What Happens at a First Speech Therapy Appointment?

At a first speech therapy appointment, the therapist gets to know you or your child, listens to your concerns, and explores communication through conversation and gentle activities, so they can build a clear picture and agree the next steps with you. There is nothing painful involved, nothing to revise for, and no pass or fail — it is a fact-finding conversation, not a test you can get wrong.

Many people arrive feeling nervous, simply because they do not know what to expect. This guide walks you through it step by step, for children — with a parent or carer there throughout — and for adults, in person and online. For practical help with getting ready, see our checklist for preparing for your first appointment.

Key Takeaways

• A first appointment is about understanding: the therapist listens to your concerns, takes a history, and explores communication through conversation and activities.
• For young children the assessment is usually play-based; for adults, conversation and a range of speaking, language and thinking tasks.
• A parent or carer stays with a child throughout; adults are welcome to bring a family member or friend.
• The therapist talks through their findings, answers your questions, and agrees next steps and goals with you.
• Nothing is painful, and there is no pass or fail — whatever the person can or cannot do that day is useful information.
• You do not need to prepare or practise anything; everyday examples and honest answers are the most helpful things you can bring.

On this page

• Before the appointment
• Arriving and saying hello
• Talking about history and concerns
• What the assessment involves
• A first appointment for a child
• A first appointment for an adult
• Online first appointments
• Talking through the findings
• Agreeing next steps and goals
• After the appointment
• When to seek help
• Questions to ask a therapist
• Frequently asked questions
• Related guides

Before the appointment

The appointment usually begins with a referral or a booking. Depending on where you live and the service involved, a doctor, health visitor, teacher or hospital team may refer you, or you may be able to contact a therapist directly — our guide to how to find a speech and language therapist explains the common routes. Some services send a short form beforehand, asking about your main concerns and background.

There is very little you need to bring, but the following can help:

• Any letters or reports you already have — from a doctor, hospital, school or nursery, or hearing test results.
• Your notes about what you have noticed — when it started, when it seems better or worse, and everyday examples.
• For a baby or child, anything that helps them feel settled — a familiar toy, a snack and drink, nappies if needed.
• For an adult, glasses or hearing aids if used, and a list of any medicines — useful background for the wider care team.
• A family member or friend, if you would like support.

You do not need to practise anything beforehand — it is more helpful if the therapist sees and hears communication as it usually is, rather than a rehearsed version.

Arriving and saying hello

First appointments happen in all sorts of places: a clinic, hospital, school or nursery, your own home, or online. Wherever it takes place, the opening minutes follow a similar pattern.

The therapist will introduce themselves and their role, and check basic details such as names and contact information. They will explain what the appointment is for, how it will run, and what happens to notes and reports afterwards — including who they are shared with, normally only with your knowledge and consent.

For a child, these first minutes are deliberately unhurried: time to look around and settle, and a warm greeting. A shy start is completely expected — a child does not need to talk to a stranger straight away, perform, or sit still at a table for the appointment to be useful.

Talking about history and concerns

First, the therapist will want to hear the story from you. This conversation — sometimes called the case history — is one of the most important parts of the appointment, because your everyday knowledge shapes what follows.

For a child, the therapist may ask about:

• Pregnancy and birth, and early development — babbling, first words, early play.
• How your child communicates at home — understanding, making needs known, play.
• Feeding and eating, including difficulties with chewing, swallowing or particular textures.
• Hearing, and any ear infections or hearing tests.
• Any family history of speech, language or learning difficulties.
• What nursery or school staff have noticed, and what worries you most.

For an adult, the conversation usually covers:

• What has changed, and when — for example after a stroke, brain injury or illness, or gradually.
• Everyday life before and since — work, family, hobbies, the conversations that matter most.
• Reading, writing, memory and thinking, if they have been affected.
• Eating and drinking, including coughing or difficulty swallowing.
• What you most hope therapy might help with.

There are no trick questions and no wrong answers. Many families find a short phone video of their child playing or chatting at home especially useful, because children often communicate differently in a new place — notes and everyday examples help in the same way.

What the assessment involves

After the conversation, the therapist explores communication more directly. This part is matched to the person’s age and the reason for referral, and is designed to show what the person can do as much as what they find hard.

Depending on the reason for the appointment, the therapist might:

• Listen to speech and conversation — how sounds are made, how words and sentences come together, how conversation flows.
• Explore understanding — following instructions, answering questions, understanding stories.
• Look at social communication — turn-taking, eye contact, play and interaction.
• Use structured tasks — picture books, naming pictures, repeating sentences, describing a scene, reading and writing tasks.
• Listen to the voice, if voice is part of the concern.
• Observe eating and drinking, if swallowing is part of the concern — usually with familiar foods or drinks, discussed with you first. Any change to food textures or drinks only ever follows an individual assessment and must be taught and supervised by the assessing therapist, because swallowing difficulties carry a risk of choking.

The therapist takes notes throughout, and may ask permission to record audio or video to listen back to later. You can ask what anything is for at any point.

A first appointment for a child

For young children, a first appointment rarely looks like a test. It usually looks like playing.

The therapist may sit on the floor with toys, bubbles, books and games, joining in your child’s play and listening closely to the sounds and words they use, how they play and take turns, and how they let others know what they want. Play is a powerful window onto communication — relaxed as it looks, the therapist is gathering a great deal of information.

A parent or carer stays throughout, and your role is valuable: you may be asked how typical the session seems — does your child usually say more, or less, than this? Comfort, cuddles and feeds are welcome whenever your child needs them, and sessions stay flexible, with breaks.

