Testing Procedures for Speech, Language and Reading Disorders

Oftentimes, parents call us, telling us that their children are experiencing difficulties in one or several areas of communication skills. After describing their child, they frequently say, "Now what happens?"

Part of that answer depends on the child's age and what the referral is for. Let's delineate two groups of children: 3 ½ and younger, and 4 years and older. A third group we will discuss are adults, since we work with all age groups at our center.

If we want to evaluate the language of a child who is 3 ½ or younger, it is best to obtain a large sample of his/her spontaneous language. We select toys that the child wishes to play with; this is called client-directed play. This will tend to elicit more language from the child. Pre-school language is described as being "egocentric"; not a value judgment, but descriptive of the difficulty young children may have at switching gears to focus on something another person said. Since this is a skill that develops over time, and falls under the category of pragmatics, we take note of this area as well. Obtaining the language sample allows an SLP to evaluate the child's best performance in the areas of:

1. Expressive vocabulary - how the child labels objects, actions, events or ideas. We also notice whether the words come out readily, whether the child struggles to access them, or uses pronouns like "this" or "that," instead of using the actual names of the items.
2. Grammatical structure - how the child puts his/her utterances together. We want to see whether the child uses complete sentences in a spontaneous situation. Does the child use subject-verb-object utterances? Are word endings that add meaning (such as 's' denoting plurals, or 'ed' denoting a past event) being used in the child's utterances?
3. Pragmatics - how the child uses language. We want to see whether the child uses language to interact with the rest of the world. Some children speak only to have a need met, such as pointing while saying, "water." However, what is surprising to many parents, is that the first function typically noted, and the primary purpose of language, is merely to interact with others. Some children echo what is said (echolalia) or repeat the same word or phrase over and over again (perseveration). These are both indicative of problems in the area of pragmatics.
4. Speech sound production - Most 3 year olds are intelligible 80% of the time to strangers. Obtaining a language sample allows us to have some sense of what sounds the child uses, whether there are any phonological disorders (such as fronting, in which the child makes sounds too far forward in the mouth). So we look for patterns and get a sense of overall intelligibility. We may also, at this time, look at the structure and function of the peripheral speech system, including the lips, tongue, mandible (jaw), etc.

Evaluating a child from the age of 4 and up requires us to not only obtain a sample of spontaneous speech and language, but to also perform a number of formal, standardized tests. To test speech intelligibility, there are several articulation tests that can be used. After the testing, we examine the child's oral mechanism, asking the child to perform certain speech movements, sometimes at his/her fastest speed. This is called diadochokinesis. Also, we use tests to a.) examine receptive and expressive vocabulary, b.) examine the ability to follow directions, and c.) understand a large variety of concepts. Children are asked to follow sequential directions, repeat sentences of increasing complexity and length, as well as to formulate sentences with a given word, etc. Testing may also examine the ability to tell and retell narrative stories, problem solve, make inferences and predictions, and so on. Because sentence structure is more complex at this age, we expect the child to both understand and use more complex utterances. We also use testing for phonological disorders, language processing, and reading and writing skills. Tests of reading generally include reading passages with questions relating to the text. In addition, we look at the child's ability to decode and manipulate phonemes. In writing, we not only evaluate structure and vocabulary, but we also examine spelling, as spelling has an impact not only on writing, but reading as well.

Many of these tests have been validated through adulthood, so we test adults with these instruments as well. Many of the skills tested in adults are similar to those tested in younger children. Often, adults that demonstrate impairments in language or speech have learned English as a second language.

For all of these evaluations, getting a background history is paramount. Often, this information is what pulls together the whole story; the whole story about why someone, adult or child, is having difficulty with speech and language skills.

To sum this all up, if there is any question about whether your child is speaking as clearly as he should, a speech evaluation is strongly recommended. If treatment is required, the earlier, the better. It will most likely be easier, faster and more fun for your child.