As I glanced out the window, I spotted “Little M” and his mother sitting in the lobby. I offered a warm greeting as his mother wrapped up the paperwork. After introducing myself, I led them to the therapy room.
On the therapy table, I had already set up a toy for “Little M”. I directed his attention to it and asked politely, “Would you like to play with this toy while I speak with your mother?” Without hesitation, “Little M” spun around and began to play.
I sat down, picked up my pen and paper, and began his speech evaluation.
Chinese Version 中文版本:
我取出病例，看见“明明”和妈妈在诊所的等候室里静静地坐着。妈妈刚刚填写好医疗保险信息。我轻轻叫着明明的名字，简单打过招呼后，领着他们走进我的诊室。诊室的儿童桌上已提前准备好一个符合明明年龄、能够鼓励他说话的玩具。
我低下头告诉明明：“你先玩，我和你妈妈说说话。”并用手指了指桌上的玩具。明明迫不及待地坐下，拿起玩具玩耍。
这个时候，我拿出笔和纸，开始了明明的语言评估。
1. What is Speech Evaluation｜什么是言语语言评估
In my article titled “My Child Needs Speech Therapy?! 4 important things to know,” I provided an introduction to speech therapy. When a child has difficulty articulating clearly, experiences speech delays, or has been diagnosed with autism spectrum disorders or other disabilities that affect language development, pediatricians often refer them for speech evaluation. Such evaluations serve to identify areas of strength and weakness in communication, ultimately leading to effective treatment plans.
“We do not speak English at home. What should we do to prepare for my child’s speech evaluation?”
Many bilingual families have posed this question. As someone who has encountered this situation frequently in my years of practice, I have 6 tips to ensure a successful speech evaluation.
Chinese Version 中文版本:
在什么？我的孩子需要言语治疗？这篇文章中我分享了言语治疗的大致内容。孩子不说话、咬字不清，儿童若有语言迟缓、自闭症等诊断，儿科医生一般都会推荐儿童接受正规的言语治疗。而开始言语治疗之前，每一个孩子都需要专业的言语治疗师来进行全面的言语、语言评估，确定潜在问题后，制定治疗方案。
“医生您好，我们不讲英文，过几天孩子就要去评估了，该做什么准备呢？”
很多华人家长对自己的英文水平不太有信心，而且孩子的主要语言环境为中文，担心这些因素会影响儿童的言语语言评估结果。作为不仅服务英文家庭，而且还为中文家庭提供治疗的的资深语言病理学家，我针对言语语言评估总结了6个建议。如果您的孩子即将接受评估，请不要错过本文内容。
2. What to Expect at Speech Therapy Evaluation｜评估过程
Speech evaluation, also known as speech therapy evaluation, is a process that speech pathologists use to collect medical history, carry out essential assessments, and establish treatment objectives. During this process, families will have the opportunity to express their concerns and gain knowledge about the available services.
言语语言评估，通常包括家长采访、标准化测试、动态评估、语言样本、设计治疗方案等。
1) How Long Does a Speech Evaluation Take｜评估用时
A speech evaluation typically lasts for 1 to 1.5 hours and includes one or multiple standardized tests to thoroughly assess a child’s communication skills.
评估用时通常根据孩子需要做的检测来决定。一般而言，评估需要1-1.5个小时。治疗师可能给孩子不止一个标准化测试，所以家长在预约评估的时候最好腾出1-2个小时。
2) Intake Process｜家长采访
A therapist may start by asking parents or caretakers about the individual’s medical history, developmental milestones, current communication at home, etc.
I suggest families to have the following information ready:
| Info | Purpose |
|---|---|
| Medical history, such as birth history, diagnoses, current medications; | To assess the medical factors that could have impacted a child’s ability to communicate. |
| Child’s communication milestones; | Developmental milestones reflect the age at which a child intentionally articulate his or her first words and the current communication status. |
| Child’s present communication patterns both at home and school, current living situation, etc. | To comprehend the communication preferences of a child and identify environmental factors that could impact communication. |
I designed a Mandarin-English bilingual intake form that I’ve been using in my practice. If you’re interested, you can download it to get an idea of the types of questions a speech pathologist might ask during an evaluation. Download below↓:
The intake process is not the only evaluation that is taking place during this time. I also observe and document the child’s language, articulation, play skills, and interactions with their parents. This is the time when I begin collecting language samples, which include the words and sounds a child makes. I also make note of the child’s behavior, such as how they seek attention from others and ask for help.
Before the formal testing begins, I like to have an age-appropriate toy ready. This helps to create a comfortable environment for the child and keeps them entertained while I speak with the parents. It’s also a great way to encourage speech during play.
