Talking Problem

mmalaka

Looking for advice about my daughter, she will be 3 years in December. until today she did not speak almost nothing, just few word from time to time. i.e. really really few words. like one word before 5 month, another word before 1 month. she can hear us very well, she understand us like when we ask her to open door close TV. Build a Lego house....etc she understand all of this. she was our only child until we got a new boy before 2 months. we used to speak our home country language at home. Then we got advice that we need to speak more English and we did that. she understand both languages. She joined a play school for a month now... some time she make sounds as talking but not a real words or at least this is what we think. when she want something she point to it and shout on us...we are using books with pictures with her now...we noticed that her response to other people (other than me or her Mom) is faster regarding this talking issue. like before one month she replied to my friend by saying 'yes' when he called her name. she repeated this many times it was amazing she never did this with us

Any advice??

High&Low

Your public health nurse should be able to provide you with some advice and point you in the direction of a speech therapist if necessary

Sleepy

Have you talked to her about why mammy and daddy speak two different languages? She might be confused by the difference and not know which one to use herself when talking?

mmalaka

High&Low wrote: »

Your public health nurse should be able to provide you with some advice and point you in the direction of a speech therapist if necessary

the public health nurse saw her and she said it seems it is just matter of time... she will speak when she ready.... she adviced us about books and stories... she adviced us also to not allow her to spend a lot of time watching TV and movies (shrek, dora, ...etc)

mmalaka

Sleepy wrote: »

Have you talked to her about why mammy and daddy speak two different languages? She might be confused by the difference and not know which one to use herself when talking?

we started to talk with her in english also... and she understand both languahes

I am not sure how I can explain this to her she is still 3 years old

Lizzykins

I was a slow talker and I've been told I was nearly 3 before I spoke. My parents were very quiet and didn't speak much to me I believe. After spending two weeks with my grandmother I couldn't be shut up!

My advice is to talk as much as you can to your daughter. The public health nurses are usually good for spotting problems and if they're not worried about your daughter's progress then that's a start. If her hearing is ok as you've said and her understanding then just let nature take it's course. Playschool is good too for kids of that age.

Try not to worry. You're doing all you can I think.Good luck!

crosstownk

I've heard that if two languages are introduced at once that it can slow the child down initially. They also have a tendency to confuse words from each language. But this is only temporary and should level out. A friend of mine's wife is Spanish and he speaks English to his daughter while mammy speaks Spanish. The girl was slow about talking but she eventually caught up and well before school started. Now she speaks both fluently - so well worth it.

It'd be no harm to talk to the district nurse if you're concerned - just to get professional advice.

raemie21

If she only has a few words and will be 3 in December, then she is experiencing a significant language delay and I'd recommend a speech/language assessment as soon as you can. It's encouraging that she seems to be following what you are saying to her and perhaps her it is affecting her expressive language only. However, early identification and advice are absolutely important for a variety of developmental delays. She may indeed be a 'late talker' but from what you've decribed, I'd definitely recommend you pursue this before she becomes frustrated and it escalates into emotional/behavioural difficulties.

Advice re bilingualism - Research continues to show that exposing a child to two or more languages from a young age is a fantastic advantage for both language and cognitive development. No need to worry about that at all although for children with difficulties in their first language, it is best to keep a consistent pattern to how they are exposed to the languages e.g. speak one at home, one at school in order to faciliate their development.

John Mason

All children develop at different rates, your child might be more advanced in, i dont know colouring or something then other kids of her age.

You should speak to the District Health Nurse but usually they wont do anything until she is 3.5 years old. You could put her into a playgroup where she will have not option but learn to communciate. if she is able to communicate at home with yourself and your husband you might be indirectly facilitating her in forming words correctly. i have direct experience of this

I would get her in a playgroup and see how you go from there

lostinnappies

All children are different, but my advice is to speak to your public health nurse and get her to refere you to a speech therapist or psychologist. There is no harm in checking.

Also be on the look out for other symptoms. My niece was diagnosed with dispraxia. Look at her balance, if she is clumsy or unsteady. If she has a good grasp of fine motor controls. Does she blow through her nose or mouth instead of saying a word.

Again im not an expert but even if an expert can give you the reassurance that everything is ok then its well worth the visit. If you go public then you maybe waiting for up to a year for this appointment

mmalaka

Thanks for all of ur replies..

The public health nurse checked her and she said it is just a matter of time and she looks healthy. her balance is ok... she understand me and my wife...she understand English and our language...

the interesting thing about this is that she seems to response and talk to other more than us...as I said before most of her few words was as a response to other people sometime we feel that she just do not want to speak with us when we repeat some words to her she look to us smiling as she is saying "I know this word but I do not want to say it" ...she joined a play school for a month now ....

Nevyn

It could be that she doesn't feel the need to communicate verbally with you if you are doing the talking for her or she feels that her needs are being met.

I know both of mine had to be encouraged to use thier words, they would gesture or communitcate or wait for me to ask what they wanted and make suggestions while they nodded or shook their heads until I said that they had to use thier words and "Ask".

tallaght01

why don't you just bring her to your GP and get a proper general check up?

mmalaka

Thaedydal wrote: »

It could be that she doesn't feel the need to communicate verbally with you if you are doing the talking for her or she feels that her needs are being met.

