What Speech Screenings Don’t Always Catch — And Why That Matters

Speech screenings are an important and helpful first step. They’re designed to quickly identify children who may need additional support with speech and language skills, especially in school or community settings.

But screenings are just that — a snapshot, not the full picture.

Many parents are surprised to learn that a child can “pass” a speech screening and still have underlying challenges that affect speech clarity, feeding, breathing, sleep, or long-term development. That doesn’t mean the screening was wrong — it means some things simply can’t be fully assessed in a brief screening format.

Here’s what speech screenings often don’t catch, and why a more in-depth look can be so valuable.

Speech screenings are meant to:

• Be quick and efficient

• Identify clear, obvious speech sound or language concerns

• Flag children who may need a full evaluation

They typically focus on:

• How a child produces certain sounds

• Basic speech intelligibility

• Whether speech is age-appropriate on the surface

This works well for catching clear articulation or language delays — but it doesn’t capture everything that supports healthy speech such as:

1. How the Mouth Is Functioning

Speech isn’t just about sounds — it’s about how the muscles of the mouth work together.

Screenings usually don’t assess:

• Tongue posture at rest

• Lip strength and closure

• Jaw stability

• How the tongue moves during swallowing

A child may produce sounds correctly during a short screening while still using inefficient or compensatory muscle patterns that affect speech, feeding, or orthodontic development later on.

2. Breathing Patterns

Many children breathe through their mouth without anyone realizing it.

Speech screenings typically don’t look at:

• Mouth breathing vs nasal breathing

• Open-mouth resting posture

• How breathing patterns affect attention, sleep, and endurance

Chronic mouth breathing can influence:

• Speech clarity

• Facial growth

• Sleep quality

• Daytime focus and behavior

3. Swallowing Patterns

Children develop swallowing patterns early, and sometimes immature or compensatory patterns persist.

Screenings rarely assess:

• Tongue thrust

• Open-mouth swallowing

• Excessive muscle tension during swallowing

These patterns may not show up in a speech screening but can impact:

• Speech sound production

• Dental alignment

• Long-term oral function

4. Oral Habits

Habits can significantly influence oral development — but they’re easy to miss in a quick screening.

These include:

• Thumb or finger sucking

• Prolonged pacifier use

• Chewing on clothing or objects

• Low tongue resting posture

A screening may catch speech sounds but not the underlying habits contributing to them.

5. Subtle or Compensated Speech Differences

Some children are excellent compensators.

They may:

• Articulate sounds correctly in structured tasks

• Struggle with clarity in longer conversations

• Fatigue with speech over time

In a short screening, these subtleties can be easy to miss.

6. How All the Systems Work Together

Speech involves more than just the mouth:

• Airway

• Breathing

• Muscle coordination

• Sensory awareness

• Endurance

Screenings don’t have the time to look at how these systems interact — but those interactions matter.

What We Look At That Goes Beyond a Screening

When we do a more comprehensive look, we consider:

• Resting posture of the tongue, lips, and jaw

• Breathing patterns at rest and during activity

• Swallowing function

• Muscle strength and coordination

• Oral habits and their impact over time

• How speech sounds are produced and supported by oral function

This helps us understand not just what a child is doing — but how and why.

Why This Doesn’t Mean a Screening Was “Wrong”

It’s important to emphasize:

• Screenings are valuable

• They serve an important purpose

• They are not meant to catch everything

A child can pass a screening and still benefit from:

• Monitoring

• A rescreen later on

• A more detailed evaluation

• Preventative or supportive strategies

This is about adding information, not contradicting previous results.

When Parents Might Want to Ask More Questions

You might consider a deeper look if you notice:

• Mouth breathing or open-mouth posture

• Ongoing speech clarity concerns despite “passing”

• Feeding or chewing challenges

• Orthodontic concerns at a young age

• Fatigue with speech or attention

• Snoring or restless sleep

Trusting your observations matters.

The Big Picture

Speech screenings are a great starting point — but they aren’t the finish line.

Looking at oral function, breathing, and muscle coordination allows us to:

• Better support speech development

• Address root causes, not just symptoms

• Be proactive rather than reactive

Our goal is never to over-diagnose — it’s to understand the whole child.