What a Speech Evaluation Actually Looks Like

How long it really takes

Between sixty and ninety minutes, including the conversation with you. The part where your child is actively participating is shorter: it rarely runs past forty-five minutes, because after that what is being observed is no longer his language, it is his tiredness.

If your child runs out before then, we stop. A dragged-out evaluation gives worse information than a short one.

The first ten minutes are only about settling in

There is no testing at the start. The therapist sits on the floor, brings out something interesting, and waits.

Those ten minutes look like dead time and they are among the most useful of the session. How a child enters a new room, how long he takes to approach an unfamiliar person, whether he checks for mom before touching a toy: all of that is information about communication, and none of it appears on any standardized test.

Meanwhile, the therapist is asking you. When he started babbling, what words he uses at home, what language or languages he hears, how he asks for things, whether the family understands him. You have data she will not get in an hour: you see him every day.

What the therapist is watching while they play

This is the part that surprises almost every parent. Language is much more than the words a child says, and a good deal of what is being evaluated happens without him speaking.

What is being observed, while it looks like they are only playing:

• What he understands. If you ask for something without pointing at it, does he do it? Understanding always runs ahead of speaking, and it is usually the part that gives the most information.
• How he asks. With words, with gestures, by taking you by the hand, by crying. All of those are ways of communicating, and the difference matters for the plan.
• Whether there is back and forth. Communicating is your turn and his turn. A child can say many words and not yet have that back and forth.
• How he sounds. Which sounds he produces, which are missing, how much of him is understood.
• How he plays. Pretend play (feeding a doll, making a block into a car) sits very close to language development.
• The mouth in motion. How he chews, how he swallows, how he closes his lips. Sometimes difficulty speaking and difficulty eating have the same root.

Alongside observation there are standardized tests, which serve to compare your child to others the same age and to justify insurance coverage. But the test is never the only thing: a number does not explain a child.

Your part: yes, you stay

You stay in the room. There is no reason to separate a small child from his mother or father at a first appointment, and many reasons not to: a frightened child does not show what he can do.

The only thing we will ask is that you do not translate.

It is the most natural impulse in the world. Your child makes a sound and you already know he wants the juice, so you tell the therapist. But that moment, the moment when he has to make himself understood by someone who does not know him, is exactly what needs to be seen.

Hold on for a few seconds. Then tell us everything.

What you get afterward, and when

A written report, usually within one to two weeks, and a conversation to walk you through it.

The report should answer four things, in language you understand:

1. What your child does today, specifically.
2. What is expected at his age.
3. Whether therapy is needed and at what frequency.
4. What the first goals would be.

If you read the report and cannot tell what it means, ask for it again. A report the family does not understand has not finished its job.

What an evaluation is not

It is not an autism diagnosis. A speech therapist evaluates communication and language. A diagnosis is made by a different professional through a different process.

It is not a grade, or a percentile that defines your child, or something that stays in his school record.

And it is not a commitment. You can do the evaluation here and the therapy somewhere else, or not start therapy yet. Nobody is going to call to pressure you.

It is a snapshot of one moment, taken by someone trained to read it.