unhappy with how early intervention is going--advice on how to handle

[Anonymous]

Our 20-month-old is getting EI for a speech delay. We're only a few weeks in, but not feeling great about the whole set-up. We loved the evaluators, so I feel (hope) that my reaction is not simply defensiveness to him having a delay. But the concerns I have continue to mount, and I'm worried that addressing them with our EI contact will make me look defensive, like I'm not accepting a need for therapy, not looking out for DS, etc.

Here are my main concerns: DS is not connecting well with our early childhood teacher who is seeing him once a week to work on language development; he is more shy than usual and spends lots of time in my lap. Consequently, she has made lots of comments about his immaturity and how he does not play appropriately with toys (ie. if there are toy cars on the ground he is not pushing them around). He plays with toys plenty, just not in front of her. She is also interacting more with me than with him (teaching me techniques), so I can understand why he's relating less to her, because she's not really engaging him.

We are getting different stories on what his issues are. Our evaluators told us clearly that DS was not on the autism spectrum. Our early childhood person seconded this and was surprised they even brought up autism as he has no other red flags. Then she told us that the evaluators told HER DS is on the spectrum, and was baffled by this. This is not what the evaluators told us.

We were told DS would be getting a specialized speech assessment in about a month, after he'd had some time to work with the teacher and make a little progress. I just got a call from someone telling me we are supposed to be setting up 2x/month speech therapy, in addition to the weekly visits we already have going on. This was never mentioned to us during the evaluation.

I feel like all of these complaints make me sound defensive/in denial, but really I'm trying not to be--we just don't understand what's going on here, what the purpose is of these different therapies, and how DS was actually assessed. That, and we're not clicking with the early childhood ed person we've got.

Any advice on how to approach this? I'm feeling a bit lost. Thanks.

[Anonymous]

hi

i only have a minute so sorry if this is brief

you should speak up.....i had to change therapists once

my child had major delays and 4 therapists coming to the house

however...i would give it a few more weeks....it can take awhile for the child and therapist to bind

also....they are really there to teach the parent how to work with the child

you as the parent will need to spend many hours working on these skills with your child in order to see progress

one hour once a week won't "fix" any issues

they are there to give you the support and skills you need to help your chiild to be more successful

i have to run
good luck!

[Anonymous]

That's so funny we're going through the same thing with our DD's EI speech therapist (We're in MoCo. so maybe the same therapist?). My DD won't do certain things for her but I know that she does them at other times so of course I come off as defensive. She's also really short and jumps on any misbehavior before I even get a nano second to react to it on my own...which then turns into a lesson on how I need to be diciplining my child. And all the things she tells me to do I'm already doing!*$%! So once again I look defensive. Also, just because I talk normally to her she assumes I don't slow down my speech to my DD and gets all over me for it. Dammit I'm talking to you and not my daughter so why would I slow down my speech!! I think EI is really great but it's hard when personalities conflict. No idea how to remedy it

[Anonymous]

Can you get an independent evaluation by a developmental pediatrician? I don't think you trust anything these folks say.

I think it is difficult to rule out an ASD in a child that young. Speech delay is obviously a red flag. There are others and one thing to be careful about is explaining them away to yourself. I thought my DS played with toys as well, but there are ways NT kids play with toys that my DS didn't. I am not saying your child has an ASD, but it may be that they were too quick to say he didn't and are now having second thoughts.

Can you get a new early childhood educator and pitch it as if you are keeping the door open to any possible diagnoses. In other words, "we don't know if the issue is his failure to connect to her, or an underlying problem, but perhaps if we had a different educator we could isolate out the issue."

[Anonymous]

Thanks everyone. I really appreciate the diversity of advice here. 10:15, I am so sorry you are having frustrations too! It's a hard process no matter what, I think--we're in a vulnerable position and feeling uncertain, and I know from my own experience it can be doubly hard when you don't connect well with the person working with your child.

To the other pp's--thank alot for sharing your perspectives. Sounds like we should give it a couple more weeks with the early childhood ed teacher and see how things go. I'll try not to get discouraged and keep an open mind.

