SOAP Note Example
Speech-Language Pathology SOAP Note Example
Below is a complete SOAP note example for a speech-language pathology session treating a 5-year-old child with a moderate articulation disorder. This example demonstrates proper documentation of phonological process analysis, stimulability testing, intelligibility estimates, parent report, and evidence-based intervention planning.
Complete Speech-Language Pathology Note
SUBJECTIVE:
Patient is a 5-year-old male referred by his pediatrician (Dr. Cortez) for a speech-language evaluation due to concerns about speech clarity. This is treatment session 6 of an authorized 24-session plan of care. Patient's mother reports that his speech is "getting a little easier to understand at home" since starting therapy but that unfamiliar listeners, including his kindergarten teacher, still have significant difficulty understanding him. Mother states that the teacher reported the patient becomes frustrated during show-and-tell and circle time when peers and adults ask him to repeat himself, and that he has started to speak less during group activities. Mother describes his speech at home as approximately 60-70% intelligible to family members when context is known, but drops to an estimated 40-50% when the topic is unfamiliar. She notes particular difficulty with words starting with "s," "r," and "l" sounds, and that he tends to leave off the ends of words. Mother reports he is otherwise meeting developmental milestones — his vocabulary and sentence structure seem age-appropriate and he follows multi-step directions without difficulty. No history of ear infections in the past 12 months; bilateral tympanostomy tubes placed at age 2 due to recurrent otitis media, tubes extruded spontaneously at age 3.5, and hearing was screened within normal limits at his pediatric visit 2 months ago. No feeding or swallowing concerns. Patient lives in a monolingual English-speaking household. He attends kindergarten 5 days per week and receives no other therapies. Patient appeared happy and willing to participate today, telling the clinician about his new toy truck during the greeting, though his description was difficult to follow due to multiple sound substitutions.
OBJECTIVE:
Standardized assessment data (from initial evaluation, session 1, for reference): Goldman-Fristoe Test of Articulation-3 (GFTA-3): standard score 72 (2nd percentile), indicating a moderate articulation disorder. Khan-Lewis Phonological Analysis-3 (KLPA-3): standard score 75 (5th percentile). Phonological processes identified as active: fronting of velars (k→t, g→d, frequency 85%), cluster reduction (sp→p, st→t, bl→b, frequency 90%), final consonant deletion (frequency 60%), stopping of fricatives (s→t, z→d, sh→t, frequency 55%), gliding of liquids (r→w, l→w, frequency 95%). Current session stimulability probes (updated this session): /k/ in isolation — stimulable with visual model and tactile cue (tongue depressor for posterior tongue placement), 7/10 correct trials; /k/ in CV syllables (ka, ko, koo) — 5/10 correct with cues, 2/10 without cues; /k/ in initial position of words — 2/10 correct with maximal cuing (model + tactile + visual mirror), 0/10 without cues. /g/ in isolation — stimulable with model, 6/10 correct; /g/ in CV syllables — 3/10 with cues. /s/ in isolation — stimulable with visual cue (mirror + "long skinny sound" verbal prompt), 4/10 correct with visible tongue protrusion on 6/10 attempts suggesting lingual placement difficulty; /s/ in initial position of words — 0/10 correct. Final consonant production in single words with direct instruction to "finish the word" — produced final consonants on 6/10 targeted words (bat, cup, dog, bike, sun, hop — correct on bat, cup, bike, sun) when given slowed auditory model and tactile cue (hand tap for final sound). /r/ in isolation — not stimulable at this time across 10 trials with various cues (visual, tactile, shaping from /ah/). /l/ in isolation — stimulable in 3/10 trials with tongue tip elevation cue using mirror. Connected speech sample (5-minute narrative retell of a picture story): intelligibility rated at approximately 45% by the clinician (unfamiliar listener standard); mean length of utterance 5.2 morphemes (age-appropriate); vocabulary and syntax age-appropriate; speech rate within normal limits; prosody and voice quality within normal limits. Oral mechanism examination: structure — normal lip, tongue, jaw, and palatal anatomy; no overt velopharyngeal insufficiency; lingual frenum within functional limits. Function — tongue protrusion, lateralization, and elevation to alveolar ridge within normal limits; lip rounding and retraction within normal limits; diadochokinetic rates (puh-tuh-kuh) — reduced rate for the /kuh/ segment with inconsistent posterior tongue contact, 3.2 repetitions per second (normative for age is approximately 4.0-4.8). Treatment provided this session (45 minutes): minimal pair therapy targeting fronting of velars — "key" vs. "tea," "cap" vs. "tap," "coat" vs. "tote," "goat" vs. "dote" — 40 trials presented in a barrier game format; patient self-corrected on 8/40 trials (20%) after communication breakdown feedback (clinician pointed to the wrong picture); auditory bombardment for /k/ and /g/ in initial position of words — 2-minute focused listening activity with amplification; phonological awareness bridging activity — patient sorted picture cards by initial sound (/k/ words vs. /t/ words) with 70% accuracy; final consonant production practice using "finish the word" cuing strategy in a turn-taking board game — 30 trials, 60% correct with one cue, 30% correct independently. Session reinforcement: sticker chart, patient earned 4 of 5 target stickers.
ASSESSMENT:
Patient presents with a moderate phonological disorder characterized by five active phonological processes, of which fronting of velars and cluster reduction are the most pervasive and impactful on intelligibility. Connected speech intelligibility of approximately 45% by an unfamiliar listener is significantly below age expectations (a 5-year-old should be approximately 90-100% intelligible to unfamiliar listeners) and is consistent with the mother's report of communication breakdowns at school. The selection of fronting as the primary treatment target is supported by the patient's emerging stimulability for /k/ in isolation (7/10 with cues) and the high functional impact — velars appear in a high proportion of English vocabulary and their substitution with alveolar stops creates frequent homophony (key/tea, cap/tap, coat/tote) leading to communication breakdowns. The 20% spontaneous self-correction rate during minimal pair therapy is a positive indicator — the patient is beginning to recognize when his productions result in communication failure and is motivated to repair. Final consonant deletion is also responding to direct intervention (60% correct with one cue), and this process was selected as a secondary target because its remediation will simultaneously improve intelligibility across many word shapes. Stopping of fricatives and gliding of liquids will be addressed in subsequent treatment phases — /r/ is not yet stimulable, which is developmentally expected and does not warrant direct treatment at this time. The patient's age-appropriate language skills, normal oral mechanism, and cooperative behavior are positive prognostic indicators for continued improvement with consistent therapy.
PLAN:
Continue speech-language therapy 2x/week for 45-minute sessions. Primary treatment targets for the next 4 weeks: fronting of velars (/k/ and /g/ in initial position of words, progressing to final position once initial position reaches 60% accuracy in single words) and final consonant deletion (targeting stops and nasals in final position of CVC words). Intervention approaches: continue minimal pair therapy for fronting with gradual increase in complexity (single words → carrier phrases → short sentences); continue auditory bombardment at the start and end of each session; introduce cycles approach for final consonant deletion — target one final consonant phoneme per cycle (2-3 sessions per phoneme: /t/, /p/, /n/, /m/, /k/) to facilitate generalization across the phoneme class. Stimulability probes for /s/ and /l/ to be readministered at session 10 to determine readiness for targeting these sounds. Criterion for advancing fronting target to phrase level: 50% correct production of /k/ in initial word position without cues across two consecutive sessions. Home practice program provided to mother: minimal pair picture cards for "key/tea" and "cap/tap" — practice 5 minutes daily as a matching game where the child must say the word clearly enough for the parent to select the correct picture; if the child fronts the velar, the parent points to the wrong picture and encourages the child to try again; final consonant deletion cards — parent says the word slowly and the child repeats, emphasizing the final sound. Parent counseled to avoid asking the child to "say it again" during natural conversation, and instead to model the correct production naturally in a recast (child says "I want the toat" → parent responds "You want the coat! Here's your coat."). Coordinate with kindergarten teacher via parent to implement classroom strategies: seat the patient near the teacher, allow extra response time, and avoid putting him on the spot to repeat in front of the group. Reassess intelligibility and phonological process frequency at session 12 using a new connected speech sample. Long-term goals (by session 24): eliminate fronting of velars to below 10% occurrence, eliminate final consonant deletion to below 10% occurrence, increase connected speech intelligibility to 75% or greater by unfamiliar listener estimate, and initiate treatment for stopping of fricatives if stimulability criteria are met.
Section-by-Section Breakdown
What to include in each section and why it matters.
Subjective
In pediatric speech-language pathology notes, the subjective section relies heavily on parent and caregiver report because young children cannot reliably self-report their communication status. Document the parent's estimate of intelligibility in specific contexts (familiar vs. unfamiliar listeners, known vs. unknown topics) as this provides ecologically valid data about real-world communication function. Include information about the child's emotional and social response to their communication difficulty (frustration during show-and-tell, reduced participation) because this establishes the functional impact and supports medical necessity for treatment. Note relevant medical history including hearing status, history of otitis media, and tubes — these are directly related to speech sound development.
Objective
Speech-language pathology documentation requires standardized test scores from the evaluation for baseline reference, plus ongoing session-specific probe data to track treatment progress. Stimulability testing results are critical for treatment planning — document the specific level at which the child can produce each target sound (isolation, syllable, word) and the type and amount of cuing required, as this directly determines where to begin treatment and what to target next. Include a connected speech intelligibility estimate by the clinician using a standardized procedure (narrative retell with unfamiliar listener rating). The oral mechanism examination documents structural and functional adequacy of the speech mechanism. Detail every treatment activity with the number of trials, accuracy percentages, and cuing levels to create a quantifiable record of within-session performance.
Assessment
The speech-language pathology assessment should provide clinical reasoning for target selection — explain why you chose fronting of velars over other active processes based on stimulability data, functional impact, and developmental appropriateness. Interpret session performance data in the context of the overall treatment trajectory, noting positive indicators like self-correction rates that signal emerging phonological awareness. Identify which processes are developmentally appropriate to defer (gliding of /r/ at age 5) versus those requiring immediate intervention. Connect intelligibility data to age-based expectations with specific normative references to demonstrate the severity of the deficit. This clinical reasoning justifies the treatment approach and frequency to insurance reviewers.
Plan
The speech-language pathology plan should specify treatment frequency and session duration, name the evidence-based intervention approaches being used (minimal pairs, cycles approach, auditory bombardment), and define measurable advancement criteria so that progress is objective (50% accuracy without cues across two sessions before advancing to phrase level). Include a detailed home practice program with specific activities the parent can implement — describe the activity clearly enough that the parent can execute it without clinical training. Provide parent counseling on naturalistic strategies like recasting that support generalization outside of therapy. Document coordination with educational settings because school-age children spend the majority of their communication time in the classroom. Set long-term goals with specific measurable targets and reassessment timelines.
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