Exploring diagnostic language assessment practices in South Africa: A national survey

Abstract

Background: Diagnostic language assessment is central to speech-language therapy; however, in multilingual contexts such as South Africa, clinicians face challenges related to linguistic diversity, limited access to culturally appropriate tools and contextual constraints.
Objectives: This study aimed to describe diagnostic language assessment practices among South African speech-language pathologists (SLPs), including tools used, screening and assessment workflows, domains assessed, time and cost considerations, interpretation practices, and clinician confidence.
Method: A descriptive, cross-sectional survey design was employed. Using convenience and snowball sampling, an online questionnaire was completed by 99 SLPs across South Africa. Data were analysed using descriptive statistics.
Results: Speech-language pathologists reported using a combination of standardised and informal assessment tools, with commonly used instruments including the Renfrew Language Scales, Clinical Evaluation of Language Fundamentals and Test of Auditory Comprehension of Language. Screening practices were inconsistent, and assessments typically spanned one to two sessions. Clinical judgement was the most frequently used interpretive approach, while reliance on standardised norms and monolingual comparisons was less common. Clinicians reported low to moderate confidence when assessing multilingual clients. Key challenges included lack of culturally adapted tools, linguistic bias in assessments and difficulties interpreting bilingual children’s results.
Conclusion: Diagnostic language assessment practices in South Africa reflect adaptive responses to systemic constraints rather than inconsistency in clinician practice.
Contribution: The findings highlight the need for culturally grounded, multilingual assessment frameworks, locally relevant tools and clearer practice guidelines to support equitable diagnostic decision-making.