Southwest Florida speech therapy
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:
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:
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.
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:
Many children, when they are young and learning to talk, develop a stutter. Their brains are processing thousands of new sounds and words in the first years of their lives (aptly named a “language explosion”). As our Fort Myers speech therapists can explain, their vocabulary “explodes,” but the brain’s neural pathways are still catching up, and may have difficulty coordinating. This can be a factor in stuttering.
Sometimes, kids struggle with repetition of syllables, sounds and words. Others’ sounds are prolonged and some have so-called “blocks,” or speech interruptions. Some speculate there is a genetic component involved. No matter the specific type of stutter or the underlying reason, our Fort Myers speech therapists can help treat it.
Different Types of Stuttering
Stuttering is what’s known as a “fluency disorder.” As noted by the American Speech-Language Hearing Association (ASHA), someone who has a fluency disorder knows what they want to say, but has difficulty speaking in a way that is flowing, or fluid. They might say parts of the word or a whole word repeatedly. There might be an awkward pause between words. That’s stuttering, which is only one type of fluency disorder. There’s also “cluttering,” where one speaks rapidly and their words run together. Or they might say “um” with great frequency.
The FOCUS speech therapy team is flush with great ideas when it comes to using a deck of playing cards to get your child talking.
Card-playing is a popular past time because decks are small, portable and offer endless possibilities. Our speech therapists love cards too because they can be used during sessions (or at home) as a “communication temptation” for our patients. A communication temptation is any type of motivation we use to get kids engaged, talking and practicing the various skills we’re working on in speech therapy.
In addition to classic card games for kids (think Go Fish, Gin Rummy and Crazy Eights), it’s fun to make up games directly tailored to the skills of the children with whom we’re working. Here, we’ll outline some examples. Feel free to try them out yourself or make up your own!