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What are speech, language, fluency, and voice disorders?

Speech Disorders include difficulty with articulation of speech sounds, fluency, and/or voice.

  • Disorders of articulation involve simple sound substitutions, distortions, and/or omissions as well as complex, multiple, and variable misarticulations as seen in apraxia.

  • Disorders of fluency involve difficulty with rate and rhythm of speech as seen in stuttering.

  • Disorders of voice involve difficulty with pitch (too high or low), loudness, and/or quality (hoarse, nasal, denasal).

  • Disorders of language, whichcan begin at birth and co-occur with speech delays and disorders, involve difficulty with language comprehension, expression, and/or functional use (pragmatics). Language disorders in children may be exhibited as limited or inaccurate

  • content or semantics (the meanings of words and sentences)

  • form (syntax, or word order and relationships), morphology (word structure), and/or phonology (the rule-governed sound system of language) and/or

  • function or pragmatics (appropriate social and functional use of language for:

  • multiple purposes such as greeting/taking leave, demanding, requesting, informing, commenting)

  • following conversational rules (such as entering/leaving a conversation, turn-taking, staying on topic, altering language when not understood, use of eye contact and proximity

  • ability to alter language so that it is appropriate to individuals/settings

What is a Speech/Language Pathologist?

A speech/language pathologist is the professional who identifies, assesses, and treats speech and language problems and swallowing disorders. Typically holding a

Master's Degree or a Ph. D., a speech/language pathologist should be certified by the American Speech-Language-Hearing Association (ASHA), the professional, scientific, and credentialing association for audiologists and speech/language pathologists, to indicate that appropriate standards for the practice of speech/

language pathology have been met.

  • ASHA certification typically is indicated by the presence of "CCC (Certificate of Clinical Competence)" following the SLP's name and educational credentials.

  • ASHA is located at 2200 Research Blvd., Rockville, MD 20850-3289 and can be reached by phone at 301/296-5700 and 800/638-8255, and via the internet at

What is a Speech/Language Assessment? A speech/language assessment is an individual diagnostic evaluation consisting of formal and/or informal measures designed to determine speech and language strengths and needs in:

  • receptive, expressive, and pragmatic language
  • speech sound production
  • voice and fluency
  • and may include a classroom and/or home observation to determine the child's function in the "real" world as well as
  • a written diagnostic report to summarize results and suggest possible goals and objectives, if they are warranted

An assessment may also look at language/literacy skills (such as phonological awareness, alphabetic principles, and concepts about print).

Practice and Cancellation Policy:

  • If a scheduled session must be cancelled, please attempt to call (301.570.4208) or email ([email protected]) at least 24 hours in advance.

  • If cancellations are made with more than 24 hours notice, the session will be rescheduled at a mutually agreed-upon time between the speech/language pathologist and the client. If less than 24 hours notice is provided, the session will not be made up without an additional hourly charge.

  • No-shows and non-cancelled sessions will be charged in full; make up sessions for these missed appointments will be at the discretion of CTS.

  • If CTS must cancel, other than due to weather-related emergencies, a make-up session will be offered.

  • The speech/language pathologist is available during your child’s appointment time. If a client arrives late to an appointment, time will not be made up without an extra charge. If the therapist arrives late to an appointment, the therapist will stay the full 50 minutes (+ 10).

  • The speech/language pathologist is available to travel to your child’s school or home for observation and/or consultation at the out-of-office treatment session hourly charge within 25 miles (of office).


  • CTS will adhere to the Montgomery County Public Schools Emergency Calendar, i.e., if Montgomery County Public Schools are closed due to inclement weather, CTS also will be closed.

  • If MCPS has a delayed opening, please call 301.570.4208 to see if our street and driveway are clear. 

Please listen carefully to school closing updates! Make-up sessions will not be offered when cancellations are due to weather-based emergencies.

How long are speech/language sessions?

A Speech and/or Language Assessment: typically takes:

  • 2 hours child contact (dependent upon child's attention and/or tests needed) plus test scoring and report-writing time (the latter not to exceed 3 hours)

  • Speech/Language Therapy: typically 50 minutes; however, 30 minute sessions can be arranged.

  • in-office individual and/or small group therapy (as caseload allows), with 10 additional minutes to address parent questions, concerns, and therapy documentation

  • in-home, with 10 additional minutes to address parent questions, concerns, and therapy documentation

  • in classroom, or daycare therapy (within 25 miles of office)

  • SLP Participation in IEP meetings and/or in- or out-of-office consultations with other professionals, as desired with length of time determined by client’s parent/s (within 25 miles of office)

  • SLP phone conferences with parents and/or professionals:  

  • first 10 minutes: complimentary.

Fee Schedule:

Assessment: billed hourly

  • $ 125.00/hour for formal and informal evaluation and scoring time
  • $ 125.00/hour for written assessment report (not to exceed 3 hours) and parent consultation

Individual and/or Small Group Therapy Session billed hourly (50 minutes) with 10 additional minutes to confer w/parent/s and document service:

  • $100.00/hour: in-office therapy
  • $ 50.00/hour: for 30 minute session
  • $115.00/hour: out-of-office (home/classroom/daycare within 25 miles)

SLP Participation in IEP meetings and/or in/out-of-office consultation: $115.00/hour

SLP phone conferences with parents and/or professionals:  

  • complimentary: first 10 minutes
  • $ 15.00 for each 10 minutes thereafter

In-office Parent Conference: $ 100.00/hour

Oral Presentations: Please call 301.570.4208 or email [email protected] to schedule; price arranged individually.

Does CTS accept insurance?

