Can you provide therapy for an infant as young as 3 or 6 months? How do you go about getting a child of that age to understand and respond?
Children are interactive from birth and are learning the building blocks of speech, language and overall communication from very early in life. Even a newborn child is communicating! There are very early and primitive ways for them to communicate whether it is through crying, smiling, cooing or eye contact.
Children need to hear their parents and caregivers speaking to them throughout the day. Parents of children aged 3-6 months can use real words as well as silly sounds and cooing to interact with their babies. It is not necessary to use baby talk, but many babies respond
well to singing and silly voices/sounds.
Unfortunately in early intervention, we rarely see children as early as we could. Pre-speech skills are developing from birth. For language skills, the critical development age is approximately 8 months, after which brain plasticity (the brain’s ability to change as a result of experience) decreases! So when we receive a referral for a child who is 2 and is not exhibiting pre-speech and language skills, therapy needs to be more intense for the remaining 12 months they are eligible for in-home pediatric Early Intervention.
In-home therapy is more convenient for families than outpatient therapy and it allows the therapist to observe and work with a child in his/her natural environment during typical daily routines.
How do you know if a child who doesn’t talk is going to need speech therapy?
Most children are referred for a speech therapy evaluation after 18 months of age. Parents are seeking assistance in determining if their child is simply a “late talker” and will begin to talk on their own or if there is a need for early intervention. Every family seems to have
experience with a relative who did not speak until they were 3 years-old, but then began speaking in full sentences without therapy. Unfortunately, we have no way of predicting who will be a late talker and who may have a more significant communication delay unless
there is a known medical diagnosis such as cleft palate or cerebral palsy. There are red flags that may cue a therapist that there may be a long-term concern, such as lack of oral motor control, inadequate respiration, and flat affect (no smiling, cooing, laughing). There are also factors that children show that are positive signs of their communication abilities.
However, with the recent update in autism statistics as well as disorders for which communication delays are significant symptoms, it is generally better to be safe than sorry.
If parents, family members or the pediatrician are concerned about a child’s lack of speech or pre-speech/language skills, it is best to get the evaluation and let the therapist make a
recommendation to the parents and other team members.
How does your therapeutic approach differ for a toddler of 2 or 3 years who is just beginning to talk from that used with infants?
There is a process of developmental skills that must be obtained in order for speech to be successful. A speech therapist looks at a child of any age, determines their present ability, and expands on the skills that they have.
When working with infants and young toddlers, the focus is on parent/child interaction and encouraging pre-speech skills. An infant may have a developmental therapist (DV) working with them to augment their lack of skills. The DV will provide suggestions for the family to encourage babbling of sounds, motor imitation (waving, clapping), or teaching some simple sign language. The DV will also work, hands on, with the child to facilitate these desired
Therapists working with infants and toddlers are excellent at incorporating the child’s interests and preferences into therapy. For example, if the child wants to play with cars today instead of blocks, the therapist will follow the child’s lead. The therapist works on babbling and sound imitation by making car and train sounds. They work on joint attention by making the vehicle move and trying to get the child to follow the therapist’s gestures/pointing to see where the car went. They work on words by saying things like “go” and “mine”. They focus on 2-word phrases by emphasizing things such as “my car” and “mama help”. They expand those phrases to include concepts like “fast”, “slow”, “up”, “down”, “on”, “off”, colors, and sizes. The approach depends on what the family’s needs
are and the child’s skill level and is individualized to each child/family.
Transfer of knowledge to parents and caregivers is a key goal of therapy. Research has shown that improved child outcomes are experienced when confident and competent caregivers actively embed, reinforce and incorporate strategies demonstrated by early intervention therapists into the family’s daily routines. All therapy is done through play and by modeling play for families to imitate. We like to incorporate the toys already in the family’s home into therapy so that after a session ends a family is able to use the same toys during play and follow through of therapy suggestions.
What do I do if I am concerned about my child’s speech and language skills and my child is ages 0-3?
You should contact your local early intervention provider as soon as possible and request a speech evaluation. We would rather see kids as early as possible than have parents take the “wait & see” approach. If you are in Allegheny County in Pittsburgh, PA you can contact the Alliance for Infants & Toddlers to request an evaluation at 412-885-6000 and request TEIS as your early intervention provider. If you live in another area of the state or if you live outside PA you can use this link for resources. If you cannot find a local EI provider by using the above links, simply Google “early intervention services 0-3” and plug in your county and state and you should come up with some local resources.