What You Can Expect From Speech Therapy {A Guide for Parents} Part Three: The Assessment Process

Welcome to the third installment of What You Can Expect from Speech Therapy {A Guide for Parents}. In the last installment, we talked about how you can go about getting your child a speech and language assessment. Now that you have decided where you will start this journey (early intervention, school district, private practice or through a hospital/medical clinic) what will this assessment process look like? What will happen and how can you prepare?

How You Can Prepare for the Assessment

Before your assessment, there are a few things you can do to prepare yourself and your child. Here are some general recommendations:

• Have any and all paperwork completed before the assessment (if this is option). This allows the SLP to be able to go over the information you provide and ask you any follow up questions. You will receive some sort of health and development questionnaire and your answers to these questions can really help your SLP get to know your child and his history. 
• If possible, let the SLP know ahead of time about your child’s interests. This can help the SLP plan appropriate activities that will allow your child to feel comfortable and help your child build trust in this new person.
• If you have a young child under age 5, you may want to let them know that a special friend will be playing with them (either in your home or in their office, depending on the location of the assessment). If you know the SLPs name ahead of time you can share that with your child as well. I usually advise my clients/parents of young children to let their child know they will be playing and talking to “Miss Katie.”
• Make sure your child is healthy and (hopefully) gets enough rest before the assessment. Sick children don’t do well being assessed.
• If your child is being assessed in the schools, you can let your child know that he/she will be pulled out of class to talk to {insert name of SLP} so she can listen to his/her speech and language skills. The SLP will also go help explain to your child what is going on, but it is always good to have these open conversations with your child and allow them to ask any questions they may have.

The Screening

A Common First Step is a SCREENING

Many times, before your child is given a full speech and language assessment, your child will first be screened by a speech pathologist. A screening usually consists of a short (20 minutes or so) meeting with your child (and yourself, if appropriate) where he will be asked to repeat some words and answer some questions and take part in a short conversation. This also may include a short observation of your child in the classroom (if your child is school aged). The information from this short meeting and any observations will help determine if an assessment is indeed indicated.

Screenings are usually the first step in the assessment process in the schools and in early intervention. In fact some schools will do school wide speech and language screenings for incoming kindergardeners. In some areas, private practices or medical/hospital clinics will offer free speech and language screenings to the public as well. There is even an SLP who comes to my daughter’s private preschool every year that does speech and language screenings for a small fee.

After the Screening: What Happens at the Assessment

After a screening, if indicated you will be off for a full assessment. Regardless of the setting of the assessment, you can expect the basic following things during the assessment process:

• Paperwork: Your SLP will be giving you some paperwork to fill out either before the assessment or during. Forms may include a health and development form (to provide her with as much background information as possible about your child’s development), a release of information form (to give her permission to communicate with other professionals if needed like your pediatrician, preschool teacher, other therapists, etc), and a permission to assess form (written permission to assess your child). There may be other informational and legal paperwork as well depending on the setting of your assessment.
• Parent Interview: The SLP will want to talk to you about your child, your concerns, and and go over the health and development form to gather as much information as possible about your child’s current levels of functioning and health background. The SLP will also want to know what YOUR concerns are for your child and why. 
• Teacher/Caregiver/Other Specialists Interview(s): With your permission, the SLP may interview your child’s teacher(s), daycare provider, and any other specialists your child may already have a relationship with (occupational therapist, physical therapist, pediatrician, neurologist, etc). These professionals may have valuable information for the SLP in regards to your child’s development.
• Observations at School/Daycare: With your permission, your SLP may ask to observe your child in different natural environments to gather more information about his/her speech, language and communication skills. I did preschool observations a LOT when I was still working in the school setting. I find these observations SO valuable in regards to seeing firsthand how a child uses his/her communication skills in different environments. Usually this is also the time the SLP will interview your child’s teacher/caregivers.
• Observations/interactions with the child: The SLP will observe your child and will interact/play with your child to both build rapport and to begin to observe your child’s speech, language and communication skills. These interactions can look like she is “just playing” or “just talking” to your child, but the SLP is observing and taking note of specific skills your child is using.
• Oral Motor Exam: The SLP will attempt to do an evaluation on your child’s oral motor abilities. She will look in your child’s mouth and ask him/her to do different movement with his/her lips, tongue, and jaw to check to make sure he/she has adequate strength, control and mobility of the oral structures for speech. I use the word “attempt” because sometimes kids just do not participate in these activities, but the SLP will do his/her best to gather information about your child’s oral motor skills.
• Speech and Language Sample: The SLP will either write down or record a short sample of your child’s speech (if your child is verbal) to later analyze, looking to see what kinds of words he uses, how many he can put together, analyze his/her syntax and semantics skills, general vocabulary use, etc.
• Formal/Standardized Assessment Measures: The exact formal/standardized assessments that your child will participate in depend on your child’s age and suspected needs (I cover these below). Formal/standardized assessments are those that are designed to compare your child’s abilities to other children of their same chronological age. The results of these assessments (along with all the other information above) help the SLP determine if your child has delays in his/her speech or language skills and if so, how severe.
• Informal Assessment Measures: Informal assessment measures refer to the activities and interactions the SLP does with your child that do not involve a standardized measure as mentioned above. This includes some “games” or “play” and conversations that happen within the session. During these activities, the SLP is taking careful note of how your child is communicating and interacting with those around him. Though you may think the SLP is just “playing and talking” to your child, in reality these activities often give SLPs the most valuable information during the assessment process!

