Speech Therapy Referral Guidelines
Warning Signs that should trigger a referral to an SLP at any age:
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Shows 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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Speech is usually slurred; difficulty controlling respiration for speech; abnormal loudness, rhythm, or vocal quality
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Produces no meaningful words or sounds that are understood only by family
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Speaks loudly in high pitched voice with frequent distortion, omission, and substitution of sounds
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Exhibits difficulty learning sounds to form words; may sound nasal, strangled and/or breathy
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Sound errors are prevalent but variable (i.e., "dog" could be produced "dog," "tog," "gog," "god" by same child)
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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
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Unaware of sound variations or exhibits varying degrees of frustration and/or anxiety regarding inability to "control speech"
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Cannot produce movements for sound production or sounds are produced without voice (whispered speech)
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Exhibits frustration and/or avoidance of speech due to difficulties
Age-specific Warning Signs
By 6 months:
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Does not laugh or squeal
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Does not look toward new sounds
By 9 months:
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Has limited or no babbling
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Does not indicate when upset
By 12 months:
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Does not point to objects
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Does not use gestures such as waving or shaking head
By 15 months:
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Has not used first word
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Does not respond to “no” and “bye-bye” appropriately
By 18 months:
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Does not use at least six to ten words consistently
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Does not hear well or discriminate between sounds
By 20 months:
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Does not use at least six consonant sounds (especially /p, b, m, n, w, h/)
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Does not follow simple directions
By 24 months (2 years):
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Has a vocabulary of less than 50 words
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Has decreased interest in social interactions compared with previously
By 3 years:
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Cannot be understood by family and/or caregivers more than 50% of the time
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Cannot correctly produce vowels and the consonants /p, b, m, w/ in words
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Cannot repeat when not understood without getting frustrated
By 4 years:
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Cannot be understood by family/strangers more than 75% of the time
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Cannot correctly produce /t, d, k, g, f /
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Cannot be asked to repeat without becoming sensitive
By 5 years:
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Cannot be understood in all situations by most listeners
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Cannot correctly produce most speech sounds
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Cannot be asked to repeat without exhibiting frustration
*Information courtesy of the American Speech-Language Hearing Association (ASHA) and the Linguisystems Milestones Development Guide (Flahive and Lanza, 2012)