Every speech and language inquiry begins with a speech and language assessment. In today’s post, we will discuss the layout of a typical assessment for children and review the most common standardized tests used by Speech-Language Pathologists (SLPs) to assess speech and language in children.
Your child’s speech and/or language skills will be assessed using a combination of parent/client interview, informal assessment and formal standardized testing. The duration of an assessment (interview, informal and formal testing) varies according to age, history of previous assessments, the severity of the speech/language deficit, as well as the collaboration and attention of the child.
During the initial parent interview, parental, physician, and teacher concerns will be discussed. Additionally, we will examine medical history, developmental milestones, language acquisition (bilingual clients), educational history and family history. If the child is older and aware of their difficulties then the SLP will also discuss their concerns with them and what they hope to gain from speech therapy.
When you call a Speech-Language Pathologist (SLP) for an appointment, they will generally schedule a phone call with you prior to the evaluation. This is sometimes referred to as an intake call. They will ask you questions about the nature of the issue, why you are seeking out an SLP, and some general information about your child. We do this so that we can prepare for the evaluation (i.e. which standardized tests we should have on hand, what specific things we will probe for during the assessment and areas of focus).
Then the SLP will send you a form to fill out (or you will fill it out at the office) in order to get more information about your child’s development, medical history, family environment and history of communicative disorders, education, speech and language development/concerns, and more. The parent interview can thus be done over the phone during an intake call along with the case history form or in person at the SLP’s office.
During the informal assessment portion, we use a variety of toys, books or videos to elicit a spontaneous speech and language sample. We also observe your child’s speech, language, behavior, attention, memory, executive functioning, motor, and social skills in a natural context (play/conversation). We also do a quick assessment of your child’s oral mechanism structure and function.
A part of the assessment will involve playing with toys or board games. This is done so that the SLP can build a rapport with your child and gain their trust so that they warm up to the SLP and fully engage. Informal assessments are crucial because communication tends to break down at higher level language tasks (e.g. conversation). Thus, this gives us a better idea of the true nature of the child’s difficulties compared to easy one word test tasks.
The SLP will elicit a sample using play, a video, or books and will audio/video record your child given your permission. After the evaluation, the SLP will transcribe and analyze the spontaneous sample to determine if there are any speech and/or language anomalies. For instance, analyze a child’s language sample to determine if their language consists of all the age-appropriate morphemes. Often times, SLPs also take a narrative language sample to informally analyze higher level language skills (e.g. sequencing, reasoning, perspective taking) according to age.
During the informal assessment portion, the SLP will also make informal observations on other cognitive areas (attention, executive functioning, motor, memory) while engaging with your child. We do this to see if any other areas could potentially be impacting the child’s speech and language skills. For instance, if the child is unable to follow directions. We need to determine if the child cannot follow a direction because they do not understand the language (e.g. receptive language disorder), they cannot attend to the SLP while the direction is given (e.g. ADHD), or they cannot retain the information for an adequate amount of time needed to carry it out (e.g. executive function/working memory issue). This also allows the SLP to make appropriate recommendations to seek out further assessments/consultations with other specialized professionals (e.g. occupational therapists, psychologists, developmental pediatricians).
An SLP can only assess/treat and give a diagnostic regarding speech and language. We can make informal observations about other areas but cannot pose any diagnostic. That is why we simply provide parents with our observations/concerns and recommend they seek out the appropriate professional for further action.
If the child demonstrates speech difficulties, the SLP will also conduct an oral motor exam. This is done to determine if the child’s speech difficulties can be attributed to a structural or neurological component. The SLP will look in your child’s mouth using a light and tongue depressor. They will assess if their oral anatomical structure looks typical (teeth, tongue, palate, tonsils, velum, uvula) and take notes. For instance, sometimes an SLP will be the first to discover that your child has a submucous cleft, which could be the cause of their resonance issues (e.g. hypernasality).
The SLP will also ask your child to perform some oral motor tasks to assess the function of their oral mechanism (lips, tongue, teeth, jaw, velum). For instance, they will have your child smile, pout their lips out, stick their tongue out (move it around in different positions), puff out their cheeks, bite down on a tongue depressor, say “ah”, etc. Each exercise looks at a specific function and oral motor coordination. The SLP will also have your child try to execute two different exercises in alternating sequences. This is done to rule out apraxia (motor planning disorder).
