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A referral for a speech and language evaluation can leave parents with many questions. What will the speech-language pathologist assess? Will the child need to sit at a table and answer questions? What happens if the child is shy, minimally speaking, or unwilling to participate?

The evaluation process varies based on the setting, the child’s age, and the concerns that led to the referral. An evaluation completed in a private practice may look different from one completed through Early Intervention or a public school. Regardless of the setting, the purpose is to identify the child’s communication strengths and needs and determine whether additional support is appropriate.

How Does the Evaluation Process Begin?

In a private practice or outpatient clinic, the process often begins when a parent discusses concerns with the child’s pediatrician or primary care provider. The provider may then send a referral to a speech-language pathologist, also known as an SLP.

Parents may request an evaluation because their child is difficult to understand, is not using as many words as expected, has difficulty following directions, or becomes frustrated when trying to communicate. A teacher, daycare provider, or another healthcare professional may also notice concerns and recommend that the family speak with the child’s medical provider.

Before the evaluation, parents are usually asked to complete forms about the child’s medical, developmental, educational, and communication history. The SLP may ask about developmental milestones, previous services, hearing history, languages spoken in the home, and the specific concerns observed by the family.

This background information helps the SLP select appropriate assessment procedures for the child.

What Happens During the Evaluation?

The SLP will usually begin by speaking with the parent or caregiver. Caregiver input is an important part of the evaluation because children may communicate differently at home than they do in an unfamiliar clinical setting.

The SLP may ask questions about how the child expresses wants and needs, responds to questions, follows directions, interacts with others, and handles communication breakdowns. Parents may also be asked how well family members and unfamiliar listeners understand the child’s speech.

The evaluation may include standardized testing, clinical observation, caregiver interviews, play-based activities, language sampling, or a combination of these methods. The specific approach depends on the child’s age, attention, communication level, and reason for referral.

Younger children may complete much of the evaluation through play. An older child may participate in more structured activities, such as describing pictures, following spoken directions, repeating sentences, or answering questions. The SLP may also observe the child’s social communication, attention, turn-taking, use of gestures, and ability to request help.

How Does the SLP Select an Assessment?

The SLP selects assessment tools based on the child’s age, communication abilities, and areas of concern. Not every child receives the same test, and one assessment does not measure every aspect of communication.

Assessment of Speech Sound Production

If the primary concern involves speech sound production or reduced intelligibility, the SLP may administer the Goldman-Fristoe Test of Articulation, Third Edition, or GFTA-3.

During the GFTA-3, the child names pictures so the SLP can evaluate the production of speech sounds in different words and word positions. The assessment helps identify which sounds the child produces correctly and which sounds are substituted, omitted, or distorted.

The SLP will not rely only on the child’s test responses. Speech is also evaluated during conversation or play because a child may produce a sound correctly in a single word but have difficulty using it consistently in connected speech.

The SLP may also examine whether the child’s errors follow a pattern. For example, a child may consistently leave off final consonants or replace sounds made in the back of the mouth with sounds made in the front. Identifying these patterns helps the SLP determine whether the errors are developmentally expected or may require intervention.

Assessment of Language Skills

If the concerns involve receptive or expressive language, the SLP may select a comprehensive language assessment. Receptive language refers to how a child understands spoken language. Expressive language refers to how a child uses words, sentences, gestures, or other forms of communication to share information.

For many school-age children, the SLP may use the Clinical Evaluation of Language Fundamentals, Fifth Edition, or CELF-5. This assessment includes tasks that may examine the child’s ability to understand sentences, follow directions, recall spoken information, create sentences, and understand relationships between words.

The SLP selects the appropriate portions of the assessment based on the child’s age and the skills being evaluated. Results are considered along with observations, caregiver concerns, educational information, and examples of the child’s everyday communication.

Assessment of Younger Children

For infants, toddlers, and younger children, the SLP may use the Preschool Language Scales, Fifth Edition, or PLS-5. The PLS-5 examines auditory comprehension and expressive communication.

