Speech Therapy
Why FOCUS Asks Parents to Stay in the Waiting Room During Evals, Sessions
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:
Speech Therapy – by The Numbers
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.
Additional Resources:
Be Tech Wise With a Toddler, American Speech-Language Hearing Association
At What Age Should My Child Start Speech Therapy?
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:
Our Favorite Sensory Gym Equipment for Kids With Disabilities & Delays
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.
How FOCUS Fort Myers Speech Therapists Teach Sound Articulation
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.
In general:
- 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
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.
How We Use Storytelling in Fort Myers Speech Therapy
From fables and fairytales to silly rhymes and serious plots, kids LOVE story time! At its core, storytelling is about connection and communication. Everyone has a story to tell, and stories help us to understand the world around us and empathize with the people in it. Being able to follow – and tell – a story helps to understand the actions and opinions of others, and allows others to understand us too. Stories can be poignant and meaningful, giving us insight into an important life lessons, or they can be simple, everyday conversations, such as what someone did that weekend. When children learn how to tell stories, they learn how to be better communicators. At our FOCUS Fort Myers speech therapy clinic, we love using creative stories in sessions. It not only teaches children important communication skills, it keeps them interested and engaged!
Teaching storytelling involves not just reading stories, but breaking them down into the most basic parts for kids to understand. In our experience with young children, it’s best to start with simple narrative stories and then help them to identify the beginning, middle, and end. We teach them the transition words (first, then, next, last…). Even if retelling the story is difficult, sparse, or choppy at first, the idea is to help ensure the retelling isn’t random – it’s an organized beginning-middle-end structure.
For instance, we’d tell the story of the Three Little Pigs like this:
- First, three little pigs built three houses.
- Then, a big, bad wolf said he would blow their houses down.
- Finally, the three pigs found safety in the house made of bricks.
Once they’ve mastered this basic Beginning, Middle, End, we can help them work on the more complicated story structures, such as orientation/setting (answering the who, where and when questions), the complication/plot (answering the what questions), the action (this answers the what and also how), the resolution (also the what and how questions) and the ending.
No doubt these are skills your child will need in school. The sooner we begin working on it when they’re younger, the better.
Does My Child Need Pediatric Speech Therapy?
If you’re wondering whether your child might need pediatric speech therapy (speech therapy provided to kids), it’s best not to “wait-and-see.” That’s because problems compound, bad habits become more ingrained, and neural pathways critical to learning become more inflexible.
Another thing to bear in mind is the proven success of early intervention. As noted by the American Speech-Language-Hearing Association (ASHA), early intervention is the process of providing support to infants, toddlers, and young children who have or are at risk for a developmental delay, disability, or health condition that might impact typical development and learning. The earlier services are delivered, the more likely the child is going to develop effective communication, language, and swallowing skills.
Areas of Development Pediatric Speech Therapy Targets
Pediatric speech therapy will target five areas of development, including:
- Communication development.
- Cognitive development.
- Physical development, including vision and hearing.
- Social-emotional development.
- Adaptive development.
FOCUS Therapy is highly effective in treating a wide range of delays, disabilities, injuries and challenges – in large part because we’re working on site at our two Fort Myers clinics with inter-disciplinary teams that include not only speech therapists, but occupational therapists, ABA therapists (who target behavior), and physical therapists.
For more information on whether your child may not be reaching important speech-language development milestones, ASHA is a great resource! So is your pediatrician, who can issue a referral for your child to be assessed by a trained speech-language pathologist with a full evaluation, which can shed light on challenges as well as treatment solutions.
FOCUS offers pediatric speech therapy at two clinics in Fort Myers, with virtual speech therapy and occupational therapy offered to kids throughout the state of Florida. Call (239) 313.5049 or Contact Us online.
Additional Resources:
Speech-Language Development 2-3 Years, ASHA
More Blog Entries:
Fort Myers Speech Therapist Tips on Reducing Kids’ Screen Time, Nov. 5, 2021, Ft. Myers Speech Therapy Blog
Fort Myers OT Insight: “How Can I Help My Child With Eye Contact?”
