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Does my 4 year old need speech therapy?
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This patient support community is for discussions relating to Speech and Language Disorders. Topics include, but are not limited to: Aphasia, Apraxia, Autism and Communication, Developmental Dyspraxia, Motor Speech Disorder, Orofacial Myofunctional Disorders, Paradoxical Vocal Fold Movement (PVFM), Tongue-Tie (Ankyloglossia), Voice Disorders

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Does my 4 year old need speech therapy?

My 4 1/2 year old son has always been in my opinion, very shy. He is currently in Pre-K and has been going to daycare since he was a year old. He  usually does not   show much interest in socializing but when coerced to get out of the house, he does interact well with his peers. He is very independent and academically inclined. He loves to read (by relating pictures to word), writes very well and can spell words ranging from 3 - 6 letters. The problem I have is that his teacher thinks that he needs an extra boost in his speech development. I took him for speech evaluation when he was 3 1/2 years old and the therapist thought that he was right on track for his age. He does talk in full sentences, but he has problems pronouncing some words, for example, he drops the 's' sound in words beginning with s. He will say 'no' instead of snow and 'tore' instead of store. For the most part people can understand everything he says. I think that all he needs is a little more time to start pronouncing his words properly but I need a second opinion. Do you think I should seek a speech therapist.
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470168_tn?1237474845
It would put your mind at rest if he was assessed by a Speech and Language Therapist who has experience of speech impairments.  
You say he talks in full sentences.  Does he repeat words or phrases from TV/DVDs he has seen?
When you ask him a question does he answer what you've asked or does he say something totally unrelated to the question?
He may have an auditory processing disorder if he is missing certain letter sounds off words.  Google central auditory processing disorder to see if that sounds relevant.
Sometimes, if a child is not hearing a word correctly they will say it exactly as their hear it.  That can cause problems with reading and writing because the words he sees are not the same as how he hears them.
It would also be useful to have his receptive and expressive language tested as sometimes there can be a difference between their ability to speak as opposed to understanding what people are saying to them.
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Avatar_n_tn
Thanks for your comment. Talking in full sentences means that he asks for what he wants, he tells us what he does and doesn't want to do, etc. If asked a question he gives relevant answers. He also follows directions well. What I did notice when he was 3 years old was that he repeated the question when asked rather than answering it. He has stopped doing that so i figured it was just the stage of his development. As for dropping the 's' off his words, whenever we correct him he does repeat the word with the 's' sound (so I know he can do it) but when saying it again at a later time, the s is dropped again. I will do some research on central auditory processing as you suggested. Thanks again.
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470168_tn?1237474845
I would speak with a SALT about his repeating the question back at you when he was 3.  As you say, that maybe part of normal language development.  But repeating words, phrases, questions, TV dialogue is called echolalia, and it is a speech disorder.  Children who learn language in this way may sound very grown up for their age, or say things that sound funny because they are from TV.  Or sometimes they can use these words phrases inappropriately and it can sound rude.  In any case, I would mention it.
I presume he doesn't have any sensory issues like cover his ears at sudden noise, or appear deaf, or complain about clothes tags or shoes or socks, or appear not to feel pain, or complain of smells/tastes/textures of food and that his balance and co-ordination are fine.
You also don't mention anything about tantrums or anger, so I presume he is fine and that you have no concerns in that area?
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Avatar_n_tn
He does complain about clothes tags a lot, in fact I have to cut most of the tags from his shirts. Is that a reason for concern? I thought that was normal especially since most toddler clothes are now being made tagless. He appears to be fine as far as the other issues you mentioned are concerned.
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470168_tn?1237474845
Things like having to remove clothes tags, or being very sensitive with socks and shoes, or appearing not to feel pain, or fluctuating between appearing to feel pain at the slightest touch and then on another occasion appearing not to feel pain, or complaining that washing/brushing/cutting his hair or nails hurts can be signs of Sensory Integration Disorder.  That can affect any or all of the senses and the senses can be either over or under sensitive and can fluctuate between the two.
It might be an idea to go to your doctor and ask for your son to be assessed by a Speech and Language Therapist and for you to mention the mispronouncing words (auditory processing/auditory memory), sensitivity to clothes tags, reluctance to socialise, appearing quite academic etc.  It maybe that he does need some input from a SALT, but the areas of difficulty you have mentioned are also common for children who are on the autistic spectrum.  From your post your son sounds very capable and therefore even if he is on the spectrum he maybe very mildly affected.  But my advice would be for you to have him assessed by a multi-disciplinary team that have experience of diagnosing autistic spectrum disorders and aspergers.  If he doesn't have enough characteristics he won't get a diagnosis.  But if he does have some autistic/aspergers type traits then the sooner he has SALT the better the outcome.  I don't want to scare you to death, but if his nursery teacher has noticed that his speech is not at the same level as his peers, then I think you need to start the process of asking for assessments.
