TN 23 (09-20)

DI 22510.055 Pediatric Consultative Examination (CE) Report Content Guidelines for Speech and Language (SL) Impairments in Children from Birth to Attainment of Age 3

Use the following guidelines to provide the minimum content in a CE report for a child disability case. Each Disability Determination Service (DDS) will notify medical sources of any additional requirements.

A. General guidelines for CE report content for pediatric speech and language disorders

The CE report content guidelines in this section are in addition to the general pediatric CE report content guidelines in DI 22510.035. For additional CE policy in a child’s case, also see DI 25205.015.

B. Report content specific to pediatric speech disorders and language disorders

The CE provider will describe and discuss, as appropriate:

a. The alleged speech or language problems;

b. The ages at which the child babbled, produced first words, and spoke in phraes or sentences;

NOTE: The DDS will provide the speech language pathologist (SLP) vendor with the child’s corrected chronological age for prematurity (see DI 25215.010) for any child who has not attained age 1 and for any child age 1 and older for whom the DDS continues to regard prematurity as a relevant factor to the case.

c. The characteristics of any unusual early feeding and eating behavior (for example, difficulty chewing, swallowing, or tolerating various food textures or temperatures);

d. Significant history of:

1. Ear infections or hearing loss;

2. Whether the child has had pressure equalizing (PE) tubes inserted and, if so, when;

3. Other developmental problems; and

4. Oro-maxillo-facial abnormalities and relevant surgeries.

e. Participation in previous or current speech and language therapy and progress made; and

f. The child's native language and the language(s) spoken in the home, the percentage of each language spoken in the home (and how many hours a week the child is with a daycare provider), and any exposure to language in a preschool program (and how many hours in a week in the program).

C. Report content specific to a speech assessment

On the CE report specific to the speech assessment, the CE provider will provide data about the child’s level of functioning and select one of two approaches to the speech assessment:

a. A statement indicating that the child’s functioning in sound production and articulation and voice is within normal limits; or

b. Information in b.1 or b.2 below, according to the component(s) of speech requiring detailed evaluation:

  1. 1. 

    When sound production and articulation is evaluated in detail, the report should include information (as age-appropriate) regarding:

    1. a. 

      Structure and functioning of the oral mechanism.

    2. b. 

      The child’s typical mode of communication (for example, uses gestures only, uses verbalization only, uses a combination of gestures and spoken language and, if so, what percentage of time for each).

    3. c. 

      Sounds in the child’s repertoire, frequency, and ease of use.

    4. d. 

      Sound play (such as pitch variations, “raspberry” productions, or producing animal sounds).

    5. e. 

      The stage of the child’s sound making (such as cooing, reduplicative babbling, or word approximations).

    6. f. 

      Test results, if applicable (full test title, test and subtest means and standard deviations, child’s standard score and subtest scores).

    7. g. 

      Articulation errors or phonological processes (with examples), based on either a formal assessment tool or a speech sample.

    8. h. 

      Whether sound patterns are typical, atypical, or delayed for chronological age.

    9. i. 

      Level of stimulability for error sounds.

    10. j. 

      Overall intelligibility percentage (not a range) as judged by the SLP (generally an unfamiliar, trained listener) if the child is using words, and whether it is within expectancy for age.

    11. k. 

      A parent’s or caregiver’s estimate of the child’s intelligibility for single words in context, single words out of context, phrases or short utterances in context, and phrases or short utterances out of context.

    12. l. 

      The extent to which any motor-based speech disorders (such as dyspraxia or dysarthria) limit intelligibility, as appropriate.

    13. m. 

      Brief clinical observations, descriptions of voice, and speech fluency.

  2. 2. 

    When voice is evaluated in detail, the report should include information regarding:

    1. a. 

      Structure and functioning of the oral mechanism.

    2. b. 

      The child’s typical mode of communication (for example, uses gesture only, uses verbalization only, uses a combination of gesture and spoken language and, if so, what percentage of time for each).

