Seeking Help for a Speech Delay

The time to seek help for a speech delay is when you have a concern, because the Centers for Disease Control and Prevention treats a parent’s concern, by itself, as a reason to act. Help can start with your pediatrician or, for a child under three, with your state’s early intervention program, which charges families nothing for its evaluation.

What you’ll learn

• Which signs are reason enough to ask for a look
• Who to ask first, and the words that make the request clear
• What a parent can still do when the advice is to wait
• What happens after you ask, and where to ask once a child turns three

When Should You Seek Help for a Speech Delay?

You can seek help for a speech delay whenever something about your child’s talking worries you, and nobody else has to share the worry first. The Centers for Disease Control and Prevention (CDC) advises parents to talk with their child’s doctor when a child is not meeting one or more milestones, has lost skills he or she once had, or when the parent has other concerns. A parent’s concern is on that list in its own right, with no particular sign needed alongside it.

The American Academy of Pediatrics (AAP) asks pediatricians to keep watch on development at every well-child visit, and to carry out a formal developmental check whenever there is a concern about development, including a concern that comes from a parent. A worry about speech can be raised between checkups as well, by calling the office and asking for an appointment about the concern itself.

Which Signs Are Reason Enough to Ask?

The American Speech-Language-Hearing Association (ASHA) publishes signs that a child may have a language problem, and each one is a reason to ask a professional to take a look. ASHA’s list includes a child who says only a few words between 12 and 18 months, who is not putting two words together between a year and a half and two, or who says fewer than 50 words at two.

The list reaches past word counts as well. Not understanding what others say, anywhere from 7 months to 2 years, is on it, and so is not using gestures such as waving or pointing between 7 and 12 months. For a child between two and three, being hard to understand even for people who know the child well is listed as a sign of a speech sound problem, meaning difficulty producing the sounds of words.

ASHA adds that every child develops in a unique way and may reach some milestones earlier or later than others, which is why a sign works as a reason to ask and never as a verdict. How talking usually unfolds across the early years is covered in speech and language development, and the term itself has a fuller explanation in speech delay in children.

When you describe a speech concern to a doctor or a program, include what your child understands as well as what your child says. Comprehension, the clinical word for how much a child understands, carries more weight in a clinician’s thinking than the number of words a child uses, so it belongs in the conversation alongside any word count.

Who to Ask First About a Speech Delay

There are three places to start, and a family can use more than one of them at once.

Your Child’s Pediatrician

The AAP tells parents to let the child’s doctor know if development seems delayed. The doctor may ask questions or give you a questionnaire, interact with your child, order a hearing test and refer you to a speech-language pathologist, or refer your child for an early intervention evaluation.

AAP policy is for a pediatrician who finds a child at risk for a developmental disorder to refer the child to early intervention and, at the same time, for complete developmental and medical evaluations, so support and the search for the causes of a speech delay run side by side.

Hearing belongs in the picture too. The National Institute on Deafness and Other Communication Disorders (NIDCD) points out that a speech and language evaluation often includes a hearing test, because a hearing problem can affect how speech and language develop. Whenever a parent or pediatrician suspects a hearing problem, the AAP says a formal hearing evaluation should be done promptly, since hearing is how a child takes in spoken language.

Your State’s Early Intervention Program

Any parent of a child under three can call the state’s early intervention program on their own, and no doctor’s referral or diagnosis is needed. Early intervention is the program run under Part C of the Individuals with Disabilities Education Act (IDEA), and federal rule lists parents among the sources a program must take referrals from. Under a federal requirement called Child Find, every state must also identify, locate and evaluate each eligible infant and toddler.

A Private Speech-Language Pathologist

A family can also go straight to a private speech-language pathologist, a clinician trained to evaluate and treat difficulties with speech and language. ASHA advises choosing one who holds its Certificate of Clinical Competence, shown as CCC-SLP after the name, and points families to its ProFind directory. A private evaluation is paid for by the family, often partly through insurance, while an evaluation through early intervention costs the family nothing.

Asking for a Speech Evaluation by Name

The CDC suggests a sentence for each of the two calls a parent might make, and both name the concern plainly and ask for one specific thing, so whoever answers knows what to arrange:

• To the pediatrician’s office: “I would like to make an appointment to see the doctor because I am concerned about my child’s development.”
• To early intervention: “I am concerned about my child’s development and would like to request an evaluation.”

From clinical practice

“Could we get an evaluation?” moves a concern forward in a way a general worry does not. Described loosely, a worry leaves the next step undecided. The word evaluation names something specific, which a pediatrician can refer for and an early intervention program can schedule.

For a child under three there is a second way in, and it is not widely known: a family can call early intervention directly. The pediatrician’s referral and the parent’s own call lead to the same free evaluation.

Before calling, jot down what you have noticed and roughly when, including what your child understands. The CDC also advises writing down who you spoke to, the date and what was said each time you call, because you might need that information later, and keeping any notes you have already made about your concerns.

A few questions are worth asking on any of these calls: whether a hearing test will be part of the evaluation, whether any services after the evaluation carry a fee in your state, and, for a child close to three, when planning begins for the move to the school district.

When the Advice Is to Wait and See

Hearing that a child’s speech needs more time leaves a parent free to ask for an evaluation anyway. The AAP tells parents that if the child’s doctor says not to worry and the parent is still concerned, it is fine to get a second opinion.

For a child under three, a parent can also call early intervention with nobody else’s referral, and asking for an evaluation is a request for information that makes no claim about what the evaluation will find.

If an early intervention program declines to start an evaluation, federal rule requires it to tell the family in writing beforehand, giving its reasons and the family’s options, which include mediation, a State complaint and a due process hearing.

What Happens After You Ask for an Evaluation

Federal rule gives early intervention 45 days to carry out the evaluation and, where a child is eligible, the first meeting to write a plan. The 45 days are counted from the date the program receives the referral, not from the day a concern first comes up at a checkup, and the clock stops while documented exceptional family circumstances get in the way or while a parent has not yet given consent.

No family is charged for the evaluation, in any state, because federal rule (34 CFR 303.521(b)) places its cost on the public. Services afterward are a separate matter, and some states charge for them on a sliding scale tied to family income.

The evaluation is multidisciplinary, meaning professionals from more than one field take part, and it includes your child’s history and an interview with you, so what you have seen at home counts as evidence. Under federal rule, no single procedure may decide whether a child qualifies, and the evaluators’ informed clinical opinion can establish eligibility even when formal instruments do not.

A delay in any one of five areas of development can qualify a child under IDEA, communication development among them, and because each state sets its own definition of how much delay qualifies, eligibility rules vary between states. The visit itself is described step by step in getting a speech evaluation.

Where to Ask Once a Child Turns Three

From the third birthday, Part B of IDEA applies, and the place to ask is the local school district. The CDC tells parents to call any local public elementary school, even one the child does not attend, and ask for an evaluation through the school system for preschool special education services.

The federal Department of Education says a parent can ask the school district for an initial evaluation at any time, and the evaluation has to be finished within 60 days of the parent giving consent, or within the state’s own timeframe. The Department also says a tiered-support process, often called response to intervention, may not be used to delay or deny that evaluation.

A district that decides against evaluating must explain that decision in writing first, and a parent who disagrees with an evaluation the school has carried out is entitled to an independent educational evaluation paid for from public funds.

For a child already in early intervention, federal rule sets the transition conference, the meeting that plans the move to the school district, no later than 90 days before the third birthday, and as early as nine months ahead if all parties agree. A child moving into preschool special education must have a school plan, called an IEP (Individualized Education Program), in place by the third birthday.

In most states early intervention ends at three. Federal rule does let a state allow a family whose child is eligible for preschool special education to stay with early intervention until the child can start kindergarten, and some states have used that option, so it is worth asking how your own state handles the third birthday.

Common Questions From Parents

How Do I Know If My Child Needs Speech Therapy?

An evaluation is how that gets answered, and no list of signs can settle it from home. Through early intervention, professionals from more than one field look at your child’s communication and history, talk with you, and decide whether your child qualifies for services.

Do I Need a Referral From My Pediatrician?

Not for a child under three. Federal rule names parents among the people an early intervention program must take referrals from, so you can call your state’s program yourself. A pediatrician’s referral is another route to the same evaluation.

My Pediatrician Said to Wait and See. What Can I Do?

You can still ask for a referral, get a second opinion, or, for a child under three, call early intervention yourself. The AAP says a second opinion is fine when a parent stays concerned after hearing not to worry.

What Should I Ask for at the Appointment?

Ask for a referral for a speech-language evaluation, and whether a hearing test should be part of it. The AAP’s policy is that a child at risk is referred both to early intervention and for full medical and developmental evaluations, so you can ask for both.

Is 18 Months Too Young for a Speech Evaluation?

No. Early intervention serves children from birth, and ASHA lists saying only a few words at 12 to 18 months as one sign of a language problem. A parent’s concern is reason enough at any age under three.

How Long Does It Take to Get an Evaluation?

Early intervention has 45 days after it receives a referral to complete the evaluation and, if a child qualifies, the first planning meeting. From age three, a school district has 60 days from your consent, or your state’s own timeframe.

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

More about Monica