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
How many times a day are you admonishing your child to please use their “inside voice”? As a Fort Myers speech therapist, I love it when kids are engaged and excited to participate in a conversation! That said, I also recognize that sometimes our little friends can get a bit TOO lively – and loud – for the situation.
The reality is all kids frequently yell, stomp, shriek, use screechy or whiny tones – and for all kinds of reasons.
Teaching kids how to control their volume – and practice using “inside voices” – is important because there are many real-life situations that require it.
Learning how and when to adjust voice volume is a life skill – one that may be particularly tough to grasp for kids with social communication deficits.
As a Fort Myers speech therapist, the goal isn’t just to teach kids how to communicate, but how to do so pragmatically, or in a way that is socially accepted and beneficial. That means teaching the “inside voice” (quieter) versus the “outside voice” (louder) is key.
Understanding Reasons Behind Voice Volume
The first step in addressing voice volume issues is understanding WHY kids are speaking loudly. Sometimes, they may feel they need to do so to get attention. They often don’t realize how loud they are actually being. And they also probably don’t understand that in certain spaces, they’re required to use a lower volume, and that failing to do so can have a negative impact on others in that space. (And for kids who are not neurotypical, it may take them more than a few reminders to remember.)
The American Speech-Language Hearing Association (ASHA) reports that it’s only between ages 4 and 5 that kids start talking differently in different settings and with different people. As a Fort Myers speech therapist, I recognize it as a speech development milestone that ultimately paves the way for them to recognize almost instantly whether this a place is one where people are using “inside voices” or “outside voices.”
Talk About Voice Volume With Your Kids
The first step to helping your child know what noise level is expected in a given setting and/or with different people is to TALK about it. That means not only telling them what is expected, but also why.
Virtually all children go through some stage of “picky eating,” and it may be both temporary and harmless. However, when it persists and a child fails to grow and thrive alongside their peers, they may be diagnosed with pediatric feeding disorder – a new diagnosis that Fort Myers feeding therapy can help to treat.
The condition was formally recognized last October, as explained by the American Academy of Pediatrics.
Pediatric feeding disorder (PFD) is understood to involve impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, or psychosocial dysfunction. It lasts more than two weeks, and is associated with 1 or more of the following:
- Medical dysfunction (cardiorespiratory compromise during oral feeding or aspiration/recurrent aspiration pneumonitis).
- Nutritional dysfunction (as evidenced by malnutrition, specific nutrient deficiency/significantly restricted intake of one or more nutrients resulting from restricted dietary diversity, or reliance on enteral feeds/oral supplements for hydration and/or nutrition).
- Feeding skill dysfunction (need for texture modification of liquid or food, use of modified feeding position/equipment, or modified feeding strategies).
- Psychosocial dysfunction (active/passive avoidance of child when being fed, inappropriate caregiver management of child’s feeding needs, disruption of social functioning in a feeding context, or disruption of caregiver-child relationship associated with feeding).
The full diagnostic criteria is spelled out by the Journal of Pediatric Gastroenterology and Nutrition.
Preterm babies, often called “preemies,” are at higher risk of speech and language delays as they develop, compared to babies born full-term. Approximately 1 in 10 babies in the U.S. is born too early, according to the March of Dimes. Our Fort Myers speech therapy team strongly recommends that parents of babies born prior to 37 weeks gestation keep a close eye on every developmental milestone, and seek early intervention therapies to assist where delays are noted.
“We’re so lucky to be living in an age where medical advancements provide even babies born extremely preterm with a good shot at survival,” said FOCUS Therapy Owner/Founder Jennifer Voltz-Ronco. “Although many preemies go on to develop normally, many do benefit from extra help – particularly in the form of early intervention speech therapy, occupational therapy, physical therapy, and feeding/swallowing therapy.”
