Need a comparison between US and UK speech therapy for 2.7 ds

[happypotter]

We've been in the US just over a year now and I took my son for his two and a half year 'well check' yesterday. All was well but the doctor raised the possibility of ds needed speech therapy for oromotor dysfunction.

Everyone who meets ds usually comments on how confident/ahead he is with his speech and he has a good vocabulary. There are a few sounds that he doesn't pronounce correctly ('r' springs to mind) and when he is telling stories sometimes he reverts to some babble words mixed up with the real words - this is what happened when he was talking to the doctor, he had drawn a picture that involved a dog, a train station and the rain but the 'joining words' were unclear. He has a tendency to be very dribbly but thought this was related to teething.

I just wondered if this was a 'usual age' for doctors to recommend speech therapy, something which just happens when children are learning to talk, or something which they focus on early in the US.

I'd really appreciate any thoughts.

Hi I'm iv no help really.... My dd (4now) spoke early and was (still is!!) very eager to talk ,range of voc great etc but like your ds her blending was poor ... She missed ch/sh/bl/gl/fl/r/th etc so words like 'black' were bwack.... I suggested therapy to HV when she had check up @2+10 and was put on waiting list..... In feb this year she still hadn't got appt so I made one privately as I felt at almost 4 these sounds should be developed .... She had 4 therapy sessions & all sounds bar ch/r/j were corrected ...r apparently can be delayed til 6yo quite commonly
My next dd is nearly 3 now and I can hear she has picked up her sisters way of talking but I'm not worried I'll just do as was recommend for dd1

I think it depends on the HV,doctor,parent as to weither it approached early... It's kinda pot luck with their opinion

Not possible to 'diagnose' without hearing the child speak, obviously!

But as general guidelines, the red flag at age 2 would be if the child is not putting two words together, which your ds obviously is. Phonetic immaturity would usually not be considered a problem until much later - it's entirely normal to have substitutions and simplifications at this age. In the UK intervention would probably be suggested only if the child's speech was not readily intelligible to strangers after the age of about 3 or so. If people other than you and your dh can understand most of what your ds is saying, then that is a good sign. I'm not sure about the dribbling, that is perhaps less usual in a 2.5yo, but might equally be nothing.

Bear in mind that in because of the way healthcare is funded in the UK, there is a tendency only to intervene when there is a recognised problem. This 'hands-off' approach can be a good thing inasmuch as lots of medical and developmental issues will resolve by themselves without the need for treatment. But obviously the potential downside is that a small proportion of issues will turn out to be an actual problem that might usefully have been addressed earlier. In general, countries like the US where healthcare is funded on a system that involves practitioners getting paid each time they do something is likely to have a culture with a higher level of intervention.

Wrt your ds, speech therapy is never going to hurt, it's not as if they're recommending invasive surgery! I'd be inclined to go back to the paed, ask him exactly what he considers the problems to be (bearing in mind medics are generally not speech experts) and what he hopes therapy will achieve. Ask what the most likely outcome is if you do nothing. The paed may have picked up a genuine anomaly in your ds's oral development, in which case therapy may help, or at least means the issue is under observation. Or he may simply be practising defensive medicine US-style, in which everything that might possibly be a problem is treated just in case. Ask a few more questions and then make a decision based on the answers you get.

That's really helpful, thank you. I did some research myself yesterday and ds seemed to be 'on track' for where he should be. Other adults can understand the majority of what ds says, he is able to ask simple questions of others and can talk in quite full sentences. He has been going to a pre-school for two mornings a week and it isn't something his teacher has raised. I hadn't thought about the potential reasons behind an 'earlier' referral here in the US, just another thing for us to get used to. As you say, speech therapy is not going to do any harm! I will go back to the doctor with a couple of questions and speak to his teacher.

fwiw, from what I pick up (I gravitate towards delayed speech threads on many websites), the US approach seems to be very pushy pro-active about possible speech delay. I doubt very much your DS would not be picked up as delayed in the UK system. You could ask about the drooling, that's the only thing that got my attention.

My 3yo DS1 can't draw a thing, at 2y7months he would not know what you meant by the words "draw", "rain", or "train station". Thing is, neither would DS1 been able to draw any of those at that age, and yet he was described as "very articulate" soon after he started school.

