Rachita's Journey of Making Voices Heard Through Speech Therapy (Part I)

Rachita Pandey: I’m Rachita Pandey. I’m a speech-language pathologist. I’ve done my bachelor's degree from the Dr. S. R. Chandrasekhar Institute of Speech and Hearing (Dr. SRCISH), Bangalore. I’ve done my Masters in speech-language pathology, which is my specialization. After that, I worked in India as a speech therapist and audiologist for 5 months. After that, I got an offer in Dubai and I’m currently working as a speech therapist here. I applied for my license in the Dubai Health Authority (DHA). So, every country has its own licensing body, where you have to apply for your license to practice. After that, you can attend the examination, clear it, get your license, and start practicing. So, after my Master's, it has been 5.8 years of me working in this field.

Rachita Pandey: My parents are running a special school in Pilani, Rajasthan. So I’ve seen these special children since my childhood. Also, two of my family members are working as speech therapists in the US. So, after my tenth standard, I took Physics, Chemistry, and Biology (PCB) because I wanted to pursue MBBS. But, back in my mind, I had speech therapy as well, as an alternative career option. I was aware that this field has a very good opportunity. The need for speech therapy has grown in recent times with all the lifestyle changes occurring today. After that, I took an exam for speech therapy in Mumbai and got a place at Dr. SRCISH, Bangalore. There, I asked my colleagues how they got into this field. They told me that I had attempted the All-India Pre-Medical Test (AIPMT) and knew about speech therapy only in counseling. Some knew through their connections. Now, due to this awareness, many people are opting for this and it is a good and safe career option. 

Rachita Pandey: I wanted to have the experience of working abroad because of the advancements and the exposure. Then, when you come back to India, you can set up a clinic of your own with a good experience. You can serve people with better quality. The reason that I had in mind was to get some exposure from outside India as well. Of course, there are some good clinics in India and I worked at Apollo here. When I was doing my studies, we had half-day classes and half-day clinics. So, from that time on, we were exposed to the patients in the clinics. But I always felt that there was a bit of a lack of things that I could learn more about when I went out. That’s the reason I moved to Dubai. 

Rachita Pandey: Usually, when we visit hospitals to see doctors, we recommend they have a checklist of milestones to keep track of the child’s development. This is to check and compare if the child is going on the right track. The second thing is that this is a busy world. Most of the parents, including myself, are working today. So what I do is plan the daily activities for my child. Also, I ensure that screen time is controlled because it is very important today. After that, the quality of interaction with the baby should be good. They can buy age-appropriate toys available on the market. If the child is with their grandparents or a nanny, ensure that they follow a scheduled routine every day. All of these support the development of the child. 

Rachita Pandey: I’ll tell you one thing very frankly. In this era, it is impossible to take away the screen completely. Also, the screen is important to learn. As mothers, we need to know the quantity of time we expose our children to screens. WHO has given the appropriate amount of time allowed for screen use age-wise. So, what WHO recommends for children aged 0–2 years, like my daughter, is either no screen time or around 30 minutes of good learning music, not visuals. After 2 years, you can start exposing children to one hour of TV show. But there should be a timetable. First, you have to prepare the child that he is going to get TV for only one hour. And then you can set a timer. For the first two days, the child will not be getting that TV, which will be switched off when the timer rings. Once the timer rings, give them the remote and ask them to switch off the TV. Commonly, they will show tantrums. But eventually, you can divert them with their favorite activity. When you follow these steps for at least 15 days, the child’s brain will get conditioned to switch off the TV.

Rachita Pandey: We usually say that by 18 months of age, a child should start following simple, basic commands. They should start communicating their needs either by pointing or by making some sounds. I would say that by the age of 18 months, the child should have at least 10–50 words in their vocabulary. This is a normal speech milestone. If we are talking about prelinguistic skills, a child should sit for at least 2–3 minutes for an activity. An important one is that they should be responding to their name when you call them. Other important milestones are having eye contact and a social smile. It is preferable to have a speech therapist conduct a screening if the child is not doing any of this by 18 months, or at most 24 months. Sometimes, the child must not have achieved it due to a lack of stimulation as well. In those cases, we either send you to a training program or refer you to put the child in play school so that you start seeing the changes. The major sign is that when the child is two and a half years old and he is not speaking well or only a few words, not socializing, being in his own world, and not following things, then you need to get immediate help. 

Rachita Pandey: This varies from place to place. In urban cities, due to the increased awareness, patients reach out directly to us. In some cities, where parents are not aware, they reach out to doctors, pediatricians, or ENT specialists, and they refer to us. We always have tie-ups with doctors and they refer to us. That’s how the referral goes on.

Rachita Pandey: Yes, we will be on the same page and we will always go hand in hand. 

Rachita Pandey: In Gurgaon, there is a space called Mom’s belief. They have a very good team for online therapy. When you approach them, they will serve the areas where they don’t have speech therapy centers. For example, if a child who needs help cannot access a speech therapist, you can apply online and the therapist will guide you. 

Rachita Pandey: We have standardized tools for each disorder. For example, if you are coming to me for the condition of stuttering, we have an assessment tool called the Stuttering Severity Index (SSI). So, first, I’ll collect a background history, apply that test, and diagnose based on the results. The same goes for autism. In autism, we have a variety of tests. And the whole team sits for it. We, as speech therapists, do REELS, which are basic communication metrics. Psychologists who diagnose autism use the Childhood Autism Rating Scale (CARS), which is very trending, and the Autism Diagnostic Observation Schedule (ADOS).

Rachita Pandey: Again, the same goes for this. The treatment plan is always based on the baseline of the child. For example, if I have a child with hearing loss, definitely the clarity of speech is going to be affected. So I’ll focus on improving the clarity by applying a simple technique called prompting, which is used for autistic children as well. These children want to speak but don’t know how to speak. They will search for the sound because they are unable to listen to and process it. So we will prompt each sound in their mouth. Likewise, there are various techniques for various problems. For example, for common problems like children being picky eaters and autistic children with sensory issues in their mouths, we do oral placement therapy. This reduces the sensitivity in their mouths, and kids will start to eat.