I know both of mine had to be encouraged to use thier words, they would gesture or communitcate or wait for me to ask what they wanted and make suggestions while they nodded or shook their heads until I said that they had to use thier words and "Ask".

I think this is the case with my child.... I think we will start to encourage her to use the word by acting that we do not know what she is pointing to or what she want

mmalaka

tallaght01 wrote: »

why don't you just bring her to your GP and get a proper general check up?

The public health nurse saw her last week, and I just remembered that our GP saw her ling time ago....

raemie21

pink fluffy bunny wrote: »

You should speak to the District Health Nurse but usually they wont do anything until she is 3.5 years old.

There is a lot of advice on this thread and ways that we can interpret your child's communication based on our own experiences - the best step is obviously to seek a professional opinion yourself - speech and language therapist can advise you if there is a difficulty, if it's fine, suggest a few changes at home and/or another opinion etc etc.

However, I would strongly recommend that you do this asap. Children can be referred to public services from at least aged two years and cetainly if the staff resources are there, are seen from aged two. A private therapist will see children even younger than that. Really, best not to wait until she reaches 3.5 or 4 due to your significant concerns - I don't mean to sound doom and gloom but there are a lot of children who present aged 5/6 with developmental problems when it's clear that they would have benefited from earlier intervention and it would have been more effective back then than now.
Best of luck.

galwaydude

I highly recommend the above advice. The quicker you get the child to a speech therepist the easier it will become. Where are you based as my wife has alot of contacts in that field. There is alot of exercises that you and your child can do to stimulate speech and make it easier.

tallaght01

mmalaka wrote: »

The public health nurse saw her last week, and I just remembered that our GP saw her ling time ago....

Your public health nurse isn't trained to examine a child for causes of speech delay. And if you saw your GP a long time ago, it may not have been for speech delay. So, your kiddy may not have been examined for conditions that cause it.

Don't muck about with a kid above the age of 2 who has speech delay. It may be nothing, but as someone said previously lots of kids present way too late.

It could well be nothing, but you only get one shot at this.

Carrigart Exile

OP I had a very similar experience with my own daughter. We approached our Education Authority who brought in language therapy services and had our daughter fully assessed by educational psychologist services. What horrified us during this time was how quickly 'the Community Autism Team' wanted to label her autistic. At the end of the full assessment she was diagnosed as needing assistance developing her language; we also had it confirmed she was not autistic. She is now 7 and her language is developing at pace and she is keeping up with her school work as normal. In fact, shutting her up is now our main problem.

luckat

Raemi21's advice is good, mmalaka. Look for that language assessment.

No matter how good your community health nurse and GP are at their jobs, they are not specialists. She needs to be assessed by specialists to make sure that there is no problem.

Please do this as soon as possible.

That said, two of my friends didn't talk until they were over five years of age. Not a word. Not a dicky-bird. One came from a bilingual family (Irish and English both spoken at home); one didn't.

One went on to become a solicitor, fluently representing clients. The other became one of the best-known and most fluent journalists in the country.

So it's not *necessarily* anything to worry about - but speech and language specialists will certainly help to rule out any underlying problem.

tallaght01

I would add, luckat, that it's a bad move to go straight to a speech pathologist for speech delay.

The most sensible route is to go to a GP, who can look for medical conditions that can cause speech delay (or, more commonly, reassure the parents). Then, if the doc thinks this is purely a problem with speech, then the referral is made to a speech pathologist.

A speech therapist won't be able to rule out many of the causes of speech delay.

undecided

OP I would follow tallaghto1 advice.

My little boy had speech delay never made sound or anything saw public health nurse regularly had hearing checked etc. Turned out when he spoke he spoke perfectly BUT the health nurse missed all the other signs of autism. should I have known of the condition I would have known he had it as it was obvious but she missed it! PLEASE NOTE IM NOT SUGGESTING THIS IS YOUR CHILDS PROBLEM!!

Get your child assessed to make sure speech is the only problem and if it is get some speech therapy the only thing it can do is benifit him/her

lol and when the child starts talking wonder when is he/she going to be quiet!:D

raemie21

tallaght01 wrote: »

A speech therapist won't be able to rule out many of the causes of speech delay.

??
That's a very ignorant comment.
They would be in a far better position than a GP and rightly so, since it's their specific area of expertise.

tallaght01

raemie21 wrote: »

??
That's a very ignorant comment.
They would be in a far better position than a GP and rightly so, since it's their specific area of expertise.

It's not an ignorant comment.

Causes of speech delay are very broad. Speech therapists are good at looking at conditions that are purely disorders of speech. But, for example, if an all round subtle developmental delay was the cause they wouldn't be in a position to judge. Or, like someone above mentioned, a speechie wouldn't be in a position to asess for autism, or poor hearing.

The way it usually works is that the speech therapist will usually get involved once we have an idea as to why the speech is delayed. They're very good at what they do, but their role is generally not a diagnostic one.

pgroarke

I disagree with some of the comments posted.

