The Dangers of “Wait and See”

I worked with a mother of a bilingual child with a significant language disorder who was told by the pediatrician to “wait and see” for TWO YEARS. This mother told me her gut feeling started when her child was three years old. She shared how she stopped speaking Spanish at home to focus only on English. The mom spoke about how inadequate, ashamed, and alone she felt when her concerns were repeatedly dismissed by the pediatrician, teachers, and even family members. She felt overwhelmingly guilty about the lost time her child could have spent in therapy getting help, but now would have to try and catch up. The mother felt remorse that her child could have had bilingual therapy, but now may need years of practice to develop a second language.

She felt like she had failed her son.

It’s a heartbreaking story, and unfortunately one I hear way too often. I have parents tell me they regretted waiting and wished they would’ve asked questions earlier. Parents who have spent thousands of dollars on years of therapy for something that could have been less severe if only they had started earlier.

Let’s change the model from “wait and see” to “DO and see.”

There are no harmful effects from helping a child who might eventually catch up to their peers. However, there are significant risks in delaying therapy for a child who will not catch up without help.

Myths of Speech Therapy

As a speech-language pathologist I feel it’s my responsibility to ensure the concerns of caregivers are heard. I believe parents are the experts on their children. They know what is typical for their child. I trust that if a caregiver has a concern or uneasy feeling about how their child is developing, it is worth my concern too.

Pediatricians are often responsible for screening children for speech and language delays at the child’s well check. However, pediatricians have only a general knowledge about speech and language development. Speech-language pathologists are the experts and have more specific education and training to help identify children who need help.

Too often caregivers seek out help and get answers like:
  • “Don’t worry – he will talk when he’s ready.”
  • “She’s just a late talker, she will catch up.”
  • “Boys talk later than girls, he’s fine.”
  • “Einstein didn’t talk until he was four, maybe she’s just really smart!”

While these statements are given by people trying to help, they are NOT ALWAYS TRUE. (I’m not sure about Einstein, but brilliant kids can also have a language disorder!)

Research says 20%-30% of “late talkers” will not catch up to their peers without intervention (Dale, Price, Bishop, & Plomin, 2003). Is waiting a risk worth taking? If your child had a 30% chance of losing their ability to walk, would you just wait and see?

CLICK HERE for more answers to common questions about speech and language development.

What’s the harm in waiting?

The recommendation to “wait and see” is extremely outdated and even inappropriate based on the research we have available now. Without early intervention, a child may be at risk for the following:

Increased undesired behaviors

Negative behaviors are often the result of communicative frustration, or not being able to understand others or have them understand you. A child may act out if they cannot request their wants/needs, engage with others, share their feelings, or tell you they are hurt.

Missed window of opportunity

Did you know 80% of a child’s brain is developed by age 3, and 90% by age 5?

Although it’s not impossible to change the brain later in life, it’s much harder for these essential brain connections to be formed. These connections are needed for many skills like self-regulation, problem-solving, and effective communication skills (Brain Development).

Increased risk of mental health disorders

Studies show children who don’t get speech therapy early are at a greater risk of mental health problems later in life (O’Hare & Bremner, 2016).

Delayed academic skills and school readiness

The foundation for academic skills – reading, writing, math, following directions, engaging appropriately with peers – all depend on language skills (Sharma, Purdy & Kelly, 2009).

Decreased social skills

One study found children with language deficits are more likely to experience social difficulties, including making friends and interacting with their peers (O’Hare & Bremner, 2016).

Longer therapy needed

It takes four times as long to intervene in fourth grade as it does in late kindergarten because of brain development and increased expectations for academic skills and communication (National Institute of Child Health and Human Development).

How will therapy help?

Caregivers:

  • Save money in the long run (Each $1.25 invested in speech therapy yields $8.04 in increased lifetime savings!!)
  • Learn how to use effective strategies to help support the child during natural routines
  • Learn how to foster communication skills that create healthy relationships
  • Reduce family stress
  • Have a plan for moving forward

Child:

  • Increased confidence and self-esteem
  • Independence for the child
  • Increased safety (able to tell adults when hurt or in danger)
  • More ability to participate with peers
  • Make progress toward goals

“DO and See:” What will happen next?

When you have a concern about your child’s development, contact a speech-language pathologist for a screening or evaluation. After that, you have three possibilities:

  1. Qualify for therapy — You partner with a speech-language pathologist, learn strategies, and feel confident about getting your child the help they need.
  2. Doesn’t qualify for therapy, but could use some extra help –You learn how to better support your child at home and get connected with resources in your community. You may do another evaluation in the future if needed.
  3. No delayed skills – You feel reassured that your child’s development is on track.

If you’re unsure your child is developing appropriately, don’t worry about finding specific milestones. Just CLICK HERE to ask yourself these four questions and then call a certified speech-language pathologist.

Parents will not regret acting early, but may regret acting too late. Of the hundreds of families I’ve worked with, not a single one which has regretted getting their child the help they need. Be your child’s advocate- DO and SEE!

References:

Brain Development. (n.d.). Retrieved from https://www.firstthingsfirst.org/early-childhood-matters/brain-development/

Dale, P., Price, T., Bishop, D., & Plomin, R. (2003). Outcomes of early language delay: I. Predicting persistent and transient language difficulties at 3 and 4 years. Journal of Speech, Language, and Hearing Research, 46, 544-560

Gilmore JH, Lin W, Prasatwa MW, et al. Regional gray matter growth, sexual dimorphism, and cerebral asymmetry in the neonatal brain. Journal of Neuroscience. 2007;27(6):1255-1260.

Nowakowski RS. Stable neuron numbers from cradle to grave. Proceedings of the National Academy of Sciences of the United States of America. 2006;103(33):12219-12220.

O’Hare A, Bremner L. Management of developmental speech and language disorders: Part 1. Archives of Disease in Childhood 2016; 101:272-277.

Quick Statistics About Voice, Speech, Language. (2017, December 21). Retrieved from https://www.nidcd.nih.gov/health/statistics/quick-statistics-voice-speech-language

Sharma M., Purdy, S.C. & Kelly, A.S. (2009). Comorbidity of auditory processing, language, and reading disorders. Journal of Speech, Language and Hearing Research, 52(3),706-22.

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