Patrice Badami  0:02

Hi, this is Patrice Badami, with Acorn to tree family podcast. And today, I have Tiffany Fitzgerald. She’s a speech pathologist, and she specializes in early intervention. Some information about her is she works with toddlers aged one to three, she coaches parents on how to expand their child’s communication skills, so that they can get a bit better get their needs met at home, which leads to more joy and harmony at home for the entire family. She enjoys using social media platform it’s talk to speech is her website, she raises awareness about the importance of early intervention. And she teaches others different ways to incorporate strategies that work during their sessions for speech language. And she has some courses available that she’ll tell you about in a few minutes. And here she is.

Tiffany Fitzgerald 0:53

Good morning. Thank you so much for having me.

Patrice Badami  0:56

Yeah, I think this is gonna be very helpful, because it’ll be able to help families who need to understand more what exactly speech therapy is, and what the services are that go along with it. So first question for you is, when should families seek out early intervention services.

Tiffany Fitzgerald 1:13

So anytime that you’re starting to feel concerned, I always say that it can’t hurt to seek out an evaluation from an early intervention team. So what parents could do is just reach out to their local early intervention program. And you could do that easily by just Googling early intervention in my area, and what they’ll do is send out a team and they will evaluate and it’s very play based and basically based on parent interview, so a, an early intervention evaluation team would consist of a speech therapist, and, or an OT, so occupational therapist, and they’ll just come in and observe your child, see how they’re doing, they will do a formal assessment, but they’ll also ask parents questions as well. So I always say, anytime you start to feel like you have concerns with communication, maybe you’re doing your own research on when they should be hitting certain milestones like sitting up, crawling, talking first words, any of those areas, early intervention can help with even self adaptive skills, like getting dressed all of that. So I know that sometimes pediatricians may say, you know, just wait and see. But there is really no need to do that. So anytime you have that gut feeling as a parent or a caregiver, there’s never a time that’s too early to reach out for that evaluation.

Patrice Badami 2:48

Right. Having had two children with special needs. From my perspective, one child with my child, my daughter was 10 weeks early, and through the actual NICU and the hospital, part of their follow up program was to ensure that she did receive early intervention at one year, because she hadn’t reached certain milestones. One thing I came across that I wanted to share is the Center for Disease and control offers a milestone tracker, it’s an app, you should download that and you can actually keep track of certain milestones that your child is achieving, or if they’re delayed in those areas. Another thing that I also experienced is you ask your pediatrician, to give you a referral, so that you can also go through your special ed department at your local school district. And they’ll also they’ll tie everything together. And they’ll they’ll make sure that you get the early intervention services and get evaluated. And some of the evaluations also I was gonna say, physical therapy, academic speech, and language and occupational therapy, those are all the ones that you would be evaluated for. So it’s make sure you take care of that if your gut like Tiffany was saying, if your gut instinct is I don’t feel comfortable, then you just get it checked out it usually you’ll be able to get it if there’s a discrepancy

Tiffany Fitzgerald 4:07

with Yes, absolutely. And one thing I will say about the milestones is that we use it as a way to see if we should seek out help. But I also don’t want parents to get nervous looking at the milestones and thinking that’s everything and oh, no, my child didn’t say the words right at 12 months. Because every child does develop on such a different path. And sometimes it can vary. And, you know, you want to check out those milestones and know when you should seek out help but don’t let it scare you away.

Patrice Badami  4:45

Definitely that’s that’s definitely true. It’s not in stone, you need to understand that there’s going to be fluctuations in your your child’s development from perhaps a neighbor, family member, etc. But just when you start getting concerned a Always keep on on the same track with your pediatrician, make sure they’re on board with your concerns, and they’ll generally direct you properly from there. What are some features of early intervention? Speech Therapy? What is play therapy? And how does it help children to engage during early intervention, speech therapy.

