Speech Therapy: What It Is and How It Works
We see you: determined to get dinner on the table before your toddler’s next meltdown while trying to keep the dog from drinking from the toilet bowl again while listening intently to your nine-year-old work through her reading assignment. Her dyslexia means she’s several grade levels behind, and her speech apraxia makes her hard to understand, but you’re relieved she’s motivated to work hard and that she’s talking so much more these days. (In fact, sometimes it feels like she never stops talking.)
You’re not alone! Speech and language delays are extremely common among children with disabilities, and they affect nearly every facet of community and school life. To look at the hows and whys of speech therapy — when to start, the benefits of individual vs. group sessions, how the focus of therapy can change over time, and how it relates to reading fluency — we sat down with speech-language pathologist Amy Wilhelm, M.S., CCC-SLP, owner of Splash for Speech, Inc., and Sara Palmer, speech-language pathologist (SLP) and AAC consultant at the Salvin Special Education Center in Los Angeles.
Early intervention is key
Studies indicate that by first grade, about 5% of kids have a noticeable speech disorder. And it’s important not to wait to address any speech delays: experts stress the importance of early intervention. As Wilhelm explains, 80% of brain growth occurs during the first three years of life. “A child who hasn’t spoken any words between fifteen and eighteen months is considered a ‘late talker,’” she says. “At that time, if a child is behind, a referral for early intervention services is warranted.”
“Early intervention cannot be emphasized enough,” Palmer says. “Then, as they enter elementary school, we start to look at whether they are being provided with the appropriate placement to support their language development, as well as whether there are areas in language that may not have been as apparent as a three-year-old but as a six-year-old are much more concerning, such as transitioning from limited expressive language to working on social language skills.”
Prior to age three, children with speech delays can access early intervention assessments and services through Regional Center’s Early Start program. After a child turns three and enters the school setting, the school can assess a child for an Individualized Education Plan (IEP). This includes screening for specific disabilities, developmental delays, and learning issues and coming up with goals, accommodations, related services, and other supports to help a child make progress in school.
Approaches to learning expressive and receptive language
There are two types of language: expressive (what we say) and receptive (what we hear and understand). Speech-language therapy addresses expressive language when treating oral motor disorders, apraxia of speech, dysarthria, and other communication issues. SLPs can also help children with receptive language disorders who speak but don’t comprehend or generalize language.
Wilhelm says, “When we work with kids who have receptive difficulties, we help build vocabulary to aid with listening comprehension and following directions. This also helps them understand what they're reading.”
To learn more about common types of speech therapy such as AAC, PROMPT, OPT, and Beckman Oral Approach, check out our therapy glossary.
The benefits of individual and group therapy
“Group therapy can be great, especially for our kiddos who are having difficulty with pragmatic language,” Wilhelm says. (Pragmatic language is the social use of language.) She continues, “Group therapy allows us to work on social skills like turn-taking, maintaining conversations, and asking questions. We don’t necessarily have the opportunity for that during one-on-one sessions with just the child and the therapist.”
Palmer agrees. “Group sessions are an amazing tool!” she says. “As an adult, and no matter how hard I try, I am very boring to most of my students. With peers around, students are motivated to engage and practice speaking, especially when having a debate about the most powerful Pokémon or which Pete the Cat song to listen to next. Kids motivate kids in a way that I cannot replicate. And kids help each other figure things out in a more relaxed way. This is particularly important for my students who are working on social skills. Speech sessions become a non-judgmental space where students can learn how to better socialize and practice skills.”
Exceptions for working on fluency
Fluency refers to the fluidity or smoothness of one’s speech. According to Wilhelm, issues with fluency often involve stuttering, which she says needs to be addressed on an individual basis. “It's important to know that every child who stutters is different. Therefore, therapy should align with the goals that mean the most to that child.”
Palmer also emphasizes the emotional support needed when working on fluency. “Being patient, giving students the time and place to practice speaking, and being aware of the emotional impact that stuttering can have on students is extremely important.”
