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early interventions
Therapies for young children are increasingly offered online now but come with challenges for children and their parents. Photo: Getty Images

A few days ago, I turned to my husband and asked him if he, too, was noticing our 3-year-old, who graduated from speech therapy in January, was suddenly a lot harder to understand.

“Yes,” he replied emphatically. We had both noticed the same things: words our son used to pronounce well were now nearly unintelligible; others were made up or nonsensical. We feared it was because he had now been out of school for a nearly a month due to coronavirus quarantining, away from his three attentive and diligent preschool teachers and his speech therapist, who regularly visited his classroom to work with students even if they were no longer enrolled in therapy.

I sat down at my computer and sent a desperate e-mail to his speech therapist. “I find myself needing to narrate what he is saying for other people far more than I ever had to before quarantine started.”

“I have a few ideas,” she replied. “Do you think he would be willing to talk to me?”

My son loves his speech therapist. On Friday morning, he asked no less than 15 times if it was time to call her. When she appeared on the screen, he instantly stood up on the couch, waving around a plastic toy syringe from his doctor kit. 

“What’s that?” she asked.

“A laser gun!” he yelled as he bounded from one couch cushion to another. 

I coaxed him to sit down and look at the computer. He practiced a few sounds that he had mastered during speech therapy as he slowly sank down to the floor. Then he popped up and started moving — nonstop — once again.

“Why don’t you go run two circles,” his therapist gently suggested.

We ran circles around the small inflatable pool in the middle of the living room that my husband and I had turned into a ball pit for our 1-year-old, and returned to the couch.

“How old are you?” she asked, hoping to get him to practice the “th” sound.

“Two!” he replied.

“You’re not two!” she exclaimed.

“Four!” he shouted in delight. 

“You’re almost four!” I said, taking a deep breath and feigning a smile. 

We turned to the “ch” sound. She demonstrated putting her fingers in a u shape around her mouth to push the lips out. My son climbed onto my lap and I copied what she was doing to push his lips slightly forward with my fingers. “Chair,” we said together. “Cherry.”

At the end, as I took over the computer and my son began to play with his toys, she promised to send me some resources. “I just need…his mouth!” she lamented. She is a fantastic therapist, and did as well as I could imagine with a wiggly 3-year-old. But it would be so much easier if she was here in person, able to gently show him how to position his lips and captivate his attention, something that many parents have found is hard to do with young children as they try to continue therapies via technology.

I know my experience is unfortunately not unique: parents nationwide are worried their children with delays or disabilities will regress without the constant, mostly in person support of highly trained teachers and therapists. Experts say losing these services during the critical early years is especially concerning considering how important early interventions are to address delays early. “We know how quickly the brain grows and changes in the first one thousand days, which is the first three years,” said Michele Rogers, executive director and co-founder of the Early Learning Center in Sonoma County, California. “So every week is a lost opportunity for that brain development.”

Across the country, some counties have fully halted early intervention services aimed at infants and toddlers up to age 3, as well as special education preschool programs and therapies available once children age out of early intervention. Meanwhile, many schools, therapists and families are now increasingly turning to online and digital sources for these early therapies. While that can be a lifeline for concerned parents, it can also pose a challenge: how do you get a toddler or preschooler to pay attention to someone on a screen and have parents support or even replicate the intricate work of a therapist?

“We know how quickly the brain grows and changes in the first one thousand days, which is the first three years. So every week is a lost opportunity for that brain development.”

Michele Rogers, executive director and co-founder of the Early Learning Center in Sonoma County, California.

In Sonoma County, California, therapists in the early intervention program run by the Early Learning Institute, which provides developmental screenings and early interventions to children, have switched to Facetime, WhatsApp and Zoom to continue to reach the nearly 400 young children they serve. Therapies look a little different now: in-person they ran for 75 minutes, but via video a child’s attention tends to peter out around 45 minutes.  Michele Rogers says parents are definitely “juggling more with this.” Therapists used to bring various resources and toys to the homes of children and now must ask parents to provide those supplies. Feeding therapists and physical therapists who rely on hands-on exercises to help children have to teach parents how to assess things like muscle tone over video; and sessions with infants are largely spent coaching parents.

Still, Rogers said virtual therapy can help in a fundamental, too often overlooked, way: “Early intervention’s goal is always to make the parent the primary early interventionist of their child,” she said. Switching to telehealth has only amplified that, she added. “It really is, I think, upping everybody’s game in that parent-coaching model.”

Some therapists and schools have turned to established telehealth platforms to offer early intervention therapies, as well as therapies for older children. Enable My Child (EMC), a telehealth company that provides therapy via video conferencing through their online platform, has seen a 15x increase in demand for therapy sessions from existing customers in the past month. Company officials say they were contacted by over 1,000 schools that wanted to use its platform during a two-week period in mid-March.

The rise in demand inspired the company to transform its model from mostly offering services through its own pediatric therapists to offering its tools for free for the rest of the academic year to help school-based therapists. EMC is also covering bandwidth costs for schools with 40 percent or more students who receive free or reduced-price lunch. “We know that consistency and continuation of services is so crucial to development, especially when we’re looking at the younger children,” said Shelli Dry, an occupational therapist and director of clinical operations at Enable My Child. “You really want to get those services in that are scheduled.”

Despite the potential of telehealth to continue services for children, it isn’t always possible, or realistic. Some state regulations may not allow schools to offer telehealth services for certain therapies, like speech and language, according to the American Speech-Language-Hearing Association. Rogers said not a small percentage of families they serve have been unable to participate, especially if they lack technology or sufficient space and privacy. And although Sonoma County’s early intervention therapists have been flexible and are willing to call in the evening around various schedules, parents who are trying to juggle parenting, teaching and a full-time job may not have the time to fit in therapy.

A California mom named Hoda, whose last name is being withheld to protect her son’s privacy, said she received some links for at-home lessons as well as some educational videos from her 3-year-old’s speech therapist, who works in the San Francisco area. But it’s been challenging to find time for those videos while juggling work and other children at home. She said she would consider a virtual session if her son could work with his same therapist from his private lessons, but she is also skeptical it could provide the same experience as in-person therapy. 

Hoda shares the fears of other parents that her son will regress. In just five months of speech therapy, he had made marked improvement, speaking more often, more clearly and with greater confidence. Hoda also learned some strategies to boost his fluency and confidence. His private therapy sessions were put on hold indefinitely in March, and the public schools closed the day he was slated to start an additional weekly session of school-based therapy. San Francisco’s schools are now closed through the end of the academic year, meaning in-person therapy is unlikely to resume for months. “There’s no light at the end of the tunnel,” she said.

In the meantime, Hoda and her husband are working with their son as much as possible to hopefully avoid regression. They’re practicing ‘language bombardment,’ or talking and reading to her their son as much as possible and using strategies they learned from his therapist to encourage him to speak more. At times, Hoda wishes therapy was considered an essential appointment so her son could continue, but she understands why it’s not. “It’s a real catch-22,” she said. “We’re just gonna keep chugging along.”

Editor’s note: This story led off this week’s Early Childhood newsletter, which is delivered free to subscribers’ inboxes every other Wednesday with trends and top stories about early learning. Subscribe today!

This story about early interventions was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for Hechinger’s newsletter.

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