The SLP might also use the diadochokinetic rate (DDK) assessment tool, which consists of having the child repeat “puh”, “tuh”, “kuh” as fast (and correctly) as they can to assess oral motor coordination and/or repeat “puhtuhkuh” or “buttercup” to assess their oral motor planning function. These types of assessments along with oral motor function exercises can help rule out the possibility of dysarthria or apraxia of speech. Not all SLPs may have your child do this. Usually it is done if they suspect an oral motor planning or coordination issue.
SLPs also assess and treat feeding and swallowing disorders. If you have concerns in this area or the SLP suspects a tongue thrust then the SLP will also conduct an informal swallowing assessment. They will usually give your child some water and some food of varied textures (e.g. pudding, fruit salad, crackers) and assess their oral function and swallowing for each type. Your child may have a tongue thrust, which not only affects their speech but the way they swallow as well. They have what is called a reverse/atypical swallow and their tongue will protrude between their teeth when they swallow. There are three phases in the swallowing process, the SLP will determine which phase is impaired and implement a suitable plan of action. Your child may also simply have aversions to certain textures sometimes attributed to a feeding disorder with no anatomical/functional difficulties.
Standardized testing is useful for quantitative information and in the public sector is necessary to determine the severity of the speech/language issue. In the public sector, your child will receive services only if they fall within a certain level of severity. There are norms associated with all speech/language standardized tests and your child’s score is compared to that of same-aged peers (recruited in the research study).
The bell curve is used to pinpoint where your child falls according to the score they received on a test. Depending on the country, there are different laws and regulations regarding the access to public speech and language services according to the scores. Usually, a child has to be within 1.5 to 2 standard deviations below the average (50th percentile) to qualify for services. However, sometimes children do very well on standardized tests and these tests are not very reflective of the extent of their deficit in naturalistic/academic environments. Hence, why the informal portion of our assessment is crucial to advocate for the need of services for the child.
If your child has an extensive speech and/or language disorder then standardized tests will be reflective of that issue. If the deficit is of minor/moderate severity then the child might sometimes do well on standardized testing but this does not mean that their speech/language disorder has a minor impact in their day-to-day life. Standardized testing also has limits. Often times, the norms used for the quantitative information were collected from same-aged peers with very different backgrounds than that of your child. For instance, a bilingual child’s score on an English standardized test cannot be compared to those collected from monolingual English speaking children. Often times, SLPs do not put a lot of focus on the scores children receive on these tests. Rather, we use these tests as guides to better understand which areas of language (semantics, grammar, pragmatics, reading comprehension, following directions) we should target in our intervention that are most challenging for your child and to track progress.
Standardized testing is time consuming. Depending on the test, the number of tests required, and your child’s language abilities, it can take several hours. That is why we usually stretch testing over several sessions so as not to exhaust the child. The SLP also usually pairs something motivating (e.g. stickers, board game turns, prize) with the testing to entice the child to continue as it can be a difficult task to carry out for young children. The following section will give you a brief description about the most commonly used standardized tests for speech and language.
The Goldman-Fristoe Test of Articulation 3 (GFTA-3) is a standardized assessment tool used to evaluate articulation skills. It can be administered to children as of 2 years old and up to adults aged 21 years old. This test analyzes articulation only in the English language. Their are two parts – Sounds in Words and Sounds in Sentences. Often times, SLPs only administer the Sounds in Words section and use their spontaneous speech sample for conversational analysis.
This is the simplest and quickest standardized test. Depending on the child’s age, speech/language skills, and attention, it can take between 5 and 20 minutes to administer. The child is shown a variety of pictures and then answers the SLP’s questions or fills in the blanks. For the most part the child is simply naming the pictures. The following are some examples of the pictures shown in the test and questions asked by the SLP. (Note: please DO NOT use these pictures and DO NOT show them to your child. Previous exposure to test stimuli can alter your child’s future results if they are assessed using the same test).
The SLP would point to the house and ask “What’s this?”, then he/she would point to the door and ask “What’s this?” and transcribe phonetically what your child produces for the words “house” and “door.”
