TN 23 (09-20)

DI 22510.060 Pediatric Consultative Examination (CE) Report Content Guidelines for Speech and Language (SL) Impairments in Children Age 3 and Older

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 for 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. 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.

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

d. Indicate 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 school program (and how many hours 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. The information in b.1, b.2, or b.3 below, according to the component(s) of speech requiring detailed evaluation:

  1. 1. 

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

    1. a. 

      Structure and functioning of the oral mechanism (for example, diadochokinetic rates, tongue mobility and strength).

    2. b. 

      Articulation errors or phonological process, usually based on a formal assessment tool, and a variety of sampling procedures (for example, connected speech sampling).

    3. c. 

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

    4. d. 

      Level of stimulability for error sounds at word or sentence level.

    5. e. 

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

    6. f. 

      A parent’s or caregiver’s estimate (elicited by asking how many of ten typical utterances he or she understands) of the child’s conversational speech intelligibility on first attempt when communicating about familiar and unfamiliar topics.

    7. g. 

      A parent’s or caregiver’s estimate of conversational speech intelligibility upon repetition (either spontaneously or by request).

    8. h. 

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

    9. i. 

      The influence of dialectal variations on the speech pattern, as appropriate.

    10. j. 

      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 (for example, diadochokinetic rates, tongue mobility and strength).

    2. b. 

      The otolaryngologist’s findings provided by the DDS (briefly) or a statement regarding unavailability of this information.

    3. c. 

      The SLP’s assessment (as guided by a clearly specified, commercially available protocol or manual) of vocal pitch, quality, and intensity (including whether the child is able to sustain phonation and whether conversational speech is audible).

    4. d. 

      Observed or reported voice used patterns and how these may contribute to any identified disorder.

    5. e. 

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

    6. f. 

      Brief clinical observations and descriptions of articulation and phonology and fluency.

    7. g. 

      Whether the voice is better at different times of day.

    8. h. 

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

    9. i. 

      Effect of the voice disorder on intelligibility.

  3. 3. 

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

    1. a. 

      Structure and functioning of the oral mechanism (for example, diadochokinetic rates, tongue mobility and strength).

    2. b. 

      Severity rating as determined using a nationally published stuttering assessment instrument.

    3. c. 

      Typical and atypical disfluencies based on parent or caregiver interview (or child interview, if appropriate), including parent and child reports regarding how often they note the two types of disfluencies in conversation with familiar and with unfamiliar listeners. (We expect that parent/child reports will more often be qualitative than quantitative.) Atypical disfluencies include part-word repetitions, audible sound prolongations, silent fixations or blockages, sound repetitions, and syllable repetitions.

    4. d. 

      Observed and reported, and frequency of, secondary behaviors.

    5. e. 

      How the child responds to his or her stuttering (such as avoiding other children during playtime or being overly anxious or fearful when interacting with others).

    6. f. 

      The approximate onset date of disfluency at its current level and any changes noted over time.

    7. g. 

      Brief clinical observations and descriptions (as well as the parent’s or caregiver’s report) of articulation and phonology and voice.

    8. h. 

      Effect of the fluency (stuttering) disorder on intelligibility.

D. Report content specific to a language assessment

On the CE report specific to the language assessment, the CE provider will provide accurate 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. “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, and individual subtest SSs. When a test provides quotients rather than SSs, report these instead.

  3. 3. 

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

  4. 4. 

    Indicate if the child needed repetition of items for tests that allow for repetition and, if so, how often.

  5. 5. 

    Provide an analysis, while also addressing and providing an account for any unusual scores, of the errors in the interpretation section and discuss the potential effect on school performance involving language comprehension and expression.

  6. 6. 

    State whether the test results are a true representation of the child’s capabilities given his or her cooperation, interest, attention and concentration, and any other variables that might affect performance (for example, other medical conditions, medication use or nonuse, energy and motivation).

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), when the child’s language age falls below 36 months.

c. Based on a spontaneous language sample, document clinical observations and descriptions of the child’s overall receptive and expressive language skills. In the report, include:

  1. 1. 

    Information on language content and form, such as the child’s ability to follow multi-step directions, express ideas with age-appropriate mean length of utterance, use and maintain social gaze or eye contact, provide comments relevant to the discussion, ask or answer questions, and produce grammatically correct sentences for age.

  2. 2. 

    A description of pragmatic skills, such as the child’s ability to:

    1. a. 

      Engage in verbal and nonverbal turn-taking;

    2. b. 

      Initiate and maintain conversational topics;

    3. c. 

      Identify and repair miscommunications;

    4. d. 

      Request, respond, direct, and comment; and

    5. e. 

      Retell experiences and events.

  3. 3. 

    Information about development of narrative skills as it relates to the child’s chronological age. For example, does a child age 6 or older produce narratives that have intact basic story structure? Does a child age 12 or older generate coherent stories using the appropriate language (such as pronouns or conjunctions) to associate elements of one sentence to those of another?

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.

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 affect the child’s ability to learn and use information and the child’s ability to interact and maintain relationships with others 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 22510.060 - Pediatric Consultative Examination (CE) Report Content Guidelines for Speech and Language (SL) Impairments in Children Age 3 and Older - 02/22/2007
Batch run: 09/25/2020
Rev:02/22/2007