Speech and language delay OSCE — assessment and counselling

Station objectives

1. Take a focused speech-language developmental history including red flags. [1]
2. Observe social communication briefly and avoid over-reassurance. [7]
3. Explain why hearing assessment is required. [1] [2]
4. Counsel concurrent SLP/early support without diagnosing from the doorway. [1] [13]
5. Use teach-back and a closed-loop follow-up plan. [13]

Candidate brief

You are the doctor in a community clinic. Station A is 12 minutes with parent and toddler. Station B is 8 minutes focused on explanation and shared plan. [1]

Station A — Assessment

Setup: 24-month-old with fewer than fifteen words. Parent says he understands some instructions. No known regression. Child plays near parent, occasionally shows a toy. [1]

Expected actions:

• Elicit word list, phrases, comprehension examples, gesture, pointing, play and languages at home. [1]
• Ask explicitly about skill loss, hearing concerns and ear infections. [2]
• Observe joint attention and social reciprocity; note uncertainty rather than force a label. [7]
• Avoid diagnosing autism or DLD in the first minute; gather discriminators. [4]
• If language discordance appears, request professional interpreter rather than using a child as interpreter. [14]

Station B — Counselling

Task: Explain findings and plan to a worried parent who was told to wait until school. [1]

Expected counselling points:

• Translate speech vs language in plain language. [1]
• Hearing check is standard and protective, not an accusation. [2]
• SLP referral now; early supports can run in parallel. [1] [13]
• Offer 2–3 home language strategies (follow child’s focus, name what they look at, pause for turns). [1]
• Safety-net for regression or new concerns; book review. [7]
• If social red flags were present, explain additional autism pathway without catastrophic language. [11]

Marking domains

• Clinical information gathering [1]
• Developmental observation and reasoning [7]
• Management planning (hearing + concurrent therapy) [1] [13]
• Communication and shared decision-making [13]
• Equity and safety-netting [14]

Common fails

• Pure wait-and-see with no audiology
• Family interpreter only in a language-discordant visit
• Diagnosing autism from word count alone
• Open-ended “we’ll refer sometime” without loop closure [13] [14]