How I Assess Speech
My last blog was all about why single sound errors are not a comprehensive way of describing a child’s speech skills. If you want to know more about why I feel that way, jump back and read it quickly here. Today, I am chatting about what I include in a speech sound assessment. Being in private practice, I am not required to meet eligibility criteria for an institution (i.e., cut offs on standardized tests). Therefore, I approach assessments as a way to first identify whether there is a speech sound disorder and establish a baseline, and then most importantly, to plan treatment. This is a run down of what I include and in the order I typically administer them.
1. Single word articulation screener. I use the free screener from Mommy Speech Therapy.
-Easy warm-up activity even for young children (can incorporate some fun rewards by crossing out the pictures as you go or blowing bubbles after a few words)
-Allows me to get an idea of a child’s speech sound errors as well as their vocabulary (i.e., can they name most of these common items)
2. Speech sample. I try to do this in conversation or naturalistic play but I will use the free park scene if needed.
-I videotape this (of course, with consent) so that I can not only go back and listen to a child’s speech but also watch them. It is so important to see what a child looks like when they speak. Areas of concern like making /p, b, m/ with teeth on lips (labiodentalization) or /s/ with tongue out (interdental or frontal lisp) are all very important parts of the puzzle.
-Assess a child’s speech in a way they use every single day (aka ecologically valid).
-Determine the origin and patterns of sound errors. A larger sample than just single words allows me to investigate whether errors are articulatory, phonological or motor speech in nature as well as specific errors.
-Determine how consistent a child’s errors are. Whether a child uses a sound 0%, 50% or 80% of the time while talking impacts treatment planning.
-Provides snapshot of other variables that may be impacting a child’s ability to be understood (aka intelligibility) including vocabulary, grammar, voice or fluency difficulties.
3. Oral mechanism exam. I currently use a form I created throughout my practice as well as learning from other disciplines (shout out to the orofacial myofunctional therapist I used to work with!). But Amy from Graham Speech Therapy is releasing an oral mechanism exam form soon and you better believe I’m buying it as soon as it is out!
-It is so important to understand how the structure and function of the speech system can impact speech. For example, I recently learned that the ‘tongue waggle’ (aka lateralization of tongue) is not just to look at range of motion but actually to determine whether a child has tongue-jaw dissociation!
-Determine whether there are any structural or physiological issues that may require other team members before initiating speech therapy.
4. Intelligibility testing. When there is a concern about how well a child is understood when talking (aka intelligibility), I will judge this from a child’s speech sample but I also provide the free Intelligibility in Context Scale (ISC) to a parent. It is a quick and reliable questionnaire that can be used as a baseline and to measure improvement with therapy. Thanks to The Informed SLP for connecting me with this resource!
5. Probes and stimulability testing. By now, I’ve hung out with my new friend for about 45 minutes and often have a pretty good idea of where we are starting in therapy. Now is the time that I see whether the child can make certain sounds in isolation, in the beginning, end and middle of words, and multi-syllabic words (if appropriate). Sometimes I also probe a child’s discrimination between their error and target sounds (e.g., Do these two words sound the same? Red, wed).
-Impacts treatment planning (read: I’m not going to work on eliciting /k/ in isolation for 2 months when there are 5 other things we could be working on!).
6. Education to parents. I do this either at the end of an assessment (if I’m quite sure of the results) or at the start of the second visit (after I’ve completed the full assessment analysis). It is so key that parents understand the type of difficulty their child has with speech (and language, if this is also an area of concern). I have a whole blog on explaining the ‘why’ to parents here!
If you include anything in your speech assessment that I haven't included here, comment below or email me. I always love learning more and adding to my SLP arsenal!