Is Bad Speech Therapy Better Than No Speech Therapy?
Hmmm….. this is a question I’ve been pondering all day long. Let me walk you through my entire thought process before you weigh in on this issue.
This morning I was in a huge hurry to get ready to go see one darling little girl for speech therapy and then pursue my other passion, being a mom, for the rest of the day. I usually check the website and my e-mail every morning for comments from readers and respond to any that I can adequately answer before dashing out the door to see my first client.
Today started no differently. I checked the comments section to see if I’d received any questions overnight. The comments section was extra-full today (14 spam messages from porn sites!) and then a comment from a parent who is facing the challenge of getting her SLP to appropriately treat her 25 month old son who was previously diagnosed with apraxia. (If you’re intrigued, see the comment from Luz.)
I was so irritated with this SLP in question when I read the comment that I knew I wouldn’t be able to generate a thoughtful, responsible reply, so I posted the comment and then left for work. I literally could not quit thinking about this situation. It bugged me so much on my drive in that I had to force myself to switch gears and start to mentally prepare for my first and only client today.
After a great hour, I returned home to start my second-shift job as mom. Before I went to chaperone the back-to-school swim party for my daughter’s middle school cheerleading team, I asked my husband if he’d take a quick ride with me to McDonalds to grab lunch. While we were sitting in the loooong drive -thru line, I asked him if he’d read the comment already.
Now for those of you who don’t regularly read this blog, this really is a two-person show. While I do all of the clinical stuff, my husband is the “techie” one who routinely figures out what I want to do and can’t, and more importantly, fixes all the things I mess up on here! He actually “runs” the site and reads most comments and e-mails before I do, so I knew he’d probably already seen the post.
As he drove me to McDonalds so I could grab our daughter some lunch (very picky and very sensitive tummy – but that’s a whole ‘nother post!), he listened to my rant about the comment I received this morning. Again, if you’re a regular reader, you know is an everyday occurrence for me. I can get pretty worked up about children who aren’t receiving optimal therapy.
While I paused to take a breath, he posed this great question to me, “Is bad speech therapy better than no speech therapy?”
Hmmmmmm. After a very brief pause, I jumped in and said, “Yes. Bad speech therapy is better than no speech therapy.” I supported my initial argument with justifications such as, “At least the child is focusing on learning language during the visit when they might not otherwise be.” I continued with, “At least the parents are getting advice about how to target improving language at home.”
As I was yelling across him to order the only chicken sandwich our daughter will eat, I glanced at the look on my husband’s face. Why was he smirking?
Then it began to dawn on me too. I started to hedge on my previously “correct” answer. I questioned aloud what he had to be thinking.
“But, what if the advice that parents get is the WRONG advice? What if the SLP is using the WRONG approach?What if the parents end up feeling more helpless and confused than ever before? Would this really be better than nothing?”
Hmmmmm……Then I arrived at my next conclusion. Bad speech therapy is not better than no speech therapy.
Actually, it could be (gulp) worse. When parents are counting on sound advice from the person they view as a “professional” and that person does not deliver, for whatever reason, be it lack of experience, or education, or in some cases, plain ole’ common sense, it may actually cause harm to the family and child.
Not harm in the way that the child is physically injured, but harm in the sense that his parents believe that they are doing “the best” job they can by seeing that he gets “the best” treatment possible. If parents don’t know any better and keep doing the same unproductive things week after week, session after session, precious months could fly by without a hint of measurable progress or even a glimmer of hope. In my opinion, contributing to lost time during this critical window of development is harm.
Then my husband asked another question. “What if the SLP herself doesn’t realize that she’s not helping a child?”
That opened up a whole new line of questions for me.
“What if she doesn’t question why her clients don’t make progress? What if she thinks it’s normal for kids to run away from her and cry? What if she gets fired and doesn’t even think it’s her fault? What if her area is so short of speech therapists that she never gets fired because nobody knows any better? What if she truly doesn’t know she’s bad?”
Hmmmmmm…… I don’t even know how to address this issue other than to tell parents, you’ve got to do what’s best for your child. If you think therapy is not going well, if you feel a pit in the bottom of your stomach during yet another horrible session, if you think there’s a problem, there is.
That’s where you parents come in. That’s where therapy supervisors come in. That’s where team members in multidisciplinary models come in. You have to have a voice. You have to speak up. You have to say to that unsuccessful therapist – there’s got to be a better way!
The answer may be helping an inexperienced therapist begin the process of self-analysis. Ask her, “Do the children on your caseload make progress?” “What expert’s material do you read?” “What would that expert recommend for my child?” “What could we do differently to make this better?” “Is there any other approach we can try?”
If your SLP can’t answer these questions, I hate to say it, but you and your child are in big trouble. The answer in this case is to find someone else to help you work with your child.
As I’ve said often on this site, most children with language delays and disorders need high quality speech therapy to make progress. Sometimes maturation kicks in and kids get better on their own or with a little help from mom and dad, but for children who have a diagnosis as a “reason” for their delay at 2 or 3, you’re going to need a professional, and a good one at that.
Many children who are just thought to be “developmentally delayed” must also have speech therapy in order to make enough progress with language to catch up to their peers. Good therapy can make a HUGE difference.
But what if there’s no “good” therapy? What if you just aren’t sure? Keep reading, keep watching, keep asking questions, and keep trusting your gut.
Sometimes bad speech therapy may be better than no speech therapy, but then again, doesn’t your child deserve better?