Firstly understanding is far important than speech.
That is great that she understands (both languages) it means she has no intellectual problems.
In fact 2 of the greatest minds of the last century were late talkers - Einstein and Feynmann.
Neither spoke until they were 3, so perhaps you have a potential physicist on your hands ?!?!

Regarding bilingual the standard advice is that one should speak ones mother tongue with the child.
That is important for the childs grammar.
That was a crucial error that many mexican mothers made in the US.
They tried to speak poor English instead of Spanish to their kids.
The result was offspring that are unfortunately incapable of grammar in any tongue.

My own daughter is being raised bilingually. I speak exclusively English my wife Swedish.
By age 12 months she had over a dozen words in both languages. Now at 15 months she has more words than we can count in both languages.
But it doesnt mean anything.
There are certain types of intellectual tasks that your child will do better from having 2 languages.

lostinnappies

raemie21 wrote: »

??
That's a very ignorant comment.
They would be in a far better position than a GP and rightly so, since it's their specific area of expertise.

Speech delay is caused not only by physical but also psychological aspects. A speech thearpist is not a doctor or a psychologist, nor are they a speech thearist. There is nothing ignorant about this comment, often it is a combined examination which reviels the real cause behind delay speech.

raemie21

tallaght01 wrote: »

It's not an ignorant comment.

Causes of speech delay are very broad. Speech therapists are good at looking at conditions that are purely disorders of speech. But, for example, if an all round subtle developmental delay was the cause they wouldn't be in a position to judge. Or, like someone above mentioned, a speechie wouldn't be in a position to asess for autism, or poor hearing.

The way it usually works is that the speech therapist will usually get involved once we have an idea as to why the speech is delayed. They're very good at what they do, but their role is generally not a diagnostic one.

I'm well aware that there are a number of causes for speech and language delay.
If by 'pure disorders' you are referring to a child presenting with a speech or language difficulty in the absence of any physical, environmental, psychological or cognitive deficit, then there are NO causes or reasons for it (by it's definition - if someone was to discover a reason 'why', they'd be heading for academic glory..)
A speech and language therapist is one of the main professionals on a multidisciplinary team for autism or any emotional/behavioural difficulties. I assure you that they are very well positioned to advise re communication difficulty and more than 'pure disorders of speech'.
You advised the OP that 'the more sensible route' would be to vist a GP first - That is was I was labelling as ignorant. No matter what service a child would take in the future, I guarantee that an SLT assesment report would be a hundred times more useful than a bland GP note referring for 'poor speech'. Plus, GPs often reassure parents to wait a bit longer or check the child's hearing. And also, a referral to the HSE services can come from parents so it seems that there would be absolutely no benefit to see a GP.
I take the point that a child would need to see a specialist team if they were presenting with general developmental delay but again, why would you recommend a parent delay a SLT assessment before this? SLT can of course aid in diagnostic work and again, if a child was to attend a developmental team in Tallaght, the Consultant would have more information, more assessment and more reports to aid the overall assessment than if he/she was going purely on their own assessment.

raemie21

lostinnappies wrote: »

Speech delay is caused not only by physical but also psychological aspects. A speech thearpist is not a doctor or a psychologist, nor are they a speech thearist. There is nothing ignorant about this comment, often it is a combined examination which reviels the real cause behind delay speech.

Yes I know that there are a number of causes for speech and language delay and indeed no apparent reason at times.
Unfortunately, I think SLT and many other allied health disciplines are poorly understood by the public (I'm not on my high horse by the way, I've just had a lot of exposure through work).
It is an ignorant comment (and I mean mis-informed) - the idea of telling a parent that the sensible thing to do is to visit the GP rather than an SLT and inferring that a GP would be in a better position to advise a parent re future intervention.
If the OP would like a GP AND SLT assessment, that's fine but I can't understand why Tallaght01 would advise her to go to GP only and label a direct SLT assessment a 'bad move' - will just end up avoiding/delaying the overall process even further for the parent and child.

tallaght01

It's not an ignorant comment, and it's certainly not misinformed.

The process of getting to the root of a speech delay is as follows (and when I use scary medical terms, I just want to point out that I'm not saying I think the OPs kid has any of these conditins, I'm just talking about the general process as it happens in most healthcare settings).

So, you notice your kid isn't speaking by 2, and you go to your GP. Your GP knows most of these kids will have absooutely nothing wrong with them, but he/she wants to check for certain problems.

The GP will start with the basics, he'll want to weigh the child, and look at the child's other physical milestones....how is her hearing, vision, fine and gross motor skills, does she walk? how is her gait etc.

The above are things that can point to speech delay just being the first manifestation of a generalised global developmental delay.

Then the GP will do a closer examination.....looking for signs of genetic problems, for example low set ears, single palmar creases, unusual nasal bridges. All very subtle signs that a GP will spot in a matter of seconds.

Then he'll need to examine the heart...is there a murmur? Lots of developmental delay that's associated with slow speech are associated with cardiac problems.