Tiffany Fitzgerald 5:19

So in my early intervention, speech therapy sessions, they are all very play based. So that what that means is that we’re really following a child’s lead with whatever they are interested in doing. So it doesn’t matter if I come over, and they don’t feel like doing this puzzle that I have presented for them, we can switch to anything else, maybe they are interested in a cardboard box, and they want to get into the cardboard box, we always have to just figure out what motivates them to communicate, because if we start to sit down with them, and push flashcards, or have them, you know, label different letters and numbers, and that’s all we’re concerned about, that usually puts so much pressure on them, when we’re telling them, say this day that Oh, can you say this word, this sound. So instead, I like to go in and just follow their lead. And I provide support for them with verbal models and visual models, and I will and even non verbal communication with like actions and having them imitate actions. So when we talk about play bass therapy, it’s really play. And that’s how children learn, because it’s so meaningful to them, they want to play and that’s how they work. It’s not like, you know, we’re sitting down in, I think, when people think about traditional speech therapy, it’s like a speech therapist sitting face to face with a child, and they maybe have flashcards and they’re drilling sounds that they want the child to say. But in early intervention, this age group birth to three years of age, it’s not appropriate to be doing things like that. So we really want to just follow their lead. And when they feel like we’re taking the pressure off of them, they’re more motivated to communicate, and they will independently initiate that communication more, instead of being like, Oh, this therapist is here to test me, or to expect all these things from me that that child may not feel confident enough to do yet. So it’s really important to just follow their lead.

Patrice Badami  7:36

Yeah, I think that what another way of looking at it is you want to enter into their comfort zone into their world. And you want to use things that they’re normally drawn to, you don’t want them to not want to go, you don’t want them to be resistant going to speech therapy, you want them to enjoy it. So the flashcards and that type of thing that That’ll come later, just to be able to do assessments. But when you begin speech therapy, it’s more of a play date, if you will, with the speech therapist, I agree with that. I’ve seen it. And it works, because I remember my children being so excited about going to speech therapy, during early intervention, they don’t even know they’re being assessed, they think they’re just playing with you, which is very important. You don’t want them to shut down and you don’t want them to be resistant. Because actually what should family seek out when they’ve determined that their child is not reaching the milestones, I believe we kind of addressed that we just reach out to the different specialists in the area, you wouldn’t contact once again, your pediatrician, or if you feel inclined to based on what your child’s developmental situation is, if they have physical limitations and whatnot, you would also, I guess, reach out to your neurologist, and then the school district special education department to set up an early review.

Tiffany Fitzgerald 8:57

So also, with early intervention, I think a lot of people don’t know that you can self refer. So you can just reach out as a parent reach out to early intervention yourself. You don’t have to wait for a referral from your pediatrician or the school district. And if you don’t qualify for early intervention, because sometimes that does happen. You can push for it and they can qualify your child based on clinical opinion. And also they could do another assessment to get that score for you so that you will qualify. So definitely advocate for yourself and for your child if you feel that these services are really warranted. But also if if early intervention is not an option, I would also seek out private practice. So you can find private speech therapists, occupational therapists, physical therapists, whatever you think, whichever service you feel is best for your child. There are always ways to find them. You can even reach out to your local hospital because sometimes they have outpatient programs.

Patrice Badami  10:01

Right? Right. And again, you know, I mentioned briefly is if your child is born with certain limitations, or if they’re premature, oftentimes, it’s an automatic situation where they’re automatically given the opportunity to have early intervention, but you should just definitely advocate for your child. Because oftentimes when you say, I really want this, they’ll do an evaluation, at the very least they’ll do that for you. Exactly. Right. So yeah, I just was about to ask you, when should families consider outside independent abouts to validate their concerns that their child needs it? We just discussed that where you can, you know, reach out to local, there’s a lot of different people who will offer different services just to ensure that your child’s facilitated? Yes, a question. Here’s a question that I want to ask you. So what are the different types of services under speech therapy that you that you will address? What are different services? In other words, do you facilitate children who have apraxia? And if not, you would do what to help that child? You would refer them in some ways? What would that be?

