10-Minute Speech Practice That Doesn't Require Sitting Still

Last updated 2026-07-10

How do I know if my child needs speech therapy?

The honest answer is: you probably already sense something. Parents who end up searching this question are almost never wrong to ask it. Your gut matters here.

That said, gut feelings need a framework. The American Speech-Language-Hearing Association (ASHA) publishes age-referenced milestones for speech and language development, and those milestones are the clearest starting point. ^[1] Missing one milestone by a few weeks is not an emergency. Missing several, or missing one by two to three months or more, is a signal worth acting on.

Two red flags should prompt an evaluation at any age, no matter what the milestone tables say. First: regression. If your child was saying words or communicating well and has stopped, call a speech-language pathologist (SLP) this week, not next month. Second: comprehension problems. A child who doesn't seem to understand what you say to them, more than a child who ignores you, needs an evaluation.

The sections below walk through milestones by age, explain what causes speech delays, and tell you exactly how to get an evaluation, including options that cost nothing.

What are the speech and language milestones by age?

Milestones are averages, not deadlines. But they're the best tool we have, and ignoring them entirely is how delays become significant.

Here's what the CDC and ASHA consider typical ranges. ^[1][2]

A couple of things this table won't tell you. Bilingual kids may show different vocabulary counts in each language while still hitting total vocabulary targets just fine. ^[3] And some kids are genuinely late talkers who catch up without any intervention. The trouble is you cannot know in advance which child yours will be, and the cost of waiting is much higher than the cost of getting an evaluation.

At age 5 specifically, if your child is hard to understand, avoids talking, struggles to follow multi-step directions, or can't retell a simple story, those are real indicators for an SLP evaluation. Age 5 is also when school-based speech services begin in earnest, so an evaluation now shapes what support is available in kindergarten.

Quick self-quiz: does my child show signs that warrant an evaluation?

Go through this list. You're not diagnosing anything. You're deciding whether to call an SLP.

At 12 months:

• Does not babble or make consonant sounds
• Does not point, wave, or gesture
• Does not respond to their name consistently

At 18 months:

• Fewer than 10 words
• Does not follow simple directions ("give me the cup")
• Does not point to show you things they find interesting

At 24 months:

• Fewer than 50 words
• Does not combine any two words
• Strangers can understand less than half of what they say

At 3 years:

• Mostly not using sentences
• You (the parent) still have trouble understanding them often
• Does not ask questions

At any age:

• Lost language or communication skills they once had
• Significant frustration, meltdowns, or withdrawal tied to not being understood
• You and your partner have both noticed something feels off
• A teacher, daycare provider, or pediatrician has raised a concern

If you checked anything in the "at any age" section, or two or more items in any age group, an SLP evaluation is the right next step. Not maybe. Actually next.

If you want a structured digital version of this, the Little Words app has a guided screen at /start that walks through these questions and helps you figure out what to do next.

Why would a child need speech therapy? What causes delays?

Speech and language delays come from many different causes, and plenty of kids have more than one thing going on at the same time.

Hearing loss is the first thing a pediatrician should rule out. Even mild or intermittent hearing loss from chronic ear infections can significantly affect how a child acquires language. If your child has had frequent ear infections, request a full audiological evaluation alongside any speech screen.

Developmental language disorder (DLD) is the most common cause of language delays in children without another diagnosis. Roughly 7 to 10 percent of children have DLD, which makes it more common than autism or ADHD. ^[4] DLD is not caused by anything parents do or don't do. It's a neurodevelopmental difference in how the language system develops.

Autism spectrum disorder often shows up first through communication differences. These can include unusual use of language (like echolalia, where a child repeats phrases rather than generating new ones), difficulty with back-and-forth conversation, or delayed spoken language alongside strong nonverbal abilities. ^[5] If your child's language development looks uneven rather than uniformly delayed, an autism evaluation may be worth running alongside the speech eval.

Childhood apraxia of speech (CAS) is a motor speech disorder where the brain has trouble coordinating the movements needed for speech. Kids with CAS often know what they want to say, but the sounds come out inconsistent or garbled. CAS requires specific therapy techniques, so getting the right diagnosis matters a lot. ^[12]

Other causes include apraxia of speech, cleft palate, tongue tie, cognitive delays, and prematurity. Some kids have a real family history of late talking and catch up on their own. But even in that scenario, SLPs can tell you whether watchful waiting is reasonable or whether intervention is needed now.

When does a child need speech therapy, more than monitoring?

Monitoring is fine for a short window. If a child is just barely behind on one milestone and has no other red flags, a pediatrician might suggest a one-to-three-month recheck. That's reasonable.

But therapy is the right call when:

• A child is two or more months behind on multiple milestones
• A child has any regression in language or communication
• Hearing has already been ruled out and delays persist
• Communication difficulties are causing distress, withdrawal, or behavior problems
• A professional (SLP, pediatrician, or developmental pediatrician) has already recommended it

The research here is pretty consistent. Earlier intervention produces better outcomes. Studies in the Journal of Speech, Language, and Hearing Research report that children who receive intervention before age 3 show significantly larger gains in expressive language than children who start later. ^[6] The word "significantly" is doing real work in that sentence. We're not talking about marginal differences.

The phrase "wait and see" has a bad track record in this field. Some kids do catch up on their own. The ones who don't lose time they can't get back. An evaluation costs you nothing except an appointment. If the SLP says your child is fine, that's a relief and money well spent. If they find something, you started early.

How do I get my child evaluated, and what does it cost?

There are three main pathways, and one of them is free by law.

Early Intervention (birth to age 3). Under Part C of the Individuals with Disabilities Education Act (IDEA), every state must provide free evaluations and, if needed, free services for children under 3 who have developmental delays. ^[7] You do not need a pediatrician's referral. You can call your state's Early Intervention program directly. A call today can result in an evaluation within 45 days. States run these programs under different names, but the federal entitlement is the same everywhere. To find your state's program, visit the IDEA website at the U.S. Department of Education.

School-based services (age 3 and up). Once a child turns 3, services shift to the school district under Part B of IDEA. Your local public school system must evaluate your child for free if you request it in writing. They must complete the evaluation within 60 days of your written request (timelines vary slightly by state). ^[7] If the evaluation finds a qualifying delay, the school provides speech therapy at no cost as part of an Individualized Education Program (IEP) or a 504 plan.

Private SLP evaluation. A private evaluation from an SLP typically costs $200 to $500 out of pocket, though many insurance plans cover it. ^[8] Private evaluations are often more thorough than school screenings and may be worth getting if you want a complete clinical picture. Private therapy sessions generally run $100 to $300 per hour without insurance.

For families who want flexible, lower-cost options, online speech therapy has expanded a lot and can be a practical route when in-person services have waitlists or are geographically out of reach.

If cost is a barrier: Medicaid covers speech therapy evaluations and treatment for eligible children in all states. ^[9] Ask your pediatrician's office for a referral and contact your state Medicaid office for specifics.

What happens during a speech therapy evaluation?

Evaluations vary depending on the child's age and what's being assessed, but most follow a similar shape.

The SLP starts by taking a detailed history from you. They want to know about pregnancy, birth, early development, hearing history, and family history of speech or language issues. This part matters. Give as much detail as you can.

Then they observe and test the child directly. For young kids, this often looks like play. The SLP watches how the child communicates, what sounds they make, whether they respond to language, and how they interact. For older kids, there are standardized tests that measure vocabulary, grammar, sentence structure, and sound production against age norms.

The SLP may also assess oral-motor function (how the mouth, lips, and tongue move) if speech clarity is a concern, and they may recommend a hearing test if one hasn't been done recently.

At the end, you'll get a report that either confirms typical development, identifies areas of delay or disorder, and recommends a course of action. That recommendation might be therapy, a home program, a referral for further evaluation (like an autism assessment), or a recheck in a few months.

You are allowed to ask questions. You are allowed to ask what specific goals therapy would target and how progress would be measured. A good SLP welcomes those questions.

Does my 5-year-old need speech therapy specifically?

Age 5 is a real checkpoint. By 5, kids are about to enter or are already in kindergarten, where language demands jump sharply. Reading instruction starts. Following multi-step classroom directions is expected. Peer conversation becomes a daily social requirement.

At age 5, these are signs that warrant an SLP evaluation:

• Speech that strangers struggle to understand
• Difficulty retelling a story or sequence of events
• Trouble understanding and following 3-step directions
• Avoidance of talking, reading aloud, or communicating in groups
• Persistent stuttering or significant dysfluency
• Difficulty learning letter sounds, which can be an early marker of phonological disorder

School-based services are available at this age under Part B of IDEA. Your child's kindergarten teacher may refer them, or you can request an evaluation in writing yourself. That written request starts the clock on the district's 60-day evaluation timeline. ^[7]

If your child already has a speech delay diagnosis and is receiving services, age 5 is a good time to review whether the current therapy plan still matches where your child is and what kindergarten demands.

One thing worth knowing: language-based learning disabilities like dyslexia often show up first as speech and phonological awareness issues in preschool and kindergarten. An SLP evaluation at 5 is about more than whether your child talks clearly. It's a window into how their language system is set up for reading.

What's the difference between a speech delay and a language delay?

These terms get used interchangeably by parents and sometimes by pediatricians, but they describe different things.

A speech delay is about the sounds and clarity of talking. A child with a speech delay may have plenty to say, but it comes out unclear, distorted, or with sound substitutions. Articulation disorders and childhood apraxia of speech are speech disorders.

A language delay is about the system behind the words. It covers vocabulary (how many words a child knows), grammar (how they put words together), comprehension (what they understand), and pragmatics (how they use language socially). A child with a language delay may speak clearly but say very little, or may not understand what others say to them.

Many children have both. The distinction matters because the treatment approach is different, and a good evaluation will separate them.

For kids on the autism spectrum, pragmatic language (the social use of language) is often the biggest area of difficulty even when their vocabulary and grammar look typical. ^[5] If your child seems to talk fine on the surface but struggles with back-and-forth conversation, reading social cues, or understanding sarcasm and jokes, a pragmatic language evaluation is worth requesting. See our full guide to autism spectrum speech therapy for more on this.

What can I do at home while waiting for an evaluation?

Waitlists for SLPs are long. In some areas you might wait two to four months for an evaluation appointment. That's frustrating, and it doesn't have to be dead time.

The strategies with the best evidence base for parents at home are simple and don't require training.

Talk more, and talk slower. Narrate what you're doing. "I'm putting on your shoes. One shoe, two shoes." This kind of parallel talk exposes kids to language in meaningful context.

Follow the child's lead. Play with whatever your child is interested in and comment on it. "You're rolling the red car. Zoom, zoom." Forced interaction rarely builds language.

Don't talk for them. If your child reaches for something, wait a beat before handing it over. Give them a chance to communicate, even if it's just a sound or a gesture.

Respond to all communication. Words, sounds, pointing, pulling your hand. Treat all of it as meaningful and respond to it. This teaches children that communication works.

Cut screen time during your interaction windows. There's no good evidence that educational TV builds language in kids under 2, and some evidence it can substitute for the face-to-face interaction that actually does. ^[10] Screens watched together with you, where you're talking about what's on screen, are less of a concern.

If you want structured at-home support, early intervention programs often include parent coaching. Ask your EI coordinator specifically about parent coaching, more than direct therapy for your child, because the research on parent-implemented strategies is strong.

The Little Words app is built around this model: structured, research-aligned activities you can do with your child in short daily sessions while you wait for or supplement formal therapy. It's not a replacement for an SLP, but it's not nothing either.

What if my pediatrician says to wait and see?

This is one of the most common and frustrating situations parents face. A pediatrician says "some kids are just late talkers" or "boys talk later" or "give it six months."

Here's the honest picture. Pediatricians have short well-child visits and see a lot of kids. Developmental surveillance is genuinely hard in a 15-minute appointment. The American Academy of Pediatrics (AAP) recommends formal developmental screening at 9, 18, and 24 to 30 months using validated tools, plus autism-specific screening at 18 and 24 months. ^[11] Not every practice does this consistently.