    3. c. 

      Any otolaryngological findings provided by the DDS (briefly), to keep internal consistency (per 20 CFR 404.1519(a)(2)) or a statement regarding unavailability of this information.

    4. d. 

      The SLP’s assessment of vocal pitch, quality, resonance, and intensity (including whether the child is able to sustain phonation and whether conversational speech is audible).

    5. e. 

      The SLP’s judgment regarding the clinical severity of the voice disorder.

    6. f. 

      Brief clinical observations and descriptions of sound production and articulation.

    7. g. 

      Any effect of other medical conditions (for example, allergies) on voice

D. Report content specific to a language assessment

On the CE report specific to a language assessment, the CE provider will provide data about the child’s level of functioning and the following, as appropriate:

a. Administer a current, standardized, comprehensive language battery that is appropriate for the child’s age (such as the Preschool Language Scale-5). “Current” means the most recently published version of the test instrument. The test report should:

  1. 1. 

    State the full title of the test(s) and include the test and subtest means and standard deviations.

  2. 2. 

    List the child’s total language standard score (SS), area composite SSs, or age equivalents when SSs are not available.

  3. 3. 

    Indicate when the child’s score falls below the lowest SS provided.

  4. 4. 

    State whether the test results are a true representation of the child’s capabilities given his or her cooperation, interest, attention and concentration.

NOTE: Our general expectation is that the transition to using the latest version of a test occurs no more than one year after publication.

b. Supplement formal test results with a parent report instrument (such as the MacArthur-Bates Communicative Development Inventories).

c. Document clinical observations and descriptions of the child’s:

  1. 1. 

    Typical mode of communication (for example, uses gesture only, uses verbalization only, uses a combination of gesture and spoken language and, if so, what percentage of time for each).

  2. 2. 

    Use of gestures (such as communicative pointing or showing objects).

  3. 3. 

    Ability to initiate and maintain social gaze or eye contact, joint attention, and turn-taking.

  4. 4. 

    Mean length of utterances (MLU). Obtain a language sample of at least 20 utterances, if possible, and then determine the MLU (in terms of morphemes, not words).

  5. 5. 

    Total number of words and word approximations in expressive vocabulary (regardless of clarity).

  6. 6. 

    Frequency and type (novel, stereotypic) of multi-word utterances.

  7. 7. 

    Range of communicative intentions (such as labeling, requesting, or socializing).

d. Document relevant information obtained through parent or caregiver report regarding the child’s language understanding and production.

e. Compare the child’s receptive and expressive language skills to those of typically developing, same-age peers, using substantive descriptions (versus a general, single statement of age-appropriateness) and provide examples.

NOTE: The CE will provide any other pertinent information and observations that may be helpful in evaluating the child (for example, include information on the child’s level of cooperation, compliance, and social interaction).

E. SLP conclusions

The CE provider will include the following information on the CE report:

a. State conclusions and correlate them with information from the history, clinical observations, and formal assessment.

b. Explain any discrepancies between the test data and observed behaviors or, if you cannot explain the discrepancies, then comment on them.

c. Provide:

1. A diagnosis, and

2. A statement of whether and to what extent the SLP may reasonably expect the identified speech disorder or language disorder to impact how the child functions every day and in all settings compared other children the same age who do not have the impairment, currently and over the next 12 months.

d. State whether norm-referenced test scores (or detailed parent or caregiver interview, if the child was reluctant to talk with the SLP) are generally consistent with observations and impressions about the child’s conversational skills (for example, oral language or social interaction) and school language skills (for example, narrative discourse).

e. Sign the report and identify his or her educational degree and certification or licensure credentials.


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DI 22510.055 - Pediatric Consultative Examination (CE) Report Content Guidelines for Speech and Language (SL) Impairments in Children from Birth to Attainment of Age 3 - 10/10/2007
Batch run: 09/25/2020
Rev:10/10/2007