Our Services & Fees

An initial consult is generally completed within an hour. It is an opportunity for the speech-language pathologist (SLP) to get to know you and your child. The SLP will find out about your child’s development, strengths and difficulties in different ways. This may include:

• Taking a detailed case history - Prior to the consult, you will be send a case history document to fill out, which will ask you questions about your child’s development. This saves a lot of time during the consult and allows the speech pathologist to ask any follow up questions.

• Informal Assessment – the SLP will chat and play with your child whilst taking note of certain skills such as turn-taking, joint attention, ability to follow directions, speech sounds and patterns, and any the words they use.

• Formal Assessment – your child may be encouraged to look at some pictures with the clinician. The SLP may ask the child to name or describe pictures and point to certain objects. These assessments will provide a score so that the therapist can compare the child’s performance with children of a similar age.

• Play and Conversation – the clinician will try to get to know your child by talking to them and joining in with their play. This will help the clinician to see how they communicate and whether they use any gestures or expressions to help them get their message across. The clinician may be interested in how the child plays and what types of toys and activities they enjoy.

• Observation – watching the child and how they communicate with their parents/carers or siblings may also be helpful for the clinician to see. If your child is quiet, the clinician may want to observe them for a while, allowing them to feel comfortable first and then approach the clinician when they feel ready.

Initial consults typically go for one hour, and you will have the opportunity to ask the speech pathologist questions too. At the end of the session the clinician may make some suggestions about what the next steps could be for your child and how to support their speech, feeding and facial, language and/or literacy development.

The speech pathologist may need to book in further assessment sessions or require more time to look at assessment findings in detail, but they will be able to provide you with some advice in the meantime. You may also be given referrals to see additional services, such as an Ear Nose and Throat (ENT) specialist, airway focused orthodontist, occupational therapist, behavioural optometrist, physiotherapist, and/or osteopath.

Please advise your speech pathologist if you would like an assessment report written. Initial Consult Reports are shorter than formal reports and are billed at a rate of $175/hr.

At times, a family, school, or agency may request a formal assessment to determine a child’s diagnosis and/or severity in order to access funding for intervention services.

A formal assessment includes conducting standardized assessment(s) in the area of speech, language, social communication and/or literacy. Standardized assessments are chosen based on the child’s age, noted areas of difficulties, and developmental abilities, and will determine a severity (e.g., mild, moderate, severe) and type of diagnosis (e.g., phonological delay/disorder, articulation delay/disorder, expressive language disorder, etc.).

Due to the nature of formal assessments (e.g., following the specific instructions and protocols of standardized tools), they often take several hours to complete.

Like an initial consult, formal assessments also gather a detailed case history, and involve informal assessment measures such as observation of the child during play and conversation with the SLP and parent/guardian.

A formal speech-language assessment report will also be provided as requested at a rate of $160/hr.

A typical speech therapy session for a younger child consists of the following:

• 30 minutes of direct intervention with the speech-language pathologist;

• 15 minute consultation with the parent - during this time, the SLP and parent will discuss the child’s progress, any home practice required (materials provided), and will give the parent a chance to ask questions or discuss concerns;

• 15-30 minutes of indirect time for the SLP - this involves time for the SLP to analyze the child’s session data and write notes, as well as to plan the child’s next session. This is done after the parent and child leave the clinic.

Depending on the child’s age, the speech therapy session may take place on the floor (e.g., play-based therapy for the littlest ones) or at the table (e.g., for children who are a bit older and are able to focus and attend for longer periods at the table). The type of intervention will be determined based on your child’s age, skills, abilities, and any special modifications needed.

A late talker is a toddler between 18-30 months old who has limited spoken vocabulary for their age, while having a good understanding of language, as well as typically-developing play, motor, thinking and social skills. 

At Piccolini Speech Therapy, we encompass parent coaching as our number one priority, as we want to empower YOU to build your child’s language skills.

Parents are a child’s first teachers. You have the skills to teach your little one to communicate - sometimes you just need a little coaching and teaching on how to do this.

Sessions begin at $175 per session. This includes the following:

• 30 minutes of play-based intervention with your little one. During this time, the SLP will demonstrate language stimulation techniques during play and naturalistic communication opportunties that arise. The SLP will then ask you to join in and offer you coaching on the specific technique you are working on with your child.

