Ever since I began sharing articles about speech therapy, I have received many inquiries from parents about their children’s communication issues:

“My child is five and we can’t understand her. What should I do?”

“My child was diagnosed with a speech delay. The doctor suspects him of having autism. What should I do next?”

“My three-year-old can’t differentiate ‘I, you, he, she, it” in English. How can I teach her?”

Families should be informed about the basics of speech therapy to ensure they are aware of this valuable resource. Additionally, informing parents about developmental milestones, especially the unique milestones for multilingual children, empowers them to recognize warning signs and take action.

In the conclusion of this article, I provided ways to locate Mandarin-speaking speech pathologists. I also explored the significance of seeking out a bilingual speech therapist in certain circumstances.

Chinese Version 中文版本:

自从我在网上分享和言语治疗有关的文章，我收到很多家长的问题：

“我的孩子5岁了话还讲不清楚，怎么办？”

“医生说我的孩子有语言迟缓，还疑似自闭症，这要怎么治？”

“请问3岁孩子分不清英文的‘我、你、她、他、它”，该如何引导？“

问题越来越多，我觉得有必要和大家分享一下什么是言语治疗、在哪里治疗，并且结合孩子的发育里程碑，尤其是讲中文儿童的语言、语音发育里程碑，让家长及早发现需要言语治疗的迹象，并为孩子争取到所需要的资源。我在文末也讨论了是否需要找讲中文的言语治疗师，以及怎样在美国找到符合中文家庭需求的言语治疗师。

1. What is Speech Therapy｜言语治疗是什么

Are you familiar with the term “speech therapy”? A few of my friends asked me this question: “My pediatrician told me my child needs speech therapy. What does that mean?” “Speech pathology” is not a well-known term to many parents. It seems like it is a service for people who can not talk. Yet, speech pathology is more than that.

In America, speech therapy is provided by speech pathologists (SLPs), as stated by the American Speech-Language and Hearing Association (ASHA). These professionals work in various settings to address a range of communication and swallowing disorders. To learn more about the role of speech-language pathologists, please refer to the following quotes from ASHA:

Speech-language pathologists, also called SLPs, are experts in communication. SLPs work with people of all ages, from babies to adults. SLPs treat many types of communication and swallowing problems.

– ASHA “Who Are Speech-Language Pathologists”

Speech therapy targets a variety of communication and/or swallowing issues, including:

These include problems with:

Speech sounds—how we say sounds and put sounds together into words. Other words for these problems are articulation or phonological disorders, apraxia of speech, or dysarthria.

Language—how well we understand what we hear or read and how we use words to tell others what we are thinking. In adults this problem may be called aphasia.

Literacy—how well we read and write. People with speech and language disorders may also have trouble reading, spelling, and writing.

Social communication—how well we follow rules, like taking turns, how to talk to different people, or how close to stand to someone when talking. This is also called pragmatics.

Voice—how our voices sound. We may sound hoarse, lose our voices easily, talk too loudly or through our noses, or be unable to make sounds.

Fluency—also called stuttering, is how well speech flows. Someone who stutters may repeat sounds, like t-t-t-table, use “um” or “uh,” or pause a lot when talking. Many young children will go through a time when they stutter, but most outgrow it.

Cognitive-communication—how well our minds work. Problems may involve memory, attention, problem solving, organization, and other thinking skills.

Feeding and swallowing—how well we suck, chew, and swallow food and liquid. A swallowing disorder may lead to poor nutrition, weight loss, and other health problems. This is also called dysphagia.

