Moving away from "Let's just wait and see"

by Cari Ebert, MS, CCC-SLP

As a pediatric speech-language pathologist specializing in Early Intervention, I often hear reports from concerned parents who were advised to wait six months before making a referral for an evaluation. When a toddler is struggling with speech and language development, parents are often told:  He's a boy. He'll talk when he's ready. He has nothing to say. His older brother talks for him. Don't give him what he wants until he says the word. He's clearly smart...he's just choosing not to talk. Let's just wait and see how he's doing in six months.

Okay, time for me to get on my soapbox. I wholeheartedly disagree with the "Let's just wait and see" approach. When parents express concerns about their child's development, the knee-jerk reaction should be to refer toddlers to the state's Early Intervention program. (Every state has an Early Intervention program that is authorized under Part C of IDEA: in Missouri it's called First Steps, in Oklahoma it's called Sooner Start, in Georgia it's called Babies Can't Wait, and so on.) Why would we encourage parents to "wait and see" when there is an established program staffed with early childhood specialists (speech-language pathologists, physical therapists, occupational therapists, and early childhood special educators) whose sole purpose is to determine whether there is reason to be concerned or not? The Early Intervention evaluation is FREE and it is completed in the child's natural environment, not in a clinic. One of the most important aspects of the Early Intervention evaluation is that it MUST assess all five developmental domains (cognitive, communication, social-emotional, physical, and adaptive/self-help), which gives families information about their child's overall development.

Because the brain triples in size during the first two years of life, sooner is always better when it comes to helping children who are struggling achieving their developmental milestones. A child who hasn't spoken his first words between 15 and 18 months is officially a "late talker." It requires the skills of a pediatric speech-language pathologist, however, to determine if the late talker has a developmental delay or a disorder that requires intervention and treatment. Knowing the difference between a "delay" and a "disorder" is the essence of my job as an early interventionist. A child with a "delay" is acquiring prelinguistic milestones in the appropriate sequence, but is just behind schedule. In other words, a child with a speech/language delay communicates like a child who is chronologically younger (the child is 24-months old but speaks like an 18-month-old child). A child with a disorder, however, has scattered skills and is not acquiring prelinguistic milestones in a typical manner. Helping the child go back and pick up missed milestones so we can establish the requisite foundation skills for learning to talk is an important component of what I do as a pediatric speech-language pathologist in Early Intervention.

Because synaptic connections are created at a rapid rate through age three, we don't want to sit back and "wait and see" when it comes to young children with developing brains and bodies. Rather, we want to get services going as soon as a parental concern is reported. If the child does have a disorder, the sooner we start services, the better the child's prognosis becomes. If the child ends up having a delay, then services may be short and sweet; but why would we take a chance when it comes to something as important as child development? If a parent is concerned...make the referral. Let's move away from the "Let's just wait and see" approach and move to #let's just see.

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