What Is Speech Therapy?
If your child needs speech therapy, you're not alone. Here's everything you need to know about speech therapy for kids and toddlers.
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Medically reviewed by Heather Clarke
If your child is currently in speech therapy or you're wondering if they might be a candidate for it, you're not alone. According to the American Speech-Language Hearing Association (ASHA), almost 8% of children in the United States have a communication or swallowing disorder. It doesn't mean you've done anything wrong, but it can be tough for families. The good news is speech therapy can make a difference.
So, what is speech therapy and how can it help? Here’s everything you need to know.
How Does Speech Therapy Work?
Speech therapy is the treatment of communication, voice, and feeding/swallowing disorders by a trained professional.
Speech-language pathologists (SLPs) have a master's degree in speech-language pathology and specialize in evaluating, diagnosing, treating, and preventing these disorders. SLPs hold a license to practice in their state.
You may also come across ASHA-certified SLPs. They have taken an additional step to pass a national exam and complete an ASHA-accredited supervised clinical fellowship.
Related: Everything You Need to Know About Language Development and Speech Delays in Children
What Does Speech Therapy Treat?
There are various reasons a child may need speech therapy. Common ones include:
1. Speech sound disorders. This means a child has difficulty with the production of speech sounds and how we combine them into words.
2. Language disorders. A child will have difficulty understanding and/or using language to communicate. Language disorders may impact vocabulary development, grammar, as well as the ability to tell a story, follow directions, answer questions, and more.
3. Social communication disorder/pragmatic language disorder. In this case, a child will have difficulty using language to socialize. This may include difficulty understanding social cues, taking turns during conversation, initiating or maintaining a conversation, and understanding personal space. A social communication disorder often leads to difficulty forming friendships. Children with these language barriers may have a concurrent diagnosis of autism spectrum disorder.
4. Cognitive-communication disorder. This includes difficulty with memory, reasoning, problem solving, and organization, impacting the ability to communicate.
5. Voice disorder. Children will have differences in voice quality (e.g., being too hoarse or too nasal).
6. Fluency disorder/stuttering. Kids will have difficulty maintaining a smooth flow of speech. A fluency disorder may include repetitions of sounds within words, prolongations of parts of words, and/or pauses in speech.
7. Feeding/swallowing disorder. This presents as a difficulty with sucking, chewing, and/or swallowing food or liquid.
Signs a Child May Need Speech Therapy
Children may need speech therapy when they have not acquired speech/language milestones by an expected age. While milestones can vary from child to child, parents should refer their child for an evaluation if they have any concerns. Evaluation, which may include both standardized and non-standardized testing as well as observation, can help diagnose a speech/language disorder.
Some signs that may indicate a need for speech therapy include:
A child isn't babbling by 6-7 months
The child is having difficulty with feeding and/or swallowing
A child beyond the age of 1 has no words
A child beyond the age of 2 is not combining words into phrases
The child's speech is difficult to understand
The child is omitting syllables or sounds in words
Speech errors are noticed during conversation
The child has difficulty following directions or understanding spoken language
The child has difficulty answering questions
The child has a smaller vocabulary than what is expected for their age
The child is stuttering
The child's voice quality has changed or is noticeably hoarse or nasal
The child has difficulty communicating with others socially
The child has hearing loss
The child has a cleft lip or palate
Related: Parenting a Child With a Speech Delay Can Be Lonely
What is Early Intervention Speech Therapy?
Early intervention refers to state-funded evaluations and interventions—including speech therapy—for children, ages birth to 3, and their families. In some states, early intervention continues until the age of 5. While professionals may refer a child to early intervention, parents can also refer their child on their own.
Speech Therapy for Toddlers
Speech therapy for toddlers usually resembles play where toys are used to elicit target skills, says Dominica Lumb, M.S., CCC-SLP, who has over 30 years of experience conducting speech therapy with children in various settings.
Children are given choices during play to encourage the need to communicate. While working on language skills, toddlers are encouraged to request objects, ask questions, answer questions, and use appropriate vocabulary.
Parents may be included in therapy sessions at this age. They may be taught to model speech sounds or how to label objects and actions during everyday routines to enhance vocabulary development.
Speech therapy can also work differently depending on a child’s needs. For example, one may require a mode of communication that differs from speaking. That’s referred to as augmentative and alternative communication (AAC) and may include picture boards or computers/iPads for communicating through text or voice synthesizer. This can begin in early intervention and beyond.
