Speech-Language Therapy

From birth, children learn to communicate in a variety of ways including through eye gazes, gestures and vocalizations. For children who are delayed in their communication skills, intervention can begin at a very young age. Improved ability to communicate reduces frustration as children become older.
Speech-language therapy helps children improve their communication skills verbally, by using gestures, sign language or the use of augmentative devices. An important part of intervention includes teaching parents and caregivers skills to stimulate their child’s communication skills.
The focus of pediatric speech-language therapy is to support the development of effective communication skills. 

Treatment may target the following areas:

  • articulation
  • production of sound
  • oral motor control
  • language development
  • cognitive skills
  • social skills
  • safe feeding & swallowing

Speech Referral Guidelines for Pediatrics

Most Common Etiologies

  • Cerebral palsy
  • Craniofacial disorders (e.g., cleft lip/palate)
  • Functional articulation and/or phonological disorders

Potential Consequences/Impact of Speech Impairment Can Include

  • Difficulty expressing need or routine information intelligibly
  • Difficulty communicating intelligibly in order to function at level of independence expected for age
  • Difficulty expressing feelings intelligibly; may be at risk for frustration or depression
  • Difficulty engaging successfully in social and/or classroom situations that require intelligible speech
  • Difficulty achieving adequate intelligible speech to reach educational potential
  • At risk for personal injury due to difficulty communicating intelligibly about a dangerous situation or calling for help

Behaviors That Should Trigger an SLP Referral

By age 3 years cannot:

  • be understood by family and/or caregivers
  • correctly produce vowels and such sounds as p, b, m, w in words
  • repeat when not understood without becoming frustrated

By age 4 years cannot:

  • be understood by individuals with whom they do not associate regularly
  • be understood by family and/or caregivers
  • correctly produce t, d, k, g, f
  • be asked to repeat without becoming sensitive

By age 5 years cannot:

  • be understood in all situations by most listeners
  • correctly produce most speech sounds
  • be asked to repeat without exhibiting frustration


Disturbance in neuromuscular control causes difficulty learning to produce sounds appropriately

  • speech is usually slurred; difficulty controlling respiration for speech; abnormal loudness, rhythm, or vocal quality
  • exhibits difficulty learning sounds to form words; may sound nasal, strangled and/or breathy
  • exhibits frustration and/or avoidance of speech due to extreme difficulty forming sounds or difficulty being understood

Disturbance in programming, positioning, and sequencing of muscular movements

  • sound errors are prevalent but variable (i.e., “dog” could be produced “dog,” “tog,” “gog,” “god” by same child)
  • varies from rarely being able to produce sounds to ongoing speech that is rarely understood, or speech that is usually understood with frequent sound errors
  • unaware of sound variations or exhibits varying degrees of frustration and/or anxiety regarding inability to “control speech”

Disturbance in performing voluntary movements with mouth and vocal mechanism

  • cannot produce movements for sound production or sounds are produced without voice (whispered speech)
  • varies from inability to produce any words to extreme difficulty being understood
  • exhibits frustration and/or avoidance of speech due to difficulties

Deafness/severe hearing loss causes severe prosodic disturbances in intonation, duration, and rhythm in addition to sound errors

  • produces no meaningful words or sounds understood only by family
  • speaks loudly in high pitched voice with frequent distortion, omission, and substitution of sounds

Autism, emotional disturbance, and/or intellectual disabilities may cause very unusual prosodic variations

  • intonation and/or rhythm of connected speech may sound abnormal
  • volume may be consistently or intermittently too loud or too soft

Deviation in structure of speech mechanism

  • difficulty producing specific sounds and intelligible speech
  • exhibits frustration and/or avoidance of speech
  • speech has excessive nasality

Difficulty in hearing and/or inability to differentiate between sounds inhibit child’s ability to detect and correct error sounds; usually unaware of errors

Intelligibility and sound production are compromised when nasal passages, nasopharynx, and larynx are bypassed due to tracheostomy/ventilator dependence

Exhibits sudden decrease in speech intelligibility

  • ranges from slurred, generally intelligible speech to total absence of speech, or totally unintelligible speech
  • awareness ranges from extremely aware to totally unaware of sound errors

Exhibits decline in ability to be understood by family, friends, and/or caregivers in the expression of basic needs, preferences, and feelings