Common mistakes made by parents of children with communication disorders

Communication disorders can be caused by a number of different things, but if your child has one, it's not your fault. The only speech and language disorders that can be blamed on the parents involve cases of extreme abuse. If that's the kind of parent you are, you're probably not here reading this.

That being said, I have observed a number of recurring mistakes made by parents of children with communication disorders. In general, these are not things that parents are doing wrong—just things they are not doing right. These are pitfalls you should try to avoid, but if you find something you've done in here, don't get down on yourself. None of these are irreversible. Pick yourself up, dust yourself off, and do what you need to do to help your child.

1. Waiting too long to seek help

Research has shown that the earlier a child receives therapy for a communication disorder, the more effective the therapy will be. This is because of what neuroscientists call the plasticity of the young brain. Plasticity means the ability to be molded or shaped; this is the property of the material we call plastic that makes it so useful. Virtually every experience results in changes to the newborn brain as neurons fire and synapse together to form pathways to process these experiences.

Of course, it’s hard to diagnose communication disorders in newborns, since newborns don’t talk; but the parents of a toddler between one and two years old who notice that their child seems to be behind in speech may not take action right away. This usually happens for one of the following reasons:

a) Denial.

My son’s preschool enrollment form asked what goals my wife and I had for him. What an easy question! “Nobel prizes in chemistry and literature,” I wrote, “not necessarily in the same year.” Hey, no sense pressuring the kid, right? When we anticipate parenthood, we picture ourselves holding a happy, healthy child without a runny nose who sleeps through the night, is potty trained by 18 months, never sucks his thumb, prefers healthy snacks to ice cream, and begins composing symphonies at five years old, unlike that loser Mozart, who waited until he was seven. Picking up the phone to request a speech evaluation is an admission that your real-life child is not the picture of perfection you had in your mind before she was born. Did the Gerber Baby need a speech eval? I think not! Taking this step involves a grieving process for many parents, and denial is part of grief. If you are in this position, don’t feel silly for experiencing grief, but do try to move beyond the denial stage as soon as you can and get your child the help he needs.

b) Bad advice.

Sometimes, when parents begin to express concern about their children's speech, people who don’t know diddly-squat about communication disorders, and have no business advising anyone on such matters, consider it their sacred duty to tell these parents what’s causing the problem and what they should do about it. Usually, the less they know, the louder they talk. Perhaps you have met one or more of the following:

The co-worker who tells you all about how Albert Einstein didn’t talk until he was nine, and obviously he did fine (actually, it was more like three, but your co-worker is not overly concerned with accuracy);

The pediatrician who tells you language development doesn’t begin until age two, so it’s way too early to worry about it;

The relative or in-law who tells you it’s because you baby him, or let him watch too much TV, or feed him wheat gluten.

If, heaven forbid, you are a vegan, had a home birth, home school your kids, or chose not to vaccinate or circumcise them, you will find no shortage of people who are happy to inform you that you brought this upon yourself. On the other hand, if you eat red meat at every meal, gave birth in a hospital with an epidural, got your kids vaccinated and circumcised before their first bath, and send them to public school, you will still be able to find people who will tell you you’re a bad parent—just not as many. What all these good folks have in common is that, although they are lovely people with the best of intentions, not a single one of them knows a grammatical morpheme from a rutabaga. Listening to their advice on communication disorders is like having me tell you how to replace your car’s piston rings. Trust me on this—you don’t want me anywhere near your car’s piston rings. Instead of relying on these people’s advice, talk to a speech-language pathologist, preferably one that specializes in childhood communication disorders.

c) Fear.

The parents may be reluctant to subject the child to the social stigma that comes with a "label" of a developmental disorder; or they may simply dread the expense of getting therapy for their child. These are both legitimate concerns. Unfortunately, there are people out there who do not understand communication disorders, and some of them are educators. No one wants their child to go through school being taught by people who have given up on the child before they’ve even met her. As for the cost, speech-language therapy can be expensive, and many insurance policies will only pay for treatment of communication disorders caused by an acquired medical condition (illness or injury). Early intervention and school-based services are supposed to be provided free or at low cost in all states in the U.S., but availability and quality vary greatly from state to state or from school district to school district. Because of the nationwide shortage of speech-language pathologists, a child may spend months on a waiting list before getting any services, and then get only minimal therapy time. I won’t tell you not to feel fear; if your child has any sort of disability, including a communication disorder, you may very well be embarking on a journey through territory you know very little about, and that’s scary. The best way to deal with that is not to avoid the journey, but to find a qualified guide to help you find your way through, sooner rather than later.

d) Cluelessness.

