What is a Speech Language Pathologist-and Does My Child Need One?

By Emily Doll, M.A., M.S., CCC-SLP

Dear SM Community,



A speech-language pathologist (SLP; also referred to as a speech therapist) is a trained clinician who evaluates and treats people of all ages who have difficulty understanding or expressing themselves or have difficulty with feeding and swallowing. Specifically, the field of speech pathology focuses on helping those who present with difficulties in the following areas:

• Articulation/Speech Sound Production: Producing sounds correctly when saying words out loud. Difficulties with articulation may sound like substituting one sound for another (i.e., “wike” for “like”), distorting a sound (i.e., “foh” for “four”), and/or omitting sounds (i.e., “geh” for “get”, “sime” for “slime”, or “appy” for “happy”). 

• Voice: Speaking with appropriate vocal quality, pitch, and loudness. Individuals with difficulties in this area may sound hoarse, nasal, breathy, or have other atypical qualities to their voice.

• Fluency: Speaking with appropriate rate, rhythm, and smoothness. Difficulties in this area include stuttering, in which individuals repeat sounds, parts of words, or whole words; experience blocks of airflow/sound production; and/or draw out sounds in words when speaking.  

• Receptive Language: The ability to understand printed or spoken language, including age-appropriate vocabulary, directions, and retaining information from stories read or heard. A child with difficulties in this area may mishear or ask for directions or information to be repeated, complete directions incorrectly, or ask for clarification in conversations frequently.

• Expressive Language: The ability to use written or spoken language to express thoughts, feelings, wants, and needs. Difficulties in this area may present as short or incomplete sentences, lack of vocabulary, or grammar or sentence structure errors. 

• Social Language/Pragmatics: The ability to understand, interpret, and appropriately react to social situations. This includes asking and answering questions, starting/maintaining/ending conversations appropriately, using and understanding nonverbal communication, social problem-solving, and other related skills. 

• Cognition: Includes skills such as memory, planning, reasoning, problem-solving, and attention. Difficulties in this area may present as trouble retaining information, prioritizing, coming up with a plan, coming up with appropriate solutions to problems, engaging in cause and effect reasoning, or trouble with other executive function skills.

• Feeding/Swallowing: Includes both physiological difficulties with eating and swallowing as well as sensory or behavioral difficulties in these areas. May present as sensitivity or difficulty with certain textures or groups of foods or malnutrition. 

What are some red flags to look out for?

Research suggests that anywhere from 35%-75% of students with selective mutism have additional speech or language needs. Some of the biggest red flags for additional speech and language needs are:

• Child is difficult to understand by familiar or unfamiliar listeners
• Child is not using age-appropriate number of words or sentence structures
• Child has difficulty putting thoughts, wants, or needs into words, and/or finding the right words to express themselves
• Child has difficulty following directions
• Child has difficulty retaining/remembering things that are said or read to them
• Child demonstrates consistent or frequent stuttering, particularly past the age of 5
• Child demonstrates food aversions or difficulties with eating

See the American Speech-Language-Hearing Association’s Speech and Language Norms and information about typical speech and language development for more information about what skills kids should have at different ages. 

Do SLPs work on selective mutism?

According to the American Speech-Language-Hearing Association (ASHA), serving as part of the evaluation team, providing direct treatment for SM, and collaborating with other team members all fall under the scope of practice for the SLP. SLPs can be a valuable member of your child’s evaluation team by determining if other speech or language needs are present and need to be addressed. SLPs help with treatment by providing input to the team about how to practice social communication skills in developmentally appropriate ways and working directly with kids to build their social communication skills with new people, in new places, and in new activities. In some cases, SLPs may be the primary therapist working with a child and family; in others, they may be part of a larger team. It’s best to find an SLP who has specific knowledge of and training in working with individuals with selective mutism or someone who is willing to learn about SM. When talking to SLPs about how they work with SM, it’s good to ask questions about what types of approaches they use, what evidence-based practices they are trained in and utilize, and what their plan is to help your child communicate more fully in various social settings and with more people.

What do I do if I have concerns about my child’s speech and language?

A good first step is to check in with your pediatrician, share your concerns, and ask for a referral to a speech-language pathologist in your area. Many SLPs practice in outpatient settings, clinics, or private practices. If your child is school-age, talk to the school and ask what the process is for requesting a school-based speech and language evaluation or holding a meeting to discuss your concerns. You can also find a list of ASHA-certified SLPs and see the Selective Mutism Association’s Find a Treating Professional page, where SLPs with training in SM are listed.

What if I am SLP who wants to learn more about working with SM?

Some ways to get additional training in this area are:

• See SMA’s list of recommended books
• Watch SMA’s free webinars
• Read SMA’s collection of articles in the online library
• Attend the Selective Mutism Training Institute for Professionals – watch for opportunities to sign up later this year
• Attend SMA’s Annual Conference in October
• Watch for an upcoming webinar specifically geared towards SLPs

Given the pervasive nature of selective mutism, having a diverse group of professionals can be helpful to make sure all aspects of treatment are considered. Speech-language pathologists can bring important insight and be valuable members of your child’s treatment team, whether they are addressing needs related to selective mutism or additional speech and language needs.

Emily Doll, M.A., M.S., CCC-SLP SMA Board of Directors, Secretary