History Matters When Evaluating Children for Murphy Speech Therapy

by Anne Bramlett Webmaster Parents might wonder why they need to provide detailed medical and developmental history prior to a speech and language assessment.  It might seem that a trained professional would be able to determine a child's needs simply by interaction and observation.  It is true that a speech language pathologist can learn a great deal from observation and interaction with their client.  However, this is only part of the puzzle that answers the question, "What is going on with this child?"

A good assessment requires the speech pathologist to gather three kinds of data, history (which includes family interview questions), standardized measures (whenever possible), and informal or formal observational measures.  Looking at all of this data leads to the best picture of a child's strengths, weaknesses and prognosis.  For families in Murphy, speech therapy and assessment  are available at Speech & Occupational Therapy of North Texas.

History typically includes medical information, family demographics, cultural information, developmental milestones, and information about how the child interacts in given situations.  The medical history and developmental history is very important because speech and language disorders may have many possible causes. And cause will typically impact diagnosis and treatment recommendations. ASHA, the American Speech Language Hearing Association lists the following as some known causes of preschool language disorders:

• Family history of language disorders
• Premature birth
• Low birth-weight
• Hearing loss
• Autism
• Intellectual disabilities
• Syndromes, like Down syndrome or Fragile X syndrome
• Fetal alcohol spectrum disorder
• Stroke
• Brain injury
• Tumors
• Cerebral palsy
• Poor nutrition
• Failure to thrive

It is important to understand that the etiology (or cause) may determine the type of treatment, the recommended amount of treatment as well as the long-term prognosis.   For instance, a two year old with a significant history or chronic otitis media (ear infections), or a similar aged child with a  severe hearing loss may look very much like a same aged toddler on the autism spectrum.   The treatment and prognosis for each child could be very different based on the underlying cause of their speech and language challenges. 

So it is critical for a speech language pathologist to find out as much as possible about a child's medical and developmental history to have an accurate picture of the child's needs.  A speech pathologist will also request medical records from the pediatrician to determine if childhood illnesses might have contributed to speech or language delays and to also see if the child has any current diagnosis that are typically associated with communication disorders, such as cerebral palsy, autism,  hearing loss or Intellectual disabilities.

Developmental information from the family helps the therapist understand whether a child has a global delay or whether they are having difficulty in just one domain of development.  For instance, a child who babbled at the typical age and who walked within a normal age range might have a different cause for a speech disorder than a child who is delayed with all milestones.  This information is valuable in determining the appropriate treatment as well.   It is also important to understand how a child functions in day to day situations and what functional communication skills the child may have developed to compensate for communication deficits.    Children with speech and language disorders may know more than a standardized tool may reveal so parental input is very valuable. 

Speech language pathologists will typically use certain standardized assessments or developmental scales to help establish a diagnosis and to shape the direction of treatment and to also show how a particular child performs compared to a normative sample.   However, developmental information from the family is invaluable in helping to determine a child's true capabilities and the best treatment strategies for that child. 

For instance, a 3 year old with apraxia (a motor planning disorder impacting speech production) may have good understanding of what someone is saying, but because he has very limited verbal skills, he doesn't respond.  The family can give good information about how he gets his needs met: by pointing, pulling, crying or just giving up.  Or perhaps he has already figured out some coping strategies, like humming his favorite movie tune to signal he wants to watch that movie.  This would clue a therapist into recommending a visual communication system to relieve frustration and encourage initiation while starting to work on speech production.   All of this  information is part of his history and key to helping the child.

As it has been established, history is an important  piece of an assessment to insure an accurate evaluation of a child's strengths and weaknesses and the development of an assessment driven treatment plan.  This treatment plan should target the most appropriate measureable goals for the individual child leading to the greatest success in treatment. 

 Developmental and medical history also play an important part in establishing medical necessity.  According to ASHA:

"For services to be considered medically necessary, they must be reasonable and necessary for the treatment of illness, injury, disease, disability, or developmental condition".

 Unfortunately the definition of medical necessity varies depending on who is paying for services.  Though some payors may have different criteria, ASHA's position is:

"Speech-language pathology and audiology services are medically necessary to treat speech-language, hearing, balance disorders, swallowing, voice, fluency, and cognitive-communication disorders. Many disorders have a neurological basis, including head injury, Parkinson's disease, stroke, autism, and cerebral palsy. Children who require services as part of their individualized education programs (IEPs) and are identified as having a disability under the Individuals with Disabilities Education Act (IDEA) are also generally considered to have met the requirements".
So families should be ready to share as much information about their child's development as they possibly can recall.  It is always wise to keep a record of milestones and have access to all of your child's medical records. For families in Richardson Tx, speech therapy and assessment is available at our Plano location.


Author Bio:  Speech and OT of North Texas - Our professional and experienced therapists offer the highest quality of Murphy speech therapy & occupational therapy. We serve surrounding cities as well with three convenient locations. We specializing in children and we fully partner with and support our families. Contact us for more information about Richardson, TX speech therapy!

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Created on Dec 31st 1969 18:00. Viewed 0 times.

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