What To Expect At A Speech Therapy Evaluation For Toddlers
A speech and language evaluation is a 1-2 hour appointment during which a speech language pathologist (aka speech therapist or SLP) assesses your child's talking, understanding, and play skills. The purpose of this evaluation is to answer the question, “Does my child need speech therapy?” The speech therapist will help you create a plan to support your toddler if any delays are found.
How do toddler's get a speech and language evaluation?
Young children are routinely scheduled for an evaluation with a speech language pathologist (SLP) when someone points out a potential concern related to their development of understanding skills, talking skills, play, or social skills. It’s possible that you brought up concerns surrounding your child's communication development and asked for this evaluation. It is also possible that someone else (like your child’s pediatrician) has concerns, but you don’t share those concerns. Both are very common scenarios for families and you are not alone! By bringing your child in for speech and language evaluation, you are being a proactive parent and are going to gain some valuable information about language development and your child.
Where will we go for a speech therapy evaluation for toddlers?
When a doctor refers you for a speech-language evaluation through your insurance company, this will most likely take place either at a private practice or at an outpatient location through a hospital/medical group. If you are referred through your county Early Intervention program, the visit may still take place at one of those facilities, but they may also come to your home or ask you to come to one of their offices. In some counties, speech evaluations for toddlers may even take place at a public school site.
How long will it take and what will we do?
Speech-language evaluations take 1-2 hours. It is usually a friendly, casual environment and the speech-language pathologist (SLP) may even have everyone sit on the carpet. The SLP will set up toys and want to observe your child play. They will interview you and ask you routine background questions (such as birth history, medical history, family history, hearing history, eating/swallowing questions). The SLP will also ask you questions about your child’s language and communication development and questions about overall development. This will include information about pacifier and bottle use.
Many times, the parent interview portion of the evaluation helps the SLP fill out a developmental checklist. As is normal for checklists, some of the questions you get asked will be for an older kid, so don’t worry if your child doesn’t do something yet. It is important to answer honestly because the SLP wants to help you and needs to know the full picture of what your child can do and what they are still working on.
In addition to interviewing you, the SLP will play with your child. A good SLP will sit on the floor and engage your child in play. Most likely, the SLP is playing with your child in a specific way to see what they do. Often the play will also include asking the child questions or giving the child directions to see how they respond. Very often children are reluctant to show all of their skills during this evaluation. We’ve all had that moment with our child where we ask them to perform in front of someone and they simply don’t do it. No doubt this will happen during your evaluation, and the SLP will be very used to this! Your expertise as the parent reporter will help fill in the gaps so the therapist gets the full picture of what your child can do. The SLP also wants to see how your child plays with you, since you are more likely to be able to get your own child to open up. You should be able to feel free to sit on the floor and play too.
The speech-language evaluation may also include other activities, such as a hearing screening, looking in the child’s mouth, and/ or watching the child eat/ drink (to look at chewing and swallowing.) It may also include looking at a specific book of pictures and asking your child to point to items, name items, or describe things. This small portion of the evaluation may be a time when the SLP does not want as much help or parent reporting from you; it is best to ask if this is a time you are allowed to guide your child or if the therapist would rather you just watch for these few minutes.
What should I bring to my speech-language evaluation?
Bring all completed paperwork that the center sends you in advance, if any. If your child has had additional testing somewhere else and the therapist does not have a copy already, bring those reports for the SLP to review. If you can, write out a list of words that your child can say (on their own, without you saying it first) and bring it with you because the SLP may ask you what words the child can say. Don’t forget to bring the normal stuff you keep in your diaper bag (snacks, favorite toys, diaper change, etc.) Keep your toys in your bag unless the SLP asks you to get them out.
Pro tip: try not to let your child play on your phone/tablet in the waiting room if they are inclined to become upset when you turn it off, just to avoid having your child already be upset when the evaluation starts.
What is the SLP looking at during the speech evaluation?
In a very basic way, there are three large skill areas that an SLP is looking at. There is expression, there is understanding, and there is social skills/play.
Expression:
What the child says/ communicates. This is the number of words a child says and if they are putting those words together yet. This also includes non-verbal communication, like pointing at stuff they want, using baby sign language, or using eye contact to communicate. For very young children, it is difficult to tease out if delays in expression are actual language delays or if there is a speech production delay (related more to producing sounds and combining sounds to make words.)
Understanding:
What the child can understand. This is the child showing that they understand the names of things, that they understand their own name, and that they can follow directions age-appropriately. For older toddlers this will also include understanding a variety of questions.
Social skills/ play:
How the child plays. The SLP is very experienced in looking at how children play and there are actually milestones for play. The SLP wants to see if the child can play with other people, if they can play with objects/ toys, if the way they play with the objects is typical for their age, and if they can play with multiple objects at the same time. The SLP is also interested in how the child interacts socially with others (especially the parent.) This includes pointing to show something to someone, understanding other people when THEY point, using eye contact to ask for stuff, approaching their parent when they need them, enjoying social interactions, and social gestures like waving. The SLP also wants to see if there are any atypical behaviors.
Does my child need speech therapy?**
In a very basic way, there are three possibilities.
If they are BEHIND with expression, but AGE-APPROPRIATE with understanding and social skills/ play, the SLP may say that they are a late talker or have an expressive language disorder. It is hard to know at this age if they are a late talker because they need extra help figuring out how to choose and use words, or if there is actually something going on with their speech production skills (sound development). A good SLP will be able to monitor a child over time to figure out if there is a speech issue. Speech therapy may be recommended for a child who falls in this category, but some therapists may suggest a “wait and see” approach, depending on the child’s age and how big the delay is.