• 15 minute parent-SLP discussion/consult - during the last 15 minutes of the session, the SLP will discuss what went well, how the child responded, and offer suggestions to improve. The parent will have a chance to ask questions and together with the SLP, they will come up with a plan for how to incorporate the technique(s) learned during session into everyday routines at home until the next session.

• 15-30 minutes of indirect SLP time - this happens after the parent and child leave the clinic. It is indirect time that allows the SLP to consolidate the data and notes taken during session, as well as plan and prep for the child’s next session.

If you suspect your child has Childhood Apraxia of Speech, a comprehensive assessment by a qualified SLP is required for diagnosis. It is typically conducted over a number of sessions to eliminate fatigue and frustration of the child as much as possible.

A speech pathologist with post-graduate training and experience in assessing and treating motor speech disorders is the professional most qualified to diagnose CAS. Andrea (at Piccolini Speech Therapy) has extensive post-graduate training in both the diagnosis and treatment of CAS.

CAS cannot be diagnosed until a child has the verbal imitation skills to participate in a dynamic motor speech assessment (i.e., a nonverbal child cannot be diagnosed with apraxia). Because Childhood Apraxia of Speech is a communication disorder (not a medical diagnosis), the most qualified professional to provide assessment, evaluation, and diagnosis is a certified speech pathologist.

Andrea will be able to determine whether your child is exhibiting signs of CAS during your initial consult and whether they require a comprehensive CAS assessment and treatment program.

This assessment process includes several standardized, norm referenced assessments as well as specialized, informal evaluations for the purposes of diagnosing CAS. This assessment process will be completed over two sessions.  Diagnostic criteria will follow recommendations from expert researchers in the field of CAS, the ASHA CAS technical report (2007), the ASHA CAS position statement (2007), and a CAS classification protocol using a pediatric adaptation of the Mayo Clinic System (Shriberg & Strand, 2014), as cited by S. Caspari (2019).  

This evaluation includes:

• Specialized assessments and evaluations for the purposes of classifying CAS/providing a differential diagnosis

• Parent Questionnaire

• Consultation with other professionals and school-based staff

• May include additional standardized, norm-referenced assessment of spoken language (understanding language and using language) 

• Appointments to debrief results with family and school team

• Written report with diagnosis and recommendations

Treatment for Childhood Apraxia of Speech looks a little different than typical speech therapy for an articulation delay or phonological disorder due to the difficulties with motor-planning that children with CAS exhibit.

It involves much more careful planning and preparation on the SLP’s part to ensure that the therapy targets meet the child with CAS exactly where they are at with regards to which speech sounds they can say, the syllable shapes they can make, and which sounds and words could be their next therapy targets.

For young children with suspected CAS (age 3-5), therapy involves a lot of learning new speech sounds and sound combinations through multiple motivating, play-based activities per session. The SLP will often spend 1-1.5 hours of time prior to each session planning and prepping the sessions specifically for the individual child.

The course (length) of therapy differs from child to child and depends on the following factors:

• The severity of the disorder

• The child’s age & developmental abilities

• The child’s ability to focus and attend to the activities and the SLP’s mouth and instructions

• The child’s ability to imitate gestures, sounds, and words

• Whether or not a child has a receptive learning delay (in addition to the speech and expressive language difficulties)

At Piccolini Speech, the main therapeutic approach for children with CAS is the Dynamic Temporal and Tactile Cueing (DTTC).

DTTC is a treatment method designed specifically for children with severe CAS, especially those who were not successful with more traditional forms of therapy and has been used successfully with moderate CAS as well. DTTC is a motor-based approach, meaning it is designed to improve the brain’s ability to plan and program movements for speech, which most experts believe is the underlying cause of CAS.

Sessions involve:

• 30 minutes of direct therapy with the SLP;

• 15 minutes of coaching during which time the parent is coached by the SLP on how to work on the specific targets with the child;

• 15 minutes of parent-SLP consultation time, during which time the parent is given home practice and a chance to discuss any concerns or questions.

• 30-60 minutes of indirect SLP time for the SLP to consolidate notes and data from the session as well as to plan and prepare the activities for the next session.

It is often recommended that a child and parent attend sessions 2x/week at minimum for a set treatment block at the beginning + home practice in between sessions.