Should I get speech therapy for my son?
January 6, 2007 4:10 PM   Subscribe

Should I get speech therapy for my 4 year old son?

My four year old son has been making some speech errors and I was not sure if they were normal or not, so I had him evaluated by a speech pathologist last week. She ran the whole gamut of testing on him and determined that he is on target with receptive and expressive language, and although his speech sounds were overall in the average range, she recommended speech therapy for his few specific speech problems.

For example, he says "baff" for "bath", and "wabbit" for "rabbit", and "thnake" for "snake". If I correct him, he will say the right thing, but his tongue thrust seems to be the most apparent of the problems and I'm not sure if I feel competent to fix these problems by working with him at home when I know nothing about speech pathology. I do NOT want him growing up with an adult tongue thrust, but don't know if speech therapy would be overkill at this stage of the game.

The speech therapist said that early intervention is best, and I know that my son will actually enjoy speech therapy because he loved the evaluation (playing games with the nice lady). Part of me feels like - of course the speech therapist is going to recommend speech therapy. I know that therapy can't *hurt* him but I am also very conservative when it comes to "intervening" medically or otherwise with my children. In fact, I can't really think of any negatives to getting speech therapy for him other than my philosophy, because it is covered by insurance.

Should I do it? TIA.
posted by forensicphd to Health & Fitness (36 answers total)
I had typed two long paragraphs that involved my family and a lot of my anger about my brother's untreated speech impediment, but it didn't really further my answer.

Yes, get him the therapy. Children can be so cruel, but adults far crueler, and your son doesn't need to be mocked by anyone, well meaning or otherwise as he perfects his use of the language.

And thank you for obviously caring for the current and future well being of your child.
posted by bilabial at 4:29 PM on January 6, 2007

I had it at that age, and don't remember the sessions in the slightest. My mother says that I was getting the therapy and not showing any signs of improvement... then I got sick with something that gave me laryngitis for a week or two. When I could speak again, I spoke properly, having internalized the lessons.
posted by xo at 4:35 PM on January 6, 2007

I had a similar problem as a child, and did have some speech therapy. (In my memory it seems like a couple of years' worth, when I was around 10 years old, but I'm not at all confident about either the age or the length of time.)

Mine was left untreated long enough that I had orthodontic problems and spent a couple of years in braces because of it. That was all-around fairly unpleasant, and looking back, I wish I'd had the speech therapy at a younger age since perhaps my teeth would never have become misaligned enough to need the braces to begin with. Plus, by that age I was pretty embarrassed about it, whereas maybe I wouldn't have been if I'd gotten the whole thing over with earlier.

So for whatever a purely personal opinion is worth, I'd say it's worth giving the speech therapy a try. But if you're uneasy about the medical intervention, perhaps get a second or third opinion first? If nothing else, you'll have been able to check out a variety of therapists and hopefully find one you feel most comfortable with.
posted by Stacey at 4:38 PM on January 6, 2007

I took speech therapy provided by my elementary school starting at age 5 or so. I had similar issues with Rs and Ss. I can't say for sure that I wouldn't have grown out of it, had I not had the therapy (no control group, after all), but I do know that I'm grateful I speak normally now, and would probably be upset if I didn't and knew something could have been done about it.

If philosophy is the only thing stopping you, I think you should definitely do it for awhile and see how it works.
posted by SuperNova at 4:39 PM on January 6, 2007

Have him take it, I had it in elementary school and middle school. I enjoyed it a bit in elementary school, but hated it so much in middle school since it was taking me away from my more interesting classes.
posted by rpmurph at 4:40 PM on January 6, 2007

I am not a speech therapist, but as you said, it couldn't hurt. Like the therapist said, early intervention is best. Your son's speech mistakes sound normal for his age, but better to address it now if there is indeed a problem. Good for you for having him evaluated in the first place.

My son has a hard time with the hard C sound. Instead of cookie, he says tookie. Tat for cat, and so on. He can be corrected and say the K sound properly when prompted, so that is a relief. Come to think of it, my son also has difficulty with the -th sound. Baff instead of bath, and so on. My son isn't in therapy, but maybe he should be after thinking and writing about it.

There is a chart that the speech pathologist will probably have that lists what speech mistakes are acceptable for a particular age group. Again, I am not an expert but your son's problems seem normal for his age. You have to keep on top of it though, so maybe the therapy will help.

I think by 7 or 8 children should have outgrown their speech mistakes. If not, there is a problem
posted by LoriFLA at 4:44 PM on January 6, 2007

David Sedaris has a funny account of his speech therapy classes (5th grade, for him) in Me Talk Pretty One Day. Here's an excerpt online.
posted by xo at 4:45 PM on January 6, 2007

Having worked with and arounds kids that age, it seems to me that the longer you wait the more difficult it is to correct/relearn.

