Speech Delay That Continues During Therapy

When a child is still talking less than hoped after a stretch of speech therapy, the therapy plan itself is built to change. Early intervention plans are reviewed every six months and school district plans at least once a year, and in either case a parent can ask for a review sooner.

What you’ll learn

• How reviews of early intervention and school district plans work
• When a reevaluation, or another hearing check, makes sense
• What to ask about goals and how often sessions happen
• How coaching for parents fits alongside therapy

Child Still Has a Speech Delay: What Can You Do?

Every speech therapy plan sets goals for a child’s speech and language development. Guidance from the American Speech-Language-Hearing Association (ASHA) calls for intervention that includes ongoing checks on a child’s progress toward those goals, with the goals changed as necessary. So if your child is still talking less than you hoped, the plan is worth looking at again.

How long therapy takes varies from child to child, and nobody can predict it for one particular child. What a parent can do is practical: use the review points the plan already has, ask clear questions about the goals and how often sessions happen, make sure hearing has been looked at, and keep the strategies going at home. Each of these is part of how therapy is meant to run, and none of them is a judgment on the therapist, the program or the family.

If your child is under three and seen privately, you are free to call your state’s early intervention program directly, with no doctor’s referral, and an early intervention speech evaluation is carried out at public expense.

Asking for an Early Intervention Plan Review

Every state runs an early intervention program for babies and toddlers under Part C of the Individuals with Disabilities Education Act (IDEA), and its written plan is the Individualized Family Service Plan (IFSP). Federal rules require the IFSP to name measurable results or outcomes for the child, including language skills where they fit the child’s development, with the criteria, procedures and timelines used to judge progress. The plan also states how often, for how long, how intensively and by what method each service is delivered.

Under federal rules, the IFSP must be reviewed every six months, or more often if conditions warrant or the family asks. The review looks at how much progress is being made toward the plan’s outcomes and whether the outcomes or services need to change. A review need not be a formal meeting, and can happen in another way that suits the parents and the others involved. At least once a year, a full meeting evaluates and revises the plan, drawing on any current evaluations.

You do not need to wait for the six-month point, and one sentence to your service coordinator is enough to start a review: “I’d like to ask for a review of the plan, because I want to look at the goals and how often sessions happen.”

Between reviews, the federal definition treats identifying a child’s strengths and needs as ongoing for as long as the child is eligible. ASHA adds that speech-language pathologists regularly track changes in a child’s language, and in their own strategies and ways of delivering services, so that a plan can be modified when it needs to be.

Reviewing a School District Plan From Age Three

From age three, speech therapy through the school district falls under Part B of IDEA, and the written plan is an Individualized Education Program (IEP). The IEP has to set measurable annual goals, describe how progress toward them is measured, and set out when periodic progress reports are provided, for example every quarter. The IEP team reviews the plan periodically, and at least once a year, to find out whether the goals are being achieved, and revises it as appropriate to address any lack of expected progress.

A parent does not have to wait for the yearly review. The Center for Parent Information and Resources, which is funded by the U.S. Department of Education, says a parent can request an additional IEP meeting at any time. Among the reasons it gives for asking are a child who does not seem to be making enough progress toward one or several goals, and a parent’s sense that the child needs more services or different ones. There is more on your rights to speech therapy under federal law.

From clinical practice

Every six months in early intervention, and at least once a year in a school district plan, a review is written in. Those reviews are where the goals, how often sessions happen and the approach itself are meant to change as a child changes. Speech-language pathologists track progress between reviews for the same reason.

Asking for a review can still feel like a complaint about a therapist the family sees regularly and has come to trust. The schedule says otherwise.

Asking for a Fresh Look at Progress

With a school district plan, the district must carry out a reevaluation if a parent or teacher asks for one, although reevaluations happen no more than once a year unless the parent and the district agree otherwise. If you disagree with an evaluation the district carried out, federal rules give you the right to have an independent educational evaluation carried out at public expense, a right that comes with conditions, so ask the district how they apply.