Tiffany Fitzgerald 11:09

Yes, so we service everything under that umbrella of speech therapy. However, it is important to know when a child should be referred out, as far as apraxia goes childhood apraxia of speech, that is a diagnosis that can come a little later. I mean, for the speech therapist listening, if you find that a child has speech down errors that are very inconsistent and not age appropriate, then of course, we definitely want to start to address it. But you know, if it’s other things like let’s say, I’m feeding, and you’re not really specialized in feeding, it is important to refer out to maybe a feeding clinic, where another speech therapist does specialize in that, or an occupational therapist will do feeding as well. And we have to know what our scope of practice is and what our limitations are. But yes, we, in early intervention, we work a lot on expressive and receptive language skills. So being able to figure out if a child can understand what we’re saying, and be able to respond back being able to communicate their needs, whether that’s through gestures or through spoken language. So that is what our main focus in early intervention is. But when it comes to things like articulation, how sounds are coming out, it is very early, because in this age group birth to three years of age, their muscles are their speech, sound muscles, everything is still developing. So a lot of those speech down errors are age appropriate. But you know, your speech therapists will know if, okay, this doesn’t really seem like an age appropriate error. Maybe we have to see what else is going on, you know, are they getting enough support physically in their body? Are they low tone, where they don’t have enough support to be able to have the breast support to communicate? So it’s very involved. But that’s why it’s important for us to look at the child as a whole and see what’s going on. And not just like, how many words do they have, we really want to see the whole picture,

Patrice Badami 13:25

right? Some children that I’ve advocated for included a child who had a cognitive as well as a physical limitation where they weren’t able to use the the muscles in their lower jaw were so weak, they weren’t able to chew properly. So they were they were assessed for a feeding therapy, but they also had the cognitive piece where they were having difficulty with responding with with the receptive language were they were responded back to the therapist. But there was another thing that’s really important to keep in mind that family was is bilingual. So there’s often delays when there’s a child who has a bilingual component in the home, where they’re having difficulty responding in the two languages. So that’s normal for them to have a little bit of a speech delay, they’ll catch up later, is that anything you’ve experienced?

Tiffany Fitzgerald 14:19

Well, the bilingualism wouldn’t be a cause for a speech delay. So that is something that sometimes parents will ask me, you know, am I going to confuse my child if I use both languages? And, you know, does that confuse my child? If I’m speaking in English, one second and Spanish and the other second? No, that is actually a myth. And I would actually encourage parents to continue to use both languages. There are just so many benefits to bilingualism. And absolutely, sometimes it just happens to be a coincidence, you know, that. Okay. There’s a speech delay there, and we’re a bilingual family. Lily, but I would continue in both, or all, you know what, however many languages you have, it’s okay because children are able to decode it all and be able to, well code switch. So be able to like switch from language to language. So that yeah, that’s, that is a myth with the bilingualism causing speech delays,

Patrice Badami  15:21

right. That’s what that’s what the concern was. That’s what I was understanding from the parent, we got a speech evaluator who was bilingual. And she determined that it was actually it was the articulation part was based on the physical deficits, but the actual delay in speech was a cognitive one, which was developmental. So wasn’t associated. That’s what I was just saying, that’s what the question was with that parent. That’s why when you have a bilingual family, you should ask for a bilingual speech pathologist, when they’re doing the Early Intervention evaluations, you’re entitled to that, and they have some,

Tiffany Fitzgerald 15:56

yeah, yes, even in speech therapy sessions, you know, if you, as a speech therapist, if you’re going into a bilingual home, you want to make sure that if you don’t speak their language yourself to have a translator with you, because that’s one of the most important things being able to not only communicate with the child that you’re seeing, but also be providing carryover strategies for the family. And if you can’t communicate with them in their language that they most and best understand. That’s not, you know, that’s not going to be efficient. So it really is important that you can communicate.

Patrice Badami  16:32

Right, right. So what are some benefits just in general, after one, when they’re in sometimes they get the early intervention? At the, for example, if they have a preschool, if they have a daycare, sometimes they get a push in for the speech pathologist, they’re often or sometimes they have it at home. Either way, what is your experience with group sessions compared to individual speech therapy sessions.

