Delayed Speech in Toddlers: Qualifying for Early Intervention

We’ve spent the past month or so being assessed for the government funded ‘Early Intervention Program’ for speech and language therapy. Delayed speech in toddlers can be incredibly frustrating for all and is common in twins. Some say twins develop their own language, and this eliminates the desire to communicate with others. Whatever it is… I’d like some progress, and I long for them to call me mama.

We are now qualified for the Early Intervention Program and ready for our first therapy session next week, so I thought I’d pass on my experience with the assessment process. I outline the criteria that qualified the boys for the program, and what appointment and tests were carried out.

What is the Early Intervention Program?

The Early Intervention Program is for babies and children up to the age of 36months, so if you are genuinely concerned it’s good to be assessed earlier rather than later. The program is free in Arizona, but the cost and qualifying criteria vary across different States. If you’re interested in the criteria for your state, see this table. The program is designed to help with physical, cognitive, social/emotional and communication delays. Each of these is assessed separately… we qualified for help with ‘communication’.

10 Reasons we Qualified for ‘Early Intervention’ at 20months:

1. The twins do not use any words consistently and with purpose (only babbling);
2. They used to say ‘mama’ and ‘dada’ months ago and stopped;
3. They do not use any of their own word like expressions other than ‘da’;
4. They will not try to copy sounds that I make to them;
5. They will not respond verbally to the use of their names;
6. They will not make sounds to try and sing along with songs;
7. They do not point at objects in a book if asked eg “where is the car?”
8. They do not point to their body parts when asked eg “where’s your nose?”
9. They do not go and get a particular toy when asked;
10. They have not made any language progress for some months;

The Qualification Process for early intervention

The assessment process usually starts with your pediatrician. You will discuss development at your well check appointments, but if you don’t want to wait until your next check up, just make an appointment to discuss development separately. We talked about moving forward with formal assessment at their 15 month appointment but we thought we’d give it another three months to see if anything changed. On reflection, I would recommend getting the ball rolling as soon as you and your pediatrician notice significant delays, because the Early Intervention assessment process takes time, and it will probably be another two months until you actually start therapy. 

Here’s a summary of the appointments we had before therapy starts:

• Referral from our pediatrician (they apply for you and you just wait for a call);
• Paperwork meeting. Someone assigned to our case came to the house to ask questions and fill in a bunch of paperwork. The twins did not have to be present.
• Developmental evaluation. Two therapists came to our house, one assessed Physical stuff (gross and fine motor skills), one assessed communication and social/emotional development. They first asked me more questions about what they could and couldn’t do, most of which was a repeat of the paperwork meeting. Then the twins were assessed through play and observation. More on how they were assessed below!
• Goals meeting. We had three lovely ladies at the house for this meeting… a little more paperwork, a few signatures to confirm their place on the program. The aim of the meeting is to agree on targets and frequency of appointments required. We are booked in for two therapy sessions a month for the next six months when we will be reassessed for progress.
• First therapy session. Our first session is next week, so I’ll keep you posted. There were about two weeks between each of these appointments so you can see it takes a little time to get sorted.

How is delayed speech in toddlers evaluated?

A lot of the assessment is done through questioning of the primary care giver. However, the assessment is carried out by trained therapists and is play based and observational. Here are some of the exercises they carried out:

• They were given pegs to put into color coordinated holes. This particular toy sprung the pegs back out which the boys found hilarious. This is testing fine motor skills (getting the peg in), communication (by asking them to do it), and social/emotional (do they find things funny?).
• Wooden stacking blocks. This is one of the staple physical development milestones… can they stack six blocks on top of each other?
• They were asked to pick out a toy banana from a row of other objects. As suspected, Arthur went straight for whatever he thought the most interesting… a fork.
• They were asked to wave, high five and clap.
• They were asked if they would like to have objects before being given them to assess verbal response. 
• They were prompted with words like ‘uh-oh’ when they dropped something, or ‘dog’ when playing with ours (who found the whole thing very exciting) to see if they would repeat the words.
• They were read to, pointing out objects in the book and prompted to repeat the word by saying it three times.

Mostly it was just hanging out and observing normal behavior. The boys were busy playing peekaboo, running around and pushing each other on their ride on cars. At the end of the appointment, each area of development is scored. The boys scored excellently for social/emotional development, scraping average for physical, below average for ‘receptive language’ (understanding), and very poor in for ‘expressive language’ (talking).

To qualify for speech and language therapy, an average score is taken for receptive and expressive language. Although the boys’ receptive language was below average, it was not low enough to qualify. However, because their expressive language was so bad, the average came out just low enough to qualify for the program. I was told the boys qualified at the evaluation appointment itself.

Advice I was given to help progress

At the evaluation appointment, I was aware it would be some time until our first therapy session. I asked for some tips for how to help them while the therapist was there. Here’s what I was recommended:

• Work on the signs for ‘more’, ‘please’, ‘all done’ and ‘help’. Do it yourself and then move their hands to copy. These words are applicable to meal times and when playing with toys. Parenting.com have a slideshow of common signs, and even give away a flashcard freebie if you’re willing to subscribe to their email list.
• When you say words, point to the part of your body doing the work to make the sound. If they’ve just pointed at the fan, say ‘fan’, over emphasizing the ‘f’ with your mouth and point at your mouth while you do it. This will help get them focused on watching you, because they may not be looking at your mouth when you talk. A ‘k’ sound may apply more to your throat than your lips for example.
• Work on one-on-one conversation. Talk to them, wait for a response, talk back. It sounds basic but encouraging them to make any verbal response is the start of communication. 

I’ll be reporting back with more information on delayed speech in toddlers after we’ve had a few therapy sessions. George is getting pretty good at “nah” (no), and he’s still bossing his brother around like he owns the place so I look forward to his verbal commands soon! Wish us luck!