What Issues Should be Considered when Assessing Speech and Language?

Assessment of children with speech and language disorder can take place from infancy through adulthood. Parents should be sure that a speech-language pathologist (SLP) is part of the assessment team for their child of any age. An audiological exam should precede a speech and language assessment to be sure there is no hearing loss or to refer to an ear specialist, if necessary.

Assessment should include a hearing test, a parent interview, an oral-motor exam, testing of both receptive (listening) and expressive (speaking) vocabulary and syntax, and assessment of speech (sound production), voice, and fluency. For children with fragile X, assessment should also include a pragmatic evaluation, if possible, with peers or family members. Assessment does not need to be primarily with formal, standardized tests, although school SLPs may wish to try and obtain scores and levels of language development.

For the parent interview, parents may wish to bring baby books or other records of developmental milestones to help them in filling out checklists and ratings. Their knowledge of the child's understanding of language, as well as his or her speech and language production, is an essential part of the assessment.

Assessment of very young children usually is based upon both checklists and rating scales given to parents and play-based assessment, where the SLP interacts with the baby or toddler using toys. She or he watches for comprehension and expression of language. She also watches for interaction with the people present and the toys. The SLP is watching for communication attempts, problems solving, and exploration by the baby or toddler, in addition to levels of language understanding and speaking ability.

At the early childhood and school-age level, the SLP may be assessing the child with a combination of parent interviews, formal, standardized tests, informal checklists, and observations. The SLP is measuring both receptive and expressive abilities in semantics (vocabulary), syntax, and pragmatics, in addition to articulation, auditory processing, oral-motor development, and hearing. For children with fragile X syndrome , the importance of a calm, quiet testing room, preferably with a familiar person, cannot be overemphasized. Many scores obtained for children who have fragile X may not be representative of their true potential, as they are anxious and overwhelmed by a strange testing situation.

For children who are speaking, the SLP may wish to obtain a "language sample". This involves conversation with the child, while video or audiotaping, for analysis of sentence length, intelligibility of speech, vocabulary, and conversational strengths and weaknesses.

Assessment of children who have fragile X should be an on-going process, not a once a year formal evaluation. SLPs monitor progress with language samples and "diagnostic teaching" (testing for a concept, teaching it, and testing again) throughout the year.

Gail Harris-Schmidt, Ph.D., CCC-SLP
Saint Xavier University
Chicago, Illinois

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