Most commonly, the GP can't find a cause, and makes a referral to a speech therapist at the same time as making a referral to a paediatric clinic.

If the GP does find something concerning he can make an urgent referral to the paediatric clinic. He can also refer the kiddy for a cardiac echo, or genetic screening at the same time.

This is why it's important to go to a generalist in the first instance. That way you have someone to co-ordinate the overall care from the start.

A speechie won't listen to your heart, or look for dysmorphic features. You don't get plotted on a growth chart in most speechie clinics, and most won't measure a head circumference.

That's not me having a go at speechies. But they're not doctors.

So, take the scenario......your child has a mild cerebral palsy that you were never aware of, and speech was the first manifestation of that. So, you go directly to a speech therapist. He/she is unlikely to diagnose cerebral palsy,and is unlikely to make huge progress without knowing the underlying diagnosis.

Your GP is likely to notice the increased tone in your child's left leg. He can refer for an MRI while waiting for the paediatricians appointment, aswell as getting the ball rolling with speech therapy and physio.

It's not always how it happens, but most GPs are very good with this type of thing, as it's relatively common. But that's how it should work. And that's how it works most of the time.

You most definitely don't waste any significant time by seeing your GP before the speechie. You can get an appt to see a GP within 2 days of wanting one, and he can refer to a speechie there and then.

Dfens

Yes, while I would sincerely hope that this is the procedure that ALL GP's in Ireland would follow in coming to a diagnosis as to the cause of a speech developmental delay, I wonder how true to the 'norm' it really is?

littlebug

Dfens wrote: »

Yes, while I would sincerely hope that this is the procedure that ALL GP's in Ireland would follow in coming to a diagnosis as to the cause of a speech developmental delay, I wonder how true to the 'norm' it really is?

Good point Dfens.

There's also the fact that many mothers would assume that the public health nurse is the best route to take but that all depends on how thorough the phn is. Plus if the child isn't actually sick they're not going to fork out money for a GP visit. If parents are constantly being told by lay people.. "oh so and so didn't talk til he was 4 and he's fine now" etc etc how likely are they to go to the GP about it. If at one of the regular developmental checks it's written off because the child's hearing seems ok and their comprehension ok then again how likely are they to go to the GP? There are a lot of barriers there really.

tallaght01

It would be pretty normal. Even the bad ones just refer the kid to the paediatricians without doing an assessment themselves first. It's not ieal, but at least the kiddy gets an overall check pretty soon.

But it's a relatively quick process and most of the GPs do it pretty well. It depends where you are, too. British GPs are the best at it, followed by Irish ones. Then the Oz and new zealand docs are terrible in comparison. that would be my experience anyway.

raemie21

Apologies for late reply but was away the past few weeks.
Hmmm, I understand what you're saying Tallaght but I still don't really agree.. certianly in my experience a typical GP letter for a child presenting with developmental delay/S&L/socialisation difficulties is something like "parent reports XXXX and school agree..past history asthma".

That's not me having a go at GPs either but I can honestly say that I've never seen a referral note or informal observations that you outlined above. It would be great if they were that detailed but unfortunately we tend seen the opposite where a kid comes into the clinic and then staff actually prompt parents to re-check something with the GP even when parents comment "Oh I mentioned that to GP before and he said it was fine" e.g. recurring ear infections, swollen parotid.

I would come from the complete other side and believe that any allied health professional such as Psych, Physio, Speechie, OT, PHN have a very solid knowledge (or should have) of typical child development across the areas as opposed to a GP who has a much wider and varied caseload - putting it rather crudely, they would see six/seven children a day for 40mins each as opposed to a GP who sees patients across the lifespan for a much shorter session.

Perhaps we've had extreme bad luck with GP referrals but I wouldn't and don't expect a GP to give such detailed information.
Either way, it's certainly not a "bad idea" for the OP to go straight to Speechie first.

tallaght01

raemie21 wrote: »

Either way, it's certainly not a "bad idea" for the OP to go straight to Speechie first.

It is.

Assessing "development" (like, say physiotherapists who work with kid are excellent at) is much much much different to looking for other causes of developmental delay (the speechie/physio etc won't look in the kids ear for physical problems, they won't listen to their heart, they won't have the details or the understanding of mum's antenatal issues......did she present to the GP with mumps during pregnancy etc).

You can keep going on about a speechi being the first port of call, but no paediatrician will ever agree with you on this. Speechies are great. They''re very important. But telling us how disordered a kid's speech is becomes less useful if no-one has diagnosed the underlying genetic illness, say.

I would also disagree about quality of GP letters. There are some bad ones, just like there are from speechies, physios etc. But in Ireland the standard is very high, and people should be using their GP as their first port of call for undifferentiated illness.

lostinnappies

id have to agree with tallaght, having know a few children with developmental delay (in speech and other areas) one of whom is a family member, I have found that when they approach their GP first they are refered straight away after a health check. Quite often in this sham of a public health system (or even if you go privatly) you will be waiting a very long time to get all the appointments (a year for the psychologist). While some of the children I knew had a simple and solvalbe physical problem rectified by the GP and had no need of any other services, two of the children I know needed ALL of the services and I dont think the "speechie" as you call them actually refered them to anyone.