[Anonymous]

Honest advice... Get your son into private therapy. We have DD in EI services, too, but we also have her in private services, and the private services are SOOOO much better. I am not a fan of the whole train-the-parent method of intervention -- I think it is the easy and cheap way out. I have not loved any of the therapists we've had under EI. They are all very nice women and I get along with them just fine, but they are not very skilled in getting the best out of my DD and spend most of their time talking to me, asking me what she is working on in private therapy and then just reiterating that to me.

When I take her to private therapy, she runs to them, goes with them into their room, and I can hear her being engaged by them for the whole time. They come out, tell me what they worked on, what she was able to do, and how I can continue that at home. Such a different world from EI stuff.

Our EI evaluators were also great. Told us they did not suspect ASD for our DD. Dev ped confirmed that. One therapist who she sees (who is particularly not good with her) asked me what her dev ped had said and I told her this, and she gave me a look that said she did not agree. However, after working with my DD for several months now, she totally agrees with dev ped.

We just do the EI basically to back up the private services (in case we have to miss, so she definitely will get her sessions in for that week). I think knowing what I know now, I'd just skip EI and go straight to private and wait until they qualify for services through the public schools (Sept. after they turn 2) and then do Child Find.

[Anonymous]

Same poster from above, just a vent here.

I HATE it when an EI therapist tells me to work on something with my kid when they can't get her to do it themselves. If you want me to work on something new, SHOW me. You are here for a full hour. Use that hour to show me how it's done, and then I will carry on with it during the week. Therapy homework should be a continuation of what was DONE during therapy, not brand new stuff you want me to figure out how to make her do.

As an elem teacher, I would never assign homework that was new knowledge I hadn't taught. Homework is always for reinforcement. I feel EI homework should be the same way.

Okay. I"m done now.

[Anonymous]

That's so funny we're going through the same thing with our DD's EI speech therapist (We're in MoCo. so maybe the same therapist?). My DD won't do certain things for her but I know that she does them at other times so of course I come off as defensive. She's also really short and jumps on any misbehavior before I even get a nano second to react to it on my own...which then turns into a lesson on how I need to be diciplining my child.

I had the same experience with MoCo! The therapist was terrible at engaging my child but worse she didn't seem to think this was a problem. I had heard bad things about MoCo speech therapists so we decided to do the country once a week and a private speech therapist once a week. I was very happy to have the comparison because our private speech therapist was amazing with DS.

My private SLP tried different techniques, all play based, but different enough to find what would engage him the most. The county SLP would only do what the county does and it did not matter if DS showed no interest in it. She would simply fill out her forms, write down not progressing if DS would not engage her and tell us that DS was manipulating us. My private SLP made goals and actually worked with DS on them. I asked the county SLP to try some of the techniques that our private SLP was using that worked. She objected even though the sound and language goals were exactly the same. The county SLP spent more time filling out her daily forms to prove she had been at work. Every few weeks, she would spend weeks doing another evaluation simply because the county required it. The results were useless because DS would run away from her and refuse to do anything. We dumped the county and just focused on what the private SLP was doing. DS made amazing progress in the following few months.

Bottom line, there is no accountability for actual results within the county. All the assessment and evaluation of the SLPs is based on them just showing up and doing the right paperwork. With a private SLP, if they are not good they do not retain clients so there is simply more incentive for them to work with your child.

[Anonymous]

OP here again. To the pp posting about your experience with your daughter--I so appreciate this. I agree that it would help enormously if the EI person could show us what to do, rather than just giving us handouts (which are still helpful but not the same). I recently read Nurture Shock, and found the chapter on language more helpful than anything our EI contact has said... We're implementing that on our own and have had good results with DS so far.

When you say private therapy, can I ask what kind of specialist you're seeing? Our evaluators told us they don't normally use speech therapy at this age because that's more for muscular issues, so I'm not even sure what kind of specialist we should seek out if we go the private route. Then again the fact that they want us to now work with a speech therapist suggests I may have this wrong--so I'm confused.

[Anonymous]

My DC started speech therapy at 20 months and there was a component that had to do with muscle development but there was also attention paid to interaction, communication (not just verbal). Its not too young and if he has a speech delay you really need a speech therapist.

[Anonymous]

OP - TO echo what an earlier poster said - get everything you can get from the county folks but also pursue private therapy. Also - put together a file and keep it with you for all appointments with any therapist that includes every report/evaluation.... they give you. Also - repeat back to them everything they say.

