Initial Assessment & Diagnosis

 

1. Why is an initial consultation or assessment needed?

An initial consultation or assessment allows the speech-language therapist (SLT) to get to know

your child and his/ her learning needs. It also gives you an idea of the therapist’s style and ask

any burning questions.

 

This includes observation and/or assessment of oromotor skills, facial and dental development,

feeding skills, play, social interaction, language, pronunciation, voice quality and overall

development, depending on concerns.

 

2. My child has been assessed recently by another speech-language therapist, can we

skip the assessment?

Therapists in Singapore must be registered with the Ministry of Health (MOH) to practise. According to MOH guidelines, therapy can only be provided after an initial consultation or assessment. Assessment(s) need not be repeated by different therapists within the same organisation. However, if you decide to consult a therapist in a different organisation, another initial consultation or assessment will have to be carried out. Depending on the training/experience of the therapist, different assessment tool(s) and/or method(s) may be used.

 

3. Should I have my child diagnosed?

Caregivers are usually more interested in understanding how best to help their child than in a label. In some cases, a diagnosis may not be necessary. A qualified psychologist can assess your child’s learning needs and recommend appropriate therapeutic and/or educational support.

 

In other circumstances, a diagnosis may be required. For example, to qualify for certain government subsidised early intervention programmes or prior to starting formal schooling (i.e. primary one). In the latter case, a diagnosis and school readiness assessment may be beneficial for appropriate school recommendation and to ensure the child is ready in terms of academic, cognitive, emotional and social skills.

 

 

Therapy & Access

 

1. How can one access therapy?

There are 2 main ways to receive therapy services in Singapore. First, parents can take their child to a polyclinic near them and explain their concerns with articulation, language, feeding, attention and/or social skills etc. The doctor will screen and refer the child to a child development department in a hospital. Wait time for the initial consultation varies from hospital to hospital.

 

Second, in the interim or alternatively, caregivers may consider services at a private hospital or

therapy centre. No referral is required in this situation; simply call for an appointment.

 

2. Should my child attend individual therapy or group therapy?

At Yakkety Yak, individual therapy is typically recommended for young children or individuals who
are new to therapy. Individual therapy for children is geared towards caregiver training. Caregivers
are taught to facilitate clear speech, language learning and/or behaviour while enhancing family dynamics.

 

Conversely, group therapy is for the client. Clients are guided to problem solve and apply what they have learnt (from individual sessions) independently. Practise in group settings help clients learn to interact appropriately with their peers and apply their skills outside the clinical setting. While the reasons listed are not exhaustive, this clarifies why individual or group therapy may be recommended. At times, both individual and group therapy may be beneficial.

 

3. How can caregivers help?

Caregivers are cheerleaders who motivate clients to persevere especially when therapy becomes challenging. Caregivers (including siblings and helpers) are also good partners for play and practise of therapy at home.

 

4. How can fathers be involved in therapy?

Both parents are recommended to attend sessions, especially for preschool clients. This facilitates caregiver education and training to learn strategies that can be useful at home.

 

With more fathers attending therapy sessions, the home program can be shared between parents based on their individual strengths. At the same time, parents can be on the same page and support each other when upbringing practises benefit from adjustment.

 

5. What is generalisation?

Generalisation refers to the application of skills, adaptability and reflection. Many clients can tell what they have learnt and why. However, the ability to apply those skills when the situation calls for it, can be challenging.

 

6. How is progress measured?

Progress depends on the goals, severity of issues and opportunities for practise. It can be measured objectively through testing and/or subjectively based on the feedback from the client, family members, teachers and others who interact with the client. Both objective and subjective feedback are equally important.

 

Additionally, the ease and consistency with which core speech and/or language tasks are carried out are useful indicators too. These are some measures that caregivers can bear in mind when discussing progress with their therapist.

 

7. When does therapy end?

In best case scenarios, therapy ends when the goal(s) of therapy or expectations have been met and the client can sustain progress independently. Other common reasons for ending therapy include a plateau in a client’s progress, scheduling conflicts or financial constraints.

 

While it may feel less awkward to discontinue sessions, ignore phone calls or email, it provides closure to be upfront and inform the therapist that you are considering stopping therapy. Often therapists are more than happy to discharge clients who are ready. After all, therapists work towards discharge as this is evidence that therapy has been effective.

 

An open discussion provides both the client and therapist a chance to acknowledge the work that both parties have put in to get to where they are. In most cases, it can feel bittersweet to consider terminating therapy as a relationship has been built. It can be unsettling, anxiety provoking even. Yet, the end of therapy is cause for celebration.

 

It can take one to two sessions to discuss how to transition the client to suitable mainstream activities to ensure maintenance and/or continued growth so that the discharge process is comfortable and empowering. This is especially valuable when a client requests to be discharged against the therapist’s advice.

 

At times, a therapist may suggest terminating therapy if they deem that they are unable to provide adequate care or when a client has plateaued. In this case, the therapist will likely refer the client to another therapist who may be better suited to their evolving needs.