• Rosemary Emanuel, Shula Chiat, and Penny Roy.
• Speech and Language Therapy Service, Bexley Care Trust, Bexley, UK. rosemary.emanuel@boxley.nhs.uk
• Int J Lang Commun Disord. 2007 Mar 1; 42 Suppl 1: 1-15.

BackgroundClinicians in the UK rely mainly on informal observations and structured and semi-structured tasks rather than standardized testing in their assessments of pre-school children referred with speech and language difficulties. The informal nature of the clinical decision-making process at this age is unsurprising given the dearth of research on early clinical referrals. Evidence of outcome for young children referred with speech and language problems typically begins in the early school years.AimsTo examine the clinical decision-making of an experienced individual therapist by evaluating the extent to which follow-up evidence supported initial prognosis.Methods & ProceduresForty-three randomly selected pre-school children referred to speech and language therapy services were seen at an average age of 2;8, when a range of informal assessments were carried out. They were followed up 18 months later. Outcomes were compared with initial diagnosis and prognosis.Outcomes & ResultsInitial judgements showed high associations between the type of problem, the presence of complex difficulties, severity ratings and prognosis. In line with previous findings, prognosis was significantly associated with the type of problem and severity at outcome, although overall changes were more pronounced than had been predicted. A minority of children were rated substantially worse than predicted at follow-up.ConclusionsThis study illustrates the potential of this kind of approach to inform the process of decision-making and reflective clinical practice with very young children. Limitations of the study and implications for future action research are discussed.

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