Speech-Language Pathology Program

The Speech-Language Pathology Program at Boston Children’s Hospital provides outpatient diagnostic evaluation and short-term therapy services for children with communication differences. As part of the Department of Otolaryngology and Communication Enhancement, we help parents find answers if their children have difficulties with language, fluency, resonance (nasality), voice quality, speech sound production, or social communication.

Language development is critical for success in school and social situations. A variety of factors, such as developmental delays, cognitive delays, and hearing loss, can interfere with a child’s social and academic success. Differences in speech production, resonance (hypernasality), and voice can also lead to communication challenges.

To effectively help a child develop language, speech, and communication skills, it’s essential to first understand the underlying issues involved.

One of our specialists will evaluate your child and help you better understand their communication strengths and needs. This includes how language and speech fit into the larger picture of your child’s development. Based on what we find, we’ll recommend treatments and, when possible, let you know what the long-term outcomes may be.

We support children with a wide range of communication challenges, including:

• Developmental language disorder
• Language learning disability
• Fluency disorders (stuttering/cluttering)
• Articulation disorder
• Phonological disorder
• Childhood apraxia of speech
• Childhood dysarthria
• Social communication disorders and differences 

Some families seek our diagnostic services as a first stop in their journey. Others come to us for a second opinion about therapy or their child’s diagnosis. In all cases, the in-depth evaluation services we offer, which may include monitoring a child’s growth and needs over time, can lead to a more complete understanding of their communication issues and how to best address them.

The speech-language pathologists on our team have several areas of specialty, including:

• Early language development
• Language disorders in school-age children
• Language and auditory processing
• Adolescent language
• Fluency
• Resonance
• Voice
• Speech sound disorders
• Social communication

Our providers regularly engage in training and coursework to expand our knowledge and clinical skills, and keep up to date on the latest research in our field.

We provide family-centered services that take every aspect of the children we see and their needs into account. Because children with communication challenges often have developmental disorders that require additional expertise, for instance, in neurology or developmental medicine, we often refer to and collaborate with specialists at Boston Children’s and in the community.

Our assessments go beyond traditional standardized test measures to include dynamic assessment, language sampling, input from parents and treating providers, and — in very young children — assessment of pretend-play development.

As part of a qualitative analysis, we will evaluate your child thoroughly and integrate our findings with other aspects of their development to get a more comprehensive picture of their skills and needs.

We provide in-depth evaluations of receptive and expressive language, speech production, fluency, resonance, voice, and social communication for children of all ages. The specific evaluation service will be based on your child’s communication needs. 

• Receptive and expressive language evaluations: This type of evaluation assesses a child’s understanding and use of language relative to their age. Areas evaluated can include comprehension of words, language concepts, sentences, directions, and stories, and production of vocabulary, grammar and sentences, conversational skills, and storytelling. For older children, we assess higher-level language skills such as inferencing and comprehension of multiple meaning words. We also screen for speech production and other aspects of communication, such as voice and social communication, during language evaluations.
• Speech production evaluations: We conduct this type of evaluation when a child’s speech is difficult to understand. The evaluation assesses a child’s ability to produce age-expected speech sounds and syllables, imitation of the examiner’s speech, and judgment of speech intelligibility. In some cases, we also test motor speech and examine the mouth and articulators.
• Fluency evaluations: We conduct these evaluations when there is concern that a child is showing signs of stuttering or cluttering. The speech-language pathologist collects language and speech sampling and listens for repetitions of sounds and words, prolongations or exaggerated lengthening of words, silent blocks or the inability to initiate sounds, as well as speaking rate, pausing, syllable collapse, and maze behaviors.
• Language and auditory processing evaluations: One of our speech-language pathologists conducts these evaluations jointly with an audiologist to assess a child’s peripheral hearing status as well as the integrity of their central auditory pathways. We compare each child’s performance to norms for children of the same age as their auditory system continues to mature through adolescence.
• Social-pragmatic evaluations: For children who have already had an assessment of their foundational language and speech skills, we can evaluate their social-communication skills, including their understanding and use of nonverbal communication, the perspectives of others, and conversation.
• Voice and velopharyngeal dysfunction evaluations: Specialists in our Velopharyngeal Dysfunction Clinic evaluate children with issues related to voice quality, resonance, or upper-airway breathing disorders. These evaluations are available after or in conjunction with a medical evaluation. Depending on the patient’s age and presenting concerns, evaluations may include perceptual ratings of voice and resonance, acoustic measurements, evaluation of breathing patterns, and assessment of speech production.

In most cases, when a child needs therapy, we refer families to services in their community. This may include services through a local early intervention program, the public school system, or local private speech-language pathologists. 

While we do offer short-term outpatient therapy services for some children, most therapy through our program does not begin immediately after an evaluation.

• Speech and language therapy: Short-term intervention and resources to support children’s communication development and help families understand their child’s needs. 
• Parent-mediated language intervention: For some young children, we provide parent-mediated language intervention (PMLI), which consists of eight to 12 total weekly sessions conducted via telehealth.
• Social communication groups: Using a strengths-based approach, we match children with similar social communication skills into very small groups where they learn about and practice specific concepts and strategies. Social groups are typically eight to 12 weeks long.
• Voice therapy: We offer voice therapy for patients who have had a medical examination and completed a voice evaluation. Children enrolled in voice therapy are generally seen on a weekly basis for six to eight weeks. We also recommend patient-specific activities families can do at home to support improved voice use.