A 2018 study published in the journal Medicine revealed babies born preterm tend to have smaller vocabular at age 3 compared to their full-term peers. They also develop gestures, words, and language understanding at a slower rate than full-term babies. This gap in language skills can expand and continue through childhood, particularly if it’s not treated.
Brain research development shows us time and again that language learning begins at birth, with the window between 6 and 24 months being a golden opportunity to maximize the brain’s neuroplasticity and support development of early communication skills.
Many babies born prematurely benefit from these therapies up to age 5 (sometimes beyond), with early intervention reducing the struggles they will face as they get older. As time goes on, the delays become less noticeable, with many preemies going on to engage in academics, arts, and athletics at the same level as their peers. Many of our preemie patients later succeed to the point you would never know they were born early unless they told you.
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:
Although many parents are concerned when their child’s communication indicates a possible speech-language delay or disorder, the reality is speech therapy is one of the most common services available for young kids.
Sometimes, speech therapy helps resolve problems with articulation (how words are said). Other times, it helps with more complex neurological social-communication conditions like autism spectrum disorder. Lots of kids may also struggle with feeding/swallowing and voice issues.
With early intervention, many of these kids go on to thrive – and you would never know they had a deficit at all!
Contact us online or by calling (239) 313-5049. FOCUS offers pediatric therapy in Fort Myers and throughout Southwest Florida.
Be Tech Wise With a Toddler, American Speech-Language Hearing Association
Most parents know the thrill of hearing a child say, “mama” and “dada” for the first time. Then comes the adorable baby talk. But what if your child isn’t saying words by the time they’re 1 year old? What if they’re still mispronouncing lots of basic words by age 5? At what point do you decide a speech therapy consultation might be in order?
The first thing to bear in mind is that kids develop at all different paces. So the fact that your child is behind a bit isn’t necessarily cause for alarm. That said, it never hurts to have your child evaluated if you aren’t sure. FOCUS Therapy in Fort Myers offers free initial consultations to help parents determine if a more extensive evaluation is necessary. Evidence has shown time-and-again that “wait-and-see” is an ineffective approach when it comes to children with speech-language disorders or delays. The reason is the longer kids go without early intervention, the more developmental skills they must catch up on. Plus, the older they are, the harder it is to unlearn bad habits and adopt new ones because neuropathways have less plasticity as we age.
“If there is reason to be concerned when your child is 18-months-old, there is no reason to wait until they’re 3 or 5 to have them evaluated,” explained FOCUS Therapy Owner/Founder Jennifer Voltz-Ronco, MS/CCC-SLP. “The earlier we can diagnose a speech-language disorder or delay, the less impact it is going to have on your child’s development, academic achievements, and social/emotional well-being.”
Speech delays can have a number of causes, including oral impairment (problems with the tongue or palate), oral-motor problems, hearing issues, or a neurological condition like autism spectrum disorder (ASD). Although we treat children of all ages, we do recommend initiating assessments as early as possible, ideally as soon as you notice an issue.
Steps to Take if You’re Concerned Your Child Might Need Speech Therapy
If you think there’s a possibility your child might need speech therapy services, consider the following steps:
A sensory gym can be summed up in a single phrase: “Putting the FUN in FUNctional!”
If your child is beginning pediatric therapy (speech, occupational, physical, or ABA) at one of our two Fort Myers clinics, you’ve probably noticed some areas decorated with bright walls and packed with an array of Some of the equipment you see might look a lot like what you’ll observe in a playground or actual gym.
Although it may look like a bit of a free-for-all, a sensory gym is strategically designed to provide a structured environment to help children with delays and disabilities work on their sensory, motor, and communication skills.
Does your child struggle to say particular sounds? Do they say “fumb” for “thumb”? Say their ‘r’ sound like a ‘w’? Leave out a sound if it’s too hard to pronounce (i.e., ‘nana for ‘banana’)? Say their ‘s’ sounds with a lisp? As our Fort Myers speech therapists can explain, these are speech sound errors, which can be addressed with a type of speech therapy called articulation therapy.
