Fort Myers speech therapy
If you’re concerned that your child may have a speech-language disorder – you aren’t alone. The American Speech-Language Hearing Association (ASHA) estimates 8 percent of U.S. kids ages 3 to 17 (about 1 in 12) have a disorder related to speech, voice, language, or swallowing. Kids younger than 3 can be diagnosed with speech & language disorders and delays too. As dedicated providers of Fort Myers speech therapy for kids, we can firmly attest to the remarkable positive impact of early intervention therapies. Children whose speech & language disorders are identified and treated very early are more likely to have no discernable communication issues as they get older.
- The type and severity of the underlying condition(s).
- The age of the child when intervention begins.
- The intensity of the intervention schedule (length and frequency).
- At-home reinforcement and consistency.
Our knowledgeable, dedicated team of Southwest Florida speech-language pathologists at FOCUS Therapy is well-prepared to treat children with a broad range of delays and disorders. That said, there are some pediatric speech-language deficits that are more common than others.
- Speech or articulation delays. While you might hear the terms “speech” and “language” used a bit interchangeably, they’re technically different skills. Speech is the mechanical or motor aspect of talking. Common speech and articulation delays among kids include things like stuttering, incorrectly combining sounds, or difficulty pronouncing words. Sometimes there is a physical reason for this (like a cleft palate), but the cause isn’t always clear. Some speech delays are related to global developmental conditions, like autism spectrum disorder or Down syndrome. Other times, they crop up as a singular issue. Speech and articulation delays may not require intervention, but it’s important to consult with a pediatric speech therapist before making that call.
- Expressive language disorders. These are conditions that involve problems with verbal expression. Often, these are conditions where kids may have difficulty formulating their thoughts or combining words to form a complete thought or sentence. Speech-language therapists can help kids with expressive language disorders by clearly identifying the issue, and then helping the child work on sound-letter associations, phonics, and pre-literacy skills.
- Receptive language disorders. Sometimes referred to as language processing disorders, these are conditions where the child can hear perfectly find, but they have difficulty decoding the meaning in their brains. Sometimes, language processing disorders may be initially misdiagnosed as speech delays, because they look very similar early on. Another reason parents and caregivers might miss receptive language disorders is because so much of early language is repetitive and can be memorized. For example, if you regularly say, “time for your bath!” your child may recognize the sound pattern and march themselves to the bathroom, but it doesn’t mean they necessarily understand the individual components of that sentence: “time,” “your,” and “bath.”
- Social and pragmatic speech disorders. Effectively using language in the correct context during social situations is a skill we call “pragmatics.” Kids who have social pragmatic communication disorder have difficulty with verbal and non-verbal communication that can’t be explained by low cognitive ability. They might talk nonstop without recognizing the other person isn’t engaged or listening. They might interject at inappropriate times or with non sequitur responses. They may fail to “take turns” when talking, or fail to make eye contact, or breeze over certain social “rules” most of us recognize as inherent to communication in social settings.
- Voice disorders. About 5 percent of kids have chronic voice disorders. These involve difficulty with voice pitch, volume, quality, etc. One’s voice may sound hoarse or harsh, too high or low, too loud or too quiet, etc. Causes vary, but can include polyps and nodules on the vocal chord, infections, acid reflux, poor movement of vocal folds, etc. Speech therapy exercises can be helpful for children with weak voices and other voice disorders.
Why Early Intervention Fort Myers Speech Therapy Makes a Difference
Years ago, pediatricians tended to adhere to a “wait-and-see” approach, which basically involves hanging back and waiting to see if concerns about speech-language development were still lingering once a child hit school-age. That has largely shifted in favor of early diagnosis and treatment of speech-language disorders because research has shown more effective results with treatment the earlier interventions begin.
Researchers examining the reason behind early intervention’s effectiveness have largely concluded that the younger the child, the more malleable their brains. As noted by the CDC, these “neural circuits” are the connectors in a child’s brain. They are most easily adaptable during the first 3 years of life. For kids with speech-language delays and disorders, those neural circuits are often missing key connections. Early intervention helps reroute them.
Children begin recognizing recurring speech patterns during their first year of life. Babies 12-18-month-old can usually understand at least a few words in the absence of gestural or other cues. They can also usually produce at least a few intelligible words. These combined skills show them acquiring both expressive and receptive speech-language skills.
Of course, spotting a speech problem in a 2-year-old is a bit trickier than in a 6-year-old. That’s not to say evaluations should wait. It’s just that toddlers as a whole are only just starting to grasp speech patterns, so things like lisping and slurring and mispronunciations are fairly common. That’s why often with younger kids, our speech therapists are less concerned with the accuracy of their word articulation and more focused on whether and how they’re trying to communicate. If they’re older than 1 and not using any words, that could be cause for concern – particularly if they aren’t using gestures, displaying a understanding of what’s being said to them, or showing any notable response their own name. Those can be an indicator of bigger issue – possibly autism, but also maybe non-related speech-language delays or disorders. In any case, it’s better to have them evaluated sooner than later.
Another way to think about early intervention speech therapy: Early on, missed speech-language milestones will be counted in months. But let enough time go by without treatment, and the delay will compound by years. A child who receives Fort Myers speech therapy at 18 months may be 6 months delayed, while another child with similar delays but doesn’t start treatment until they are 3 will be 1.5 years behind. The earlier a child starts receiving therapy, the better chance they have to catch up sooner.
If you have additional questions about early intervention speech therapy for your child, we offer initial consultations as well as comprehensive speech-language evaluations and ADOS testing.
FOCUS offers pediatric speech therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
Why Act Early if You’re Concerned about Development? U.S. Centers for Disease Control and Prevention
More Blog Entries:
The Best Age for Fort Myers Speech Therapy? Mind the Milestones., Nov. 3, 2022, Fort Myers Speech Therapy Blog
When we’re looking at the best age for kids to start a Fort Myers speech therapy program, one thing we’re going to zoom in on is whether they’re meeting certain developmental and language milestones.
In the first 3 years of life, a child’s brain grows and matures rapidly. It’s an intensive period for acquiring critical speech and language skills. These are developed in a world that is rich with sights, sounds, and regular exposure to the speech and language use of the people all around them – parents, daycare workers, siblings, grandparents, cousins, friends, shop workers, and more.
One of the reasons language develops so fast during this time period is that the brain of a baby, toddler, and young child has a great deal of plasticity. What this means is it’s able to absorb a great deal for quickly. It also means that the neuropathways that allow us to cement certain skillsets are not yet rigid. So if one neuropathway isn’t working as it should, new ones can develop – assuming they are taught to do so. This is why early intervention therapies are so important.
Speech and language development can vary from child-to-child, but if they’re missing major milestones, it’s important to take action.
Too often, we see parents and even some specialists take a “wait-and-see” approach if a child isn’t meeting these milestones. But it’s our firm belief this is a mistake. Because just as quickly as kids develop these skills, they can also fall behind. If we pass these small windows of time without Fort Myers speech therapy intervention, it’s going to be more difficult for the child to learn. Not impossible, mind you, but tougher.
CDC Milestones for Speech Language Development
The U.S. Centers for Disease Control & Prevention has a hearing & communicative development checklist that we recommend reviewing (it’s based on the “How Does Your Child Hear & Talk” guide from the American Speech-Language hearing Association). Ultimately though, if you have a concern, it’s best to start exploring interventions right away.
Even if professionals evaluate your child and determine they don’t need Fort Myers speech therapy, it’s better than waiting too long and having the impact of a delay snowball – particularly considering that so many specialists and clinics in Southwest Florida are on extensive waitlists.
Some milestones to consider:
Birth to 3 Months
- Reacts to loud sounds
- Calms down or smiles when spoken to
- Recognizes your voice & clams down if crying
- When feeding, starts or stops sucking in response to sound
- Coos and makes pleasure sounds
- Has a special way of crying for different needs
- Smiles when he/she sees you
4 to 6 Months
- Follows sounds with eyes
- Responds to tone of voice changes
- Notices toys that make sounds
- Pays attention to music
- Babbles in a speech-like way with lots of different sounds, including those that begin with p, b, and m
- Babbles when happy, excited, or unhappy
- Gurgles when alone or playing
7 Months to 1 Year
- Likes playing pat-a-cake & peek-a-boo
- Turns and looks to where sounds originate
- Listens when spoken to
- Understands common words like “milk,” “up,” “cup” etc.
- Responds to basic requests “come here”
- Babbles using short and long groups of sounds (upup, bibibi, tata, byeybye)
- Babbles to get up or to keep attention
- Communicates with gestures like holding up arms, waving, or even pointing
- Imitates various speech sounds (even if they don’t make sense)
- Has 1 or 2 words (Hi, Mama, Dada, Bye-bye)
- Knows a few body parts, can point to them if asked
- Follows simple commands “bring the cup,” “roll the ball” and simple questions, “where is the dog?”
- Likes simple rhymes, songs, and stories
- Will point to pictures in books when named
- Picks up new words on a regular basis
- Uses some of those 1-2 word questions “Go bye-bye?” “Where doggy?”
- Can put together 2 basic words “more juice” “want car”
- Uses different consonant sounds at the start of words
- Has words for most everything
- Uses 2-3-word phrases to talk about and ask for things
- Can use the d, n, t, f, g, and k sounds
- Is easily understood when talking to family and friends
- Can easily name objects to ask for or direct attention to them
- Hears when you call from another room
- Asks simple WH questions (who, what when, where, why)
- Talks about preschool, grandparents’ house, activities with friends
- Uses sentences with 4 or more words
- Speaks easily without having to repeat words or syllables
- Pays attention to short stories and can answer basic questions about it
- Hears & understands most of what is said at home and in school
- Uses sentences with lots of details
- Tells stories that stay on topic
- Communicates easily with adults and other kids
- Uses rhyming words
- Names letters and numbers
- Says most sounds correctly (except for tricky ones like r, s, v, l, ch, z, sh, and th)
These milestones are understood to be when about 90 percent of typically developing kids in a given age range have mastered these skills.
Although we don’t want parents stressing milestones, it’s a good idea to keep track of them because we don’t want them to fall behind.
Also worth noting is that these are just the basic milestones for speech and hearing. There are others that focus on growth, movement, physical development, and literacy. Any kind of concern for speech, language, or hearing issues is best addressed promptly. In addition to in-depth exams, FOCUS also offers free screenings to help you determine if it’s an issue you should raise with your pediatrician.
Should I Be Comparing My Child’s Speech & Language to Other Kids in Their Class?
The answer to this is yes… And no.
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
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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.
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: