How do I know if my child needs speech therapy? How do I pick the appropriate therapist or setting to receive therapy? What can I expect at the evaluation and during therapy sessions?
Hi, Chelsea here! I have been a pediatric speech language pathologist since 2015. I have worked in multiple different settings and am here to help you answer these questions. This will be a multi-part series, where we help parents determine if their child needs therapy, where to go to receive therapy that best meets their needs, and what to expect when starting therapy.
This post contains Affiliate Links. If you make a purchase using the links, we may earn a small commission, with no additional charge to you. Please read our full Affiliate Disclosures
Why Might My Child Need Speech Therapy
There are several different reasons why your child might need speech therapy. This is an extensive list, but it definitely does not cover every type of disorder or reason your child needs speech therapy. Instead, it is intended to help guide you and give you an overview of common reason(s) your child may need therapy.
Oral and/or Feeding Skills:
Early on, your child may have to be in the NICU or may have difficulty latching to take the breast or bottle.
Your child may have a tongue tie that needs to be corrected for appropriate oral feeding skills.
Your child may be a picky eater or have difficulty transitioning to a straw or open cup.
Your child may be a habitual “mouth breather” or may struggle with drooling.
Language Development Delays/Disorders:
Your child may be delayed in developing play skills, gestures, babbling, or imitation skills.
Your child may not yet be using single words around 12 months of age.
Your child may have some words but is not putting words together by 2 years of age.
Read more about how to support successful language development in our Language Development Series:
Narrating for Successful Language Development
Waiting for Successful Language Development
Play: The Most Important Childhood Skill
Behavior is Communication: Part 1
Behavior is Communication: Part 2
Speech Sound Difficulties:
Your child may have a robust vocabulary, but you and/or others have difficulty understanding them.
Read more about that in 6 Reasons You Cannot Understand Your Child When They Talk
Language Content Difficulties
Your child may use a low number of words in sentences or lacks descriptive language.
Language Form Difficulties
Your child may have difficulty with grammar skills, such as using plural “s” or appropriate past tense forms of words.
Language Use Difficulties
Your child may lack initiation, have difficulty maintaining eye contact, or struggle with maintaining conversations.
Your child may have difficulty with peer interactions or making friends.
Academic Concerns
Your child may have difficulty learning to read and write or have difficulty with comprehension.
Your child may have difficulty composing written works, such as essays or book reports.
Your child may struggle with executive functioning tasks, such as planning, organizing, and initiating.
Other
Your child may stutter or have disfluent speech.
Your child may have hearing loss that affects their speech and language development.
Your child may have a voice disorder that affects their breathing or vocal quality.
Your child may have an established diagnosis that is known to correlate with speech and language difficulties, such as Down Syndrome, Autism Spectrum Disorder, Congenital Heart Defects, Global Developmental Delay, or Cleft Lip and/or Palate, just to name a few.
Who Might Identify My Child’s Need for Speech Therapy
You or someone in your family may recognize your child’s need for therapy. Many children are screened at their well checks by their healthcare professional and identified as needing a referral to speech therapy. Additionally, childcare providers or educators may identify your child’s need for speech therapy. And, even people in the community may encourage you to seek speech therapy for your child (maybe kindly or not so much).
As a parent, if you have concerns about your child’s speech and language skills, you have a few options for taking the next step, including talking to your child’s healthcare provider, self-referring to speech therapy services, and/or researching recommended therapists or locations for services. Below is a little more detail about each.
Healthcare Provider
- You can talk to your child’s healthcare provider about their opinion and/or for referral options to speech therapy.
- Please note, however, many healthcare providers have a general knowledge of these oral, speech, language, feeding skills, etc. You are the expert on your child, and if you do not agree with their view of your child, you can self-refer to several different providers.
- Additionally, many healthcare providers are limited on who they refer to for speech therapy, and you as the parent are not limited to who they refer you to.
Self-Referral
- You can self-refer to many service providers, such as early intervention or private practices. Of note, if you are going to a place that bills insurance, you will likely need a referral from your child’s healthcare provider.
- Research local speech therapy options and seek recommendations from people you know. Other parents are often the best resource for recommendations. I see posts like this a lot on social media. This may be an option for you, but sometimes people want to keep the information about their child more private. In that case, you may talk to friends and family members, or people who are a part of your closer, trusted network to see if anyone else has any recommendations.
