“He’s just not talking like my daughter did – I know I shouldn’t compare.”
“She understands everything, but has no words.”
Working as a pediatric speech-language pathologist for the last 10 years, I can almost predict these words before they leave a parent’s mouth. The conversation usually begins this way and ends with: “Early Intervention said he didn’t qualify” or “The pediatrician said to wait and see, she is only two.” I can’t hide the uncontrollable eye roll that accompanies an empathetic head nod. After an evaluation, I proceed to make my recommendations: I recommend intervention. Why? Why do I recommend therapy for children who do not technically “qualify?” Why do I disregard another professional’s work or a research article disproving my clinical opinion? I intervene because I do not work for a large, insurance-based, outpatient office. I do not work for a school district. I do not work for the state. I work for families.
I work for caregivers who cannot communicate with their children. The parents who rarely get through a morning without a tantrum, because they couldn’t guess the specific color and shape fruit snack their child wanted by their shouting, crying, and melting to the floor. I work for families who no longer want to stand in as their child’s personal translator. I work for siblings who want to be able to play with their little brother without having to “just let him have it.” I work for the kid who knows exactly what he wants but has no way to tell his grandmother who watches him once a week. For me, that is enough evidence to intervene. When lack of communication skills interferes with family life, it is no longer considered developmental. Family goals are therapy goals.
The reason families seek my help is the same reason that I started a private practice: I want to treat my clients without restrictions. I want to use the knowledge within my scope to help families tackle their everyday challenges and give their children foundational skills before they reach school and “wait to fail.” Does this mean I take everyone that walks through my door? Absolutely not. That is not the goal of private practice. There are limits to what we, as speech-language pathologists, can address, and I respect those boundaries. I turn away families for whom I do not think I can help, and I refer others to specialists. What I do know is this: I can help the children who fall into this gray area. I know because I have seen it, repeatedly and increasingly. Sometimes their progress takes three to four visits, sometimes it takes twelve. However, 100% of the time, it takes one family member following their gut to get a second opinion.
Parents know their children better than any specialist, but they do not know how to be a speech pathologist, nor should they. Parent training as part of speech therapy changes the ways that they interact with their child on a day to day basis to encourage language and communication. By making small changes to their environment and sharing our best “tricks,” speech-language pathologists can encourage families to feel confident, help their children, and reduce the number of “gray area” kids. I encourage you to go against traditional guidelines, flex your clinical opinion muscles, and provide families with that they need. It doesn’t hurt.
Molly Cervini, M.S., CCC-SLP
Pediatric Speech-Language Pathologist
Owner Eat Play Learn LLC.