Importance of Case History

The Importance of a Case History (Background Information) in a Speech and Language Assessment

Before we initiate testing, we firstly administer an in depth case history (collecting background information) with the parents. The Case History identifies any red flags that may be a factor or a contributing factor to Speech and Language difficulties. The Case history may take 15 minutes to 30 minutes before the Speech Therapist starts to testing the child. The more information the parent is able to give the therapist during this 30 minute session, the better the diagnosis will be. In most cases the collection of information during the Case History provides is more important than the testing as it gives the therapist an indication of what Speech and Language difficulty to look out for.

What does the Case History consist of?

The Case History consists of the following:

  1. General Background information- What is the child’s home language? What are the parents occupations? What are the parents ages? Who does the child live with? Does the child have siblings? etc.
  2. Prenatal and Birth History- What was the mother’s health like during pregnancy? Birth weight? Type of Delivery? etc.
  3. Medical History- Was the child ever hospitalized? Did he/she suffer from ear infections? Is she on any form of medication? etc.
  4. Developmental History – When did he start to sit, crawl, stand and walk? When did she start to use single words? etc.
  5. Educational History – What school does she attend? How is the child’s performance at school? Doe he attend any special classes? etc.

The collection of background information provides the key to the puzzle in identifying what may be the child’s difficulty and the cause of the difficulty. Without background information children may continue to struggle to incorrect diagnosis and inappropriate intervention. For accurate diagnosis it is important that the therapist collects a detailed case history of the child’s development and family history. This will ensure that the child will receive therapy relevant to his/her needs.

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