Report of the Recommendations - Communication Disorders

Ordering Information

Single copies of the guideline publications are available free of charge to residents of New York State. Multiple copies are available free of charge to New York State Early Intervention providers and municipal officials for use with parents and staff. To order, contact:

New York State Department of Health
P.O. Box 2000
Albany, New York 12220

A small fee will be charged to cover printing and administrative costs for orders placed by non-residents of New York State and for multiple copies requested by other than those above. To order, contact:

Health Education Services
P.O. Box 7126
Albany, New York 12224

Mastercard and Visa accepted via telephone: 518-439-7286.

  1. Clinical Practice Guideline: Report of the Recommendations. Communication Disorders, Assessment and Intervention for Young Children (Age 0-3 Years). 5½" x 8½", 288 pages. 1999 Publication No. 4218
  2. Clinical Practice Guideline: Quick Reference Guide. Communication Disorders, Assessment and Intervention for Young Children (Age 0-3 Years). 5½" x 8½", 128 pages. 1999 Publication No. 4219
  3. Clinical Practice Guideline: The Guideline Technical Report. Communication Disorders, Assessment and Intervention for Young Children (Age 0-3 Years). 8½" x 11", 368 pages. 1999 Publication No. 4220

For permission to reprint or use any of the contents of this guideline, or for more information about the NYS Early Intervention Program, contact:

NYS Department of Health, Early Intervention Program
Corning Tower Building, Room 208
Empire State Plaza, Albany, New York 12237-0618
(518) 473-7016

The New York State Department of Health gratefully acknowledges the contributions of individuals who have participated as consensus panel members and peer reviewers for the development of this clinical practice guideline. Their insights and expertise have been essential to the development and credibility of the guideline recommendations.

The New York State Department of Health Early Intervention Program especially appreciates the advice and assistance of the New York State Early Intervention Coordinating Council and Clinical Practice Guidelines Project Steering Committee on all aspects of this important effort to improve the quality of early intervention services for young children with Communication disorders and their families.

The contents of the guideline were developed under a grant from the U.S. Department of Education. However, the contents do not necessarily represent the policy of the Department of Education, and endorsement by the federal government should not be assumed.

The New York State Early Intervention Program does not discriminate on the basis of handicap in admission, or access to, or treatment or employment in, its program and activities.

If you feel you have been discriminated against in admission, or access to, or treatment or employment in the New York State Early Intervention Program, you may, in addition to all other rights and remedies, contact Donna M. Noyes, Ph.D., Director, Early Intervention Program, New York State Department of Health, Room 208, Corning Tower Building, Empire State Plaza, Albany, NY 12237-0618.

Table of Contents - Communication Disorders Assessment and Intervention for Young Children (Age 0-3 Years)

Chapter I: Introduction

Chapter II: Background: Understanding Communication Disorders

Chapter III: Assessment Methods for Young Children with Communication Disorders

Chapter IV: Intervention Methods for Young Children with Communication Disorders


  1. Appendix A Methodology Tables
  2. Appendix B Summary of Evidence: Assessment
  3. Appendix C Summary of Evidence: Assessment and Intervention
  4. Appendix D General Development Tests
  5. Appendix E Early Intervention Program: Program Information
  6. Appendix F Peer Reviewers
  7. Appendix G Additional Resources

Subject Index

Communication Disorders
Clinical Practice Guideline Development Panel

Pasquale Accardo, MD
Guideline Panel Chairman
Westchester Medical Center Valhalla, New York
Cindy Geise Arroyo, MS, CCC-SLP
Oceanside, New York
Dolores E. Battle, PhD, CCC-SLP
Buffalo State College
Buffalo, New York
Deborah Borie, MS
State University College of Technology at Canton
Canton, New York
Joann Doherty, MS
Alcott School
Scarsdale, New York
Judith S. Gravel, PhD, CCC-A
Albert Einstein College of Medicine
Bronx, New York
Deirdre Greco
Children's Center
Troy, New York
Karen Hopkins, MD
New York University
Medical Center
New York, New York
Carolyn Larson, EdM, CSP
Child Development Associates
Albany, New York
Susan Platkin, MD
East Northport, New York
Julie Santariga
College Point, New York
Deborah Schallmo
Fairport, New York
Richard G. Schwartz, PhD, CCC-SLP
City University of New York
New York, New York
M. Virginia Wyly, PhD
Buffalo State College
Buffalo, New York

