Introduce yourself to Julie and her mother and state the aim of your assessment. Make sure that her hearing is normal either by testing or by asking Susan if she has any concerns with Julie's hearing.  Assess all four areas of her speech and language if possible.

I suggest you start your assessment by assessing the Julie's expressive language.  Like in every aspect of paediatric examination, you will have to be opportunistic. Try to engage her in a conversation. You could ask her about her toys, friends, or what she had to eat that morning. Observe for any sounds, words, phrases, sentences, grammar and their ability to narrate. Start your assessment at a level appropriate for her age and work your way either up or down depending on her ability.
 

Assess her concentration and attention. You can do this by testing her interest and concentration on some interesting activity.  Also comment on whether she is sitting attentively and listening to you or changing from one activity to the other. You could also get this information from her mother. 

Check her understanding using:-

object recognition-can she recognise common objects(pen,book, pencil, spoon, telephone) by name/use?

picture recognition- can she recognise the pictures of common objects by name and or by use?

ability to carry out instructions- can she carry out an instruction containing three information carrying words or two commands(put the bowl on the floor and brush the doll's hair)?

Get information from her mother on the size of her vocabulary.

Summarise your findings and present them to the examiner. State whether Julies’ development is appropriate for her age, delayed or advanced. Give a plan of management.

The following are expected for a 3 year old child
i.    Expressive language:
1.    3-4 word phrases or sentences
2.    uses pronouns and question words

ii.    Concentration and attention:  will look listen and attend to adult choice of activity

iii.    Understanding:
1.    Has developed functional understanding.
2.    Is able to name 3 primary colours.
3.    Is able to name parts of the body and point to parts of a dolls body.
4.    They are able to follow instructions that carry 3 information carrying words or two instructions.
5.    Understands verbs, big and small, prepositions, simple adjectives and negatives
6.    Has an understanding of time with reference to the past – this morning, yesterday

iv.    vocabulary: 500-1000 words

From your assessment, Julie’s speech and language is delayed. You propose a referral for a formal hearing test and a full developmental assessment with an appropriate tool. You also make a referral to the speech and language therapist and request input from portage. She already attends a special needs nursery and there are plans in place for when she starts school. Her parents are receiving disability living allowance. They have a good relationship with social worker in charge of children with special needs.
 

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