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.

The CE provider will describe and discuss, as appropriate:

1. 1. 

   New information per caregiver or child report which is not in the medical history or any information reported that is inconsistent with records already in the file;

2. 2. 

   Previous, current, or planned interventions (e.g., speech/language therapy, cleft lip/palate repair, pressure equalizing tube insertion, special education classroom program);

3. 3. 

   Language(s) spoken in the home and the child's preferred language;

4. 4. 

   Whether the CE was conducted in person or via telehealth (for children over age 5). If a telehealth CE, document confirmation that the child could clearly see any visual stimuli presented;

5. 5. 

   Whether the speech-language pathologist (SLP) is familiar with the child;

6. 6. 

   Information obtained by parent or child report rather than by direct clinical observation and assessment, which the SLP must clearly indicate as such;

7. 7. 

   Any test(s) and subtests administered. Document deviations from the administration procedures outlined in the test manual; and

8. 8. 

   When formal testing cannot be completed or is inappropriate for the child. In these situations, the SLP must conduct informal speech or language testing, clearly document the reason for informal testing, and ask the child to complete language probes/tasks that are age appropriate (e.g., asking the child to name/describe photographs, sequence pictures, or real objects; asking the child to follow directions for manipulating blocks/objects; obtaining a speech/language sample based on the child's interests and during the devised informal assessment).

When the child's functioning in sound production, articulation, voice, and fluency is within normal limits, provide a general statement to indicate that and include an intelligibility rating. When an individual component(s) of speech requires detailed evaluation, the CE report must include the following:

1. 1. 

   Information regarding the structure and functioning of the oral mechanism (e.g., diadochokinetic rates, lingual mobility, and strength);

2. 2. 

   When articulation and phonological development is evaluated in detail, the report must include information regarding:

   a. Test results, if applicable: Provide the full name of the test and any subtests administered, raw scores, standard scores, and percentile ranks. Do not provide standard scores for children age 6 years and older;

   b. For children younger than 4 years, sounds in the child’s phonemic repertoire;

   c. For children younger than 3.5 years, whether the child can imitate words;

   d. Level of stimulability for error sounds at word or sentence level and a judgment about whether a speech skill (e.g., production of /s/, producing consonants in final word position) is emerging;

   e. The child’s articulatory patterns based on spontaneous productions (e.g., produces errors for /s/, s-blends, omits all final-word consonants) and their effect on intelligibility; and

   f. Overall intelligibility percentage (not a range) in conversation as judged by the SLP if the child is using words, and whether it is within expectancy for age. Provide percentages for:

   • •

     First attempt at transmitting the message to familiar and unfamiliar listeners in known and unknown contexts; and

   • •

     After the message has been repeated one time.

3. 3. 

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

   a. Brief clinical observations and descriptions of articulation, phonology, and fluency;

   b. The SLP’s assessment (as guided by a clearly specified, commercially available protocol or manual) of vocal pitch, quality, and intensity (including ability to sustain phonation and audibility of conversational speech);

   c. The SLP’s judgment regarding the clinical severity of the voice impairment;

   d. Observed or reported voice used patterns and how these may contribute to any identified impairment;

   e. Excessive breathiness, aphonia, or dysphonia;

   f. Inability to sustain speech in conversation and why not;

   g. Whether voice functioning fluctuates throughout the day;

   h. Whether audibility was affected by behavioral factors (e.g., mumbling, inattention, shyness);

   i. Any effect of other medical conditions (e.g., allergies) on voice; and

   j. Effect of the voice impairment on intelligibility.

4. 4. 

   Assess fluency as indicated for children age 4 years and older. When fluency is evaluated in detail, the report must include information regarding:

   a. Standard scores and percentile ranks for fluency tests;

   b. Percent stuttered words or syllables obtained through a speech sample;

   c. The child’s fluency pattern (e.g., blocks, part-word repetitions) and their effects on timely communication of the message; and

   d. Effect of the fluency impairment on intelligibility.

The CE report must include the following:

1. 1. 

   A current, standardized, comprehensive language battery that measures semantic and syntactic competency and morphological development in both receptive and expressive modes, and that is normed for the child’s chronological age. Do not use a test that probes language along with other domains of functioning, such as motor skills or adaptive behavior. The test report must provide the full name of the test and any subtest(s) administered, raw scores, standard scores, and percentile ranks for core language, receptive language, expressive language, and when appropriate, pragmatic language;

2. 2. 

   Receptive language, and expressive language strengths and weaknesses (for the child’s age) for any tests/indices that are below average;

3. 3. 

   A description of the child's primary mode(s) of communication (e.g., oral, gestural, sign, assistive and augmentative communication device) and percentage of time each is used;

4. 4. 

   A description of the child’s language stage (e.g., uses word approximation, uses one-word utterances, uses two- to three-word phrases, uses simple sentences, uses complex sentences) with examples collected from a non-test speech sample of at least 20 utterances/statements; and

5. 5. 

   For pragmatics, a list of strengths and weaknesses based on direct observations and probes for basic pragmatic skills (e.g., establishing joint attention, verbal and nonverbal turn taking, initiating a conversation, maintaining the conversational thread, asking and answering questions, interpreting and using nonverbal cues involved with body language and facial expressions, using language for a variety of functions, using language relevant to the listener and situation).

Use the following additional guidelines to provide the minimum content in a CE report for a child who:

• •

  comes from an environment where a language other than English is present and could or has had a significant impact on the child's level of English language proficiency; or

• •

  comes from a cultural or linguistic background that has resulted in factors that indicate a language difference rather than a language disability.

1. 1. 

   Follow American Speech-Language-Hearing Association (ASHA) guidelines for collaborating with interpreters. Use interpreters in direct assessment of the child in the non-English primary language, as well as caregiver interview (see DI 23040.001 DDS: Interpreters for Individuals with Limited English Proficiency (LEP) or Individuals Requiring Language Assistance)). Consider asking the interpreter:

   a. Whether the child mispronounces or omits speech sounds in the non-English language;

   b. How the child responds to general conversational questions; and

   c. Whether any test stimuli appear to reflect cultural or linguistic bias, based on observation.

2. 2. 

   Administer age-appropriate speech and language tests in the child’s primary language (using tests normed for the child’s language if commercially available, such as Spanish tests), or use an interpreter (per ASHA guidelines) for tests in which the child’s language has not been normed;

3. 3. 

   Do not report standard scores if the child’s linguistic background is not adequately represented in the normative sample;

4. 4. 

   When it is inappropriate to report standard scores, substitute a comprehensive description of communicative performance. Use alternative assessment tools to assess and analyze the child's language;

5. 5. 

   When speech is evaluated in detail, include a statement of how articulation affects intelligibility in the primary language and in English, with reference both to familiar and unfamiliar listeners in known and unknown contexts;

6. 6. 

   When fluency is evaluated in detail for a child age 6 or older, document a spontaneous speech sample of statements (not words) obtained in the non-English language (or in both languages if the child also speaks English, totaling two samples), with percent stuttered words for each;

7. 7. 

   Collect a non-test language sample of at least 20 utterances/statements, describe the child’s language stage in relationship to expectations for age (e.g., reduplicative babbling, uses one-word utterances, uses simple phrases or sentences, uses complex sentences), and provide examples;

8. 8. 

   Document second language factors that may affect overall test results; and

9. 9. 

   If the SLP is unable to complete a formal assessment, the SLP must document the reason and provide clinical observations and descriptions of the child’s overall receptive and expressive language skills based on a spontaneous language sample.

The CE report must include the following:

1. 1. 

   A statement of conclusions correlated with information from the history, clinical observations, and formal assessment;

2. 2. 

   A statement that indicates whether direct assessment data are generally consistent with observations and impressions about the child's conversational skills (e.g., oral language or social interaction) and school language skills (e.g., narrative discourse), and that explains or comments on any discrepancies;

3. 3. 

   If the child uses a hearing aid or glasses but did not bring them to the examination, a statement regarding the validity of the examination results;

4. 4. 

   If a diagnosis is established, a statement that explains whether and to what extent the identified speech or language impairment may reasonably be expected to affect the child’s functioning (specifically the child's ability to acquire and use information and to interact and relate with others over the next 12 months); and

5. 5. 

   The CE provider's signature, educational degree, and certification or licensure credentials.