The nine areas SLPs work in, what therapy looks like, and what it means for bilingual children
When people hear “speech therapy,” they often picture a child repeating sounds. That’s part of it, but the profession covers much more.
Speech-language pathologists (SLPs), called speech and language therapists (SLTs) in the UK, support children with communication, eating, drinking and swallowing (ASHA, 2016). That might mean helping a toddler reach their first words, a school-age child follow classroom instructions, or a baby feed more comfortably.
SLPs also work with parents, teachers and other professionals, because children learn to communicate in everyday life, not only in a therapy room. Support is built around each child, so no two therapy plans look the same.
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Communication starts long before first words. Babies communicate with cries, eye contact, sounds and gestures, and slowly start using them on purpose.
Early therapy rarely looks like drills. An SLP uses toys, books, songs and daily routines, and often coaches parents to follow the child's lead, respond to every attempt to communicate, and model words naturally. Most early learning happens in everyday moments, and parent-led approaches have good evidence for young children's language (Roberts & Kaiser, 2011). An SLP will also usually suggest a hearing check (ASHA, n.d.-d).
Some children use signs, pictures or a device, known as augmentative and alternative communication (AAC). Research shows AAC doesn't stop children from learning to talk, and it often helps (ASHA, n.d.-a; Millar et al., 2006).
Count words across all of your child's languages. Toddlers often know some words in Arabic and others in English, so looking at only one language can underestimate their vocabulary (Pearson et al., 1993). An SLP should look at your child's communication across languages (ASHA, n.d.-e).
Children learn speech sounds gradually, and young children often say words differently from adults. Some have difficulty for longer than expected (ASHA, n.d.-j).
An SLP looks at which sounds your child uses, how they use them in words, and whether this fits their age and language background. Therapy might teach a new sound, help a child hear the difference between sounds, or change a pattern of errors.
A smaller group of children find it hard to plan the movements for speech. This is called childhood apraxia of speech, and it needs a different kind of practice (ASHA, n.d.-b). Mouth exercises without speech, like blowing or tongue push-ups, aren't supported by evidence for improving speech sounds (McCauley et al., 2009).
The aim is clear, comfortable communication, not perfect pronunciation.
Arabic and English have different sounds and timelines. In Jordanian Arabic, ر usually develops between ages 4 and 6, while sounds like ص، ط، ث، ذ and ج can still be developing after 6 in their standard forms (Amayreh & Dyson, 1998; Amayreh, 2003). Dialect pronunciations, like ق said as ء or "g," aren't errors (ASHA, n.d.-j; Hamdan & Amayreh, 2007).
Language is about meaning: understanding what others say (receptive language) and expressing ideas (expressive language) (ASHA, n.d.-k).
A child might manage "Get your shoes" but not "Before you put your shoes on, bring me your jacket."
Therapy might build vocabulary, understanding of sentences, grammar, answering questions or storytelling. Younger children learn through play and shared books. Older children might work on classroom vocabulary or planning a story. SLPs also show parents and teachers how to make everyday language easier to follow.
Some children have language difficulties that last into the school years. This is called developmental language disorder (DLD). It can affect reading and learning, which is why early support matters (Bishop et al., 2017).
A child may be stronger in one language and may mix languages in one sentence. Mixing, called code-switching, is usually a normal part of being bilingual. Assessment should look at every language your child uses (ASHA, n.d.-e).
Social communication is how we use language with other people: joining conversations, taking turns, and understanding what someone really means (ASHA, n.d.-i). Children communicate in different ways, and a different style isn't automatically a problem.
SLPs focus on communication that matters in the child's own life, like asking for help, sharing interests, fixing misunderstandings or speaking up for themselves. Good therapy respects communication differences, including those of autistic children, as part of who the child is, rather than training them to copy others (ASHA, n.d.-i).
Support often means changing the environment too, helping families, teachers and classmates understand the child and meet them halfway. Some children use gestures, pictures or a device alongside or instead of speech, and that counts as communication.
Conversation rules differ between cultures, like how children address adults or how direct they are. Differences in social norms aren't a disorder, so an SLP should know what's typical in your family's culture (ASHA, n.d.-i).
Everyone pauses or repeats words sometimes. In stuttering, also called stammering, sounds or syllables repeat, stretch out or get stuck (ASHA, n.d.-c).
Not every child who stutters is bothered by it. Some talk freely; others feel frustrated or anxious.
Therapy isn't only about stopping stuttering. Depending on age, an SLP may help a child talk with less effort, reduce struggle and avoidance, and feel confident speaking at home, at school and with friends (ASHA, n.d.-c).
For young children, parents are closely involved. For older children, therapy may also explore how they feel about talking.