The SLP would point to the red light and say “red means stop” then he/she would point to the green light and say “green means _”, then the SLP would wait for your child to say “go” and transcribe what they produced phonetically.
The SLP would point to the duck and ask “What’s this?”, then he/she would ask “What does the duck say?” and phonetically transcribe your child’s productions for “duck” and “quack.”
The Preschool Language Scales 5th Edition (PLS-5) is a standardized assessment tool used to evaluate pre-linguistic, expressive language and receptive language skills in children. It can be administered to children as of birth and up to 7 years old. This test can be administered in English and in Spanish. It is lengthy to administer, depending on the child’s age, attention and linguistic skills it can take between 45 min to 1 hour. Their are two parts – Auditory Comprehension and Expressive Communication. It is unique compared to most standardized tests because it uses manipulatives as well as picture stimuli and each test item can be scored according to whether the skill was observed, elicited or reported by a parent.
Some of the items in this test are relatively intuitive and some children will test very well. If this is the case but there is evidence of speech and language issues in the informal assessment portion, then it is possible that the SLP still recommends services. For infants and toddlers (up to 2;11 years old) this is the standardized test that is commonly administered. However, if the child is 3 years old, the SLP may opt for a different language assessment such as the CELF-P2.
The auditory comprehension section is used to assess the child’s pre-linguistic skills (e.g. functional play, symbolic play) and receptive language skills (e.g. following directions, understanding of nouns, verbs, adjectives). Children are given manipulatives (e.g. a bear, a box, a ball, a spoon, a cup, crayons) and asked to point to certain things or carry out specific actions (e.g. feed the bear). The children are also shown pictures and asked to point to what the SLP named or described. Depending on the child’s age, most of the assessment might simply involve assessing early pre-linguistic communicative skills and some use of manipulatives. Children 18 months and above will answer questions using both manipulatives and picture stimuli. The following are some examples of the pictures shown in the test and questions asked by the SLP. (Note: please DO NOT use these pictures and DO NOT show them to your child. Previous exposure to test stimuli can alter your child’s future results if they are assessed using the same test).
The SLP would ask the child to point to the thing they name (e.g. point to the bird, point to the cookie, point to the balloon). To get points the child has to point to the correct picture named by the SLP.
The SLP would ask the child to point to a specific kitten (e.g. point to the white kitten that is sleeping or point to a kitten that is not black). This tests the child’s understanding of language components such as nouns, verbs, adjectives, prepositions and linguistic concepts (e.g. negation – not).
The SLP would ask the child to point to the elephants in a specific manner (e.g. point to the elephants in order from biggest to smallest). This tests the child’s understanding of qualitative concepts (biggest, smallest).
The expressive communication section is used to assess the child’s pre-linguitic (e.g. smiling, vocalizations, imitating facial expressions) and expressive language skills (e.g. communicating using words, naming a variety of words, answering questions). Children’s expressive communication is assessed during play and with the use of manipulatives/picture stimuli. For example, the SLP analyses whether the child requests for objects and how they request (gestures, words, signs). The children are also asked to respond verbally to the SLPs questions regarding the picture stimuli. The following are some examples of the pictures shown in the test and questions asked by the SLP. (Note: please DO NOT use these pictures and DO NOT show them to your child. Previous exposure to test stimuli can alter your child’s future results if they are assessed using the same test).
The SLP would point to each picture and ask “What’s this?” and wait to see if the child could verbally name each one “spoon, cat, apple.” This tests the child’s ability to name pictures.
The SLP would ask the child “Kathy wants to play outside. What could she ask her father?” The SLP would then write down the child’s response and assess their ability to formulate meaningful, grammatically correct questions.
The SLP always gives an example of what is expected of the child. In this case, the SLP wants the child to describe something about one of the animals and the SLP has to point to the correct animal (e.g. point to the one with little ears, big ears). This tests the child’s ability to use modifying nouns in phrases.
The Clinical Evaluation of Language Fundamentals Preschool-2 (CELF-P2) is a standardized assessment tool used to evaluate expressive language and receptive language skills in preschool-aged children. It can be administered to children as of 3 years old up to 6;11 years. This test is administered in English. There is also a Spanish version. It is lengthy to administer, depending on the child’s age, attention, linguistic skills and amount of subtests given. It can take between 5 min – 20 min per subtest.