Having said that, with one child the "speechie" was invaluable and diagnosed the problem that the others were just guessing at.

It would be my first port of call to go to a GP first while waiting on other appointment.

raemie21

Meh, you can keep going on about causes and GP examining for signs but children mostly present with speech and language difficulties in the absence of any other 'problem' or cause. I think more so for three-four year olds if nothing has come to attention beforehand (i.e. cleft palate, physical/significant intellectual disability).

The assessment you outlined earlier, that would be fantastic if that was the norm but I've never seen anything like that.

Nope, any previous report available to a consultant is much appreciated and speeds up the overall assessment & intervention plan, rather than a GP letter alone.

Either way, kids who are 'late talkers' are at a risk for going AWOL and undetected by GPs. It absolutely does happen.

If the OP goes to GP alone and is reassured that there doesn't seem to be any problem, then I would still strongly advise to seek another opinion from a child development professional with more expertise in the area, be it speech and language, psychology, occupational therapy etc.

tallaght01

raemie21 wrote: »

Meh, you can keep going on about causes and GP examining for signs but children mostly present with speech and language difficulties in the absence of any other 'problem' or cause.
.

I'm perfectly aware of this.

But are you actually implying we shouldn't check for physical/medical causes???? PLEASE tell me that's not the point you're making.

The GP will refer tot he paediatrician and the speechie. The speechie won't refer to the paediatrician. The child needs both. that should be an easy concept.

I don't know where you're a paediatrician, but I don't share your experience. The GP letters I get tend to be pretty good. Even if they're not, the kid ends up with a paediatrician, and that's the important thing. If a letter arrives on my desk saying "3 year old, no speech", then at least they're going to be seen and assessed properly. Those letters are about as much use as a full speech assessment telling me the kid is speech delayed, to be quite honest.

Would you go straight to the cardiac rehabilitation nurse if you had some chest pain?

metrovelvet

Tallaght- I think it depends on what country you are in. In the US you would probably go stright to the specialist. Kids and babies tend to go to the pediatrician to start with and not a GP.

And yes if people had chest pains they would go to the cardiologist and when I had UC I went straight to the gastroenterologist, or if I had needed a cervical smear Id go to the gyne.

In my experience it does tend to make things faster as it cuts out the middleman so to speak. I prefer this system to the GP referral system, especially when it comes to scans because then you have a whole other delay.

lostinnappies

Also if you go straight to the specialist in this country with out a referal from your GP your insurance will not cover the costs because it was not "deemed to be medically ness" Its rediculus but there you have it.

Also some children have other problems that just arent noticable, as well as speech delays. This was the case with one of my family members.

But at the end of the day if you want to have your insurance cover everything then you need a referal from your GP. If they have speech problems and get sent to a speechie and later find out that that was not the problem then it is still covered because your GP sent you. Where as if you go ahead and go to a speechie in that case your insurance will say that it wasnt ness. and wont pay for it.

tallaght01

metrovelvet wrote: »

Tallaght- I think it depends on what country you are in. In the US you would probably go stright to the specialist. Kids and babies tend to go to the pediatrician to start with and not a GP.

And yes if people had chest pains they would go to the cardiologist and when I had UC I went straight to the gastroenterologist, or if I had needed a cervical smear Id go to the gyne.

In my experience it does tend to make things faster as it cuts out the middleman so to speak. I prefer this system to the GP referral system, especially when it comes to scans because then you have a whole other delay.

The US is very different to Ireland, because there's enough supply to cover demand, and insurance covers most of the middle classes to go privately.

Can you imagine if everyone in Dublin with a sick kid went to the clinic in Crumlin or Tallaght. Would be a meltdown.

Plus, your chest pain could be muscular, or respiratory. That's why you should go to a generalist first.

But even if the paediatrician in America example held water....that paediatrician can assess the kid, and work out of there's another medical problem (ie somehting that the speech delay is a SYMPTOM of), whereas the speechie won't do that.

raemie21

tallaght01 wrote: »

I'm perfectly aware of this.

But are you actually implying we shouldn't check for physical/medical causes???? PLEASE tell me that's not the point you're making.

The GP will refer tot he paediatrician and the speechie. The speechie won't refer to the paediatrician. The child needs both. that should be an easy concept.

I don't know where you're a paediatrician, but I don't share your experience. The GP letters I get tend to be pretty good. Even if they're not, the kid ends up with a paediatrician, and that's the important thing. If a letter arrives on my desk saying "3 year old, no speech", then at least they're going to be seen and assessed properly. Those letters are about as much use as a full speech assessment telling me the kid is speech delayed, to be quite honest.

Would you go straight to the cardiac rehabilitation nurse if you had some chest pain?

To be honest, you don't seem to be aware of the fact that a child may present with a specific speech & language delay as you keep talking about referring on to other services and the GPs role in this.

In response to your capital letters, no I'm not saying that - reread my posts and if you're still finding it hard to understand, PM me and I'll explain it further.

I'm in CAMHS, not Paeds for whatever use that is.

