A comprehensive Speech and Language evaluation examines a child’s communication and learning skills. Specific assessments are administered based on concerns a parent, referring physician, or teacher may have for the child. Various areas of skills are examined such as articulation, phonological disorder, speech motor planning, receptive language, expressive language, pragmatic language, written language, auditory processing, fluency and voice, oral motor functioning and cognitive skills.
Our Speech and Language evaluation includes standardized testing processes, language sampling, a hearing screening, behavioral observations, and informal data collection. Standardized tests can provide more information as to the possible causes of speech and language delays and disorders.
Articulation is the process of producing speech sounds by coordinating the movements of the speech mechanism such as the tongue, jaw, teeth, lips, palate, vocal folds, and respiratory system. An articulation disorder occurs when a child produces a sound incorrectly (such as saying /s/ with the tongue between the teeth resulting in a “th” sounds instead of the tongue being behind the teeth to a make a crisp ‘sss’ sound), substitutes one sound for another sound (such as producing the /r/ sounds as /w/), omits a sound, or produces the sound in a distorted manner (such as producing a sound such as /s/ with a lateral airflow, instead of a centralized air flow resulting in a “slushy” sound quality). A phonological disorder is considered a speech sound disorder that is characterized by consistent error patterns that can be grouped together called phonological processes. Phonological processes are the patterns that young children use to simplify adult speech. All children use these processes while their speech and language are developing. As children mature, their speech does as well and they stop using these patterns to simplify words. When a child continues to use these processes beyond a certain stage of development, it is considered developmentally inappropriate and can be diagnosed as a speech sound disorder. For example, a child may express the phonological process of fronting where velar sounds (sound produced in the back of the mouth) /k/ and /g/ are produced in the front of the mouth as a /t/ and /d/.
Speech motor planning is the ability to come up with an idea, plan how to say or express that idea, and then coordinate the articulators (including the tongue, lips, cheeks, and respiratory system) and movements needed, to appropriately sequence the sounds within words in order to articulate intelligible speech. CAS is a motor planning, programming, and sequencing disorder that is neurologically based and in the absence of muscle weakness by which the precision and consistency of movements underlying speech are impaired. A child with a motor planning and sequencing disorder, such as CAS, may know what they want to say, but is unable to successfully plan, organize, initiate and sequence the motor movements needed to formulate sounds and words to produce their intended speech. This often results in significant difficulty producing intelligible words (or sentences), inconsistent and unpredictable errors, and increased difficulty as the complexity (a simple consonant-vowel-consonant word vs. a multi-syllable word) and length (a word vs. formulating a sentences) is increased.
Receptive language is the ability to understand words and language. Receptive language, also sometimes referred to as language comprehension, includes aspects such as following directions, answering questions, understanding concepts (such as size, shape, colors, sequencing, and time), understanding of grammar (such as plural –s means more than one, or past tense verb forms indicate something happened in the past), understanding vocabulary and word meaning, and understanding what your communication partner is saying or asking and providing appropriate responses. Receptive language also includes gaining information from visual information within the environment as well as written information and text.
Expressive language is the use of words, sentences, gestures, and the general ability to use language to communicate. Expressive language includes labeling objects, describing actions and events, telling stories, communicating wants, needs, ideas, thoughts, and asking questions. Expressive language also involves being able to functionally use vocabulary appropriately, make requests or actions, make comments, use descriptive language, formulate sentences that are grammatically correct, and following the social rules of conversation such as staying on topic, using eye contact and knowing how to respond when asked a question. Expressive language can be classified into three distinct parts semantics (the meaning of words and language), syntax (how words and phrases are arranged to make well-formed sentences in a language), and morphology (how words are formed, and their relationship to other words in the same language such as root words, prefixes, suffixes, etc.). Written language is also a critical component of expressive language.