You do not need a pediatrician's referral to access Early Intervention services for a child under 3. You can self-refer. Call your state's EI program directly.

For children over 3, you also do not need a doctor's referral to request a school-based evaluation. Send a written letter to the special education director at your local school district. The letter just needs to say you're requesting an evaluation for your child's speech and language development. That written request legally starts the clock.

If your pediatrician says wait and see but your gut says something is wrong, getting a second opinion from a developmental pediatrician or directly from an SLP is completely reasonable. ASHA's "Find a Professional" tool at asha.org can help you locate licensed SLPs in your area. ^[1]

Frequently asked questions

Does my child need speech therapy if they only say a few words at 18 months?

At 18 months, most children use at least 10 to 25 words. If your child has fewer than 10 words, or fewer than 6 to 8 with no new words appearing, an SLP evaluation is warranted. Under IDEA Part C, children under 3 are entitled to a free evaluation through your state's Early Intervention program. You can self-refer without a pediatrician's referral.

How do I know if my child needs speech therapy or is just a late talker?

Genuine late talkers (sometimes called "late language emergence") make up roughly 10 to 15 percent of toddlers, and about half catch up by age 3 without intervention. The problem is there's no reliable way to predict which child will catch up. Red flags that tip toward needing therapy include: fewer than 50 words at 24 months, no word combinations by 24 months, comprehension problems, or a family history of language disorders.

When does a child need speech therapy urgently, more than eventually?

Seek an evaluation urgently if your child loses language or communication skills they previously had, stops responding to their name, or goes from talking to near-silence. These are potential signs of a medical or neurological issue that needs prompt attention. Regression in any developmental domain warrants a same-week call to your pediatrician and a request for immediate evaluation.

Why would a child need speech therapy even if they talk a lot?

Talking a lot doesn't mean language development is on track. Some children have strong vocabulary but poor sentence structure, difficulty with comprehension, social communication challenges, or speech that's hard for others to understand. Pragmatic language disorders, in particular, can look invisible because the child is verbal, but they struggle with conversation, sarcasm, and social language. An SLP evaluates all of these dimensions.

How to tell if your child needs speech therapy at age 5?

At age 5, look for: speech that's hard for strangers to understand, difficulty retelling a simple story, trouble with 3-step directions, avoidance of talking, or persistent stuttering. Age 5 is also when phonological awareness problems show up as early reading difficulties. If you're seeing any of these, request a school-based evaluation in writing from your school district. They're required to evaluate at no cost under IDEA Part B.

Is speech therapy covered by insurance?

Many private insurance plans cover speech therapy evaluations and treatment, especially when there's a diagnosis code. Coverage varies widely, so call your insurer and ask specifically about speech-language pathology benefits and whether prior authorization is needed. For children under 3, Early Intervention services are free under federal law. Medicaid covers speech therapy for eligible children in all states. School-based services are free for qualifying children 3 and older.

Can my child get speech therapy through school?

Yes. Under IDEA Part B, public school districts must provide free speech-language evaluations and therapy to children age 3 and up who qualify. Send a written request to your district's special education director. The district has 60 days (timelines vary slightly by state) to complete the evaluation. If your child qualifies, services are provided through an IEP at no cost to your family.

How long does speech therapy usually take?

There's no universal answer, and anyone who gives you one without knowing your child is guessing. Mild articulation issues might resolve in a few months of weekly therapy. Language disorders often require a year or more of regular services. Childhood apraxia of speech typically needs intensive, frequent therapy over many months. Progress depends on the nature of the delay, how early intervention starts, and how much practice happens at home between sessions.

Does my child need speech therapy for stuttering?

Stuttering that starts between ages 2 and 5 is common, and about 75 to 80 percent of children who stutter recover naturally without treatment, usually within 12 to 24 months of onset. An SLP evaluation is still recommended, especially if stuttering is worsening, if your child is showing frustration or avoidance, if stuttering started after age 5, or if there's a family history of persistent stuttering. Don't ask your child to slow down or repeat themselves.