If they are behind with expression AND understanding, but age-appropriate with social skills/ play, the SLP may say that the child has a receptive/expressive language disorder. This means that the child will benefit from help with their understanding as well as their talking. Speech therapy for children who fall in this category may look slightly different because a child with a delay in both needs help with their understanding first.
If the child is behind in expression, understanding, AND social skills/ play, the SLP may say that they have a receptive/expressive language disorder AND may also say a social-pragmatic language disorder. In addition to speech therapy, a child in this category would probably benefit from additional testing to see if there is something else going on that is causing the receptive/expressive/ pragmatic language disorder. The SLP will likely suggest a referral to a developmental specialist such as a developmental pediatrician or a developmental psychologist to get information about the child’s overall development. The SLP wants a developmental specialist to rule out another diagnosis for the child, such as autism.
What your speech language pathologist may report at your child's speech and language evaluation:
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If the SLP notices a delay in…
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then the SLP might say…
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Expression only |
That there is an expressive language disorder and/or a speech disorder. They might recommend speech therapy depending on how big the delay is. |
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Expression and understanding |
That there is a receptive/expressive language disorder. They will likely recommend speech therapy. |
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Expression and understanding and play/ social skills |
That there is a receptive/expressive language disorder and speech therapy will be recommended. The SLP will likely suggest additional testing with a developmental specialist to explore why there is a delay in play/ social skills. |
What might the SLP suggest I do?
There are lots of things that may come from your speech therapy evaluation for toddlers. If a language delay of some kind is identified, the SLP may suggest speech therapy. They also will likely have suggestions of other places you can call to access services, and possible referrals to other specialists.
The unique thing about a speech-language evaluation for toddlers is that this is possibly the longest you’ve ever spent with a professional watching your child. Your evaluating SLP has likely worked with hundreds of children your child’s age and therefore is very experienced at identifying other areas of need beyond just speech. Based on what they see and you report, they may also suggest referrals to:
-occupational therapy (to assess feeding, fine motor, or sensory skills)
-physical therapy (to assess gross motor development)
-audiology (for a routine hearing test)
-developmental psychology/ developmental pediatrics (to assess overall development and rule out other diagnoses, like autism)
-behavior specialist
-neurology
-genetics
-ear/nose/throat doctor (ENT)
Just because the therapist recommends referrals to these places doesn’t mean something is wrong, just that they want to make sure that you are getting all the help you need for your child. Be sure to write down any recommendations the therapist makes, or ask them to write it down for you. It is usually a lot of information and might be hard to remember in the moment, especially with your child there. If you can, get your evaluator’s contact information so that if you think of more questions later, you can ask them.
The SLP will likely also give you a few suggestions or tips of things to try at home with your child, specifically geared toward your child’s current strengths and weaknesses. This is a great opportunity to gain specific ideas of what to work on and how to do it with your child. These suggestions may be given to work on things while you wait to begin speech therapy; they are usually things you can start immediately. If your SLP does not give you suggestions, ask for what to work on at home.
Having a speech-language evaluation for your child is a great way to feel empowered and:
Understand your child’s strengths
Uncover what your child may be struggling with and what to do about it
Discover the next steps for your child and their development
Learn what you can do to help your child at home, starting today
Here are some other questions that parents often ask about speech therapy evaluations for toddlers:
Do I have to have a speech and language evaluation to know if my toddler child needs speech therapy?
The short answer is yes. In order to begin speech therapy, your toddler will need a speech and language evaluation to document that they are delayed and would benefit from speech therapy sessions.
But, there are some resources you can use at home to get a better understanding if your child might need speech therapy before you go for a speech therapy evaluation.
How do I know if my child needs speech therapy?
Just like speech therapists, you can watch for your child to reach communication milestones at home. If you notice that your child is missing one or more of their speech and language developmental milestones, they may need a speech therapy evaluation to qualify them for speech therapy.
Speech therapy evaluations for toddlers are designed to identify why it is harder for your child to learn a communication skill and how you can best support them. Then ongoing speech therapy sessions are used to implement proven strategies and help toddlers reach their speech milestones.
To learn more about speech and language milestones throughout toddlerhood, you can look at our free Communication Milestones Checklists:
Why would a kid need speech therapy?
Speech therapy evaluations for toddlers are designed to identify why a particular child would need speech therapy. Because every child is developing speech and language skills in their own way, there is no one reason why a child would need speech therapy.
Some of the most common reasons why a kid might need speech therapy include: speech and language delays, articulation disorders, autism spectrum disorder, and childhood apraxia of speech.
If you want to learn more about some of the most common reasons why kids need speech therapy, I have linked further reading below:
How do you know if your child has a speech problem?
You can consult with “Doctor Google” to learn about communication milestones and see if your child might have a speech problem. But to know for sure, you’ll want to schedule a speech therapy evaluation for your toddler. During a speech and language evaluation, a speech therapist can take a look at your child’s speech and language skills compared to what is expected for their age to determine if they qualify for speech therapy.
At what age should I be concerned about my child's speech?
It’s a good idea to talk to your child’s pediatrician about their speech and language development any time you may have a concern regardless of your child’s age. There is no minimum age for speech therapy, and in general the earlier you get started the easier it is for your child to learn new communication skills.
Here are some common age milestones that might be missed for toddlers who are speech delayed. Children generally begin to say their first words between 10-14 months, have learned to say 40 words or more by 18 months, and are putting words together by 20 months.
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Written By:
Stephanie Burgener-Vader, MA CCC-SLP
© 2020-2023. Stephanie Keffer, MS CCC-SLP. All Rights Reserved.
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