What You Can Expect From Speech Therapy {A Guide for Parents} Part Four: Understanding the Assessment Results and Recommendations

Welcome to the fourth installment of What You Can Expect from Speech Therapy {A Guide for Parents}. In the last installment, we talked about the assessment process. Now that you have gone through the assessment process, it is time to go over the assessment results and the recommendations.

Welcome to a Whole New Language

Before we start, I just have to say: BREATHE. The assessment process can be a stressful and confusing one and now that you are in the middle of it, you will be given a report with a bunch of words that make no sense to you.

The thing is, the world of special needs and special education has it’s own LANGUAGE. Terminology that you have never seen before, numbers you don’t understand, percentiles that you are not sure are good or bad. Some reports can be PAGES AND PAGES long, depending on how many professionals are involved, how many assessments were given, and how thorough the testing process was overall.

So breathe in and out and know that eventually, most of this will make sense (I hope!).

The Assessment Report Format

Speech and language assessment reports will all look a little different depending on many factors such as the setting of the assessment (school vs. private vs. medical), the reason for the assessment (what the concerns were), and the style preference of the individual SLP. In addition, some assessment reports are just for the area of speech and language, while other assessment reports will be team based and will contain the results from assessments in many different domains (psychological, learning, fine motor, gross motor, etc).

Regardless of the exact format of the report, the speech-language pathologist will be reporting on some or all of the following communicative domains: Articulation/Phonology/Intelligibility, Oral Motor Skills, Receptive Language, Expressive Language, Social Pragmatic skills, Voice, Fluency,  and will likely comment on general behavioral observations during the assessment process. Typically you will see the report separated by these domains and they *should* be explained within the assessment. I went over what all these domains in the last installment(Part three).

Within each domain, the report will explain the assessment measures used to assess your child’s skills. These may include observations, informal and formal assessments, parent reports/interviews, check lists, etc. A brief description of these assessment measures is usually included to provide you will more information on how the assessment was given and exactly what it measures. If not, ASK. (TIP: As you read through the assessment report, make notes with your questions that you can address when you go over the report with the SLP. Ask ask ASK as many questions as you can. We don’t expect you to understand it all and though we try to explain things within the report and during face-to-face meetings, we SLPs will sometimes forget that you may not know what a term or a number means. So take notes and ask!).

The Assessment Results: What Do These Numbers Mean!?

BEFORE WE BEGIN: I have to say that these numbers are JUST numbers. They do NOT define your child nor do they define you as a parent. These numbers also cannot predict how much progress your child can make. These numbers are only important, in most cases, to determine if your child has a disability and if they qualify for services. Beyond that, they are not really very helpful. What is helpful, is all the information we gather during the entire assessment process which tells us your child’s strengths and weaknesses, so that we can best help your child. 

Sometimes, the numbers can be scary. It is ok to be scared, but know that we are here to help your child thrive, no matter what numbers you see. 

When your child is assessed using a standardized testing measure, the test scores available compare your child’s performance to that of their same aged peers (chronologically). The two main scores that are typically reported are the Standard Score and the Percentile Rank. There may also be an Age Equivalent listed as well. In addition, they may refer to standard deviations. Let’s talk about these terms.

Your Child’s Chronological Age: As I have mentioned before, standardized assessments compare your child to children of the same chronological age. Therefore, you will see your child’s chronological age at the time of testing listed on the report. We report your child’s age in years and months, because especially in the first five years of life, there can be quite a bit of variance of skills in a 3 or 6 month time frame. So, if your child is 3 years and 8 months old, your child’s age will be reported as 3-8.

Standard Score: Standard scores are based on a scale where 100 is the average (mean) score. 15 points above and 15 points below, so 85-115, are considered to be in the “average range” in comparison to children of the same chronological age. Below 85 is considered below average and above 115 is considered above average.

Standard Deviation: Standard deviation is a set value point away from the mean (average). Standard deviations are used to determine eligibility for services in some settings. For example, in some areas a child will need to score two (or more) standard deviations below the mean (average) on an assessment (or multiple assessments) to qualify for speech and language services. Standard deviations go both ways, so -1SD or -2SD would be 1 and 2 standard deviations BELOW the mean, while +1SD and +2SD would be 1 and 2 standard deviations ABOVE the mean. Clear as mud, right? I usually do not report standard deviations in my reports, but some SLPs have to for the purpose of qualifying children for services.

Percentile Rank: Percentile ranks compare your child’s performance to that of his chronologically aged peers just like standard scores, but in a slightly different way.  If your child scored in the 75th percentile on an assessment, that means that he performed higher than 75% of his chronologically aged peers and that 25% of his peers performed higher than he did. So the higher the percentile rank, the higher your child performed in relation to his peers of the same chronological age.

