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:
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.
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.
Kids’ recreational screen time more than doubled in the U.S. during the COVID-19 pandemic, according to a recent study by the Journal of the American Medical Association Pediatrics. This is concerning news because, as a Fort Myers speech therapist will tell you, excessive use of screen time can have numerous adverse impacts. In particular, these include:
- Unhealthy weight gain.
- Reduction in social skills.
- Delay in speech-language development (particularly for younger children).
The researchers looked at a group of more than 5,400 kids. Their average daily screen time prior to the pandemic was about 3.8 hours (still pretty high!). (The data was initially gleaned to study how cognitive development is impacted by screen time.) Then during the pandemic, kids’ use of electronic screens doubled to 7.7 hours daily. It should be noted that figure excluded school-related screen time, which many kids engaged in on-and-off, either in virtual school or some hybrid. Here in Southwest Florida, many schoolchildren are also assigned a set number of weekly minutes through a reading-math program called iReady. This too would have been excluded.
Analysts were solely looking at recreational screen time. That would include the use of electronic devices (phones, iPads, gaming systems, etc.) for things like:
- Multiple-player gaming.
- Single-player gaming.
- Social media.
- Video chatting.
- Browsing the internet.
- Watching streaming movies, videos, or television shows.
Speech and language skills are critical to a child’s ability to learn and interact in the world around them. When speech-language delays are identified and treated right away, there are exponential benefits for their social-emotional and academic growth. The early years are the most important for building strong speech and language skills. In this stage, your child’s brain is growing extremely fast in the first five years of life. During this window, kids are more open to learning than they’ll ever. To minimize the long-term negative impacts of a speech-language delay or disorder, our Fort Myers speech therapy team recommends early intervention – starting before age 3, if possible.
Communication is one of the most critical developmental tasks of early childhood development. It’s the way children start to form their understanding of the world. When a child has trouble communicating (being understood and/or understanding others), it can hinder their ability and confidence to express their ideas and observations of the world around them.
Kids who struggle with communication in earlier stages of development may struggle with:
- Low frustration tolerance.
- Emotional outbursts.
- Excessive shyness.
They may also appear less academically advanced than their peers. That’s because reading, writing, and verbal assertions are essential to the learning process. The foundation for these skills starts very early – from birth. Your child may be too young yet for school, but if you notice they aren’t on pace with their peers in terms of speech and language skills, it’s a good idea to act promptly. The sooner you can address it, the less chance they’ll fall too far behind academically.
Also by the time kids get to school, their speech and language delays or difficulties may become markedly obvious, sometimes even to them. This realization can be a blow to their confidence, leading to lower class participation and performance. The earlier they can start working on it with a licensed speech-language pathologist (SLP), the less the deficit is going to impact them later on.
A child’s inability to express themselves or understand what’s being expressed to them has an undeniable negative impact on their ability to fully enjoy and participate in daily life. The earlier we can intervene with speech therapy, the less difficulty they’ll have as they get older.
As the weather cools in Southwest Florida, it’s the perfect time to get outside and play with your child! It’s not just about enjoying the day and making some memories (though these are worth it in itself). Our speech, occupational, physical, and ABA therapists know that spending time outdoors is great way to boost child development.
Being in nature has been proven to boost kids’ academic achievement, physical health, mental health, and overall well-being. One analysis of hundreds of studies on the subject found that nature boosts learning in eight distinct ways. Those include:
- Improves attention.
- Relieves stress.
- Boosts self-discipline.
- Increases physical activity and fitness.
- Promotes self-motivation.
- Increases enjoyment.
- Improves engagement.
As pediatric therapists dedicated to helping disabilities and delays make strides, we have found that nature provides a calmer, quieter, and safer setting for learning. It can also help with:
- Motor skills
- Social-emotional skills
- Speech and language skills
- Executive function
- Sensory integration
- Relaxation and emotional regulation
Spending time outdoors creates opportunity for more creative, exploratory forms of play – and play is how children learn best!
Some parents note when filling out our Fort Myers speech therapy intake forms that we inquire as to whether their child had a low birth weight. You may wonder what this has to do with speech therapy. The answer, as noted in research published by the National Institute on Deafness and Other Communication Disorders, is that compared to babies with a birth weight in the normal range, those with low birth rate:
- Were more likely to have a communication disorder.
- Were more likely to have used speech-language, occupational, and physical therapy services.
- Had weaker motor abilities.
- Had lower school performance.
- Had higher incidence rates of pneumonia.
- Were three times more likely to repeat a grade.
In short, while some babies with low birth weight are perfectly fine, some are at high risk for communication and developmental problems that can extend well into childhood. Our Fort Myers speech therapy team at FOCUS Therapy can help.
Your child has autism. You know it. The rest of the family knows it. His teachers and therapists know it. Maybe even a few of his classmates know it. But when should HE know it? And how should you tell him?
It’s something many of our FOCUS Therapy families grapple with at some point, and answers really depend on the individual. Some parents opt to tell their child when they’re very young, hoping an early understanding of why they struggle more with certain things might make it all less confusing. Other parents wait until their child becomes aware of their differences and starts asking questions. A few parents wait until their child is older with a better ability to fully grasp what their diagnosis means. Our FOCUS speech, occupational and ABA therapists know there isn’t a singular right answer, but we’re here to support our patients and help guide families in these discussions.
Recently, a patient’s mother asked about the best way to handle some of the questions her 7-year-old son on the spectrum was asking. Christie Lawrence, a registered behavior technician (RBT) with our Fort Myers ABA therapy team and herself the mother of a teenager with autism, offered her thoughts.
“I would say the most important part of informing your child of their autism diagnosis is to empower them,” Lawrence said. “Autism can bring many gifts, and it’s so important to teach our children to find and focus on their strengths and build confidence from their success.”