A child may avoid eye contact for a number of reasons, but it’s something to really pay attention to because it’s one of the earliest indicators of autism spectrum disorder (ASD). Infants who avoid eye contact with their parents – something that can be observed in a baby as young as 3 months – need to carefully monitored and assessed if the problem persists. Most babies start making eye contact no later than 6 months of age. If this is something you’ve noticed, it’s imperative to talk to your pediatrician about a potential referral for ADOS testing. If you already know your child is on the spectrum and is struggling socially, our Fort Myers OT (occupational therapy) team has some strategies that may help improve eye contact.
When Should My Baby Be Making Eye Contact?
Babies start using eye gaze to regulate behavior at around 5-6 months of age. By around 7-9 months, they use eye gaze to initiate joint attention. Joint attention is when a person purposefully coordinates his/her focus of attention with that of another person. In other words, two people are intentionally paying attention to the same thing for social reasons. If you say to your child, “Look at that big ball,” and the child looks to where you have pointed to see the ball. You’ve just engaged in joint attention. Kids on the autism spectrum struggle with joint attention, as it’s considered a social skill. Difficulty with joint attention can lead to or at least be closely correlated with developmental language delays.
As our Fort Myers OT professionals can explain, most toddlers will pair eye contact with their gestures at least half the time when they’re communicating. When kids struggle to pair their gestures or words with an eye gaze, it could be a red flag. For a child with social-communication deficits, consider that it can be really difficult to listen to someone talk, understand what they are saying and look at them at the same time.
Even as they get older, kids with autism may be apprehensive about establishing eye contact because they don’t have the ability to communicate. Some kids on the spectrum require a great deal of concentration to make and sustain eye contact. It’s important for parents not to force their kids to have eye contact, as this could result in frustration and anxiety. Instead, there are tactics we as occupational therapists can use in sessions and teach you for carryover.
Fort Myers OT Tips for Encouraging Eye Contact
With patience, positivity, and encouragement, you can help your child make and maintain eye contact. It can be difficult at first, but know that working on this skill is something that is not only going to help them in the short term, but long term when it comes to making friends and succeeding throughout life.
Four Things to Know About Developmental Language Delay in Kids
Some kids are “language late bloomers.” A percentage will catch up to children their same age on their own. Others, however, will continue to struggle with language learning. We call this a developmental language delay. If these difficulties persist beyond the earlier stages of development (past the age of 5), it can significantly impact their reading, writing, math, reasoning, and social skills later on.
Kids whose language troubles can’t be explained by some other cause (such as a disability, syndrome or physical impediment) and continue until they’re in school are typically diagnosed with Developmental Language Disorder.
Some indications of a language delay may include:
- Not babbling by 15 months.
- Not speaking by the age of 2.
- Inability to speak in short sentences by the age of 3.
- Trouble following directions.
- Difficulty putting words together in a sentence.
- Leaving words out of sentences.
If you suspect your child may be struggling with language comprehension or expression, you do not need to wait until they are school age to have it addressed. In fact, you should have it assessed and treated much sooner, if possible. As noted by the American Speech-Language Hearing Association (ASHA), early intervention (before age 5 and preferably before age 3) can have a substantial impact on the long-term implications of a speech-language disorder or developmental language disorder.
Our early intervention speech therapy team at FOCUS Therapy can help your child struggling with language skills to catch up to their same-age peers, specifically targeting skills like:
- Cognitive thinking (problem-solving, thinking, learning).
- Communication (listening, talking, understanding, gesturing).
- Physical/sensory skills (seeing, hearing, crawling, walking, climbing).
- Social-emotional skills (playing, understanding feelings, making friends).
- Adaptive/self-help skills (eating, drinking, bathing, dressing, etc.).
If you think your child may need some extra help in the area of language development, here are four things to know: