Behaviors that should trigger an SLP referral:

  • By age 3 years cannot:
    • be understood by family and/or caregivers.
    • correctly produce vowels and such sounds as p, b, m, w in words.
    • repeat when not understood without becoming frustrated.
  • By age 4 years cannot:
    • be understood by individuals with whom they do not associate regularly.
    • be understood by family and/or caregivers.
    • correctly produce t, d, k, g, f.
    • be asked to repeat without becoming sensitive.
  • By age 5 years cannot:
    • be understood in all situations by most listeners.
    • correctly produce most speech sounds.
    • be asked to repeat without exhibiting frustration.
  • Disturbance in neuromuscular control causes difficulty learning to produce sounds appropriately.
    • speech is usually slurred; difficulty controlling respiration for speech; abnormal loudness, rhythm, or vocal quality.
    • exhibits difficulty learning sounds to form words; may sound nasal, strangled and/or breathy.
    • exhibits frustration and/or avoidance of speech due to extreme difficulty forming sounds or difficulty being understood.
  • Disturbance in programming, positioning, and sequencing of muscular movements.
    • sound errors are prevalent but variable (i.e., “dog” could be produced “dog,” “tog,” “gog” or “god” by same child).
    • varies from rarely being able to produce sounds to ongoing speech that is rarely understood, or speech that is usually understood with frequent sound errors.
    • unaware of sound variations or exhibits varying degrees of frustration and/or anxiety regarding inability to “control speech.”
  • Disturbance in performing voluntary movements with mouth and vocal mechanism.
    • cannot produce movements for sound production or sounds are produced without voice (whispered speech).
    • varies from inability to produce any words to extreme difficulty being understood.
    • exhibits frustration and/or avoidance of speech due to difficulties.
  • Deafness/severe hearing loss causes severe prosodic disturbances in intonation, duration, and rhythm in addition to sound errors.
    • produces no meaningful words or sounds understood only by family.
    • speaks loudly in high pitched voice with frequent distortion, omission, and substitution of sounds.
  • Autism, emotional disturbance, and/or mental retardation may cause very unusual prosodic variations.
    • intonation and/or rhythm of connected speech may sound abnormal.
    • volume may be consistently or intermittently too loud or too soft.
  • Deviation in structure of speech mechanism.
    • difficulty producing specific sounds and intelligible speech.
    • exhibits frustration and/or avoidance of speech.
    • speech has excessive nasality.
  • Difficulty in hearing and/or inability to differentiate between sounds inhibit child‚s ability to detect and correct error sounds; usually unaware of errors.
  • Intelligibility and sound production are compromised when nasal passages, nasopharynx, and larynx are bypassed due to tracheostomy/ventilator dependence.
  • Exhibits sudden decrease in speech intelligibility.
    • ranges from slurred, generally intelligible speech to total absence of speech, or totally unintelligible speech.
    • awareness ranges from extremely aware to totally unaware of sound errors.
  • Exhibits decline in ability to be understood by family, friends, and/or caregivers in the expression of basic needs, preferences, and feelings.

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