Tiffany Fitzgerald 16:57

So yeah, so early intervention, the families can choose whether the therapist goes into the home or whether the therapist goes to daycare, and I find that there is a lot, there are benefits to both. But I think being in the home, you’re really seeing the child environment, right, and you’re able to talk to the parents. And that is such a huge component, talking to the parents, and, you know, we see the child once a week, for 45 minutes to an hour, that will really do nothing if parents and families don’t carry that over. So that’s one of the benefits of being in the home, and really seeing what the child sees every day and what’s in their environment, and how we can use those things to their advantage. But then being in the daycare is also great, because you see them in a social setting, and you see them with their peers. And a lot of the times that other toddlers will come up to you during the session, and they want to get involved. So that’s a great way to also model a lot of sharing and turn taking skills, and all of that. So, you know, there are benefits to both, I personally find that it’s a little more focused when we have those individual sessions, because when we have a lot of toddlers running around, you know, it’s a lot. But I understand like a lot of families, the parents, it just doesn’t work with their schedule, and the child is at daycare, all the time, from you know, from Monday to Friday, all hours of the day. So whatever it’s really about what works best for the family. And that’s what we’re here for to make it as easy as possible for the family. So if we do end up seeing a child in daycare, it’s important to communicate with their teachers and give them the carryover skills if they’re spending a lot of time at school,

Patrice Badami 18:51

right. And some schools will offer a pullout situation where they have a designated therapy room. So that if you feel that if you do have a schedule where you are the child is in daycare from like perhaps six in the morning till six at night, and you don’t have the opportunity to have the person evaluate your child at home, then you can ask or request a lot of facilities have a designated room where the child is pulled out, has their independent speech therapy and then also can be observed in the setting with the other children. So that’s something you can request or have them set up for you if you’re not able to do it at home. Another thing I was going to say is that, in general with speech therapy, I worked with children who are nonverbal with autism, what and they and I worked with children from 18 months to 21 year so I’m wondering what is your take on having to tact and use visual picture systems in order to facilitate children on the spectrum? Who are lower functioning? Have you had experience with that and how does that work?

Tiffany Fitzgerald 19:55

Yes, so children on the spectrum we do We work with every child. And I think that it is important to get on their level, which what however that may be. And I always say to parents speech, spoken speech is not the marker for success, you know, sometimes they do need augmentative alternative communication. And maybe we and also like, maybe that’s a good place to start to facilitate the communication. That’s the same thing with like, gestures and sign language, and how that can be a stepping stone to spoken language. So yes, this and I also like to refer out for them to get an evaluation from a developmental pediatrician, because they really specialize in children, with people who are on the spectrum, or also, maybe have ADHD, all of those things that fall under that category, I like to refer out just to get another opinion, and get more strategies that could benefit this child.

Patrice Badami 21:09

Right. And that was gonna say, just from my experience, what I did with both children is that I did sign language at first people sometimes are concerned that the sign language will delay speech, I found that it was the opposite, that giving them the tools not only it helped the speech to develop, but it also helped to deal with behavior management, when the child was able to express to me that they wanted more that they wanted milk that they wanted to stop, they wanted to sleep by using sign language and the speech language did it you know, the actual verbal language did come quick. I also another thing I want to encourage parents is, if your child is nonverbal, right now, we don’t You don’t know where the future is going to head, continue to read, read to them all the time, you’ll have no idea until they start to develop how much they’re retaining, because I recall with my son, who was on the spectrum, I read this one particular book he loved, all of a sudden, one day he started reading it. So they’re retaining that learning, even if they might not be communicating with you verbally. So you should continue to do that, you know, and then consider the sign language as a possible stepping stone to verbal language later.

Tiffany Fitzgerald 22:20

Yes, absolutely. It is a myth that it will delay language, you know, I had that question, too. Oh, if my child uses gestures, aren’t they just going to just use that and not feel the need to speak, but that is far from the truth it’s give, it’s giving them a way to communicate when they don’t have that confidence yet, or that strategy to be able to communicate with you verbally. So it really helps decrease the frustration if they can just gesture to you. Because, again, that takes the pressure off of them, because maybe they don’t feel ready to use spoken words yet. And so they could just give you a gesture, and they can get their needs met that way. It’s really about however they can get their needs met and communicate with you. It doesn’t matter if it’s spoken or not.

