I meet many parents who repeatedly tell me, “I’m not worried,” when we discuss the reason they’re bringing their child to me for an evaluation. One of the best things I learned in college was to begin each meeting with the same questions for parents: “Who referred you to seek an evaluation for your child and what are your concerns?”
From these essential questions, I quickly learn how ready parents are to seek my help, as well as their feelings about the original referral. As the evaluator, I determine how the parent feels about the evaluation. Some parents just go through the motions of getting an assessment, because their pediatrician recommended it, but they truly believe their child is just fine and might outgrow the concern. Earlier in my career, I would have tried to convince the parents they should take action right away by seeking speech-language pathology services.
Now I take another approach. I have learned to respect parents and families wherever they find themselves on their journey accepting their child’s speech or language disorder. Reluctant parents might be in denial, hopeful their child will outgrow any issues, or they might feel addressing a speech disorder is not a high priority. Whatever their attitude at the time of evaluation, I eventually realized it’s not my place to convince them of the value of my services. It is my job to inform.
When I encounter families demonstrating a lack of interest in moving forward with treatment, I just educate them to the best of my ability. I try to take my ego about the value of my skills out of the situation. I offer evidence-based information, such as typical developmental milestones at various ages to help them understand their child’s abilities.
Here’s an example of how I state what I observe as objectively as possible: “I notice your child can say words. However, to request objects, he grabs and grunts. Do you notice that too?” Asking the parent to watch and comment on what you’re evaluating can help them see your observations.
Here’s another scenario: I find that the child demonstrates significant delays in an early intervention assessment, but the parents indicate that they aren’t concerned. During our post-evaluation conversation, I stick to facts. I might explain at what age along the developmental timeline their child speaks and understands speech as compared to their chronological age. I also let them know that I respect their level of concern about their child’s issues and their interest in treatment. I share the benefits of early intervention, such as how seeking treatment now helps prepare a child for future academic success.
When I see parents in denial or defensive, I ask one parent to call the child’s name. Together, we count how many tries it takes for the child to respond. This is usually more effective than just asking parents if their child responds consistently. I also might instruct the parent to hold a preferred object without letting go to discover if the child uses gestures or words to request the object. This exercise gives parents a telling demonstration of their child’s ability to request.
Finally, I try to ask open questions: “In what areas do you feel your child needs help? What would you like your child to gain from treatment if we feel he needs services?” Getting the parent to talk about what might help their child, rather than areas where they struggle, can show parents the bigger picture. Assessment is just the beginning of the process, intended to detect whether the child needs help and how to get that help.
In the end, I feel it is essential to help the parents make an informed decision about waiting or moving forward with speech-language intervention for their child. But I no longer see my role as having to convince families to seek treatment. Parents or caregivers need to come to their own conclusion about when to elect treatment for their child. I give reluctant families all of the information I can from my training and years of experience. If they still choose not to use my services, I explain the process of getting a re-evaluation in the future and know I did all I could do.