snapshot in time during the child’s development,” Voltz-Ronco said. “It’s like taking a picture of a child now, and then expecting it not to change in a few months. … If your child cannot access therapy within 1 or 2 months of that evaluation, the results are no longer going to be accurate. Kids develop new skills every few months. But the longer the child goes without therapy, the more significant that standard score comparison/discrepancy to same-age peers is going to be.”
Beyond this, families who rely on insurance to cover the cost of these evaluations (and they aren’t cheap) should be aware that insurers typically only cover one evaluation every six months or so. Even though clinics can utilize standardized assessments administered by another, it’s not ideal.
“Your child gets the most benefit when the team that directly observed your child’s abilities and deficits are the ones who ultimately formulate a plan of care and follow through with treatment,” Voltz-Ronco said. “In my opinion, it’s unethical for a clinic to profit from an evaluation that reveals a child is delayed or needs intervention – without providing that help.”
Types of Pediatric Evaluations FOCUS Therapy Offers
Children are usually referred to FOCUS Therapy and other therapy specialists by their primary care physician. Evaluations are typically ordered when a child is showing some developmental deficit, such as not sitting up or crawling, not talking or making regular eye contact, or red flags for a possible cognitive deficit. They could also be diagnosed with a condition that we can pretty well say for certain is going to require some combination of therapy services (such as cerebral palsy, down syndrome, vision impairments or hearing deficits).
Depending on the child’s condition and identified areas of concern, qualified therapists will be scheduled to conduct age-appropriate assessments to determine the need for therapy intervention services.
The specifics of the evaluation may vary, but they are generally going to include:
- A look at case history, including medical status, education, socioeconomic, cultural, and linguistic backgrounds, and information from other providers.
- Child and/or parent interview.
- Review of the child’s auditory, visual, motor, and cognitive status.
- Standardized and non-standardized assessments of specific aspects of speech, non-spoken language, swallowing function, cognitive communication, etc.
- Assessment of self-care and/or self-awareness.
- Skilled observation. This is where we keenly observe an accurately record a child’s abilities and behaviors.
There are several different types of standardized tests (including the ADOS test for autism screening, which FOCUS Therapy also provides).
“If a parent wants a second or third opinion after their child has been evaluated by a school or another provider, that’s one thing,” Voltz-Ronco. “But they’re most likely going to pay for that out-of-pocket – and they’re going to understand the purpose upfront. But if parents are looking for action, to get the ball rolling on the therapy interventions that a child needs, then the clinic conducting the assessment should be able to provide that.”
Not all of them do. Therefore, it’s incumbent on parents to ask the question before scheduling the assessment.
“We’ve gotten calls from parents of children who were evaluated other clinics, only to be told after the fact that the clinic did not have the ability to treat their child,” Voltz-Ronco said. “They were told to just call around and see what other clinics may be able to use the report generated from their assessment. That, to me, is not ethical.
“It’s a situation where parents need to be aware of this issue, and make sure they are asking the question upfront: ‘If I schedule this assessment and my child needs treatment, do you have the capacity to provide that treatment?’ If not, I would advise parents to move on and find a place with the capacity and willingness to do both.”
FOCUS offers ADOS testing and other standardized assessments in Fort Myers and throughout Southwest Florida for children who may need speech therapy, occupational therapy, physical therapy, or ABA therapy. Call (239) 313.5049 or Contact Us online.
Assessment and Evaluation of Speech-Language Disorders in Schools, American Speech-Language Hearing Association
More Blog Entries:
ADOS Testing, FOCUSFlorida.com
When working with kids who have varying sensory struggles, it can be difficult to tell the difference between a tantrum or a sensory meltdown. Our Fort Myers ABA therapists recognize that it often takes some detective work to differentiate. But determining which is which is important when formulating the most effective response.
A sensory meltdown can be especially tough to identify because a child’s sensory thresholds can vary from day-to-day or even hour-to-hour.
Some behaviors that may be present in BOTH:
- Hiding or avoidance
Tantrums, however are typically a response to a child not receiving something they want or an anticipated outcome. Sensory meltdowns, meanwhile, stem from sensory overload, with reactions being to the big feelings that the overload can cause.
In the case of a meltdown due to sensory issues, parents may need to formulate a strategy that plans ahead, rather than simply react to the meltdown when it happens. That means meeting their sensory needs through a sensory diet (unique to each child) that can help them avoid feeling completely overloaded and overwhelmed.
We need to look carefully at the sorts of things that can trigger a sensory meltdown. Some possible meltdown triggers can include:
- Being overly tired or hungry.
- Generally not feeling well. (This can stem from illness, food sensitivity, overheating, etc.)
- Being expected to “hold it together” for long periods of time, such as going to summer camp, school, or on play dates.
- An abrupt change in routine – anything outside of the ordinary – can set off sensory overload.
Because the overload may not be immediate, it can sometimes appear like a meltdown “came out of nowhere.” But there is almost always a source when we look very carefully at the “antecedents,” or events that occurred prior to the meltdown. You may even have to go back a few days to pinpoint the cause.
