What Happens in Speech Therapy? An SLP’s Guide

“What should we expect in speech therapy?” It’s a natural question! You want to understand what your child will experience and how we’ll be working together to help them communicate more effectively.

While every child’s journey and specific therapy goals are unique, the good news is that speech therapy sessions are designed to be engaging, supportive, and effective. The “look and feel” of a session will change quite a bit as your child grows, adapting to their developmental stage, individual needs, and learning style.

Let’s take a walk through what you might expect at different ages:

Early Intervention (Birth to 3 Years): It’s All About Play and Partnership

• Where it happens: Often, therapy for our littlest communicators takes place right in your home or their familiar daycare setting. This is because young children learn best in comfortable, natural environments.
• What it looks like: These sessions are very play-based and routine-oriented. My primary role is often to act as a coach for you, the parent or caregiver. We’ll work together, using your child’s favorite toys and daily activities (like mealtime, bath time, or getting dressed) as opportunities for language learning.
• Typical activities:
  • Playing on the floor with blocks, cars, or dolls, modeling simple sounds, words (“up,” “more,” “ball”), and turn-taking.
  • Singing songs and fingerplays that encourage imitation of sounds and actions.
  • Looking at picture books together, naming objects and actions.
  • Strategizing with you on how to create communication opportunities throughout your day and how to respond to your child’s attempts to communicate.
• Your role: You are the star player here! You’ll be actively involved in the session, learning and practicing strategies that you can use all week long.

Preschool (Ages 3-5): Learning Through Structured Play and Imagination

• Where it happens: Therapy might be in a clinic, a specialized preschool program, or your child’s community preschool.
• What it looks like: Play is still a huge component, but it becomes a bit more structured. We start to introduce more targeted activities to work on specific speech sounds, build vocabulary, help them form longer sentences, and develop early social skills. Sessions might be individual or in small groups with peers.
• Typical activities:
  • Crafts or art projects that incorporate target sounds or vocabulary (e.g., making a “silly snake” while practicing the /s/ sound).
  • Interactive storybook reading, where we might act out parts of the story, answer “wh-” questions (who, what, where), or predict what happens next.
  • Pretend play scenarios like playing “store” or “doctor” to practice conversational skills and new words.
  • Simple board games or turn-taking games that encourage following directions and interacting with others.
• Your role: We’ll share what we worked on, provide suggestions for fun home practice, and collaborate on how to support their progress.

Early Elementary (Kindergarten – 2nd Grade): Building Blocks for School Success

• Where it happens: Often school-based (your child might be “pulled out” for a session or the SLP might “push in” to their classroom), but clinic-based therapy is also common.
• What it looks like: Sessions become a bit more structured, often incorporating themes or activities related to what they’re learning in the classroom. While still fun, there’s a clearer focus on mastering speech sounds, developing reading readiness skills (like phonological awareness), understanding and using grammar correctly, and telling stories.
• Typical activities:
  • Targeted articulation practice using picture cards, fun worksheets, or interactive digital games.
  • Activities focused on rhyming, blending sounds, or identifying sounds in words.
  • Sequencing picture cards to tell a story and then retelling it with important details.
  • Role-playing social situations they might encounter at school, like asking a friend to play or resolving a simple conflict.
• Your role: You’ll likely receive regular updates, perhaps a communication notebook, and specific activities or “homework” to reinforce skills. Collaboration with your child’s teacher is also key. If you do not hear from your child’s SLP regularly, I would encourage you to send them an email to check in. 

Late Elementary (3rd – 5th Grade): Diving Deeper into Language and Learning

• Where it happens: Usually school-based, with similar pull-out or push-in models, or in a clinic.
• What it looks like: Therapy now often tackles more complex language skills needed for academic success. This includes understanding more abstract concepts, making inferences, grasping figurative language, and organizing thoughts for writing and speaking. We also continue to work on any persistent speech sound errors or fluency (stuttering) concerns.
• Typical activities:
  • Reading short passages and discussing the main idea, characters’ perspectives, or predicting outcomes.
  • Vocabulary-building games and activities often tied to their science or social studies curriculum.
  • Practicing how to explain concepts clearly, summarize information, or give a short presentation.
  • Working on strategies for smooth speech if fluency is a goal.
• Your role: Supporting more complex homework, encouraging your child to use their strategies in everyday conversation, and maintaining open communication with the SLP and teacher.

