University of Washington	File #:
SPEECH AND HEARING CLINIC	Client:	LASTNAME, FirstName
4131 15TH Ave NE	DOB:
Seattle, WA 98105	Parent/s:
206-543-5440	Address:
Phone:

SPEECH-LANGUAGE PATHOLOGY REPORT

Date of Evaluation:
Lead Clinician:	, B.S.
Asst. Clinician:	, B.S.
Interviewer:	, B.S.
Supervisor:	Laura Sargent, Ph.D., CCC-SLP

HISTORY (Within each section present information in a chronological sequence. Order of sections may change depending on how important that info is.)

Identifying Information, Referral source and Chief Concerns

Medical/Birth

Developmental

Social/Educational

Previous Evaluations

Previous Treatment

Do not write your report with bullets. Information is bulletted and highlighted below in order to provide suggestions/reminders of what goes in each section of the report.

EVALUATION

Test Environment and General Behaviors

Assessment Tools

List formal tests – underline or italicize test names (then be consistent); provide abbreviation (e.g., Test of Auditory Comprehension of Language – 3 (TACL-3)

List procedures

Hearing

screening that we did

or if we didn’t screen, why not

testing that was done by other agencies

Language Test Results

Use a table to report score. If it makes more sense to report the scores with the specific sections below – go ahead and do that.

Here’s a table all made for you:

Test Name or Abbreviation

Subtest	This evaluated X’s ability to…	Standard Score*	Percentile Rank	Interpretation
Provide a brief description of what the subtest evaluated – put it in your own words if you can
Above average

Within normal limits (can qualify: high average/average/low average)

Borderline

Significantly Delayed
* “average” = 85 – 115 or 7 – 13 (depending on the scale used)

Receptive Language

Formal measures

Briefly reiterate interpretation of scores.

As appropriate, discuss areas where child either did very well or had difficulty – depending on your analysis of child’s performance. Some tests help you with item analysis or you can do your own.

Informal observations

commands/semantic relations followed,

question types answered,

concepts understood etc.

interpret information based on developmental information

Comment on whether the different sources of data support one another. If not, why not?

Expressive Language

Form.

Performance on formal measures (e.g., grammatic closure tests, sentence imitation)

MLU – interpret – what’s normal?

word order

syntactic structure/complexity- age appropriate

grammatical morphemes used – age-appropriate or not? Consider what’s there and what’s missing

Give 3 examples of most complex language child used

Does the formal and informal information support each other?

Content.

topics discussed (here/now; past, present, future events)

appropriateness of language to context vs tangential or echolalic language

perseverative language

semantic relations used

vocabulary

Formal measures of vocabulary

TTR

NDW

narrative skills

Use.

communicative intentions used

eye contact/physical proximity and body language

topic initiation, maintenance, conclusion

measures (e.g., Prutting checklist)

turn taking skill

Speech

Formal Measures: The (Artic Test) was given as a measure of speech sound production within a single word context. The results follow:

Articulation Test Name or Abbreviation

Standard Score*	Percentile Rank	Interpretation
Above average

Within normal limits (can qualify: high average/average/low average)

Borderline

Significantly Delayed
* “average” = 85 – 115 or 7 – 13 (depending on the scale used)

Errors observed on formal measures (you may need to adjust this table for phonological problems)

Sound	Substitution	Word Position	Example	Age Sound Typically Mastered (years)
Here are IPA symbols for you to use (they have been embedded into the document so should show up correctly on other people’s computers). Copy and paste as needed:

( ( ( ð ʒ( ə ( ɝ ɚ ʤ ʧ ɜ (

Connected Speech:

sound errors noted

consistent or inconsistent with test??

consistent across opportunities?

intelligibility (rating scale or percentage)

other observations (e.g., rate, prosody, intonation, inflection, etc.)

Structural-Functional Exam.

Stimulability.

Voice

Quality

hoarse

aphonic

Pitch

too high

too low

variable

Resonance

nasal

denasal

mixed

Breath support; type of breathing used

diaphragmatic

thoracic

clavicular

Muscular tension

Stimulability of improved voice

Fluency

Types and frequencies of dysfluencies

Associated motor behaviors

hand movements

eyeblinking

Avoidance of sounds, words, or situations; anticipation of stuttering

Speech rates with and without dysfluencies

Stimulability of fluent speech

Related Factors

Play Skills/Cognition.

Preliteracy.

Other Observations

motor and coordination (as is necessary/appropriate)

SUMMARY (this should relate back to the purpose of the exam. Start information relating to the family’s primary reason for coming. Don’t present information in the summary section that was not introduced previously in the body of the report. )

(Start with most primary impairments, also include strengths.)

Include:

Statement of diagnosis

Concise statement of most significant findings

Prognosis as appropriate

Client X, age X;X presents with_____________.

RECOMMENDATIONS

Treatment or no treatment

Where?

School district?

Private?

SPSHC?

if SPSHC –

inform family of waitlist, provide waitlist Frequently Asked Questions handout

Follow-up evaluations

Where?

CHDD

Children’s Hospital

Other?

With whom?

Psychologist?

Learning Disabilities Specialist

OT/PT

Audiologist

For What

Cognition?

Literacy?

Motor?

Hearing?

Recommendations for specific treatment types (be careful!)

Suggestions for parents or other professionals to help with child’s needs

Parent Articles

Recommended books

Recommended websites

Re-evaluate vs have family contact clinic as necessary

Other?

Clinician Name, B.S.	Laura Sargent, Ph.D., CCC-SLP

Graduate Clinician	Clinical Supervisor

Cc:	Parents Names
Address
Address

Date of Evaluation:	xx-xx-xx	LASTNAME, Firstname – page 3
File #:

University of Washington

UW Speech and Hearing Sciences

2004-05-14

University of Washington