提前准备好鼓励语言的适龄玩具 (Photo by Jerry Wang on Unsplash)
Chinese Version 中文版本:
正如文章开头“明明”的例子，在评估之前家长需要填写医疗保险信息，签署服务协议等。评估开始时，言语治疗师通常会提前准备好儿童喜欢的适龄玩具，一方面是为了记录儿童在游戏中的语言沟通，另一方面是为了转移孩子的注意力，让家长采访顺利进行。
家长采访的目的是获取儿童的医学信息、语言发育情况、日常沟通表现、家庭生活情况等。这个环节也是家长和治疗师沟通的关键阶段。
为了保证评估流程顺利进行，请家长请提前准备好以下信息：
| 采集信息 | 目标作用 |
|---|---|
| 儿童的详细医学背景，如：出生史、发育史、有哪些医学诊断、正在服用的药物等 | 产前、产后信息、儿童的病史等，一定程度上能够帮助治疗师推测影响儿童语言沟通能力的医学因素。 |
| 儿童掌握发音的时间段 | 即：儿童的发育里程碑。孩子在几个月开始有意识地发声、几个月开始牙牙学语、几岁说第一个字、词等。 |
| 儿童日常沟通表现、家庭生活情况等 | 儿童现阶段的沟通习惯和偏好。间接反映影响儿童语言沟通的环境因素。 |
我根据工作经验，总结了一份中英双语语言评估家长采访问卷，并在每次评估的时候使用。欢迎家长和治疗师下载，提前了解评估时涉及到的问题，点击下载。
治疗师和家长交流以上信息时，治疗师同时也在忙着观察和记录儿童现场的行为表现。我会随手在纸上记录孩子游戏时发出的声音或说的字词、儿童的游戏能力，并且记录儿童和家长的互动行为。如：孩子遇到困难，如何向家长求助；孩子用什么方式吸引家长注意等。
3) Assessment Tools｜标准化测试
Speech pathologists use gathered information to choose the most suitable assessment tools. Various standardized tests are available to evaluate different communication aspects.
The widely used ones include:
| Age Range | Test Name | Special Features |
| Age 0-3 | Receptive-Expressive Emergent Language Test-Fourth Edition (REEL-4) | Obtains receptive and expressive language skills through caregiver interview. |
| Age 0-7 | Preschool Language Scales (PLS-5) | Offers both a pragmatic language screening tool and a thorough language assessment; has a Spanish version. |
| Age 5-21 | Clinical Evaluation of Language Fundamentals | Fifth Edition (CELF-5) | Evaluates language skills including semantics, morphology, syntax, and pragmatics, often administered to school-age children and teenagers. |
| Age 3+ | Goldman-Fristoe Test of Articulation (GFTA-3) | Articulation test for English-speaking individuals. |
| Age 2+ | Stuttering Severity Instrument–Fourth Edition (SSI-4) | Stuttering assessment for both children and adults. |
Chinese Version 中文版本:
了解基本信息后，就根据儿童的年龄和需要考察的范围选择不同的标准化测评工具。
目前美国市面上有很多针对不同问题的标准化测试，具体用哪一个或哪几个测试，则由治疗师根据经验来有针对性地选择。
常见的有：
针对0到3岁的 Receptive-Expressive Emergent Language Test-Fourth Edition (REEL-4) ，主要以家长问卷为主；
适用于0至7岁儿童的 Preschool Language Scales (PLS-5)，也翻译为《学龄前语言量表》，除了语言测试以外还有有简单的社交语言沟通问卷，目前有英文和西班牙语版本；
针对5到21岁的 Clinical Evaluation of Language Fundamentals | Fifth Edition (CELF-5)，常用于学龄儿童和青少年，全面考察语言、构词、句法、社交语言等方面；
针对3岁和3岁以上儿童发音问题的 Goldman-Fristoe Test of Articulation (GFTA-3)；
以及针对2岁以上口吃问题的Stuttering Severity Instrument–Fourth Edition (SSI-4)。
以上仅为临床常用到的部分标准化测试，市面上还有很多不同的测试工具，完全由治疗师根据孩子情况来决定选择哪一种或哪几种。
3. Techniques for Bilingual Assessment｜双语评估的独特测试方法
1) How to Adapt Assessment Tools｜中文评估
Currently, most standardized tests are designed for English-speaking children living in the United States. Unfortunately, there is no widely used standardized test available for Mandarin-speaking or other bilingual children. However, this does not mean that speech pathologists cannot use existing tests as a reference point.
As a native Mandarin-speaking speech pathologist, I typically adapt a test according to the concept being tested, if it is adaptable. Additionally, I familiarize myself with developmental milestones and take note of a child’s strengths and weaknesses observed during our session.
It is important to recognize that standardized tests can only be used for reference purposes due to the lack of norms for bilingual children. As a speech pathologist, I can use the results to create therapy goals and compare results for progress in the same child.
Chinese Version 中文版本:
以上几个量表用的常模参照都是讲英文的儿童，其中有几款有西班牙语的版本，而中文版的标准化测试工具仍有待开发或普及。如果孩子不会讲英文，或者家庭环境为中英双语，我通常根据英文测试的考察内容、结合儿童发育里程碑以及我的经验来完成测试。值得注意的是，因为缺乏讲中文儿童的常模参照，考察结果仅供治疗师和家长参考，用以制定治疗方案，并不能提供标准化测试结果，如：语言能力分数、语言能力对应年龄等。治疗师也可以用测试结果来对比同一个孩子在治疗前和治疗后的进步情况。
如果孩子有中文发音问题，我整理了一套专门针对汉语声母和韵母的非标准化量表，用同样的诊断方法来找出孩子的发音规律。
2) Dynamic Assessment｜动态评估
When evaluating bilingual children, dynamic assessment is a crucial component. I encourage parents to play with their child while I observe and record their interactions, as well as the child’s language usage. A natural setting such as this provides a language sample that accurately reflects the child’s skills.
