If your child is starting speech therapy, you may have spent weeks—or even months—getting to this point.
There may have been an evaluation. A referral. Phone calls. Insurance approvals. School meetings. Waiting lists.
Then you finally get the appointment.
But what are you supposed to do before your child's first speech therapy session?
Parents are often told when and where to show up, but not necessarily how to prepare. You may not know what information the speech-language pathologist (SLP) needs, what questions you should ask, what goals you should be thinking about or even what speech therapy will look like for your child.
A little preparation can help.
That's why The Spectrum Dispatch created a Before You Start Speech Therapy Guide to help parents think through their child's current communication, priorities and questions before therapy begins.
But first, here's what families should know before that first appointment.
What Does Speech Therapy Help Children With?
One of the biggest misconceptions about speech therapy is that it is only about teaching children to pronounce words correctly or encouraging a nonspeaking child to talk.
Speech-language therapy can address many different aspects of communication.
Depending on your child's individual needs, a speech-language pathologist may work on areas such as:
- Expressive language
- Receptive language
- Speech production and articulation
- Social and pragmatic communication
- Functional communication
- Augmentative and alternative communication (AAC)
- Communication across different environments
- Feeding or swallowing when appropriate to the SLP's training and the child's needs
For autistic children and children with developmental disabilities, this distinction can be particularly important.
The goal isn't simply to produce more spoken words.
The bigger goal is helping a child communicate effectively.
That communication might happen through speech. It might also happen through gestures, sign language, pictures, an AAC device or a combination of different communication methods.
Before Speech Therapy Starts, Look at How Your Child Already Communicates
Before focusing on what your child can't do yet, take inventory of what they already do.
How does your child let you know what they want?
How do they tell you they don't want something?
How do they ask for help?
How do they get your attention?
How do they communicate when they're uncomfortable, tired, frustrated or excited?
Your child may use:
- Spoken words
- Sounds or vocalizations
- Gestures
- Pointing
- Facial expressions
- Sign language
- Pictures
- An AAC device
- Leading someone toward an object
- Bringing an object to another person
- Behavior
Some of these forms of communication may be easy for other people to recognize. Others may only be understood by people who know your child well.
That is useful information for your child's speech therapist.
You aren't just bringing a list of things your child needs to learn. You're helping the therapist understand the communication system your child already has.
Think About the Communication Skills Your Child Needs Most
It's natural for a parent to enter speech therapy thinking: I want my child to talk more.
But try taking that goal one step further.
What does your child need to be able to communicate?
For example:
- Can your child ask for help?
- Can they say no or reject something?
- Can they tell someone when something hurts?
- Can they ask for food or water?
- Can they request a break?
- Can they make a choice?
- Can they communicate that they need the bathroom?
- Can they tell you that something happened at school?
- Can they communicate with someone who doesn't already know them well?
These questions can help families and therapists identify communication goals that have an immediate impact on a child's everyday life.
For some children, learning to request a favorite toy may be an appropriate goal.
For another child, being able to communicate "stop," "help," "hurt" or "I need a break" may be a much more urgent priority.
Speech therapy goals should ultimately help a child communicate in the world beyond the therapy room.
Bring Real-Life Examples to Your Child's Speech Therapist
A speech-language pathologist gets to observe your child for a limited amount of time.
You see your child across environments and situations.
That makes your observations incredibly valuable.
Before your child's first speech therapy appointment, think about a few specific examples of communication challenges you've noticed.
Instead of saying: "She has trouble communicating."
You might explain: "She can ask for her favorite foods, but she can't tell me where she's hurt."
Instead of: "He doesn't use his AAC device enough."
You might say: "He uses his AAC device at school, but we rarely see him initiate with it at home."
Or: "She speaks in full sentences with us but stops responding when an unfamiliar adult asks her a question."
Specific examples give the therapist information about where communication is breaking down, not just whether your child can demonstrate a particular skill.
If Your Child Uses AAC, Ask How It Will Be Included in Speech Therapy
If your child already uses augmentative and alternative communication (AAC), bring that system to the appointment whenever possible.
If AAC has been recommended but you haven't started yet, ask the speech-language pathologist how it might fit into your child's communication plan.
AAC can include communication boards, picture-based systems, speech-generating devices and communication apps.
