Question
I am a pediatrician in training. When a child is referred to a speech and language pathologist, what constitutes an assessment?
Answer
When a child is referred to a speech-language pathologist, one of the first questions asked is, "Does this child have a communication disorder?" If it is determined that the child has a communication disorder, what aspects of communication are affected? Other areas that need to be addressed are: determining client and/or family reactions to the disorder, identifying associated problems, determining factors that may cause problems to be exacerbated, and determining prognosis. Therefore, the assessment consists of gathering information (e.g., interviews, written questionnaires, standardized tests, observation, and instrumented observation).
Typically the assessment begins with a case history. The case history usually involves a written case history, information-getting interview, and information from other professionals. As important is the identification of contributing factors (e.g., hearing impairment, medical factors, dental problems, etc. Assessment involves looking at the speech mechanism, commonly referred to as the oral mechanism examination. This is considered the physical examination of the speech mechanism (mouth and related structures). We examine the oral mechanism for structural and functional adequacy (e.g., range of motion, strength, symmetry of movement). Another area of assessment is an evaluation of speech sound production known as articulation. Tasks involve speech sampling and stimulability of error testing. A child's articulation skills will be judged based on number of errors, error types, forms of errors, consistency of errors, intelligibility, rate of speech, and prosody.
As part of the evaluation, one must examine basic motor processes (respiration, phonation, resonance, prosody, in addition to articulation) that are involved in the production of speech. Evaluation of a child's language ability (both receptive and expressive) is crucial to the assessment process. When assessing a child's language skills, the evaluation should focus on the following areas: pragmatics (use of language in context to express intent), syntax (patterns of word combinations), morphology (set of inflections that allows altered words), semantics (a child's vocabulary development), and phonology (sound system). Receptive language measures include identifying the child's ability to comprehend and follow directions.
Another area of the assessment is evaluation of child's fluency skills. Evaluation measures will examine and identify any disfluencies in the child's speech. Voice is another assessment area that is a component of a speech-language pathology assessment. The evaluation measures will identify if there is a persistent abnormality in the sound of voice. In addition, a swallowing evaluation may be conducted to investigate the child's swallowing abilities.
A hearing screening will usually be conducted as part of the assessment. The screening is used to identify if the child needs further evaluation which must be conducted by an audiologist.
The speech-language pathologist will use developmental norms and standardized measures to make a communication impairment diagnosis. Providing information to the client in the form of a written report concludes the assessment.
References:
Shipley, K., & McAfee, J. (2004). Assessment in Speech-Language Pathology: A resource manual (3rd ed.). New York: Delmar Learning.
Tomblin J., Morris, H., & Spriestersbach, D. (Eds.). (1994). Diagnosis in Speech-Language Pathology. San Diego: Singular Publishing Group.
Dr. Angela Sherman has been a speech-language pathologists for 11 years. She is an Associate Professor at Louisiana Tech University, Ruston, Louisiana. She resides in Calhoun, Louisiana.