Middle School (6th – 8th Grade): Navigating Academic Demands and Social Worlds

• Where it happens: Predominantly school-based, though clinic services are an option.
• What it looks like: Therapy at this stage is highly focused on the language skills needed for increasingly complex academic work and social interactions. We work on critical thinking, understanding complex texts, writing organized essays, effective study skills (from a language perspective), and navigating nuanced social situations.
• The Balancing Act – Class Time vs. Therapy Time: We understand that as students get older, missing class time is a significant concern. SLPs work closely with the school team (teachers, counselors, and you!) to determine the best way to provide support. This might mean:
  • Shorter, targeted pull-out sessions: Focusing intensely on specific skills.
  • Push-in or integrated therapy: The SLP might co-teach a lesson with the classroom teacher or support your child (and others) within the classroom on a specific assignment.
  • Consultative services: The SLP provides strategies and support to teachers and families to implement within the student’s regular schedule. The goal is always to find the least restrictive environment that still allows for effective intervention, often linking therapy directly to curriculum demands.
• Typical activities:
  • Analyzing complex texts to identify arguments, biases, or implied meanings.
  • Learning strategies for outlining and writing persuasive essays or research reports.
  • Practicing pragmatic language skills like debating, negotiating, understanding sarcasm, and advocating for themselves.
  • Developing executive functioning skills related to language, like planning and organizing long-term assignments.
• Your role: Encouraging your child’s independence and responsibility in using their strategies, discussing how their communication skills impact their schoolwork and friendships, and staying connected with the school team.

High School (9th – 12th Grade): Preparing for the Future

• Where it happens: Almost always school-based, with a strong emphasis on functional skills for life after high school, or in a private clinic if specialized needs persist.
• What it looks like: Therapy goals become very individualized and often focus on transition planning—whether that’s for college, vocational training, or employment. We work on advanced academic language, sophisticated social communication, self-advocacy, and the language components of executive functioning.
• The Balancing Act (Continued): The strategies mentioned for middle school continue, with an even greater emphasis on ensuring therapy directly supports the student’s post-secondary goals. Sessions might be integrated into study skills classes, or the SLP may work closely with guidance counselors and vocational specialists. The student themselves often takes a more active role in deciding what they want to work on.
• Typical activities:
  • Practicing interview skills and developing professional communication.
  • Analyzing college-level texts or workplace documents.
  • Developing and delivering complex presentations.
  • Refining skills for advocating for their needs in academic or work settings.
  • Working on time management and organizational skills crucial for managing assignments or job responsibilities.
• Your role: Supporting your teen as they take more ownership of their goals, facilitating their independence, and collaborating with the school team on transition plans.

Across All Ages: The Common Threads

No matter your child’s age, you can expect their SLP to:

• Create individualized goals based on a thorough assessment.
• Use evidence-based practices.
• Work to build your child’s confidence as a communicator.
• Strive to make therapy a positive and motivating experience.
• Collaborate with you and other important people in your child’s life (like teachers).

Open communication is key! Never hesitate to ask your child’s SLP questions about their sessions, their progress, or how you can best support them at home. We’re a team, and together we can help your child find their voice and thrive.

Disclaimer: This article provides general information and suggestions for educational purposes. It is not a substitute for professional diagnosis or treatment from a certified Speech-Language Pathologist. Please consult with a qualified professional if you have specific concerns about your child’s speech and language development.

Resources

For more information, practical tips, activity ideas, and to connect with a community, consider exploring these resources:

• First Words Bright Futures Facebook Page & Instagram Page: Follow us for daily tips, engaging activity ideas, and answers to frequently asked questions to support your child’s language journey.
• American Speech-Language-Hearing Association (ASHA) – For the Public: ASHA is the national professional, scientific, and credentialing association for audiologists and speech-language pathologists. Their website (asha.org/public/) offers a wealth of reliable information on various speech and language topics, developmental milestones, and how to find certified professionals.
• MDS: Boost Your Child’s Speech With Language-Rich Morning Routines
• MDS: Helping Your Child with Final Consonant Deletion