By analyzing a child’s speech and determining their Mean Length of Utterance (MLU), I gain a better understanding of their language proficiency. I can also identify speech sound disorders by examining the patterns of articulation errors, such as substitutions, fronting, and final consonant deletion.
Additionally, I note the child’s communicative intent and observe how the parent responds and models speech and language.
Chinese Version 中文版本:
完成标准化测试后，还有动态评估。这一环节对于非英语母语的儿童而言至关重要。我一般鼓励家长和孩子一起玩，模拟日常的互动，这时治疗师会观察并记录儿童在自然环境下的语言和行为，获取语言样本、看看孩子是否有沟通意图、一般在什么情况下有沟通意图、记录家长的语言示范习惯和互动方式、儿童的游戏方式和兴趣等。
在缺乏中文标准化测试工具的情况下，除了以上方法，语言样本是双语言语治疗师成功进行评估的重要环节。通过记录儿童的发音、语言、词汇、句子等，我能够估计出儿童的平均话语长度，了解儿童的语言现状。此外，我能够通过分析儿童在沟通中出现的发音规律，如：替代、尾音省略等错误，来总结儿童是否存在构音障碍。
具体的中文动态评估方法我未来将会在网站上更新。
4. Results and Treatment Plan｜评估结果和治疗计划
After a speech evaluation, a speech pathologist can determine if a child needs speech therapy. They will discuss the results with the family and may suggest some simple activities that can be done at home. I always allow time for questions and ask families about their most pressing needs and goals for the next 3, 6, and 12 months. During this time, I also explain the treatment methods and how often they will be needed.
It’s important to involve parents in the treatment planning process because most children have multiple areas that need improvement. By incorporating the family’s goals, therapists can get a better understanding of the child’s daily life and the areas that need the most attention. Involving families in the sessions enables them to apply the skills learned in therapy to daily activities, which leads to better treatment outcomes.
Chinese Version 中文版本:
完成以上评估后，治疗师就开始整理评估结果。一般而言家长现场就能够知道自己孩子是否需要言语治疗，以及所存在的沟通问题。
最后很重要的就是治疗师和家长的沟通环节。这时候我会把评估情况和结果解释给家长，同时咨询家长现阶段、3个月、6个月、甚至一年内最希望治疗的内容，和家长一起定制出最适合孩子和家庭情况的治疗方案。这时候也是和家长沟通治疗形式、频率的机会。
为什么要问家长现阶段最希望治疗的内容呢？很多情况下儿童有很多需要练习的方面，除了按照孩子的发育特点来安排优先次序以外，参考家长的意见能够让治疗师知道当务之急，优先干预影响到儿童生活的沟通问题。当然，治疗方案还是由治疗师最终决定。
根据我的工作经验，我一直相信授人以渔的重要性。让家长加入评估过程和一起制定治疗方案，同时在治疗期间把方法教给家长，这样治疗效果也更好。
5. Final Thoughts｜结语
Different therapists have varying preferences when conducting a speech evaluation. This article discusses the most common practice employed by bilingual speech-language pathologists when assessing non-English speaking children. If you have experience evaluating bilingual children, I invite you to comment your thoughts and insights below.
There are more specific and detailed methods for evaluating children with particular diagnoses, like Autism Spectrum Disorder. Soon, I will be sharing my knowledge on speech language evaluation for autistic children as part of an interdisciplinary team. I encourage you to subscribe to my website to stay up-to-date with the latest updates and information.
Chinese Version 中文版本:
每一个治疗师的方法策略可能略有不同，本文主要讲的是我以及大多数双语言语治疗师针对非英语母语的儿童的评估过程。如果您恰好也是言语治疗师，欢迎您在文末留言补充交流。如果您是儿童家长，也欢迎您在文末留言，分享您在评估时遇到的问题或感受！
此外，一些因具体的疾病导致的沟通障碍还有更有针对性的诊断过程，如：自闭症。我将发表文章详叙我在跨学科团队合作诊断自闭症儿童的经验，欢迎大家订阅我的网站，不错过任何更新。
If you find my post helpful, I’d like to invite you to subscribe to my site or share it with your friends. Also, you could support me financially at JoannaGaoSLP . Your donation helps me focus on producing beneficial content for everyone. Thank you so much! 写稿不易，写双语文章更需要大量时间反复雕琢。如果您喜欢我的文章，欢迎您订阅本站或将文章分享给您的朋友，让更多人了解本站。也欢迎您在JoannaGaoSLP 成为赞助伙伴，鼓励我持续创作优秀的的免费资源，谢谢您！
Joanna is a certified bilingual speech-language pathologist. She has been working with children and their families on various speech, language, and feeding issues. She is passionate about empowering parents and helping them bond with their children. She is a mother, author, and guest lecturer. Her story can be found here.
