The Speech Language Evaluation As a Speech Language Pathologist in private practice I often receive phone calls from caregivers concerning their child's speech and language development. Some of the most frequently asked questions are concerning the speech and language evaluation. Foremost a Consultation with the Speech Language Pathologist should not be confused with a Speech and Language Evaluation. These are two separate processes. The first, a Consultation is a meeting with the Speech Pathologist. For caregivers who are uncertain about the necessity of an Evaluation, the Consultation provides an opportunity to explore the concerns, regarding their child's issues, with the therapist. It is during this time that the therapist identifies the primary issues and what, if anything, needs to be evaluated. If previous evaluations are available it is possible that they might be sufficient. Or if the information gleaned during the Consultation process warrants it, further assessments, perhaps in domains that have not been considered, will begin to guide the Evaluation process. Sometimes, a caregiver will have a very specific concern such as language; articulation; oral motor; or oral sensory function. Under such circumstances it is possible to limit the evaluation process to the focus of the primary concern. But it is not unusual for a caregiver to have concerns that they just can't quite put their finger on. In such instances the caregiver's concerns may be motivated by an intuitive sense that something is not quite right with the child. Typically these concerns are better served by a comprehensive evaluation that looks at the whole child. In a comprehensive evaluation it is not unusual for me to request a review of family videotapes of the child's earlier development. A review of previous evaluations can also provide important background information. I may visit the child in the home to observe play behaviors, feeding behaviors, and communicative interactions with the caregiver. The child may again be observed at my center. Additional visits may also be made to the child's daycare or school setting and a spontaneous language sample may be taken. A feeding, oral motor, and oral sensory assessment may also be performed. A feeding/oral motor assessment may require the parent to bring foods of various textures, tastes, and consistencies as well as something to drink. This can provide important information on how the child responds to the sensory aspect of the food, how the oral structures manage the function of eating and drinking, and whether the child is utilizing any strategies to compensate for oral motor inefficiency. Information is also obtained on how efficiently the child uses a cup, straw and utensils. Caregiver's may also be provided with a questionnaire that gathers information on the child's food preferences, eating habits, mouthing habits, taste and textures preferences, seating position, quantities consumed and duration of mealtime. If appropriate, standardized tests are administered. Standardized tests are those that have been normed on a group of children who are representational of the overall population. Standardized tests provide a score referred to as a percentile rank. The percentile rank gives a basis of comparison of the child's performance to those in the general population. Standardized tests also have a reliability coefficient. For example, most worthwhile tests have a reliability coefficient of .80. This number tells the clinician that the test is 80% reliable in measuring the domains it claims to assess. Tests with a reliability coefficient less then .80 are typically not considered to be as accurate and therefore may not provide an appropriate appraisal of a child's abilities. A standardized test will often consist of showing the child pictures or objects. The child is then asked to respond to a series of questions by gesturing or verbally responding. Standardized test are also referred to as formal assessments. Observations of the child's play, feeding, language and oral/sensory functioning is often referred to as an informal assessment. Using informal assessment methods the clinician gathers information and draws clinical conclusions based upon developmental expectations. Informal assessments are useful in evaluating children who may be described as "untestable" or difficult to assess. During an informal assessment a child could be provided with a variety of toys or enticements. How the child interacts with the toys, problem solves, or responds to the enticement often provides valuable developmental information. Surveys and questionnaires, which are filled out by the caregiver, can also provide pertinent information. By using both formal and informal assessment procedures a clinician is often able to get the best "picture" of the child and the most accurate impressions of their abilities across a variety of developmental domains.