My son is diagnosied with High Functioning Autism, and it was my neighbours who are both teachers, who spoke to me when he was 3+ years old and told me that my son wasn't speaking enough and that I should have him assessed because he would struggle academically and socially in nursery/school.  He eventually received a diagnosis 18 months later, but the SALT was the first professional to assess my son and she told me from her first assessments that I should expect to receive a diagnosis of autistic spectrum disorder.
It is quite possibile to have auditory processing, sensory integration disorder or sensory difficulties and not be on the autistic spectrum.  I have auditory processing and sensory difficulties but I am not autistic.  But most, if not all, of those on the spectrum also have those difficulties.
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Avatar_n_tn
The symptoms of Sensory Integration Disorder are very similar to some of the characteristics displayed by my son. I will definitely mention this to his doctor. thank you for your help.
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470168_tn?1237474845
My son, who is nearly 8 now, has improved alot since he was a toddler.  I don't know if he is becoming less sensitive, or his senses are perceiving things better, or the communication between the brain and inter senses has improved.  But the supports I  used for him made him able to go into new environments whereas previously he just wanted to stay indoors at home.  
I had him assessed for Irlen Syndrome as this can accompany autism, SID or dyslexia.  It is remedied simply by wearing irlen tinted lenses in glasses.  Google it to see what it is.  Irlen Syndrome is a recognised medical condition and our local hosplital now screens for it.  The reason I had my son assessed was because I suspected he had some visual perception problems and 80%+ of sensory information is visual.  I figured that if his visual sense was out it could have any impact on his other senses.  My son is mainly hyper sensitive with sound and touch.  But he also appears deaf at times and appears not to feel pain.  With SID the reception fluctuates day to day and throughout the day, or it isn't a matter of assessing your son to find out what his difficulties are because they will be different throughout the day.  That is why I found the questionnaire at the back of the book by Olga Bogdashina (Sensory and Perceptual Differences in Autism and Aspergers), very useful because it tells you which sense is affected.  Once you know that you will start to recognise from their behaviours whether too much or too little sensory information is coming in because of their behaviours.  For example lack of visual input would cause a child to look intently at things, or like mirrors or shiny things.  Being oversensitive visually would mean picking out every detail in their surroundings eg. a piece of fluff on the floor.  
When you go to see the doctor also mention his speech difficulties.  All of his difticulties maybe linked.  He may have a mild form of autism, or maybe not enough to get any diagnosis but it maybe recognised that he has traits of autism.  Even if he doesn't get a diagnosis, if he has these types of difficulties then the same kind of supports they use for high functioning autism and aspergers would also benefit your son.
Your son may prefer to be at home on his own because of his difficulties.  He may have some social interaction difficulties.  And it would be worth a SALT assessing his social interaction and language skills just to make sure everything is okay.  It would be much worse to find out at a later stage because he would have missed years of opportunity for therapy.  And because everything is always funded on a budget it is quite hard to get any kind of input, but especially for those mildly affected.
I would advise you to be very open with your doctor and ask him outright about the possibility of your child being on the spectrum.  Sometimes doctors don't know much about autism, or they don't recognise the symptoms and send parents to endless referals that lead to nothing.  Tell him that you have concerns about his language, lack of interest in social interaction, sensory issues and that you would like him assessed by professionals who have experience of diagnosing autistic spectrum disorders.  If your son does not have autism he won't get a diagnosis, and if he does then you can start to get things into place eg. therapies and supports in school.  This can take a while (depending on where you are).  For example it took me 2 years waiting to see an Occupational Therapist for SID!  And that was in addition to the 18 months it took to get a diagnosis.  So from school first raising their concerns at 4+ years old, I am only now (some 4 years later) at a stage where professionals are beginning to put programmes of therapy together and I have moved my son to a school that has experience and expertise in teaching children with autism.  It is still a mainstream school, and there are 9 other children in his class of 18 who are on the spectrum.  I cannot emphasise how important it is for your child to be in a school that understands and can meet and support his educational and social needs.  
I hope all goes well.  If you want to send me a PM to ask me questions or let me know how things are going that is fine.
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Avatar_n_tn
Thanks again for all you advice. I will keep you posted on how things are going.
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1850460_tn?1319305894
Having little to no personal experience with the symptoms you speak of, I felt compelled to at least share with you the fact that Richard Phillips Feynman never spoke, according to his biography, until the age of 3. What became of the man thereafter you may want to Google if you don't already know.
I do my own research on notable personalities and use their full birth names and birthdates to test the validity of both numerology and astrology in assessing both character and potential health traits. If you've any interest, kindly let me know. This is has been a hobby of mine for 50 years now.
Am in agreement with other posters that earliest assessments yield the best long-term results, however.
Many blessings.
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