Speech Therapy – To Recommend Services or Not?

Our speech therapy practice has the pleasure of collaborating with many preschools and schools in San Francisco and, at several of these schools our speech therapy practice provides on-site speech language screenings. A screening is a brief tool that is used to indicate if a further speech and language assessment is indicated. Sometimes, we note articulation errors but do NOT recommend immediate follow-up. Parents are often confused about this. Why, if the child has articulation errors, are you not recommending therapy? Below is a letter we share with parents explaining why we might not recommend services right away.

Dear Parents,

Many of you may be wondering how a child can pass the screening evaluation when he or she consistently makes errors on certain sounds. The answer is that the expectations are different for children at different ages. Certain sounds take longer to be mastered, and errors on these sounds are not viewed as unusual at younger ages. For example, “k” and “g” have been mastered by 90% of children by the age of three. So, when a two year old makes errors on these sounds, it is not considered a problem; however, for a three year old, it is a problem. On the other hand, a three year old who makes errors on “s,” “r” or “th” is not of concern, since these sounds take longer for children to master and are not expected at age three. While many three year olds do produce these sounds correctly, as a group, they still frequently make errors on these and other sounds.

The same is true for four and five year olds, although the expectations are different in terms of the specific sounds involved and the number of overall errors expected. A child may make errors on several sounds and still pass the screening test; however, if some of the sounds involved are those that are expected to be mastered at a younger age0that is cause for concern.

The real question is “When does a sound error become a problem?” For sounds like “s” and “r,” this is a difficult question. The age that is typically used is six. That is, errors on these sounds traditionally have not been considered a problem until children turn six. In fact, in the public schools, errors on any single sound, such as “s” or “r” or “th”, may not qualify a child for speech therapy until first or second grade. The fact is, however, that by this age, such errors are no longer “typical,” and the child’s speech calls attention to itself through these errors. The error that was not a problem at age five is often viewed as a problem at age six.

The dilemma, therefore, is how to determine which children, aged five, will outgrow these errors on their own and which will not-which children will require speech therapy to correct their errors. So far, the best predictive tool we have is whether a child CAN produce the sound correctly when shown how. Research has indicated that children who CAN produce a sound are more likely to change on their own than children who cannot. Some children seem to be in the process of correcting their errors. They make errors on specific sounds, but they also produce the sounds correctly at times, and when asked to repeat a word, they can generally correct their errors. Other children are consistent in their errors and never produce the sound correctly. These children are more likely to need assistance in correcting their speech sounds.