The CELF-P2 consists of seven subtests, often times SLPs will administer the primary 3 subtests (Sentence Structure, Word Structure and Expressive Vocabulary) to generate a Core Language Score. The Core Language score is calculated as a measure of general language ability and is used to evaluate a child’s overall performance. The other subtests that can be administered are Concepts & Following Directions, Recalling Sentences, Basic Conceps, and Word Classes. The following are some brief summaries of each subtest along with examples. (Note: please DO NOT use these pictures and DO NOT show them to your child. Previous exposure to test stimuli can alter your child’s future results if they are assessed using the same test).
The sentence structure subtest measures the child’s ability to understand grammatically correct sentences. Following an orally presented sentence by the SLP, the child points to the corresponding picture.
Given this picture, the SLP would ask “Point to – the girl has a big, spotted, black and white dog“, then the child has to point to the corresponding image given a field of 4 pictures to choose from. The SLP then writes down the child’s answer using a scoring sheet.
The word structure subtest measures the child’s ability to use morphological (grammatical) rules. The SLP shows a picture and gives a model of the target morphological rule, then starts the first part of a similar phrase and waits for the child to fill in the blank.
For example, given this picture, the SLP would point to the first image and say “This man sings. He is called a singer.” Then he/she would point to the second image and say “This man teaches. He is called a _”, pause and wait for the child to answer verbally “teacher.” The SLP then writes down the child’s exact answer.
The expressive vocabulary subtest measures the child’s ability to use referential naming (vocabulary). The child is given a picture and asked to verbally name the object, person or action.
For example, given this picture, the SLP would ask “What is the girl doing?”, then the child would have to verbally answer. The correct responses could be “riding, biking, pedaling.” The SLP then writes down the child’s answer on the scoring sheet.
The concepts and following directions subtest measures the child’s ability to interpret verbal directions of increasing length/complexity and recall nouns, characteristics and order of objects from the given direction. The SLP gives a verbal direction and then the child must point to the images according to the corresponding direction.
For example, given this picture, the SLP would ask “Point to the monkey after you point to the cats”, then the child has to point to the corresponding images in the given order. The SLP then takes note whether they answered correctly and any deviations made from the correct order (e.g. pointed to the monkey first).
The recalling sentences subtest measures the child’s ability to recall and imitate sentences of variable length and complexity. The child has to verbally repeat sentences orally presented by the SLP. There is no visual stimuli, this is an auditory task. The child needs to process the auditory information and be able to repeat it exactly as it was said. For example, the SLP might say a simple phrase to start like “He is nice” and increase the complexity to a sentence like “Because tomorrow is Saturday, we can stay up late tonight.”
The basic concepts subtest measures the child’s ability to understand concepts such as direction/location, sequence, size, number, quantity, and same/different. Following an orally presented sentence by the SLP, the child points to the corresponding picture.
For example, given this picture, the SLP would ask “Point to the one that is empty”, then the child has to point to the corresponding image given a field of 3-4 images to choose from.
The word classes subtest measures the child’s ability to understand and explain semantic relationships. There is a receptive and expressive component to this subtest. The child has to pick which two words go best together and then explain how they go together given auditory and visual information.
For example, given this picture, the SLP would first label each image “crayon, pencil, strawberry” and ask the child “tell me the two words that go together.” The SLP would then write down the child’s response for the receptive portion. For the expressive portion, the SLP would then ask how the two correct words go together (e.g. how do crayon and pencil go together?) and write down the child’s explanation (e.g. both are used for writing/drawing).
There are some additional rating scales, screenings for phonological awareness, and supplementary subtests. In a few cases, SLPs may administer these or ask that you fill out the forms for pragmatics skills.
The Clinical Evaluation of Language Fundamentals 5th edition (CELF-5) is a standardized assessment tool used to evaluate expressive language and receptive language skills in school-aged children and young adults. It can be administered to children as of 5 years old up to 21 years old. This test can be administered in English. There is also a Spanish CELF-5 version and French CELF-4 version. It is lengthy to administer, depending on the child’s age, attention, linguistic skills and amount of subtests given. It can take between 5 min – 20 min per subtest.