  • No. Payment is due at time of service; however, a billing statement will gladly be provided for you to submit to your insurance company.
  • Please feel free to ask the speech/language pathologist if you need more information regarding cost of diagnostic and therapeutic services.

What are some signs that a child should be referred to a speech/language pathologist? 

ASHA and other professionals suggest that referral be considered if:

  • an infant is premature and/or

  • lacks eye contact or smiling
  • cannot follow the gaze of an adult
  • is extremely quiet
  • cannot or loses ability to engage with adults in reciprocal (back and forth) interactions/vocal play

  •  is extremely fussy
  • lacks/loses ability to babble
  • has feeding or swallowing issues and/or reflux
  • has motor issues (such as difficulty with head control)
  • has frequent ear infections, a cleft palate, cerebral palsy, and/or other medical issues

  • a 2 year old

  • seems not to hear you when you speak
  • does not verbalize words and 2-word phrases
  • loses language skills

  • a 3 year old

  • is not understood by family/caregivers
  • inaccurately produces vowel sounds and p, b, m, w sounds in words
  • is frustrated when not understood and asked to repeat
  • does not use some 3-word combinations

  • a 4 year old

  • is not understood by unfamiliar individuals
  • incorrectly produces t, d. k, g, f sounds
  • is frustrated when not understood and asked to repeat 

  • a 5 year old

  • is not understood by most listeners in all situations
  • incorrectly articulates most speech sounds
  • is frustrated when not understood  

  • a child

  • speaks unintelligibly
  • omits final consonants (e.g., "ba" instead of "ball") in words
  • responds to and/or uses "stock phrases" rather than self-generated language
  • echoes words/phrases/sentences without using them meaningfully or
  • spontaneously within self-generated utterances

  • cannot follow oral directions
  • does not appear to understand feelings
  • shows little affect (facial expression)
  • exhibits repetitive movements and/or play and/or
  • exhibits play that appears to be non-meaningful, such as lining up car/people/items without further developing a "plot (pretending car is going to the gas station, etc.)"

  • responds to visual cues but not so much to speech
  • is tactually defensive (avoiding touching and/or being touched in and/or outside of mouth; on the hands or body (clothing labels may be a problem)
  • is a picky eater (avoids touching and/or eating certain textures/colors/temperatures)
  • shows little awareness that his/her mouth is full of food

  • inappropriately mouths items and/or eats inedibles
  • shows little awareness of surroundings so frequently trips/bumps into things/people
  • under or over-reacts to the environment (e.g., sounds/sights may be "too much")
  • exhibits behaviors and/or attention problems which may mask communication issues

  • a child exhibits neuromuscular control issues (including control of respiration for speech) which cause inability to accurately produce speech sounds, and/or

  •  uses slurred speech
  • uses abnormal-sounding voicing/vocal quality/rhythm
  • is frustrated and/or avoids speech because speech sound production is hard and/or because of inability to be easily understood by others)

  • a child exhibits difficulty with motor planning/positioning/sequencing of speech muscle-movements evidenced by:

  • use of frequent, variable speech sound errors, e.g., a word might be produced correctly as well as with multiple and different inaccuracies on repetition or within connected speech
  • variable intelligibility of connected speech with little or no self-awareness of that variability
  • frustration about lack of speech control

  • a hearing loss or deafness results in inaccurate articulation, intonation (prosody), rhythm, and duration of speech such that:

  • speech is understood only by very familiar listeners
  • speech is too loud, voice is pitched too high
  • meaningful speech may be absent

  • hearing loss and/or difficulty discriminating differences between speech sounds results in inability or decreased ability to self-monitor, detect, and correct speech errors

  • atypical prosody (intonation) patterns caused by autism, emotional disturbance and/or cognitive issues exist which may be evidenced by:

  • speech is understood only by very familiar listeners
  • speech is too loud, voice is pitched too high
  • meaningful speech may be absent

  • structural deviations of the speech mechanism exist (such as cleft lip and/or palate) which result in:

  • frustration and/or speech-avoidance
  • use of nasality
  • inaccurate and/or unintelligible speech  

  • speech production and intelligibility issues result from tracheostomy or ventilator-dependence

  • speech intelligibility decreases unexpectedly and/or

  • frustration and/or speech-avoidance
  • use of nasality
  • inaccurate and/or unintelligible speech  

  • a regression in ability to express needs/wants, preferences, and feelings is observed.


For more information on communication-related topics, please refer to the following websites:

American Speech-Language-Hearing Association (ASHA): for 

information on:

  • professional credentialing for speech/language pathologists and audiologists
  • normal child developmental milestones
  • specific speech, language, and communication disorders
  • private speech/language pathology providers within the U.S.
  • related concerns such as oral motor issues and bilingual language development
  • specific speech/language/oral motor therapy techniques

Autism Spectrum Disorders:

Feeding Disorders, Oral Motor Development, and Mealtime Experiences: 


PROMPT Institute/PROMPT Therapy: information on assessment and therapy for individuals with apraxia:

Sign Language:

Social Skills: 

Social Thinking: phone: 408-557-8595: [email protected]


Non-Speech Oral Motor Therapy:

  • McCauley, R., Strand, E.,Lof, G.L., Schooling, T., & Frymark, T. (2009). Evidence-based systematic review: Effects of non-speech oral motor exercises on speech. American Journal of Speech-Language Pathology, 18, 343-360.
  • Lof, G.L. (2009). The nonspeech-oral motor exercise phenomenon in speech pathology practice. In C. Bowen, Children's Speech Sound Disorders. Oxford: Wiley-Blackwell, pp. 181-184.
  • More information on oral motor issues can be found on the ASHA website: