[frx909]

Hello,

I am a 2nd year graduate student in speech-language pathology and anticipate working with school-age children in the next year. In addition to offering speech-language treatment, I anticipate working as part of the team that will diagnose children as having a speech-language disorder. Although I have participated in many counseling seminars; honestly, I still feel unprepared to tell parents that their child has been diagnosed with a communication impairment. My largest concern is being able to inform parents of their child's diagnosis in a manner that reflects sensitivity to their family.

I am writing this entry as a request to parents for advice of how speech pathologists should inform you of your child’s speech-language diagnosis. How can the speech pathologist explain your child’s diagnoses in a way that reflects empathy and sensitivity towards you and your child? How can the speech pathologist sufficiently explain your child’s diagnoses to you and options for treatment? How can the speech pathologist be accommodating to you and your child?

As mentioned, I am a graduate student in speech-pathology and anticipate evaluating and treating children within the next year. I would greatly appreciate any advice or suggestions of factors that should be taken into consideration when informing parents of their child’s language disorder.

Thank you very much for your reply.

[momraine]

One thing you may not realize is that by the time a child is being tested, the parent already suspects a problem. They may be relieved to find out thier child has a problem that is fixable. They may have worried that thier child is severely delayed or cognatively impaired. If the child only has a speech issue and is actually of normal intelligence, this is good news to a worried parent.

[KarynB]

I also really appreciate hearing the positives and not just the problem. Not false positives, but how we are going to work on it, and what can be done.

[Barksum]

One of my Ds's was significantly speech delayed, and had other delays as well. (Didn't speak until age 4, then began to slowly develop speaking in sentences.) I was very discouraged to be told every time we had an evaluation of all the things that my son wasn't doing, of all the areas where he was behind. It meant much to me to hear the professionals say what a joy my child was to work with (if applicable, of course!) and discuss his progress in positive terms instead of always in terms of how far behind he still was. For the most part the therapists we worked with were encouraging and made positive statements, but at different times during the course of the years we were in therapy they were overshadowed by the constant stream of information regarding all of his deficits.

I was encouraged during discussions about the various dx's for my son when the therapists and other professionals were able to in some way incorporate the belief and body language that this child was going to do well and that we as parents would make a difference for him.

I also appreciated having information as factually as possible, and also being presented with a plan for how to deal with specifics. Having a time line sort of presentation helped. Something that showed tentative long term goals and the proposed incremental steps to reach the long term goal. I also appreciated being heard when I had questions about goals, or especially when I disagreed with a goal or the steps proposed.

I know that the therapists we worked with were sometimes run down by the families that weren't very proactive for their children and who didn't read the info the therapists provided and do the exercises at home, or perhaps research and find information for themselves. Still it was nice to have therapists who were encouraging, supportive, and weren't syrupy sweet with my kids. (Oh - the syrup. It was not helpful to have anyone let my kids 'get away with' behaviors that weren't acceptable, like whining or not taking turns, not answering questions when spoken to, etc.)

As to getting the initial dx from professionals, we already knew there was an issue...we'd sought testing, after all. We knew that he was delayed, we knew that he didn't speak, we knew that there were problems. What we craved was information and support in working through the issues with him.

[teachermomof3]

First of all, thank you so much for having the concern about your future families enough to have posted these questions. That in and of itself says a lot about what a great job you will do. Having been on the parent and the teacher side of special education, the one thing I can say for certain is that you will have all types of families and there is nothing that will work with all of them. The first part of an IEP meeting always asks parents their vision for their child and I think you can get a great deal of information about where the parents are thinking from those statements, you know for sure what to address to meet their specific needs. On the parent side, I agree with everyone that said to provide as much information as possible. We have had 3 SLPs (they keep changing, not us) and I have had excellent relationships with 2 of them. I listen, ask questions, ask them for more ideas, and let them know what is and is not working at home. 2 of them are totally open and receptive, the other doesn't listen and then I have nothing new to work with, which isn't benefitting my child. Also, I as the parent have requested assessment after a big growth spurt in language, it helped me keep working to see that the delay was shrinking. Good luck!

[DannieAS]

two pieces of advice for you:

1. the first year is very nerve wracking and you will want to present in a way that you are comfortable with...please remember that many parents are not familiar with 'our jargon of terminology' so just prepare to explain every area and why you assessed in that area...(I had a big fear of talking to parents my first year mostly because I started working very young 22yo) some parents appreiciate the professional terms and some appreciate laymans explanation...You will learn which parents are which.

