Does speech therapy work?
You pack up your child for yet another visit with the speech therapist. After a few minutes in the waiting room, the therapist comes and fetches your child. 30 minutes later, they reappear from the back room. As you head back to your car, you ask your child, “Did you have fun?” As usual, they don’t say anything. That’s because they still aren’t talking.
After all these sessions, I don’t see any progress, you think, “Is speech therapy even working?”
If this sounds like the voice in your head, I’m happy to share with you my tips, as a mom and speech therapist, for making the most of speech therapy.
I’ll start by talking about how to set you and your little one up for success, and talk about some reasons why speech therapy might NOT be working. At the end, you’ll have learned some specific things you can do if you feel that speech therapy really isn’t working.
The Key To Success: Setting realistic goals for speech therapy
A lack of progress in a particular therapy or approach is unfortunately something that a lot of families encounter. To help families set themselves up for the most success, we always suggest realistic goals.
A good therapist will write measurable realistic goals for your child. But it is also important that families enter into a therapeutic experience with their own realistic goals. For example, even with expensive private lessons, your 10-year-old won’t become a world-class piano player after only a few sessions.
Unfortunately in this day and age of quick results (“Lose Weight Fast!”, “Get your Degree in only 18 Months!”) many parents enter into speech therapy with expectations that are not in alignment with their child’s overall trajectory, age, and diagnosis.
Determining the right goals for your child
We always suggest talking with your therapist about what their goals are for your child, and what the timeline for those goals are. This will help you be realistic about what might happen in the next few months.
It will also help you later evaluate the quality of the intervention you are receiving by seeing if your therapist
a) wrote realistic goals and
b) had the skills to help your child reach those goals.
When a child isn’t meeting their speech therapy goals
In my opinion, when a child does not meet a therapist’s goals it is not the fault of the child.
It is usually that the goal is:
not realistic/appropriate (or was written before the therapist knew the child very well)
the goal is not actually measurable
the child is mis-diagnosed
the family is not following through with the home program
and/or there is a mis-match between the child and the skill set of the therapist.
If a child is not meeting speech therapy goals, explore if any of these reasons might be applicable.
Let’s dive a little deeper in thinking about why your child might not be making progress in speech therapy.
Not making progress in speech therapy? Perhaps your child doesn’t have the right diagnosis.
In some cases, a lack of progress might be because the child does not have the correct diagnosis and therefore the approach is not working.
A classic example that we speech therapists see is when a child has a motor speech disorder (called apraxia) but the child is instead being treated for a language disorder. This is comparable to a child with a food allergy instead being treated for a stomach bug.
Without correctly identifying the actual underlying issues and treating them appropriately, there might be minimal progress.
It’s okay to periodically check in with your therapist about what they consider your child’s current diagnosis and ask them if they have learned anything new about your child. Sometimes starting the conversation will allow an experienced therapist a moment to step back and confirm (or reconsider) if the current treatment plan is still appropriate for your child.
Not making progress in speech therapy? Maybe the therapy isn’t family-centered enough.
Sometimes a child isn’t making progress because the treatment approach is therapist-centered instead of family-centered.
If a child is under the age of 5 and the therapist wants the parent to wait in the waiting room during the child’s session, this is a therapist-centered approach and may result in slower progress. In a therapist-centered approach, intervention only happens when the therapist is present (so only 30-60 minutes a week.) \
Progress happens much more quickly for toddlers when the approach is family-centered. This means that some of the session is devoted to family education and engagement and that the parents are present for all of the session.
In an ideal world, a therapist should be able to train a parent to such a high level that the therapist wouldn’t be needed at all anymore. Therapy should include an explicit, functional home program (aka speech homework).
In this approach, therapy happens throughout the day during interactions between the parent and the child (so at least 30-60 minutes a day.)
If your speech therapist has been providing therapist-centered intervention, you might want to consider staying in the room and asking for explicit home activities.
Not making progress in speech therapy? Maybe the therapist isn’t the right match.
In other cases, a lack of progress might be a mis-match between the child and the therapist.