As you are having these conversations and doing your research, you may come across several different therapy settings or places where you can receive therapy. I will provide some details about each below.
Where Can I Get Speech Therapy
Early Intervention
Every state has an early intervention program, but many operate off of a different name, which can make it confusing. Some examples of names I have seen: “Help Me Grow, Birth to Three, First Steps”.
This program provides services to children ages 0-3, with services stopping 1 day prior to the child’s third birthday, and with an option to transition to public school services, pending an evaluation to determine qualification.
Early intervention services are provided in the child’s “most natural environment”. This means in the child’s home or other setting, such as daycare, the park, or a library. Therapy services, such as speech, occupational, and/or physical, are most commonly provided through early intervention. However, there may also be services, such as vision, hearing, dietician/nutrition, nursing, and more.
An intake process, evaluation, and meeting to write the individualized plan occur prior to the start of therapy services. There are strict timelines that are required in terms of completion of each of these tasks so as not to delay services for your child. Many of these meetings and possibly the evaluation can take place virtually to help with convenience of scheduling.
Depending on your location and the availability of therapist(s), all disciplines may not be available. In this instance, a virtual therapist may be offered or your child may have to go onto a waiting list for when a service provider may become available.
Find out more for each specific state: https://www.cdc.gov/act-early/early-intervention/contact-information-by-state.html
School
Public school services are available, pending qualification, to children who are 3 years of age or older. In order for a child to qualify, their deficits need to negatively impact academic performance. If the evaluation team does not determine this qualification, they will not be eligible for school services. In the event of this, your child may still qualify for services in another setting, such as outpatient services, because their qualification standards are different.
School therapy may be provided as a “walk in” service, where children are taken to the school for a designated speech therapy appointment time. Or, this can be implemented as part of their school day (e.g. preschool, grade school, middle or high school).
Many children transition into public school therapy after they “age out” of early intervention services (e.g. 3 years old). If your child receives services through Early Intervention your service coordinator will ask if you want to opt into being evaluated through the school system before your child’s third birthday.
If you opt out, no evaluation with the school will take place and services will end. You may still choose to enroll your child into school services, but you will be responsible for contacting the school to initiate services.
If you opt into the transition evaluation from early intervention, the receiving school in your district will set up an intake meeting with you and the First Steps coordinator. The school system must complete the evaluation and hold a case conference before your child’s third birthday. This ensures no major gaps in therapy occur. During the case conference the evaluation team will discuss their findings with you, and together, with you, will decide if your child is eligible for areas that were assessed (Speech Impairment, Language Impairment, Developmental Delay, etc.).
If you are a parent of an older child or a child who is not in Early Intervention, or you declined the school evaluation through Early Intervention, you can contact the school and request services. Once you contact the school, a permission to evaluate will be created. You will sign it, and once the school receives your signature back a timeline begins.
*The number of days will vary based on state and school district. For example, Lauren’s school district has a 50-day timeline.* This means the school evaluation team has 50 school days (not including weekends, holiday breaks, etc.) to complete the evaluation and hold the initial case conference. Again, at this initial case conference the team will discuss their findings and together you will decide if your child qualifies for services.
Outside of parent referrals, many children begin speech therapy after being identified through screenings, such as Kindergarten speech and language screenings. Other children may be referred by their classroom teacher.
After determining eligibility and completing the process described above, therapy services will be conducted by the SLP or by an SLP-A, who is an assistant. Services provided by assistants will be overseen by the SLP. Each state has its own laws and regulations that govern the type and degree of supervision provided to an assistant.
Speech therapy in the school setting varies largely between therapists, school systems, etc. Some kids will participate in a group setting, others will have 1:1 sessions; some will have therapy within the classroom, and others will have it in the hallway.
Outpatient Clinics
There are several different outpatient settings including outpatient hospital clinics, private practice clinics, and university clinics. In each of these settings, you take your child to the specific clinic location for therapy. Oftentimes these are 1:1 therapy sessions, where your child works directly with the therapist. But, there are often groups that are run by SLPs or even in collaboration with other therapists (OTs, PTs) that target specific skills, such as social groups or feeding groups.
