Is it really “speech only?”

What is a multidisciplinary evaluation?

A multidisciplinary evaluation is a team evaluation involving several disciplines and method of gathering information to capture a better picture of the whole child. No child is just their reading ability, just their speech development, just their behavior. A multidisciplinary evaluation strives to see how strengths and challenges in all areas influence each other to determine a child’s ability in a given environment. Disciplines involved in a multidisciplinary evaluation might include: Speech Language Pathologist, Occupational Therapist, Physical Therapist, Special Educator, School Psychologist, School Adjustment Counselor, etc.

Conversely, a “speech only” evaluation would only look at a child’s speech and language skills.

The Problem with The Speech Only Evaluation

Consider Scarborough’s Reading Rope analogy. Skilled reading is a rope made of many component skills woven together. The two main components are word recognition (phonological awareness, decoding, and sight recognition) and language comprehension (background knowledge, vocabulary, syntax, semantics, verbal reasoning, and literacy knowledge). Viewing this model, you can see that written language, including reading and writing, are really just skills on the continuum of speech and language development. Only assessing a child’s speech language skills and not evaluating or at the very least monitoring their literacy development is a huge omission in their development as a learner.

Now, not every child with a speech-language disorder will experience challenges with literacy development. So, how do we know when to advocate for more than just a speech-language evaluation? We can turn to the research to support our decision for when to refer our “speech only” students.

Speech Sound Disorders & Reading Disabilities

Jin et al. (2020) found poor speech intelligibility in preschool nearly doubled a child’s likelihood of reading disability at age 8. Their research indicated predictive factors of which children may develop a reading impairment included concomitant language impairment, family history of reading or language disability, SES, and being female.

Several studies have found that approximately 25% of children receiving speech therapy for a Speech Sound Disorder meet the criteria to be at risk for a reading disability (Tambryraja et al., 2020). Furthermore, of those children identified as at-risk for a reading disorder, a statistically small percent made improvement with speech therapy alone over the course of one school year.

Language Impairment & Reading Disabilities

McArthur et al. (2000) found that greater than 50% of students identified with Specific Language Impairment met the criteria for reading disability.

Murphy et. al. (2016) concluded that the risk for reading difficulty in children with language impairments can be reliably determined in preschool. They identified poor alphabet knowledge, phonological awareness, name writing, and oral language abilities as the key predictors of later literacy development. These differences in ability were present before any formal reading instruction.

The Bottom Line

Children with language impairments and speech sound disorders are at greater risk for reading disabilities. Even more so for those students with both language impairment and speech sound disorder. Understanding this risk is important for early identification, especially since children who enter school with reading difficulties are very likely to remain on that path!


Gosse, C. S., Hoffman, L. M., & Invernizzi, M. A. (2012). Overlap in speech-language and reading services for kindergartners and first graders.

Jin, F., Schjølberg, S., Eadie, P., Nes, R. B., & Røysamb, E. (2020). Preschool Speech Intelligibility and 8-Year Literacy: A Moderated Mediation Analysis. Journal of Speech, Language, and Hearing Research63(10), 3380-3391.

McArthur, G. M., Hogben, J. H., Edwards, V. T., Heath, S. M., & Mengler, E. D. (2000). On the “specifics” of specific reading disability and specific language impairment. The Journal of Child Psychology and Psychiatry and Allied Disciplines41(7), 869-874.

Murphy, K. A., Justice, L. M., O’Connell, A. A., Pentimonti, J. M., & Kaderavek, J. N. (2016). Understanding risk for reading difficulties in children with language impairment. Journal of Speech, Language, and Hearing Research59(6), 1436-1447.

Tambyraja, S. R., Farquharson, K., & Justice, L. (2020). Reading risk in children with speech sound disorder: Prevalence, persistence, and predictors. Journal of Speech, Language, and Hearing Research63(11), 3714-3726.

Thanks for reading!