ACPA Family Services

Part 4–One From the Team: Speech Therapy and the School-Aged Child

Part 4–One From the Team: Speech Therapy and the School-Aged Child

Why Aren’t We Done Yet?

My child already had speech therapy when she was preschool age.  Why does she need speech therapy again when she’s school-age?  

First, keep in mind that “speech” includes many different areas that change over time.  Ongoing changes with your child’s mouth, muscle control, dental development and learning can lead to some periods of a break from speech therapy followed with a course of speech therapy. Some children require secondary surgeries on the palate to improve and normalize speech and resonance (oral speech vs nasal speech).

In early childhood and preschool programs, the emphasis of the speech therapy may have been to target language skills. This includes comprehension of language, vocabulary, grammar usage and the development of more complex language that precedes reading and writing in school. If your child needed this type of intervention, the quality of the speech may have been considered less a concern at that time.

Learn more about cleft care and the school-aged child, here.

Learn more about cleft care and the school-aged child, here.

As children progress into elementary programs, the differences between their speech and resonance and that of their peers may draw unwelcome attention to your child. He or she may be in need of a secondary surgery on the palate to improve their speech production. Children may get lost to follow-up with their cleft team due to family relocations, changes in insurance or just because parents and school professionals may believe that the child’s speech problems have settled down and now seem to be fine. However, if the school-based speech pathologist suggests the need for additional speech therapy it is very likely needed.  Remember the importance of your regularly scheduled treatment team evaluations in supporting the timing of speech therapy.  Additionally, your team will help minimize the delay in identifying the need for additional surgical management for speech.  Although your school-based speech pathologist may suspect speech issues are related to the palate, he or she may not feel qualified to make the recommendation. The coordination between the two settings is critical to the correct timing and outcome of surgical management, if needed.

Secondly, some speech error patterns, even in the presence of normal palate structure and function (meaning they are not in need of an additional palate surgery for speech) can take years to correct.  If this is the case for your child, consideration of additional speech therapy with a specialist in cleft palate may be needed.  The school-based speech pathologist may be hesitant to recommend additional speech therapy outside of school, suggesting that they are not doing it correctly or worried about the school having financial liability. However, it is often a very specialized speech approach that is needed and not all school-base speech pathologists have the expertise in this unique specialty area.

Finally, as you consider speech therapy for your school-aged child, always:

  1. Consult with your team speech pathologist about the progress or lack of progress.
  2. Discuss the need for possible additional speech therapy with a speech pathologist specialized in cleft palate.
  3. Share your questions and concerns regarding insurance coverage and funding or consult with the social worker on your team.

Speech and resonance issues can certainly require speech therapy into the school years but you should see continued progress over time. It’s important that all providers, including the treating Speech Pathologist, have an understanding of structural limitations and how these limitations will be managed over time to promote solid speech development.

Miss earlier posts in this series?

Part 1Speech with the Team, Speech at School here.
Part 2–Building the Relationship Between Parents, Team and School here.
Part 3–Timing and Need for Speech Therapy here.

About this series: We recently asked Theresa M Snelling, M.A.,CCC-SLP, to help us learn more about speech development and support for the school-aged child. We are so pleased to share her response with you in this special eight-part, One From the Team series, Speech Therapy and the School-Aged Child.

Teresa is clinical coordinator for the Cleft Palate and Craniofacial Center at Rose Medical Center, Denver, CO and has been working with patients and families affected by clefts for more than 30 years. If you need assistance locating a team or a cleft-specializing speech therapist, please, drop us a line or give us a call! 1.800.242.5338 or



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