Speech Therapy for a 5-Year-Old in Pre-Kindergarten
If your 5-year-old has speech or language concerns, refer immediately to a speech-language pathologist for evaluation and therapy, as early intervention is associated with better long-term outcomes and improvements extend beyond speech to include socialization, confidence, and school readiness. 1, 2
When to Refer for Speech Therapy
Refer any child not meeting expected developmental milestones for speech and language, regardless of whether formal screening tools have been used. 2 The evidence does not support waiting or "watchful waiting" when concerns exist. 3
Red Flags That Should NOT Delay Referral
Do not attribute significant speech or language delays to the following common explanations, as they are insufficient to explain true disorders: 4
- Male sex
- Bilingual home environment
- Birth order (being a younger sibling)
- History of chronic ear infections alone
Essential Concurrent Evaluation
When speech and language delay is identified, refer to both: 2
- Speech-language pathologist for comprehensive language evaluation
- Audiologist for hearing assessment, as hearing loss is a common secondary cause of language delay 2
Consider comprehensive developmental evaluation to rule out conditions where language delay is a secondary feature, including: 2, 4
- Autism spectrum disorder
- Intellectual disability
- Chromosomal or genetic conditions
- Neurologic disorders
Expected Benefits of Speech Therapy
Direct Speech and Language Improvements
Good-quality evidence demonstrates that speech-language therapy produces significant improvements in multiple domains: 3
- Articulation and phonology (sound production)
- Expressive language (ability to communicate ideas)
- Receptive language (understanding others)
- Vocabulary acquisition
- Grammar and syntax
Broader Functional Outcomes Often Overlooked
Parents consistently observe improvements that extend far beyond speech measures alone, particularly in areas that matter most for quality of life: 5
- Social participation: Improved play skills with peers, better socialization at school and in the community 5
- Confidence and self-esteem: Children become more willing to communicate and engage 5
- Behavior: Reduced frustration-related behavioral problems at home and school 5
- School readiness: Speech and language development directly correlates with reading, writing, attention, and academic success 2
Parents report twice as many changes in participation and personal factors compared to clinicians, highlighting improvements in real-world functioning that standard testing may miss. 5
Treatment Approach and Intensity
For Isolated Speech/Language Delay
Speech-language therapy alone is effective for primary speech and language disorders, particularly expressive language disorder. 2 Therapy should include: 1
- Measurable, individualized goals based on the child's specific deficits
- Consistent monitoring of progress toward goals
- Parent training to implement strategies at home 4
For Children with Autism or Developmental Delays
If autism or broader developmental concerns are identified, implement intensive intervention: 6
- 20-30 hours per week of structured therapy combining behavioral interventions with speech-language therapy 6
- Parent training in communication strategies (5 hours per week minimum) 6
- Alternative communication modalities if the child is not yet using words (Picture Exchange Communication System, sign language, voice output devices) 6
Critical Pitfalls to Avoid
Do not delay referral waiting for the child to "grow out of it." Early identification and intervention are associated with better long-term outcomes. 1, 4
Do not rely solely on informal developmental surveillance. While parental concerns should always prompt action, systematic evaluation is essential because language problems may be the first manifestation of other developmental conditions. 2
Do not assume therapy only improves speech sounds. The evidence shows broad improvements in socialization, behavior, confidence, and school readiness that profoundly impact quality of life. 5
Do not accept common risk factors as adequate explanations for significant delays. Male gender, bilingualism, or ear infections do not cause the degree of impairment seen in true speech-language disorders. 4
Monitoring and Adjustment
Therapy plans should include: 1
- Specific, measurable goals tailored to the child's needs and parents' priorities
- Regular reassessment of progress
- Adjustment of strategies based on response to intervention