This study investigated the methods of assessment and intervention used by speech-language therapists (SLTs) in the Western Cape when working with children with speech difficulties. Children with speech difficulties are likely to form a considerable part of SLT caseloads in South Africa, but assessment choice may not be clear-cut given the linguistic diversity of the region and that few assessments have been developed specifically for the SA population. Selection of intervention approaches may also pose difficulties, linked to the lack of assessments and the limited evidence base in our context. A questionnaire was sent to SLTs working with pre- and/or primary-school-aged children. Twenty-nine clinicians responded (18.7% response rate). The majority (89%) use informal assessment in combination with formal assessment. When using formal assessments, more than 50% of SLTs surveyed make procedural or linguistic modifications. Participants used a variety of interventions such as auditory discrimination and phonological awareness, often in combination, and based on a child's profile of difficulties. Forty-six per cent of SLTs felt unsure about the selection of assessments and intervention for bi/multilingual children. Clinical implications arising from this preliminary investigation are discussed together with some suggestions for developing knowledge of children's speech difficulties in South Africa.