Voices Unheard: the Silent Struggle of Women in Speech Therapy

Guest: Ashlyn Lelej, MS, CCC-SLP | Founder, Speech Matters Clinic Host: Dr. Soma Mandal, MD Website: speechmattersclinic.com | Instagram: @speechmattersclinic EPISODE DESCRIPTION What happens when the healthcare system decides your child's feeding struggles aren't serious enough — or that the therapy your doctor recommended isn't covered? And what does it cost a woman to spend decades not knowing she's autistic? In this episode of Soma Says, Dr. Soma Mandal sits down with Ashlyn Lelej, speech-language pathologist and founder of Speech Matters Clinic in Charlotte, NC. Since opening her doors in 2009, Ashlyn has built a practice rooted in the belief that every person deserves the right to communicate, connect, and thrive — on their own terms. Together they pull back the curtain on a field that is quietly foundational to women's and children's health, yet chronically underfunded, undervalued, and misunderstood. From insurance denial playbooks to the sensory roots of pediatric feeding, from late autism diagnoses in women to the neuro-affirming therapy debate — this conversation is equal parts practical and paradigm-shifting. If you've ever been dismissed by a system that should have been listening, this episode is for you. WHAT YOU'LL LEARN IN THIS EPISODE Why insurance coverage for speech therapy is wildly inconsistent — and where the biggest gaps are right now How missed or late autism diagnoses in girls and women ripple into school services, mental health, relationships, and self-understanding What neuro-affirming therapy actually means — and why it's still controversial in some clinical circles A step-by-step playbook for fighting insurance denials (including the call scripts, manager escalations, code nuances, and grant options most families never hear about) Why maternal concerns about pediatric feeding are so frequently dismissed — and what parents can do right now The sensory–feeding connection that changes how we think about picky eating and feeding disorders How the female-dominated nature of speech-language pathology contributes to the field's chronic undervaluation What AI means for the future of speech therapy — and why Ashlyn has concerns How to access Speech Matters Clinic in Charlotte, NC — including how to get evaluated without a physician referral EPISODE HIGHLIGHTS "Insurance and Research Gaps" [03:29] Ashlyn breaks down where coverage has improved (feeding therapy, autism) and where it has quietly regressed (adult aphasia) — and explains why clinical reality almost always moves faster than the research that insurers are willing to accept. "Autism Missed in Girls" [05:31] The diagnostic criteria for autism were built around male presentations. Ashlyn walks through exactly what that costs girls and women — in school services, in self-knowledge, in mental health — and what it looks like when a woman finally gets answers in midlife. "Neuro-Affirming Therapy Debate" [11:01] What does it mean to support someone's communication without asking them to mask who they are? Ashlyn addresses the controversy head-on and explains how SLPs can build social-language skills in a way that affirms rather than erases. "Insurance Denials Playbook" [14:37] One of the most practically useful segments in this episode. Ashlyn shares real strategies for challenging denials: how to call insurers effectively, when to involve your employer's HR department, how billing codes can make or break a claim, and where to find grant funding when coverage falls short. "Pediatric Feeding Disorders" [22:30] Feeding challenges in children are among the most emotionally loaded — and most dismissed — concerns a parent can bring to a provider. Ashlyn explains what's really happening, why it matters, and what the research actually says. "Sensory Roots of Feeding Issues" [26:32] Picky eating is not a parenting failure. Ashlyn connects the dots between sensory processing and feeding difficulties in a way that reframes what families are often told about their children — and themselves. "Why Speech Therapy Is Underpaid" [29:53] A frank conversation about what it means to work in a field that is over 95% female — and how that reality shapes reimbursement, institutional respect, and the day-to-day experience of practicing clinicians. CHAPTERS 00:00 — Welcome and Disclaimer 00:57 — Meet Ashlyn Lelej 01:34 — Why She Built a Clinic 03:29 — Insurance and Research Gaps 05:31 — Autism Missed in Girls 07:41 — Midlife Diagnosis Support 09:48 — Why She Chose SLP 11:01 — Neuro-Affirming Therapy Debate 14:37 — Insurance Denials Playbook 22:30 — Pediatric Feeding Disorders 24:10 — When Feeding Concerns Are Dismissed 25:41 — Getting Evaluated Without a Referral 26:32 — Sensory Roots of Feeding Issues 29:53 — Why Speech Therapy Is Underpaid 34:29 — Advice for Practice Owners 37:06 — AI in Speech Therapy 39:00 — Mission: Everyone Can Express 40:48 — Find Speech Matters Clinic 42:21 — Podcast Wrap Up ABOUT THE GUEST Ashlyn Lelej, MS, CCC-SLP is a speech-language pathologist and the founder of Speech Matters Clinic, a family-centered practice she established in Charlotte, NC in 2009. With over 20 years of experience spanning private practice, schools, inpatient, outpatient, and home health settings, Ashlyn brings both clinical depth and business-owner perspective to the conversations most providers aren't having. Her areas of focus include pediatric feeding disorders, neurodiversity, aphasia, and the evolving models of speech therapy treatment. She is a passionate advocate for families navigating complex systems — and for the clinicians working inside them. 🌐 speechmattersclinic.com 📸 @speechmattersclinic on Instagram ABOUT THE HOST Dr. Soma Mandal, MD is a board-certified internist and nationally recognized expert in midlife and menopause. She is the author of Dear Menopause, I Do Not Fear You and Midlife Masala, and the host of Soma Says — the podcast where women's health gets personal. Dr. Mandal blends Western medicine with Eastern wisdom to deliver no-fluff conversations for women 40 and up navigating perimenopause, hormone health, aging, and beyond. 🌐 somamandalmd.com 📸 @drsomamandalmd on Instagram CONNECT & SUBSCRIBE 🎧 Subscribe to Soma Says on Apple Podcasts or Spotify so you never miss an episode. ⭐ If this episode resonated with you, please leave a review — it helps more women find conversations that actually matter. 📤 Share this episode with a parent, a clinician, or a woman who has ever felt dismissed by the system. They need to hear this. The content of this podcast is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for guidance specific to your situation.