TN 1 (05-00)

DI 22510.055 Pediatric CE Report Content Guidelines - SL Impairments in Children from Birth to Attainment of Age 3

A. Policy - General

Specific requirements exist in addition to all general pediatric guidelines in DI 22510.035.

B. Policy - Developmental History

The developmental history should:

1. Record alleged speech-language problems, with specific examples.

2. Review developmental milestones for speech-language, including cooing, babbling, jargoning, first words, phrases, sentences. Note age at which milestones were achieved, and correct the chronological age for prematurity up to age 24 months, if applicable.

3. Note early feeding and eating behavior (e.g., swallowing, ability to tolerate various food textures and temperatures).

4. Identify significant birth and post-natal history; history of ear infections or hearing loss; use of PE tubes or hearing aid(s); family history of communication problems; and developmental problems in other areas.

5. Report participation in previous/current speech-language therapy and progress made.

6. Indicate primary language used in the home if the family is bilingual or non-English speaking.

C. Policy - Comprehensive Speech Testing

The comprehensive speech testing should:

1. Include an oral-peripheral examination.

   • Examine and describe the structural aspect of the oral mechanism.

   • Note unusual oral-motor behaviors, such as the presence of excessive drooling, excessive mouthing of objects, aversion to oral-related activities (e.g., brushing teeth).

   • Observe interest in, and ability regarding, imitation of nonspeech-motor and speech-motor movements.

2. List sounds in the child's repertoire, and note frequency of use.

3. Describe the child's play with sounds (e.g., ability to vary pitch, change intensity, produce “raspberries,” squeals, and tongue clicks).

4. Evaluate the stage of the child's sound-making (e.g., cooing, one-syllable babbling, reduplicative babbling, nonreduplicative babbling, jargoning, mature jargoning).

5. Comment on the frequency and ease with which the child is able to use and vary sound patterns and combinations.

6. Determine whether or not the child's sound patterns are typical, delayed, or atypical for the child's age.

7. Comment on whether speech is sufficient to support the development of expressive language.

8. Comment on overall intelligibility of speech (if the child is using words) and whether the degree of intelligibility is within expectancy for the child's age.

9. Observe voice quality and its impact on intelligibility.

10. Indicate whether speech fluency is developmentally appropriate.

11. Comment on adequacy of breath support for speech as it relates to intensity, the capacity to sustain speech, and the ability to maintain a normal rate of vocal/verbal turn taking.

D. Policy - Comprehensive Language Testing

The comprehensive language testing should:

1. Include a current, well-standardized comprehensive communication battery when possible (e.g., The MacArthur Communicative Development Inventory: Words and Gestures; Preschool Language Scale-III (PLS-3)), appropriate to the child's age (and native language, when available).

   • State the full title of the test and include test/subtest means and standard deviations (if reported for the test).

   • Report the total language standard score (SS); area composite SSs when part of test protocol (e.g., PLS-3 Auditory Comprehension); and age equivalents (if needed).

   • Comment on the validity of test results with regard to the child's behavior (e.g., cooperation, interest, attention/concentration).

2. Supplement formal test results with a parent questionnaire (e.g., REEL, Rosetti Infant-Toddler Language Scales), when appropriate. Determine language age equivalencies, as appropriate.

3. Provide clinical observations and descriptions, as well as the parent's/caregiver's report of the child's spontaneous language understanding and production, and compare them to:

   • Language skills of typically developing, same age peers, and

   • Child's cognitive level (if known).

4. Provide information about the child's:

   • Primary mode of communication, verbal or nonverbal;

   • Use of gestures (e.g., communicative pointing, showing objects);

   • Ability to engage in reciprocal eye gaze and joint referencing;

   • Ability to engage in turn taking, first at the sound level, and later, at the spoken language level;

   • Total number of words in his/her vocabulary (regardless of clarity), and whether the range of semantic relations is expressed;

   • Occurrence, frequency, and quality (e.g., novel and rule-governed, stereotypic) of multiword utterances;

   • Mean length of typical utterances;

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

E. Policy - Conclusions

The SL pathologist (SLP) signing the report must:

1. Review the reported findings which must represent the information obtained in the examination of the child.

2. Correlate the conclusions provided by the SLP with the findings from the history, observations, and formal testing obtained in conjunction with this examination.

3. Explain all abnormalities, or provide comment if an explanation cannot be provided.

4. Discuss whether, based on test results and clinical observations, the speech and/or language disorder would be likely to affect the child's learning and/or social development.

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