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Questions & Answers - Other Concerns
I have a 12 month old little girl with Down Syndrome. We
participate in an early intervention program. Currently, she
receives 2.5 hours a week of PT,OT, and developmental and 1.5 hour a
week of speech. My question is two fold: First, how do you know if
your child is receiving good quality therapy, and second, how much
therapy should she be receiving? I do not think she is receiving
enough time.
Thanks for your question. It sounds like your daughter is
receiving quite a lot of services through early intervention, which
is great. Typically, children in EI programs in PA receive one hour
per week of each of the services you mentioned, unless the need for
more is well justified. Often children do not even begin receiving
speech therapy services until age 18 months-2 years, especially if
they already have a developmental therapist working with them,
unless the speech therapist is working on feeding skills. I am sure
this varies from program to program and from state to state. As a
therapist, my philosophy has always been quality, not quantity of
service...in other words more is not always better.
Does having 5 hours of physical therapy a week make a child
progress faster than having it once or twice a week? I can't really
answer that, it might for some children and might not for other
children. What I can say is that the philosophy of early
intervention is to not only work with the child, but to teach the
entire family how to work with the child so that the family can
follow through with weekly therapy suggestions and learn how to help
the child on a daily basis. Parents and extended families are the
ones that make all the difference in early intervention! You know
your child best and you are with your child 24 hours per day, we as
therapists are there to help teach you & your child. It is your
follow through, not our 1-2 hours a week of service that creates
progress and success. Early intervention is not meant to be out
patient therapy, we as therapists cannot succeed with your child
unless you are helping us succeed.
You can judge quality of
service by asking yourself if you understand your child's goals,
both short and long term. You should have an IFSP in place for your
child that clearly states what skills you as a family want your
daughter to work on and achieve. Each therapist that comes to your
home should have a focus to their session which is working toward
these goals and objectives. You should ideally be a part of every
therapy session and be doing "hands on" with your child with the
guidance of the therapist. Most therapists leave progress notes at
the end of their sessions which state what the child worked on that
day, how the child is progressing and some "homework" for your
family to work on for the week or until the next session occurs.
Your child and therapist should work well together and you should
have a rapport with the therapist as well. However, this does not
mean that your child will not cry during physical therapy or other
sessions, since some exercises and therapies are "hard work" for the
child and they learn early on that "hey, this lady makes me do stuff
I don't like to do!".
Keep in mind, therapy is through play at this age, and play is
very important. Therapy is play with a purpose. I emphasize the word
"play" over the word "therapy". You do therapy with your child every
day without realizing it. You don't need to focus on the word
"therapy", but rather think that when you simply read a book with
your child you are working on receptive language (listening and
recognizing pictures) and expressive language skills (trying to
imitate new sounds & words), cognitive skills (attention span &
memory), and fine motor skills (pointing to pictures). If you are
rolling a ball back and forth with your child you are working on
visual tracking skills, fine motor skills, gross motor skills,
language skills, etc. Children under age 2 typically don't tolerate
sessions longer than an hour from early intervention and I am always
careful about overwhelming children with too much too soon. You and
your therapists as a team will be able to know what your child can
tolerate and will be able to judge the progress she is making.
If you do not think your child is receiving enough service from
early intervention, I would discuss this with your team of
individual therapists. Some parents still would like more therapy
for their child than early intervention provides, and so they seek
out private therapy through a local hospital or clinic that is paid
for by private insurance.
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