How speech and reading delays are intertwined
The ability to produce speech sounds is the basis of developing an awareness of phonics, reading comprehension, and being able to express clear thoughts about what we’ve read.
Wilhelm puts it this way: if a child is substituting the T sound for the K sound, which is a common issue, they are going to misunderstand the words they’re reading, which means they will misunderstand what a sentence is about, and it compounds from there. Later, in middle school, this can even translate into troubles with math. She explains in this clip:
Differences between clinic- and school-based speech therapy
School-based SLPs use a large variety of resources, tools, and service delivery models that are based on the needs of the student. “As a school-based therapist,” Palmer says, “we assess how a student is functioning within the school setting. Some students may benefit from small group sessions while other students benefit from push-in services.” For small-group sessions, she says, board games, puzzles, vocabulary cards, and other interactive tools work well. In the classroom, SLPs work collaboratively with teachers and other classroom staff.
Wilhelm says that clinics are often better able to help kids with speech apraxia because school-based therapists are not usually allowed to touch a child on the face, which is needed when dealing with this kind of motor issue. “Usually children with apraxia have a good understanding of language, and they know what they want to say. The difficulty here is carrying out the complex sequence of movements that are necessary for intelligible speech.”
For more information about the differences between school- and clinic-based therapies as well as cost, eligibility, delivery, and other factors, check out this article.
Stay on top of speech goals in your child’s IEP
Unfortunately, it’s not uncommon to see the same IEP goals roll over year after year, which is why we can’t stress enough how important it is to sit down to the dreaded task of mastering the art of writing standards-based IEP goals.
When it comes to speech therapy, Palmer says that if your child is not making progress on their goals, parents should reach out to their school-based SLP to find out why. “There can be many different reasons for this,” she explains. “Perhaps your child is always going to have some difficulties with a certain sound. Do they have a diagnosis that impacts speech production, or, if your child is older, how do they feel about the way they speak?”
But regardless of the reason, Palmer says that considering a change in approach — such as targeting a different speech sound or transitioning to developing compensatory strategies for misarticulations — is very important. “We want to see progress in our student's IEP goals and when there is not, then something needs to change. As part of the IEP team, parent input is very important.”
Common IEP accommodations
Here are some examples of IEP accommodations relevant to speech therapy:
- Use of assistive technology, text to speech (TTS) and speech to text (STT) apps
- Access to AAC device
- "Chewlery" and chewy tools
- Home school communication log
- Tests given orally done with their SLP
- Reading/fluency assessments not timed
- No requirement to read out loud in front of other students
- Added time for test taking
- No point deductions for mispronounced words during oral presentations
- Teacher calls on student only when hand is raised, rather than putting them on the spot.
Why it’s so important to keep the work going (at home)
As Wilhelm likes to say, speech therapy “is a marathon, not a sprint.” So how does it change over time, and what can sessions look like when a child is young versus when they’re older?
“A typical speech session is going to look different depending on how old the child is and what goals you’re targeting,” she explains. “When I’m working with my early intervention population, we’re on the floor using puppets, play food, toys, and bubbles. I also like to use a multisensory approach, such as a sensory bin — we reach in, pull items out, and describe them.” She adds, “As the child gets a little bit older, now we’re doing some tabletop activities, we're working on reading comprehension. We might still be working on articulation of sounds, but we’re always keeping it motivating, keeping it positive, keeping it fun, and keeping the language going.”
The goal, she says, is not to master every sound. For some kids, that may not be a possibility, and that’s okay. “We have to start small,” she says. “We have to get them to be able to produce the sound independently, and build that awareness.”
She encourages parents to get creative with their kids at home. For example, she says, “If your child is working on the K sound, maybe this is a good time to make cookies, or make cupcakes, or have corn for dinner, or go on scavenger hunts — find a key, a car, a cow.”