Example of letter written after first appointment

Speech & Language Therapy
(Date)
Parents of ********
Dear (Parent’s name),
You brought M for a speech and language assessment on (date). This is a
summary of the session.
I asked you what your best hopes were from coming to this assessment. You
said that you thought that I would assess M and that you were pretty sure that
he will need therapy. You said that you have concerns about his behaviour as
well as his communication.
Background information
You brought M to the speech and language therapy drop-in clinic in (name of
month) because of your concern about his delayed speech. We took a
referral at that point. You told me that have a bilingual home. Spanish is your
first language. M’s Dad speaks English. You told me that you speak to M
both in Spanish and in English and you consider that English is M’s primary
language. You said that sometimes you “double up” meaning that you say the
sentence first in Spanish and then in English.
You talked about your concerns
You aren’t sure how much M understands. He often appears not to listen
but then responds to a word that he recognises and likes
Sometimes he repeats the question that you have asked him (for example
“what shape is that?”)
You described him as having his “own grammar” and his own way of
saying words and sentences
He is not into shared play - he plays by himself

I asked you what changes you have been pleased to see in recent
months. You have noticed the following:
• M recently starting using phrases and short sentences (for example “don’t
eat it”). He says these in the correct contexts
• He recognises numbers and can count long sequences
I wondered what you have noticed gets M’s attention and what seems to
help his communication. You talked about the following:
• M likes physical play (for example being chased)
• He likes music (for example listening to classical music, playing with his
ukulele and singing)
• He asks you to “draw a train” which you do. You also draw different things
and encourage him to name what you draw
• You realise that he doesn’t always turn to his name but that he is more likely
to respond if you name an item he is interested in as well as calling his
name (for example “M! Look at the train!”)
• He likes playing with trains and magnets with his dad
• You recognise that sometimes he needs direct motivation to do something.
For example you give him a sweet when he gets out of his chair
• You have noticed that he is more likely to repeat words/phrases when he
plays with his dad
During the assessment session you gave me a lot of useful information about
M. Although you thought I would assess him, I felt that for this first
appointment it was more useful for me to observe him while he played by
himself and with you. This gives more information about his understanding
and talking in real-life. More formal assessments might be helpful at a later
point. Here is what I noticed:
Receptive Language: This means a child’s ability to understand what other
people are saying. This includes the understanding of words, concepts and
grammar. M’s receptive language:
appropriate for age
delayed for age
needs further assessment

M doesn’t always respond to what you say to him. As you had told me, it is
hard to know how if this is because he doesn’t understand or because he just
isn’t interested. You said that M sometimes repeats a question that you have
asked. This can indicate that he doesn’t understand what you are saying.
However, it is likely that he understands more that is immediately apparent
but that he needs to be very interested before he responds.
Expressive Language: This means a child’s ability to use words
meaningfully and to join words to form sentences, tell stories and to express
his/her needs to others. M’s expressive language is:
appropriate for age
delayed for age
needs further assessment
M is 3 years old. At his age you would expect him to use lots of words and
sentences. M does use words and phrases but far fewer than I would expect
for his age.
Speech (pronunciation): this means a child’s ability to say speech- sounds
and to use these speech-sounds clearly in words and sentences. M’s speech
was:
appropriate for age
delayed for age
not assessed
It was hard to understand what M was saying at times. However, this seems
to be more because of his expressive language difficulties rather than
difficulties saying specific speech-sounds.
Social Communication: This means a child’s overall ability to use both
words and non-verbal skills to communicate. It includes being interested in
interacting with another person and using words or non-verbal communication
(for example gestures, facial expression) to connect with people. M’s social
communication skills:

appropriate for age
delayed for age
need further assessment
This is the area that I am most concerned about. It is hard to get M’s attention
and he was happy to play by himself for a lot of the session. His eye-contact
with me was best when he liked an activity (for example bubbles). There
were times that he engaged well with me for a few seconds at a time. For
example, when I was talking to you, he opened up the lego-door and peeped
through to get a response from me. When he liked that response, he tried it
again a few times. He said “nose” and pointed to the tissues to let you know
that he wanted to wipe his nose. When I was blowing bubbles and I waited,
he said “more bubbles”. Therefore there are times when he uses
words/phrases communicatively. However, overall, from what I observed and
what you told me, he doesn’t use words and phrases to communicate socially
as much as I would expect.
What else?
During the session M’s behaviour wasn’t challenging or disruptive. However,
you said that it is very hard to get his cooperation a lot of the time. You said
that it is like there is a “barrier inside him” and that he won’t compromise if he
decides he doesn’t want to do something. You said that he is “resistant to
being taught” and learns best from a screen (for example nursery rhymes,
colours) rather than a person.
You also talked about M’s dislike of some food-textures and that it is difficult
for you to predict what he will and will not eat. Sometimes he rejects a food
that he happily ate before. Before he eats any food, he presses it against his
lips or nose first. I noticed him do this with biscuits you gave him during the
session.
In summary:
M is 3 years old. His receptive and expressive language are delayed. This
means that he isn’t understanding or saying as much as I would expect for his
age. I am more concerned with his social communication in that it is hard to
get his attention and he doesn’t use his words and phrases as
communicatively as I would expect.

You also expressed some concerns about his behaviour and some sensory
issues (food-textures).
You asked if M might have autism spectrum disorder (ASD). I have noticed
that he seems to have social communication difficulties but I can’t say if that is
because he has ASD or not. However, I do think that it will be useful to make
a referral to the Early Intervention Team for further assessment. I will discuss
that with you at our next appointment.
What happens next?
1. I talked to you about a group that we run for parents of children who have
difficulties with social communication. This group is made up of 5
sessions in total. There will be 3 sessions for parents only and 2 sessions
for just you and M.
The parent sessions will be held on the following dates:
*************************************************************
The other 2 sessions for videoing will be arranged separately with you.
You will get a letter about this group in the next few weeks so you can
respond to that letter when you get it.
I hope that I have correctly written everything that you told me.
If you have any questions feel free to contact me.
Yours sincerely,
Senior Speech and Language Therapist
************ *************