Speech Therapy

Speech therapy is assessment and treatment by a speech-language pathologist (SLP) for difficulties with speech sounds, language, stuttering, voice, social communication, and feeding and swallowing, at any age.¹ For children it most often starts with a toddler who is talking late or speech that is hard to understand. In the US a parent can refer a child under three to the state’s early intervention program directly, and the evaluation is free.² From age three, a child who qualifies for special education can receive speech-language therapy at school at no charge, and clinics provide it through insurance or privately.³

What speech therapy is

Speech therapy is the work of a speech-language pathologist, usually shortened to SLP: a clinician trained to assess, diagnose and treat communication and swallowing disorders in people of all ages. SLPs work in schools, health care settings and private practice.¹ “Speech therapist” is the everyday name for the same profession, and it undersells the job: an SLP’s work covers far more than speech sounds.

Three things are often collapsed into one. Speech is the sounds: articulation, clarity and fluency. Language is the meaning: understanding what is said, and getting ideas out, whether in words, signs, gestures or a device. Feeding and swallowing is the mouth’s other job, and SLPs assess and treat that too.¹ A child can have clear speech with a language difficulty, or strong language with speech that is hard to follow, and an SLP works across both. The focus is communication that works in daily life: at home, at daycare or school, and with friends.

What speech therapy helps with

The condition pages carry the developmental detail and their own sources; this page explains what the therapist does and points you to them. What brings children to an SLP:

• Delayed speech and late talking: a toddler using fewer words, or putting words together later, than expected for their age.
• Language disorders: difficulty understanding language, or putting thoughts into words and sentences, that persists past the toddler years.
• Childhood apraxia of speech and other speech-sound difficulties, where speech stays hard to understand.
• Lisps and individual sounds that have not settled.
• Stuttering, in children and in adults whose stutter has continued.
• Social communication: conversation, play and the back-and-forth of talk, which matters for many autistic children, including those who learn language in chunks through gestalt language processing.
• Augmentative and alternative communication (AAC) for nonspeaking children: signs, picture systems and speech-generating devices.
• Feeding and swallowing, including sensory-based feeding difficulty and the oral-motor skills behind eating and speech, and the questions a tongue-tie raises.

On effectiveness, a Cochrane review of 25 randomized trials found speech and language therapy effective for children with speech-sound (phonological) and vocabulary difficulties, with less evidence of effect where the difficulty is understanding language.⁹ The speech and language hub lists every condition page on the site.

Who speech therapy helps, by age

From infancy, when the work is feeding and early communication, through the school years and into adulthood. What therapy looks like changes a great deal with age, so each stage has its own page:

• Speech therapy for infants and toddlers (0 to 3): feeding, babbling, gestures, first words and late talking, usually through early intervention and often at home.
• Speech therapy for preschoolers (3 to 5): clarity, sentences, early stuttering and getting ready for school.
• Speech therapy for school-age children (6 to 12): language for learning and reading, sounds that have not settled, and social communication.
• Speech therapy for teenagers (13 to 18): stuttering, language for higher-level schoolwork, and communication for independence.

Speech therapy for specific conditions

Many children see an SLP because of a diagnosis that affects communication or feeding. Each of these pages sets out what speech therapy works on for that condition and what the evidence says:

• Speech therapy for autism, and a shorter guide for parents of autistic children
• Speech therapy for ADHD
• Speech therapy for cerebral palsy
• Speech therapy for Down syndrome
• Speech therapy for developmental delays
• Speech therapy for dyspraxia
• Speech therapy for sensory processing disorder
• Speech therapy for Ehlers-Danlos syndrome

Families weighing approaches often compare speech therapy with ABA or with occupational therapy; for autism, the overview of autism therapies sets them side by side.

When to consider a speech evaluation

CDC’s milestone checklists give parents a clear yardstick. Talk to your child’s doctor and ask about a speech-language evaluation if your child:

• is not trying to say three or more words besides “mama” or “dada” by 18 months;⁴
• is not saying at least two words together, like “more milk,” by age two, or uses no gestures beyond waving and pointing;⁴
• does not talk well enough for others to understand most of the time by age three;⁴
• is not saying sentences of four or more words by age four;⁴
• has difficulty eating, drinking or swallowing at any age, or seems frustrated by not being understood.

