Does my child need speech therapy? A parent's honest guide

Last updated 2026-07-10

How do I know if my child needs speech therapy?

If you're asking, you've probably already noticed something. Parents who search this question are almost never wrong to wonder. Your gut is worth trusting here, but it helps to pair it with something more concrete.

The American Speech-Language-Hearing Association (ASHA) publishes age-referenced milestones for speech and language development, and they're the clearest starting point you'll find. ^[1] Missing one milestone by a few weeks isn't an emergency. Missing several, or missing one by two to three months or more, is worth acting on.

Two things should send you to an evaluation regardless of age or milestone charts. The first is regression: if your child was talking or communicating well and has stopped, call a speech-language pathologist this week. The second is comprehension. A child who doesn't seem to understand what's said to them, as opposed to one who just ignores you, needs to be seen.

What follows covers milestones by age, what tends to cause speech delays, and how to actually get an evaluation, including options that don't cost anything.

What are the speech and language milestones by age?

Milestones are averages, not deadlines, but they're the best tool available, and ignoring them entirely is how small delays turn into bigger ones. Here's what the CDC and ASHA consider typical. ^[1][2]

A couple of things this table doesn't capture: bilingual kids may have different vocabulary counts in each language while their total vocabulary across both is right on track. ^[3] And some kids are genuinely late talkers who catch up with no help at all. The problem is there's no way to know in advance which kind of child yours is, and waiting costs a lot more than an evaluation does.

By age 5, if your child is hard to understand, avoids talking, struggles with multi-step directions, or can't retell a simple story, those are real reasons to get an SLP evaluation. This age also matters because school-based speech services start in earnest around kindergarten, so an evaluation now affects what support is already in place when school begins.

A quick self-check

Run through this list. You're not diagnosing your child, just deciding whether to make a call.

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 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 anything in the "at any age" section applies, or two or more items in any single age group, an evaluation is the right next step. Not maybe, actually next. If you'd rather work through this in a more structured way, the Little Words app has a guided screen at /start built around these same questions to help you figure out what to do.

What actually causes speech delays?

Delays come from a range of causes, and it's common for a child to have more than one factor at play.

Hearing loss is the first thing a pediatrician should check for. Even mild or intermittent hearing loss from chronic ear infections can meaningfully affect how a child picks up language, so if your child has had frequent ear infections, ask for a full audiological evaluation alongside any speech screen.

Developmental language disorder (DLD) is the most common cause of language delay in children who don't have another diagnosis. Somewhere between 7 and 10 percent of children have DLD, making it more common than autism or ADHD. ^[4] It isn't caused by anything a parent does or doesn't do; it's a neurodevelopmental difference in how the language system develops.

Autism spectrum disorder often shows up first as a difference in communication: unusual use of language (like echolalia, where a child repeats phrases instead of generating new ones), trouble with back-and-forth conversation, or delayed speech alongside strong nonverbal skills. ^[5] If your child's language looks uneven rather than delayed across the board, it may be worth running an autism evaluation alongside the speech one.

Childhood apraxia of speech is a motor speech disorder where the brain struggles to coordinate the movements speech requires. Kids with it often know exactly what they want to say, but the sounds come out inconsistent or garbled, and it needs specific therapy techniques, so getting the diagnosis right matters. ^[12]

Other causes include apraxia of speech, cleft palate, tongue tie, cognitive delays, and prematurity. Some kids come from families with a history of late talking and catch up on their own, but even then, an SLP can tell you whether watchful waiting makes sense or whether it's time to start therapy now.

When is it time for therapy instead of just watching?

Monitoring makes sense for a short stretch. If a child is only barely behind on one milestone with no other red flags, a pediatrician might suggest checking back in one to three months. That's reasonable.

Therapy is the right call when a child is two or more months behind on several milestones, has lost skills they once had, still has delays after hearing loss has been ruled out, is showing distress or behavior problems tied to communication struggles, or when an SLP, pediatrician, or developmental pediatrician has already recommended it.

