TN 1 (05-00)
DI 22510.060 Pediatric CE Report Content Guidelines - SL Impairments in Children Age 3 and Older
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:
Record alleged speech-language problems, with specific examples.
Identify significant birth and post-natal history; history of feeding problems; history of ear infections or hearing loss; use of PE tubes or hearing aid(s); family history of communication problems.
Report participation in previous/current speech-language therapy and progress made.
Indicate the child's primary language and primary language used at home if the family is bilingual or non-English speaking.
C. Policy - Comprehensive Speech Testing
The comprehensive speech testing should:
Include an oral-peripheral examination.
Examine and describe the structural aspect of the oral mechanism.
Determine performance on imitative tasks involving both nonspeech-motor and speech-motor movements, including both sequenced and unsequenced patterns.
Provide clinical observations and descriptions, as well as the parent's/caregiver's report of articulation, voice, and fluency, and compare them to:
Speech skills of typically developing, same age peers, and
Child's cognitive level (if known).
Provide information about:
Overall speech intelligibility (in percentages) at the conversational level based on a speech sample; comment on intelligibility with both familiar and unfamiliar listeners and when the topic is known and unknown, if relevant to the child's age and experiences;
Ability to improve intelligibility, and by what percentage, upon repetition or imitation of a message;
Patterns of articulation errors and/or phonological processes, with statements as to whether patterns of errors/processes are developmental, delayed, or atypical for (cognitive) age; provide at least 2 examples;
Pattern of dysfluencies and presence/absence of secondary or struggle/tension behavior with statements as to whether dysfluencies are developmental or atypical for (cognitive) age;
Voice quality and its impact on intelligibility;
Adequacy of breath support as it relates to intensity, the capacity to sustain speech, and the ability to maintain a normal rate of conversation;
The contributing effect of any motor-based speech disorders (e.g., dyspraxia, dysarthria);
Use of dialectal variations in speech patterns.
Include a current assessment tool (e.g., Weiss Comprehensive Articulation Test, Riley Stuttering Prediction Instrument for Young Children), if needed to validate ratings of intelligibility at the conversational level. The test report should:
State the full name of the test.
Include scores and operational definitions of terms, as appropriate.
Discuss the validity of the test results with regard to the child's cooperation, interest, and attention/concentration.
D. Policy - Comprehensive Language Testing
The comprehensive language testing should:
Use a current, well-standardized, comprehensive language battery that measures semantic and syntactic competency in both receptive and expressive modes, and that is appropriate to the child's chronological age (and native language, when available). The test report should:
Include the full title of the test(s), as well as the test/subtest means and standard deviations (SD).
Report the child's total language standard score (SS); area composite SSs (e.g., PLS-3 Auditory Comprehension, TOLD-3:I Semantic Composite); and individual subtest SSs (e.g., CELF-3 Oral Directions), when these are part of the test protocol. If the test does not calculate discrepancies from the norm to 3 SD or more below the mean, and the child's score falls below the lowest SS provided, indicate this fact in the report.
Discuss the validity of the test results with regard to the child's behavior (e.g., cooperation, interest, attention/concentration).
Provide clinical observations and descriptions, as well as the parent's/caregiver's report of spontaneous language understanding and production, and compare them to:
Based on a spontaneous language sample, comment on the child's overall receptive language skills, (e.g., ability to follow directions) and overall expressive language skills (e.g., Mean Length of Utterance (MLU) for younger children, syntactic usage for older children) when the child is engaged in spontaneous conversation.
Based on a spontaneous language sample, discuss development of conversational skill, as it relates to the child's chronological age. For example, does the child:
Produce a full range of communicative intentions, e.g., requesting, responding, directing, commenting, labeling, stating, describing, informing?
Engage in verbal/nonverbal turn taking?
Establish and maintain conversational topics?
Identify and repair miscommunications?
Take into account the listener's background and knowledge (i.e., the child's ability to use presuppositional knowledge)?
Discuss development of narrative skills as it relates to the child's chronological age. For example, does the child:
Age 3 and older retell experiences and events (that are not immediate occurrences) in an increasingly appropriate sequence?
Age 6 and older produce narratives that have intact basic story structure (e.g., setting, beginning, middle, end, resolution of conflict)?
Age12 and older generate coherent stories using linguistic tools (e.g., use pronouns, conjunctions) to tie elements of one sentence to those of another?
E. Policy - Conclusions
The SLP signing the report must:
Review the reported findings, which must represent the information obtained in the examination of the child.
Correlate the conclusions provided by the SLP with the findings from the history, observations, and formal testing obtained in conjunction with this examination.
Explain all abnormalities, or provide comment if an explanation cannot be provided.
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.
Comment on whether the child's language test profile reflects his/her everyday language skills (i.e., oral language skills, language-learning skills) or school language skills (i.e., literacy skills, metalinguistic skills) or a combination of these.
Sign the report and identify his/her educational degree and certification and/or licensure credentials.