Hospital Clinics
Outpatient hospital clinics are associated with a local hospital. Many are within the hospital and others are in a dedicated building outside the hospital. In this setting, they often bill insurance and some offer self-pay discounts for insurance plans that do not cover pediatric speech therapy. This setting usually requires a referral from a healthcare provider.
Private Practice
These are privately owned clinics. The location of these may vary from stand alone buildings, to business complexes, shared spaces, or even a room out of an SLP’s home. Many private practice clinics bill some or all forms of insurance, however others may not bill insurance. Depending on the specific clinic, a physician’s order may or may not be required.
Another type of private practice may provide services in client homes or another designated location (e.g. community setting, childcare facility). This is how we at Three Roads Therapy provide our services!
Services provided in this type of setting may or may not bill insurance and likely do not require a referral from your child’s healthcare provider, although some may.
University Clinics
These are outpatient clinics that are associated with a University SLP program, often a graduate program but some undergraduate programs also offer them. In this setting, you can expect to receive therapy from students in training who are directly supervised by SLPs.
This supervision may take place in the room, from an observation window, or from their office via a camera. Students are obviously not certified and are learning, but they work closely with their supervisors to learn and implement therapeutic skills. Each clinic will have its own billing and referral requirements, which can be discussed when scheduling.
How to Choose the Right Setting for My Family
There are pros and cons for every service location discussed above. When considering your options, it may feel overwhelming. I suggest creating a list of each of the options you have gathered that are available in your area and write the pros and cons of each to best determine.
Some things to consider as you make your decision:
Cost
Does your child’s health insurance cover pediatric speech therapy? Are there visit limitations, deductibles, or only specific diagnoses that are covered?
Do you need a place that bills insurance or are you able to afford a private pay rate?
Schedule
What type of schedule do you and your family keep?
How flexible are you and how available are you during the hours of operation of the specified setting? Many SLPs maintain full schedules and often have very little margin, however, the hours of operation for an outpatient hospital clinic may vary from those of an in-home private practice.
Do you need the services to take place while your child is at daycare or school?
Are you open to virtual or remote services? There are many specialty services that you can receive virtually from large hospital systems or even through private practitioners.
Area of Need
How old is your child? If they are in the 0-3 age range, you may consider early intervention. If your child is a teenager, you may seek a specialty outpatient center that specializes in their specific disorder or age range.
Does your child have a specific disorder type that requires specific intervention, such as Orofacial Myofunctional Disorders, Passy Muir Valve Placement, or prescription of an AAC device? The skillset of a specific SLP varies and is often setting-dependent as well.
Severity of Need
Does your child have severe or multiple different areas of need? You may need an SLP who is experienced in multiple areas or even different SLPs to address each area of need.
Does your child need therapy multiple times each week? You may consider multiple different settings, such as a combination of early intervention and private practice. Or school services and outpatient.
Does your child have mild deficits? These may only require consultation or intermittent check in appointments.
Final Notes
Now that you have a basic understanding of if your child needs speech therapy and the different setting you may choose, I will go into more detail about what to expect once your child starts therapy! Be sure to follow along the next few weeks to learn more.
References
Learn the Signs. Act Early. Early Intervention (2026). Retrieved from: https://www.cdc.gov/act-early/early-intervention/index.html
Cover photo and Pinterest images are not originally created by Three Roads Therapy LLC. Obtained from Canva: Crystal Sing from Corelens; Sergaispas from Pixabay; Karola G from Pexels; Yan Krukau from Pexels.
Information Disclaimer
The content, images, materials, and information provided on this website is only intended to be general summary information to the public. It is not intended to take the place of either the written law or regulations. It should not be viewed as medical, financial, legal, or professional advice of any sort. We will do our best to confirm the accuracy of all information that appears on our website but cannot guarantee accuracy, reliability, or timeliness. All recommendations are made without guarantee or warranty. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information, products, services, or related graphics contained on the website for any purpose. Any reliance you place on such information is therefore strictly at your own risk.
We cannot predict and do not guarantee that you will attain a particular result from the information provided in or through this website, and you accept and understand that results differ for each individual. Each individual’s results depend on his or her unique background, traits, dedication, desire, motivation, resources, actions, and many other factors. You fully agree that there are no guarantees as to the specific outcome or results that you can expect from using the information you receive on or through this website.