A Speech-Language Pathologist (SLP) addresses a broad range of human communication and swallowing disorders across the lifespan. Their expertise includes the physical production of speech sounds, fluency, and the understanding and use of language, including reading and writing. SLPs also treat voice quality, pitch, volume, and cognitive aspects of communication, such as memory and problem-solving related to language. Recognizing the signs that warrant an evaluation is the first proactive step in ensuring timely intervention, which can significantly improve outcomes.
Early Developmental Milestones (Ages 0-3)
Parents and caregivers should monitor communication development closely in the first three years, a period of rapid language acquisition. A potential sign for concern is the lack of pre-speech behaviors, such as no babbling by nine to ten months, or the absence of simple gestures like waving or pointing by 12 months. These early non-verbal actions are foundational for later spoken language.
By 16 months, a child should be using at least a few single words; the absence of true words by this age is a red flag. If a child is not spontaneously combining two different words, such as “more juice” or “go out,” by 24 months, it suggests a delay in expressive language. If a toddler rarely imitates new words or sounds, or if their vocabulary seems significantly limited compared to peers, an evaluation is recommended.
Difficulties with language comprehension, known as receptive language, can also signal a need for an evaluation. If a child consistently fails to follow simple, one-step directions without heavy accompanying gestures by 18 months, or does not understand familiar names of people or objects, this warrants attention. Any loss of previously acquired communication or social skills at any age is an immediate indicator that a professional assessment is necessary.
Indicators for School-Aged Children (Ages 4+)
Once a child enters the school environment, concerns shift from initial language acquisition to the clarity and complexity of their communication. By age four, a child’s speech should be largely intelligible to unfamiliar listeners, though certain late-developing sounds like ‘r’, ‘v’, or ‘th’ may still be inaccurate. If articulation errors persist to the point that strangers understand them less than 75% of the time, this points to a potential phonological or articulation disorder requiring assessment.
Fluency disorders, commonly presenting as stuttering, become more noticeable and disruptive in the school years. An evaluation is warranted if a child’s speech repetitions, prolongations, or blocks are frequent, accompanied by physical tension, or cause frustration or embarrassment. Children in this age group may also struggle with complex language required for academic success, such as following multi-step directions involving temporal concepts like “first” and “next.”
Social communication, or pragmatics, is another area for concern, including skills like staying on topic, understanding non-literal language, and adjusting speaking style to different listeners. Persistent voice abnormalities, such as hoarseness, a breathy quality, or a voice that is too high or low in pitch, should prompt a referral if they last for more than a few weeks. These issues can impact a child’s social participation and academic performance.
Speech and Communication Concerns in Adults
For adults, the need for a speech-language evaluation is often triggered by an acute medical event or the progression of a chronic condition. A sudden change in communication following a stroke or traumatic brain injury (TBI) is a frequent reason, potentially resulting in aphasia (affecting language comprehension and expression) or dysarthria (slurred speech due to muscle weakness). These acquired disorders significantly impact the ability to participate in daily life, requiring immediate attention.
Progressive neurological diseases, such as Parkinson’s disease or Amyotrophic Lateral Sclerosis (ALS), often cause gradual changes in speech and swallowing. Individuals with Parkinson’s frequently develop hypokinetic dysarthria, characterized by a soft voice (hypophonia), monotony, and imprecision. They may also experience word-finding difficulties or struggle to keep up with the flow of a conversation.
Swallowing difficulties, medically termed dysphagia, are a common adult concern, particularly in older adults or those with head and neck cancer. Signs like frequent coughing during or immediately after eating, a sensation of food “sticking” in the throat, or a wet, gurgly voice after swallowing indicate a potential safety risk and require urgent evaluation. Persistent voice changes unrelated to a cold, such as chronic hoarseness or a strained voice, also necessitate an SLP assessment, often in collaboration with an otolaryngologist.
What Happens During a Speech Therapy Evaluation
The evaluation process begins with a comprehensive case history, where the SLP gathers information about the individual’s medical background, developmental milestones, and current concerns. This consultation helps the therapist understand the context of the difficulty and guides the selection of appropriate testing materials. Following the history, the SLP conducts a series of formal and informal assessments.
Formal assessments involve standardized tests that compare an individual’s skills in areas like articulation, language comprehension, or fluency against others in their age group. Informal assessments include observation, such as watching a child play or conversing with an adult, and performing a physical examination of the mouth and throat structures used for speech and swallowing. Finally, the SLP reviews the findings, discusses the diagnosis or clinical impression, and provides evidence-based recommendations for a treatment plan or further referral.