All About Speech Therapy

Michelle considers herself an expert on obtaining and receiving speech-language therapy services. "All three of my children needed speech therapy," she says. "If there's one thing I learned, the earlier you start, the better!"

We are reminded that children crawl, walk and talk following their own developmental schedules. Yet parents can't help but compare their child to other children they see in playgroups, classes or on the playground.

Differences in verbal abilities are easy to detect; one toddler may use one or two words to communicate while another seems to speak in paragraphs. Michelle started worrying when her oldest child had only a handful of words at age 2. She raised her concerns with her pediatrician, who suggested she contact her area's early intervention program for an evaluation.

The difference between speech and language

Speech involves verbal output. Children with speech delays may have issues with:

• Articulation - including not being able to say sounds or words correctly. One example of this is a lisp -- when a "th" sound is voiced instead of an "s" or "z" sound.
• Fluency - including stuttering or abnormal stoppages that disrupt the normal rhythm of speech.
• Voice - including issues with volume or pitch.

Language is a broader category and encompasses both receptive and expressive components.

• Children with receptive language issues have difficulty understanding and processing language.
• Children with expressive language issues have difficulty expressing themselves. For example, they may not put words together correctly when speaking or may have word-finding problems.

Some children may have only one area of difficulty, such as an articulation issue, while others may have more than one area of concern.

Causes of speech and language delays

A variety of factors can contribute to speech and language delays, such as the following:

• Physical characteristics of the tongue or palate
• Oral-motor issues

Problems involving planning or coordinating the muscles around the mouth can make it difficult to produce certain sounds. Some of the issues can be caused by:

• Chronic ear infections. The constant presence of fluid in the ears can lead to trouble hearing, understanding and imitating speech.
• Brain injury or cognitive developmental delays
• Breathing or swallowing disorders

When to seek an evaluation

Since trouble with hearing can cause speech issues, a hearing evaluation will often be requested before a child's speech is evaluated. But you might want to consider obtaining a speech-language evaluation if your child falls into one of the following categories:

• An infant who isn't responding to sounds or vocalizing
• A 2-year-old who isn't producing spontaneous speech, cannot follow simple directions, or is more difficult to understand than his peers
• A 3-year-old who is not understood by family and familiar caregivers, or who can't correctly produce p, b, m, w or vowel sounds in words
• A 4-year-old whose speech is not easily understandable (to both familiar and unfamiliar people), or who can't produce the sounds t, d, k, g, f
• A 5-year-old whose speech is, for the most part, not understood or produced correctly.
  

Children whose speech is frequently slurred, or whose rhythm or quality of voice doesn't sound quite right might also benefit from an evaluation.

Visit the American Speech-Language-Hearing Association's website for a detailed list of language developmental milestones, as well as information about speech, language, or hearing issues.

Bilingual children

The same milestones -- speaking a first word by age 1 and using two-word combinations by age 2 -- are seen in bilingual children, although it can be normal for bilingual children to mix up words and grammar when learning to speak.

What happens in evaluation and therapy sessions

Using age-appropriate activities and language, a speech-language pathologist (who is an educated professional with at least a master's degree) will interact with and assess your child. The speech-language pathologist will note the ways your children communicate, their receptive and expressive language abilities including speech and sounds produced, as well as how well the muscles around their mouths work.

Once they are identified as needing services, most kids enjoy their speech-language sessions. Using toys and games, a speech-language pathologist will converse with the children, modeling and trying to elicit certain sounds. The pathologist might work on oral-motor exercises to strengthen muscles around the mouth. Some sessions are one-on-one; others may involve groups of children with similar issues.

Depending on a child's situation, the speech-language pathologist may make suggestions about activities or exercises to do at home. "I always asked for homework so I could work with my children during the week," says Michelle.

Evaluations for children under the age of 3
Each state has an early intervention program, which serves children ages 0-3. The goal of an early intervention program is to identify any developmental delays (such as speech, gross motor, or fine motor) as early as possible so that the delays can be treated. Early intervention programs provide free evaluations. Depending on where you live, however, you may need to pay for the services received (such as speech therapy, physical therapy, or occupational therapy).

While your pediatrician can point you to your local early intervention program, you don't need a doctor's referral to initiate the evaluation process.

Evaluation options for children older than 3
Your town or city's public school system is responsible for evaluating children over the age of 3, and these evaluations are free. To get started, contact your neighborhood school or your school department and ask about special education services.

You can also choose to have your child evaluated through a private agency. In this case, costs will vary. Be sure to check if your insurance will cover all or part of the cost.

The bottom line
If you have any concerns, it never hurts to get your child evaluated.

"Trust your gut!" urges Mary Kay, whose daughter received speech therapy. "I knew there was a problem, but our pediatrician just kept telling me to wait until my daughter was 3. Looking back, I should have started the process earlier. Once we started, my daughter's speech improved drastically!"

For more information:
Nemours Foundation: Speech-Language Therapy

Deborah Elbaum, M.D. lives in Massachusetts with her family. She writes about a range of family and medical issues for Care.com.