Case history information is vital to the assessment process. It is important to note history of developmental delays or abnormalities, prior services from health, mental health, or education professionals, family history of speech, language, or academic deficits, and educational history.

Early case history information that has been shown to predict language disorder status includes maternal education level, 5-Minute Apgar score, birth order,  biological sex (Rudolph, 2017), family history of DLD, delayed gesture production, and limited vocabulary, syntactic comprehension, and absence of two-word combinations at 30 months of age (Sansavini et al., 2021). Case history information for school-age children and adolescents suspected of having a language disorders should include information about medical history, educational history, family history of learning and communication disorders, and perspectives of the parents, teachers, and patient/client/student about the presenting concern (ASHA, 2014).

Case history information typically is gathered using questionnaires, interviews, and information from referral sources.

Questionnaire

Questionnaires are frequently used to gather information about the child’s history and current concerns. It is important to keep in mind the following information when reviewing completed questionnaires. First, how well does the respondent know or remember the information? For example, prior to having my own children, I fully expected to be able to remember when each of my children met each of their developmental milestones. At the time of this writing, my children’s ages are 11 years, 10 years, and 16 months, and I must admit that I do not exactly recall when my 10- and 11-year-old children met their milestones! If asked this information, I would probably list the typical ages milestones are expected to be met, as I know that my children met their milestones at the expected times. Similarly, because I knew the predictive value of Apgar scores, I asked for these scores when my children were born, which seemed to surprise the nurses. I do not remember my children’s Apgar scores. Parents of children who were adopted may not have access to this information at all.

It is also important to know whether the respondent had enough time to complete the questionnaire. If the questions were answered in a hurry, there may be missing or incomplete information. Having time to think about and reflect on the answers to the questions is important to ensure accuracy and completeness.

The respondent’s understanding of the questionnaire is critical to know. Some adults do not read well, or do not read in English. If the respondent’s language is one other than English, the questionnaire must be translated by a qualified individual into a language the respondent can understand. Cultural considerations must be acknowledged, as not all cultures have the same views on disabilities or the sharing of information. Some respondents may have concerns about immigration status, and may hesitate to convey information in writing. It is critical to discover the preferred method of communication and the values of the individuals providing case history information.

Interview

Although questionnaires provide useful information and can save some time in information-gathering, face-to-face interviews can provide more complete information. Questionnaires tend to be generic, with little opportunity for follow-up within the form. Interviews provide the opportunity to probe further, and  to observe the respondent’s reaction to the questions, which can give valuable insight into the processes used for assessment and intervention, and the type of counseling to integrate into the assessment and intervention plans. As with questionnaires, cultural considerations are important to remember in the interview process, and familiarity with the family’s cultural views on disabilities, remediation, interviewing, interactions, and information-sharing is necessary. Haynes and Pinzola (1998) provide an approach to interviewing that centers around three goals: obtaining information, giving information, and providing counseling. Recording of interviews, if the interviewee agrees, is useful for ensuring that information is not forgotten or misremembered. If the interviewee is not comfortable being recorded, it is critical to take good notes to ensure accurate recollection.

Obtain information

Clinicians need to listen prior to speaking. This can be challenging, especially for newer clinicians. Listening prior to speaking gives clients the opportunity to discuss their concerns, gives the clinician information about the nature and scope of the information the clients will need, and helps the clinician hypothesize about the communication disorder. The client/parent should do most of the talking at the initial interview.

Asking questions in an “inverted funnel” approach, which proceeds from specific to general, can be useful. Open-ended questions are more useful than yes/no questions for obtaining specific information. Questions should be phrased in a manner that will promote truthful answers without making the respondent feel as though there will be judgement. For example, when I attended my first appointment with a new healthcare provider, I was asked, “You don’t smoke, do you?” rather than “Do you smoke?” Since I am a non-smoker, this manner of questioning did not result in the provision of inaccurate information, but if I had been a smoker, I might have hesitated to admit it. As a clinician, you should not ask a question such as, “You read to your child daily, don’t you,” which might make a parent feel the need to respond in the affirmative. Instead, you could ask, “If you read to your child, how frequently do you do so?” Ensure that responses are non-judgmental, and monitor not only your words, but your suprasegmentals, facial expressions, and body language. Pay attention to feelings and attitudes conveyed by the interviewee, as well as the symptoms and etiological factors. If the interviewee’s responses wander a bit, gently guide the questioning back to the point without being abrupt.