I'm very happy that you get 'pretty good' GP letters - I can only draw on my own experience and after seeing letters from well over 100GPs, I'm afraid it's not the same in my catchment area.

"The kid ends up with a paediatrician, that's the important thing"
:rolleyes: What a fantastic advertisement you are for the medical model of service delivery, I love it!

And then your point about previous contact with professionals -
A letter telling you that a 3year old has no speech is as much use as a full S&L assessment..???
Does that mean that a note saying that a child has learning difficulties is as much use as a full psychological assessment report?
A note that a child has motor difficulties is as much use as a full occupational therapy report?
A note that a child has musculoskeletal problems is as much use as a full physiotherapy report?
Wow.


We could go on and on about this (and maybe we should, in the best interests of the public and health promotion) - we clearly have vastly different opinions and clinical experience and are unlikely to reach an agreement.

In the best interests of the OP and other parents reading this - just to say that even this week, I had three sets of parents in my office talking about how their first port of call was their GP and each of them were falsely reassured with the "..ah he's fine, sure I didn't speak til I was four".
I think what was more interesting thing about these cases, was that each of these children have been receiving services for the past few years but yet this memory of the initial GP contact and that feeling of not having done enough as early as they could, is still in parents' minds 4 to 7 years later.
And for the record, it ended up being a speech and language therapist that advised the referral in two cases and a trainee psychologist who was on placement in the preschool who did the other.

metrovelvet

tallaght01 wrote: »

But even if the paediatrician in America example held water....that paediatrician can assess the kid, and work out of there's another medical problem (ie somehting that the speech delay is a SYMPTOM of), whereas the speechie won't do that.

What do you mean by "held water"? Babies and kids do go to pediatricians, including the ones on public health insurance.

Why wont the speech therapist do that?

Shelllz

Hi OP

Here's a link to a website with some information on 'normal' speech and language development. I would say if you have any concern at all bring your child to have an assessment. If intervention is indicated, your child is at the right age for therapy.

In relation to your bilingual home enviornment, this may have a temporary delay in the onset of both languages.

You should also get your GP to rule out any middle ear infections as this may have an effect on your childs speech and language development.

Anyway here's the website: http://www.speech-language-therapy.com/devel2.htm

tallaght01

raemie21 wrote: »

To be honest, you don't seem to be aware of the fact that a child may present with a specific speech & language delay as you keep talking about referring on to other services and the GPs role in this.

In response to your capital letters, no I'm not saying that - reread my posts and if you're still finding it hard to understand, PM me and I'll explain it further.

I'm in CAMHS, not Paeds for whatever use that is.

I'm very happy that you get 'pretty good' GP letters - I can only draw on my own experience and after seeing letters from well over 100GPs, I'm afraid it's not the same in my catchment area.

"The kid ends up with a paediatrician, that's the important thing"
:rolleyes: What a fantastic advertisement you are for the medical model of service delivery, I love it!

And then your point about previous contact with professionals -
A letter telling you that a 3year old has no speech is as much use as a full S&L assessment..???
Does that mean that a note saying that a child has learning difficulties is as much use as a full psychological assessment report?
A note that a child has motor difficulties is as much use as a full occupational therapy report?
A note that a child has musculoskeletal problems is as much use as a full physiotherapy report?
Wow.


We could go on and on about this (and maybe we should, in the best interests of the public and health promotion) - we clearly have vastly different opinions and clinical experience and are unlikely to reach an agreement.

In the best interests of the OP and other parents reading this - just to say that even this week, I had three sets of parents in my office talking about how their first port of call was their GP and each of them were falsely reassured with the "..ah he's fine, sure I didn't speak til I was four".
I think what was more interesting thing about these cases, was that each of these children have been receiving services for the past few years but yet this memory of the initial GP contact and that feeling of not having done enough as early as they could, is still in parents' minds 4 to 7 years later.
And for the record, it ended up being a speech and language therapist that advised the referral in two cases and a trainee psychologist who was on placement in the preschool who did the other.

I am still fascinated by your stance. I had assumed you were a paediatrician, as you keep talking about GP letters that come to paediatricians being of poor quality.

I think you're mistaking quality with length. I know a great GP in my catchment area, who will write "dear Tallaght01. Please see this 4 year old who has delayed speech. She can say the following words......
Nothing else to find physically. No psychoscial concerns".

To me that's acceptable, as I know a lot of our GPs. I know "nothing else to find physically" is a nice shorthand way of summarising his findings. But if you're not a doctor, I'm not sure what your perspective on GO letter to paeds is. Allied health letters are almost alwas too long. But I digress.

Nothing you say counters the argument.

You're talking about isolated speech delay. That's fine. It's common. I'm talking about how we know it's isolated. Someone has to decide it's isolated. That should be a doctor. Because no-one else is qualified to rule out other causes. You talk about a hundred GPs in your catchment area, and you talk about 3 kids who weren't referred quick enough. To be honest, I could give you more than 3 examples in my patch. Just like I could give you more examples of where speechies, and mental health services or whatever have cocked up.