Social skills and pragmatic language involve the ability to appropriately use language to convey an intended message (persuade, request, inform, express, regulate), change language (such as modifying language for different audiences or contexts), follow conversational rules (such as appropriate turn-taking, topic introduction and maintenance, and fixing conversational breakdowns), and interpretation and use of nonverbal communication. Social skills also include the ability to consider the context or situation, as well as considering your own and others’ thoughts, emotions, beliefs, perspectives and intentions and the ability to interpret and respond to information in socially accepted manners. Social Skills and pragmatic language also involve metalinguistic skills. Metalinguistics requires a person to reflect on and consciously ponder about oral and written language and how it is used. Metalinguistics requires interpretation beyond communication and meaning, and to instead focus attention on the underlying structures and meaning. Metalinguistic tasks involve skills such as the ability to interpret nonliteral or abstract language, interpret double meaning words, and make inferences. Metalinguistics are also integral to reading acquisition and literacy development and the writing process (for both compositions and revisions). Social skills, pragmatic language, and metalinguistics are critical skills for academic success as well as everyday interactions with peers and adults. For example, reading and analyzing stories requires understanding the deeper meaning behind the actions of the characters and their relationships. *For more information regarding social skills and pragmatic language refer to ‘Social Skills Groups’ under the ‘SERVICES’ dropdown menu.
Written language is a highly involved linguistic task that include metalinguistic skills and executive functioning, in addition to the motoric component of actually writing (or typing). Written language consists of several components including the mechanical component (the ability to write legibly), the productive component (the ability to generate enough sentences to convey one’s thoughts adequately), the conventional component (the ability to write in compliance with accepted standard of style), the linguistic component (the ability to use acceptable English) and the cognitive component. Written language also encompasses formulating ideas and concepts, pre-planning and organization, and composition. Additionally, written language includes the ability to spell, know and implement appropriate grammar and syntax. It is also highly metalinguistic as it involves the ability to reflect on, revise, and edit written text; the ability to address specific audience needs and convey the purpose of the text.
(Central) Auditory Processing refers to the perceptual processing of auditory information in the central auditory nervous system. This may include auditory attention, auditory discrimination, auditory sequential processing, auditory memory, auditory tonal processing, auditory figure-ground processing, temporal processing, and language processing. Difficulties that may be associated with auditory processing deficits may include difficulty in understanding speech in noisy environments, discriminating similar sounding speech sounds, following directions, and being able to localize or focus on a specific auditory source when background noise is present. It is important to note that auditory processing may coexist with other disorders such attention-deficit hyperactivity disorder (ADHD), language impairment, and learning disability. Differential diagnosis can be imperative in constructing the best treatment plan for a child with auditory processing concerns.
Paralinguistic communication is a meaningful and intentional means of communication that includes such skills as eye gaze, gestures, and imitation, but does not yet utilize a symbolic (or language based) system such as true verbalizations. Paralinguistic skills may include joint attention, social interaction, symbolic and parallel play, joint activities, and daily routines. Typical development of paralinguistic communication develops around 9-15 months and establishes the foundation for future linguistic communication. Paralinguistic communication is a prerequisite for later communication, fostering overall social and emotional development. This means of communication should be consistent and convey clear meaning with intent.
Fluency refers to the rate, smoothness, and effort in which speech is produced. While some disfluent speech is typical, often developmentally appropriate (and experienced by many children), the most common fluency disorder is stuttering. Stuttering includes repetitions of words or parts of words, as well as prolongations of speech sounds. Voice refers to the pitch, loudness, and rate of speech.
Oral-motor functioning refers to the use and function of the lips, tongue, jaw, teeth, and the hard and soft palates. The movement and coordination of these structures is very important in speech production, safe swallowing, and consuming various food textures. A child with an oral-motor disorder may have trouble controlling their lips, tongue, and jaw muscles, making everyday tasks such as speech, eating, or sipping from a straw exceptionally difficult. An example of oral motor dysfunction may be Oral Apraxia.