Communication disorders just aren't on some parents' radar, and they don’t realize there’s anything wrong until their child gets into a setting such as preschool or kindergarten. In these cases the problem usually gets spotted by a teacher who has worked with a lot of children and has a pretty good idea of what the average child is able to do at that age. This is most likely to happen with first-time parents who are young and inexperienced, but it can also happen with parents who already have one or more older children. Some families, and some communities, just don’t get overly worried about what developmental milestones children are supposed to reach at what age, and actually, there’s a lot to be said for that. Relaxed parents tend to raise relaxed children, and anxious parents tend to raise anxious children. Still, it’s good to be aware of what you can expect from your children as they grow and develop, so that you can recognize when it’s time to take action.

2. Seeking help from the wrong people

Usually, the first professional a worried parent talks to about a communication disorder is the family physician or the child’s pediatrician. Now, before I write another word, let me just say that I have the greatest respect for family doctors and pediatricians. They are highly trained, highly skilled, highly qualified professionals. Nothing I say here or anywhere else should be construed otherwise. A physician spends four grueling years in medical school learning about anatomy, physiology, disease processes, pharmacology, and all manner of other stuff in preparation for a career diagnosing and treating illness and injury, then several more grueling years of residency learning to put all that training into practice. If your child is ill or injured, a doctor is … well, just what the doctor ordered.

That said, however, a physician is not the professional of choice when it comes to communication disorders. That’s because, although there are illnesses and injuries that can result in communication disorders, communication disorders themselves are not illnesses or injuries, and doctors simply are not trained to diagnose or treat them, any more than they are trained to fix your broken blender. If this sounds surprising or you have a hard time believing it, don’t take my word for it—go to any medical school website (Google “medical school curriculum”) and look at the courses medical students are required to take. You probably will not find any courses on speech and language development or communication disorders. The closest I’ve found are a couple of electives at Harvard on learning disorders, children with disabilities, and child psychiatry. These courses may or may not include modules on communication disorders, but the course descriptions say nothing about speech or language.

So, if your child has an ear infection, a broken arm, or leukemia, by all means consult a physician—just don’t expect your doctor to know a lot about communication disorders. The responsible thing for a physician to do when you ask about a speech, language, or hearing concern is to refer you to a speech-language pathologist or audiologist for an evaluation. Sometimes, however, an otherwise very good doctor will forget how to say, “I don’t know.” Bless their hearts, they’ve been so busy studying biochemistry and embryology, they forget that other people go to school and develop whole other areas of expertise that doctors don’t have.

Occasionally, a doctor will misinterpret an expression of concern as a request for reassurance. If your physician tells you not to worry, or to wait a year or two and see if your child catches up, that doesn't make her a bad doctor—she just isn't a very good speech-language pathologist. Pleasantly and politely explain that you would feel a lot better if you could get an evaluation as soon as possible to rule out a potential communication disorder. Most doctors will not refuse to write a referral—it costs them nothing, after all. If yours does refuse, get a second opinion.

3. Trying to “fix” the problem by themselves

Occasionally, I’ll run into a parent (usually a mom) who has been working with her child to try to correct a speech disorder for a few months and calls me because she’s not seeing the kind of improvement she had hoped for. People, the wheel has been invented! If you want a do-it-yourself project, build a solar oven.

If it works, you can cook your food using free energy from the sun, and if it doesn’t, you can still cook your food in your conventional oven, or order pizza, and try a different design next week. No harm done. But if you try doing speech therapy by yourself without the proper training, and your child makes no progress for six months, you’ve just wasted half a year of neural plasticity, during which a qualified speech-language pathologist could have been actually helping your child.

Think of it this way: it became obvious early in my son’s life that he had inherited my overbite and was going to need braces. What would you think of me if, instead of taking him to the orthodontist and paying over $5,000, I got out some paper clips, a tube of Krazy Glue and a copy of the CliffsNotes summary of Introduction to Orthodontics from the library and tried to fix his teeth myself? I mean, how hard can it be, right?

Most non-SLP parents who try to treat their own children's communication disorders are wonderful, well-intentioned people with a high level of intelligence and education, but they lack the training to identify exactly what’s wrong and to design and implement an effective intervention program. In one hundred percent of the cases like this that I’ve encountered, the parent has correctly identified one or two obvious problems (for example, a distorted /s/ sound or a substitution of /t/ for /k/), but completely missed something else that also needs to be addressed, such as a grammatical deficit, or difficulty with phonemic awareness. Click here for an example.

When I took my son to the orthodontist (rest easy, I left the Krazy Glue in the drawer!), he fitted him with a bionator, a device that caused his bottom jaw to grow forward and bring the lower teeth into line with the upper teeth. Who knew? I would have just tried to push his top teeth back! Of course, the answer to "Who knew?" is: "The orthodontist." It’s the orthodontist’s job to know how to fix overbites and crooked teeth, because that’s what orthodontists are trained to do. Likewise, it’s the speech-language pathologist’s job to diagnose and treat communication disorders. It’s our job because that’s what we’re trained to do. We know.

