When a preschooler has a lisp, we often think of it as precious, even harmless. But as he or she grows up, that sweet lisp can present challenges both in and out of school.
“It’s adorable on a kid. It’s not cute on an adult,” says Anthony Koutsoftas, PhD, an associate professor at Seton Hall University’s Department of Speech-Language Pathology (SLP). It’s important to consider the ways speech disorders can impact children academically and socially. “The child may not talk much [in] class, or participate fully in school. Or, the child may not have many friends, or may be bullied,” says Susan Karr, associate director of school services at The American Speech-Language-Hearing Association (ASHA).
Even if your child seems to be thriving despite having a stutter or trouble articulating certain sounds, problems may become more obvious as academic expectations increase and socializing becomes more sophisticated. If your child appears to be struggling, here’s how to help.
TALK TO YOUR DOCTOR.
Schedule an appointment to address your concerns. You may find that your child’s speech issues are age appropriate, or that the issue is structural and a visit to an ENT is in order. Your doctor may take a wait-and-see approach, even if you don’t want to. That’s fine. But remember: The doc only sees your kid for a few minutes, while you see him every day. If you suspect something’s wrong, go with your gut. “Ninety percent of parents that have concerns are usually right about it,” says Koutsoftas. “Don’t defer to pediatricians. If you think something isn’t quite right, there’s no harm in getting an evaluation,” says Maplewood-based speech therapist, Reesa Solomon. “Trust your instinct.”
ASK FOR A FORMAL EVALUATION.
Federal law mandates that students with disabilities receive services. Either a parent or teacher can request an evaluation from your child’s school, which must take place within 90 days of parental consent—provided the school’s child study team determines one is warranted (proof that speech has been an ongoing concern helps). Each school district may have its own process, but generally speaking, a request sets off a cascade of actions culminating in an IEP (Individualized Education Plan) complete with SLP services—or it doesn’t.
“A disorder has to adversely impact the child’s functioning in the school. If it’s a mild situation, the school may say that child doesn’t qualify for service,” says Karr, adding that said impact can vary from academic struggles to problems on the playground. Services are offered based on fairly strict criteria, so if your child scores too high or the teacher doesn’t see a serious problem, you may not qualify for speech therapy at school.
CONSULT A PRIVATE PRACTITIONER.
“If your child doesn’t qualify based on the criteria but you or the teacher still have concerns, contact a private speech language therapist,” says Solomon. “You want your child to be understood. It’s a quality of life issue.” Even if your child does qualify for school services, they may not be long enough or frequent enough for your kid. Not only are many school SLPs overloaded with students, there’s a limit to how much time a student can be pulled from the classroom, so you may want to supplement with a private SLP.
References from friends or family and local parenting boards will likely reveal a wealth of state-licensed SLPs accredited by the ASHA (search asha.org for providers), says Solomon. Once you’ve narrowed your list, schedule a phone consultation to make sure they have the right credentials (a masters or doctorate plus certification), along with experience in your child’s issue and a style that suits him or her. If this is supplemental, ask that your child’s school and private therapist collaborate to reinforce similar goals. “It’s good to [coordinate] so that both SLPs are aware of what the other is working on,” says Karr.
CONSIDER THE COST…
Cards on the table…speech therapy can be expensive, and it’s often not covered by insurance. “Some will cover in-network, some out-of-network, but they often won’t cover general therapy,” says Solomon. This means that while they may cover rehabilitative sessions (like after a stroke), they won’t cover habilitating services designed to improve skills that haven’t developed properly. So before choosing a therapist, ask your insurance what diagnoses and treatment codes are covered—if they don’t match your child’s evaluation, expect to go the out-of-pocket route.
If private speech therapy is simply unaffordable, Koutsoftas suggests inquiring at a university with a speech clinic—it won’t be free, but it’ll be significantly cheaper and possibly offered on a sliding scale. Still coming up empty? “Consult a speech language pathologist for a session or two, and request exercises to do with [your] child,” he says. Ask if you can sit in and observe. It’s not ideal—“compliance isn’t always great with parents,” he says—but it may be better than nothing.
…BUT KNOW IT’S NOT FOREVER.
How long will speech therapy last? “That’s the big-ticket question,” says Solomon. “It depends on the severity and nature of the speech language disorder, the motivation of the student and the commitment to home practice. Those things all come into play.” At the onset of treatment, your child’s SLP will develop with a plan for frequency and duration of services, along with an individualized set of long- and short-term goals, whether it’s working towards age-appropriate (not perfect) speech, improving stutter control (versus eradication) or becoming consistently understood by strangers. “We never work towards 100 percent mastery,” says Solomon, and it’s not uncommon to work up to a goal and take a break. Both can help keep expenses at bay, as can taking daily homework seriously.
PRACTICE MAKES (CLOSE TO) PERFECT.
“We believe that [daily] practice is what kids need,” says Koutsoftas. “It’s a repeated muscle behavior, like going to the gym. Even if your child’s seeing a speech language therapist twice a week, it’s not nearly enough. So ask for homework if [it’s not given] by the speech therapist.”
Along with insisting kids practice their speech therapy drills for a set amount of time each day, it’s important to model proper speech patterns (like repeating words back correctly) without overcorrecting or being too critical. Positive feedback on proper enunciation is also important. “Some parents get too hyper-focused on pronunciation,” he says. You don’t want to be that parent who interrupts an exciting story to point out a verbal mistake.
Outside of their dedicated practice time, what they’re saying still needs to be more important than how they’re saying it. And that’s ultimately what we all want for our kids—not just to be understood, but truly heard.
—Jennifer Kantor is a parenting and lifestyle writer.