Patrice Badami  23:12

And when they’re doing the sign, for example, more you say more, more. So you you take the what the sign is, and you verbalize it to them. And then before you know it, they’ll do the sign and say the word war. So that’s what happened in my experience. So in summary, what we discussed about how families can reach out to different in different ways to school districts, to pediatricians to specialists to to facilitate their children. What’s some like other topics or other things you think that you want to share? About what you’re doing? Actually, your website, what you provide? That will be a great thing?

Tiffany Fitzgerald 23:48

Oh, thank you. Yeah, I, when I first started talk to speech, it was really something for me to just have like a creative outlet. And I just was like, oh, you know, it was, it was just two months after COVID started. So I had a lot of free time on my hands. And I was just wondering, you know, what could I do? And so it’s really become something where I can, I just want to help parents and other speech therapists better understand the toddler brain really, and how they really are still. So under construction, and I want to advocate more for early intervention and the services that we provide and how, how it all works. And one of the main things that I always advocate for is, again, play based therapy following a child’s lead, taking the pressure off of them and really giving them space. I’m sure it’s so nerve wracking for new parents when maybe the milestones aren’t being met. And so I really try to communicate on my social media that a lot of times that is normal, and there are outlets to help you and be able to learn different strategies to increase their communication. And I really would like to, even if I can make a small impact on being able to help them increase that toddler communication, to just make everything more joyful and peaceful at home, because when we can all communicate together, it really helps everyone, from the siblings, to the parents, to the grandparents, everyone could be in more harmony together. So I advocate for that on my social media and also helping other therapists understand, because when I first started, it was really nerve racking, and I didn’t know what I was doing. So I have courses up right now. And one is for specifically for speech therapists, and everything you need to know about early intervention from how to find an agency to work for, what are the pros and cons of all of that, how to provide parent coaching, how to make a referral and voice your concerns to how to write your session notes, how to provide daycare. So it’s all the stuff that I wish that I knew when I was a new therapist, because there’s not that much information out there about, you know, you’re going into families homes, and it could be really scary. And when you’re new, it could feel like okay, I have no idea what I’m doing, I can’t believe they’re trusting me to go into their home and provide therapy. So that’s one of the courses that I’m really passionate about. And then also I have another one for parents where it kind of like an introductory course about what early intervention is, when you feel like or when is it appropriate to seek out services? And when you are receiving services? What should you really be looking for from your speech therapist? What should they be providing for your child? And how to transition from early intervention to preschool? What are appropriate questions to ask your school district. So I have all of that.

Patrice Badami  27:15

That’s really that’s important, because a lot of parents who come to me and they asked me to advocate for their families. I mean, from experience, I have some of that information. But yours is more comprehensive. And it’s like a packet that you can print, you can have it with you. And you can be able to advocate for your child appropriately. I love the fact that you also have the speech therapists, the kids who are just graduating shouldn’t call them kids, but the people graduating and they’re starting their new career as a speech pathologist to be able to have an inside track on what you need to do and just helpful tools. These are just so invaluable to everyone to the educators as well as the caretakers of children in early intervention. Very helpful. So your website again, Tiffany Fitzgerald, Her website is called Talk t hold on for a second. It’s called talk to speech.com Sorry about that. On Instagram, you can find her where else can we find

Tiffany Fitzgerald 28:13

Facebook Tik Tok? I am most active on Instagram though, but you can always reach out to me through email Tiffany at talk to you speech.com. And yeah, so Instagram talk to you speech would be the best place.

Patrice Badami  28:26

Right? Yeah, that’s where I found you. When I was looking, I was very, very helpful information. So I want you to take a look at her website. Definitely print out things, everything you can find so that you can help your child talk to you. speech.com Tiffany Fitzgerald, thank you so much for being a guest today. I was just so happy to have you. And I think this information is invaluable to a lot of people who are concerned for their children and trying to get them some help.

Tiffany Fitzgerald 28:52

Thank you so much for having me. This is a great conversation and I think it’ll be really helpful for families. Thank you.

Patrice Badami  28:57

Yes, thank you so much, everybody, for once again, tuning in to Patrice Badami. Acorn to tree.com parents, that’s the parents portal. We’re gonna go onto the once again this is going to be available on the acorn to tree family podcast in a few days, but I’m glad that you came and listened and we’re going to try to provide you with more information to help your children. Thanks again.