The speech-language evaluation process: what to expect

A speech-language evaluation session will often begin with the speech-language pathologist asking you questions about your child's health history. This might be in an interview format, or you may be asked to fill out a questionnaire before or during the session, or there may be a combination of the two. Answer all questions as honestly and completely as you can, even if you don't understand why they're being asked.

In most cases, the SLP will administer one or more standardized tests. In addition, the SLP will spend some time interacting spontaneously with your child, or watching you interact with her. During this period, the SLP is watching and listening for behaviors that round out the pre-testing impressions of what strengths and needs the child has and where to focus the speech testing.

A speech-language evaluation will often include a hearing screen to rule out a hearing loss as a cause or contributing factor. The hearing screen does not prove conclusively whether or not your child has a hearing loss. If your child fails the screen, you will be referred to an audiologist for further testing.

If you are present during the evaluation session, the SLP may sit down with you afterwards to discuss initial observations. Remember that this is not a final or definitive diagnosis. The SLP has gathered a lot of information and now needs time to sit down and analyze it. Most SLPs are able at this point to have a pretty good read on the child's strengths and needs, but the analysis and scoring of the test results should not be done hurriedly. Goals and recommendations that are well-matched to the child's needs are more important than same-day service.

The next step in the process is for the SLP to write up a report detailing the findings of the evaluation and recommending a course of action, and to meet with you to discuss the findings and recommendations. A thorough report will include:

  1. History: a brief summary of your child's development, the reason for the evaluation, and any medical issues relevant to your child's speech-language development.
  2. Related testing: if your child has had any other testing that could be relevant to her speech or language skills, a brief summary of resuls is listed here. This could include occupational or physical therapy, psychometric testing, cognitive skills testing, etc.
  3. Tests and results: This is the section describing what measures were used to assess your child's abilities, and the results of those measures. Ideally, there will be some sort of explanation of the results. Percentile ranks and standard scores are no help at all if you don't know what they mean.
  4. Clinical impressions: Here the SLP discusses strengths and weaknesses that have shown up during the testing session. Some of these will be based on test results, but they may also come out of observation of the child's spontaneous interaction during the testing session. This section may also make note of factors that may warrant follow-up through related services (e.g., concerns about hearing loss or attention deficit disorder).
  5. Summary and Recommendations: This section will recap the child's background and reasons for the referral, the test results, and the clinical impressions. However, the main part of this section will lay out the SLP's recommendation for addressing the child's speech and language needs. It should contain a clear recommendation regarding speech-language therapy, including frequency and length of sessions; if therapy is warranted, this section will also list short-term and long-term goals to be targeted.

If the evaluation was provided by the school system, the meeting may also include the child's classroom teacher, a school administrator, and a special services coordinator, as well as any others who were involved in testing (e.g., occupational therapist, school psychologist) or who will be involved in providing services, such as a special education teacher if applicable. If the evaluation is done at a clinic or hospital, it may be only you and the SLP at this meeting.

During the meeting, you should think of yourself as part of the treatment team, because you are. You may not know as much about speech and language as the SLP, but (a) you know your child better than anyone, and (b) you spend more time with your child than anyone. If you don't understand something, or if you disagree with something, this is not the time to 'make nice' and let it pass without voicing your misgivings. In some cases, you will be asked to sign a document attesting that you understand the recommendations and agree to their implementation. You owe it to your child to understand what you are signing on to.

After the meeting, the next step is the therapy itself, if that is what is agreed upon. This is where the real work begins.

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