We should start by saying that some articulation difficulty is 100% normal, and your child will grow out of it. The question will be how old they are and where they should be at developmentally for their age group.
- By 32 months, a child should be able to say the /p/, /h/, /b/, /m/, /n/ sounds.
- By 36 months, your child should be able to properly say the /f/, /w/, /b/, /g/, /d/ sounds and the “ng” sound.
- At 48 months, your child should be able to correctly say the /s/ sound.
Another element to consider is how well your child is generally understood by people other than you.
- By 2, your child should be about 65% intelligible (understood) to most listeners.
- By 3, your child should be about 80% intelligible to most listeners.
- By 4, your child should be very intelligible in connected speech. Sometimes people will describe it as, “talking like a little adult.”
Trouble with articulation is only considered a “disorder” when a sound that should have been acquired.
Florida speech-language pathologists are in high-demand – at our Southwest Florida pediatric therapy clinic and elsewhere. Speech-language pathology (SLP) ranks as one of the most desirable – and fulfilling – careers out there. Not only do these professionals enjoy significant job stability, good compensation, and numerous opportunities for career advancement, they have a direct role in the tangible well-being of their patients – and that’s truly why most of us are drawn to this field.
We know that at FOCUS Therapy, watching a pediatric speech therapy session can seem a bit like you’re watching play time. (And don’t get us wrong – we do have A LOT of fun!) But there is actually a great deal of study and consideration that goes into tailoring each session to help the individual child reach their goals.
We find that for parents, it’s helpful to know exactly the kind of training and dedication these professionals take on to get to the point of being able to structure play-based therapy (the kind we find most effective when working with children).
What Exactly Do Florida Speech-Language Pathologists Do?
Speech-language pathologists are experts in communication, and can actually work with people of ages – from infants to the elderly. They treat many different kinds of issues related to communication and swallowing. Some of these include:
- Speech sounds. This is how we say sounds and put sounds together to form words. We sometimes refer to these as articulation or phonological disorders. They can also include dysarthria and apraxia of speech.
- Language. This is how well we understand what we hear or read and how we use words to tell others what we’re thinking. With adults, this is referred to as aphasia.
- Literacy. This refers to how well someone is able to read and write. Lots of people (especially children) with speech & language disorders may also have trouble reading, writing, and spelling.
- Social communication. This is how well someone is able to follow social rules, like talking to different people, how close you should stand to someone when you’re talking, and how to take turns in a conversation. Formally, this is referred to as pragmatics.
- Voice. This is how a voice sounds. One might talk through their nose, speak too loudly, lose their voice easily, sound hoarse, or struggle/be unable to make sounds at all.
- Fluency. Most people know this as “stuttering,” and it refers to how well speech flows. Lots of young children stutter, but many grow out of it. Those with persistent issues should consult with an SLP.
- Feeding and swallowing. This involves how a person chews, sucks, and swallows liquid and food. Poor nutrition can cause a host of health problems. Southwest Florida speech-language pathologists can help.
- Cognitive communication. A deficit in this area would involve problems with organization, attention, memory, problem-solving and other thinking skills.
You can find speech-language pathologists in private pediatric practices like FOCUS Therapy, but they’re also employable at schools, hospitals, doctors’ offices, rehabilitation clinics, and colleges/universities.
Steps to Becoming an SLP
The basic steps to becoming a speech-language pathologist in Florida are:
- Earning your bachelor’s degree in a related field. This is a four-year commitment. Two undergraduate degrees that many SLPs commonly earn are a Bachelor of Science in Communication Sciences and Disorders and a Bachelor of Science in Speech-Language Pathology and Audiology. These are ideal if you know early on you want to become a speech-language pathologist. But it’s not uncommon for people to switch majors a few years in. Other bachelor’s degrees that can be well-suited to a later career in speech-language pathology are education, linguistics, and psychology (particularly if you pair them with a minor in something like communication sciences and disorders.