– ASHA “Who Are Speech-Language Pathologists”

Chinese Version 中文版本:

不知道在北美的家长们对于“言语治疗”了解多少？我有几个朋友就问过我——“我家孩子去看了儿科医生，医生要我孩子去speech therapy，这是啥？！我孩子有病吗？“。“Speech therapy”的翻译是“言语治疗”，听起来像是专门给话说不清楚的人的“治疗”。其实，言语治疗并不只有这些。

既然是“科普”，那就要引用可靠的信息。根据美国言语语言听力协会（American Speech-Language-Hearing Association – ASHA）的官方介绍：言语治疗师（speech-language pathologist，简称SLP) 在美国直译为“语言病理学家”，主治与沟通、吞咽障碍有关的各类疾病。治疗对象从婴儿到老人，涵盖到各个年龄层人群。在美国，言语治疗就是由通过认证的语言病理学家（CCC-SLP）提供的。

言语治疗的范畴很广，常见问题包括：

• 构音失常：比如吐字不清，音节混淆（对，“大舌头”、l,n不分也可以治疗的）；言语失用症
• 语言迟缓、失语症：比如孩子不说话、说话晚、听不懂指令；成人中风后答非所问
• 读写困难、阅读障碍
• 社交语言沟通障碍
• 嗓音障碍
• 口吃
• 认知沟通障碍：指的是由于大脑神经细胞病变或者损伤导致的认知能力、思考能力、表达能力受阻
• 喂养和吞咽障碍：比如婴幼儿喝奶呛奶；母乳喂养困难；挑食；进食呛咳

2. Where can I receive this service｜哪里提供言语治疗

The process of a child starts speech therapy: parents or teachers notice some issues→they inform the pediatrician→pediatrician performs some tests and refers the child to a speech evaluation→speech pathologists (SLPs) provide comprehensive testing and create a treatment plan→speech therapy begins.

It’s worth noting that many schools offer speech therapy services as well. Every year, SLPs perform hearing and speech screenings at school. Based on the results of the screening, a child may be referred for further evaluation if necessary.

For those kids who are already receiving treatment in a hospital, rehabilitation center, or private clinic, they may continue to receive services at school if they still meet the criteria. Public schools typically offer speech therapy services free of charge. However, if children require services outside of school, there may be a fee associated, depending on their health insurance coverage. Some children may receive services both at school and at a rehabilitation facility based on factors such as medical diagnosis and therapy plans.

Chinese Version 中文版本:

由于本专业涵盖的知识非常广、治的病多种多样，所以在美国我们的职业还根据年龄段分为：儿科、成年、老年。同时，言语治疗师根据不同的就业环境，每天常见的病患也不同。美国言语语言听力协会说，言语治疗师（在美国均为持CCC-SLP认证的语言病理学家，下同）主要的就业单位为：

Private practices 私人诊所
Physicians’ offices 医院门诊
Hospitals 医院
Schools 学校
Colleges and universities 高等院校（如：大学教授）
Rehabilitation centers, long-term and residential health care facilities 康复中心、养老院

– ASHA “Who Are Speech-Language Pathologists”

以语言迟缓为例，成功得到言语治疗的过程一般是这样的：家长或老师发现孩子说话有问题->家长与儿科医生沟通，通过初步检测后医生推荐儿童到当地儿科医院接受言语治疗，这里的英文是”referral”，即：转诊。言语治疗师对孩子进行详细的专业评估，并根据评估结果设计言语治疗方案，孩子成功开始言语治疗。

需要了解的是，很多家长并不知道孩子的学校其实也有言语治疗这个服务。每年学校一般会有言语治疗师来给学生们进行语言、言语、听力能力筛查，言语治疗师会通过筛查结果决定学生是否需要更详细的言语或听力检测。

另外，已经在医院或私人诊所开始言语治疗的儿童，当他们达到学龄后，家长可以选择是否继续在医院或诊所接受言语治疗，还是开始在学校接受言语治疗。公立学校的言语治疗服务是免费的，而私立学校、医院、诊所所提供的言语治疗则需要医疗保险核实或者自费。同时在学校和医院或诊所接受言语治疗的儿童并不少见，但这都是根据孩子的情况以及不同家庭状况，由家长和言语治疗师决定的。

3. Does my child need therapy｜我的孩子是否需要言语治疗

1) Developmental milestones｜用儿童语言发育里程碑自查

Parents often are the first ones to notice their children’s need for speech therapy. However, many parents doubt their judgment or want to “wait it out”, and eventually miss the best treatment period. I encourage parents to be familiar with the developmental milestones, especially the ones for communication. Rise your concerns during pediatric checkups, or contact the doctor immediately if you find your child missing a lot of milestones. 

