Expert: Valerie Herskowitz - 3/23/2010

Question
I will try to keep a long story short....My (just this week turned) 4 son is getting speech therapy for a diagnosed expressive language delay, as well as social/play therapy to supplement, as some of his delay has been attributed to his extreme introversion the first few years of life.  He has really come out of his shell in the last year. The original eval was done at our Pediatricians office, who didn't think there was any other issues to evaluate.  So we've been in speech since December, with significant results, and just started play therapy about a month ago.  We are even scheduling an OT eval to cover that base as well (fine motor is behind), though the sensory questionnaire I filled out didn't indicate a sensory issue.  I guess my question is, what is the best way to get a big picture evaluation for all of these various issues?  I feel like we are chipping away in a very piece meal way, with no one saying there's a bigger underlying problem, but seems there should be a more efficient approach and one source to look at all the angles (language, sensory, social, etc..)

We seem to keep getting directed to the school district, which I'm scheduled to do in a couple months, but my gut is not sold on that.  It seems that if we are doing speech, play and possibly OT as well, we are covering all our bases without the label game in the school system.    Would love to hear your thoughts.  Thanks.

Answer
Hi Susan

Thank you for your question.

I am hearing two opposing things:
1. You feel like you are approaching your son's therapeutic needs in a piecemeal way without really looking to see if there is a bigger underlying problem and that concerns you.
2. You are going for an evaluation at the school district who may find that underlying problem and label him and that concerns you as well.

How much of a language delay is there? Can you describe his speech skills? Also, I am concerned about the extreme introversion in the first years of life-this is a red flag for me as is the fine motor component and play skill issue. When all combined, I start thinking about a developmental delay that is more global in nature.

That said-who cares really? Even if you get a diagnosis, you are still just going to get him the same services: Speech therapy, Occupational Therapy and pragmatic social skills therapy. I guess if you bring him to school they will offer a special class for him as well. You have decide if that is what you want.

I would add home program to the mix. Research indicates that a child should have 25 hrs minimum per week of intensive stimulation in the early years to provide the best outcome for the child. You could supplement that at home. I can help you with that.

If you want to talk, you can call me at 954-980-0134