For older children and teenagers, the appointment is a friendly conversation mixed with activities and, sometimes, more structured tasks — and the therapist will want their own view of what is tricky and what they would like to be easier.

A first appointment for an adult

For adults, the appointment is built around conversation: everyday life, how communication is working and, depending on the difficulty, finding words, building sentences, understanding, reading and writing, voice, or clarity of speech.

Tasks might include describing a picture, telling a short story, reading aloud, writing a few sentences, or following instructions of increasing length; some tasks explore memory and attention too, where those are part of the picture. None of it is an exam: getting stuck tells the therapist something useful, and you can pause or rest at any time — communication difficulties are tiring, and a first appointment can feel like hard work.

If swallowing is part of the referral, the therapist will ask about meals and coughing, and may observe eating and drinking with items discussed first. They may also look inside your mouth with a small torch, to see how the lips, tongue and palate move — painless, and explained beforehand.

Online first appointments

Many first appointments now happen by video call, and the shape is much the same: introductions, the history conversation, and activities adapted for the screen — sharing pictures, stories and games, and watching communication in the person’s own surroundings.

A few practical things help: a quiet room, the device propped up so the person’s face is clearly visible, familiar toys nearby for a child, and testing the link beforehand. Seeing a child at home, relaxed among familiar things, gives the therapist a very natural picture of everyday communication. Our page on online therapy describes how remote appointments work in more detail. If part of an assessment cannot be done well online — looking inside the mouth, or a swallowing observation — the therapist will explain and arrange for that part to happen in person.

Talking through the findings

Towards the end, the therapist talks through their findings: strengths as well as difficulties, what they think is going on — in plain language — and how it connects to your concerns.

This is a conversation, not an announcement — you can ask the therapist to slow down, explain a term again, or write things down. If the picture is not yet complete — the therapist may need more information, or to speak with a school or another professional, with your consent — they will say so honestly. A first appointment may not end with a definite label; careful assessment sometimes takes more than one session.

The therapist may also explain who else might be involved — the professionals who can support communication, and how their roles differ, are explained in our guide to who does what in communication support. General information about speech and language therapy is also available from the American Speech-Language-Hearing Association (ASHA).

Agreeing next steps and goals

The appointment usually ends by agreeing what happens next. Depending on what the assessment has found, the next steps might include:

• Therapy sessions, with goals agreed together — for a child, goals often grow out of play and everyday routines; for an adult, out of the conversations and activities that matter most to them. Goals are usually small, specific and functional — such as being understood by family at mealtimes.
• Ideas and strategies for home or school, explained and often demonstrated in the appointment.
• Another appointment to continue the assessment, or a review after home practice.
• A referral onward — to a hearing specialist, doctor or other professional — if something outside speech and language therapy needs attention.
• Advice only, with the door left open: sometimes the assessment shows development within the expected range, or a difficulty that needs only monitoring — the therapist will explain what to watch for and when to come back.

You should leave knowing the plan, even if it is “wait and watch, with these strategies”. If anything is unclear, ask — and ask for it in writing if that helps.

After the appointment

Afterwards, the therapist writes up their notes and, in many services, produces a report summarising the discussion, the findings and the agreed next steps. Copies go to you and, with your consent, to your doctor, your child’s school, or other professionals involved.

If therapy is recommended, later sessions build on the goals and feel more focused. The work differs quite a bit between children and adults — see our comparison of speech therapy for children vs adults. If your circumstances change, or a new difficulty appears, you can contact the service again: a first appointment is the start of a relationship, not a one-off transaction.

When to seek help

Do not wait for a crisis before asking for a first appointment. Seek advice whenever you are worried about a child’s speech, language, communication or feeding, or when an adult’s communication changes after illness or injury.

Some changes are an emergency, whenever they happen. If someone suddenly loses speech, their speech suddenly becomes slurred or impossible to understand, their face droops on one side, they have sudden weakness in an arm or leg, or they are choking or having difficulty breathing, call your local emergency number immediately — do not wait for a scheduled appointment. Sudden speech changes can be a sign of a stroke, and urgent medical help comes first.

Repeated coughing or choking during meals, or repeated chest infections, should also be raised promptly with a doctor.

Questions to ask a therapist

A first appointment is also your chance to ask questions — the therapist will expect them:

1. What did today’s assessment show — what are the strengths, and what is harder?
2. What do you think is causing the difficulty, and is more assessment needed before we know?
3. What are you recommending, and why — therapy, strategies at home, a review, or referral to someone else?
4. If therapy is recommended, what will the goals be, and how will we know things are improving?
5. What can we do at home, at school or in everyday life to help in the meantime?
6. Who will receive the report, and can we have a copy?
7. Who should we contact if things change or we become more worried?

Frequently asked questions

Related guides

• What does a speech and language therapist do? A complete guide
• How to find a speech and language therapist: a step-by-step guide
• Preparing for your first speech therapy appointment: a checklist
• Speech therapy for children vs adults: how the work differs
• Get in touch online

A gentle next step

Knowing what to expect takes most of the worry out of a first appointment — what you will find is a conversation: someone listening carefully to your concerns and building a picture of how they can help. If you are thinking about a first appointment for yourself or your child and would like to talk it through, you are very welcome to get in touch online. There is no obligation and no pressure: just a friendly first conversation, at your pace.

By Hamayal Adnan, Speech-Language Pathologist

This article is for general educational purposes only and is not medical advice. It does not replace an assessment by a qualified speech and language therapist or other healthcare professional. Every person is different. If you have concerns about speech, language, feeding or swallowing, please seek professional advice. In an emergency, call your local emergency number.