It is crucial to understand that developmental milestones have an average range and are only intended as a reference. They cannot replace evaluation tools provided by a medical professional.

I have 4 websites that I recommend for developmental milestones, and I ranked them according to my personal preference:

1. How Does Your Child Hear and Talk? (ASHA)
2. Developmental Norms for Speech and Language (ASHA)
3. CDC’s Developmental Milestones (Multiple Languages)
4. Developmental Milestone for Children 0-6 Years (Mandarin)

The Beijing PKUCare Brain Health has compiled a list of Speech and Language Developmental Milestones for Mandarin-Speaking Children aged 0-18. The lists highlight the unique sounds in Chinese (Pu Tong Hua) compared to English. You can download the lists here, or you could download them below.

As a speech pathologist, I always turn to ASHA as my primary source for developmental milestones related to communication skills. The websites I mentioned not only provide these milestones, but also give suggestions on how to encourage speech and language development.

In addition, the CDC offers a comprehensive handbook that covers developmental milestones not only in communication skills, but also in gross and fine motor skills. This handbook also provides advice to families and is available in multiple languages. Download the handbook in Mandarin.

For Mandarin-speaking children aged 0-6, the United Nations Children’s Fund (UNICEF) and the Ministry of Education of the People’s Republic of China have created a Chinese handbook. This handbook is also available for download.

I created Youtube videos specifically for Chinese-speaking families about developmental milestones. These videos include tips for promoting language development. I invite you to watch the video I posted below:

Chinese Version 中文版本:

很多时候，家长是第一个发现孩子存在语言沟通问题的。可惜的是，很多家长不相信自己的判断，常常一拖再拖，错过了儿童的语言最佳治疗期。我建议，当家长觉得自己的孩子”不太对劲“的时候，就可以在家用儿童语言发育里程碑进行自查，同时在孩子接受儿科例行检查的时候将自己的担忧提出来，让医生做进一步的检查来决定孩子是否需要语言评估。如果你发现孩子没有达到里程碑里提到的大部分内容，那么就要及时联系医生，让专业人士进行评估。

值得注意的是，所有的发育里程碑是参考绝大多数儿童的平均水平来决定的，具有个体差异。而且在新冠期间CDC更新了儿童成长发育指标中的很多内容，在业内引起轩然大波，所以这些指标主要还是参考为主，并不能替代专业人士的标准化筛查工具。

在哪儿可以找到权威的儿童语言发育里程碑？这里有四个网站分享给大家：

1. How Does Your Child Hear and Talk?
2. Developmental Norms for Speech and Language
3. CDC’s Developmental Milestones
4. “早期儿童养育与发展”合作项目：0～6岁儿童发展的里程碑

此外，北大医疗脑健康行为发展教研院也整理了针对讲中文儿童的语言和发音里程碑：「0-18岁儿童青少年语言发展里程碑」和「儿童语音发展里程碑」，其中的语音发展里程碑列举了所有普通话声母的发育时间表，大家可以免费下载：

作为言语治疗师，我建议大家首先去最权威的美国语言言语听力协会ASHA的官方网站查询。这个网站上不仅有语言发育不同的阶段，还有英文发音的不同发育阶段，同时还有一些促进语言沟通的基本方法。ASHA是儿童语言沟通、听力等方面最权威的机构，所以如果想咨询这方面的信息，首选ASHA。

除了ASHA官网，美国疾病预防控制中心（CDC）也提供儿童发育里程碑阶段的详细手册，不仅覆盖语言发育的内容，还包含大运动和精细运动等发育指标，最重要的是，所有内容已翻译成中文，供家长参考。中文手册下载链接