2. People/parents appreciate professionalism mixed with honesty. It is ok to say that you will collaborate with and keep in contact with them....it is ok to say that a particular area (let's say a kid is experiencing all the signs and characteristics of childhood developmental apraxia) may need collaboration with other speech pathologist/specialist...whatever your district calls you...to help their child.

As you start working more and putting more years in...I'm now in my 30s after starting out in my early 20s...some things will naturally fall into place.

WARNING: Please refresh yourself on latest research and take time for yourself. School districts may zap you of your energy and you don't want to become a robot just doing your job. Taking time to keep yourself positive by reorganizing....asking for a different school for the next year if you need to... will keep your enthusiam for your work strong...which is ultimately something the parents of your kids will love you for.

(Barksum....I had to laugh....do you know in my portable I have a big sign that says "NO WHINING"...I can't tolerate negative behaviors that are able to be managed)

[Hadley2]

good for you for asking. I apologize in advance that my suggestions are by way of negative cautions. Unfortunately, they arise out of our experiences.

As pp's said, clarity and honesty. If you sugarcoat something to me or, worse, in writing, my child will be denied services she needs unnecessarily. With today's tight school district budgets, you can't afford a soft touch if you expect to provide services.

Further to that thought, please, please, please stick to your scope of expertise, especially in written reports. Everything you write is documentation of that child and can and will be used in some way to deny services or treatment, if possible. Sorry to be so cynical, but BTDT, it's true in some cases. It is not helpful to have other, professional dx and recommendations in other areas--psychological, emotional, audiological, neurological, etc. --undermined by what is essentially a stray comment made by someone not qualified to document in that area. E.g., I have a RAD child. It is not helpful for an SLP to write, "Felicity is a delightfully cooperative child...." when what your report really only calls for is "Felicity understood and followed directions. The power of documentation can be great.

If the school district or other entity for which you work wants you to head up an assessment in an area in which you are not truly qualified by ASHA standards, then insist on bringing in a qualified provider, e.g., an audiologist for CAPd, to do the assessment and play the lead role in developing or collaborating on an appropriate plan.

Please be very specific re the tasks in your recommendations for a plan using the goal-objectives-tasks paradigm. I have seen difficulty in that sometimes goals and objectives are not communicated coherently (e.g., what are actually objectives are listed and mixed in with higher goals and tasks are listed as objectives, etc.) and tasks are left to the interpretation of the in-school provider.

If you are handling an application to insurance for a particular service, treatment, device, etc., be sure to let the parent see what you have written to be sure that you have relayed the facts regarding the child's situation accurately. Our child was denied an item because the person making the application misunderstood what the school was and wasn't providing...we ended up bypassing that source of funding because of the length of time it would have taken to go through a fair hearing, etc.

Finally, it should go without saying, but if you come across a child whose difficulty doesn't rise to the level required to provide services through school district or insurance, don't be afraid to be clear with the parent on those points. Let the parent know what the child's difficulties are and what the parents' options, beyond school and insurance, are to help the child. DO NOT refer the parent to your own or any other specific practice. Again, BTDT, the school SLP referred us to her own practice...right after she denied our child school-based services. That didn't sit well.

Good luck in your new career. There are lots of kids (and adults!) out there who need people like you.

[DannieAS]

Hadley2

right on the money!

also that bit about not referring the child to your own practice "moonlighting" 2nd clinic if you do per diem after you discuss with parents why child is not eligible for speech services through the school system, is unethical so that's a no no.

[ladyjubilee]

Most people who post here are of normal or above average intelligence. We can follow a discussion---and are very capable of speaking up. BUT...most people aren't in that position.

My mom is a special ed teacher and we've talked about it, but even I was caught unaware during an IEP meeting. Part of that was because I wasn't advised I'd be in an IEP meeting! But the ST went through this whole long thing about how my fd's goal was to use a complete sentance. I asked if she'd ever met my fd who not only spoke in complete sentances but entire paragraphs!

Disagreement aside--I (of the PHD level) was intimidated by a cirle of professionals "ganging up" on me. And frankly that was with me understanding what they were saying. Imagine I was boardline mentally retarded and didn't even understand the words!

So basically, my advice is to listen, and accomdate your listener.