The goal is a child who communicates freely and feels good about it, not one who stays quiet to sound fluent.
Learning two languages doesn't cause stuttering. Children who stutter usually stutter in both languages, so an SLP should listen to each one (ASHA, n.d.-c; Choo & Smith, 2020).
Reading and writing build on spoken language. Children need to understand language and hear the separate sounds in words before reading and spelling come easily (ASHA, n.d.-m).
An SLP may work on phonological awareness (noticing and playing with the sounds in words), plus vocabulary, sentence understanding and storytelling, which all support reading and writing. For school-age children, SLPs usually work alongside teachers and learning support staff. Therapy doesn't replace good reading teaching, but it can address the language difficulties underneath (ASHA, n.d.-m).
Arabic-speaking children talk in their dialect at home but learn to read and write in Modern Standard Arabic, which has some different sounds, words and grammar. This gap, called diglossia, makes early Arabic reading harder for all children, not only those with difficulties (Saiegh-Haddad, 2003). An SLP who understands diglossia won't mistake it for a reading problem.
Some SLPs have specialist training in children's feeding and swallowing (ASHA, n.d.-g). Eating uses coordinated movements of the lips, tongue, jaw and throat, along with sensory and motor skills.
A specialist SLP looks at how your child manages food and drinks. Support might involve building feeding skills, changing textures or how food is offered, strategies for safer swallowing, or helping families make mealtimes calmer.
Feeding difficulties can have medical, nutritional, skill and emotional sides, so SLPs work with paediatricians, dietitians and occupational therapists (Goday et al., 2019).
Voice is the sound made as air passes through the vocal folds. It includes pitch, loudness and quality.
A cold can change a voice for a few days. Hoarseness that lasts longer is worth checking.
A child with ongoing voice changes should be seen by an ear, nose and throat (ENT) doctor, who can examine the vocal folds. This is part of good voice care alongside therapy (ASHA, n.d.-l).
An SLP with voice training helps the child use their voice with less effort and builds healthy habits at home and school, like not shouting over noise. Families learn which habits help the voice and which strain it.
The tongue, lips and jaw are used for chewing, swallowing and resting, not just talking. An orofacial myofunctional disorder is when these patterns are different in a way that affects function (ASHA, n.d.-f).
Noticing one of these doesn't mean your child has a problem. Mouth breathing, for example, can come from a blocked nose or airway, so a doctor should check that first (ASHA, n.d.-f).
An SLP with specialist training can assess these patterns. If they find a difficulty that affects how your child eats, swallows, speaks or rests their mouth, and medical or structural causes have been checked, therapy can help your child become aware of these patterns and change them. They work closely with dentists, orthodontists and ENT doctors (ASHA, n.d.-f).
Mouth exercises aren't a replacement for speech therapy when a child has speech sound difficulties (McCauley et al., 2009).
Read more: Thumb sucking and mouth breathing →You know your child best, and it’s always fine to ask. It’s worth talking to an SLP or your child’s doctor if:
If your child loses words or skills they used to have, talk to their doctor promptly (CDC, n.d.).
Ask about a hearing check too. Hearing affects how children learn to talk, and it’s quick to test (ASHA, n.d.-d).
Not sure what’s expected at your child’s age? Check our milestones tool, or get simple ideas to use at home with Try Something Today.
There’s no single standard session. A toddler’s session might look like play, with toy animals, songs and books, while the SLP shows you how to use the same strategies at home. A preschooler might play games that practice sounds or build longer sentences. An older child might work on explaining ideas, using new sounds in conversation, or skills that support reading.
Therapy doesn’t always mean working with the child alone. Often the most useful support comes through the adults around them, such as coaching parents during play or meals, or helping teachers adapt instructions.
It starts with getting to know your child: talking with you, watching them, and assessing their skills. Then you and the SLP agree on goals that matter to your family, and review them as your child grows.
Read more: What to expect from your child’s speech-language therapy sessions →
Raising your child with two or more languages does not cause speech, language or communication difficulties (RCSLT, n.d.). If your child does have a difficulty, you don’t need to stop using your home language. Children with language difficulties, autism or Down syndrome generally do as well with two languages as with one (ASHA, n.d.-e; Kay-Raining Bird et al., 2016).
Bilingual children develop a little differently, and that’s expected. They may:
Some children speak very little when they first start using a new language, at nursery or school for example. They may listen for a while before talking, and usually keep talking in their home language. Not every child goes through this. Talk to an SLP if the silence carries on, if your child also stops speaking their home language in that setting, or if you’re worried. Silence in certain settings can be a sign of selective mutism (ASHA, n.d.-h).
A good assessment looks at all of your child’s languages, not just one (ASHA, n.d.-e; Stow & Pert, n.d.). It’s fine to ask:
