Your Pediatrician Says 'Wait and See' — But Should You? Understanding Speech Delay Evaluation

Your child is four, maybe five. Kindergarten is approaching — or maybe they are already there. And people still cannot understand what they are saying. Other kids are reading simple books, following multi-step directions, telling stories. Your child is struggling to be understood, frustrated when peers do not get what they mean, falling behind in a classroom where clear communication is suddenly essential.

You have mentioned it before — to the pediatrician, to preschool teachers. The response? Let's give it more time. They will catch up. Some kids are just late bloomers.

But your child is not two anymore. They are not three. They are entering a world where language is the foundation of everything — reading, writing, making friends, following instructions, succeeding in school. And the wait-and-see approach that might have made sense when they were a toddler? It does not make sense anymore.

In this post, we will explain why the stakes are different for school-age children, what red flags mean it is time to stop waiting, and why comprehensive evaluation — not just basic speech screening — is critical at this stage.

Why the 'Wait and See' Advice Lingers — Even for Older Children

The wait-and-see approach made more sense when your child was a toddler. At 18 months or two years old, there is genuine variability in development. Some children are late bloomers who do catch up on their own. Pediatricians know this, and they do not want to alarm parents unnecessarily.

But by age four or five, the developmental window has shifted. The children who were going to catch up naturally have largely done so. The ones who have not? They are not late bloomers anymore. They are children with persistent communication challenges that will not resolve without intervention.

And yet, the wait-and-see advice persists. Sometimes it is because the child is doing okay in other areas and the language delay does not seem severe enough to worry about. Sometimes it is because schools are stretched thin and formal evaluations take time. Sometimes it is because no one wants to label a child or make parents feel their child is behind.

But here is the reality: by kindergarten, clear communication is not optional. It is foundational. And continuing to wait at this stage is not protecting your child — it is putting them at risk.

Why Waiting Past Age Four Is Especially Risky

When children enter kindergarten, the academic and social demands explode. They are expected to follow multi-step directions, answer questions about stories, use language to solve problems, and communicate with peers. Reading instruction begins — and reading is built on a foundation of strong language skills.

Children with unresolved speech and language delays at this age are not just behind in talking. They are at significant risk for reading difficulties, writing struggles, and academic underachievement that can follow them through their entire school career.

Research shows that children with language delays in preschool are far more likely to struggle with literacy in elementary school. One study found that over 80 percent of children who had language delays at age 30 months still had not caught up by age six. Many went on to be diagnosed with learning disabilities years later — long after early intervention could have made the biggest difference.

There is also a social cost. Children who cannot communicate clearly often struggle to make friends, participate in group activities, or advocate for themselves. They may become withdrawn, frustrated, or develop behavior problems as a way to cope with their inability to express themselves.

By age four or five, the window for effortless language development is closing. The brain is still highly responsive to intervention — but every month you wait, the gap between your child and their peers widens.

Red Flags for Children Ages Four and Older

If your child is four or older and showing any of the following signs, waiting is no longer an option. These are clear indicators that evaluation and intervention are needed now.

Speech Is Mostly Unintelligible to Strangers

By age four, strangers should understand at least 90 percent of what your child says. By kindergarten entry, speech should be fully intelligible. If teachers, peers, or other adults frequently cannot understand your child, this is not something they will outgrow — it requires intervention.

Difficulty Following Multi-Step Directions

By age four or five, children should be able to follow directions like Go to your room, get your shoes, and bring them to me. If your child consistently struggles with multi-step instructions, gets lost in the middle, or needs everything repeated multiple times, this suggests a receptive language delay that will significantly impact classroom learning.

Limited Sentence Complexity

Four- and five-year-olds should be using sentences with five or more words, asking questions, using past and future tense, and telling simple stories. If your child is still primarily using short, simple sentences or struggling to express ideas in a way others can follow, this is a concern.

Cannot Answer Simple Questions About a Story

Kindergarten readiness includes the ability to listen to a short story and answer basic questions like What happened? or Who was in the story? If your child cannot do this, they are not ready for the language demands of formal schooling.

Struggles to Name Letters, Numbers, or Colors

While not all children need to know their ABCs before kindergarten, significant difficulty naming common letters, numbers, or colors can signal a broader language-based learning issue. This is especially true if the child has been exposed to these concepts regularly.

Frustration, Tantrums, or Withdrawal

Children who cannot communicate effectively often express their frustration through behavior. If your child has frequent meltdowns, avoids speaking situations, or becomes aggressive when they cannot make themselves understood, the behavior is not the problem — the underlying communication difficulty is.

Teacher Concerns About Classroom Participation

If your child's preschool or kindergarten teacher has raised concerns about language, listening, following directions, or participating in group activities, take it seriously. Teachers see your child in a structured setting alongside peers and can spot delays that may not be as obvious at home.

What a Comprehensive Evaluation Looks Like for School-Age Children

For children ages four and up, a speech and language evaluation should go beyond basic articulation screening. It should assess expressive language (what your child can say), receptive language (what they understand), vocabulary, sentence structure, narrative skills (can they tell a story?), and pragmatic language (how they use language socially).

In many cases, particularly when there are concerns about attention, behavior, learning, or overall development, a comprehensive neuropsychological evaluation is the better choice. This type of evaluation assesses not just speech and language, but also cognitive abilities, memory, attention, executive functioning, and early academic skills like phonological awareness (critical for reading).

A neuropsychological evaluation is especially important if your child is struggling in multiple areas, if there is a family history of learning disabilities, if behavioral issues are present, or if the speech delay seems tied to broader developmental concerns. It provides the complete picture you need to understand what is going on and how to help.

Why Speech Therapy Alone Is Not Always Enough

Speech therapy is often the first step when a child has a language delay, and for many children, it is exactly what they need. But sometimes speech delays are a symptom of something bigger. A child who is not talking might also have trouble with attention, social interaction, sensory processing, or overall cognitive development.

This is where a comprehensive neuropsychological evaluation becomes essential. It helps answer the bigger questions: Is this an isolated speech delay, or is it part of a broader developmental pattern? Are there cognitive strengths and weaknesses that need to be understood? What accommodations or interventions will help this child succeed not just in speech, but in school and in life?

Understanding the full picture ensures that your child gets the right kind of support — not just speech therapy, but a holistic plan tailored to their unique needs.

When a Brief Period of Monitoring Might Still Be Appropriate

To be fair, not every four-year-old who mispronounces a few sounds needs immediate intervention. Some mild articulation issues — like trouble with R or TH sounds — may resolve with time and do not necessarily interfere with being understood or succeeding in school.

A brief period of close monitoring might be appropriate if your child has only mild articulation errors, strong language comprehension, age-appropriate sentence structure and vocabulary, no behavioral or social concerns, and is making steady progress on their own.

But if your child is about to enter kindergarten and still has significant communication challenges, waiting is not the right call. The academic and social demands of school will not wait for your child to catch up — and neither should you.

The Bottom Line: Trust Your Instincts

If your pediatrician says to wait and see, but your gut tells you something is not right, trust yourself. You know your child better than anyone. You see them every day. You notice the frustration when they cannot communicate, the isolation when other kids are chatting and playing and they are on the sidelines, the growing gap between them and their peers.

Early intervention works. Research proves it. Waiting does not make the problem go away — it just delays the solution.

You do not need permission to seek an evaluation. You do not need to wait for your doctor to refer you. If you are concerned, act. Get answers. Give your child the support they need while their brain is still most receptive to change.

Concerned about your child's speech or language development? Contact Dr. Koffman today to schedule a comprehensive evaluation and get the clarity your family deserves. Early answers lead to better outcomes.