Toddlers and preschoolers may be especially prone to tantrums because they do not have the motor, language, or problem-solving skills to work through some of their frustrations on their own. They may have an emerging desire to be independent, without having the skills to actually BE independent. They might have emerging language skills, and thus are unable to communicate what they actually want or need. They may have big feelings, but lack the prefrontal cortex development to emotionally regulate. They may have a growing understanding of the world around them, but also a lot of anxiety about how to move through it.
Tantrums usually only end when a child gets what they want or when they’re rewarded for better behavior.
Meltdowns, on the other hand, only end when the child tires out or the sensory input is altered. They stem from what we sometimes refer to as a “physiological traffic jam” in the central nervous system. There is too much overstimulation and feeling limited in your ability to “exit.” This can trigger a “fight or flight” response.
As parents, therapists, teachers, and caregivers, it’s important to recognize that the behaviors we’re seeing are not controllable behavioral reactions. Rather, they are physiological responses. This is why our Fort Myers ABA therapists and occupational therapists put such emphasis on identifying which is which so that you can appropriately respond.
With tantrums, you need to recognize the motivation or purpose, reinforce positive behavior, and build skills for success.
Meltdowns, however, can sometimes be avoided when we use visual schedules, social stories, and checklists to help kids know what is expected. There are no surprises or question marks. Reducing the unexpected changes in routine is going to reduce the overall stress that can trigger a meltdown.
We also recommend routine sensory diet activities, like scheduling quiet time or offering them breaks for sensory input.
Parents and teachers should also be able to recognize signs of a child’s distress. This could be covering their ears or rocking back-and-forth or humming or bolting from the room. Once you are able to quickly recognize the signs of overstimulation, you can respond to help them regulate before reaching the meltdown stage.
FOCUS offers pediatric ABA therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
Expert Ways to Help Tame Tantrums and Manage Meltdowns, June 18, 2021, By Alescia Ford-Lanza, MS, OTR/L, ATP, Autism Parenting Magazine
More Blog Entries:
Study: Less than 1/2 Kids With Autism Undergo Early Intervention Therapy, July 30, 2022, FOCUS ABA Therapy Blog
Early intervention therapy for autism is crucial to optimal long-term outcomes for children on the spectrum. “Early intervention,” defined as a combination of speech therapy, occupational therapy, physical therapy, nutrition/feeding therapy, and ABA therapy, should ideally begin before age 3 to be the most effective. Yet a new study found that more than 50 percent of children with autism do NOT get the critical early intervention that has been proven to lay the foundation for yielding the best sustained results.
Researchers at Rutgers University analyzed the early intervention participation of kids with autism in one state, and found less than half were receiving early intervention therapies before turning 3.
The study, published in JAMA Pediatrics, revealed income and racial disparities unfortunately played a role in how likely children were to have access to early intervention. Study authors opined that the issue was likely worse in other states.
As our FOCUS Therapy Fort Myers team understands it, the researchers analyzed data from the New Jersey Autism Study, a monitoring system that was set up by the Rutgers New Jersey Medical School, focusing on the records of some 23,000 kids. They identified approximately 4,000 8-year-olds diagnosed with autism. Of those, only 1,890 of them had participated in early intervention therapy services. This was true even though these services are required by federal law under the Individuals with Disabilities Education Act.
To identify where the disparities were most prominent, the team analyzed information on wealth indicators (median household income, primarily) and discovered that kids who lived in areas with higher incomes were 80 percent more likely to have access to early intervention autism services than kids who lived in lower-income neighborhoods. They also learned that Black and Hispanic children were less likely to enroll in these services compared to their white counterparts.
Study authors stressed that understanding socioeconomic and cultural barriers to both early diagnosis and these essential therapy services are important components of helping improve education and access.
Early Intervention Therapy Key to Addressing Child Development Concerns
ABA therapy is considered the gold standard treatment for kids with autism spectrum disorder (ASD). But the process of starting this therapy is not as simple as calling and setting an appointment. There are several steps that must be taken to initiate the process.
It begins by recognizing the early signs of autism, and sharing these concerns with your child’s pediatrician. Doctors should screen all children at 18 months for risk of autism as a matter of routine – but parents absolutely can bring concerns to their doctors at any point. Signs of autism can be clearly identified as early as 12-months-old.
The doctor will then initiate a referral for a full assessment, known as ADOS testing. This test must be administered by a qualified provider. FOCUS Therapy does provide ADOS testing for children in Southwest Florida. The results of the ADOS test are then shared with a pediatric specialist, who ultimately makes the diagnosis and then issues a referral for early intervention services – such as ABA therapy, speech therapy, and occupational therapy.
If your child is under the age of 3 in Florida, they may qualify for early intervention services through a state program called Early Steps. This can serve as an important stop-gap, given that many private therapy clinics that offer Applied Behavioral Analysis in Southwest Florida have waitlists.
Our ABA therapy services at FOCUS Therapy are conducted one-on-one, in-clinic with experienced professionals called RBTs (registered behavior technicians), with oversight from a BCBA (Board Certified Behavior Analyst) and physician specialist.