Parents may also worry that introducing AAC will prevent or discourage their child from developing spoken language. Research has not supported the idea that AAC inherently prevents speech development, and AAC can provide children with another way to communicate while speech and language skills continue to develop.
Questions parents can ask include:
- How will AAC be incorporated into therapy?
- How can we model AAC at home?
- Should the system be available throughout the day?
- How will school staff and other caregivers learn to use it?
- What should we do if my child doesn't independently use the device yet?
- How will we know whether the current AAC system is meeting my child's needs?
Most importantly, AAC should be viewed as communication, not as a failure to develop speech. A child having a reliable way to express themselves matters.
Ask What Speech Therapy Should Look Like at Home
Parents often leave therapy knowing that they're supposed to "practice" but aren't sure what that actually means.
Before leaving a session, ask for specifics.
- What skill are we working on?
- What should I model?
- When should I practice it?
- How often?
- What counts as progress?
- Should I prompt my child? If so, how?
- What should I avoid doing?
For many children, the most meaningful communication practice won't look like sitting at a table recreating a therapy session.
It happens during everyday life.
Breakfast.
Getting dressed.
Playing.
Bath time.
Riding in the car.
Going to the store.
Choosing a snack.
Getting ready for school.
Those routines create natural reasons to communicate.
If a child can demonstrate a communication skill with a therapist but never uses that skill anywhere else, the family may need help figuring out how to support generalization across people, places and situations.
Ask How Your Child's Speech Therapy Progress Will Be Measured
Before speech therapy begins—or during the first few sessions—parents should understand what the therapist is working toward.
Ask:
- What is my child's current baseline?
- What goals are you recommending?
- Why were these goals selected?
- How will progress be measured?
- How often will goals be reviewed?
- How will I know whether my child is making progress?
- What happens if progress stalls?
- How will we work on using these skills outside the therapy room?
You don't need to become a speech-language expert.
But you should understand what your child is working on and why.
It can also help to distinguish between demonstrating a skill and independently using that skill in everyday life.
A child answering a particular question correctly during a structured activity may represent progress.
The next question is whether that communication skill becomes useful to them outside the session.
What If My Child Doesn't Talk During the First Speech Therapy Appointment?
This is something parents shouldn't panic about.
Your child may walk into the first appointment and barely communicate with the therapist.
They may hide behind you.
They may explore the room instead of participating in activities.
They may use fewer words than they use at home.
They may communicate differently around an unfamiliar adult.
An autistic child may need time to become comfortable with the therapist, the room, the expectations and the sensory environment.
That doesn't mean the appointment was unsuccessful.
Your child's first speech therapy session is not a performance they have to pass.
It's the beginning of the therapist learning who your child is and how they communicate.
If your child communicates very differently at home, tell the therapist.
Videos or specific examples from home may also be useful if the therapist welcomes them.
Questions to Ask Before Starting Speech Therapy
You don't have to ask every possible question at the first appointment.
But these can help start the conversation:
- What do you see as my child's biggest communication strengths?
- What communication skills should we prioritize first?
- How were these goals selected?
- How will you incorporate my child's interests into therapy?
- How can we support these goals at home?
- If my child uses AAC, how will it be incorporated?
- How will you communicate progress to us?
- How often will goals be reassessed?
- How can we help my child use these skills with different people and in different environments?
- What should we do if something you're seeing in therapy looks very different from what we're seeing at home?
And don't be afraid to ask why. Parents should be able to understand the purpose behind their child's therapy goals.
Download the Before You Start Speech Therapy Guide
When you're sitting in an evaluation or your child's first speech therapy appointment, it can be surprisingly difficult to remember everything you wanted to discuss.
Preparing ahead of time can help.
The Spectrum Dispatch created the Before You Start Speech Therapy Guide to help parents organize important information about their child's communication before therapy begins.
Use it to think through how your child currently communicates, where communication is breaking down, what skills would make the biggest difference in everyday life and what questions you want to bring to the speech-language pathologist.
Download the Before You Start Speech Therapy Guide and bring it with you to your child's first appointment.
Already started speech therapy?
You can still use the guide before a progress meeting, annual review, new evaluation or transition to a new speech-language pathologist.
Because the goal isn't simply getting your child into speech therapy.
It's making sure the people working with your child understand how they communicate, what they need to communicate and what meaningful progress should look like in their everyday life.