The bottom line is that gifted therapists can occassionally be less than clear when communicating with adults. Our private OT is marvelous - so focused and gifted with my child - but a tad muddled when actually communicating with adults. It is like her brain is not there - she is already thinking about the next appointment - the next developmental game she will set up. So, I have to really RAISE the bar on communicating and use every technique available to ensure we are on the same page. Think of it as if you are the PROJECT MANAGER on the most important project you have ever had and all these different people are team members. Some members of the team will be great, some might not even know they are part of a team. It is your job to keep everyone up to speed on what therapies your child is getting, on the exact methodology being followed by each therapist and to share written evaluations as appopriate among team members and to find out if there are differing views among team members.

If you show your county or private therapist that you are engaged, take notes, and have a great memory - they seem to up their organizational game when it comes to you.

This is really HARD. You are not alone in being frustrated.

[Anonymous]

Don't wait - ask for a new therapist.

One who is comfortable and is familiar with very young children. Ask for their credentials - if they have no credentials in an early childhood setting don't accept them as a therapist. They will waste your time and your child's precious time. Many have early elementary ed experience which they believe they can simply dumb down and make it appropriate for a toddler and it doesn't work. Been there, done that.

If I knew then, what I know now, I would have been way,way, way more pushy demanded proof of just about everything as well as having everything in writing.

Also echo PP's, private therapy is the best way to go.

[Anonymous]

I'm in Fairfax county so I'm not sure how it works in Montgomery, but we have a case manager who is very helpful and knowledgeable. We did not click with our first county speech therapist and decided to switch quickly. It was fine. DS started county and private speech therapy at 18 months. This is not too young. I am glad we are doing both EI and private. Overall the private is much more effective. To be fair, the county has a different approach than private--the county is a parent coaching model and the private is more one-on-one with the child. I do recommend, OP, that you go to a private speech language pathologist ("speech therapist") and get a consultation and strongly consider that option in addition to EI. Also, it may be a bit proactive but I would also go to a development pediatrician for a full evaluation. An EI assessment is helpful but they really can't diagnose things like ASD, it's not appropriate. We ended up going to someone wonderful (Dan Shapiro) and it was expensive because he doesn't take insurance and ours doesn't reimburse out of network, but it was well worth it.

[Anonymous]

Sorry to hijack the thread, but I'd love recommendations for private speech therapists in Montgomery County. My daughter is 23 months and we're early in the EI process in Montgomery county and suspect we'll need private services too. Thanks!

[Anonymous]

Anonymous wrote:When you say private therapy, can I ask what kind of specialist you're seeing? Our evaluators told us they don't normally use speech therapy at this age because that's more for muscular issues, so I'm not even sure what kind of specialist we should seek out if we go the private route. Then again the fact that they want us to now work with a speech therapist suggests I may have this wrong--so I'm confused.

Glad I could be helpful to you. I put her in private OT starting at 18 months old, and I put her in formal private speech therapy starting at 20 months old.

She now does private speech 2x per week for 30 minutes and EI speech 1x per week for 60 minutes, along with private OT 1x per week for 60 minutes and EI OT once every other week for 60 minutes. She will start special ed preschool in fcps in September for 3 half days a week, and at that point her EI services will drop (woohoo!) and all her services will be directed at her, not me (woohoo!). I intend to keep her private speech and OT going the same as they are now.

Our EI evaluators told us the same thing about DD being "too young" for speech therapy at 18 months and that she only needed an educator 1 hour per week at that point. I found it very, very frustrating that they were telling me that my 18 month old was 12 months behind, and all they were offering her was 1 hour a week of services. That's what caused me to turn to private services, and I'm so glad I did.

The educator just came to our house and tried to engage her in stacking blocks, stacking cups, etc. Pretty much I would show the educator what I had been able to her DD to do, and the educator would do that with her. It was useless.

We saw a dev ped when DD was 20 months old, and she said to insist upon speech therapy. We got her in private speech therapy right away and then started the process of getting EI to change her from seeing an educator to seeing a speech therapist (they would not do both). EI was cooperative during this. They still thought I was nuts, but they switched us over without a fight. I also requested an OT evaluation, which they granted me, and then they offered DD OT every other week.

FYI, I live in Fairfax County. Not sure where you live. Perhaps you were given the same educator we were given…