Be certain to obtain more than superficial answers to questions. Asking about the same information in different ways at different points during the interview can resolve discrepancies in answers or fill in gaps in information. Pauses can be helpful, as typically when a pause in conversation lasts longer than two seconds, someone will fill the pause. This does not mean that clinicians should allow excessive uncomfortable silence, but giving the interviewees time to respond, gather thoughts, and provide more complete answers results in more helpful information.

Give information

Haynes and Pinzola (2014) recommend six basic principles for providing information. First, know that emotional confusion can decrease the interviewee’s comprehension of information you provide, and you might have to provide some information more than once, perhaps at another time. Second, avoid lecturing. This is not the time to provide lengthy descriptions, and you should not be critical of families’ situations or coping mechanisms. Third, be aware of professional jargon, and define terms that may be unfamiliar to the listener. We tend to use a great deal of jargon without even realizing it, as our own professional terms become part of our lexicons. Remember that not everyone has studied communication disorders, and be certain that you are using terms that the family members can understand. Fourth, give the parents something they can do to help their child, as this demonstrates to them that they are a crucial part of the team. Do not overload families with hours of work, but do give some suggestions of things they can do as they go about their daily lives. For example, engaging in self-talk, in which adults describe their own actions, can be done in any context. Fifth, be pleasant, but frank. It can be difficult to deliver news that you think might upset a client or parent, but hedging is not helpful. Most people prefer to be given information honestly. Finally, understand that if you are the first one to communicate to a parent that the child has a disorder, the parent may be emotional, or direct negativity at you. Try not to take this personally. This does not mean that you have done anything wrong. Parents may be feeling guilty, confused, or overwhelmed. This brings us to the next goal of the interview, providing release and support.

Provide release and support

Communicate to clients that you value their feelings and attitudes. Be aware of the amount of information and counseling a client wants to receive. Some have a preference for receiving a great deal of information at the beginning, whereas others need time to process prior to receiving information. Some like to discuss their feelings in-depth, others prefer to display little emotion. When upset, some like to be comforted, others prefer to have little focus allocated to their reaction. Meet your clients “where they are,” and support them accordingly. There is no “right way” to feel or react, and it is important that you are supportive, even if a parent or client reacts in an unexpected manner.

Referral

In schools, teachers are often sources of referral, although children may have been identified via school-wide screenings. Collaboration with teachers is essential in order to determine how children are performing relative to their peers in class. Teachers are able to provide information on both academic and social functioning. When working in a school or school district, it is critical to form relationships with the teachers and share information about your role in the school in order to facilitate the referral process. Surprisingly, some teachers still think that the “speech teacher” only works on speech sounds. Using the title “speech-language pathologist,” and sharing information about our scope of practice can help teachers recognize when a referral might benefit a student.

Parents also may refer their children for assessment. Involvement of the child’s family is critical to the assessment process, and facilitates holistic understanding of the child in multiple contexts. Parents may have observed difficulty in social contexts that differ from the social context of the school, and can provide insight into the communication needs in these contexts.

References

Haynes, W.O., & Pinzola, R. H. (1998). Diagnosis and evaluation in speech pathology (5th ed.). Needham Heights, MA: Allyn & Bacon.

Rudolph, J. (2017). Case history risk factors for specific language impairment: A systematic review and meta-analysis. American Journal of Speech-Language Pathology, 26(3), 991-1010. https://doi.org/10.1044/2016_AJSLP-15-0181

Sansavini, A., Favilla, M. E., Guasti, M. T., Marini, A., Millepiedi, S., Di Martino, M. V., … &

Lorusso, M. L. (2021). Developmental language disorder: Early predictors, age for the diagnosis, and diagnostic tools. A scoping review. Brain Sciences, 11(5), 654.