The CELF-5 consists of two separate forms – one for ages 5-8 years old and one for ages 9-21 years old. We will begin by discussing the subtests in the 5-8 years old category.
For ages 5-8 yeas old, the CELF-5 consists of seven subtests, often times SLPs will administer the primary 4 subtests (Sentence Comprehension, Word Structure, Formulated Sentences, and Recalling Sentences) to generate a Core Language Score. The Core Language score is calculated as a measure of general language ability and is used to evaluate a child’s overall performance. The other subtests that can be administered are Linguistic Concepts, Word Classes, and Following Directions. The following are some brief summaries of each subtest along with examples. (Note: please DO NOT use these pictures and DO NOT show them to your child. Previous exposure to test stimuli can alter your child’s future results if they are assessed using the same test).
The sentence comprehension subtest measures the child’s ability to understand grammatically correct sentences. Following an orally presented sentence by the SLP, the child points to the corresponding picture.
Given this picture, the SLP would ask “Point to – the bear is in the wagon”, then the child has to point to the corresponding image given a field of 4 pictures to choose from. The SLP then writes down the child’s answer using a scoring sheet.
The linguistic concepts subtest measures the child’s ability to interpret spoken directions with basic concepts, which requires logical operations such as inclusion/exclusion, orientation/timing and identifying mentioned objects. Following a verbal direction, the child points to the corresponding images in the correct manner.
For example, given this picture, the SLP would say “If there is a ball, point to the house”, then the child has to carry out the direction as indicated (i.e. point to the house since there is a ball).
The word structure subtest measures the child’s ability to use morphological (grammatical) rules. The SLP shows a picture and gives a model of the target morphological rule then starts the first part of a similar phrase and waits for the child to fill in the blank.
For example, given this picture, the SLP would point to the first image and say “This girl has two cats” then he/she would point to the second image and say “This girl has two”, pause and wait for the child to answer verbally “dogs.” The SLP then writes down the child’s exact answer and checks if they added the plural -s at the end of “dog”, which is the rule being measured in this picture.
The word classes subtest measures the child’s ability to understand relationships between the meanings of associated words. The child has to pick which two words go best together given a field of 3-4 words.
For example, given this picture, the SLP would first label each image “hand, foot, belt” and ask the child “tell me the two that go together best.” The child would then have to point to the two images that go together best. As the complexity increases, the children no longer have visual pictures. The SLP simply says 4 words verbally and asks the child to repeat which 2 words out of the 4 go together best.
The following directions subtest measures the child’s working memory identification of picture objects, and ability to understand spoken instructions. The SLP gives a verbal direction and then the child must point to the images according to the corresponding direction.
For example, given this picture, the SLP would say “Point to the first X, then point to the last square”, then the child has to point to the corresponding images in the given order. The SLP then takes note whether they answered correctly and any deviations made from the correct order (e.g. pointed to the square first).
The recalling sentences subtest measures the child’s ability to listen to spoken sentences and repeat sentences without changing the sentence’s structure or meaning. The child has to verbally repeat sentences orally presented by the SLPs. There is no visual stimuli, this is an auditory task. The child needs to process the auditory information and be able to repeat it exactly as it was said. For example, the SLP might say something simple like “The children are working” and then increase length and complexity such as “The book was not returned to the library by the teacher.”
The formulated sentences subtest measures the child’s ability to create sentences that are grammatically correct and meaningful using given words and a context. The SLP gives one or two words the child must use in their sentence along with the picture stimuli for context (sentence must be in relation to the given picture).
For example, given this picture, the SLP would say “Say a sentence about the picture and use the word in”, then the child has to produce a sentence that is semantically related to the picture, grammatically correct and that has the target word (e.g. in). For example, the child could say “the fish is in the tank.”
The following subtests (Understanding Spoken Paragraphs, Word Definitions, Sentence Assembly and Semantic Relationships) are administered to children 9 years and older up to adulthood. The following are some brief summaries of each subtest along with examples. (Note: please DO NOT use these pictures and DO NOT show them to your child. Previous exposure to test stimuli can alter your child’s future results if they are assessed using the same test).
The understanding spoken paragraphs subtest measures the child’s ability to listen and comprehend a short story by answering questions following the passage. The SLP reads a passage out loud to the child and then asks them comprehension questions about the story they just heard, the child must also rely on their working memory since they do not have any visual support for this task.
