To Speech Therapy or Not?

A Constantly Present Struggle

Author : Mahasri Das

Published : 2024, January 2 (12 min read)


In one of my previous articles, I talked about the dangers of self-diagnosis via the Internet, which involved a common issue, “Unable to consult an Speech Language Therapist” for assessment. Towards the end I had also noted that follow-up sessions on a regular basis are as important as first time consultation

Why is follow up on a regular basis important?

The answer is simple. Our community focuses primarily on verbal communication. Without the same, any person will naturally find it difficult to express himself in such a community.

Speech therapy is not a short-term “treatment.” It is a long-term intervention process involving attending therapy sessions on a regular basis, observing the sessions attended and carrying out similar activities at home to achieve the target goals. Skipping out, or worse, not attending the sessions invariably results in making it difficult for your child to successfully take part in social interactions putting him at a disadvantage when communication skills are taken into account.

But, what if the follow-up never happens?

While it may surprise some that this can be a possible issue, not attending speech therapy sessions is actually the most common issue I have noted in the sessions. The Why? can be due to various reasons; some circumstances being common and some unique

But what do I mean by not attending? Not attending in this case can take on many forms from the perspective of any Speech Language Therapist but in general, they revolve around 3 themes: “Not starting,” “Dropping out,” and “Irregularity.” Though all three are areas of major concern, they all come with a different set of problems

As the title clearly states, post-assessment, even when recommended to do so, the client never turns up for speech therapy, even for a single session. In such instances, the parents have no clear understanding of how to begin working on language stimulation.

If a simple analogy is to be given, if the child were a boat already drowning in the sea, no attempts whatsoever have been made to pull the boat out in the first place, resulting it in quickly sinking down

It means the client has attended some sessions, but after some time, he/she has stopped attending the therapy sessions. The client has discontinued attending therapy sessions either gradually (i.e., gradually reducing regularity till he/she no longer comes) or abruptly (Suddenly stopping to attend sessions)

Scenario A - Here, the client often risks losing any progress made during therapy, especially if no attempts to continue therapy are made at home. This resultant decline in understanding/usage of language skills is termed “RELAPSE”. If a simple analogy is to be given, if the child were a boat already drowning in the sea, attempts that were being made to rescue the boat have been stopped, resulting in it drowning again.

Scenario B - A second possibility is that even if the sessions are discontinued, attempts to continue therapy at home is still present. This may often lead to a stage where further clear progress is not noted resulting in “STAGNANCY”. If a simple analogy is to be given, if the child were a boat already drowning in the sea, attempts that were being made to rescue the boat are present but the strength is not enough for the boat to come out, resulting in it being stuck in one place. 

While this does not strictly equate to stopping therapy, it does indicate the client attends therapy sessions in an on-off, randomized pattern. The client may attend the session once, then skip a few sessions for some reason or another, and then randomly come again, resulting in the pattern of attendance being rather unpredictable and spotty in nature. This results in the possibility of level and nature of the child’s performance being equally unpredictable. There may be instances of progress occurring at an unpredictable rate. Then there may be instances of regressions again occurring at an unpredictable rate. And then there may be instances of complete stagnancy

If a simple analogy is to be given, if the child were a boat already drowning in the sea, attempts that were being made to rescue the boat may be present with enough or not enough strength to pull it out and sometimes be completely absent, resulting in it being going up and down in a highly randomized fashion. While the therapy is not discontinued, it is difficult to predict how much further (how much more) and to what extent the therapy plan timeframe will have to be changed.

To summarize, when a client attempts to deviate from a set therapy plan in any such manner, his/her child will invariably face difficulties in communication, albeit in different patterns and with varying severity. Only when one follows the set plan of action can he/she ensure that the child’s speech and language skills are being honed correctly

Is there any instance when therapy can be discontinued?

There is one instance in which speech therapy can be discontinued safely: When the client is DISCHARGED from the speech therapist’s end. As noted above, speech therapy involves a plan. One of the key components involves a rough estimate of duration in which the set goals can be achieved. (NB: A rough estimate is on condition that the sessions are attended regularly. In this case, Rough means giving an approximate, not a specific, timeframe. Once all the set therapy goals have been achieved, preferably (not explicitly) within the set timeframe, it is generally considered safe to discharge the client.

It is important to understand that discharge is the only way in which the client can safely discontinue therapy as it is a process monitored carefully by the speech therapist. The sessions are not halted abruptly but are gradually ended in a phased manner


Final Thoughts

Does speech therapy completely end post discharge?

If we take formal therapy sessions into account yes. However if we are to consider activities at home, it is common for a speech therapist to give a home therapy program, which generally involves components like how to monitor a child’s language development and a timeline in which new concepts may need to be introduced by a parent. It is also not uncommon for a clinician to suggest the client to follow up for possible therapy sessions in the future if any applicable red flags can be seen


NB: “Follow-up sessions” in this article is simply another term for “Speech therapy sessions” and both the terms may be used interchangeably across the article.