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The Speech-Language Evaluation:

When and Why to do it, and What to expect

When Should I Take My Child for An Evaluation?

Parents are good judges of what their child knows and understands, and are often the primary people in the child's life who understand what he/she is saying.  Often, when parents look at their child they may be consciously or unconsciously comparing him/her to siblings or other children of the same age. When parents are concerned about their child's speech and language development, they usually seek advice from friends or family members.  In response they often hear comments such as "Oh, he's (she's) just a 'late-talker' like I was, and now I'm fine", or "He'll (she'll) grow out of it".   Also, parents may turn to their child's pediatrician, who may tell them "Let's wait and see". The reason behind this response, is that although the developmental speech and language milestones occur in a consistent sequence, the ages at which children hit those milestones varies a lot.  However, there is a problem with this response: if you take the advice of "wait and see", you can sometimes run the risk that the child will fall farther behind.  So, you may ask... "How can I know for sure that he'll 'grow out of it and be fine'?" The answer: You won't know for sure - It's difficult to say with certainty where any young child's speech and language development will be in 3 months, 6 months or a year from now.  Ultimately, you need to follow your instincts.  If you're concerned, even a little bit, then chances are it's worthwhile to investigate into it.

Here are a few factors which you can consider while making your decision of when to have your child evaluated: (Some of the following are excerpts from various articles including those from the  American Speech-Language Hearing Association [www.asha.org])

•  Use of gestures: One study has found that when there is a low number of gestures used by late-talking children (with comparably low expressive language) it can indicate late language abilities. On the other hand, children with a greater number of gestures, used for different communication purposes, are more likely to catch up with peers.

• Age of diagnosis: More than one study has indicated that the older the child is at the time of evaluation and/or diagnosis, the less positive the outcome. Also, if a child is developing slowly during an age range when other children are rapidly progressing (e.g., 24-40 months), that child will be falling farther behind.

• Progress in language development: Although a child may be slow in language development, he/she should still be doing new things with language every month (at the very least).  For example: new words may be added; or already existing words may be used for new and different purposes (ex: "bottle" may one day mean "That is my bottle", the next day it means: "I want my bottle," and the next week it means: "Where is my bottle? I don't see it.").  Also, words may be combined into longer utterances, or such utterances may occur more often.  If there does not seem to be this type of progress being made, then it is time to look into an evaluation.

• Other factors efftecting speech development may include: Chronic ear infections, family history of speech and language problems, other medical conditions (ex.: pre- or post-natal complications or early childhood diseases or disorders), pre-maturity, and/or difficulties in other areas of development (gross- or fine-motor, etc).

It should be emphasized at this point, that if children exhibit the negative aspects of the above factors, it does not mean there is definitely a speech and/or language problem.  However, only an evaluation will be able to give you more definite information specifically about your child.   Of course, the decision is always yours as the parent, and the 'wait and see' theory may work for your child.  However, it should be noted that many studies have found that intervention early-on seems to be very beneficial for a child's success. An evaluation can only serve to help you and your child. If you are still unsure, contact a Speech-Language Pathologist (Speech Therapist) to discuss your concerns.

Why Is An Evaluation Necessary?

Speech-language evaluations are administered by Speech-Language Pathologists (Speech Therapists) in order to determine where a child's strengths and weaknesses are.  The information gained from an evaluation is used to determine if further assessment is needed, and if intervention (therapy) is needed or not.  Do not make the assumption that an evaluation always leads to therapy.  There are cases where the Speech-language Pathologist will not recommend therapy at the conclusion of the evaluation.  Sometimes, the therapist determines that the child is performing adequately for his/her chronological age, and may then recommend a re-evaluation in a specific length of time (usually 6 months to a year), in order to monitor the child's progress.  If therapy is recommended, the information gained from the evaluation will be used in forming goals and objectives for the child to work toward.  Therefore, the therapy can focus on helping the child achieve success in those areas.

 What to Expect:

 Initially, a case history form is usually filled out by the parent which gives the Speech-Language Pathologist some background information about the child and his/her family.

 The evaluation usually lasts about one to two hours - depending on the child's age, the child's cooperation, as well as the type of evaluation that is administered.  Parents are often in the evaluation area in order to offer additional information about the child's speech and language use at home or around others, and to interact with the child to help him/her feel at ease.   

As much as possible, administration of standardized tests is used in order to look at statistical information on where the child falls in relation to other children of the same chronological age.  In addition to standardized testing, informal testing methods are also used via playing with toys, looking at pictures, and having conversations.  The informal methods give the Speech-Language Pathologist a chance to see the child skills during natural interactions.  

Following the evaluation, the Speech-Language Pathologist will discuss the results of the testing and provide the parents with recommendations for what the next step will be. Some examples of common recommendations are: 

1.      A re-evaluation in a set length of time without the initiation of therapy;

2.      Initiation of therapy and the specified length of sessions (ex: 30, 45 or 60-minute sessions) and frequency of sessions (i.e.: how many sessions per week);

3.      Referral to a physician (ex: an ENT, a Developmental Pediatrician, etc.)

4.      Referral to another specialist / therapist (ex: an audiologist, a physical therapist, an occupational therapist, etc)

5.      Referral for an educational evaluation or placement (ex: State-run Early Intervention Programs, School district child-study team evaluations, etc.)

 Usually, there is a written report which outlines the child's background history, the statistical information from the evaluation, and a diagnosis or clinical impression. There is usually a recommendation section and a section which outlines suggestions for therapy goals. Of course, every Speech-Language Pathologist has her/his own method for conducting the evaluation, discussing their recommendations, and writing reports.

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