For a child under three, the way to ask for a fresh look at progress is a plan review, which a family can request whenever it chooses. Bring what you have noticed at home, such as new words or new ways your child gets your attention, because the review weighs progress toward the plan’s outcomes and your view of daily life belongs in it.

Checking Hearing Again

Hearing is worth raising again even when it was checked at birth or earlier on. ASHA’s guidance on late talking, which it calls late language emergence, includes a hearing check to rule out hearing loss as a possible contributing factor in language difficulties, with referral to an audiologist for a full hearing evaluation when there is a concern.

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), hearing loss can occur at any time of life, and some inherited forms don’t appear until a child is older. The NIDCD links childhood illness, ear infection, head injury, certain medications and loud noise with hearing loss in children, and it tells parents who have concerns about a child’s hearing, at any age, to talk to their pediatrician right away.

How Often Sessions Happen, and Whether More Would Help

ASHA calls the frequency, intensity and duration of therapy its dosage, and says the right dosage depends heavily on what the child, the family and other caregivers need. Dosage varies with a child’s goals, and in ASHA’s words, more sessions do not always mean better outcomes. ASHA also notes that features of the intervention itself, such as how unfamiliar or complex it is, often guide decisions about dosage more than how severe a child’s difficulty is.

Families differ as well. As ASHA describes it, some families need to hear from the therapist more often, with more concrete support, while others prefer more time between visits, which leaves room to use the strategies at home. In early intervention the schedule is written into the IFSP, so changing it changes the plan. At a review, it is fair to ask what the current schedule is meant to achieve and whether it still suits your household, and these questions to ask a speech-language pathologist cover goals and approach too.

Parent Coaching Alongside Speech Therapy

ASHA describes coaching in early intervention as clearly defined, observable and measurable steps that support the adults around a child in their own efforts to help the child learn and develop. You can ask whether coaching can be part of your child’s sessions.

A 2020 review published in Early Childhood Research Quarterly pooled 25 randomized controlled trials, with 1,734 children who had, or were at risk for, language impairment. The review found modest improvements in expressive vocabulary, the words a child uses, and small improvements in expressive language, and the authors concluded that language interventions carried out by parents may have positive effects. Both results describe groups of children, and the strategies belong alongside therapy as part of it, never in place of it.

Between sessions, three habits keep the work going: describing what your child is doing instead of asking for words, keeping a favorite snack in sight but out of reach so there is a reason to ask, and answering a point with words, which shows a child that communicating works. Ask the speech-language pathologist which ones suit your child’s goals, and there are more everyday ways to help a toddler talk.

Common Questions From Parents

How Long Does Speech Therapy Take to Work?

No one can say in advance for a particular child, because the length varies from one child to the next. What each plan does set out is how progress will be judged, which gives you something concrete to ask about at every review.

Can I Ask for My Child’s Plan to Be Reviewed Early?

Yes. Early intervention plans come up every six months, and a family can ask sooner. With a school district plan, the Center for Parent Information and Resources says that at any time, a parent can ask for an additional IEP meeting.

Can I Ask for My Child to Be Evaluated Again?

With a school district plan, yes: the district must reevaluate when a parent asks, though not more than once a year unless you both agree. For a child in early intervention, ask for a plan review instead, which you can request whenever you choose.

Would More Sessions Help?

Not necessarily. ASHA says the right amount depends on the child’s goals and needs and on what suits the family, and that adding sessions does not always lead to better results. If the schedule seems off, raise it at a review and ask what it is designed to do.

Should My Child’s Hearing Be Checked Again?

Yes, it is worth asking. Hearing loss can start at any age, according to the NIDCD, some inherited forms appear only later in childhood, and ear infections are among the linked factors. ASHA’s guidance includes a hearing check when language is slow to come in.

What Can I Do at Home Between Sessions?

Ask whether the speech-language pathologist can coach you during sessions. A 2020 review of trials found modest gains in the words children use when parents carried out language strategies. That is a finding about groups, and home practice goes alongside therapy, not in place of it.

Reviewed by Monica d’Errico-Franklin, M.S., CCC-SLP

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