The CDC milestones are set at the age by which at least three in four children reach them, precisely so that a missed one prompts action rather than a wait-and-see approach.⁵ Loss of words or communication skills a child previously had warrants prompt attention at any age.⁴

For bilingual families: learning two or more languages does not inhibit language development, and ASHA advises against recommending that a family drop a language in response to a delay.⁶ A strong model in any language helps build the foundation for others, and a child who is having difficulty in both languages may need an evaluation.⁶

What a speech evaluation and a session involve

An SLP evaluation combines a developmental history, parent report, standardized measures and observation of how your child communicates in play. It usually includes a hearing screening, because hearing loss has to be ruled out as a cause of a language difficulty, and a bilingual child is assessed in every language they use.⁶ Goals are set in daily-life terms, such as “asks for what she wants using two words,” rather than as test scores.

Sessions are play-based for young children. For a toddler that may mean the SLP coaching you to use particular strategies during play and routines, since you are with your child far more hours than any therapist; for an older child it looks more like structured practice. Both direct therapy and indirect work through parents and caregivers are standard parts of an SLP’s role.⁶

If your child does not yet speak, an SLP may introduce AAC: signs, pictures or a speech-generating device. ASHA is explicit that there are no prerequisites for AAC, and that AAC used alongside speech may help natural speech develop.⁷ In the strongest studies reviewed, no child’s speech decreased after AAC was introduced; 89% gained.⁸

How to choose a speech-language pathologist

Look for an SLP licensed in your state who holds ASHA’s Certificate of Clinical Competence, shown as CCC-SLP after the name; you can check a clinician’s certification on ASHA’s site.¹⁰ Then look for pediatric experience that matches your child. Reasonable questions to ask:

• What is your experience with children like mine, at this age?
• How do you set goals, and how will we know they are being met?
• How will I be involved, and what should we do at home between sessions?
• For feeding, AAC or stuttering specifically: what training and experience do you have in that area?

Fit between your child, your family and the therapist matters alongside the credential.

Paying for speech therapy: early intervention, school and insurance

Under three: early intervention runs under Part C of the Individuals with Disabilities Education Act. Parents are named in the regulations as a referral source, so you do not need a doctor’s referral, and the evaluation and assessment are carried out at public expense with no fee to you. Services are delivered in natural settings such as your home wherever appropriate.²

Three and over: under Part B, schools provide speech-language pathology as a related service when a child with a disability needs it to benefit from special education, at public expense and without charge.³ Request an evaluation in writing, so there is a dated record. Clinic-based therapy is available alongside school services, through health insurance or privately.

Coverage varies by plan; does insurance cover therapy for kids? explains habilitative benefits, visit limits and appeals, and therapy without insurance covers the other routes. Some families use online speech therapy where there is no clinic nearby, and in-home therapy covers therapy at home, from early intervention to Medicare home health.

Speech therapy for adults

SLPs work with adults as much as with children, though the reasons differ. Adults see an SLP for language and cognitive-communication difficulty after a stroke or brain injury, for voice disorders, for stuttering that has continued into adulthood, and for swallowing difficulty, which clinicians call dysphagia.¹

Speech-language pathology licensure is not divided by age group, but individual practices choose who they see. Ask directly whether a practice takes adult referrals and has experience in the area you need, since adult and pediatric work are quite different day to day. Speech therapy for adults covers what adult SLPs treat and what Medicare covers; adult neurologic therapy covers recovery after a stroke or brain injury, and adult therapy covers our writing for adults across the other specialties.

Find a speech therapist near you

The speech therapy directory lists clinics by state and city, with each practice’s own description of what it treats. Start from your state:

Alabama · Alaska · Arizona · Arkansas · California · Colorado · Connecticut · Delaware · District of Columbia · Florida · Georgia · Hawaii · Idaho · Illinois · Indiana · Iowa · Kansas · Kentucky · Louisiana · Maine · Maryland · Massachusetts · Michigan · Minnesota · Mississippi · Missouri · Montana · Nebraska · Nevada · New Hampshire · New Jersey · New Mexico · New York · North Carolina · North Dakota · Ohio · Oklahoma · Oregon · Pennsylvania · Rhode Island · South Carolina · South Dakota · Tennessee · Texas · Utah · Vermont · Virginia · Washington · West Virginia · Wisconsin · Wyoming

Or browse occupational, physical and speech therapy by state together.