Communication Disorders
Project Staff

Project Director
Demie Lyons, RN, PNP
PharMark Corporation
Lincoln, Massachusetts
Director of Research/Methodologist
John P. Holland, MD, MPH
Seattle, Washington
Senior Research Associate
Mary M. Webster, MA, CPhil
Seattle, Washington
Research Associates
PharMark Corporation
Beth Martin,MLIS
Celeste Nolan,MS
Seattle, Washington
Carole Holland, BA
University of Washington
Geralyn Timler, MS, CCC
Ann Garfinkel, PHC
Topic Advisors
Lesley Olswang, PhD
University of Washington
Seattle, Washington
Michael Guralnick, PhD
University of Washington
Seattle, Washington
Writers/Copy Editors
Patricia Sollner, PhD
Winchester, Massachusetts
Diane Forti, MA
Dedham, Massachusetts
Meeting Facilitator
Angela Faherty, PhD
Portland, Maine
Department of Health

Department of Health Project Manager
Donna M. Noyes, PhD, Director
Early Intervention Program


Young children with communication disorders comprise a heterogeneous group and have available to them a correspondingly heterogeneous array of assessments and interventions. Especially when an early intervention program is being considered, selecting the most appropriate assessments and intervention strategies for individual children constitutes a considerable challenge even for experienced professionals in the field. Knowledge of the most current information based on research and practice is accessible but often difficult to organize systematically due to differing methodologies, conceptual frameworks, and quality of the work.

The Clinical Practice Guideline for Children with Communication Disorders has successfully addressed this problem by creating a sophisticated, methodologically sound, and rigorous resource that accurately gathers and summarizes information based on the available evidence. Readers utilizing this Guideline will immediately recognize how this well-organized, balanced, and thoughtful document will assist them in making highly informed decisions with respect to assessment and intervention for young children with communication disorders.

University of Washington


Why the Early Intervention Program is Developing Clinical Practice Guidelines

In 1996, a multi-year effort was initiated by the New York State Department of Health (DOH) to develop clinical practice guidelines to support the efforts of the statewide Early Intervention Program. As lead agency for the Early Intervention Program in New York State, the DOH is committed to ensuring that the Early Intervention Program provides consistent, high-quality, cost-effective, and appropriate services that result in measurable outcomes for eligible children and their families.

This guideline is a tool to help assure that infants and young children with disabilities receive early intervention services consistent with their individual needs, resources, priorities, and the concerns of their families.

The guideline is intended to help families, service providers, and public officials by offering recommendations based on scientific evidence and expert clinical opinion on effective practices for the following:

  • Early identification of children at risk or suspected of having a disability through routine developmental surveillance and screening targeted to identify specific disabilities.
  • Provision of multidisciplinary evaluations and assessments that result in reliable information about a child's developmental strengths and needs and, when possible, a diagnosis.
  • The determination of effective intervention strategies and reaching agreement on the frequency, intensity, and duration of early intervention services that will lead to positive outcomes for children and families.
  • The measurement of outcomes achieved.

The impact of clinical practice guidelines for the Early Intervention Program will depend on their credibility with families, service providers, and public officials. To ensure a credible product, the DOH elected to use an evidence-based, multidisciplinary consensus panel approach. The methodology used for these guidelines was established by the Agency for Health Care Policy and Research (AHCPR). The DOH selected the AHCPR model for this effort because it is an effective, scientific, and well-tested approach to guideline development.

The DOH has worked closely with the State Early Intervention Coordinating Council throughout the guideline development process. A state-level steering committee of early intervention officials, representatives of service providers, and parents was also established to advise the department of this initiative. A national advisory group of experts in early intervention has been available to the department to review and to provide feedback on the methodology and the guideline. Their efforts have been crucial to the successful development of this guideline.