I've met middle school kids who have similar problems and it's really sad watching them struggle and try to compensate.

Go for it and good luck to you and your son!
posted by snsranch at 4:45 PM on January 6, 2007

My little brother had problems saying his Rs (wabbit instead of rabbit) and Ys (lellow instead of yellow). He grew out of the Y problem, probably at around 5 years old. The Rs, however, he did need to work on with a speech therapist, at age 8 or 9 (through a speech pathologist at his elementary school).

You can try putting off therapy for a year or so and see if any of the problems get better on their own. But I agree with others that kids can be cruel, and any continuing speech problems should be taken care of sooner than later, for the sake of your son's self esteem.

But really, especially since he enjoys the sessions now (and he's not likely if he does them later through school, when he's singled out as being different), there's no reason not to do it now.
posted by twoporedomain at 4:57 PM on January 6, 2007

This chart may be helpful.
posted by LoriFLA at 4:59 PM on January 6, 2007 [1 favorite]

I wouldn't think of this kind of therapy as medical intervention exactly. It's more bahavioural, the therapist is going to give him exercises and training to help him form words better. It's not like he's having surgery or some kind of modification. He'll still sound like himself afterwards.

It's more like when I pulled a muscle in my back in high school, my physio gave me stretches and exercises to build up the muscles and teach me how to move properly so it wouldn't happen again. Yes it was medical treatment of a kind, but not in any heavy handed or overt kind of way.

If you do give it a try (and I think you should, my boyfriend had something similar at about your sons age and a year or so's speech therapy sorted it out in a very low key, unstressful way*) then you can probably sit in on the sessions and be sure it's something you feel comfortable with. Also it's something you can stop doing easily enough if you decide it's not a good thing, unlike taking drugs or surgery or whatever. It's not necessarily a yes or no question.

*my boyfriend still gets all tongue tied when he's been drinking which is rather cute
posted by shelleycat at 5:13 PM on January 6, 2007

How many adults do you know who say "baff", "wabbit" and "thnake"? He's four years old. He will grow out of it.
posted by dydecker at 5:14 PM on January 6, 2007

You might want to get a second opinion about the appropriateness of therapy at this age for these issues. As noted above, schools must provide these services for free if there is an "educational" need. You might take your son to one of their ChildFind days or call the school district to arrange a meeting with their speech therapist.

I'm not a speech therapist but these sound substitutions sound a lot more developmental than they do an impairment. The school district will give you a free second opinion.
posted by ajpresto at 5:23 PM on January 6, 2007

Our little guy (4 years old) has similar sound issues as everyone else has noted; R's, Y's, S's.

We started him in speech therapy about 6 weeks ago - haven't noticed any improvement. One of his preschool's handles it 'inclusively'.

We are also wondering if fluid in-the-ear or ear infections may have something to do with it, but have done no testing yet.
posted by jkaczor at 5:36 PM on January 6, 2007

Speaking as a tongue thruster in her mid-20s doing the braces thing now because mom couldn't afford it when I was younger, do it now. I wish my mom was aware of my tongue thrusting at such an early age.
posted by quoththeraven at 6:13 PM on January 6, 2007

If insurance will pay for it, go for it. Do it now, and he won't be using class time to go to speech in school. You were concerned enough to do the evaluation, so you must have thought that there were some issues. Also, it will help him to learn to read if he can say the sounds correctly. (Phonetics is big in learning to read - if you can't say it correctly, it makes it harder to learn it correctly.) It may even help him to learn to read faster as he is learning to do the sounds with the therepist.

My 4 year old has apraxia, very different from what your son has, but the therepy has been a huge help. I did learn that "th" sound is not pronounced correctly by most kids until age 5 to 6. Figures that we would name my son with a name that starts with it!

wife of 445supermag
posted by 445supermag at 6:38 PM on January 6, 2007

I had similar problems when I was around his age and am glad that I went through speech therapy. I might not be able to order spaghetti today otherwise, and I love spaghetti...