Speech Therapy for Elementary-Aged Kids
Speech therapy at this stage is typically more structured. Games are often used for motivation, but goals are targeted through practice and repetition. Children practice new skills throughout a continuum until they're able to use these skills naturally in all environments.
After early intervention, children may continue receiving services in elementary school through an individualized education plan (IEP). The IEP is written by all specialists who will be working with the child. It states the child's goals and documents any accommodations the child may need to meet them.
Therapy at this age may follow a “pull-out” model where a child receives support in a separate classroom or a “push-in” model where an SLP provides services within the regular classroom. This model can change throughout the duration of therapy. For example, a child working on the correct production of a sound will typically begin with pull-out therapy and, when ready, will be observed in their classroom to assess for carryover of this skill.
SLPs in the school setting also consult with teachers to provide the support children need to communicate effectively in the classroom.
What About Private Speech Therapy?
While children must qualify for speech therapy through early intervention and in public schools, private practices can provide services beyond these standards.
Speech therapy in the private practice setting typically occurs one-on-one with the child receiving the SLP's undivided attention. But group therapy may occur when beneficial to the child.
"Therapy in the private practice setting is very child and family focused," explains Shanna Klump, M.S., CCC-SLP, CEO of Kid Connections Therapy in Severna Park, Maryland. "The family's goals for their child are often at the forefront of the work we do. In addition, parents and other family members often participate in the sessions to learn strategies that can be implemented at home to encourage generalization of skills."
What Age Is Best To Start Speech Therapy?
Parents should refer their child for a speech/language evaluation when they first notice their child is falling behind in any area of speech/language or is no longer meeting speech/language milestones. It is never too late or too early to start therapy but, in general, earlier intervention leads to a better outcome. If you're unsure if your child requires speech therapy, a referral to an SLP is always recommended.
Related: 7 Ways to Help Your Child's Language Development
How Parents Can Refer Their Child for Speech Therapy
A parent can contact their local early intervention office to learn about speech therapy options. The Centers for Disease Control and Prevention (CDC) provides early intervention contacts by state. Parents can also reach out to their child's health care provider to determine where their local early intervention office is located.
A school-aged child can be referred for a speech/language evaluation by reaching out to the child's teacher or the school's SLP.
An evaluation by a private SLP is an option at any age, but evaluations through early intervention or a public school district are provided at no cost. ASHA ProFind connects parents to SLPs who have indicated they are accepting referrals.
Does Insurance Cover Speech Therapy?
While public school therapy is free, private outpatient speech/language therapy is often covered by health plans, but with limitations.
According to Klump, insurance coverage for speech therapy varies by state, insurance plan, and diagnosis. She explains that while some states require habilitative service coverage for children, others do not.
Often, private practices, including Klump's Kid Connections, complete a benefits verification before initiating speech evaluation or therapy. In her experience, therapy sessions without insurance coverage may cost between $100-150, depending on location.
As each health plan has its own coverage, it is important to reach out to your insurance company to determine your out-of-pocket costs.
Insurance and Speech Therapy Coverage
If you're looking to see what insurance covers, Shanna Klump, M.S., CCC-SLP, CEO of Kid Connections Therapy, suggests parents obtain the following information from their insurance carrier:
Visit limit. This may be a hard or soft limit which refers to whether an extension of services could be granted if deemed medically necessary
Whether the visit limit is combined with other services. For example, occupational therapy and physical therapy are sometimes grouped with speech therapy in the number of sessions covered
Whether there are exclusions to coverage for different diagnoses
If a deductible must be met
The co-pay amount per session
How Long Will My Child Be in Speech Therapy?
Speech therapy can take anywhere from months to years. Each child makes progress at their own rate and has individualized goals based on their communication needs. Just as children develop and meet milestones individually, the time it takes them to master new skills will vary.
How Effective Is Speech Therapy?
Speech therapy has been found to be effective for children. One study of more than 700 children with speech or language disorders up to 16 years old, found an average of six hours of speech therapy over six months significantly improved communication performance. Speech therapy was shown to be much more effective than no treatment over the same period.
Children of all ages typically find speech therapy engaging, fun, and rewarding. They're able to see their progress and use their newly learned skills proudly. Speech therapy is an effective way to enhance a child's ability to communicate and through these communication skills, a child will have better access to the world.
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