Speech Therapy or Wait and See?

Have you ever nodded and agreed with your child even though you had no idea what they said?

You are not alone; at 24 months, a child is only expected to be about 50% intelligible. As children become more aware of sounds, and their oral- motor skills develop, typical patterns such as shortening words begin to resolve. By 5 years old, children are close to 100% intelligible, with later-developing sounds such as “r” and “th” acquired by 7 years old. Given the range of typical speech development, how can you tell whether your child is in need of an extra push?


What is Speech?

Speech refers to how we produce sounds and words using our articulators: tongue, teeth, and lips. There are multiple ways in which a child may struggle with speech:

  1. They produce a sound, or multiple sounds, incorrectly. For example, the tongue comes between the teeth for “s” (frontal lisp). Errors in articulation of specific sounds may make a child difficult to understand.

  2. Their speech includes error patterns based on difficulty with phonological awareness of rules for sequencing sounds. An error pattern that typically resolves by 3 years old may persist, such as deletion of final consonants (e.g. “buh” for “bus”).

  3. Their oral-motor skills are impacted by issues with muscle tone and/or coordination. For children with apraxia of speech, messages from the brain are not transmitted correctly to the muscles for speech. For children with dysarthria, weak muscles in the face, lips, and tongue impact execution of speech movements. Feeding may also be affected.


Time to Schedule an Eval? You may wonder whether to wait and see how speech develops, or to initiate speech-language therapy. Consider an evaluation by a speech-language pathologist if your child is:

  • 8 months and does not babble

  • 21 months and does not readily imitate new words

  • 3 years old and often hard to understand, even to primary caregivers

  • Producing words inconsistently; not saying words the same way every time

  • frequently frustrated by communication difficulties

  • 5-7 years old and has persisting articulation errors


What Comes Next?

Once a child is evaluated by a speech-language pathologist and found to qualify for speech therapy, treatment can begin. There are several methods a speech therapist may use to

support a child’s speech development:

  • Therapists trained in the PROMPT method (Prompts for Restructuring Oral Muscular Phonetic Targets) use touch cues and hands-on support to shape speech sound production.

  • Oral-motor exercises may be used as a warm-up in preparation for speech, to increase sensory awareness or muscular engagement. The therapist may use tools such as a nuk brush or tongue depressor.

  • Children may benefit from cues in a variety of forms (verbal, visual, tactile) to increase awareness of speech sounds and patterns. A picture of a snake, or sliding a finger down a child’s arm, may help elicit “s.” Older children may respond to verbal instruction for placement of the tongue.

As with any motor skill, progress in speech requires repeated practice. Caregivers can implement therapeutic strategies at home in communication with the child’s SLP to facilitate carryover of new skills. With the right amount of support, children can make significant progress in their speech development and become more effective communicators.


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