What Will the Speech Pathologist be Looking For? What Areas Will Be Assessed?

The exact assessments your child will participate in will depend on what the suspected areas of weakness are. However in all speech and language assessments the SLP will be looking at the following skills, either formally or informally:

• Articulation/Phonological Skills: How your child can physically produce and sequence speech sounds and your child’s speech intelligibility. For more information on articulation/phonology, check out my post HERE.
  
• Oral Motor Skills: How well your child can move and coordinate the lips, tongue, jaw and other oral motor muscles required for speech production as well as to check the strength of these mechanisms.
• Receptive and Expressive Language: What your child can understand and what he says. For more information on the definition of language, please read by post HERE.
• Pragmatic Language/Behavior skills: These are also known as social skills or social language. This looks at how your child USES language to communicate and if he/she can use language appropriately in different situations. For little ones, we look to see if the child uses language to request, protest, initiate interactions, ask questions to gain information, etc. We also look at how children use eye contact and body language to communicate as well as how the child interprets  OTHER people’s body language and nonverbal communication.
• Speech Fluency: This refers to how fluent a child’s speech is. Is there stuttering behavior present? You can read more about stuttering HERE.
• Voice Quality: Lastly, the SLP will be listening to your child’s voice to make sure his/her voice quality is healthy and free from horseness, nasality, etc.

Special Considerations

I mentioned the use of standardized/formal and informal assessments above. It is important to know, that sometimes standardized/formal assessments are not appropriate or even possible to administer, at least not “correctly” for some children. Many assessments are very specific in how they are to be administered (like with specific wording, few or no repetitions, no additional cuing, etc) in order for the score to be valid. There are many children with special needs that simply cannot participate in the test in the way it was designed. In these cases, the SLP may depend solely on informal assessment measures or the SLP may still administer some formal assessments but with modifications. Though modifications will void the validity of the standardized score, an SLP can still gain a great deal of valuable information about a child’s speech, language and learning skills by using the standardized assessment in a non standardized fashion.

Timelines: How Long Does All This Take?

It is important to know, that assessments don’t happen overnight. When you are dealing with public services (like Early Intervention or the School District) there are legal timelines they must follow from the time you ask for an assessment until actually have an assessment and then until you have a meeting to determine eligibility. The exact timelines vary from state to state so I ENCOURAGE YOU to do your research to make sure you stay on top of the timeline in case the agency you are working with slips up. Here in California, for example, a school district has 60 days to perform an assessment once you have signed the consent to assess.

If you are seeing out an assessment by a private practice, you may have to deal with wait lists and with medical/hospital services you may have to deal with pre approvals as well as wait lists…so be sure to be proactive and start the process as soon as you have concerns in case you have to wait to get in for your assessment

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Now that we have covered how to go about getting an assessment and the general process, it’s time to go over the RESULTS of the assessment. 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. 

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