My question is this....what would you do if a kid walked in through your door with speech delay. Tell me what you'd look for. I've told you what "The medical model" involves....ie full physical examination, referral to paeds with concurrent referral to physio, speech, audiology, OT or whatever. Will you examine the child's ears/dysmorphism/tone/development/growth?

I have never seen that happen.

Metrovelvet, when I talk about your argument "holding water" what i mean is that if Irish kids could go see a paediatrician routinely. In the states, the paediatrician is like the kiddy GP, as there's so many of them. It's a ridiculous waste of a paediatrician's skills, but that's US healthcare. The speech therapist isn't qualified to work out of there's another underlying medical problem.

tallaght01

raemie21 wrote: »

"The kid ends up with a paediatrician, that's the important thing"
:rolleyes: What a fantastic advertisement you are for the medical model of service delivery, I love it!

.

Can I also double check what the above means? Cheers.

Because I took it to mean that, regardless of the quality of the GP letter, at least the kid is getting referred on to us. Do you think it would be better not to refer kids with speech delay? What a bizarre stance. I'd much rather a kid got referred badly, than not at all.

lostinnappies

tallaght01 wrote: »

Can I also double check what the above means? Cheers.

Because I took it to mean that, regardless of the quality of the GP letter, at least the kid is getting referred on to us. Do you think it would be better not to refer kids with speech delay? What a bizarre stance. I'd much rather a kid got referred badly, than not at all.

Id have to agree too.

Far be it for me to say but wouldnt a speechie like to perform their OWN complete clinical assesment without influence from what the GP has said... the little that is said the more the speechie will have to investigate which imho would result in a more accurate assesment.

Also in realtion to one of my realitives who has speech delay and was assumed it was dispraxia, now turns out it wasnt. It was due to further MEDICAL complications that now they are saying it is a medical problem. The jury still isnt in but all signs are pointing to a medical problem..... she has very few other visable problems and only a Dr. would be able to determine this.

If your GP fobs it off by all means go to a speechie yourself, perhaps they can determine if it is something which needs further investigation. However my money is and will always be to go to the GP first. I think it is the most responsible thing to do and to say on these boards. Chances are they WILL be refered to a speechie and im sure given however long that may take the speech delay will still be there.

dairygold

Hmm... there are a lot of points going back and forth on this topic. From what I can tell, Tallaght01, for whatever reason you seem to have a poor opinion of speech and language therapists. I take your point about a GP looking at underlying root causes for speech and language delays but at the same time, any good SLT would also look at this. It is standard practise for an SLT to explore gross and fine motor development, any diffiuclties at birth, medical history etc as well as speech and language difficulties. In my experience (which seems to be the opposite of yours) SLTs frequently are the FIRST professional to flag a more general medical/developmental issue such as ASD, muscular dystrophy, dyspraxia etc (again, stressing that I am not suggesting that the OP's child has any of these issues!). Many SLTs DO work in a diagnostic setting and have the skills and experience to evaluate a wide variety of developmental issues and refer on to other professionals (e.g. neurologists, physio, OT, psychology etc)
However, getting back to the original post she/he did specify that the child had already been to see a GP as well as the PHN so therefore I would agree with raemie21 that the next step would be an SLT evaluation, either through the HSE or privately (www.iasltpp.com is a list of SLTs in private practise in Ireland if you are interested). Also, RE the post about going directly to a private SLT and then not having insurance covering the costs as it is "not medically necessary" as far as I know (and I could be wrong on this) for VHI/Bupa the only requirement is that the SLT be a member of the Irish Association for Speech and Language Therapists (IASLT) in order to claim back on insurance... but again I could be wrong!
Hope that helps

tallaght01

dairygold wrote: »

Tallaght01, for whatever reason you seem to have a poor opinion of speech and language therapists.

Utter nonsense.

I work with the best speech+language therapists in the state.

I have huge respect for my neurosurgery colleagues too, but I wouldn't recommend them as your first port of call if you had a headache.

dairygold wrote: »

I take your point about a GP looking at underlying root causes for speech and language delays but at the same time, any good SLT would also look at this. It is standard practise for an SLT to explore gross and fine motor development, any diffiuclties at birth, medical history etc as well as speech and language difficulties. In my experience (which seems to be the opposite of yours) SLTs frequently are the FIRST professional to flag a more general medical/developmental issue such as ASD, muscular dystrophy, dyspraxia etc (again, stressing that I am not suggesting that the OP's child has any of these issues!). Many SLTs DO work in a diagnostic setting and have the skills and experience to evaluate a wide variety of developmental issues and refer on to other professionals (e.g. neurologists, physio, OT, psychology etc)

If you think that

A) there's huge groups of kids kicking around who've had their developmental delay flagged by SALTs

SALTs are trained in physical examination

C) SALTs can reliably pick up subtle physical signs of developmental delay/DMD, such as heart murmurs, altered epicanthic folds, hypertrophy of the gastrocnemius etc etc etc etc.....

well, there's probably nothing I can say to convince you that you're so far wrong. The most dangerous healthcare professional is the one who doesn't know their own limitations.

