What does a speech therapist do and when should you see one? Signs in children and adults

Many people associate speech therapy with the child who can't pronounce the letter R properly. That is part of the job, but not the only part: speech therapists also see adults who often lose their voice, people who stammer and those who have lost some of their speech after a stroke. Knowing what a speech therapist does helps you seek advice at the right time, without waiting too long and without worrying too soon.

What is a speech and language therapist and what training do they have?

A speech and language therapist is a healthcare professional specialising in the prevention, assessment and treatment of disorders of communication, language, speech, voice and deglutition, that is, swallowing. In Spain it is a health profession regulated by the law on the organisation of health professions (Ley de ordenación de las profesiones sanitarias), and practising it requires a degree in Speech Therapy (Grado en Logopedia), a four-year university qualification.

Their work is not simply ‘teaching people to talk’. First they assess what is going wrong and why, and then they design a plan of exercises with specific goals, adapted to each person's age and situation. They often work alongside other professionals: the paediatrician, the ENT specialist, the neurologist, the dentist or the school team.

It is worth not confusing them with other roles. A speech therapist does not prescribe medication or examine the ear or the vocal cords with medical instruments: that is the doctor's job. Nor are they the same as the Hearing and Language teachers (maestros de Audición y Lenguaje) in schools, who are specialist teachers working within the education system.

What do they treat? Speech, language, voice, swallowing and literacy

Speech therapy covers more areas than people tend to think. The main ones are these:

• Speech and pronunciation. Difficulty articulating certain sounds (known as dyslalia), speech that is hard to understand, or fluency problems such as stammering.
• Language. Late appearance of first words or sentences, a small vocabulary for their age, difficulty understanding what is said to them or putting a story in order. In adults, loss of language due to a brain injury, known as aphasia.
• Voice. Persistent hoarseness, a voice that tires or gives out with use, and lesions such as vocal cord nodules, once an ENT specialist has assessed them.
• Orofacial functions and swallowing. Atypical swallowing (the tongue pushes against the teeth when swallowing), mouth breathing and, in adults, difficulty swallowing safely after a stroke or in some neurological conditions.
• Reading and writing. Persistent difficulty learning to read and write, such as dyslexia, which often becomes evident in the first years of primary school.

When should a child see a speech therapist? A guide to the signs by age

Every child develops at their own pace, and comparisons with brothers, sisters or classmates usually confuse more than they help. Even so, there are milestones that most children reach around certain ages. The table summarises, as a rough guide, those set out in child development guidelines such as those of the US Centers for Disease Control and Prevention (CDC).

Two useful clarifications. Some sounds take time to arrive, and the strong rolled Spanish R is usually one of the last, at around five or six: a four-year-old saying ‘pero’ instead of ‘perro’ is not, on its own, a cause for alarm. Also, between the ages of two and five it is common for children to repeat syllables or words while their language develops. It is worth seeking advice if this goes on for months, if the child gets stuck or strains to speak, or if they start avoiding speaking.

There are situations in which you shouldn't wait, whatever the child's age: if they lose words or skills they already had, if there is any doubt about whether they hear well, or if they have repeated ear infections. Ear infections with fluid behind the eardrum (glue ear) can reduce hearing for weeks and, with it, the stimulation that language needs; that is why, when speech is delayed, hearing is usually checked first. In all these cases, the paediatrician is a good first port of call.

Speech therapy for teenagers and adults: voice, stammering and neurological rehabilitation

Speech therapy doesn't end in childhood. In teenagers and adults, there are three common reasons for seeing a speech therapist.

Voice problems

Teachers, call centre staff, singers or anyone who uses their voice a lot can suffer from repeated loss of voice, vocal fatigue or lesions such as nodules. The speech therapist teaches you to use your voice efficiently: breathing, support, resonance and vocal care habits. Before that, an ENT specialist needs to examine the vocal cords to find out what is going on. Hoarseness that lasts more than two or three weeks always warrants that medical assessment.

Stammering

Stammering that continues into adolescence or adulthood can also be worked on. The aim is not only to speak more fluently, but to reduce the tension and the tendency to avoid situations that often come with it, so that the person can communicate more calmly in everyday life.

Neurological rehabilitation

After a stroke or a head injury, or in conditions such as Parkinson's, difficulties can appear in finding words, articulating or swallowing safely. Speech therapy is part of rehabilitation: it aims to restore communication and safe eating or, when that is not fully possible, to compensate for what has been lost.

If difficulty speaking comes on suddenly (not being able to find words, slurred speech, a drooping mouth or loss of strength on one side of the body), it could be a stroke. It is an emergency: call 112.

What happens at the first assessment and who refers you

The first appointment is usually an assessment. The speech therapist takes a history: when the difficulty began, how development has gone, what previous reports there are and what has been noticed at home, at school or at work. They then observe and assess using tests suited to the person's age: how they understand, how they express themselves, how they pronounce, how they breathe or swallow and how their voice sounds.

With that information, they explain what they have found and propose a plan: goals, the approximate frequency of sessions and exercises to practise at home, which in the case of children involve the family. If they spot something that another professional should look into, such as possible hearing loss, they will tell you.

Many people are referred by their paediatrician, GP, ENT specialist, neurologist, dentist or orthodontist, or on the school's recommendation. But you don't always need a referral: if you have concerns about your child's speech or your own voice, you can ask for an assessment directly. Bring any reports you have, as they provide context and save time.

If you recognise any of these signs in your child or in yourself, on the Speech Therapy page you will find out how our team works and how to book a first assessment.