One of the most common questions I am asked is whether or not a child should be formally evaluated. It's a complicated question, and is usually unfamiliar territory for parents. There are a lot of factors to consider, so lets talk through it. Or type through it. Whatever.
If you are having concerns about your child's speech or language and you are asking this question, you have achieved the first step of the intervention process: admitting there is a problem. Like Alcoholics Anonymous without the alcohol. Sometimes you know exactly what the problem is ("My kid is two and only says 'baba'," "Other people can't understand what my child is saying") and sometimes you can't quite put your finger on it. Either way, the idea of testing your child or getting them some sort of services has crossed your mind, if not consumed your every waking thought. There are lots of reasons to be apprehensive about testing that I didn't really understand for a while.
My thought was always "Speech testing has yet to cause injury or sudden death. If you have concerns, why not test?" Then I realized that speech testing from a clinic or hospital runs somewhere in the $400 range. Owchie. Sometimes it's covered by insurance, lots of times it's not. Parents are concerned about "labels" that could follow them their whole life. Sometimes, it's hard to admit that there may be something different about the way your child is developing. Testing can also be an intense and taxing process for a young child. All of these things are real concerns, and they are valid.
The following questions can help you decided what the best direction is for you and your child.
1. Do I already know what my concern is? If you know that your child isn't using pronouns correctly, you probably don't need a standardized test to tell you what is wrong or how to direct treatment. On the other hand, if your child has different "gaps" in their language that are difficult to describe, or if you have more than a few concerns with their language (they don't understand basic directions and don't understand "who" questions, but they can talk in full sentences), you might need a standardized test that looks at a variety of language skills to find all the holes. Think about what new information formal testing would provide. Is that information necessary? Sometimes it is, sometimes it isn't. You can ask a speech therapist about it! Don't be afraid to call someone up and ask them what they would recommend.
2. Do I need a formal diagnosis? When trying to get speech services for your child, you may need a diagnosis, or a "label." For services in schools, your child needs to have a primary diagnosis or classification to receive those services. You may need a formal assessment and diagnosis to have insurance cover your therapy treatment. Maybe you just want a name for what is going on for your own peace of mind.
Lets go back to the "label following my child" idea. This is a common concern with parents. Let me tell you exactly how that label follows your child. They qualify for special education services under a certain classification. This classification describes the primary reason your child needs services. Some common classifications are Autism, Other Health Impairment (like ADD or medical diagnosis), Speech/Language Impairment, or Specific Learning Disability. Your school can then provide services to help your child progress in their education because they determined that their classification is affecting the way they learn.
As they move from grade to grade, they have a special education file that "follows" them (meaning it is kept in the school they are attending). The only people who have access to that file are the people providing services to the child, and the parent. Anyone else has to have a pretty darn good reason to look inside, and has to have permission first. Teachers are made aware of students in their class that will be receiving services by the special education teachers and/or speech therapist at the beginning of the year so they can be pulled from class and so teachers can collaborate with the special education staff.
If your child is ever exited from services, be it speech, academics, or otherwise, your school district hangs on to that file. It's in a special cabinet in case there are ever new concerns or if you ever wanted a copy of something in that file later on. After your child is exited or released from services, a general education teacher will not know that they received those services unless they have academic concerns and want to make a referral for the child to be in special education. Then, the team would find their inactive file, review the testing and data in it, and get an idea about the child's educational history.
That's it! Hopefully, that eases some concern about labeling kids and their file that "follows" them. It's not like the whole world know they have a diagnosis. The file doesn't haunt them throughout their educational career. It's just a quick and easy way to communicate why a child is receiving services.
3. Will testing give me a better picture of what my child's needs are? Sometimes kids are puzzling. They have multiple areas of concern. They do things that seem just plain weird. It's totally OK. I love puzzle kids because they are challenging and fun and when you make a breakthrough you get to celebrate like crazy. There are cases where speech isn't the only concern or the primary concern, and there are a variety of issues going on. That could be motor development, facial deformities, syndromes, behavior, and the list goes on. There are times when you might want to rule out any speech and language issues, investigate a certain aspect of language that they might be at risk for, maybe their diagnosis has changed or their language skills have changed drastically for an unknown reason. It can be worthwhile to have that speech/language piece so you can make more informed decisions for your child.
After discussing these questions with your spouse, doctor, therapist, educators, or anyone else who may have a valuable opinion, you can hopefully feel more confident in your decision.
What are your testing concerns? What helped you decide whether or not to have a formal evaluation?
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