When to Refer a Student for Speech Therapy

When you think of students receiving speech therapy, you probably think of a student who has difficulty pronouncing sounds. How many students have you had who say “wabbit” instead of “rabbit” or stutter? While these students may need help from the school speech therapist, let’s identify some other students who could benefit from a speech-language evaluation by looking at what speech-language pathologists (SLPs) target in the school setting and what to do if you think a student needs to be referred to your school’s SLP. 

SLPs in schools work with students in many different areas: 

• Articulation for students who produce speech sounds incorrectly by substituting another sound or omitting the correct sound.  
• Fluency for students who stutter by repeating sounds, words, or phrases, or have other disfluencies in their speech, like taking long pauses between their words. 
• Receptive language for students who struggle to take in and understand what they hear. Students with receptive language disorders will often have difficulty following directions (not due to ADHD or other disorders), understanding information read to them, or following along during conversation.
• Expressive language for students who have trouble expressing themselves either verbally or nonverbally through writing. There are many signs to watch for, such as trouble producing correct grammar or syntax or cohesively providing a narrative. 
• Pragmatics for students who are challenged by social language skills, such as entering, exiting, or maintaining a conversation; understanding nonliteral language like sarcasm, idioms, similes, or metaphors; or understanding social aspects of communication, such as nonverbal language (facial expressions, gestures, body language, etc.) or rules like turn-taking. 

The following two areas are not often targeted in schools but are within SLPs’ scope of practice. Teachers who notice a student having these issues can refer them to their school’s SLP for help.

• Voice for students who have a vocal quality that is too raspy, high, nasal, or otherwise disordered in a way that affects their communication.
• Swallowing for students who often cough or seem to choke while eating or drinking or otherwise seem to have difficulty swallowing.

Reading is also within the scope of practice of SLPs, but these students are often best served by a reading specialist, dyslexia interventionist, or special education teacher. However, if your school does not have one of these amazing reading experts, you can certainly turn to your SLP. 

Collecting Data

When you encounter a student who exhibits some speech or language concerns, what do you do first? This process can vary by school, and legally a referral can be made formally or informally. However, a good first step is to collect data to bring to the SLP or special education team. For instance, if you are concerned about a student’s expressive language, you want to have specific examples of what you are seeing in class. Do they have trouble producing full sentences? Is their sentence structure inappropriate for the grade level? Do they have trouble defining or describing common items? Having exact incidences of their errors is helpful, as well as providing written work that supports your observations. 

It is important here to consider what a typical student of their age and grade level is capable of. Remember that “wabbit” kiddo from earlier? Would you be concerned if a pre-K student exhibited that articulation error? Probably not, right? However, if you saw that same error in a first grader, you would rightfully be concerned about their articulation skills and should consider making a referral.

A word of caution: Remember that all people speak in a particular dialect, and a dialect is inherently different from a disorder. Many of our students use a dialect that does not follow the rules of Standard American English, but that does not make it any less valid a communication style. Therefore, a student who says “toof” instead of “tooth” or “What you wanna do?” instead of “What do you wanna do?” may not need to be referred if their speech and/or language patterns are consistent with their dialect. 

Reaching out to an SLP

Once you have collected data that demonstrates a student’s area(s) of weakness, the next step is to present that to your school’s SLP or to a member of the special education team if your school does not directly employ a speech therapist. Once they have that information, they should schedule a referral conference to obtain consent from the student’s parent or guardian to conduct an evaluation.

If therapy is warranted, an individualized education program (IEP) will be put in place for speech therapy. In all IEP conferences, a general education teacher is a required participant. Your presence is not only legally mandated but vital when determining the student’s strengths and weaknesses. 

After consent is obtained and the evaluation is conducted, another meeting will be held with the IEP team to review the results and determine placement. If the student demonstrates a need for speech services, then the team will make decisions regarding minutes, placement, and goals. While writing the IEP, input from the general education teacher regarding the curriculum and grade-level standards is crucial in ensuring that the IEP is appropriate for this particular student.

As educators, we are our students’ best advocates. Classroom teachers are indispensable to those of us in special education, as they are the ones who know their students best and are often the first to identify students who are struggling. We need you to help identify the students who may need some extra assistance. Let’s work together to ensure that all students are receiving what they need to be successful.