When to Refer to a Speech-Language Pathologist
1. When there is concern about speech or language development.
2. The child is not talking at all by age 18 months.
3. If there are other medical or developmental concerns that may effect speech development.
4. The child is embarrassed by his/her speech at any age.
(If child is aware, self-esteem may be effected)

At age 2 if:
a. Hearing impaired and/or does not respond to quiet sounds or voices.
b. Cleft palate or excessive nasal quality in voice.
c. The child does not begin combining words by age 2.
d. The child exhibits limited vocabulary development.
e. The child is not responding to conversation speech.

At age 3 if:
a. Nonfluent or thought to stutter.
b. Absence of sentence structure.
c. Speech is difficult for family to understand.
d. There are many omissions of initial and final consonants.
e. Speech limited to echoing other's statements, songs, rhymes,
commercials, etc.
f. Any of the previously listed problems.

At age 4 if:
a. Word endings (i.e. "-ed", "-ing") are consistently dropped, or used inconsistently.
b. Communication skills are inadequate for interaction in a school
environment.
c. Sentence structure is noticeably faulty.
d. Any of the previously listed problems.

At age 5 if:
a. The child is noticeably dysfluent, or parents express concern.
b. Hoarse, harsh or unusual voice quality.
c. Mispronounces any sounds.
d. Any of the previously listed problems.

At age 6 if:
a. When a speech or language problem is present and speech therapy is unavailable in the school system.
b. Has learning disability.
c. Any of the previously listed problems.