Speech, occupational and physical therapy side by side

Many children see more than one therapist, and the three disciplines overlap at the edges: feeding is shared between speech and occupational therapy, and movement planning runs through all three. The short version, with the occupational therapy and physical therapy guides for the other two:

Sources

1. American Speech-Language-Hearing Association; Communication Health Support Association. Who are speech-language pathologists, and what do they do? SLPs “help people communicate effectively and eat and swallow safely,” and are trained to assess, diagnose and treat difficulties with speech sounds, language, literacy, social communication, voice, fluency (including stuttering), cognitive communication, and feeding and swallowing, in “people of all ages.” ASHA’s public pages at asha.org/public redirect to this site. Checked October 6, 2026.
2. Individuals with Disabilities Education Act, Part C, 34 CFR Part 303. Parents are named among the “primary referral sources”: §303.303(c)(3). Evaluation and assessment are “required functions that must be carried out at public expense, and for which no fees may be charged to parents”: §303.521(b)(2). Services are provided “to the maximum extent appropriate, in natural environments,” which “may include the home or community settings”: §§303.126 and 303.26. Text as published in the eCFR. Checked October 6, 2026.
3. Individuals with Disabilities Education Act, Part B, 34 CFR §300.34(a). Related services are the “developmental, corrective, and other supportive services as are required to assist a child with a disability to benefit from special education,” and include “speech-language pathology and audiology services” and “physical and occupational therapy.” Special education and related services under an IEP are “provided at public expense, under public supervision and direction, and without charge”: §300.17(a). Checked October 6, 2026.
4. Centers for Disease Control and Prevention. Learn the Signs. Act Early. Milestone checklists: 9 months (“Sits without support”), 18 months (“Tries to say three or more words besides ‘mama’ or ‘dada’”; “Walks without holding on to anyone or anything”; “Tries to use a spoon”), 2 years (“Says at least two words together, like ‘More milk’”; “Kicks a ball”; “Runs”; “Walks (not climbs) up a few stairs with or without help”), 3 years (“Talks well enough for others to understand, most of the time”), 4 years (“Says sentences with four or more words”; “Unbuttons some buttons”; “Holds crayon or pencil between fingers and thumb (not a fist)”). The overview: “If your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early.” Checked October 6, 2026.
5. Zubler JM, Wiggins LD, Macias MM, Whitaker TM, Shaw JS, Squires JK, et al. Evidence-informed milestones for developmental surveillance tools. Pediatrics. 2022;149(3):e2021052138. PMID 35132439. The CDC checklists use “milestones most children (≥75%) would be expected to achieve” by each visit age, in order to “clarify when most children can be expected to reach a milestone (to discourage a wait-and-see approach).”
6. American Speech-Language-Hearing Association. Late Language Emergence (Practice Portal). Screening includes “conducting a hearing screening to rule out hearing loss as a possible contributing factor”; for bilingual children “assessment in all languages is necessary”; “Monolingualism is not necessary and should not be advised as a response to LLE. A strong model in any language helps build a linguistic foundation that will aid in the acquisition of other languages”; “providing direct and indirect treatment” and collaborating with family members and caregivers are among the SLP’s roles; and “Bilingualism has not been shown to inhibit language development or therapeutic outcomes in the presence of language disorders.” Checked October 6, 2026.
7. American Speech-Language-Hearing Association. Augmentative and Alternative Communication (Practice Portal). “Potential AAC users may believe that AAC reduces motivation to improve natural speech and delays language development. However, AAC use may help improve natural speech when used in a multimodal approach”; “early AAC use can help develop speech and language”; and “There are no prerequisites for AAC intervention.” Checked October 6, 2026.
8. Millar DC, Light JC, Schlosser RW. The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: a research review. Journal of Speech, Language, and Hearing Research. 2006;49(2):248–264. doi:10.1044/1092-4388(2006/021) (PMID 16671842). Of the 27 cases in the studies with adequate experimental control, none showed a decrease in speech production, 11% showed no change, and 89% showed gains, mostly modest.
9. Law J, Garrett Z, Nye C. Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database of Systematic Reviews. 2003;(3):CD004110. doi:10.1002/14651858.CD004110 (PMID 12918003). Twenty-five randomized trials: effective for phonological (SMD 0.44) and vocabulary (SMD 0.89) difficulties; less evidence of effect for receptive (understanding) difficulties (SMD −0.04).
10. American Speech-Language-Hearing Association. Audiology and Speech-Language Pathology Certification. The Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP), and the public tool to verify an individual’s certification status. Checked October 6, 2026.
11. National Board for Certification in Occupational Therapy. NBCOT: certifies occupational therapists (OTR) and occupational therapy assistants (COTA), with a public “Verify an OTR/COTA” search. Checked October 6, 2026.
12. American Physical Therapy Association. About physical therapists and physical therapist assistants (ChoosePT). Physical therapists “are licensed health care providers. They evaluate, diagnose, and manage health conditions and movement problems in people of all ages and abilities”; “Since 2016, all physical therapists in the United States have graduated from a three-year, post-baccalaureate program and earned a Doctor of Physical Therapy, or DPT, degree” and must pass a national exam to be licensed; physical therapist assistants “also are licensed” and “provide care under a physical therapist’s direction and supervision.” Checked October 6, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. If your child has lost skills they previously had, contact their doctor promptly.