另外，中国教育部与联合国儿童基金会的“早期儿童养育与发展”项目，也提供完整全面的《0~6岁儿童发展的里程碑》中文手册。中文手册下载链接

同时，我也制作了视频，详细分析不同年龄段的语言发育情况和促进语言沟通的方法，点击直达视频。欢迎大家关注我的Youtube频道：@JoannaGaoSLP。

以上是我认为权威可信的儿童语言发育里程碑，而且全都是免费资源。可以看出，不同组织致力于让家长了解儿童的发育状况，了解迹象，尽早采取措施。

2) What’s the next step?｜自查有问题，该找谁评估呢？

If your child does miss several developmental milestones, contact your child’s doctor immediately!

If you live in Mainland China, it is recommended to take the child to a local pediatric hospital and seek out “developmental pediatricians”. These professionals can provide a thorough assessment and make referrals to speech therapists as needed.

For families in America, call the pediatrician. Most pediatricians can administer initial tests and refer the child to speech evaluation with a speech pathologist.

I wrote an article about things to prepare for the speech evaluation. Hope it will be helpful before going to one: 6 Tips to Prepare for a Successful Bilingual Speech Evaluation.

Chinese Version 中文版本:

一般而言，如果孩子在国内，则咨询当地儿童医院的儿保科医生，医生将决定是否要到语言康复门诊做专业评估和治疗。

如果家长在美国，则立刻联系孩子的儿科医生，让医生初步评估是否需要言语治疗。如果医生认为孩子的确存在沟通问题，医生就会转诊儿童到言语治疗师那儿进行专业检查，英文是speech evaluation. 

另外，如果孩子在上学，也可以直接联系孩子的老师，让学校的言语治疗师进行初步筛查。英文是speech screening。

我详细写了一篇当孩子接受语言评估时家长的前期准备以及评估过程，推荐需要进行语言评估的家长提前阅读：双语孩子需要言语治疗，语言评估6项必要准备。

4. How to find a bilingual speech pathologist?｜怎么找讲中文的治疗师？

1) ASHA ProFind

Many parents asked me about how to find a Chinese-speaking therapist. There are only approximately 300 Mandarin-speaking SLPs in the country, including the ones who only speak Cantonese. Therefore, the possibility of finding one locally is low.

I highly recommend visiting the ASHA ProFind website. All registered SLPs are listed on this website, and families can narrow down their search by selecting their state or entering their home address or zip code. This website offers a variety of language options to accommodate all families.

Chinese Version 中文版本:

除了以上内容，我还收到很多在北美的家长提的关于讲中文的治疗师的问题：

“请问纽约现在有什么机构不用排很久的speech therapy吗？”

“我们在家讲中文，加州有讲中文的言语治疗师推荐吗？”

目前在美国会讲中文的言语治疗师屈指可数，包含粤语在内的言语治疗师大约300人。考虑到全美国的需求，能在当地找到中文治疗师的几率并不高。

我推荐家长直接去美国语言言语听力协会的官方网站搜索当地治疗师资源，即：ASHA ProFind.

所有在ProFind网站上的治疗师都是美国权威认证、持有CCC-SLP执照的语言病理学家。家长可以输入家庭住址或邮编来搜索附近的治疗师：

同时，还可以选择所在州和语言，来缩小范围：

2) Does my child need a SLP that speaks our language?｜是否一定要找讲中文的言语治疗师？

Is it important to find a SLP who speaks the same language as the child? If there is a therapist who can speak the child’s language and has experience treating bilingual children, it would be beneficial to choose them.

For instance, Mandarin has many sounds that are not present in English, and Chinese has four tones that can be confusing for English speakers. I had a 4-year-old client who was considered “normal” at school, but her mother struggled to understand her at home. After conducting a thorough speech evaluation in both English and Mandarin, we discovered that she had a speech sound disorder, characterized by substituting compound vowels with simple vowels in Chinese. With a 16-week treatment that involved her parents, her speech intelligibility improved significantly.

