A speech, language, and feeding evaluation is a 1-2 hour appointment, where a speech-language pathologist (speech therapist or SLP) assesses your child's receptive (understanding), expressive (spoken), social language, articulation, feeding, and play skills. The purpose of this evaluation is to answer the clinical question, “Will my child benefit from services?” The speech therapist will help you create a plan to support your child's development.
The most common concerns prompting this question can range from “I can’t understand my child,” to “My child is not talking as much as their peers,” to “My child just doesn’t seem to understand what I am saying,” and even “Mealtime is stressful and long.” If you have found that you have similar concerns about your child’s speech, language, and/or feeding development it may be time to consider a comprehensive speech and language evaluation.
How do children get a speech and language evaluation?
Children are scheduled for an evaluation with a speech language pathologist (SLP) when someone points out a potential concern related to their development of receptive (understanding), expressive (speaking), social skills, articulation, feeding, and/or play skills. It’s possible that you brought up concerns surrounding your child's communication development and asked for this evaluation. It is also possible that someone else (your child’s teacher or pediatrician) has concerns, but you don’t share those concerns. Both are very common scenarios for families-you are not alone! You are being a proactive and responsible parent by bringing in your child for a comprehensive evaluation! You will gain valuable information and strategies about language, play, and feeding development for your child.
Where will we go for a speech therapy evaluation for children?
There’s variability on where to go for an evaluation based on how you were referred. If a doctor refers you for evaluation through your insurance company, this will most likely take place either at a private practice or at an outpatient location through a hospital/medical group. If you are referred through your county's early intervention program, the visit may still take place at one of those facilities, but they may also come to your home. If your child is school-aged and referred through their school the speech evaluations will take place at your public school site.
How long will it take and what will we do?
A thorough speech and language evaluation can take 1-2 hours in an engaging and casual environment. The evaluation consists of different components, including:
Case History
Prior to the evaluation, your speech-language pathologist (SLP) will ask you to complete and return a case history form. This will include personal information as well as family, developmental, medical, and educational history. There will be a section concerning speech, language, and feeding history so the therapist can sufficiently prepare for the evaluation. This section will include questions about speech and language milestones, how your child is currently communicating and will provide an opportunity for you to share your concerns surrounding speech, language, social, feeding, and play skills.
Caregiver Interview
I like to think of this session as more of a discussion rather than an interview. Parents and caregivers know their children best and are the best informants therefore it’s critical that they’re involved throughout the evaluation process! Thus beginning with a caregiver discussion is typically the first portion of the evaluation. Many times, the parent interview portion of the evaluation helps the SLP gather a timeline of developmental milestones by discussing speech, language, feeding, and play skills as well as caregiver, teacher, or doctor concerns. Some of the questions you may be asked will be for an older child, so don’t worry if your child doesn’t do something yet. It is important to answer honestly because the SLP wants to help you and needs to know the full picture of what your child can do and what they are still working on. The SLP will ask questions related to the case history form you completed and what your goals are for the speech and language assessment. If you don’t feel comfortable holding a discussion around the child, a phone call can be arranged prior to the evaluation session.
Observations
After the SLP has a good idea of parent concerns and goals for the evaluation, they will get to know the child informally, during play and conversation. A good SLP will sit on the floor and engage your child in play. Most likely, the SLP is playing with your child in a specific way to observe what they do. Often the play will also include asking the child questions or giving the child directions to see how they respond. Very often children are reluctant to show all of their skills during this evaluation. We’ve all had that moment with our child where we ask them to perform in front of someone and they simply don’t do it. No doubt this will happen during your evaluation and the SLP will be very used to this! Your expertise as the caregiver informant will help fill in the gaps so the therapist gets the full picture of what your child's current functioning! The SLP also wants to see how your child plays with you, since you are more likely to be able to get your own child to open up. You should be able to feel free to sit on the floor and play too. The SLP will ask follow up questions after getting to know the child.
The evaluation may also include other activities, such as a hearing screening and/ or watching the child eat/ drink (to look at chewing and swallowing.) It may also include looking at a specific book of pictures and asking your child to point to items, name items, or describe things. This small portion of the evaluation may be a time when the SLP does not want as much help or parent reporting from you; it is best to ask if this is a time you are allowed to guide your child or if the therapist would rather you just watch for these few minutes.
Oral Motor Examination
Oral motor skills refer to the movement of muscles of the face (e.g. lips and jaw) and oral area (e.g. tongue and soft palate), especially the movements related to speech If an oral motor examination is warranted and appropriate, the SLP will examine the child’s facial symmetry, dentition, and take a look inside their mouth. They will also ask your child to make certain movements (silly faces) with their lips and tongue. We realize this may be uncomfortable and feel scary for a young child so we make it quick and have some tricks to make it fun!
Formal Testing
There are many standardized speech and language tests used to examine different domains. Some areas that may be tested include: articulation, apraxia of speech, receptive/expressive language, feeding, play, social skills, fluency/stuttering and reading/writing. An SLP will use different tests for a toddler with delayed language and an elementary school student with reduced intelligibility. As such, this portion of the evaluation will vary greatly depending on a child’s age and speech and language concerns. During this portion of the assessment, the SLP will administer 1 or more standardized tests to the child. Many standardized tests are norm-referenced, meaning the test yields a score or multiple scores used to compare your child’s scores to those of same aged children Assessments for toddlers are typically play-based, completed on the floor and involve parent and caregiver input. For preschool and elementary school children, parents are asked to watch quietly. These often involve looking at pictures in a book (test stimuli), following directions and answering questions. For older children reading and writing may be tested as well to assess all aspects of language.
Language Sample
A language sample is used as a way to analyze speech intelligibility and expressive language skills. A language sample consists of eliciting and gathering a spontaneous sample of one’s speech. It often consists of at least 50-100 utterances spoken by the child.
Language samples are critical for assessing one’s speech and they allow us to gather a variety of data. We can assess utterance length, vocabulary, syntax, semantics, morphology, pragmatics, narrative skills, comprehension, and more. It’s best to elicit a language sample during play using highly engaging toys while following the child’s lead.
Discussion of Results and Recommendations
At the end of the evaluation, the SLP will briefly discuss initial impressions and recommendations with you. There are numerous points that may come from your speech therapy evaluation. If a speech, language, and/or feeding delay is identified, the SLP may suggest speech therapy. They also will likely have suggestions of other places you can call to access services, and possible referrals to other specialists. .
What should I bring to my speech-language evaluation?
Bring all completed paperwork that the center sends you in advance, if any. If your child has had additional testing somewhere else and the therapist does not have a copy already, bring those reports for the SLP to review. If you can, write out a list of words that your child can say (on their own, without you saying it first) and bring it with you because the SLP may ask you what words the child can say. Don’t forget to bring the normal stuff you keep in your diaper bag (snacks, favorite toys, diaper change, etc.) Keep your toys in your bag unless the SLP asks you to get them out.
Pro tip: try not to let your child play on your phone/tablet in the waiting room if they are inclined to become upset when you turn it off, just to avoid having your child already be upset when the evaluation starts.
Having a speech-language evaluation for your child is a great way to feel empowered and educated to better:
Understand your child’s strengths
Learn what your child may be struggling with and what to do about it
Discover the next steps to foster your child’s development
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