Yes, the drooling is bothering me more now he has all of his teeth, before I just put the dribble down to teething.
My ds's picture was his lines and mark making on paper, he just said he had drawn a dog, rain and the train station

DS1 refused to draw a single thing before he was nearly 5yo. Now, 11yo, is quite a good artist, actually :).

DS3 might attempt to draw, but he would only say "digdig!" for digger, because he asks me to draw him diggers, so he thinks all drawings are diggers, he doesn't know what else can be drawn...

I do wonder if the US system isn't ridiculously over-pro active re speech development. I'd like to see studies that show that their zeal is necessary in most cases. You do realise a lot comes down to your individual ped's experience & opinion? It's not half as standardised as in the UK, what the criteria are for referral to SALT. Would you have to pay for the SALT (what is your health insurance like, I mean)?

Typically, they would refer you to SALT if a baby doesn't say first word by 12 months, doesn't have X many words by 15 months (or hasn't pointed by then), not using 2 word phrases by 18 months, not speaking in full sentences by 2yo, 75% comprehensible to 75% of strangers by 2.5yo, etc.

And yet they (mostly) start school a full year later than in the UK, and preschool is generally both very expensive and only privately funded .

We are not sure yet whether it will be covered by our health insurance. The insurers said they don't cover anything developmental. The doctor kept saying that he didn't think it was a developmental problem just poor pronunciation. Tbh, if ds had just sat there and just given short answers to the doctor I doubt if it would have been raised. DS was trying his best to impress so he could go and play on the mini school bus in the waiting room, so didn't stop talking!! He is due his next well check when he is three in Sept so I'm thinking about reviewing it then. I'm going to try and find a few more websites so I'm a bit more informed myself. Do you know of any good sites I could look at?

Here's a Dr Sears article on drooling that may set your mind at rest.

Sometimes when people who are foreign go to a doctor in the US, things can get 'lost in translation'. I knew a child who had excessive dribbling that went on until he was at least 7, when I lost contact with his family. He was referred to speech and occupational therapy at about age 5. The child had parents from rural Ireland and accents that bespoke their origins and I think their DC's problems, that were very obvious to me and to his parents, were dismissed by the doctor they had; I believe he thought the whole family must be a bit thick or that slowness might be normal for an Irish child. OTOH, I wonder if an English R pronunciation may be at issue here? Americans roll the R and a perfectly fine English R might be seen as strange by an American doctor.

I'm friends on a parenting forum where most of the woman are American, two of whom are speech therapists. My best friend's DS at 2.5yo was saying very little and she was referred to speech therapy. So I guess I've heard of examples from both the UK and US systems. As others have said the US seem exceptionally pro-active with speech (and physical development). From a parent's perspective (my friends) it seems better to access help asap and get their lo to fulfil their maximum potential. Which is fair enough. The UK system, which tends to be more evidence based (due in large part to cost-effectiveness) tends to only refer past 2.5yo. My US friends seem to talk about having a series of 1 on 1 sessions - my best friend had group therapy sessions (probably 1 on 1 would be better I'd imagine?).

Oh, and the friends on the US forum were seeing speech therapists from various ages - from around 2nd birthday or just before. Think the reason the parents were concerned ranged from their lo getting frustrated as to not being able to express themselves (had very few words by 2yo), that type of thing.

I'm really pleased I posted this as I'm getting perspectives that I hadn't even considered. I hadn't thought of the difference in pronunciation with english and american sounds being a factor. I got the impression from the doctor that ds would be able to have 1-2-1 sessions. I'm picking up from the posts that the US are quite pro-active with speech development so I suppose that is the type of comparison I was looking for.
Thanks again for all of your posts - now off to read the Dr Sears article, thanks mathanxiety

I self referred ds (now 4 1/2) for speech therapy just before he was 3 as we no longer have most of the hv checks (i.e. no 8 month or 2 year check). He had a lot of speech sound errors and was hard to understand by people who didnt know him. He started speech therapy and had a 6 week block of 1-2-1 sessions. He then had a few months break and is part way through his second block - he improved a lot between the blocks and we had stuff to work on at home to improve his speech. The speech therapist said he was at a good age for therapy as he was a bit older, could follow instructions and had a longer attention span than a younger child would have.

Seona1973 I was thinking about ds attention span and what they would do in the sessions. He can focus on something for quite a while but only when he is in the mood to do so and something of his choosing!!

LeonieDelt Are you an american living in the UK? I can't imagine how frustrated you must feel. I really hope you get your Early supports services visit soon.