If you have questions about autism screening, ADOS testing, or ABA therapy in Southwest Florida, our trusted team of therapists, coordinators, and insurance billing professionals can help.
FOCUS offers ABA Therapy and ADOS testing in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
What Are the Early Signs of Autism? HealthyChildren.org, American Academy of Pediatrics
More Blog Entries:
5 Fort Myers ABA Therapy Techniques, May 24, 2022, Fort Myers ABA Therapy Blog
FOCUS Therapy in Fort Myers conducts a range of in-depth evaluations for children who have been referred for speech, occupational, physical, or ABA therapies as well as ADOS testing. During our evaluations and therapy sessions, we rarely allow families to directly participate – but we have evidence-based reasons for our position.
During evaluations, we want to ensure every child receives an assessment that is as accurate as possible because that is what is going to allow us to:
- Determine whether the child needs therapy.
- Calculate the frequency/level of therapy that might be recommended.
- Make a strong case to the relevant insurer(s) about the medical necessity of the therapy.
Parents, when present in the room during FOCUS evaluations, can unwittingly stand in the way of those goals. Why? Mainly because children rely on their caregivers when things get tough – to help them, to comfort them, to make it better. When a child is struggling in a certain area, such as communication or independence with self-care skills, our clinicians need to independently observe the particulars.
Parent input is a key aspect of our evaluations, but we need to see for ourselves, too. Jennifer Voltz-Ronco, MS-CCC/SLP and FOCUS Therapy Owner/Founder, explained that when a child is accompanied by a parent during the direct observation portion of the assessment, parents often interfere without intending to do so or even realizing it.
“For example, in speech evaluations, parents might talk to the child or give clues to help their child ‘get the right answer’,” Voltz-Ronco explained. “We might ask the child to point to an object out of an array of 3-4 items by saying, ‘Show me the cup.’ Standardized testing requires that we be very specific in how we present these items – and with the requirement that we wait. And while we wait, we’re looking to see how long it takes them to process the directive and what they do. Will they look at us to see if we’re looking at the object? Will they point to it or make a face if they’re unsure? They might associate a cup to mealtime and instead point to a cookie. If the child looks to our face to get a clue, that would indicate social awareness and joint attention – key pre-linguistic communication skills. If there is a delay in their response, there may be an auditory processing issue. If they grab the first thing in reach, they may have impulsivity issues. Watching a child while they’re thinking tells us so much. But parents in the room might think the evaluator presumes the child doesn’t know the answer, so they interject. They say to the child, ‘You know what a cup is, like the blue sippie cup you have at home.’ Unfortunately, what that does is give the child numerous opportunities to hear the word, ‘cup,’ and in many standardized tests, we aren’t allowed to repeat the word or give a description or synonym. So with that, we lose the opportunity to see what we needed to see, and must in turn score the response incorrectly – which impacts the overall results.”
She went on to explain that often the key responses FOCUS therapists are looking for aren’t necessarily what an untrained observer may presume.
What’s more, some children can become what we call “prompt dependent.” That means the child looks to the parent to prompt them (to take an action, answer a question, etc.) – even if they don’t necessarily need the prompt. Many of our team members are parents ourselves, so we wholeheartedly understand how difficult it is to wait for your child to “do it themselves.” It is actually instinctual to intervene when we see or sense our child needs help. But during these evaluations, this intervention – however slight – can actually prove more of a hindrance when what we’re seeking are accurate results.
We DO Want Parents Involved in Their Child’s Therapy Journey
Although it is important for parents to remain outside the room during evaluations, this does not mean we lack transparency or that we don’t want parents involved at all in the therapy process. In fact, we get the best results from therapy when parents are fully engaged!
But we discourage direct engagement during the evaluation process and therapy sessions because we want to ensure our findings are accurate and that your child gets the true level of support they need.
While we want parents to be involved in consultation, goal-setting, education, and carryover, we strongly advise parents against sitting in during therapy sessions for the following reasons:
ADOS testing, also known as the Autism Diagnostic Observation Schedule, was found in a recent, large study to measure severity of autism traits equally well in both girls and boys. This is good news because research has shown doctors may misdiagnose or overlook autism in girls, because it can sometimes look a little different than it does in boys. Boys are four times more likely to have a diagnosis than girls.
FOCUS offers ADOS testing in Fort Myers at our pediatric therapy clinic. Early diagnosis is important for both girls and boys to be able to access early intervention support and therapy, so it’s important that the testing effectively recognizes the symptoms in all kids. The U.S. Centers for Disease Control and Prevention estimates about 1 in 59 kids have an autism diagnosis.
As our Florida ABA therapy team can explain, autism spectrum disorder (ASD) is a developmental condition impacting one’s ability to communicate and socialize with others. However, it’s necessary to recognize that symptoms of autism can very significantly from person-to-person. (Hence the phrase, “If you’ve met one person with autism… you’ve met one person with autism.) Still, girls may not always fit the “traditional” understanding of a person who has autism. In some cases, they may also be better at hiding it.