Speech Therapy

What is Speech Therapy? - Referral Process - Speech and Language Disorders

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 mental retardation 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.