Auditory comprehension includes skills such as responding to spoken language, identifying familiar objects, understanding basic concepts, and following directions. Expressive communication includes the use of gestures, sounds, words, and sentences to communicate.

The assessment may involve toys, pictures, familiar objects, and play-based activities. Parents may also provide information about communication skills that the child uses at home but does not demonstrate during the appointment.

Assessment of Children Who Are Minimally Speaking

A child does not need to use spoken language consistently to participate in an evaluation. For a very young child or a child who is minimally speaking, the SLP may use a developmental assessment such as the Developmental Assessment of Young Children, Second Edition, or DAYC-2.

The DAYC-2 can be completed using caregiver interviews, clinical observation, and direct interaction with the child. It allows the SLP to gather information about skills demonstrated during familiar routines and everyday activities.

This approach can be helpful when a child is unable to participate in a highly structured assessment or when direct testing does not provide an accurate picture of the child’s abilities.

The SLP may also assess how the child communicates through gestures, facial expressions, vocalizations, signs, pictures, or an augmentative and alternative communication system. Communication includes more than spoken words.

Is a Diagnosis Based on One Test Score?

No. Standardized testing can provide useful information, but a comprehensive evaluation should not be based on one score alone.

A child’s performance may be affected by fatigue, attention, anxiety, unfamiliarity with the setting, cultural background, language exposure, or comfort with the evaluator. Some children may not demonstrate their typical communication skills during a single appointment.

The SLP considers multiple sources of information, which may include:

• Parent or caregiver concerns
• Medical and developmental history
• Teacher or daycare provider input
• Standardized assessment results
• Clinical observations
• Play and conversation samples
• Speech intelligibility
• Functional communication across daily activities
• Hearing status

For a child who speaks more than one language, the SLP should consider the child’s exposure to and use of each language. Learning more than one language does not cause a speech or language disorder. A language difference should not automatically be identified as a disorder.

Why Is Hearing Important?

Hearing plays an important role in speech and language development. Even a mild or temporary hearing difficulty can affect how a child hears and learns speech sounds and spoken language.

The SLP may ask whether the child has passed a recent hearing screening or has a history of ear infections. If hearing has not been assessed recently or there are concerns about the child’s responses to sound, the SLP may recommend an evaluation with an audiologist.

What Happens After the Evaluation?

After the assessment is completed, the SLP reviews the results and explains them to the family. The SLP should discuss the child’s strengths, areas of concern, and how the findings relate to everyday communication.

Possible recommendations may include:

• No speech-language therapy at this time
• Monitoring the child’s communication development
• A follow-up evaluation at a later date
• Speech-language therapy
• A home program with strategies for caregivers
• A hearing evaluation
• Referral to another healthcare or developmental professional

If therapy is recommended, the SLP will develop goals based on the child’s individual communication needs. The family should have an opportunity to ask questions about the results, recommendations, treatment frequency, and ways to support communication outside of therapy.

How Can Parents Prepare for the Evaluation?

Parents do not need to practice test questions with their child before the appointment. The goal is to observe the child’s current communication skills, not to determine how well the child can prepare for a test.

Parents can prepare by writing down their concerns and bringing relevant medical, hearing, educational, or developmental information. It may also be helpful to think about specific situations in which communication is difficult.

Useful questions to consider include:

• How does my child usually request something?
• How well do familiar and unfamiliar people understand my child?
• What types of directions can my child follow?
• Does my child become frustrated when communicating?
• Are there words, sounds, or communication skills my child uses at home?
• Have teachers or caregivers noticed similar concerns?

A speech and language evaluation is not intended to judge a child or the child’s family. It provides an opportunity to better understand the child’s communication abilities and determine whether support may be beneficial.

This article is intended for educational purposes only and does not replace an individualized speech-language evaluation or medical advice. Assessment procedures, referral requirements, and eligibility criteria vary by provider, setting, and location.