Phonological awareness is the explicit understanding, awareness, and ability to hear and manipulate a word’s sound structure. Phonological awareness is a multi-level set of skills that includes how words can be broken down into smaller units in differing ways. Tasks that require children to segment words into syllables, (syllable-level tasks), identify or produce rhyming words (rhyme-level tasks), identify individual sounds in words, blending sounds to make words, or segmenting words into their individual sounds (phoneme-level tasks) are all examples of skills that are encompassed under phonological awareness. Phonological awareness skills are critical for the efficient decoding of printed words and the ability to form connections between sounds and letters when spelling. *If your child’s primary concerns are related to phonological awareness, early literacy, or general reading skills, please refer to the ‘Diagnostic Dyslexia Evaluations’ under the ‘EVALUATIONS’ dropdown menu or the ‘SYNERGY DYSLEXIA CENTER’ tab for further information.
Cognitive skills are the core skills your brain uses to think, read, learn, remember, reason, and pay attention. Each cognitive skill plays an important part in processing new information. Cognitive functions may include logic and reasoning (e.g., forming concepts, problem solving, reasoning), long- and short-term memory, processing speech, auditory processing, and attention.
The Speech and Language evaluation is typically scheduled across two days. Duration of testing can last approximately two-three hours per testing session depending on the age and ability level of the child.
The parent or caregiver will be asked to complete a series of forms and questionnaires while the child is being tested (or prior to the evaluation appointment). These include general information forms, as well as a historical questionnaire and a learning and behavior rating questionnaire. These questionnaires are part of the complete testing profile, and it is important to answer the questions as fully and as honestly as possible so that we may get a clear determination of your child’s core needs. A parent or caregiver’s perspective is a critical piece in the testing process.
Any additional information you would like to bring, such as your child’s IEP, most current school or outside evaluation, is encouraged.
Your child will enter one of our colorful play therapy rooms with the pediatric speech-language pathologist and engage in floor play or sit at a table across from the test administrator and will be asked to respond to various test stimuli. Depending on the test being administered, he or she may be asked to wear headphones, look at pictures, remember and repeat information from a story, repeat a sequence of information, or other tasks. In the event that your child is unable to complete a particular test due to age or disability, alternative testing will be attempted in order to determine the underlying need. For example, if a child is unable to wear headphones for the auditory assessment, we can use another technique to determine the depth of phonological processing.
We prefer that the parent or caregiver not remain in the room when testing is being administered because we have found that it can be distracting for the child, or that the parent/caregiver feels compelled to “help” the child or “explain” a child’s answers, all of which can sway, or invalidate, the results.
It is important to remember that testing and therapy have two very different objectives. During testing, we are probing for a ceiling, or limit, on a child’s ability in specific areas. For example, a child might have to respond incorrectly to five questions in a row before the examiner stops asking questions and moves on to the next test. Testing must be conducted in a controlled environment, with no “coaching” beyond the practice items from the test administrator, in order to ensure accurate, valid results. We can’t tell a child, for example, if the response is correct or not. We also cannot guide the child towards the correct response. It is critical that the child respond to all test questions from their own knowledge and skill base so that we can determine the areas of need. We have an observation window on all our treatment room doors so parents may view their child during testing at any time.
The speech and language evaluation process consists of three appointments. This first two appointments are the direct evaluation with your child. The third appointment is the 30-minute results feedback session with just the parent(s) and the SLP. This feedback session is typically scheduled five business days from your child’s evaluation. This may be an in-person feedback session (preferred), or via phone, depending on circumstances. This feedback session is imperative to understanding the neurological underpinnings of your child’s delays and deficits and to participate in the formulation of his/her treatment plan. This one-on-one time with the SLP facilitates the importance of an ongoing relationship with your child’s intervention team. At the feedback session we will discuss the results of your child’s speech and language evaluation and provide you with therapy and/or program recommendations, as needed.
You will receive an email with the written report upon its completion. The written report will include interpretation of findings, a proposal for any recommended programming, recommended treatment plan including time and frequency of therapy sessions, and information on each of the recommended programs. We will only send a copy of the report to your child’s physician, specialist, school or other professional at your written request and authorization.
If your child’s evaluation was conducted within the past year, it is likely that your child will not have to undergo another comprehensive speech and language evaluation. However, it may be recommended that we administer one or two specific tests in the event that our speech-language pathologist feels there are missing components in the evaluation you bring to us.