Current referral rates do not match prevalence data!
Communication Disorders are the most common disorder of childhood. Prevalence data tells us that as many as 1 in 12 children between the ages of 3 and 17 has a Communication Disorder. It also tells us that Speech Sound Disorders are the most common Communication Disorder.
At Speechie, we are concerned that referral rates in New Zealand are much lower than they should be. We worry this means that children with Communication Disorders are not being properly identified and are not being referred or are being referred too late.
So, we have made it our impact priority to make sure that children with Communication Disorders are identified, assessed, diagnosed, and treated as early as possible. Through our 'communication currency for kids' shared funding initiative, we are building a sustainable, subsidised speech-language therapy service for children with guarantees of consistent, comprehensive communication screening, a first appointment in 10 days, and initial assessment in 30 days.
Because a child's oral language at school start predicts their success at school and in life.
Because quality speech-language therapy ASAP is what changes outcomes for children with Communication Disorders.
At Speechie, we are concerned that referral rates in New Zealand are much lower than they should be. We worry this means that children with Communication Disorders are not being properly identified and are not being referred or are being referred too late.
So, we have made it our impact priority to make sure that children with Communication Disorders are identified, assessed, diagnosed, and treated as early as possible. Through our 'communication currency for kids' shared funding initiative, we are building a sustainable, subsidised speech-language therapy service for children with guarantees of consistent, comprehensive communication screening, a first appointment in 10 days, and initial assessment in 30 days.
Because a child's oral language at school start predicts their success at school and in life.
Because quality speech-language therapy ASAP is what changes outcomes for children with Communication Disorders.
General referral guidelines
- Referral rates for speech-language assessment should match the Communication Disorder prevalence rate of 1 in 12 children.
- If in doubt, get your child checked out.
- Speech-Language Therapists are the only professionals uniquely qualified to assess, diagnose and treat Communication Disorders. We caution that it is not appropriate for medical and education professionals to take it upon themselves to tell concerned parents that their child's communication skills are 'fine.' Instead, we recommend that it is appropriate for medical and education professionals to behave as referrers and to tell concerned parents to seek the professional opinion of a registered Speech-Language Therapist.
- Where possible, we recommend that concerned parents get in touch with an independent registered Speech-Language Therapist. That way parents can be sure that their child's Speech-Language Therapist is not bound by any service constraints and has the complete professional freedom to diagnose Communication Disorders and to make intervention recommendations that fit.
- We recommend that children are referred for assessment by a Speech-Language Therapist on the basis of formal, objective, standardised, norm-referenced, and comprehensive speech, language, and communication screening - not just based on a subjective 'can you take a quick look at this child' approach. We also recommend comprehensive assessment of a child's total speech, language, and communication skills - not just isolated evaluation of a specific concern mentioned by the child's parents or teacher.
- Children with communication problems often don't talk a lot. They may have difficulty understanding what is going on and lack the confidence to participate or may not know what response is expected of them. Sometimes they are aware that something is wrong but lack the language and self-advocacy skills to talk about it. As a result, it is common for children with communication problems not to say much. We worry that adults tend to make a lot of assumptions when children don't speak, including that they are just shy, have an introverted personality, don't have anything to say, or even that they are deliberately choosing not to talk and are really being naughty and rude. Assumptions like these are one of the reasons why Communication Disorders sometimes stay hidden for a long time, so we recommend comprehensive communication screening of quiet children to formally rule out a Communication Disorder before jumping to any other conclusions.
ECE referral guidelines
Given that children's oral language at school entry predicts their success at school and in later life AND Communication Disorders are the most common disorders of childhood:
- Children who do not reach critical communication milestones should have their hearing tested and be evaluated by a Speech-Language Therapist.
- A child is never too young to be referred to a Speech-Language Therapist. The idea that children can't start speech-language therapy before age 3 is a misunderstanding. We recommend the earlier the referral, the better. After all, communication development begins in the womb when fetuses' brains start to develop, and their first responses to their Mothers' voices happen before they are even born. If as parent you are concerned about your child's communication skills, we recommend you follow your gut instinct and talk to a registered Speech-Language Therapist - for peace of mind, early identification of problems, and most importantly: early intervention.
- Toddlers between 18 and 30 months old who say few words for their age and have difficulty talking in the context of otherwise good understanding and normal general development are considered 'late talkers' and should be referred to the Speech-Language Therapist. This is because most late talkers go on to have weaker language skills than other children, even if they seem to 'grow out of it' by the time they start school. So we recommend speech-language intervention for all toddlers who are late talkers to help prevent later difficulties at school.
- The 'Delay 3+ criterion' (Klee et al, 1998) recommends that children are referred to the Speech-Language Therapist if they are 24 months old AND either have fewer than 50 words OR have more than 50 words but are not yet combining words into phrases AND either their parents are concerned OR they had 6+ ear infections during the first 2 years of life.
School referral guidelines
Given that Communication Disorders are the most common disorders of childhood, and given that Communication Disorders are also the least diagnosed disorders of childhood:
- When children are struggling with participating, contributing, communicating, listening, understanding, literacy, learning, or struggling with social-emotional skills and behaviour, it is prudent to rule out a Communication Disorder in the first instance through comprehensive speech, language, and communication screening.
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