The sentence assembly subtest measures the child’s ability to put together words to formulate a grammatically correct and coherent sentence. Children are given a set of mixed up words/phrases and asked to place them in the correct order to formulate two different sentences. The SLP reads out the words and the children also have the written words in front of them for reference.
For example, given this set of words, the SLP would read out the sets of phrases/words and then the student would write down a sentence in their booklet such as “He finished his homework before he played hockey” or “Before he played hockey, he finished his homework.” There can be multiple correct ways of assembling sentences.
The word definitions subtest measures the child’s ability to analyze words for their meaning features, define words referring to relationships and shared meanings, and describe word meanings that are unique to the reference or instance. The SLP gives a booklet to the child to record their answers in written format. The child is told a word and then listens to the word being used in a sentence, then he/she has to write the definition of the target word. For example, the SLP would say the word is mustard and the sentence is Mom asked, “Would you like mustard on your hamburger?” The child then has to define the word mustard in writing.
The semantic relationships subtest measures the child’s ability to interpret sentences that make comparisons, identify spatial concepts, specify time, include serial order, or are expressed in a passive voice. The SLP reads a sentence and then asks the child to choose two correct answers from a series of four choices.
For example, given the following visual, the SLP would say “an hour is longer than a _” and then read out the 4 choices “minute, day, second, or morning” and the child would have to pick the correct two choices. In this case – minute and second.
There are some additional rating scales, reading/writing tasks and supplementary subtests. In a few cases, SLPs may administer these or ask that you fill out the form for pragmatics skills.
The Expressive Vocabulary Test 2nd edition (EVT-2) is a standardized assessment tool used to evaluate expressive vocabulary skills in children and adults. It can be administered to children as of 2;6 years and up to 90+ years old. This test is administered in English. Depending on the child’s age, attention and linguistic skills it can take between 10-30 minutes. The children are simply presented with pictures and asked questions to measure their expressive naming skills.
This is a very simple and easy test to administer. The following are some examples of the pictures shown in the test and questions asked by the SLP. (Note: please DO NOT use these pictures and DO NOT show them to your child. Previous exposure to test stimuli can alter your child’s future results if they are assessed using the same test).
The SLP would ask “What shape is this?” and wait to see if the child could verbally name “star”.
The SLP would ask “What is he doing?” and wait to see if the child could verbally name the action by saying “jogging”, “racing” or “running.”
The SLP would say “Tell me another word for father” and wait to see if the child could verbally name a synonym such as “dad”, “daddy”, “pa”, “papa”, or “dada.”
The Peabody Picture Vocabulary Test 4th edition (PPVT-2) is a standardized assessment tool used to evaluate receptive vocabulary skills in children and adults. It can be administered to children as of 2;6 years and up to 90+ years old. This test is administered in English. Depending on the child’s age, attention and linguistic skills it can take between 10-30 minutes. The children are simply presented with pictures along with a verbal label presented by the SLP and asked to point to the corresponding image given a field of 4 pictures to measure their understanding of vocabulary (i.e. what words they know).
This is a very simple and easy test to administer. The following are some examples of the pictures shown in the test and labels provided by the SLP. (Note: please DO NOT use these pictures and DO NOT show them to your child. Previous exposure to test stimuli can alter your child’s future results if they are assessed using the same test).
The SLP would say “Point to banana” and wait to see if the child could point to the correct image in a field of 4.
The SLP would say “Point to empty” and wait to see if the child could point to the correct image in a field of 4.
The SLP would say “Point to floating” and wait to see if the child could point to the correct image in a field of 4.
Usually SLPs administer both the EVT-2 and PPVT-4. They are then able to compare receptive and expressive vocabulary scores to see if their is a significant difference between the child’s receptive and expressive skills. For example, a significant difference between scores with the EVT-2 lower than the PPVT-4 could indicate that the child has a word retrieval/word finding problem.
After the assessment, the SLP will meet with you to go over their findings and make the necessary recommendations. This is your opportunity to ask your questions and advocate for your child’s needs. If speech and language intervention is recommended then you will plan your schedule and make your future appointments at this time as well.
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