But I guess most people make the right decisions at the end of the day.

raemie21

tallaght01 wrote: »

I am still fascinated by your stance. I had assumed you were a paediatrician, as you keep talking about GP letters that come to paediatricians being of poor quality.

I think you're mistaking quality with length. I know a great GP in my catchment area, who will write "dear Tallaght01. Please see this 4 year old who has delayed speech. She can say the following words......
Nothing else to find physically. No psychoscial concerns".

To me that's acceptable, as I know a lot of our GPs. I know "nothing else to find physically" is a nice shorthand way of summarising his findings. But if you're not a doctor, I'm not sure what your perspective on GO letter to paeds is. Allied health letters are almost alwas too long. But I digress.

Nothing you say counters the argument.

You're talking about isolated speech delay. That's fine. It's common. I'm talking about how we know it's isolated. Someone has to decide it's isolated. That should be a doctor. Because no-one else is qualified to rule out other causes. You talk about a hundred GPs in your catchment area, and you talk about 3 kids who weren't referred quick enough. To be honest, I could give you more than 3 examples in my patch. Just like I could give you more examples of where speechies, and mental health services or whatever have cocked up.

My question is this....what would you do if a kid walked in through your door with speech delay. Tell me what you'd look for. I've told you what "The medical model" involves....ie full physical examination, referral to paeds with concurrent referral to physio, speech, audiology, OT or whatever. Will you examine the child's ears/dysmorphism/tone/development/growth?

I have never seen that happen.

Metrovelvet, when I talk about your argument "holding water" what i mean is that if Irish kids could go see a paediatrician routinely. In the states, the paediatrician is like the kiddy GP, as there's so many of them. It's a ridiculous waste of a paediatrician's skills, but that's US healthcare. The speech therapist isn't qualified to work out of there's another underlying medical problem.

Don't know why you assumed I was a paed and neither do I know why it matters so much. For what it's worth, I have obviously done placements in different services and areas of medicine, similar to you I'm sure.
Furthermore, GP letters to consultant/reg psychiatrists are not that different to those to consultant/reg paeds.

I'm not mistaking quality with length.

In fact, I think it's quite bizarre that you would not take value from allied health prof reports. As I said already, a profile of, in this case, speech & language diff, is absolutely essential to our diagnosis and overall management.

"Nothing I say can counter the argument" - :rolleyes: IMO, that's a sign of someone unable or unavailable to learn from others. Geez, even I've been flexible and responded briefly to some of your points.

It doesn't have to be a doctor who decided re isolated speech & langauge delay (btw, the porfessional term is Specific Language Impairment, maybe you haven't picked that up yet from your best in the state SLTs?). Sure, I can collect and gather infor from the psychologist, SLT, OT and make a decision but they are also more than capable to do this themselves.

Christ, I have hundreds of examples of delayed referrals, not just three. In fact out of all allied health prof, I think S&L is the one that is not out there enough, little to no public awareness and I don't understood why the association haven't done something about it.

EVEN IF you wanted a medic to ultimately decide re specific lang impairment, I would never do this without a detailed S&L assessment. And about what I would look through if a kid walked through my door, where i work and what I do think works best for us, is that I would have a case file, usually with S&L, OT, Psych or whatever previous reports and they would be a big, big factor before I give an opinion after seeing the kid for an hour or whatever.

raemie21

tallaght01 wrote: »

Can I also double check what the above means? Cheers.

Because I took it to mean that, regardless of the quality of the GP letter, at least the kid is getting referred on to us. Do you think it would be better not to refer kids with speech delay? What a bizarre stance. I'd much rather a kid got referred badly, than not at all.

I mean that even as a medical professional - this notion that everything needs a medical opinion, that the doctor is the be all and end all, that nothing is sorted until the doctor has his say is very dated and frankly, often not the best course of action at all.

raemie21

tallaght01 wrote: »

Utter nonsense.

I work with the best speech+language therapists in the state.

I have huge respect for my neurosurgery colleagues too, but I wouldn't recommend them as your first port of call if you had a headache.




If you think that

A) there's huge groups of kids kicking around who've had their developmental delay flagged by SALTs

SALTs are trained in physical examination

C) SALTs can reliably pick up subtle physical signs of developmental delay/DMD, such as heart murmurs, altered epicanthic folds, hypertrophy of the gastrocnemius etc etc etc etc.....

well, there's probably nothing I can say to convince you that you're so far wrong. The most dangerous healthcare professional is the one who doesn't know their own limitations.

But I guess most people make the right decisions at the end of the day.

Bullsh1t.
Absolutely, in my experience about 60-70% of kids were picked up by SLTS and often after they had seen GP or PHNs.

Obviously SLTs are not trained in physical examination, Dairygold I don't think said that. What she meant was that any SLT or AHP would have the basic skills to note the presence or absence of dysmorphism, for example.

Ha, you're reduced to making comparisons to SLTs and heart murmurs now? The OPs original problem was about her bilingual child with delayed lang... but now we need to do a full head to toe medic exam??? :eek:

I think the most dangerous and unprofessional professional, is one who is unable to work in a team, who puts themselves above others and does not fully understand the value of his/her colleagues.