Everyone is different of course, and he may grow out of it since he can correct himself when you point it out, but it sounds like he might get over it faster with some concentrated help.
posted by rfbjames at 6:40 PM on January 6, 2007

I work in early childhood special education, with lots of preschoolers who see SLPs and it has been beneficial for every child I know. I think that theres never any negative consequnces when your child receives one-on-one services from a professional. Go for it - especially since it has been a postive experience.
posted by enaira at 6:53 PM on January 6, 2007

As with 445supermag's son, my name begins with "ch," which is the sound I had trouble with. I had therapy in elementary school (and a bit in middle school), and have only positive memories of it. I still have trouble with it sometimes, and, if earlier intervention would have solved it, I would have loved to have had it. It's not some huge burden, but I do find that I practice saying my name before important telephone calls.
posted by Alt F4 at 7:23 PM on January 6, 2007

Given the advice you have received I honestly don't think there is any reason to resist this. I had it for a lisp starting at 7 and I certainly could have started earlier. To me it was fun, certainly no source of worry or trauma - I mean, grown ups are always teaching you how to do stuff right at that age, you just learned to poop in a toilet for heaven's sake.

By the time I was seven lisping the s sound was so reinforced that I literally did not know how to pronounce it correctly - I couldn't say it right if I tried. I had to be painstakingly instructed how to actually position my tongue, going through a kind of intermediate shh sound, drilling and practicing until it became natural. I have to believe earlier intervention (due to family moving/timing issues I started school somewhat late) would have made it easier/quicker. Trust the expert.
posted by nanojath at 7:24 PM on January 6, 2007

I would say go for it, especially since your insurance covers it. There's nothing to be lost by him getting help now, and possibly something to be lost by waiting. One of my stepdaughter's friends is 7 years old and still can't say "r" or "l" properly. I think if she hadn't been homeschooled, someone would have intervened and convinced her parents to get her some speech therapy. The really sad thing is that she can't even properly pronounce her own name (it comes out as "Wydia"), her brother's ("Bwyce"), or my stepdaughter's ("Sawah").
posted by Shoeburyness at 7:40 PM on January 6, 2007

If you got evaluated by the school SLP then it's probably necessary. We don't get bonuses the more kids we see, so we have no reason to recommend unnecessary therapy. If you were serviced through a private practice SLP and don't want to spend the money, try to get some services through the schools. It'll be free.

Even so, it sounds like he could benefit. Just go for it :)
posted by christinetheslp at 8:04 PM on January 6, 2007

If it's decided that the impediment is unusual for his age and development level, which, in a preliminary fashion, waiting on a second opinion, it seems to be, yes get him in soon.

I remember getting it much later (8-10?) -- it didn't stick too well, I still have speech problems, and I was so ashamed to even go to speech therapy as I was already getting teased and knew why. Hell, my dad can't even say the R, and he's getting on in years, and it bugs him as much as it bugs me.

When I was a kid, after people began to give up on me in speech therapy, I even changed the way I pronounced words so that I could drop the Rs... So people now think I'm British because the change to avoid the Rs became so widespread that it begin to take over non-R words. I can't escape my childhood fear of getting teased now, although with some (late!) orthodontic treatment, it's improved a lot.

Quite frankly, speech problems suck. Early treatment doesn't. Earlier is better.
posted by flibbertigibbet at 8:17 PM on January 6, 2007

I don't see a downside. You get him help earlier, he gets over it earlier. You wait to see if he "outgrows" it, he either does or doesn't. If he does, cool. If he doesn't he's older now and it's going to take longer, because it's more deeply ingrained. Either way, with a little help, he outgrows it faster. You're already working with him a little, he's used to it, he won't think it's anything special that someone else is doing it too.
posted by unrepentanthippie at 9:30 PM on January 6, 2007

My mother always likes to tell the story about how she took me to a speech therapist because I would say certain words funny. Her favorite is Fermis for Thermos.

The therapist proved that I could say Thermos. Apparently I said I just liked the way Fermis sounded better.

There isn't really a downside to taking him a few times. See how it goes, and if you think it will really make a difference, keep going. Otherwise, you've only wasted a short bit of time. He won't remember it if he's only four.

Good luck.
posted by jesirose at 9:37 PM on January 6, 2007

I didn't find out I had a tongue thrust until a couple of years ago, but my teeth are very gappy because of it. I've been told that I would basically have to relearn how to swallow before I should even consider getting braces because I would promptly push my teeth out again. Get the therapy.
posted by sugarfish at 10:11 PM on January 6, 2007

My 6 yr old twins receive speech therapy (different issues). In my several years' involvement with various professionals, I'd say - yes, do it, the earlier the better, and make sure it is of sufficient intensity (frequency and direct intervention) to have an impact.
posted by kch at 10:11 PM on January 6, 2007

Honestly? At 4 I wouldn't bother, especially if he says it correctly mimicking you. If in 3 more years, he still has trouble with his rrrrs, then maybe. Even then, having been a kid that couldn't say her R's until magically in 6th grade (after years of speech pathology and teachers who thought my tongue should be sliced), it's still kind of a crapshoot. Kids can sometimes speak weird for years and then magically, no more peanut butter on the roof of the mouth, no more wed wooster, it just all works somehow...
posted by jenh at 11:31 PM on January 6, 2007

I honestly can't imagine caring! I can't recall the last kid I saw in the 0-6 age group that didn't have some peculiarity in speech.

