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Speech and Hearing Perspectives

Early Evaluations: A Plea to Pediatricians

Published September 18, 2014 9:29 AM by Speech Merion
By Jasna Cowan, MS, CCC-SLP, a bilingual speech-language pathologist on a multidisciplinary team at Golden Gate Regional Center, San Mateo, Calif. 

Dear Pediatrician,
Why? Why are the child and parent sitting in my office in front of me seeking my opinion? They are concerned with their child's speech and language skills. The parents are now officially worried because Kindergarten is around the corner and frankly they are confused. The grandparents have noticed a delay, the neighbor has noticed something's not right, and the daycare provider has even voiced concern. The parent is seeking your opinion because your opinion is held to the highest regard. Maybe the child is not too interested in others and he won't even look into people's eyes. When the child says something he is echoing the statements of his favorite TV shows. His play is repetitive and he isn't using any pretend play yet. The teachers report he plays alone at preschool and has a difficult time making friends. He is overly fascinated with letters, shapes and numbers or some other subject.

You have seen this child in your office at least a half dozen times now for check-ups and illnesses. I have to wonder, did you see the same things I am seeing? I have to give you the benefit of the doubt; maybe you couldn't see what I see because the child was scared and screamed frantically when they visited. Or maybe the child was playing on an electronic device that they never set down during the visit. But did you take the time to listen to the parent when the parent mentioned to you that their child lost words, or that they are not saying many words at all? Did you read between the lines when the parent said their child was "just fine" but you thought maybe otherwise? Or did you ignore the signs or pacify the parents by saying "wait, just wait..." Wait?? Why wait? Why wait when there are fantastic social workers, occupational therapists, early interventionists, behavior therapists, and speech-language pathologists that specialize in early intervention. We get the ball moving so that the child can progress and be more ready for future challenges such as sitting at circle time, sharing their favorite toy from home in front of the class, making new friends, and telling their teacher about the bully who is hitting them. Wait, you say? Wait for what, so a therapist or resource specialist can knock on the door or their first grade class and call the child's name in front of his 23 other classmates for pull-out therapy? Wait so that when the child returns from therapy he is confused, has missed out on an important class lesson, or recess? Wait so that kids make fun of the child because he "talks funny" or is "weird"?

Frankly doc, waiting is already affecting this child's future, his self-esteem, his socialization skills. Is it really worth waiting? I know you are an expert of a child's health and wellness, but we are specialists of certain areas of these children's developmental skills. Can you please seek our opinion if you are even a little unsure or when a parent casually mentions a concern? You will have made a lasting change in the child's life and maybe even changed and fostered the new pathways to that child's developing brain. Please, I plead, please give us a chance to give our opinion so that the child can get into services that he might need. We might never be able to detect all of the benefits that the child has gotten from starting early, but we definitely know all the consequences that occur if a child is not offered the services that he needs at an early age. Please doc, give us a chance to determine whether the child needs help in our areas of specialty. That's what we are here for... to provide your patient with an EARLY START.

P.S.: Thank you to the doctors who believe in the Early Start process and recommend their patients be evaluated "just in case!"

Thanks for listening.

Jasna Cowan, MS, CCC-SLP
Early Intervention Speech-Language Pathologist and team member.

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posted by Speech Merion


Thank you! I have been doing early intervention services for about 17 years and over the past 3-5 years I am getting more and more kids over 2 years old who are not speaking and just beginning EI services. Last year I was servicing one child and her sister who was 15 months at the time was not talking. Mom was concerned about her speech and language delays but was told to wait until she was at least 18 months old. The child was receiving OT services. When I called the service coordinator I was told that he would ask the OT her opinion. WHAT? A speech pathologist, a specialist in speech and language, is telling you there is a reason to be concerned and the child should be evaluated ASAP and your response is that you will consult with the OT. Well almost 5 months later this little girl was finally evaluated and was approved for services once a week. YES once a week for a child who was almost 2 years old and wasn't even babbling. Unfortunately this little girl has made very little progress and continues to tantrum and cry to have her needs met. I know had she, and others I have had over the last couple of years, received services earlier they would have made so much more progress.

I'm assuming states think they are saving money. However these children are going to need special education services in school so the "savings" is only for a short time.  As the kids enter school there will be more children needing services than there would have been had they received therapy earlier.  The actual long tem savings are in providing services at a younger age so that less children need services when they enter school and those who continue to need therpay will need less frequent services. I realize I am preaching to the choir but it feels good to vent to those who understand.

Stacy, Speech Pathologist October 29, 2014 9:52 AM
Brooklyn NY

Amen! I have been saying this for years. Here in the Cincinnati area, I've been shocked to see so many children come into the preschool special education program with so many of the same symptoms that you describe as 4 and 5 year olds with no services under their belt. When you talk the parents, they've been expressing concerns to their doctor for years. Fairfax County Virginia had a wonderful program (that started over 25 years ago) where the itinerant teachers went into doctors office in their area and talked to doctors and trained doctors on what to look for and who to contact and put parents into contact with if they had concerns - wonderful forward thinking. I can't imagine how they got the funding but I wish Ohio and other states would follow suit! In the 14 years, that I worked there, we rarely had a child come in over the age of 4 with a "new" diagnosis of autism. It was caught earlier and the children were sent to our program quickly and received services much earlier!%0d%0a%0d%0aWay to go for writing that letter  - now can we send it to all pediatrician's office so they start referring them early!%0d%0a%0d%0a%0d%0aKelly

Kelly O'Connell, Ohio - Wilmington October 9, 2014 7:18 PM
Maineville OH

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