Nina Goldfuss
Speech and Language Therapist
What Happens in a Speech Therapy Assessment? A Step-by-Step Guide for Parents
If you've been thinking about getting your child's speech or language checked, you're probably feeling a mixture of things right now. Maybe you've been Googling "signs my child needs speech therapy" at midnight, or comparing your little one to other children at playgroup and wondering whether you should be worried. If that's you, 5 Red Flags That Your Child Might Need a Speech Assessment is a helpful place to start.
That's completely normal. Most parents I work with feel exactly the same way before they book an assessment. There's often this sense of not knowing what to expect, and that uncertainty can feel bigger than the concern itself. The good news is that a speech therapy assessment isn't anything scary. It's a conversation, an observation, and a plan. And by the end of it, you'll have clarity instead of questions.
Not sure whether your child's speech and language is on track? Take our free quiz to get a quick picture of where they are.
Why Do Parents Put Off Booking an Assessment?
This is something I see all the time. A parent has been worried for weeks, sometimes months, but they haven't booked an assessment because they're not sure if their child's difficulties are "serious enough" to warrant one.
Sometimes it's the fear of being told something you don't want to hear. Sometimes it's the worry that you're overreacting. And sometimes it's simply not knowing what a speech therapy assessment actually involves, which makes the whole thing feel like a bigger deal than it is.
Here's what I'd say to that: if you're worried, that's reason enough. You don't need to wait until your child is significantly behind. You don't need a referral. You don't need to be certain something is wrong. An assessment is simply a way to find out where your child is and what, if anything, would help.
Key takeaway: You don't need to be sure there's a problem to book an assessment. If something doesn't feel right, getting it checked is always a reasonable next step.
What Does a Speech Therapy Assessment Actually Involve?
So, the assessment itself has two main parts. I'll walk you through both so you know exactly what to expect.
Part One: The Case History Chat
This is a conversation between me and you, the parent. It usually takes around 30 to 40 minutes, and it's really just a chance for me to build a full picture of your child.
We'll talk about:
- Your child's health history -- things like birth, hearing, any illnesses or hospital stays
- Family history -- whether anyone else in the family had speech or language difficulties, or was a late talker
- Your child's development so far -- when they started babbling, their first words, how they communicate now
- Your specific concerns -- what you've noticed, what's worrying you, and how long it's been going on
- Daily life -- how your child plays, how they interact with other children, whether they get frustrated trying to communicate
This part isn't a test. There are no wrong answers. I'm not judging your parenting or looking for things you've done wrong. I'm just gathering information so I can understand your child as a whole person, not just a set of symptoms.
A lot of parents tell me they actually find this part reassuring. It's often the first time someone has sat down and properly listened to everything they've been noticing, without rushing them or telling them to "wait and see." If you've been given that advice, "Wait and See" or Act Now? explores when waiting is reasonable and when it isn't.
Part Two: Observing Your Child at Play
The second part is about seeing your child in action. I'm looking at how they communicate naturally -- not under pressure, not in a test setting, just during play.
For online assessments, I ask parents to send me a 10-minute video of them playing with their child at home. This is genuinely one of the best ways to see how your child communicates, because they're relaxed, they're in their own environment, and they're interacting with the person they're most comfortable with -- you.
I'll give you guidance on how to film it. Nothing complicated -- just you and your child on the floor with a couple of toys, playing normally. No need to try to get them to perform or show off their words. In fact, the less pressure the better. I want to see what they do naturally.
During that video, I'm looking at things like:
- How many words they're using and how they're using them
- Whether they're combining words (like "more juice" or "daddy go")
- How they get your attention -- do they point, pull your hand, make eye contact?
- How they respond to you -- do they follow simple instructions, look when you point at something, react to their name?
- Their play skills -- are they exploring toys in different ways, pretending, copying what you do?
- Their speech sounds -- can you understand what they're saying, or are a lot of sounds unclear?
Every child is different, so I'm not looking for one specific thing. I'm building a picture of where your child is across all the different areas of communication -- understanding, talking, speech sounds, social interaction, and play.
Key takeaway: The assessment is a relaxed conversation and a natural observation of your child at play. There are no tests, no pressure, and nothing to prepare for.
How Does an Online Assessment Work for Toddlers?
I know what you might be thinking: can online speech therapy for toddlers really work? It's a fair question, and one I get asked a lot. If you'd like practical at-home examples of how this looks day to day, How to Help Your Late Talker at Home is worth reading too.
Here's the thing -- for the assessment specifically, online can actually work really well. That 10-minute video of your child playing at home often gives me a better picture than a clinic appointment where your child is anxious, clingy, or refusing to cooperate because they're in an unfamiliar environment.
Young children tend to show you their best communication when they feel safe and comfortable. And where do they feel most comfortable? At home, with you.
The case history chat happens over video call, so we can talk face to face. I can see your expressions, you can see mine, and it feels much more like a real conversation than a phone call.
For families across the UK, private speech therapy online also means no travel, no waiting rooms, no rushing to get to appointments on time with a toddler in tow. You can do it during naptime for a sibling, or in the evening after bedtime. It removes a lot of the logistical barriers that make in-person appointments stressful. If you're weighing private versus NHS routes, Private vs NHS Speech Therapy: What's the Difference? compares both options.
That said, I'm always honest about the limitations. For very young children or children with complex needs, there are times when in-person might be more appropriate, and I'll always tell you if that's the case.
What Happens After the Assessment?
This is the part that parents often find most valuable. Once I've gathered all the information -- your case history and the play observation -- I put together a detailed written report.
