K.H.
The problem with First Steps, in my opinion, is it all comes down to "the almighty dollar." When our son was 22 months old, it was our day care's director who said she was seeing some "red flags" wiith his development. She handed me a First Steps pamphlet and told me to give them a call. I called First Steps about a month before our son turned 2 years old. The woman that took my information asked me how many "words" our son had at the time. I told her he basically had three: "ma," "da," and "ba" (for ball). She then asked if he understood things that were being said to him, which is called "receptive" language. I told her that I believed he did understand receptively and could follow simple one-step instructions. (i.e. "Go get your sippy cup.") The intake coordinator that I was talking to then told me that in order for our son to qualify for First Steps, he would need to have an overall delay of 50% or more in BOTH receptive and expressive language. Quite honestly, I was a bit naive about how things worked back then. She kept saying, "Do YOU, as the parent, feel he has an overall delay in BOTH areas?" Of course I came back with an "I don't think so" response. Two months later we had our son's 2-year check up with his pediatrician. My husband and I mentioned how concerned we were that our son wasn't talking yet. The doctor kind of smirked and very matter-of-factly said, "He's a boy; boys take longer to speak than girls do." All I can say is I wish to GOD I HADN'T listened to him and went with my "gut feeling." I knew it wasn't right that he wasn't talking yet, but when my doctor didn't seem worried, I thought it was "normal" and that he was just fine. We ended up switching day care centers and began a new day care within our district. Two weeks after he started there, I got a phonecall from the Parents As Teachers woman who had been seeing our son. She was at the school one day and saw our son in the classroom setting. She told me that his "classroom teacher" at day care was going crazy because our son was eloping from the classroom 20 to 25 times a day. She suggested we call our pediatrician. He was 2 1/2 years old then and we again called our pediatrician. When I told him that this was the second day care that saw problems, he FINALLY referred us to a pediatric neurologist. After filling out a number of questionnaires, we finally met with the neurologist. Within five minutes of this doctor observing him, he daignosed our son with PDD-NOS (Pervasive Developmental Delay - Not Otherwise Specified, which is on the "Autism Spectrum." Our lives changed that day, and have every day since then. Now that we had an actual diagnosis in hand from a reputable doctor, our son qualified for First Steps. Unfortunately, I trusted First Steps to give my son what he needed. They only gave our son one hour of speech/language a week and one hour of occupational therapy every OTHER week.
I certainly don't want to scare you, S., but for your child not to be speaking at all at 21 months of age . . . that's not normal. I would definitely have him evaluated by a medical specialist (pediatric neurologist or psychiatrist) and request an overall developmental evaluation be performed. If someone had clued me in to knowing what autism was six years ago, we may have been able to get my son more of the early intervention he desperately needed when he was 2 1/2 years old. Again, I don't want to rattle you, but please do not just accept what First Steps says and do nothing else. If I knew then what I know now, I would have definitely got our son extra Speech and Language services, even if it meant we had to pay privately. Unfortunately, time is of the essence and life isn't a dress rehearsal. If you think First Steps is really wanting to help your son, think again. There have been tremendous budget cuts over the past few years, and one almost has to BEG in order to get appropriate services. Nine times out of ten, the services offered are less than appropriate for any kiddo.
Who exactly evaluated your son? If it was a teacher, they can't diagnose an autism spectrum disorder. It's scary, but there are so many pediatricians out there who know very little about autism spectrum disorders. We trusted our pediatrician. We thought we were doing everything right. He almost mocked us because we were a little over protective of our son. We lost months of early intervention thanks to him. Back when our doctor was in medical school, the incidence of an autism spectrum disorder was 1 in 10,000 children. Today, the incidence is 1 in 150 children. I suggest you Google warning signs for autism. We didn't think it was a big deal that our son didn't play "peek-a-boo" or "pat-a-cake" or be able to point at certain pictures when requested to do so in a book. I do remember calling his name a lot and him not turning his head to look in the direction of where my voice was coming from. I at first thought he might have a hearing problem, but if I around in the cabinet where the pots and pans were stored, he could hear that noise, so I knew he wasn't deaf. Ahhhh. It sickens me that more isn't written about autism and the signs and symptoms in all those "What to Expect When You're Expecting" or "What to Expect the First Year"-type books. We perceived our son to be developing quite normally. You'll rest a bit easier if you look in-depth into his overall development in many areas, not just speech. (i.e. gross motor skills, fine motor skills, sensory integration dysfunction, etc.)
Please, please, please don't think I'm trying to scare you. It's just that I wish someone who had "been there" before us took our hand and clued us in to what might really be going on.
Best of luck to you and your family. Hopefully, it's nothing more than just a minor speech delay, but you can never be too cautious . . . especially with the rate of autism increasing steadily year after year.