Ordering Information

The New York State Early Intervention Program is part of the national Early Intervention Program for infants and toddlers with disabilities and their families, first created by Congress in 1986 under the Individuals with Disabilities Education Act (IDEA). IDEA is also the federal law that ensures all children and youth ages 3 to 21 years with disabilities the right to a free, appropriate education. In New York State, the Early Intervention Program is established in Article 25 of the Public Health Law and has been available to all eligible infants and toddlers and their families since July 1, 1993.

To be eligible for services, children must be under 3 years of age and have a confirmed disability or established developmental delay in one or more areas of the following areas of development: physical, cognitive, communication, social-emotional, and adaptive development.

The Early Intervention Program offers a variety of therapeutic and support services to infants and toddlers with disabilities and their families, including: family education and counseling, home visits, and parent support groups; special instruction; speech pathology and audiology; occupational therapy; physical therapy; psychological services; service coordination; nursing services; nutrition services; social work services; vision services; and assistive technology devices and services.

Major provisions of the New York Public Health Law that govern the Early Intervention program require:

  • Local administration of the program by an Early Intervention Official (EIO) designated by the chief elected official of each of the fifty-seven counties and New York City. The EIO is responsible for ensuring eligible children and families receive the services included in the Individualized Family Service Plan (IFSP) that is developed for the child and family.
  • Identification and referral of children at risk or suspected of disability by primary referral sources (including physicians and other health-care providers).
  • Periodic developmental screening and tracking of at-risk children.
  • Provision of service coordination services to eligible children and their families.
  • A multidisciplinary evaluation of children referred to the program, at no cost to families, to determine eligibility.
  • Individualized Family Service Plans (IFSP) for eligible children and their families.
  • Provision of early intervention services as specified in the IFSP at no cost to the family.
  • Delivery of services in natural settings in the community where peers are typically found to the maximum extent appropriate.

The mission of the Early Intervention Program is to identify and evaluate as early as possible those infants and toddlers whose healthy development is compromised and provide for appropriate intervention to improve child and family development. The program goals are to:

  • Support parents in meeting their responsibilities to nurture and to enhance their children's development.
  • Create opportunities for full participation of children with disabilities and their families in their communities by ensuring services are delivered in natural environments to the maximum extent appropriate.
  • Ensure early intervention services are coordinated with the full array of early childhood health and mental health, educational, social, and other community-based services needed by and provided to children and their families.
  • Enhance child development and functional outcomes and improve family life through delivery of effective, outcome-based high quality early intervention services.
  • Ensure early intervention services complement the child's medical home by involving primary and specialty health care providers in supporting family participation in early intervention services.
  • Assure equity of access, quality, consistency, and accountability in the service system by ensuring clear lines of public supervision, responsibility, and authority for the provision of early intervention services to eligible children and their families.

New York State Public Health Law designates the Department of Health as the lead agency for this statewide program. As the lead agency, the DOH is responsible for the overall supervision and administration of the Early Intervention Program. Responsibilities include:

  • Implementing statewide policies, procedures and programmatic and reimbursement regulations.
  • Implementing a comprehensive public awareness and child-find system.
  • Approving, compiling, and disseminating lists of approved service coordinators, evaluators, and service providers.
  • Providing training and technical assistance to municipalities and service providers to enable them to identify, locate, and evaluate eligible children; developing individualized family service plans; ensuring the appropriate provision of early intervention services; and promoting the development of new services where there is a demonstrated need.
  • Safeguarding parent and child rights under the Early Intervention Program.
  • Establishing and maintaining an Early Intervention Coordinating Council to advise and assist the department in program implementation.

The Department of Health sponsored the development of these guidelines for the Early Intervention Program as a part of its mission to make a positive contribution to the quality of care for children with disabilities in New York State.

Throughout the document, information about relevant Early Intervention Program (EIP) policy is presented in boxes with this symbol. The relevant policy information can be found in Appendix E.

The Clinical Practice Guideline: Report of the Recommendations provides the full text of the recommendations and a summary of the evidence supporting the recommendations.

A more complete description of the methodology used to develop the recommendations and a review of the articles cited as evidence can be found in The Guideline Technical Report

Chapter I
Table of Contents