What is the difference between a speech delay and autism?

Speech delay is one possible feature of autism, but they're not the same thing. Many children have speech or language delays with no autism diagnosis. And some autistic children are not delayed in speech at all, but have significant pragmatic language differences. An autism evaluation looks at social communication patterns, repetitive behaviors, and sensory differences across settings. An SLP evaluation focuses on speech and language skills. Both can be done at the same time.

How do I find a speech-language pathologist for my child?

ASHA's "Find a Professional" directory at asha.org lets you search by zip code, specialty, and age group served. Look for an SLP with a CCC-SLP credential (Certificate of Clinical Competence), which means they've completed graduate training and a supervised clinical fellowship. For children under 3, contact your state's Early Intervention program. For school-age kids, start with a written request to your school district.

Can I do speech therapy at home without a therapist?

Parent-implemented strategies have solid research support as a supplement to professional therapy, not as a replacement for an evaluation. Following the child's lead, narrating your actions, expanding on what the child says, and reading aloud daily are all evidence-based approaches. Ask your SLP for a home program specific to your child's goals. Research on Early Intervention consistently shows parent coaching, where an SLP teaches you the techniques, produces strong results.

What does a speech therapist do differently than what I do at home?

An SLP has graduate training in how language and speech develop, how they break down, and the specific techniques that move the needle for different disorders. They can identify whether a pattern of errors is typical development or a clinical sign, select evidence-based treatment approaches matched to your child's profile, and track progress against standardized benchmarks. Home practice is powerful, but it works best when it's directed by an SLP who knows what your child specifically needs.

Does my child need AAC (a communication device) if they're not talking?

Possibly, and research has consistently found that AAC does not reduce a child's motivation to develop spoken language. For children with limited speech, AAC devices can dramatically reduce frustration and support language development while spoken communication develops. An SLP with AAC experience should make this recommendation, but if your child is using very few words and having significant communication breakdowns, it's worth asking the question directly at your next evaluation.

Sources

1. ASHA - Speech and Language Developmental Milestones: ASHA age-referenced milestones for speech and language development and SLP finder tool
2. CDC - Learn the Signs, Act Early: Developmental Milestones: CDC developmental milestones by age including language expectations at 12, 18, 24 months and beyond
3. ASHA - Bilingual Children: Bilingual children may distribute vocabulary across languages while meeting total vocabulary targets
4. Norbury et al. (2016), Journal of Child Psychology and Psychiatry - Prevalence of DLD: Developmental language disorder affects approximately 7 to 10 percent of children, making it more common than autism or ADHD
5. ASHA - Autism Spectrum Disorder: Autism spectrum disorder often presents through communication differences including echolalia and pragmatic language difficulties
6. Journal of Speech, Language, and Hearing Research - Early Intervention outcomes: Children who received intervention before age 3 showed significantly larger expressive language gains than those who started later
7. U.S. Department of Education - IDEA Individuals with Disabilities Education Act: Part C of IDEA provides free evaluations and services for children under 3 with developmental delays; Part B covers school-age children with 60-day evaluation timeline
8. ASHA - Reimbursement and Practice: Private SLP evaluations typically cost $200 to $500; private therapy sessions range $100 to $300 per hour without insurance
9. Medicaid.gov - Benefits: Medicaid covers speech therapy evaluations and treatment for eligible children in all states
10. AAP - Media and Young Minds (Council on Communications and Media): Educational TV does not build language in children under 2 and may substitute for face-to-face interaction that drives language development
11. AAP - Developmental Surveillance and Screening Policy Statement: AAP recommends formal developmental screening at 9, 18, and 24 to 30 months, plus autism-specific screening at 18 and 24 months
12. ASHA - Childhood Apraxia of Speech: Childhood apraxia of speech requires specific therapy techniques distinct from other speech disorders
13. ASHA - Late Language Emergence: Roughly 10 to 15 percent of toddlers are late talkers; about half catch up by age 3 without intervention