Speech and language therapy is not rocket science; you can do many of the things an SLP does. But, because no one has ever shown you how, you shouldn’t try without first consulting an SLP. I know speech and language therapy is expensive. That’s because speech-language pathologists are highly trained, highly qualified, highly skilled professionals with years of training and experience. It’s also because most insurance companies won’t pay for it, but that’s a rant for another day. My message here is, you get what you pay for. You should be involved in your child’s therapy (see #4 and #5 below), but bring in an expert to support and guide you—you’ll get much better results that way, and the money you spend will get you better value.

4. Not following a home program

If your child takes piano lessons, your job is to make sure she practices. When your child starts school, it’s your job to see that she does her homework, and help her with it at times. Even if it’s not your child that’s involved, there is almost no example of being able to hand a job over to an expert and having no responsibility for assuring success. I take my car to the mechanic for repairs, but once I get the car back I still need to monitor the fluid levels, watch the warning lights on the dash, wash the salt and grime off it to prevent it from rusting, and so on. So I’m always a bit perplexed when I arrive at a child’s house to do therapy and the parent (usually mom) ushers me into the room where therapy is to take place, brings the child in, and then leaves to wash the dishes, do the laundry, read, take a nap, or whatever for an hour while I, presumably, fix the child. To be fair, not all parents do this; many stay in the room to observe the therapy session; sometimes even both parents are present. But this is often not the case. Once I actually arrived at a child’s home to discover my two-year-old client alone with his twelve-year-old sister; their mother had gone grocery shopping. Leaving aside for the moment how incredibly stupid a thirty-something guy would have to be to enter a house in which he is alone with an unrelated female minor and her two-year-old brother, this is a far cry from good therapy.

And then there’s school-based speech therapy. Because it takes place in school, the parents are almost never present for therapy. I generally saw parents of my school-based clients once a year when we met to review their child’s individualized education plan (IEP). I had a few gung-ho parents who would do all the activities I sent home with their children and send them back with a note asking for more, but for many parents, speech-language therapy was something that was out of sight and out of mind. I’m not blaming or condemning these parents—people who work for a living often can’t go and sit in on their child’s therapy sessions on Tuesday and Thursday mornings from 9:50 to 10:15. But about 80% of the “homework” I sent home with the children never came back. Ideally, I’d like parents to spend 10 to 20 minutes a day working with their children, but if I can’t even get them to do 10 minutes twice a week, what chance is there of that happening?

If your child’s SLP gives you a home program, do it. If not, ask for one. A guy once asked his dentist whether it was really necessary to brush and floss every day. “Of course not,” replied the dentist. “You only need to do that with the teeth you want to keep.” I’ve come up with my own variation on that advice for speech therapy home programs: “You don’t need to work with your child every day—just on the days you want her to make progress.”

5. Failure to self-educate

You’re reading this, so if this is a mistake you’ve made, you’re not making it any more. Pat yourself on the back and keep it up!

Information is power. Knowing as much as possible about communication disorders gives you the tools you need to find the services, and provide the follow-up, that will provide the maximum benefit to your child.

Now that the age of the Internet is in full swing, there’s really no excuse not to self-educate. But remember: A little bit of knowledge is a dangerous thing. Don’t half-educate yourself—this is your child we’re talking about! My site is a good place to start, but there are hundreds of other sites out there, including many that focus more closely on specific disorders and syndromes. Find the ones that pertain to your child and read them carefully.

In addition to the Internet, you can find books and articles at your local library. If you’re not lucky enough to be living near a university with a major research library, you can get materials through inter-library loan programs.

You’ll probably read some conflicting opinions about communication disorders, and you’ll probably also come across “information” that’s just plain wrong. There’s a lot of snake oil being peddled on the “World Wild West.” So read with a critical eye and a healthy supply of skepticism. Take time every now and then to do a reality check. Talk to real live speech-language pathologists. Trust me, we totally don’t mind—in fact, we love it when people ask us to share what we know. We’re nerds; use it to your advantage!

Talk to other parents who have been where you are. Join an online discussion forum like this one and ask your fellow participants what has worked for them and their children with communication disorders. In addition to the information you gather, you’ll be reminded that you’re not alone.

All parents make mistakes; why should you be any different? To err is human, but so is learning from our mistakes. None of the pitfalls I’ve described on this page are irreversible. You can go on making the same mistakes, or you can stop. As with so much in life, what you choose to do is entirely up to you.

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