When seeking speech therapy, it is crucial to prioritize evidence-based treatment strategies. It is more important to find an experienced SLP than purely focus on bilingual SLPs, considering they are in such high demand. An experienced SLP should know what tests to provide and how to modify evaluation materials for children who speak different languages.

Many rehabilitation centers and clinics offer interpretation services through an onsite interpreter, or via phone or video. It is important to request language assistance when scheduling an appointment, as setting up interpretation services can take time.

In conclusion, the decision of whether to select a speech-language pathologist who speaks the child’s language should be made on a case-by-case basis. Unfortunately, it’s not uncommon for some children to wait more than a year for services. This is a significant amount of time to waste. The solution is to act right away and find a qualified SLP. It’s important to inform the therapist about the child’s bilingual background so that they can plan accordingly.

Chinese Version 中文版本:

言语治疗的重中之重在于治疗方法。如果是针对语言、口吃、嗓音、吞咽、挑食等问题，找到一位有经验的言语治疗师比一味寻求会说中文的言语治疗师更重要。现在大部分的医院诊所配备真人、电话或视频翻译，如果只是家长单纯需要了解言语治疗师的指导内容，在找不到中文治疗师的情况下，这些翻译也可以胜任。为了不耽误每次治疗会议时间，建议家长在开始言语治疗之前和治疗师沟通好语言需求，这样治疗师可以提前准备。

但是，如果家长发现孩子的中文发音有问题，并且想要孩子接受和中文语音有关的治疗，一位会讲中文的言语治疗师是有必要的。因为中文中的韵母，如：单韵母，复韵母或者鼻韵母，以及声调等，在英文中并不存在。我就曾经接受过一位4岁的孩子，孩子在学校的筛查并没有发现问题，但是孩子的妈妈听不懂孩子说的话，最后家长找到了我。通过完整的中英文评估，我们发现孩子仅存在单韵母，所以导致口齿不清。孩子通过16周的治疗，发音得到明显提高。

因为言语治疗的排期很长、言语治疗师供不应求，从3岁等到快4岁才接受治疗的儿童也是大有人在。所以，如果家长暂时找不到会说中文的、在双语治疗方面有经验的言语治疗师，不妨先开始英文的言语治疗，找到讲中文的言语治疗师后再换治疗师也不迟。关键在于——别拖延！

3) Involve families in speech therapy｜实践证明有效的言语治疗方法

Through years of practice, I have discovered the significance of including caregivers in treatment sessions. As a result, I have been offering one-on-one parent training courses to equip them with the most effective strategies to facilitate communication in a child’s natural surroundings, such as their home, school, extended family, parks, and playgrounds.

Many families have shared that their children seem to “improve with therapists” but “struggle at home”. Traditionally, parents drop off their kids for therapy and wait in the waiting room. SLPs usually spend the last 5 minutes of the session speaking with the parents about what the child accomplished during therapy. Unfortunately, parents are often overwhelmed with the amount of information provided or distracted by their children, making it difficult to fully comprehend what the therapist is saying. Consequently, children tend to behave in the same manner at home and parents may only notice slow progress or no progress at all.

I strongly believe in the philosophy of “teaching a man to fish” rather than just giving him one. In the case of communication between parents and children, it’s important to provide parents with the tools and skills to communicate effectively with their children. As parents are with their children all the time, communication goes beyond just an hour of therapy each day. From my experience, I’ve noticed that after parents take my 1-on-1 live course, there’s a faster progress and stronger bond between caregivers and children. Currently, there’s a waitlist for my direct service, but you can email me to join the waitlist or ask me any questions about the 1-on-1 service:

Chinese Version 中文版本:

