Cheryl Maguire is a Boston-based mother of three. When her twins were 2, “they were not saying any words yet,” she told HuffPost.
“I was in a group for moms with multiples (twins, triplets, etc.), and they suggested that I get them evaluated,” Maguire said.
The process was simple. Maguire called to request an evaluation via Massachusetts’ Early Intervention program, which provides services for children with a developmental delay or a condition likely to cause one. An EI evaluator came to her home to assess the twins and returned later with the results. Both children qualified for services based on their delayed speech.
After that, two therapists — one for each child — came to Maguire’s home once a week.
“My kids loved it,” said Maguire. “They would sing songs and play games.”
In addition, her children qualified for a classroom-based program for about two hours a week. “It was similar to preschool, with a teacher and maybe 10 kids. They would play games and do arts and crafts,” she said.
When they moved on to preschool, Maguire’s children were evaluated for individualized education plans — legal documents laying out students’ goals and the special assistance they will receive at school — but they didn’t qualify for services at that point.
Later, both were diagnosed with attention-deficit/hyperactivity disorder. Maguire said she’s heard that the condition is common in kids who qualified for EI when they were babies or toddlers.
Overall, she said, EI was “a wonderful experience for all of us. Being a stay-at-home mom of twins, it was hard for me to go anywhere with them. So it was really nice to have that time when they had fun and played games. I think EI also helped them to talk and develop social skills.”
The kinds of activities that her twins did with the therapists would benefit any child, Maguire said.
What is Early Intervention?
Early Intervention is a free or low-cost government program that provides therapeutic services for children with special needs. Though federally funded, each state runs its own program, so there are differences between states.
As Emily Duszynski, a developmental therapist in Michigan, explained to HuffPost: “Generally, a child will receive a comprehensive evaluation to determine if they qualify for the state’s Early Intervention program. A child will have to show a percentage of delay, as determined by the state (i.e., 30% delay) in an area of development. These areas of development include cognition, receptive language, expressive language, fine motor, gross motor and social and emotional development. Children may also enter the program if they have a qualifying medical diagnosis, such as Down syndrome.”
The premise of EI is that intervening early makes a difference, potentially preventing bigger issues down the road.
“Early Intervention has been linked to greater outcomes for young children and their families,” Duszynski said.
“Research has shown that 1 in 3 infants and toddlers who received Early Intervention services did not later present with a disability or require special education in preschool.”
For autistic children, research has also shown the benefits of early diagnosis and interventions.
How do I know if my child qualifies?
Duszynski suggested requesting an EI evaluation “if your child is not hitting developmental milestones, if your child is having difficulty at home or at day care, if your child has difficulty engaging socially with others, or if you as a parent are feeling stressed, overwhelmed and at a loss.”
Grace Bernales, a speech-language pathologist in California, told HuffPost that signs of a speech delay may include “the child not responding to their name, difficulty following directions, not yet combining words at 24 months old, and/or not yet producing between 10 to 50 words at 18 months old.”
If your child has a genetic condition, hearing loss or another diagnosis that may lead to a delay, they will qualify for services. Children considered at-risk for a developmental delay due to preterm birth or low birth weight, for example, also qualify for EI in several states.
Children entering the foster care system may need an evaluation as well, said Patty Maxwell, a Pittsburgh-based behavior specialist and the founder of Engage Kidz, which provides children’s behavioral and educational therapy. If you are a foster parent, the agency you are working with can help you request one, as can child welfare services.
How do I get services for my child?
A child care or medical provider may refer your child for an evaluation or suggest that you get one. In some places, parents can call their state’s EI program to directly request an evaluation. Evaluations take place in a familiar setting, such as the child’s home or day care.
Duszynski described the process: “At least two evaluators will be present during the evaluation and will learn about a child’s routines, interactions and development through conversation with caregivers. Also, the evaluators will be interacting with the child through play — children often don’t know they are being evaluated and often enjoy this process. Evaluators understand different temperaments and will often adapt the evaluation to meet the needs of the child.”
If your child meets the state criteria for a delay and qualifies for services, you will work with the evaluators to create an individualized family service plan, or IFSP, outlining your child’s goals and the services they will receive.
“The IFSP will determine what EI services will look like for that family, including type of provider and frequency of services,” Duszynski said.
If your child does not qualify for EI but you believe they need support, your health insurance may cover services, or you could pay for them out of pocket. Providers who see patients under a state’s EI program might take private clients. You can also request that your child be evaluated again later.
Knowing that it makes a difference to start services early, Maxwell was eager to get her own son evaluated when she suspected a delay.
“Because I work in this field, I was super cautious with both of my children,” Maxwell told HuffPost. “At 14 months, my son would say a random word after grunting. He finally qualified for Early Intervention services at about 18 months old.”
What do services look like?
If your child qualifies, services are provided at low or no cost to you in a setting that is familiar to your child, such as your home, their day care, a relative’s home or a park. A therapist will typically work with your child once a week for one hour, Maxwell said.
She explained that most providers use a “coaching model.”
“Parents and caregivers are supposed to be involved and learning how to work with the kids,” Maxwell said. ”[The] therapist might do one-on-one work with the child, modeling for the caregivers what to do.”
Therapy is also play-based.
“Toddlers learn best through play,” Bernales said. She explained that therapists tend to use items from a child’s natural environment, such as toys or books already in your home, during therapy. They may also teach you strategies to help you support your child’s development.
What are the benefits of EI?
“If a child starts in EI, they have a better foundation than a child who waits and starts receiving help in preschool and/or elementary school,” Maxwell said.
“One of the thoughts behind Early Intervention is to catch the child as early as possible so they don’t need services the rest of their life,” she added.
Research shows that the first three years of life offer an unparalleled opportunity to impact a child’s development.
“A child’s brain grows at a greater rate during the first few years of life than during any other point during their lifetime,” Duszynski said. “Not only are more neural connections created during this time, but the brain is also more adaptable during the first three years of life, making learning new skills an easier task in comparison to later in life.”
While it is true that some children’s delays will resolve naturally over time, Duszynski, Bernales and Maxwell agreed that there is no reason to put off seeking an evaluation if you think EI might help your child.
“If parents are told to ‘wait and see’ for their child to talk, I believe they should follow their gut and seek another opinion,” Bernales said.
Duszynski said she often hears that when parents express concerns to pediatricians or other care providers, they are told things such as “give your kid time” or “he will grow out of it.”
“But why wait?” she said. “This service is only available until your kiddo is 3. Trust your parent instincts and seek support if you feel that your family can benefit from it.”
There are really no risks to play-based therapies, and children usually enjoy them. “The child doesn’t even realize they are working,” said Maxwell. “In their eyes, they’re playing.”
If, for some reason, a therapist isn’t working out, Maxwell suggested that you “ask for a new therapist and kindly state that it was not a good fit.”
What happens when my child turns 3?
EI services are funded until your child turns 3. To continue receiving them after that point, they will need to qualify for preschool special education. Under the Individuals With Disabilities Education Act, children ages 3 to 5 with developmental delays or related diagnoses can receive services.
A few months before your child turns 3, you should work with your therapist or service coordinator to have your child evaluated to see if they qualify for preschool special education. Though some children will continue to need therapies or other support in preschool and elementary school, it is not uncommon for children to no longer have delays once they approach age 3.
Maxwell’s son received speech services for about a year when he was a toddler.
“He has not stopped talking since,” she said. “He just graduated high school.”