This project was designed to create and pilot test a checklist for use with populations of children that present challenges for evaluators. The World Health Organization's International Classification of Functioning, Disability, and Health-Children and Youth (ICF-CY) system was used to create a checklist to better characterize functional limitations in children. The checklist evaluates Body Structures and Functions, limitations in Activities and Participation resulting from speech-language difficulties, and relevant Environmental factors. Seven children with rare disorders and ten native Spanish-speaking children in Guatemala were evaluated using formal (standardized and non-standardized) tools and the pilot version of the ICF-CY based checklist. The results of testing and case studies demonstrate the clinical utility of the checklist. The main benefit of the ICF-CY checklist was identifying how children's speech-language impairments impacted their participation in daily activities. As a result, the checklist was also used to make functional treatment recommendations.