At what age is speech therapy typically recommended for children with speech or language difficulties?

When to Recommend Speech Therapy for Children

Speech therapy should be initiated as early as 6-18 months of age when speech or language delays are identified, with formal assessment beginning at this age and continuing routinely thereafter. 1

Identifying Children Who Need Speech Therapy

Early Identification Timeline

• 6-18 months: Initial speech/language assessment for children with identified risk factors or developmental concerns 1
• Ages 2-5 years: Critical period when 5-12% of children are diagnosed with speech or language delays 2
• Preschool years: More pronounced expressive language deficits often become evident 1

Risk Factors Requiring Earlier Intervention

• Children with specific conditions:

  • Autism spectrum disorder 1
  • Cleft palate (typically repaired around age 1 year) 1
  • Velopharyngeal dysfunction (VPD) 1
  • 22q11.2 deletion syndrome 1
  • Down syndrome 1
  • Permanent hearing loss independent of otitis media with effusion (OME) 1
  • Blindness or uncorrectable visual impairment 1
  • Developmental delays 1

• Other risk factors:

  • Male sex, prematurity, low birth weight, late birth order, larger family size 2
  • Recurrent/chronic middle ear infections with hearing loss 1
  • Parental concern about speech development 3

Assessment Process

Initial Screening

• Pediatric clinicians should monitor language milestones during well-child visits 3
• For children with autism spectrum disorder or suspected speech delays, speech/language assessments by cleft/craniofacial specialists are recommended 1
• When VPD is clinically suspected, velopharyngeal imaging (nasendoscopy/videofluoroscopy) should be performed once adequate speech is present 1

Warning Signs That Warrant Referral

• Not meeting expected developmental milestones for speech and language 4
• Pronunciation difficulties that persist beyond expected developmental stages 5
• Receptive and expressive language delays 1
• Speech apraxia 1
• Hypernasality, compensatory articulation patterns, and poor intelligibility 1

Treatment Approach

Intervention Timing

• For children with identified speech disorders, early intervention is critical:
  • Overt palatal clefts are typically repaired around age 1 year 1
  • Early implementation of augmentative communication (e.g., sign language) is recommended for children with significant delays 1
  • Longer duration of therapy (>8 weeks) is associated with better clinical outcomes 6

Treatment Effectiveness

• Speech-language therapy shows good evidence of effectiveness, particularly for:
  • Children with phonological difficulties 6
  • Children with expressive vocabulary difficulties 6
  • Children with expressive language disorder 4

Common Pitfalls to Avoid

• Delayed intervention: 50% of children with speech/language delays experience persistent issues into adolescence with educational and occupational challenges 2
• Misattribution: Male sex, bilingual environments, birth order, and chronic otitis media are not adequate explanations for significant speech delays 3
• Overtreatment: For some children with mild articulation problems, a "watchful waiting" approach may be appropriate as these can represent normal variations in speech motor development 5
• Insufficient treatment duration: Many children require intensive speech-language therapy throughout childhood, and progress may be slow for those with cognitive/learning differences 1

Special Considerations

For children with complex conditions like 22q11.2 deletion syndrome, a multidisciplinary approach is essential, as they often present with a complex communication profile including structural, neurologic, developmental, and cognitive speech-language disorders 1. These children typically require more intensive and specialized intervention approaches.

For children with autism spectrum disorder, behavioral interventions that incorporate speech/language therapy are recommended, particularly early intensive behavioral and developmental interventions 1.