Last Updated on October 10, 2023
Now we come to most important question: “What to do?” In other words – to speech delay treatment in Germany. In the first part it was a question “What is happening?” In the second part – “What is the cause?”
Let’s try to go from symptoms, not from age. And at the end also two important questions: What can you do yourself? and How to convince a pediatrician, that your child needs an examination?
Read part 1 Norm and problems,
part 2 Possibily deceases
part 4 Where you can find help. Speech therapist in Germany
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Table of Contents
- 1. Your child does not respond well to sounds / does not hear well after a cold / confuses similar-sounding words
- 2. Your child does not make contact, cannot look directly in the eyes, he is aggressive or fearful
- 3. If you suspect ADHS (attention deficit hyperactivity disorder) by the child’s behavior
- 4. Your child speaks indistinctly, ununderstable to strangers
- 5. Your child begins to draw initial consonants, insert letters in front of words (a, u, e), repeat the first syllables of words
- Speech delay treatment – what can you do yourself?
- How to speak with a pediatrician?
All normal speech therapists, unlike pediatricians, believe that the sooner a child receives speech therapy, the better. This raises the problem of how to get a recipe and where to claim it.
The more complex the problem, the more terms you need to take at the same time. Do not wait for results!
Also, it will look like this: at the same time HNO (2 month waiting period), Audiologie (up to 9 month), SPZ (9 month waiting and 2 year all examination – also without diagnose), Speech therapy (now up to 6-7 month).
1. Your child does not respond well to sounds / does not hear well after a cold / confuses similar-sounding words
— > go to the otolaryngologist (HNO) / Pädaudiologie
You can start with an ordinary city doctor. For him you need no recipe. The consequences of a cold, water in the ears, which often becomes the source of the problem, can be perfectly detected by an ordinary otolaryngologist.
It makes sense to wait 6-9 months for a term from an audiologist if some serious hearing problems are suspected or if the child confuses similar words (this requires diagnosis on special equipment).
2. Your child does not make contact, cannot look directly in the eyes, he is aggressive or fearful
— > go to Frühförderung (up to 3 years old), SPZ (ask for feedback! It’s better to go to the SPZ that specializes in autists), psychologist, speech therapist
This can be a sign of autism. Just keep in mind: a child who does not own his mouth is likewise aggressive and has frustration. Put yourself in his shoes and see why (nobody understands you – what can you do as a child?) For example, my very open and friendly child in the kindergarten was used as a baby toy. Children all the time poked him with a pacifier, dressed him up and put him in a stroller (judging by the photos). Kindergarten teachers did not understand him at all (and did not try to understand). But they were very surprised by the his frustration and wrote a lot of nonsense in the documents for SPZ.
Autism in a really problematic form is difficult to overseen, so I’m not talking about it. Another thing is not very expressed Asperger. It can be fully diagnosed after 7-8 years, before this age it is not clearly diagnosed (it depends, of course, on the degree).
Therefore if the child has normal intellect, but doesn’t speak, SPZ writes “autism is suspect” and does not look for other diagnoses. Сonsequence? You lost time. 2 years on SPZ down the drain.
But nonetheless, lack of speech or poor speech is strongly associated with autism, including in mild form, so in any case, check how your child matches the symptoms by age in this topic:
Boys have a more obvious problem than girls. Girls with Asperger are usually labeled as “wild” or strange in preschool organizations, but they are already more or less adapting to high school. Often, a mother’s Asperger is diagnosed after being diagnosed with her son.
The speech therapist for autists is an supporting specialist, and not the main one.
3. If you suspect ADHS (attention deficit hyperactivity disorder) by the child’s behavior
then go to Frühförderung (under 3 years old), SPZ or a psychologist
If the diagnosis is confirmed, then the speech therapist will also be necessary. But it will be much easier for him to work with the diagnosis than blindly.
4. Your child speaks indistinctly, ununderstable to strangers
There can be very different options, let’s try to differentiate them.
А. The child is bilingual, purely foreign language at home
Foreign language is correct (that is key point), German is behind. This is especially true of the volume of the dictionary.
There is no need to fight for the recipe, rather to fight against a recipe for SPZ.
After 4 years, you can (don’t have to) ask for a recipe to a speech therapist for “grammar problems”. In most cases in the 1. Grade the child catches up with classmates.
B. The child is bilingual, languages are distributed by parents
The child’s languages mix, they lag behind the age norm, especially in the vocabulary, but the basic skills and vocabulary are present. There are some correct words. Sounds are age appropriate (with a few exceptions). Sentences for the norm appear (it does not matter in what language or in what mixture).
It is not necessary to fight for a recipe to a speech therapist, but it is not bad to have one (see below which speech therapist to choose) if you can convince the doctor to give it without sending the child to the SPZ.
It’s a good idea to visit the Beratungsstelle at a speech therapy school if you have one: they usually indicate that they are advising parents of bilingual children. You don’t need a recipe for that. But the most important thing is to think over the rules for the distribution of languages in the family and strictly follow them.
C. The child has problems with articulation
The number of words, the presence of sentences are age appropriate. You have already check the ears.
The problem is in the articulation of sounds: they are bad at pronouncing, for example, w, s, sh, g, k, and of course r. The cause may be weakness of the muscles of the mouth (“lazy tongue”), it is treated with training, massage.
Usually this problem is heard even by a pediatrician, and you will calmly get a recipe to a speech therapist after 4 years.
D. A child at 2 years old speaks only vowels, a certain number of syllables and no words
And especially if the child remains in the same position even at three years old.