The school hooked me up with some speech therapist out of th blue one day in the second or third grade. She'd never tell me why I had been singled out for this treatment, she was very forceful that her way of saying things was the right way. To this day I have a deep visceral resentment of her.

It seems extremely strange to me to be worried about a FOUR YEAR OLD saying "wabbit" and "baff."
posted by Matt Oneiros at 12:01 AM on January 7, 2007 [1 favorite]

I honestly can't imagine caring!

You ... um ... don't have kids, do you?
posted by Alt F4 at 5:13 AM on January 7, 2007

Response by poster: You all are awesome, really. I think I'm going to do it once a week for a while. It's a $25 copay, which is $100 a month, but it's worth it for my little man. I might check with the school system for free services though. I'll be in there with him at the appointments, so I will make sure that it is a positive experience like the evaluation was. I will also explain what is going on to avoid the effect that Matt described.

About my philosophy of minimal medical intervention, shelleycat is right. It's not like he'll be getting injections or antibiotics or anything. He'll be playing games with a nice lady. That's it.

LoriFLA, thank you for posting that resource. I went over some of the word lists with my son, and it was interesting to pinpoint some of the specific words he has trouble with that I didn't realize. For example, "bored" and "bird" sound the exact same when he says them.

Again, thank you.
posted by forensicphd at 5:34 AM on January 7, 2007

It will probably sort itself out. My son is four and a half, and is just now starting to get the R sound right (which has been tough, since his name is Art--he's been pronouncing it "Out," which confuses everyone when he introduces himself: "I'm out.")

posted by rikschell at 6:28 AM on January 7, 2007

Best answer: A little late to the game here, but I am a speech pathologist. Those errors you mentioned are age-appropriate and he probably wouldn't qualify for school-based services (unless the errors persisted into 2nd-ish grade). The only area of concern for me MIGHT be the "th" for "s". Does he only do that in blends, or with all s's? Does he do it just with s, or also with z? The more pervasive it is, the more I'd lean toward therapy. The fact that he CAN make the sounds when you model them for him says to me that they're emerging without the need for professional intervention. Also, the fact that he's making "th" for "f" is likely related. He's misplacing both the "th" and the "s" one step forward in his mouth. This says to me it's a phonological rule (one that needs to be "reset" to the adult rule) rather than an anatomical/physiological problem. The latter is more of an indication of needing therapy in this case.

True "tongue thrust" is something that manifests itself in feeding AND speech, and the SLP who evaluated him (and/or who treats him) should be able to tell the difference. But from the limited info you gave it sounds like he's just slightly misplaced his s.

And I disagree with the blanket statement that "early intervention is best." Many kids aren't able to think about their own speech and language (think metalinguistically) and incorporate the things they learn into their everyday speech. Yours might be able to now, or it might take some maturing.

All in all, I wouldn't worry about it if it were my child (of course I would know how to guide him at home!), but intervention can't hurt either, especially if he likes going.
posted by kmel at 9:34 AM on January 7, 2007

I'm a little late too, but have you talked to his pediatrician?
posted by IndigoJones at 3:16 PM on January 7, 2007

Response by poster: Yes, I talked to his pediatrician about it at his 4 year checkup. She did not have an opinion about it because she doesn't know as much as a speech pathologist would, so she asked me if I wanted him referred for an evaluation and I said yes.
posted by forensicphd at 7:03 AM on January 8, 2007

This is Poq's girlfriend.

I am a speech therapist in the schools. The SLP that evaluated your son is right; his sounds are still within normal limits for his age. I would consider therapy if there are langauge concerns. If you go with therapy through a preschool, it shouldn't cost you extra. if you decide to go with therapy, they can always target the sounds anyway even if it's not explicitly stated as a goal.

It also sounds like you're willing to work with your son at home. This is really good. Not only will you see faster progress, your son might not even need the therapy for a long time.

Most of the therapy for younger children will be a play-based therapy. There's probably a lot of modeling and cueing that you could pick up on to work with your son at home. It'll be fun.

Yes, take my advice with a grain of salt because I am in the field. I do like the comments of those who have had positive experiences with their speech therapist. It's validation that we're doing something right.
posted by poq at 12:11 PM on January 8, 2007

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