The research is fairly consistent on this: earlier intervention leads to better outcomes. Studies in the Journal of Speech, Language, and Hearing Research report that children who start intervention before age 3 show significantly larger gains in expressive language than those who start later. ^[6] That word "significantly" isn't decorative here; the gap is real, not marginal.

"Wait and see" doesn't have a great track record. Some kids catch up on their own, sure. The ones who don't lose time they won't get back. An evaluation costs you an appointment, nothing more. If the SLP says your child is fine, that's a relief. If they find something, you caught it early.

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

There are three main routes into speech evaluation, and one of them is free by law.

The first is Early Intervention, for kids from birth to age 3. Under Part C of the Individuals with Disabilities Education Act (IDEA), every state has to provide free evaluations, and free services if needed, for children under 3 with developmental delays.^[7] You don't need a pediatrician's referral for this. Just call your state's Early Intervention program directly, and a call today can lead to an evaluation within 45 days. States give these programs different names, but the federal entitlement is the same everywhere. You can find your state's program through the IDEA website at the U.S. Department of Education.

The second route is school-based services, which kick in at age 3. Once your child turns 3, things shift to the school district under Part B of IDEA. Your local public school has to evaluate your child for free if you ask in writing, and they must finish the evaluation within 60 days of that request (timelines shift slightly by state).^[7] If the evaluation turns up a qualifying delay, the school provides speech therapy at no cost through an Individualized Education Program (IEP) or a 504 plan.

The third option is a private evaluation from an SLP, which typically runs $200 to $500 out of pocket, though many insurance plans cover it.^[8] These evaluations tend to be more thorough than what schools offer, so they're worth considering if you want a full clinical picture. Private therapy sessions themselves generally cost $100 to $300 an hour without insurance.

If you want something more flexible and cheaper, online speech therapy has grown a lot in recent years and can be a real option when in-person services have long waitlists or aren't available nearby. And if cost is the main obstacle, know that Medicaid covers speech therapy evaluations and treatment for eligible children in every state.^[9] Ask your pediatrician's office for a referral and call your state Medicaid office for the details.

What actually happens during an evaluation?

Evaluations differ by age and what's being assessed, but most follow the same general pattern. The SLP starts by taking a detailed history from you, covering pregnancy, birth, early development, hearing history, and any family history of speech or language issues. This part matters more than parents expect, so give as much detail as you can.

After that, 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, how they interact. Older kids get standardized tests measuring vocabulary, grammar, sentence structure, and sound production against age norms. If speech clarity is a concern, the SLP may also check oral-motor function (how the mouth, lips, and tongue move), and they might recommend a hearing test if one hasn't been done recently.

At the end you get a report that either confirms typical development or identifies areas of delay or disorder, along with a recommended next step: therapy, a home program, a referral for further evaluation (an autism assessment, for instance), or a recheck in a few months. You're allowed to ask what specific goals therapy would target and how progress gets measured. A good SLP welcomes those questions.

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

Age 5 is a real checkpoint. Kids this age are entering or already in kindergarten, where language demands jump: reading instruction starts, multi-step classroom directions become routine, and peer conversation turns into a daily requirement.

At this age, signs that warrant an SLP evaluation include speech that strangers struggle to understand, trouble retelling a story or sequence of events, difficulty following 3-step directions, avoiding talking or reading aloud in groups, persistent stuttering or significant dysfluency, and trouble learning letter sounds, which can be an early marker of phonological disorder.

School-based services are available under Part B of IDEA at this age. A kindergarten teacher might refer your child, or you can request an evaluation yourself in writing, which starts the clock on the district's 60-day timeline.^[7] If your child already has a speech delay diagnosis and is in services, age 5 is a good moment to check whether the current plan still fits where they are and what kindergarten will ask of them.

One thing worth knowing: language-based learning disabilities like dyslexia often show up first as speech and phonological awareness issues in preschool and kindergarten. So an evaluation at 5 isn't just about clear talking, it's a look at how a child's language system is set up for reading.

Speech delay versus language delay

Parents, and sometimes pediatricians, use these terms interchangeably, but they describe different things. A speech delay is about the sounds and clarity of talking: a child might have plenty to say, but it comes out unclear, distorted, or with sound substitutions. Articulation disorders and childhood apraxia of speech fall under this category.

A language delay is about the system behind the words: vocabulary, grammar, comprehension, and how a child uses language socially. A child with a language delay might speak clearly but say very little, or might not understand what others say to them. Plenty of kids have both, and the distinction matters because treatment differs. A good evaluation will tease the two apart.

For kids on the autism spectrum, the social use of language is often the biggest struggle even when 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, it's worth asking for a pragmatic language evaluation specifically. Our full guide to autism spectrum speech therapy covers this in more depth.

What to do while you wait

Waitlists for SLPs are long, sometimes two to four months for an evaluation appointment. That's frustrating, but it doesn't have to be wasted time. The strategies with the best evidence behind them are simple and need no 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 puts language in a meaningful context. Follow your child's lead rather than forcing interaction. Play with whatever interests them and comment on it: "You're rolling the red car. Zoom, zoom." Forced interaction rarely builds language the way this does.

Resist talking for them. If your child reaches for something, wait a beat before handing it over so they have a chance to communicate, even if it's just a sound or a gesture. And respond to everything they offer, whether that's words, sounds, pointing, or pulling your hand, so they learn that communication works.

It also helps to cut screen time during the windows when you'd otherwise be interacting. There's no good evidence that educational TV builds language in kids under 2, and some evidence it can crowd out the face-to-face interaction that actually does.^[10] Screens watched together, where you're talking about what's happening on screen, are less of a concern.

Early intervention programs often include parent coaching if you want more structured support at home. Ask your EI coordinator specifically about parent coaching rather than only direct therapy for your child, since the research on parent-implemented strategies is strong. The Little Words app works on this same model: structured, research-aligned activities you do with your child in short daily sessions while you wait for or supplement formal therapy. It won't replace an SLP, but it isn't nothing either.

What if my pediatrician says to wait and see?

This is one of the most common and frustrating situations parents run into. 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, and developmental surveillance is genuinely hard to do well in 15 minutes. The American Academy of Pediatrics 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 don't need a referral to access Early Intervention for a child under 3, you can self-refer by calling your state's EI program directly. For children over 3, you also don't need a doctor's referral to request a school-based evaluation: just send a written letter to the special education director at your local school district asking for an evaluation of your child's speech and language development. That written request is what legally starts the clock.

If your pediatrician says wait and see but your gut says otherwise, 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 near you.^[1]

Common questions parents ask

My 18-month-old only says a few words. Do they need therapy?

Most children this age use somewhere between 10 and 25 words. If your child has fewer than 10, or fewer than 6 to 8 and nothing new is showing up, it's worth getting an SLP evaluation. Children under 3 are entitled to a free evaluation through your state's Early Intervention program under IDEA Part C, and you don't need a pediatrician's referral to start that process yourself.

Is my child a late talker, or something more?

Late talkers (the clinical term is "late language emergence") make up roughly 10 to 15 percent of toddlers, and about half catch up by age 3 with no intervention at all. The tricky part is that nobody can reliably tell you in advance which child will be in that half. Some signs push more toward getting help sooner: fewer than 50 words at 24 months, no two-word combinations by then, trouble understanding what's said to them, or a family history of language disorders.

When is it urgent rather than just something to watch?

If your child loses language they used to have, stops responding to their name, or goes from talking regularly to near silence, don't wait. Call your pediatrician the same week and ask for an immediate evaluation. Losing skills in any area of development can point to a medical or neurological issue that needs prompt attention.

Can a child who talks a lot still need speech therapy?

Yes. A big vocabulary doesn't guarantee everything else is on track. Some kids know plenty of words but struggle to put sentences together, or have trouble understanding what's said to them, or find social conversation hard, or simply aren't easy to understand. Pragmatic language disorders are especially easy to miss this way, since the child is clearly verbal but struggles with back-and-forth conversation, sarcasm, or reading social cues. An SLP evaluation looks at all of these angles, not just vocabulary size.

