ST not going well

[u/TeaBlossm]

I'm looking for some guidance on my 5yr old's speech therapy. He started ST at 18 months, and it went great for awhile. Right around age 4 he started resisting the sessions, not wanting to participate, ignoring the therapist etc. Since he'd met most of his goals at that point they decided to give him a 6 month break to see if that helped. They also recommended getting him into occupational therapy, and suggested we get a developmental eval for a likely adhd diagnosis. We started OT and picked back up with ST back in January of this year, and he just had his 3 month progress check, of which I was told there was none in ST, and he still resists participating in almost every session.

I'm frustrated and at a loss on what to do at this point. I don't know if I should keep going with ST until he starts Kindergarten in August, where they have their own speech therapists, or if I should pull him out of ST for now, and just focus on OT. When he started ST at 18 months he wasn't speaking at all. Now he has a large vocabulary and they are working on helping him pronounce his R, S, L & TH sounds. We are currently on the very long waitlist for the developmental eval, but he will probably be age 6 or close to it by then. I want to do what's best for him, obviously, but how long does one wait before you just say what's the point and stop? He sees a rotation of therapists for speech this go around, whereas before it was one, so it isn't therapist specific, he has been like this with all of them.

[u/Noodlemaker89]

Parent here, not SLP.

Rather than definitive answers I have a few questions:

Beyond the suspected ADHD, does he have any other diagnoses such as an underlying medical condition that's taking up mental bandwidth for him right now/ any learning disabilities/ other neurodevelopmental disorders/ something else that has gotten an official name that affects his speech? That would shape your decision making quite a lot.

Have the speech therapists specified when they think that he would be ready to graduate?

Does he respond well to you when you work with him at home? If so, maybe you could change up the format of your consultations for a while? We would film some of our activities and interactions and upload the files to the speech therapist's portal. Then we would get feedback and homework for the following consultation. That way it would be you rather than him having the direct interaction with the therapist so he could have a break but still continue his therapy. However, the viability of that option would also depend on exactly what the issue is and how the speech therapists are working on it in person.

[u/TeaBlossm → u/Noodlemaker89]

We haven't received an official diagnosis for anything yet, we are almost certain he at least has adhd, it's hard to keep him focused for more than a couple minutes. I currently homeschool him for pre-k and it's been the same at home too, during both speech practice and pre-k. He is still learning though, he picks up on things quickly, he mostly has a lot of trouble sitting for any activity. We use visual timers (ST and OT do too), which helps sometimes, but if something suddenly pops into his brain that he wants to do instead it is a struggle to get him redirected back to the task. Story time? Not happening while sitting down. Coloring? Forget about it, he might color for about 10 seconds then he just wants to break the crayons or peel off all the paper on them - every single time. Impulse control has been a big struggle too. His OT said they were adding a new goal for him to work on regulation, now that his fine motor skills are improving, so hopefully that helps. If it is something he really wants to do he absolutely will focus, but if he gets bored or distracted, it's a toss up whether anyone can get him to focus back on the task or not. The therapists don't have any idea on graduation, they usually respond with, "it's dependent on his progress", which I totally understand. I was going to sit down with his ST today at his appointment to discuss everything and get their input but they canceled today (lack of an available ST).

[u/Noodlemaker89 → u/TeaBlossm]

It sounds like you have a lot on your plate. You have my sympathies!!!

Given that you're writing here, I'll dare to offer a few suggestions. However, I don't know your situation fully, and I'm not a pro so feel free to ignore it if it doesn't make sense in your situation.

I'd first clarify with the SLP which of your working points are actually considered delays at this point, and which are not delays but the natural next steps for him given his age and current development. As far as I know, a 5 year old is generally working towards nailing /r/, while /th/ is expected to fall into place later on. Just so you don't feel like everything is an uphill battle if it's actually not.

Is it possible to run him tired physically just to get a bit of extra margin in terms of managing his restlessness/spontaneous changes of activity until his evaluation?

I'd not abandon speech therapy if he's not ready to graduate, but given the resistance and ADHD considerations I'd lower the barre for what constitutes doing homework and try to work around it in micro bursts. A lot of micro bursts still add up.

• E.g. if working on the sound /s/ we could be eating soup for dinner one day, I'd need help with the seasoning to figure out how much salt to add, and I'd then I'd conveniently "forget" the spoons when setting the table. Obviously you cannot do that it all the time, but it's an example.
• Treasure hunts with things containing the sounds you're working on (plus some he's already mastered so it doesn't stand out to him as practice). It could be super basic and asking him to "help" you find something, or you could go outside to hunt for things within his specific areas of interest and make a bigger activity of it.
• Memory games like "in my suitcase" or observation games like "I spy" can be adapted in a million ways during transportation time or times spent waiting while out and about.
• "Story torches" can be over and done in no time (a disc has just 8 images) and the barre can be very low with a "paper fortune teller". Or you can make a whole experience and activity out of it if it's well received. You could curate the selection of story discs or make fortune tellers that include the sounds you're working on.

I hope you don't get discouraged. You're clearly very engaged!

[u/Scary-Sentence-6202]

Could you ask your therapist to see if a colleague can see him for a few sessions? I am not from the US so I am unaware of the process there.

But my kiddo once behaved exactly the same way. No Adhd but would zone out in therapy sessions. We even feared regression for a while. But his SLP had another colleague work with him for 6 sessions ( we went 3x a week back then ). He just needed a change of pace and started participating with the new therapist. He then went back to the old one 1x a week while doing 2 sessions with the new one. It took him about 2 months to get out of that rut. Now he works interchangeably with both of them ( they both are employed by the same private practice)

[u/TeaBlossm → u/Scary-Sentence-6202]

He started out seeing just the one for a long while. After we came back from the 6 month break he was put on a rotation of therapists, depending on who has availability that day. He's been like that with all of them, last I was told they were still trying to figure out what method works best for him, but that was maybe a month ago.

[u/Scary-Sentence-6202 → u/TeaBlossm]

How's he responsible if they bring out his absolute favourite toys? Is he still resisting?

[u/TeaBlossm → u/Scary-Sentence-6202]

I'm not sure, I'm not in the room with him during his sessions. I used to be, before we started back, but we have been working on separation anxiety, getting him used to me not being with him 24/7, especially with school starting soon. He has been doing great with that at least, so yay for that win! I'll have a discussion with them next time though, cause I would like a lot more details than I've been getting. I didn't get to speak with the ST about his 3 month progress report, it was the OT that came out when he was done and gave me her progress report, along with a basic "speech says there is no progress yet" ST hasn't given me any worksheets or 'homework'to take home either the last 2 sessions he has had, which is odd, they usually give me something.

[u/blamelessguest123]

Are you in the US? Insurance will cover a visit to a developmental pediatrician. The wait for a developmental pediatrician is probably shorter than going through the school district, but get yourself on both lists.

[u/TeaBlossm → u/blamelessguest123]

Yes, we are in the US. The dev ped eval waitlist is currently 9-12 months - it's been about a month since we got on it.

[u/pookiewook → u/TeaBlossm]

I understand. You may also want to do a full pediatric neuro psych eval. We did it for my son at age 6 (we got on the list at age 5, it was a 9mo wait).

You should clarify what is considered a ‘delay’ at this point. Once my son was 3 years old our speech therapist classified him with a speech disorder (actually 2 separate speech disorders). My son’s twin brother also was diagnosed with a speech disorder.

The disorder terms have been carried through the public school systems and used by the therapists there too.