Speech therapy, formally known as Speech-Language Pathology (SLP), involves the assessment and treatment of communication and swallowing problems across the lifespan. Services address issues such as delays in language development, difficulties with speech production, and acquired conditions resulting from illness or injury. Recognizing the signs that intervention is needed is the first step toward ensuring a timely evaluation and effective support.
Developmental Milestones and Red Flags in Children
Early childhood is a period of rapid language acquisition, and developmental benchmarks guide parents and caregivers. For infants, a lack of babbling by nine months or an inconsistent response to their name by 12 months warrants consultation. By 18 months, a toddler should be using a few recognizable words and consistently using gestures like pointing or waving.
Between 18 and 24 months, a red flag is a vocabulary of fewer than 50 words or a failure to combine two words into simple phrases. Receptive language, or understanding, is also important; the child should be able to follow simple one-step directions without visual cues. A loss of previously acquired speech or social skills at any age requires immediate assessment.
By three years old, a child’s speech should be about 75% intelligible to unfamiliar listeners, and they should be consistently using three-to-four-word sentences. If a three-year-old’s speech is mostly understood only by immediate family members, an evaluation is recommended. By four years of age, a child should be understood nearly all the time and should be able to tell short stories or describe events.
Beyond the preschool years, therapy may be needed if a child struggles to follow multi-step directions, indicating a possible receptive language difficulty. Persistent difficulties with grammatical structures, such as verb tenses or plurals, compared to peers also suggest a need for intervention. Early identification of these difficulties is associated with better long-term outcomes in literacy and academic performance.
Identifying Specific Speech and Language Issues
Intervention may be necessary even when a child’s general language development is on track, particularly when specific speech disorders are present. Fluency disorders, commonly known as stuttering, involve disruptions in the flow of speech, such as repetitions of sounds, prolonged sounds, or blocks. While many young children experience normal, temporary disfluencies, therapy is recommended if the stuttering lasts longer than six to twelve months, or if the child shows signs of physical tension or avoidance when speaking.
Voice disorders require attention if a child or adult experiences persistent hoarseness, raspiness, or a strained vocal quality lasting more than two to four weeks. These symptoms may indicate vocal cord issues caused by chronic vocal abuse or an underlying medical condition. Consulting an ear, nose, and throat (ENT) specialist is the recommended first step, often followed by voice therapy performed by an SLP.
Therapy for articulation, or sound production, may be required if certain late-developing sounds are not mastered by specific ages. The sounds /r/ and /s/ are common examples. Intervention for /r/ errors is typically most effective if started by age 7.5, as error patterns can become ingrained by age 8.5. An error like a lateral lisp, where air flows over the side of the tongue during /s/ or /z/ production, is not a typical developmental stage and requires intervention regardless of the child’s age.
Acquired Communication Needs in Adults
Speech-language services are commonly needed for adults following a sudden neurological event that impacts communication. After a stroke or traumatic brain injury (TBI), individuals may experience aphasia, a language disorder affecting the ability to speak, read, write, or understand others. They may also develop dysarthria (slurred or weak speech due to muscle control issues) or apraxia of speech (difficulty planning the movements necessary for clear speech).
Progressive neurological conditions also necessitate intervention to maintain communication and swallowing function as the disease advances. Individuals with Parkinson’s disease often experience hypokinetic dysarthria, marked by a quiet, monotone voice. Early therapy is beneficial for strengthening vocal output. For conditions like Amyotrophic Lateral Sclerosis (ALS), therapy focuses on establishing alternative communication methods before natural speech becomes compromised.
A change in swallowing ability, known as dysphagia, is a frequent reason adults need an SLP, especially after a stroke or with a progressive disease. Signs of dysphagia include frequent coughing or choking while eating or drinking, a wet or gurgly voice quality after swallowing, and unexplained weight loss. Swallowing difficulties should be evaluated promptly to prevent aspiration pneumonia, malnutrition, and dehydration.
Steps for Seeking Professional Assessment
When a concern arises, the first action is to consult a primary care physician (pediatrician for a child, general practitioner for an adult). This initial consultation helps determine if the issue is solely related to speech or language, or if it is connected to an underlying medical factor, such as hearing loss or a neurological condition. The physician can then provide a medical referral for a comprehensive evaluation.
The Speech-Language Pathologist (SLP) is the qualified specialist who conducts the formal evaluation. This assessment typically involves taking a detailed case history, including developmental milestones and medical background. The SLP uses standardized tests, which compare the individual’s performance to others of the same age, along with informal observations of communication during conversation or play.
Following the assessment, the SLP discusses the findings, determines if a speech or language disorder is present, and recommends a treatment plan if therapy is warranted. This plan outlines specific, measurable goals and the recommended frequency of sessions. Parents and adults should ask questions about the results and the proposed course of action to ensure a collaborative approach to intervention.