What should I look for at age 5?

Watch for speech strangers can't understand, trouble retelling a simple story, difficulty following three-step directions, avoiding talking altogether, or stuttering that hasn't let up. Age 5 is also when weak phonological awareness starts showing up as early reading struggles. If any of this sounds familiar, put your request for a school-based evaluation in writing to your district. They're required to evaluate at no cost under IDEA Part B.

Will insurance cover it?

Many private plans cover speech evaluations and treatment, particularly once there's a diagnosis code attached. Coverage differs a lot by plan, so call your insurer directly and ask about speech-language pathology benefits and whether you need prior authorization. Under 3, Early Intervention is free by federal law. Medicaid covers speech therapy for eligible kids everywhere. Once a child qualifies for school-based services at 3 or older, those are free too.

Can school provide speech therapy?

Yes. Public school districts have to provide free evaluations and therapy under IDEA Part B for qualifying children 3 and up. Send your request in writing to the district's special education director. They have 60 days (this shifts slightly by state) to complete the evaluation, and if your child qualifies, services come through an IEP at no cost to you.

How long does therapy typically take?

Anyone who gives you a firm number without meeting your child is guessing. A mild articulation issue might clear up in a few months of weekly sessions. Language disorders often take a year or more of consistent therapy. Childhood apraxia of speech usually needs frequent, intensive work over many months. What speeds things along is starting early and practicing at home between sessions, on top of the nature of the delay itself.

What about stuttering specifically?

Stuttering that begins between ages 2 and 5 is common, and about 75 to 80 percent of children who stutter recover on their own, usually within 12 to 24 months of it starting. Even so, an evaluation is worth getting, especially if the stuttering is getting worse, your child seems frustrated or starts avoiding talking, it began after age 5, or persistent stuttering runs in the family. One thing to avoid: asking your child to slow down or repeat themselves.

Is a speech delay the same as autism?

No, though they can overlap. Plenty of children have speech or language delays with no autism at all. And some autistic children speak right on schedule but have real differences in pragmatic language, the social side of communication. An autism evaluation looks at social communication, repetitive behaviors, and sensory patterns across different settings, while an SLP evaluation is focused specifically on speech and language skills. There's no reason both can't happen around the same time.

How do I actually find an SLP?

ASHA runs a "Find a Professional" directory at asha.org where you can search by zip code, specialty, and age group. Look for the CCC-SLP credential (Certificate of Clinical Competence), which means the person has completed graduate training plus a supervised clinical fellowship. If your child is under 3, your state's Early Intervention program is the place to start; for school-age kids, start with a written request to the district.

Can I just work on this at home myself?

Parent-led strategies have real research behind them, but as a supplement to professional evaluation, not a substitute for it. Following your child's lead, narrating what you're doing, expanding on what they say, and reading aloud daily are all approaches backed by evidence. Ask your SLP for a home program built around your child's specific goals. Early Intervention research consistently shows that parent coaching, where the SLP teaches you the techniques directly, gets strong results.

What does an SLP bring that I can't do myself?

Graduate training in exactly how speech and language develop and break down, plus the specific techniques that actually move the needle for different disorders. An SLP can tell whether a pattern of errors is normal development or a clinical flag, choose treatment approaches matched to your child's profile, and track progress against standardized benchmarks. Your home practice matters, but it works best when an SLP is the one directing what to focus on.

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

Maybe, and it's worth knowing that research has consistently found AAC does not reduce a child's motivation to develop spoken language, contrary to a common worry. For kids with very limited speech, AAC devices can cut down on frustration considerably and support language while spoken words are still developing. This is a call an SLP with AAC experience should make, but if your child has very few words and communication breakdowns are frequent, it's a fair question to raise directly at your next evaluation.

This article is meant to help you know what to ask and when to act, not to replace an actual evaluation from a qualified professional.

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