This isn't a dry clinical document full of jargon. It's written in plain language, and it's designed to be genuinely useful. Think of it as a step-by-step guide for supporting your child's communication at home.
The report includes:
- A clear summary of where your child is right now -- their strengths as well as any areas of difficulty
- Specific, personalised recommendations -- not generic tips, but strategies tailored to your child
- Practical activities you can start using straightaway, explained step by step
- Next steps -- whether that's therapy sessions, monitoring, onward referrals (for things like hearing tests or developmental assessments), or simply continuing with the strategies at home
I'll also send you relevant workshops -- these are video-based resources that walk you through strategies for language building, speech sounds, or social communication, depending on what your child needs. You can watch them in your own time, rewatch them when you need a refresher, and share them with other family members or nursery staff.
At the end of the assessment, we'll have a conversation about what I've found and what I'd recommend. I'll explain everything clearly and make sure you have the chance to ask questions. You'll leave knowing exactly where your child is and exactly what to do next.
Key takeaway: You won't just get a diagnosis or a label. You'll get a personalised plan with practical, step-by-step recommendations you can start using immediately.
What Are the Signs My Child Might Need an Assessment?
Every child develops at their own pace, and there's a wide range of what's considered typical. But here are some signs that it might be worth getting things checked, based on what I see in my clinical work. You can also compare this list with 5 Red Flags That Your Child Might Need a Speech Assessment.
- By 12 to 18 months: your child isn't using any words at all (not even "mama" or "dada"), or isn't babbling
- By 2 years: your child has fewer than 50 words and isn't starting to put two words together (like "more milk" or "daddy gone")
- By 2.5 to 3 years: your child isn't using three-word combinations, or you find it difficult to understand what they're saying most of the time
- By 3 to 3.5 years: most of their speech sounds should be clear, with only a few exceptions -- if people outside the family really struggle to understand them, that's worth looking into
- At any age: your child doesn't seem to understand what you say, doesn't respond to their name, avoids eye contact, or gets very frustrated trying to communicate
These aren't definitive rules. Some children are late talkers who catch up beautifully on their own. Others need a bit of support to get there. The only way to know which situation you're in is to have someone experienced take a proper look.
If you're on an NHS waiting list, you don't have to wait. Private speech therapy in the UK means you can get an assessment within days rather than months, and anything we find can be shared with your NHS team too. If wait times are your biggest challenge right now, NHS Speech Therapy Waiting List Too Long? Your Options breaks down the in-between steps.
What You Can Do While You're Deciding
Even before an assessment, there are things you can start doing at home that support your child's communication. These are strategies I recommend to almost every family I work with:
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Set up "special time" every day. This is 10 to 15 minutes of one-on-one play where your child leads and you follow. Sit on the floor, put out a couple of toys, turn off the TV and your phone. Let your child choose what to play with and copy what they do. This builds shared attention and connection without any pressure. I explain special time in more detail in How to Help Your Late Talker at Home.
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Talk about what your child is doing, not what you want them to do. Instead of asking questions ("What's that? What colour is it?"), try commenting on their actions. If they're pushing a car, say "push the car!" If they're stacking blocks, say "up, up, up!" This is called modelling language, and it gives your child words at exactly the right moment.
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Simplify your language. Match the level your child is at, then add one word. If they're using single words, use two-word phrases back to them. If they're using two-word phrases, model three. This makes language feel achievable rather than overwhelming.
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Reduce the questions. I know it's tempting to test whether your child knows words by asking "what's this?" constantly. But for a lot of children, especially those who are finding communication difficult, questions create pressure. Comments and descriptions are much more effective.
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Follow their interests. Children learn language best when they're engaged and motivated. If your child loves cars, talk about cars. If they love water play, use that. You don't need flashcards or structured activities -- their natural play is your best tool.
Every child is different, and these are general strategies. If you'd like advice that's tailored specifically to your child, an assessment can give you that clarity.
Frequently Asked Questions
How long does a speech therapy assessment take?
The full assessment usually takes around 60 to 75 minutes in total. That includes the case history conversation with you and the observation of your child. For online assessments, the video is recorded separately in your own time, so the live part of the session is the case history chat and the feedback conversation.
Do I need a referral from my GP or health visitor?
No. You can book a private speech therapy assessment directly -- you don't need a referral from anyone. If your child is already on an NHS waiting list, a private assessment can give you answers and strategies to use in the meantime.
Will my child need to sit in front of a screen?
Not for the assessment. The observation part is based on a video you record of your child playing naturally at home. Your child doesn't need to sit on a screen, perform, or do anything differently from normal. For any therapy sessions that follow, the focus is heavily on parent coaching -- I'm teaching you strategies to use during everyday life, so it's much more about me and you working together than your child sitting still for 30 minutes.
What if the assessment shows everything is fine?
Then you'll have peace of mind, and that's genuinely valuable. I'll still give you strategies and tips to support your child's communication going forward. An assessment that finds no concerns is never a waste of time -- it's one less thing to worry about.
What if I'm told my child does need support?
Then you'll have a clear plan. The report will outline exactly what your child needs, with practical recommendations and next steps. If therapy is recommended, we can talk about what that looks like. If onward referrals are needed (such as a hearing test or a developmental assessment), I'll guide you through how to access those too. The goal is always to leave you feeling more confident and less uncertain, not more worried.
If you've been going back and forth about whether to get your child assessed, I hope this has made the process feel a bit less daunting. An assessment is simply about getting a clear picture of where your child is and what would help. No pressure, no judgement, just honest answers and a practical plan.
If you'd like to talk it through before booking, book a free chat and we can figure out the right next step together.