Speech-language pathologists claim to be a science-driven profession that follows the evidence. We cite evidence-based practice in our values, policies, and professional rhetoric. But in day-to-day reality, clinical decisions are often shaped less by research and more by revenue. The uncomfortable truth? Profit, not evidence, increasingly dictates what gets promoted, adopted, and normalized in our field.
From high-priced certifications with little empirical support to therapy programs marketed through influencer networks rather than peer-reviewed data, SLPs are routinely sold the idea that a trademarked method is more effective simply because it costs more or comes with a certificate. These systems reward branding over outcomes and create pressure to “keep up” professionally, regardless of whether the approach aligns with current research. This isn’t just a theoretical concern. It has real consequences for clinical quality, equity of access, and the integrity of our profession.
Let’s talk about what’s happening.
1. Well-Marketed, Low-Evidence Programs Dominate
Numerous commercially available programs and approaches, including but certainly not limited to Orofacial Myofunctional Therapy (OFM), TalkTools, PROMPT, Natural Language Acquisition (NLA), DIR/Floortime, Orton-Gillingham (OG) (branded and unbranded programs), Social Thinking, Interactive Metronome, Cogmed, Fast ForWord, etc., are frequently promoted as essential interventions or certifications for speech-language pathologists (SLPs). However, a review of the peer-reviewed literature indicates that many of these approaches are supported by limited, low-quality, or no high-level empirical evidence, particularly when measured against standards for evidence-based practice in clinical care.
These programs often require clinicians or institutions to invest in costly trainings, certifications, proprietary materials, or recurring therapy sessions, which may not offer added benefit compared to established evidence-based practices. This creates a system where money, not results, often drives which interventions become popular and widely used.
For instance, despite the lack of randomized controlled trials or large-scale efficacy data, many clinicians are told that only certified providers can “do it right.” Parents are pressured into paying out-of-pocket or seeking private treatment because schools often (rightfully) decline to use unvalidated interventions.
This isn’t just unethical, it’s harmful. It sidelines lower-cost, evidence-based alternatives for treatment of speech, language, and literacy, including ReST, DTTC, child-led intervention, explicit grammar instruction, narrative-based intervention, robust vocabulary instruction, synthetic phonics, etc. These are all effective, accessible, and research-backed approaches that require clinical reasoning, not a certificate.
2. Schools Deny Services to Protect Budgets, Not Kids
In the public school setting, we also see the financial bottom line driving decisions, but in the opposite direction. Students who clearly need support are denied services because “we don’t offer that frequency” or “he doesn’t qualify under our criteria.”
Let’s be honest: that “criteria” often hinges on the use of standardized tests with poor sensitivity. Tools like the CASL-2, CELF-5, and one-word vocabulary batteries continue to be preferred, not because they offer better diagnostic information, but because that’s all the district owns and also because they allow fewer children to qualify. By contrast, tests like the TILLS are deliberately avoided in some districts because their improved psychometric properties and sensitivity to real language weaknesses would expand the caseload.
When the evaluation tool is chosen to serve the system, not the student, that’s not evidence-based practice. That’s gatekeeping.
3. Training and Therapy Access as a Commodity
Let’s talk about the broader trend of monetizing access to therapy strategies. Too many programs now operate like multi-level marketing schemes. Only those who pay for the training get the “secrets.” The information becomes proprietary rather than public knowledge. This directly contradicts the spirit of clinical science, where findings should be replicable, peer-reviewed, and freely shared for the benefit of the field.
Ask yourself: if an approach is truly evidence-based and broadly effective, why is access restricted to those who can afford thousands of dollars for a brief training course?
4. Who Benefits When Services Are Withheld or Monetized?
Not the children.
When under-qualification, low-evidence interventions, and inflated training costs drive our field, we end up privileging access to services based on wealth and location, not need. Parents with money can pay out of pocket. Schools with budgetary constraints can use insensitive tools to justify minimal service. Clinicians are often nudged toward expensive trainings not only because of social media buzz or professional pressure to conform, but also because they’re promised better job prospects and higher salaries for holding certain certifications.
Meanwhile, the students who need consistent, evidence-based, language-focused intervention, those with DLD, literacy disorders, pragmatic challenges, etc., fall through the cracks.
What Needs to Change?
- Clinicians must push back against the normalization of expensive, unproven programs.
- Administrators must be held accountable when they choose the budget over students.
- Graduate programs must stop promoting outdated assessments or uncritically including programs with limited evidence.
- Parents must be informed consumers, encouraged to ask, “Where is the research?” before spending thousands.
The field doesn’t need more branded programs. It needs more clinical integrity.
Evidence-based practice isn’t flashy or branded. It doesn’t rely on trademarks or certification fees. It’s grounded in decades of solid research and sound clinical reasoning, and that should be what guides our work.