Or if the child randomly changes syllables, and most of the consonants are missing. The child has only one syllable of the word, for example second (pu – computer)
Or if the child replaces all inconvenient consonants with comfortable ones – so that it is almost impossible to understand him.
The child eats for a long time, does not like hard food. There may be varying degrees of motor problems.
At the same time, you do not suspect problems with autism (or admit that if there is autism, then a weak Asperger) or intellect (in this case check Fragile X syndrome), but you think that the child cannot control his mouth (this can be seen – ask him to repeat a series of two movements with his lips or tongue).
Well, you can be “congratulated”. Very likely, you receive endless speech therapy work with a dyspraxia.
If we are talking about the age of two, go to Frühförderung, from there it will be easier for you to get to the Logo and Ergo. If you are lucky it was a another diagnosis and the problem will resolve up to 3 years.
If we are talking about the age of three years, the problem will not go away and recipes should be taken for everything (see below how to choose a specialist) and immediately, since in many places the wait is up to 9 months.
It can be:
Beratungsstelle at a speech therapy school – without recipe
Frühförderung – without recipe
HNO in the city – without recipe
SPZ – but only good one! Better Kinderzentrum
Ears must be checked quickly and in any case. You go to city HNO and take a term by Pädaudiologie. This will give you the opportunity to tell the pediatrician that everything is in order with child’s ears, but, of course, you will check them with an audiologist, but in the meantime, still give please a recipe to a speech therapist.
Ask for a recipe at least for diagnostics to a speech therapist specializing in toddlers (for three sessions). If the speech therapist suspects dyspraxia – hurry up, take a terms wherever you have not yet.
Many “specialists”, especially in the country, tend to write off everything to bilingualism. But no bilingualism can be reason the absence of recognizable (albeit without a couple of sounds) words in 2,5 to 3 years – in both languages.
E. The child has limited vocabulary, has big problems in grammar in both languages
The pronunciation is normal, autism or other diseases are unlikely.
If at the same time there are also problems with concentration – this is a suspicion of ADHS.
If not, it looks like a Specific Language Impairment.
And in the first, and especially in the second case, you need a lot of speech therapist. The question comes up more likely by the years 4-5, so the problem with the recipe is unlikely to arise.
Read about different #insurance in Germany and what does public health insurance cover in Germany
G. Your child speaks at a wrong pace, which makes it very difficult to understand
More often, he speaks too fast, trying to get out everything he has in his head, and there is too much in his head. Sometimes, on the contrary, it suddenly slows down a lot. He changes words order, rearranges syllables. It is characteristic that he himself believes that he speaks normally.
This problem is called Poltern. Therapists have not yet studied this phenomenon at all. They know no causes, no recommended method. Only the first conference on this disease has passed.
5. Your child begins to draw initial consonants, insert letters in front of words (a, u, e), repeat the first syllables of words
The child suddenly raises his voice, often falls silent, helps himself with movements of his head or hands, This can be a sign of an approaching stutter.
Ask for at least a recipe for diagnosis – if the child is stutter, you need to see a doctor as early as possible.
Speech delay treatment – what can you do yourself?
- Listen to your child speak, take a week to write down everything he is trying to say. Write down all the sounds that are pronounced, and your assumptions – what this might mean. Ask all the family to do the same. Do such a list every 3 month.
- Repeat after him all the time the guessed “words”. He says “aa” – you repeat “Yes, car”. He says “ei” – you repeat “Play”. The children, if other people do not understand them, stop trying to say words correctly. The words lose their communicative function for them.
- See how the child articulates: ask him to stretch his lips, stick out and raise his tongue, click, make a sequence of mouth movements (for example, lips forward-wide-forward-wide). Analyze what and how the child eats – whether there are problems with solid food (meat, for example). This information helps by therapist and doctors.
- Check your child for a vocabulary: for example point to objects in pictures, point to body parts.
- Test the child for understanding:
give him a task of several actions.
ask to show words in the pictures that differ by one letter (as toy-boy). Speak the words in a whisper. Before that, check if he knows these words at all.
How to speak with a pediatrician?
Pediatricians don’t listen to parents. They especially don’t trust parents who don’t speak perfect German. This is typical, subconscious, intuitive: if you do not speak the language, you are an idiot. The exception will be native speakers of a highly respected language – for Germans, these will be native English speakers.
What can you do?
- Come to pediatricians together – mother and father of child. The pediatricians trust fathers more.
- Print the informations from speech therapists Websites. There are many such Websites, where they tell, that therapy should earlier begin. Tell about your family situation, your education, how you work with child. Take a list of child’s “words”. That is proove, that you are not the parents, which do not take care of the child and his speech.
- Ask for all possible doctor examinations at the same time, not one after another. Search for specialists carefully! And ask recipes (Überweisungen) not for nearest, but for best specialists, even they are far from your town.
- Take a letter from kindergarten, that your child has problems and needs an examination and speech therapy.
- You must be well prepared and speak confidently. Sometimes it makes sense to argue! I hate it, but I had to learn – otherwise you are just kicked out with nothing.
Otherwise, the years just fly away, and you stupidly wait for six months or more for the next term. It is difficult even for German-speaking parents. One mother in the special kindergarden said: “I feel like a beggar at the doctor’s office”. But for us, expats, it requires even more struggle and strength, since pediatricians tend to write off everything for bilinguality.
Next – part 4 Where you can find help. Speech therapist in Germany
All posts about #logopedia (#speech therapy)
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