Virtual speech therapy for kids: does it work, and how to set it up

Virtual speech therapy, also called telepractice, can work well for many children. Research comparing online and in-person delivery has found comparable outcomes for speech sound and language goals in school-age children, and parent coaching for toddlers translates naturally to video. It is not the right fit for every child or every goal, and a good clinician will tell you which is which. This guide covers the evidence, the setup and the limits.

What the research says

Telepractice was already growing before 2020, and the pandemic pushed most Ontario services online for a period. Many Preschool Speech and Language Program agencies, school boards and private clinics kept a virtual option afterward because it worked and because families liked skipping the drive.

The evidence base has grown alongside it. A systematic review by Wales, Skinner and Hayman (2017) looked at telehealth-delivered speech and language intervention for primary school-age children and found that outcomes were comparable to in-person delivery across the studies reviewed. Coufal and colleagues (2018) compared traditional and telepractice delivery for children working on speech sound production and found no meaningful difference in progress on a functional outcome measure. The American Speech-Language-Hearing Association’s Practice Portal on telepractice summarizes the wider literature and treats telepractice as an appropriate model of service delivery when the clinician judges it suitable for the client.

For toddlers, the picture is a little different. Very young children rarely engage with a screen for a full session, so virtual work for this age group is mostly coaching the parent. That is not a compromise. Research reviewed by Roberts and Kaiser (2011) found that parent-implemented language interventions produce meaningful gains for young children, and coaching a parent over video is a direct way to deliver that model.

In Ontario, CASLPO permits registrants to deliver services by telepractice provided the clinician judges it appropriate, obtains informed consent, protects privacy and meets the same standards as in-person care. The registration requirements are the same, so check the CASLPO Public Register exactly as you would for an in-person clinic.

Which children and goals suit virtual therapy

Telepractice tends to work well when the child can sit and attend to a screen for 20 to 30 minutes, when the goal is something the clinician can see and hear clearly on camera, and when a parent is available to help. The table below summarizes common goals.

If your child falls into a “limited” row, that does not rule out virtual care. It means the clinician may suggest a hybrid: an in-person assessment, then virtual sessions, with occasional in-person checks.

Setting up at home

A few small decisions make a big difference to how a session goes.

Device. A laptop or tablet on a stable surface at the child’s eye level works well. A phone screen is small and tends to get held, which means the camera moves and the clinician cannot see the child’s mouth. If you only have a phone, prop it up and sit close.

Lighting. Light should fall on your child’s face, not come from behind them. Sit facing a window or lamp rather than with the window at your back. Speech sound work depends on the clinician seeing lips and tongue clearly.

Sound. A quiet room with the door closed. Turn off the television and ask siblings to play elsewhere for half an hour. Headphones for the child are optional and some children dislike them. A clinician can usually hear fine through a laptop microphone in a quiet room.

Internet. If video freezes often, move closer to the router, plug in an ethernet cable, or ask other household members to pause streaming during the session.

A parent as co-therapist. This is the most important piece. For young children the parent sits beside them, holds up objects, keeps toys ready, redirects attention and models target words. For older children the parent may step back but should stay within earshot to help with technical problems and to hear the home practice instructions at the end. Treat the session as something you are doing together, not something you are watching.

Materials. The clinician will tell you what to have ready. Common requests include a few favourite toys or books, paper and crayons, a mirror for speech sounds, and a small reward like stickers. Printed word lists or minimal pairs are handy for articulation sessions.

What a session looks like

A virtual session follows the same shape as an in-person one. Imagine a five-year-old working on the “k” sound. The clinician opens with a minute of chat and a quick check of last week’s home practice. Then comes a warm-up, perhaps a shared-screen game where the child names pictures that start with “k” while the clinician gives feedback on each attempt. Next is a short structured drill with the parent holding a mirror so the child can watch the back of their tongue lift. A story or game that uses the target words brings the sound into connected speech. The session closes with the clinician explaining the home practice to the parent and emailing a short plan.

For a two-year-old, the session looks quite different. The parent and child play on the floor with the device set up nearby. The clinician watches, names what the parent is doing well, and suggests one change at a time: wait longer before filling the silence, copy what the child says and add one word, narrate play in short phrases. The clinician may pause the play to explain why a strategy matters, then watch the parent try it. Most of the session is the parent and child interacting, with the clinician as coach. Ideas from our guide to everyday strategies that help your child talk are the kind of thing that gets practised.

Limits and when in-person is better

Virtual therapy has real limits and it is better to know them going in.

• Very young children. Under about three, direct screen-based therapy rarely holds attention. Choose a clinician who offers a coaching model for this age.
• Hearing concerns. If there is any question about your child’s hearing, that needs an in-person audiology appointment first. Hearing cannot be screened reliably over video, and unaddressed hearing loss changes everything else.
• Some assessments. An oral-motor examination, where the clinician looks at the structure and movement of the lips, tongue and palate, needs to be in person. Some standardized tests are not licensed for virtual use or lose accuracy on a screen. The clinician may complete part of an assessment online and part in the clinic.
• Children who need physical prompts. Some approaches for childhood apraxia of speech use touch cues on the face. A parent can learn to provide these, but it takes more coaching time.
• Attention and behaviour. A child who finds screens either boring or overwhelming may do better in a room with a person. Try a session and see; most clinicians will tell you honestly if it is not working.
• Technology access. Not every family has a reliable connection or a quiet room. There is no shame in choosing in-person for practical reasons.

What happens next

If you are considering virtual therapy, ask the clinician the questions in our checklist for starting speech therapy, and add three more: which platform they use, how they handle a session where the child will not engage, and whether they recommend any in-person visits. Fees are often similar to in-person; our guide to the cost of speech therapy in Ontario covers the differences, and the speech therapy cost calculator can compare the two.

Speechie plans to offer virtual and in-person pediatric speech-language pathology in Ontario once the clinician’s registration with CASLPO is confirmed.