Getting speech therapy for your child starts with an evaluation, and in most cases you can get one for free. Federal law requires every state to provide no-cost developmental screenings and evaluations for children from birth through age 21. The path you take depends largely on your child’s age: children under 3 go through your state’s early intervention program, while children 3 and older can be evaluated through the local school district. You can also pursue private therapy on your own at any time.
Signs That Warrant an Evaluation
Before anything else, it helps to know what’s typical. By their first birthday, most children have one or two words like “mama” or “hi” and are imitating speech sounds. Between 1 and 2, they start combining two words (“more cookie”), picking up new vocabulary regularly, and using several consonant sounds at the beginnings of words. By age 2 to 3, a child typically has a word for almost everything, uses two- or three-word phrases, and produces sounds like k, g, f, t, d, and n.
From 3 to 4, children speak in sentences of four or more words without repeating syllables or getting stuck. By 4 to 5, they use detailed sentences and pronounce most sounds correctly, though a handful (l, s, r, v, z, ch, sh, th) may still be developing. If your child is consistently behind these markers, or if strangers can’t understand much of what they say by age 3, that’s a clear reason to request an evaluation. You don’t need a doctor’s referral to start the process.
For Children Under 3: Early Intervention
Every state operates an early intervention program under Part C of the Individuals with Disabilities Education Act (IDEA). These services are free or low-cost regardless of family income. To get started, you contact your state’s early intervention program directly. A quick search for “[your state] early intervention program” will bring up the right agency and phone number.
Once you call, the program assigns a service coordinator who arranges a developmental evaluation at no charge. The evaluation team assesses five areas: cognitive development, physical ability (including vision and hearing), communication, social and emotional skills, and adaptive behavior like feeding and dressing. Evaluators use a mix of standardized tests, direct observation of your child at play, and a parent interview where you describe what your child does at home. Your firsthand knowledge of your child’s daily communication counts as part of the clinical picture.
If your child qualifies, the team creates an Individualized Family Service Plan (IFSP) outlining the therapy they’ll receive. Services often happen in your home or at a daycare, wherever your child spends their day. The entire process from your initial call to the start of therapy typically takes a few weeks to a couple of months, depending on your state’s waitlist.
For Children 3 and Older: School District Services
Once a child turns 3, responsibility shifts from early intervention to your local school district, even if your child isn’t enrolled in school yet. You can request a free evaluation by writing a letter or email to your school district’s special education department. Put it in writing, because that starts a legal timeline: the district generally has 60 days to complete the evaluation after you consent.
The school’s evaluation team, which includes a speech-language pathologist, assesses whether your child has a communication disorder and whether it affects their ability to participate in the general education curriculum. The team considers three questions: Is there a disability? Does it have an adverse effect on educational performance? Does the child need specially designed instruction or support to make progress? If the answer to all three is yes, the district develops an Individualized Education Program (IEP) that includes speech therapy sessions during the school day at no cost to you.
One thing to be aware of: school-based services are designed to support educational access, not necessarily to address every aspect of a speech disorder. A child who qualifies for an IEP might get one or two sessions per week at school, which is appropriate for many types of delays. But if your child needs more intensive therapy, you may want to supplement with private services.
Private Speech Therapy
You don’t have to wait for a school evaluation or early intervention referral to start therapy. Any parent can schedule a private evaluation with a speech-language pathologist at any time. Private therapy gives you more control over the frequency of sessions, the specific therapist you work with, and the goals of treatment.
Session costs vary widely by region, but expect to pay somewhere between $100 and $250 per session out of pocket for a 30- to 60-minute appointment. Initial evaluations often cost more. Many private practices accept insurance. Major carriers like Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicaid plans commonly cover speech therapy when it’s deemed medically necessary. Your child will need a diagnosis from the therapist or a referring physician for insurance to process the claim. If your provider is out of network, the practice may still file on your behalf, with payment going toward your out-of-network deductible.
When choosing a therapist, look for the credentials CCC-SLP after their name, which stands for the Certificate of Clinical Competence in Speech-Language Pathology. This is the national standard awarded by the American Speech-Language-Hearing Association and means the therapist has completed a graduate degree, a clinical fellowship, and passed a national exam. You can search for certified providers in your area using ASHA’s ProFind directory on their website.
What Happens During an Evaluation
Whether the evaluation is through early intervention, a school, or a private clinic, the basic components are similar. The speech-language pathologist will observe your child during play and structured activities, looking at how they communicate, what sounds they produce, and how they respond to language. You’ll be asked about your child’s developmental history, daily routines, and communication habits at home.
The therapist also uses standardized tests designed for young children. These might measure how many words your child understands versus how many they say, how clearly they pronounce specific sounds, or how they use gestures and eye contact to communicate. The whole process usually takes one to two hours, sometimes split across two appointments for younger children who tire easily. Afterward, the therapist writes a report summarizing the results and recommending whether therapy is needed, and if so, how often.
How Often Therapy Happens
Session frequency depends on the type and severity of the delay. For many children with moderate speech or language delays, one to two sessions per week is standard. Each session typically lasts 30 minutes for younger children and up to 60 minutes for older kids.
Some conditions require more intensity. Children with apraxia of speech, a motor planning disorder that makes it difficult to coordinate the movements needed for speech, benefit from three to five individual sessions per week. Research supports shorter, more frequent sessions over longer, less frequent ones. For example, four 30-minute sessions per week produces better results than two 60-minute sessions, even though the total time is the same. The key is giving the child repeated practice opportunities spread across the week.
Online Therapy Is a Viable Option
If wait times are long in your area or you don’t have a nearby provider, teletherapy is worth considering. Research comparing in-person and online speech therapy for school-age children found minimal differences in outcomes. Children working on speech-sound production and language comprehension made comparable gains in both settings. In one large study, 87% of students receiving online therapy for speech-sound production improved by at least one functional level, and 81% improved in language comprehension and production.
Interestingly, children in online therapy also spent less time per week in sessions. Over half received less than 40 minutes per week via teletherapy, compared to 74% of in-person students who received 42 to 60 minutes weekly, yet the outcomes were similar. For families in rural areas, or for children who do better in a familiar home environment, teletherapy can be just as effective as a clinic visit.
Steps to Take This Week
If your child is under 3, search for your state’s early intervention program and call to request an evaluation. If your child is 3 or older, send a written request to your school district’s special education office asking for a speech and language evaluation. In either case, you can also schedule a private evaluation with a CCC-SLP if you want answers sooner or want a second opinion. Many families pursue both paths at the same time, using free school services as a foundation and adding private therapy for extra support.
Keep a simple log of what your child says and how they communicate over the next week or two. Note the words they use, the sounds they struggle with, and situations where they get frustrated trying to communicate. This kind of real-world detail is exactly what evaluators need and can make the assessment more accurate.