When To Refer

When to refer a child to a speech-language pathologist:

A child should be referred for a speech or language assessment if he or she has the following symptoms:

Birth to 2 Years:

  • When a parent is concerned about speech or language development
  • If the child is not talking at all by age 18 months
  • If there are medical or developmental concerns that may affect speech
  • If the child is embarrassed by his/her speech at any age

At Age 2 if:

  • The child has a hearing impairment and/or does not respond to quiet sounds or voices
  • The child has a cleft palate or excessive nasal quality in the voice
  • The child does not begin combining words by age 2 (e.g. “more milk”)
  • The child exhibits limited vocabulary development (e.g., uses less than 50 words)

At Age 3 if:

  • The child is nonfluent or thought to stutter for longer than six months
  • There is an absence of sentence structure
  • Speech is difficult for a family to understand
  • There are many omissions of beginning and ending consonants
  • Speech is limited to echoing others’ statements, songs, rhymes, etc.

At Age 4 if:

  • Word endings (e.g. “ed” or “ing”) are consistently dropped or used inconsistently
  • Communication skills are inadequate for interaction in the school environment
  • The child has difficulty answering “wh” questions
  • The child is not demonstrating correct word order for basic sentences

At Age 5 if:

  • The child is noticeably dysfluent, or parents express concern
  • The child has a hoarse, harsh, or unusual voice quality

Caregivers who suspect that a child may need speech or language therapy should speak with
the child’s physician about getting a referral for assessment. Please contact us for information
on the assessment process.