Some therapists are very structured and might sit at a table with flashcards and worksheets. Other therapists might sit on the carpet with your child, putting on sunglasses and silly hats. Both of these approaches might be very effective for the right child.
The trouble is, many times we are assigned a therapist and don’t know that it is the wrong fit until we have had a few sessions together.
Similarly, if a therapist is unable or unwilling to provide home programming at the request of a family, that is a clear mis-match of therapist and patient.
It is important to keep in mind that speech therapy is a very broad field. Many speech therapists (such as those working at a hospital for adults) might go their entire career and never work with a toddler. Other therapists might work exclusively with toddlers, but would be out of their element if an older child came in. We always recommend asking your therapist to tell you briefly about their experience and what types of patients they regularly see.
When the therapist’s approach does not seem to match your child’s learning style, it is worth having a candid conversation with the therapist to see if things can be helped. Perhaps let them know about what activities or games engage your child at home. You can even bring in a toy and show the therapist how you play together at home.
But if after a few tries you still don’t feel like it is the right fit, it is okay to try to switch to a different therapist.
This time, you can probably state what it is that you are looking for in a therapist (“I’d like someone who is energetic and does therapy while moving around,” “I’d like someone who does a lot of book-based tasks,” ”I’d like someone with lots of experience with toddlers,” “I’d like someone who uses a lot of baby sign language.”)
If your child does not click with a professional after a reasonable number of visits, it makes sense to try someone new. You are there to help your child and make progress, so continuing with someone who is not a good fit does not work toward that goal.
Now that we’ve covered some reasons your child may not be making in progress in speech therapy (realize that none of them are your fault or your child’s fault), it’s a good time to talk candidly about how long speech therapy may last.
How long are we going to be in speech therapy?
Very few things about speech therapy are fast.
Speech therapists wish they had a magic wand that can turn someone verbal in just a few sessions.
Unfortunately, depending on the age and diagnosis of the child, therapy may take a year or more.
In some cases (such as when the child has a language disorder secondary to another diagnosis, like autism or Down Syndrome,) therapy will likely be ongoing for many years.
Is it time for a break from speech therapy?
We all need breaks sometimes.
When progress plateaus, or the child’s engagement during the therapy sessions falters, it might be time to consider a therapeutic break.
Any therapist worth their salt will recognize when the time is ripe for a break.
Signs we therapists look for are:
when a previously engaged child stops having fun during the sessions
when sessions start to be frequently canceled,
when the family admits that they have not been keeping up with the home programming.
Sometimes a family can only commit to so many different things at once and it might be that another type of therapy needs to take priority for a few months. Perhaps a family needs to take a three month break from speech therapy so that they can have the time and energy to devote to physical therapy. Or perhaps the family is feeling a lot of stress right now because of the birth of a new baby and it will be easier to commit to a home program again when the summer starts.
For many families, therapy is a marathon, not a sprint. It’s okay to take breaks sometimes so that your child can practice the skills they have already learned.
And here are the answers to two last questions parents often ask:
Does speech therapy really work for toddlers?
Yes it does.
How fast therapy progresses depends on a number of factors: if the intervention is family-centered, if the family is given a home program, if the child has the correct diagnosis, if the child’s style matches the therapist’s style, and if the therapist is experienced with toddlers with that diagnosis.
I don’t think my child likes their speech therapist. Can we switch?
Yes you can.
There are lots of different children and lots of different therapists. It is normal that your child would “click” more with some than others.
If you have tried speaking with the therapist to see if they are willing to try different games/ toys and it still isn’t working, talk to your insurance and see if other providers are covered.
You might consider reading their bios online, interviewing a potential therapist, or even schedule a trial appointment to see if it is a good match.
Sometimes within a private practice there are multiple therapists. You can request a make-up session one week at a different day/time as a way to try a different person.
Us therapists know that we all have different skill sets and different styles and we want you and your child to find the right fit.
Written By: Stephanie Burgener-Vader, MA CCC-SLP
© 2020-2023. Stephanie Keffer, MS CCC-SLP. All Rights Reserved.
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