Preschool Communication Assessment: Why We Need to Focus Beyond Direct Speech Outcomes

Current speech-language evaluation methods for preschoolers predominantly focus on direct skills and body functions, while overlooking the crucial aspect of participation in daily life. This scoping review reveals only 15% of assessments measure how intervention impacts a child’s actual participation in everyday activities—the very outcome that matters most to families. Speech pathologists must expand evaluation frameworks to ensure our interventions create meaningful change in children’s lives, not just improvements in clinical settings.

Are We Measuring What Truly Matters in Children’s Communication?

As speech pathologists, we dedicate ourselves to helping children communicate effectively. Yet, I often wonder whether our assessment methods truly capture what matters most to children and their families. A comprehensive scoping review by Cunningham and colleagues (2017) reveals a concerning pattern in our field: most of our evaluation methods focus on discrete skills rather than meaningful participation in everyday life. This research draws attention to a critical gap in how we measure success in speech pathology intervention for preschoolers with communication disorders—a gap that potentially limits our understanding of intervention effectiveness from the perspective that matters most: the child’s ability to participate in their world.

What Does the ICF-CY Framework Tell Us About Assessment Approaches?

The International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) provides a comprehensive framework for understanding children’s functioning across multiple domains. It categorises health and functioning into three key components:

1. Body Functions and Structures: The physiological functions of body systems and anatomical parts
2. Activities: The execution of tasks or actions by an individual
3. Participation: Involvement in life situations

Cunningham et al.’s (2017) scoping review examined 214 peer-reviewed publications using this framework to categorise assessment methods for preschoolers with communication disorders. Their findings revealed a stark imbalance: 65% of measures evaluated Activities (e.g., producing speech sounds, following directions), 20% evaluated Body Functions (e.g., oral motor skills, auditory processing), and only 15% evaluated Participation (e.g., engaging in conversations with peers, participating in classroom activities).

This distribution suggests that our field has prioritised the assessment of discrete skills over meaningful real-world participation. While we’ve become increasingly sophisticated at measuring specific communication abilities, we may be missing the forest for the trees.

Why Should Speech Pathologists Care About Participation-Based Outcomes?

The ultimate goal of speech-language intervention isn’t merely to improve specific communication skills in isolation. Rather, it’s to enhance a child’s ability to participate meaningfully in their daily activities and social contexts. When we focus exclusively on discrete skills, we risk creating a disconnect between our clinical objectives and what truly matters in children’s lives.

Consider a preschooler with a phonological disorder who masters correct production of the /k/ sound in therapy. Traditional assessment might celebrate this achievement, but a participation-focused evaluation would ask: “Has this improvement enabled the child to be better understood by peers during play? Has it increased their confidence in sharing ideas during story time? Has it reduced frustration during family interactions?”

Participation-based measures bridge the gap between clinical improvement and real-world impact. They help us understand whether our interventions are making a meaningful difference in children’s lives beyond the therapy room. Moreover, they align our professional goals with the priorities of children and families, who typically value social inclusion and participation above clinical metrics.

How Has Assessment in Paediatric Speech Pathology Evolved?

The review by Cunningham and colleagues noted a slight increase in participation-based outcome measures between 2012 and 2015. This suggests a gradual shift in our field towards more holistic assessment approaches. However, the overall prevalence of participation-based measures remains disappointingly low at just 15%.

This evolution reflects broader changes in healthcare towards patient-centred outcomes and functional goals. However, speech pathology appears to be lagging behind other allied health disciplines in adopting truly participation-focused assessment frameworks.

In Australia, where family-centred practice is emphasised in early intervention frameworks such as the National Disability Insurance Scheme (NDIS), there’s a growing recognition of the need for outcome measures that reflect meaningful participation. Yet, our assessment protocols often remain stubbornly focused on discrete skills and activities, potentially undermining our commitment to family-centred practice.

What Are the Practical Implications for Speech Pathologists?

The findings from this scoping review have significant implications for clinical practice in paediatric speech pathology:

1. Expand assessment frameworks: We need to incorporate participation-based measures alongside traditional assessments. This might include structured observations of children in natural environments, parent/teacher questionnaires about daily communication, or child-friendly self-report measures.
2. Reframe goal-setting discussions: When establishing intervention goals with families, we should explicitly discuss how improved communication skills will translate to enhanced participation in meaningful activities. Questions like “What would successful communication look like in your child’s everyday life?” can guide these conversations.
3. Document participation outcomes: Our clinical documentation should reflect changes in participation, not just skill acquisition. This might include narrative descriptions of a child’s engagement in classroom discussions, play interactions, or family routines.
4. Advocate for participation-focused tools: As clinicians, we should advocate for the development and validation of assessment tools that explicitly measure participation for preschoolers with communication disorders. This might involve collaborating with researchers or participating in tool development ourselves.
5. Educate stakeholders: Parents, educators, and other health professionals may need education about the importance of participation-based outcomes. By shifting the conversation from “fixing speech sounds” to “enabling communication for participation,” we can promote more holistic views of success.

For telehealth-focused services like Speech Clinic, this shift is particularly important. Remote service delivery offers unique opportunities to observe and support children’s communication in natural environments, potentially facilitating more authentic assessment of participation.

How Can We Bridge the Assessment Gap for Better Client Outcomes?

Moving forward, bridging this assessment gap requires collaborative effort across multiple levels:

At the individual practitioner level, we must critically examine our assessment protocols and intentionally incorporate measures that capture participation. This might involve supplementing standardised assessments with structured observations or validated participation measures where available.

At the organisational level, practices like Speech Clinic can develop systems that prioritise the documentation of participation outcomes alongside traditional clinical measures. Team discussions can centre around how intervention is impacting children’s participation in family, educational, and community contexts.

At the professional level, our peak bodies and educational institutions must emphasise participation-focused assessment in professional development and entry-level training. The slight increase in participation measures noted in the review suggests momentum in this direction, but more deliberate effort is needed.

At the research level, we need increased investment in developing and validating participation measures specifically designed for preschoolers with communication disorders. These tools must be practical for clinical use while capturing meaningful outcomes that resonate with families.

Reimagining Success in Paediatric Speech Pathology

The findings from Cunningham et al.’s scoping review challenge us to reimagine how we define success in paediatric speech pathology. Traditional metrics of articulation accuracy, vocabulary size, or grammatical complexity provide valuable information but tell only part of the story. True success lies in how these improvements enable children to participate more fully in their worlds.

As we move forward, let us expand our vision beyond the confines of discrete skills to embrace a more holistic view of communication—one that prioritises meaningful participation in daily life. By doing so, we align our professional objectives with what matters most to children and families, ultimately enhancing the relevance and impact of our services.

Speech pathologists have always been advocates for children’s communication rights. By adopting participation-focused assessment approaches, we strengthen our advocacy by ensuring that the outcomes we measure reflect the outcomes that truly matter in children’s lives.

If you or your child need support or have questions, please contact us at Speech Clinic.