The evaluation process usually begins with a gathering and review of historical information about the child. Historical information can be gathered from parent interviews, previous clinical information, and standard questionnaires. This information may include reasons for referral, results from previous testing or treatment, as well as pertinent developmental information about the child. When gathering this information, the team must determine what is known about the child versus what needs to be learned in the current evaluation to establish the presence and type of disorder, and to contribute to the development of a treatment plan. Basic questions to consider when gathering this initial information regarding a child’s communication include:

A common method for gathering this case history information is to ask families to fill out a questionnaire with queries like the above, prior to the evaluation session, and to conduct an interview with the parent at the time of the assessment to clarify and supplement the written information. Caregiver information gained through questionnaire and interview procedures can supplement results gathered from direct interaction between the clinician and child. Caregivers can provide information about the child’s communicative functioning among a variety of contexts, including home, school, and with peers. Caregivers can describe their own concerns by outlining the child’s communication performance across these natural contexts. Parent report can give the clinician a better sense of the child’s everyday communication challenges and areas of weakness. Tyler and Tolbert (2) describe other advantages to caregivers as partners in the assessment process, including the tendency for young children to be reluctant to interact with a clinician or in an unfamiliar environment.
Allowing a child to play or converse with a parent, for example, provides a way for the clinician to observe the child’s communication and interaction style indirectly, and may put the child and parent at ease. Additionally, parents may be reluctant or anxious to raise certain of their concerns or reveal specific information in direct conversation with an unfamiliar clinician. In order to decrease both caregiver and child stress, to minimize additional testing sessions, and to obtain a representative sample of the child’s skills, gathering information from parents and caregivers as they both describe and interact with their child, can increase the efficiency of an assessment, as well as decrease the stress induced by long testing sessions. Some examples of parent report instruments appear in Table 4.2.5.3.

Once sufficient information about the history and the problem has been gathered, the team will determine the child’s general developmental level to begin the evaluation process. Assessment of general developmental level, usually through psychological testing of cognitive and motor function, will help to establish the level of communication skills that might be expected, and help to select instruments that will target skills at the appropriate level.

Communication evaluation will usually include a battery of standardized assessments that provide an answer to the question of whether this child is significantly different from other children in terms of the ability to speak, understand language, and use speech and language to communicate with family, teachers, and peers. For this purpose, again, tests with strong psychometric properties must be chosen in order to answer the question in a fair and valid way. Some examples of tests often used for evaluation at various stages of development are listed in Table 4.2.5.4.

If testing confirms the observations of parents and teachers and corroborates the screening result that the child is showing difficulty with communication skills relative to others at his/her developmental level, the child can be identified as having a disorder in this area. However, not every child who tests low on a standardized test will be able to receive services for a communication deficit. Local, state, and federal regulations determine what level of impairment is necessary for eligibility for educational services of various kinds, including communication services. Thus, one outcome of evaluation will be a determination as to whether a child’s disability is severe or pervasive enough to qualify for publicly funded services. Clinicians, then, need to be aware of local requirements for eligibility. If a child fails to meet eligibility criteria, parents may opt to obtain services privately.

In addition to establishing eligibility for services, the evaluation process is aimed at integrating data from the various professionals on the team in order to arrive at a diagnostic label that best describes the child’s conditions. Communication disorders are very frequently associated with a variety of conditions, as Chapter 3.1.4 explains. So although failure to talk or poor speech development is frequently a child’s presenting problem, it is often the case that evaluation uncovers deficits in other areas of development, such as cognition, hearing, motor or social skills that contribute to the choice of diagnostic label. When this happens, the child may receive a diagnosis of mental retardation, autism, etc. The conferring of one of these diagnoses, however, does not mean that the child’s need for communication assessment and intervention diminishes. Even when a child’s primary diagnosis is something other than a specific speech or language disorder, assessment of communication strengths and needs remains important in order to develop an intervention program that will address all of the child’s developmental concerns.