In her book Childhood Speech, Language, and Listening Problems, (pg 45 in the 2001 copy I have) Speech Language Pathologist Patricia Hamaguchi explains that percentile ranks range from 1-99 and usually can be interpreted as follows:

95-99 far superior to peers
75-94 exceeds average performance
60-74 on the higher end of average
40-59 average
25-39 on the lower end of average
15-24 below average (may need help)
1-14 low (needs help)

Age Equivalent: Oh age equivalents. I personally am not a fan of these, and rarely report them because they are notorious for being a less accurate type of score in relation to a child’s abilities and the numbers can really scare parents. Unfortunately, however, some states/agencies require the use of age equivalents for the purpose of determining eligibility for services, so you may see this score on your child’s report. An age equivalent score is reporting that your child performed on the assessment with skills of that of a child of a certain age. So, your child may be 5 years 2 months old, but according to a given assessment measure, it may say he is only performing as a child at age 3 years 10 months. The reason these scores can be very inaccurate, is that often times, children with speech and language delays present with what we called scattered skills. This means, that they often will present with skills at an age appropriate level but will struggle with some skills usually mastered at a younger age. The assessment then “averages out” this performance, which can make a child “look” on paper to be performing much lower than he/she really is. And when a parent sees that their child’s “language skills are equivalent to a 3 year old” when their child is 4, how do you think that makes them feel?

What are the Assessment Results and Scores Used For?

There are a few things that we use these scores and assessment results for:

• To determine if your child has a disability and qualifies/needs specialized services
• To measure progress over time
• To help determine the type of service a child needs and the level of those services
• To help write appropriate goals and objectives for your child

What if There are No Scores?

There are some circumstances where the use of standardized assessment measures are not appropriate or possible. There are other times when a standardized assessment measure may be used in a non-standardized fashion (I talked about this in the last installment). For example, when SLPs are evaluating older children with more severe speech and language delays, we may use an assessment that is only standardized for young children, because tests normed for the child’s age will be too difficult to administer and the information gathered from the assessment would not be very useful. In these cases, it is not the scores but rather the information gathered during the assessment that is important. If this is the case for your child, this should be explained within the report.

Beyond the Assessment Results and Scores: Eligibility & Recommendations

Your child has now been assessed, and you have read over the results (and hopefully they have been explained to you in a meeting of some kind, depending on the setting of the assessment). Now it is time to move on to eligibility and recommendations.

Eligibility for Services: The whole assessment process’ purpose was to determine if your child has a delay/disability and of your child requires/is found eligible for services. As I talked about previously, each setting has its own set of eligibility requirements. Schools have different criteria from hospital/medical which are again different from those in private clinics/practices. The report should indicate of your child is eligible for services in whichever setting you are in and why/why not. If your child is found eligible for services, the SLP will then tell you her/his recommendations.

Service Delivery Models: Based on your child’s performance during the assessment process, recommendations for services (if your child is found eligible) will be discussed. The exact recommendations may or may not be included in the report itself. This will depend on the setting for the services as some settings cannot/will not provide service recommendations in the report. Whether in the report or discussed in person, there are many different types of services delivery models that may be recommended for your child, depending on his/her individual needs. Service delivery models refer to the way a child will receive speech and language therapy/support. Some of these service delivery models include:

• Individual speech services (also known as 1:1). This is where your child will be seen alone 1:1 with an SLP. 
• Group speech services (small or large): This is where your child will be seen in a group for speech therapy, and these can be small groups or larger groups. In the school system, this is one of the main service delivery models. Typically children are pulled out of their classroom with a few of their peers (3-6) for their speech services.
• Push-in speech services: This is where the SLP “pushes in” to the child’s classroom and prvides interventions within the classroom environment.
• Consultation speech services: This is a type of indirect speech service. This means, that the SLP will not be working directly with your child, but rather indirectly by consulting with the people in his/her life and coaching them on ways to help your child. This could mean working with your child’s teacher(s), other therapists (OT, PT, behavioral), as well as with YOU as the parent.
• Parent Education services: A model that is very common in Early Intervention is the parent education model. This is where the SLP does not work directly with your child, but rather works directly with YOU as the parent, to teach YOU how to best support your child. This is a fantastic model for the right children/families.
• Special Education Classroom: if your child has significant delays in speech and language skills, a special education classroom may be recommended with or without additional speech therapy. The type and quality of these classrooms vary from setting to setting and program to program. These classrooms can be available in early intervention programs as well as elementary, middle, and high school. There are some classes that are specifically for children with speech and language delays and some classes are actually taught by a speech-language pathologist!

It is important to note, that more than one model may be recommended for your child. For example, I usually offer both direct and consultation services to my clients (within the same session) when I work privately and in the schools I often added monthly consultation time as well so that I could consult with parents and teachers of my students. Another example is the combination of a special education classroom and direct speech therapy, or a combination of both individual and group therapy. The exact types of service delivery models will vary depending on your child’s needs and the setting of services.

Service Levels: Once a service delivery model has been recommended, it is time to talk about the level of service, or on other words, how often your child will get this service. The service level again will vary depending on your child’s individual needs and the setting in which he will be getting services. Some services are offered only once a month, while others are offered 5 days a week (like a special education classroom). In the schools, it is common for children to be seen 1-2 days a week for 20-30 minutes at a time in small groups. In private clinics, you will see a huge range from 30 minute to one hour sessions one day a week to multiple days a week. In early intervention, you may be offered weekly visits, bi monthly visits, or only monthly visits.

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Now that we have covered how to go about getting an assessment, the general process, the results and recommendations, it is time to talk about the ins and outs of speech therapy. What will the sessions look like? Will there be homework? How can you help? That’s up next!

Looking for more? A  great book that also covers all this information in more detail and more is (affiliate link->) Childhood Speech, Language, and Listening Problems by Patricia Hamaguchi. I highly recommend it!

To read the other installments in this series, click HERE. And stay tuned for more information on therapy settings, speech therapy myths, and what your SLP wants you to know!

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