根据我多年在高强度的工作环境下得出的实践经验，我愈发觉得邀请家长融入到治疗当中的重要性。起初，大部分的言语治疗模式是家长将孩子送到诊所，然后家长在门外等待，治疗师在治疗结束前预留几分钟跟家长沟通当天和孩子做的活动、孩子表现，以及家庭作业。我发现，因为时间紧迫而且内容抽象，家长其实并不知道该怎么做，所以回家后孩子进步缓慢，越来越多的家长反映：“孩子在治疗师面前都会做，回家就又变回原样了”。

于是，我开始融入”家长培训“的概念，在每次治疗的时候，将家长请到治疗中，共同参与。一开始家长只是观摩，我会选取几个比较简单的方法让家长和孩子练习。多次治疗会议后，我逐渐将主权交给家长，通过沟通和提供必要辅助，让爸妈觉得自己学会了针对孩子以及家庭环境的治疗策略。父母是孩子最好的老师，当家长在专业人士的指导下掌握了正确方法，就能够在每日同儿童的互动中帮助孩子沟通，更能够建立良好的亲子关系。

“授人以渔”，赋能于家长，才真正帮助到每个孩子。

针对有语言沟通、发音障碍的儿童，我提供线上一对一家长培训。通过提前与家长沟通，我根据家中现有环境指导家长、根据孩子进度来计划最符合孩子沟通发展的康复方案。目前，我的家长培训1对1课程已满，如果您感兴趣，欢迎来信备注”加入等待名单“，我会在有空额的时候按报名顺序联系您。

5. Free therapy resources for children｜美国0-3岁儿童免费言语治疗资源

Families often worry about the cost of therapy services. However, if you live in the United States and your child is under three years of age, there is some good news. Your child may qualify for an excellent free service that can either come to your home or school.

Please refer to this article for details: Free Early Intervention Therapy Services for Children 0-3

Chinese Version 中文版本:

那么言语治疗要花多少钱呢？有个好消息要分享给大家：如果您的孩子在0到3岁，并且居住在美国，那么你的孩子很有可能能够接受高质量而且免费的言语治疗。具体该如何申请，请阅读这篇文章：0-3岁儿童不要错过的免费言语治疗机会。

6. Final thoughts｜结语

I sincerely hope that this article has provided you with a clear understanding of the fundamentals of speech therapy. Ascertaining the unique challenges our children face in comparison to their peers can be a daunting task. However, by taking timely action, we can potentially identify the optimal intervention window. My hope is that every child can reach their full potential and enjoy a fulfilling life. Do you have any suggestions for a parent who just started this journey? Share your thoughts below!

言语治疗师（Speech Therapist，或称 Speech Pathologist）在美国的康复医疗领域与物理治疗师（Physical Therapist）、职能（作业）治疗师 (Occupational Therapist) 一同起着关键的作用。这三类治疗师常常交叉合作，一起为病人提供最优质的康复治疗方案。希望这篇文章能够为您拨清眼前的迷雾，当孩子需要言语治疗的时候，能够及时迈出康复治疗这一步，越早开始，康复效果越好。您的孩子需要言语治疗吗？您有什么问题，欢迎在本文下方留言！

If you find my post helpful, I’d like to invite you to subscribe to my site or share it with your friends. Also, you could support me financially at JoannaGaoSLP . Your donation helps me focus on producing beneficial content for everyone. Thank you so much! 写稿不易，写双语文章更需要大量时间反复雕琢。如果您喜欢我的文章，欢迎您订阅本站或将文章分享给您的朋友，让更多人了解本站。也欢迎您在JoannaGaoSLP 成为赞助伙伴，鼓励我持续创作优秀的的免费资源，谢谢您！

参考资料｜Reference: American Speech-Language-Hearing Association. “Who are speech-language pathologists, and what do they do.” American Speech-Language-Hearing Association. Retrieved July 31 (2022).

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Joanna Gao, MA, CCC-SLP

Joanna is a certified bilingual speech-language pathologist. She has been working with children and their families on various speech, language, and feeding issues. She is passionate about empowering parents and helping them bond with their children. She is a mother, author, and guest lecturer. Her story can be found here.

www.joannagaoslp.com