September is quickly approaching and school-based speech language pathologists (SLPs) are preparing to go back to work. Many of them are looking to update their arsenal of speech and language materials for the upcoming academic school year.
With that in mind, I wanted to update my readers regarding all the new products I have recently created with a focus on assessment and treatment in speech language pathology. Continue reading New Products for the 2017 Academic School Year for SLPs
September is practically here and many speech language pathologists (SLPs) are looking to efficiently prepare for assessing and treating a variety of clients on their caseloads.
With that in mind, a few years ago I created SLP Efficiency Bundles™, which are materials highly useful for SLPs working with pediatric clients. These materials are organized by areas of focus for efficient and effective screening, assessment, and treatment of speech and language disorders.
A. General Assessment and Treatment Start-Up Bundle contains 5 downloads for general speech language assessment and treatment planning and includes:
B. The Checklists Bundle contains 7 checklists relevant to screening and assessment in speech language pathology
C. Social Pragmatic Assessment and Treatment Bundle contains 6 downloads for social pragmatic assessment and treatment planning (from 18 months through school age) and includes:
D. Multicultural Assessment and Treatment Bundle contains 2 downloads relevant to assessment and treatment of bilingual/multicultural children
E. Narrative Assessment Bundle contains 3 downloads relevant to narrative assessment
F. Fetal Alcohol Spectrum Disorders Assessment and Treatment Bundle contains 3 downloads relevant to FASD assessment and treatment
G. Psychiatric Disorders Bundle contains 7 downloads relevant to language assessment and treatment in psychiatrically impaired children
You can find these bundles on SALE in my online store by clicking on the individual bundle links above. You can also purchase these products individually in my online store by clicking HERE.
Today I am writing my last installment in the five-part early intervention assessment series. My previous posts on this topic included:
Today I’d like to talk about the assessment of feeding abilities of children under 3 years of age. Just to be clear, in my post, I am not offering tips on the assessment of medically fragile or neurologically impaired children with complex swallowing and feeding disorders such as severe food selectivity. Rather, I am offering suggestions for routine orofacial and feeding assessments of young children with normal swallowing but slightly immature feeding abilities.
First, let take a look at what the typical feeding development looks like in children 0-3 years of age. For this, I really like to use a resource from Dr. Joan Arvedson entitled: Developmental milestones and feeding skills birth to 36 months from her article Swallowing and feeding in infants and young children which was published online in 2006.
| Age (months) | Development/posture | Feeding/oral sensorimotor |
| Source: Adapted from Arvedson and Brodsky (pp. 62–67). | ||
| Birth to 4–6 | Neck and trunk with balanced flexor and extensor tone Visual fixation and tracking Learning to control body against gravity Sitting with support near 6 months Rolling over Brings hands to mouth |
Nipple feeding, breast, or bottle Hand on bottle during feeding (2–4 months) Maintains semiflexed posture during feeding Promotion of infant–parent interaction |
| 6–9 (transition feeding) | Sitting independently for short time Self-oral stimulation (mouthing hands and toys) Extended reach with pincer grasp Visual interest in small objects Object permanence Stranger anxiety Crawling on belly, creeping on all fours |
Feeding more upright position Spoon feeding for thin, smooth puree Suckle pattern initially Suckle suck Both hands to hold bottle Finger feeding introduced Vertical munching of easily dissolvable solids Preference for parents to feed |
| 9–12 | Pulling to stand Cruising along furniture First steps by 12 months Assisting with spoon; some become independent Refining pincer grasp |
Cup drinking Eats lumpy, mashed food Finger feeding for easily dissolvable solids Chewing includes rotary jaw action |
| 12–18 | Refining all gross and fine motor skills Walking independently Climbing stairs Running Grasping and releasing with precision |
Self-feeding: grasps spoon with whole hand Holding cup with 2 hands Drinking with 4–5 consecutive swallows Holding and tipping bottle |
| >18–24 | Improving equilibrium with refinement of upper extremity coordination. Increasing attention and persistence in play activities Parallel or imitative play Independence from parents Using tools |
Swallowing with lip closure Self-feeding predominates Chewing broad range of food Up–down tongue movements precise |
| 24–36 | Refining skills Jumping in place Pedaling tricycle Using scissors |
Circulatory jaw rotations Chewing with lips closed One-handed cup holding and open cup drinking with no spilling Using fingers to fill spoon Eating wide range of solid food Total self-feeding, using fork |
Now, let’s discuss the importance of examining the child’s facial features and oral structures. During these examinations it is important to document anything out of the ordinary noted in the child’s facial features or oral cavity.
Facial dysmorphia, signs of asymmetry indicative of paresis, unusual spots, nodules, openings, growths, etc, all need to be documented. Note the condition of the child’s mouth. Is there excessive tooth decay? Do you see an unusual absence of teeth? Is there an unusual bite (open, cross, etc.), unusual voice or a cough, in the absence of a documented illness? Here’s an example from a write up on a 2-8-year-old male toddler, below:
Facial observations revealed dysmorphic features: microcephaly (small head circumference), anteriorly rotated ears (wide set), and medially deviated, inward set eyes. A presence of mild-moderate hypotonicity (low tone) of the face [and trunk] was also noted. FA presented with mostly closed mouth posture and appropriate oral postural control at rest but moderate drooling (drool fell on clothes vs. touching chin only) was noted during speech tasks and during play. It’s important to note that the latter might be primarily behavioral in origin since FA was also observed to engage in “drool play” – gathering oral secretions at lip level then slowly and deliberately expelling them in a thin stream from his mouth and onto his shirt.
Articulatory structures including lips, tongue, hard palate and velum appeared to be unremarkable and are adequate for speech purposes. FA’s dentition was adequate for speech purposes as well. Oral motor function was appropriate for lingual lateralization, labial retraction, volitional pucker and lingual elevation. Lingual depression was not achieved. Diadochokinesis for sequential and alternate movements was unremarkable. Overall, FA’s oral structures and function presented to be adequate for speech production purposes.
FA’s prosody, pitch, and loudness were within normal limits for age and gender. No clinical dysfluencies were present during the evaluation. Vocal quality was remarkable for intermittent hoarseness which tended to decrease (clear up) as speech output increased and may be largely due to a cold (he presented with a runny nose during the assessment). Vocal quality should continue to be monitored during therapy sessions for indications of persistent hoarseness in the absence of a cold.
From there I typically segue into a discussion of the child’s feeding and swallowing abilities. Below is an excerpt discussing the strengths and needs of an 18-month-old internationally adopted female.
“During the assessment concerns presented regarding AK’s feeding abilities only. No swallowing concerns were reported or observed during the assessment. As per the parental report, at the age of 18 months, AK is still drinking from the bottle and consuming only puréed foods, which is significantly delayed for a child her age. AK’s feeding skills were assessed at snack time via indirect observation and select direct food administration. The following foods and liquids were presented to AK during the assessment: 2 oz of yogurt, 18 cheerios, 4 banana and 2 apple bites, and 40 ml of water (via cup and straw). AK was observed to accept all of the above foods and liquids readily when offered.
Spoon Stripping and Mouth Closure: During the yogurt presentation, AK’s spoon stripping abilities and mouth closure were deemed good (adequate) when fed by a caregiver and fair when AK fed self (incomplete food stripping from the spoon was observed due to only partial mouth closure). According to parental report, AK’s spoon stripping abilities have improved in recent months. Ms. K was observed to present spoon upwardly in AK’s mouth and hold it still until AK placed her lips firmly around the spoon and initiated spoon stripping. Since this strategy is working adequately for all parties in question no further recommendations regarding spoon feeding are necessary at this time. Skill monitoring is recommended on an ongoing basis for further refinement.
Biting and Chewing Abilities on Solids and Semi-Solids: AK’s chewing abilities were judged to be immature at this time for both solid (e.g., Cheerios) and semi-solid foods (e.g., banana). AK was observed to feed self Cheerios from a plate (1 at a time). She placed a cheerio laterally on lower right molars and attempted to grind it. When the cheerio was presented to AK midline she was observed to anteriorly munch it, or mash it against the hard palate. Notably, when too many cheerios were presented to her, rather than grasping and consuming them AK began to bang on a plate with both hands and throw the cheerios around the room.
During feeding, the most difficulty was observed with biting and chewing solid and semisolid fruit (e.g., apple and banana pieces). When presented with a banana, AK manifested moderate difficulties biting off an adequately sized piece (she bit off too much). Consequently, due to the fact that she was unable to adequately chew on a piece that large, manual extraction of food from the oral cavity was initiated due to choking concerns. It is important to note that during all food presentations AK did not display a diagonal rotary chew, which is below age expectancy for a child her age. Feeding strengths noted during today’s assessment included complete mouth closure (including lack of drooling and anterior food loss) during assisted spoon and finger foods feeding.
Cup and Straw Drinking: AK was also observed to drink 40 mls of water from a cup given parental assistance. Minor anterior spillage was intermittently noted during liquid intake. It is recommended that the parents modify cup presentation by providing AK with a plastic cup with two handles on each side, which would improve her ability to grasp and maintain hold on cup while drinking.
Straw drinking trials were attempted during the assessment as it is a skill which typically emerges between 8-9 months of age and solidifies around 12-13 months of age (Hunt et al, 2000). When AK was presented with a shortened straw placed in cup, she was initially able to create enough intraoral pressure to suck in a small amount of liquid. However, AK quickly lost the momentum and began to tentatively chew on the presented straw as which point the trial was discontinued.
Based on the feeding assessment AK presented with mildly decreased abilities in the oral phase of feeding. It is recommended that she receive feeding therapy with a focus on refining her feeding abilities.”
I follow the above, with a summary of evaluation impressions, recommendations, as well as suggested therapy goals. Finally, I conclude my report with a statement regarding the child’s prognosis (e.g., excellent, good, fair, etc.) as well as list potential maintaining factors affecting the duration of therapy provision.
So what about you? How do you assess the feeding and swallowing of abilities of children under 3 on your caseload? What foods, tasks, and procedures do you use?
In the past several years, due to an influx of adolescent students with language and learning difficulties on my caseload, I have begun to research in depth aspects of adolescent language development, assessment, and intervention.
While a number of standardized assessments are available to test various components of adolescent language from syntax and semantics to problem-solving and social communication, etc., in my experience with this age group, frequently, clinical assessments (vs. the standardized tests), do a far better job of teasing out language difficulties in adolescents.
Today I wanted to write about the importance of performing a clinical reading assessment as part of select* adolescent language and literacy evaluations.
There are a number of standardized tests on the market, which presently assess reading. However, not all of them by far are as functional as many clinicians would like them to be. To illustrate, one popular reading assessment is the Gray Oral Reading Tests-5 (GORT-5). It assesses the student’s rate, accuracy, fluency, and comprehension abilities. While it’s a useful test to possess in one’s assessment toolbox, it is not without its limitations. In my experience assessing adolescent students with literacy deficits, many can pass this test with average scores, yet still present with pervasive reading comprehension difficulties in the school setting. As such, as part of the assessment process, I like to administer clinical reading assessments to students who pass the standardized reading tests (e.g., GORT-5), in order to ensure that the student does not possess any reading deficits at the grade text level.
So how do I clinically assess the reading abilities of struggling adolescent learners?
First, I select a one-page long grade level/below grade-level text (for very impaired readers). I ask the student to read the text, and I time the first minute of their reading in order to analyze their oral reading fluency or words correctly read per minute (wcpm).
For this purpose, I often use the books from the Continental Press series entitled: Content Reading for Geography, Social Studies, & Science. Texts for grades 5 – 7 of the series are perfect for assessment of struggling adolescent readers. In some cases using a below grade level text allows me to starkly illustrate the extent of the student’s reading difficulties. Below is an example of one of such a clinical reading assessments in action.
CLINICAL READING ASSESSMENT: 8th Grade Male
A clinical reading assessment was administered to TS, a 15-5-year-old male, on a supplementary basis in order to further analyze his reading abilities. Given the fact that TS was reported to present with grade-level reading difficulties, the examiner provided TS a 7th-grade text by Continental Press. TS was asked to read aloud the 7 paragraph long text, and then answer factual and inferential questions, summarize the presented information, define select context embedded vocabulary words as well as draw conclusions based on the presented text. (Please note that in order to protect the client’s privacy some portions of the below assessment questions and responses were changed to be deliberately vague).
Reading Fluency: TS’s reading fluency (automaticity, prosody, accuracy and speed, expression, intonation, and phrasing) during the reading task was marked by monotone vocal quality, awkward word stress, imprecise articulatory contacts, false-starts, self–revisions, awkward mid-sentential pauses, limited pausing for punctuation, as well as misreadings and word substitutions, all of which resulted in an impaired reading prosody.
With respect to specific errors, TS was observed to occasionally add word fillers to text (e.g., and, a, etc.), change morphological endings of select words (e.g., read /elasticity/ as /elastic/, etc.) as well as substitute similar looking words (e.g., from/for; those/these, etc.) during reading. He occasionally placed stress on the first vs. second syllable in disyllabic words, which resulted in distorted word productions (e.g., products, residual, upward, etc.), as well as inserted extra words into text (e.g., read: “until pressure inside the earth starts to build again” as “until pressure inside the earth starts to build up again”). He also began reading a number of his sentences with false starts (e.g., started reading the word “drinking” as ‘drunk’, etc.) and as a result was observed to make a number of self-corrections during reading.
During reading, TS demonstrated adequate tracking movements for text scanning as well as use of context to aid his decoding. For example, TS was observed to read the phonetic spelling of select unfamiliar words in parenthesis (e.g., equilibrium) and then read them correctly in subsequent sentences. However, he exhibited limited use of metalinguistic strategies and did not always self-correct misread words; dispute the fact that they did not always make sense in the context of the read sentences.
TS’s oral reading rate during today’s reading was judged to be reduced for his age/grade levels. An average 8th grader is expected to have an oral reading rate between 145 and 160 words per minute. In contrast, TS was only able to read 114 words per minute. However, it is important to note that recent research on reading fluency has indicated that as early as by 4th grade reading faster than 90 wcpm will not generate increases in comprehension for struggling readers. Consequently, TS’s current reading rate of off 114 words per minute was judged to be adequate for reading purposes. Furthermore, given the fact that TS’s reading comprehension is already compromised at this rate (see below for further details) rather than making a recommendation to increase his reading rate further, it is instead recommended that intervention focuses on slowing TS’s rate via relevant strategies as well as improving his reading comprehension abilities. Strategies should focus on increasing his opportunities to learn domain knowledge via use of informational texts; purposeful selection of texts to promote knowledge acquisition and gain of expertise in different domains; teaching morphemic as well as semantic feature analyses (to expand upon already robust vocabulary), increasing discourse and critical thinking with respect to informational text, as well as use of graphic organizers to teach text structure and conceptual frameworks.
Verbal Text Summary: TS’s text summary following his reading was very abbreviated, simplified, and confusing. When asked: “What was this text about?” Rather than stating the main idea, TS nonspecifically provided several vague details and was unable to elaborate further. When asked: “Do you think you can summarize this story for me from beginning to the end?” TS produced the two disjointed statements, which did not adequately address the presented question When asked: “What is the main idea of this text.” TS vaguely responded: “Science,” which was the broad topic rather than the main idea of the story.
Text Vocabulary Comprehension:
After that, TS was asked a number of questions regarding story vocabulary. The first word presented to him was “equilibrium”. When asked: “What does ‘equilibrium’ mean?” TS first incorrectly responded: “temperature”. Then when prompted: “Anything else?” TS correctly replied: “balance.” He was then asked to provide some examples of how nature leans towards equilibrium from the story. TS nonspecifically produced: “Ah, gravity.” When asked to explain how gravity contributes to the process of equilibrium TS again nonspecifically replied: “gravity is part of the planet”, and could not elaborate further. TS was then asked to define another word from the text provided to him in a sentence: “Scientists believe that this is residual heat remaining from the beginnings of the solar system.” What is the meaning of the word: “residual?” TS correctly identified: “remaining.” Then the examiner asked him to define the term found in the last paragraph of the text: “What is thermal equilibrium?” TS nonspecifically responded: “a balance of temperature”, and was unable to elaborate further.
Reading Comprehension (with/out text access):
TS was also asked to respond to a number of factual text questions without the benefit of visual support. However, he presented with significant difficulty recalling text details. TS was asked: When asked, “Why did this story mention ____? What did they have to do with ____?” TS responded nonspecifically, “______.” When prompted to tell more, TS produced a rambling response which did not adequately address the presented question. When asked: “Why did the text talk about bungee jumpers? How are they connected to it?” TS stated, “I am ah, not sure really.”
Finally, TS was provided with a brief worksheet which accompanied the text and asked to complete it given the benefit of written support. While TS’s performance on this task was better, he still achieved only 66% accuracy and was only able to answer 4 out of 6 questions correctly. On this task, TS presented with difficulty identifying the main idea of the third paragraph, even after being provided with multiple choice answers. He also presented with difficulty correctly responding to the question pertaining to the meaning of the last paragraph.
Impressions: Clinical below grade-level reading comprehension assessment reading revealed that TS presents with a number of reading related difficulties. TS’s reading fluency was marked by monotone vocal quality, awkward word stress, imprecise articulatory contacts, false-starts, self–revisions, awkward mid-sentential pauses, limited pausing for punctuation, as well as misreadings and word substitutions, all of which resulted in an impaired reading prosody. TS’s understanding as well as his verbal summary of the presented text was immature for his age and was characterized by impaired gestalt processing of information resulting in an ineffective and confusing summarization. While TS’s text-based vocabulary knowledge was deemed to be grossly adequate for his age, his reading comprehension abilities were judged to be impaired for his age. Therapeutic intervention is strongly recommended to improve TS’s reading abilities. (See Impressions and Recommendations sections for further details).
There you have it! This is just one of many different types of informal reading assessments, which I occasionally conduct with adolescents who attain average scores on reading fluency and reading comprehension tests such as the GORT-5 or the Test of Reading Comprehension -4 (TORC-4), but still present with pervasive reading difficulties working with grade level text.
You can find more information on the topic of adolescent assessments (including other comprehensive informal write-up examples) in this recently developed product entitled: Assessment of Adolescents with Language and Literacy Impairments in Speech Language Pathology currently available in my online store.
What about you? What type of informal tasks and materials are you using to assess your adolescent students’ reading abilities and why do you like using them?
Helpful Smart Speech Therapy Adolescent Assessment Resources:
As SLPs we routinely administer a variety of testing batteries in order to assess our students’ speech-language abilities. Grammar, syntax, vocabulary, and sentence formulation get frequent and thorough attention. But how about narrative production? Does it get its fair share of attention when the clinicians are looking to determine the extent of the child’s language deficits? I was so curious about what the clinicians across the country were doing that in 2013, I created a survey and posted a link to it in several SLP-related FB groups. I wanted to find out how many SLPs were performing narrative assessments, in which settings, and with which populations. From those who were performing these assessments, I wanted to know what type of assessments were they using and how they were recording and documenting their findings. Since the purpose of this survey was non-research based (I wasn’t planning on submitting a research manuscript with my findings), I only analyzed the first 100 responses (the rest were very similar in nature) which came my way, in order to get the general flavor of current trends among clinicians, when it came to narrative assessments. Here’s a brief overview of my [limited] findings. Continue reading The Importance of Narrative Assessments in Speech Language Pathology (Revised)
To date, I have written 3 posts on speech and language assessments of children under 3 years of age. My first post offered suggestions on what information to include in general speech-language assessments for this age group, my second post specifically discussed assessments of toddlers with suspected motor speech disorders and my third post described what information I tend to include in reports for children ~16-18 months of age.
Today, I’d like to offer some suggestions on the assessment of social emotional functioning and pragmatics of children, ages 3 and under.
For starters, below is the information I found compiled by a number of researchers on select social pragmatic milestones for the 0-3 age group:
3. Development of Theory of Mind (Westby, 2014)
In my social pragmatic assessments of the 0-3 population, in addition, to the child’s adaptive behavior during the assessment, I also describe the child’s joint attention, social emotional reciprocity, as well as social referencing abilities.
Joint attention is the shared focus of two individuals on an object. Responding to joint attention refers to the child’s ability to follow the direction of the gaze and gestures of others in order to share a common point of reference. Initiating joint attention involves child’s use of gestures and eye contact to direct others’ attention to objects, to events, and to themselves. The function of initiating joint attention is to show or spontaneously seek to share interests or pleasurable experience with others. (Mundy, et al, 2007)
Social emotional reciprocity involves being aware of the emotional and interpersonal cues of others, appropriately interpreting those cues, responding appropriately to what is interpreted as well as being motivated to engage in social interactions with others (LaRocque and Leach,2009).
Social referencing refers to a child’s ability to look at a caregiver’s cues such as facial expressions, body language and tone of voice in an ambiguous situation in order to obtain clarifying information. (Walden & Ogan, 1988)
Here’s a brief excerpt from an evaluation of a child ~18 months of age:
“RA’s joint attention skills, social emotional reciprocity as well as social referencing were judged to be appropriate for his age. For example, when Ms. N let in the family dog from the deck into the assessment room, RA immediately noted that the dog wanted to exit the room and go into the hallway. However, the door leading to the hallway was closed. RA came up to the closed door and attempted to reach the doorknob. When RA realized that he cannot reach to the doorknob to let the dog out, he excitedly vocalized to get Ms. N’s attention, and then indicated to her in gestures that the dog wanted to leave the room.”
If I happen to know that a child is highly verbal, I may actually include a narrative assessment, when evaluating toddlers in the 2-3 age group. Now, of course, true narratives do not develop in children until they are bit older. However, it is possible to limitedly assess the narrative abilities of verbal children in this age group. According to Hedberg & Westby (1993) typically developing 2-year-old children are at the Heaps Stage of narrative development characterized by
In contrast, though typically developing children between 2-3 years of age in the Sequences Stage of narrative development still arbitrarily link story elements together without transitions, they can:
To illustrate, below is a narrative sample from a typically developing 2-year-old child based on the Mercer Mayer’s classic wordless picture book: “Frog Where Are You?”
Of course, a play assessment for this age group is a must. Since, in my first post, I offered a play skills excerpt from one of my early intervention assessments and in my third blog post, I included a link to the Revised Westby Play Scale (Westby, 2000), I will now move on to the description of a few formal instruments I find very useful for this age group.
While some criterion-referenced instruments such as the Rossetti, contain sections on Interaction-Attachment and Pragmatics, there are other assessments which I prefer for evaluating social cognition and pragmatic abilities of toddlers.
For toddlers 18+months of age, I like using the Language Use Inventory (LUI) (O’Neill, 2009) which is administered in the form of a parental questionnaire that can be completed in approximately 20 minutes. Aimed at identifying children with delay/impairment in pragmatic language development it contains 180 questions and divided into 3 parts and 14 subscales including:
Therapists can utilize the Automated Score Calculator, which accompanies the LUI in order to generate several pages write up or summarize the main points of the LUI’s findings in their evaluation reports.
Below is an example of a summary I wrote for one of my past clients, 35 months of age.
AN’s ability to use language was assessed via the administration of the Language Use Inventory (LUI). The LUI is a standardized parental questionnaire for children ages 18-47 months aimed at identifying children with delay/impairment in pragmatic language development. Composed of 3 parts and 14 subscales it focuses on how the child communicates with gestures, words and longer sentences.
On the LUI, AN obtained a raw score of 53 and a percentile rank of <1, indicating profoundly impaired performance in the area of language use. While AN scored in the average range in the area of varied word use, deficits were noted with requesting help, word usage for notice, lack of questions and comments regarding self and others, lack of reciprocal word usage in activities with others, humor relatedness, adapting to conversations to others, as well as difficulties with building longer sentences and stories.
Based on above results AN presents with significant social pragmatic language weaknesses characterized by impaired ability to use language for a variety of language functions (initiate, comment, request, etc), lack of reciprocal word usage in activities with others, humor relatedness, lack of conversational abilities, as well as difficulty with spontaneous sentence and story formulation as is appropriate for a child his age. Therapeutic intervention is strongly recommended to improve AN’s social pragmatic abilities.
In addition to the LUI, I recently discovered the Theory of Mind Inventory-2. The ToMI-2 was developed on a normative sample of children ages 2 – 13 years. For children between 2-3 years of age, it offers a 14 question Toddler Screen (shared here with author’s permission). While due to the recency of my discovery, I have yet to use it on an actual client, I did have fun creating a report with it on a fake client.
First, I filled out the online version of the 14 question Toddler Screen (paper version embedded in the link above for illustration purposes). Typically the parents are asked to place slashes on the form in relevant areas, however, the online version requested that I use numerals to rate skill acquisition, which is what I had done. After I had entered the data, the system generated a relevant report for my imaginary client. In addition to the demographic section, the report generated the following information (below):
I find the information provided to me by the Toddler Screen highly useful for assessment and treatment planning purposes and definitely have plans on using this portion of the TOM-2 Inventory as part of my future toddler evaluations.
Of course, the above instruments are only two of many, aimed at assessing social pragmatic abilities of children under 3 years of age, so I’d like to hear from you! What formal and informal instruments are you using to assess social pragmatic abilities of children under 3 years of age? Do you have a favorite one, and if so, why do you like it?
References:
In this post, I am continuing my series of articles on speech and language assessments of children under 3 years of age. My first installment in this series offered suggestions regarding what information to include in general speech-language assessments for this age group, while my second post specifically discussed assessments of toddlers with suspected motor speech disorders.
Today, I’d like to describe what information I tend to include in reports for children ~16-18 months of age. As I mentioned in my previous posts, the bulk of children I assess under the age of 3, are typically aged 30 months or older. However, a relatively small number of children are brought in for an assessment around an 18-month mark, which is the age group that I would like to discuss today.
Typically, these children are brought in due to a lack of or minimal speech-language production. Interestingly enough, based on the feedback of colleagues, this group is surprisingly hard to report on. While all SLPs will readily state that 18-month-old children are expected to have a verbal vocabulary of at least 50 words and begin to combine them into two-word utterances (e.g., ‘daddy eat’). When prompted: “Well, what else should my child be capable of?” many SLPs draw a blank regarding what else to say to parents on the spot.
As mentioned in my previous post on assessment of children under 3, the following sections should be an integral part of every early intervention speech-language assessment:
In my two previous posts, I’ve also offered examples of select section write-ups (e.g., receptive, expressive phonology, etc.). Below a would like to offer a few more for this age group. Below is an example of a write-up on an 18-month-old bilingual child with a very limited verbal output.
RECEPTIVE LANGUAGE:
L’s receptive language skills were solid at 8 months of age (as per clinical observations and REEL-3 findings) which is significantly below age-expectancy for a child her age (18 months). During the assessment L received credit for appropriately reacting to prohibitive verbalizations (e.g., “No”, “Stop”), attending to speaker when her name was spoken, performing a routine activity upon request (when combined with gestures), looking at familiar object when named, finding the aforementioned familiar object when not in sight, as well as pointing to select body parts on Mrs. L and self (though identification on self was limited). L is also reported to be able to respond to yes/no questions by head nods and shakes.
However, during the assessment L was unable to consistently follow 1 and 2 step directions without gestural cues, understand and perform simple actions per clinician’s request, select objects from a group of 3-5 items given a verbal command, select familiar puzzle pieces from a visual field of 2 choices, understand simple ‘wh questions (e.g., “what?”, “where?”), point to objects or pictures when named, identify simple pictures of objects in book, or display the knowledge and understanding of age appropriate content, function and early concept words (in either Russian or English) as is appropriate for a child her age.
EXPRESSIVE LANGUAGE and ARTICULATION
L’s expressive language skills were judged to be solid at 7 months of age (as per clinical observations and REEL-3 findings), which is significantly below age-expectancy for a child her age (18 months). L was observed to spontaneously use proto-imperative gestures (eye gaze, reaching, and leading [by hand]), vocalizations, as well waving for the following language functions: requesting, rejecting, regulating own environment as well as providing closure (waving goodbye).
L’s spontaneous vocalizations consisted primarily of reduplicated babbling (with a limited range of phonemes) which is significantly below age-expectancy for a child her age (see below for developmental norms). During the assessment, L was observed to frequently vocalize “da-da-da”. However, it was unclear whether she was vocalizing to request objects (in Russian “dai” means “give”) due to the fact that she was not observed to consistently vocalize the above solely when requesting items. Additionally, L was not observed to engage in reciprocal babbling or syllable/word imitation during today’s assessment, which is a concern for a child her age. When the examiner attempted to engage L in structured imitation tasks by offering and subsequently denying a toy of interest until L attempted to imitate the desired sound, L became easily frustrated and initiated tantrum behavior. During the assessment, L was not observed to imitate any new sounds trialed with her by the examiner.
During today’s assessment, L’s primary means of communication consisted of eye gaze, reaching, crying, gestures, as well as sound and syllable vocalizations. L’s phonetic inventory consisted of the following consonant sounds: plosives (/p/, /b/ as reported by Mrs. L), alveolars (/t/, /d/ as reported and observed), fricative (/v/ as observed), velar (/g/ as observed), as well as nasal (/n/, and /m/ as observed). L was also observed to produce two vowels /a/ and a pharyngeal /u/. L’s phonotactic repertoire was primarily restricted to reported CV(C-consonant; V-vowel) and VCV syllable shapes, which is significantly reduced for a child her age.
According to developmental norms, a child of L’s age (18 months) is expected to produce a wide variety of consonants (e.g., [b, d, m, n, h, w] in initial and [t, h, s] in final position of words) as well as most vowels. (Robb, & Bleile,(1994); Selby, Robb & Gilbert, 2000). During this time the child’s vocabulary size increases to 50+ words at which point children begin to combine these words to produce simple phrases and sentences (as per Russian and English developmental norms). Additionally, an, 18 months old child is expected to begin monitoring and repairing own utterances, adjusting speech to different listeners, as well as practicing sounds, words, and early sentences. (Clark, adapted by Owens, 2015)
Based on the above guidelines L’s receptive and expressive language, as well as articulation abilities, are judged to be significantly below age expectancy at this time. Speech and language therapy is strongly recommended in order to improve L’s speech and language skills.
Typically when the assessed young children exhibit very limited comprehension and expression, I tend to provide their caregivers with a list of developmental expectations for that specific age group (given the range of a few months) along with recommendations of communication facilitation. Below is an example of such a list, pulled a variety of resources.
Developmental Milestones expected of a 16-18 months old toddler:
Attention/Gaze:
Reaching and Gestures:
Play Skills/Routines:
Receptive (Listening Skills):
Expressive (Speaking Skills):
Materials to use with the child to promote language and play:
Strategies:
Core vocabulary categories for listening and speaking:
Select References:
Click HERE for the Early Intervention Evaluations PART IV: Assessing Pragmatic Abilities of Children Under 3
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Summer is in full swing and for many SLPs that means a welcome break from work. However, for me, it’s business as usual, since my program is year around, and we have just started our extended school year program.
Of course, even my program is a bit light on activities during the summer. There are lots of field trips, creative and imaginative play, as well as less focus on academics as compared to during the school year. However, I’m also highly cognizant of summer learning loss, which is the phenomena characterized by the loss of academic skills and knowledge over the course of summer holidays.
According to Cooper et al, 1996, while generally, typical students lose about one month of learning, there is actually a significant degree of variability of loss based on SES. According to Cooper’s study, low-income students lose approximately two months of achievement. Furthermore, ethnic minorities, twice-exceptional students (2xE), as well as students with language disorders tend to be disproportionately affected (Graham et al, 2011; Kim & Guryan, 2010; Kim, 2004). Finally, it is important to note that according to research, summer loss is particularly prominent in the area of literacy (Graham et al, 2011).
So this summer I have been busy screening the phonological awareness abilities (PA) of an influx of new students (our program enrolls quite a few students during the ESY), as well as rescreening PA abilities of students already on my caseload, who have been receiving services in this area for the past few months.
Why do I intensively focus on phonological awareness (PA)? Because PA is a precursor to emergent reading. It helps children to manipulate sounds in words (see Age of Aquisition of PA Skills). Children need to attain PA mastery (along with a host of a few literacy-related skills) in order to become good readers.
When children exhibit poor PA skills for their age it is a red flag for reading disabilities. Thus it is very important to assess the child’s PA abilities in order to determine their proficiency in this area.
While there are a number of comprehensive tests available in this area, for the purposes of my screening I prefer to use the ProPA app by Smarty Ears.
The Profile of Phonological Awareness (Pro-PA) is an informal phonological awareness screening. According to the developers on average it takes approximately 10 to 20 minutes to administer based on the child’s age and skill levels. In my particular setting (outpatient school based in a psychiatric hospital) it takes approximately 30 minutes to administer to students on the individual basis. It is by no means a comprehensive tool such as the CTOPP-2 or the PAT-2, as there are not enough trials, complexity or PA categories to qualify for a full-blown informal assessment. However, it is a highly useful measure for a quick determination of the students’ strengths and weaknesses with respect to their phonological awareness abilities. Given its current retail price of $29.99 on iTunes, it is a relatively affordable phonological awareness screening option, as the app allows its users to store data, and generates a two-page report at the completion of the screening.
The Pro-PA assesses six different skill areas:
After the completion of the screening, the app generates a two-page report which describes the students’ abilities as:
The above is perfect for quickly tracking progress or for generating phonological awareness goals to target the students’ phonological awareness weaknesses. While the report can certainly be provided as an attachment to parents and teachers, I usually tend to summarize its findings in my own reports for the purpose of brevity. Below is one example of what that looks like:
The Profile of Phonological Awareness (Pro-PA), an informal phonological awareness screening was administered to “Justine” in May 2017 to further determine the extent of her phonological awareness strengths and weaknesses.
On the Pro-PA, “Justine” evidenced strengths (80-100% accuracy) in the areas of rhyme identification, initial and final sound isolation in words, syllable segmentation, as well as substitution of sounds in initial position in words.
She also evidenced emerging abilities (~60-66% accuracy) in the areas of syllable and sound blending in words, as well as sound segmentation in CVC words,
However, Pro-PA assessment also revealed weaknesses (inability to perform) in the areas of: rhyme production, isolation of medial sounds in words, segmentation of words, segmentation of sounds in words with consonant blends,deletion of first sounds, consonant clusters, as well as substitution of sounds in final position in words. Continuation of therapeutic intervention is recommended in order to improve “Justine’s” abilities in these phonological awareness areas.
Now you know how I quickly screen and rescreen my students’ phonological awareness abilities, I’d love to hear from you! What screening instruments are you using (free or paid) to assess your students’ phonological awareness abilities? Do you feel that they are more or less comprehensive/convenient than ProPA?
References:
Those of you who have previously read my blog know that I rarely use children’s games to address language goals. However, over the summer I have been working on improving executive function abilities (EFs) of some of the language impaired students on my caseload. As such, I found select children’s games to be highly beneficial for improving language-based executive function abilities.
For those of you who are only vaguely familiar with this concept, executive functions are higher level cognitive processes involved in the inhibition of thought, action, and emotion, which located in the prefrontal cortex of the frontal lobe of the brain. The development of executive functions begins in early infancy; but it can be easily disrupted by a number of adverse environmental and organic experiences (e.g., psychosocial deprivation, trauma). Furthermore, research in this area indicates that the children with language impairments present with executive function weaknesses which require remediation.
EF components include working memory, inhibitory control, planning, and set-shifting.
Simply put, EFs contribute to the child’s ability to sustain attention, ignore distractions, and succeed in academic settings. By now some of you must be wondering: “So what does Hedbanz have to do with any of it?”
Well, Hedbanz is a quick-paced multiplayer (2-6 people) game of “What Am I?” for children ages 7 and up. Players get 3 chips and wear a “picture card” in their headband. They need to ask questions in rapid succession to figure out what they are. “Am I fruit?” “Am I a dessert?” “Am I sports equipment?” When they figure it out, they get rid of a chip. The first player to get rid of all three chips wins.
The game sounds deceptively simple. Yet if any SLPs or parents have ever played that game with their language impaired students/children as they would be quick to note how extraordinarily difficult it is for the children to figure out what their card is. Interestingly, in my clinical experience, I’ve noticed that it’s not just moderately language impaired children who present with difficulty playing this game. Even my bright, average intelligence teens, who have passed vocabulary and semantic flexibility testing (such as the WORD Test 2-Adolescent or the Vocabulary Awareness subtest of the Test of Integrated Language and Literacy ) significantly struggle with their language organization when playing this game.
So what makes Hedbanz so challenging for language impaired students? Primarily, it’s the involvement and coordination of the multiple executive functions during the game. In order to play Hedbanz effectively and effortlessly, the following EF involvement is needed:
Consequently, all of the above executive functions can be addressed via language-based goals. However, before I cover that, I’d like to review some of my session procedures first.
Typically, long before game initiation, I use the cards from the game to prep the students by teaching them how to categorize and classify presented information so they effectively and efficiently play the game.
Rather than using the “tip cards”, I explain to the students how to categorize information effectively.
This, in turn, becomes a great opportunity for teaching students relevant vocabulary words, which can be extended far beyond playing the game.
I begin the session by explaining to the students that pretty much everything can be roughly divided into two categories animate (living) or inanimate (nonliving) things. I explain that humans, animals, as well as plants belong to the category of living things, while everything else belongs to the category of inanimate objects. I further divide the category of inanimate things into naturally existing and man-made items. I explain to the students that the naturally existing category includes bodies of water, landmarks, as well as things in space (moon, stars, sky, sun, etc.). In contrast, things constructed in factories or made by people would be example of man-made objects (e.g., building, aircraft, etc.)
When I’m confident that the students understand my general explanations, we move on to discuss further refinement of these broad categories. If a student determines that their card belongs to the category of living things, we discuss how from there the student can further determine whether they are an animal, a plant, or a human. If a student determined that their card belongs to the animal category, we discuss how we can narrow down the options of figuring out what animal is depicted on their card by asking questions regarding their habitat (“Am I a jungle animal?”), and classification (“Am I a reptile?”). From there, discussion of attributes prominently comes into play. We discuss shapes, sizes, colors, accessories, etc., until the student is able to confidently figure out which animal is depicted on their card.
In contrast, if the student’s card belongs to the inanimate category of man-made objects, we further subcategorize the information by the object’s location (“Am I found outside or inside?”; “Am I found in ___ room of the house?”, etc.), utility (“Can I be used for ___?”), as well as attributes (e.g., size, shape, color, etc.)
Thus, in addition to improving the students’ semantic flexibility skills (production of definitions, synonyms, attributes, etc.) the game teaches the students to organize and compartmentalize information in order to effectively and efficiently arrive at a conclusion in the most time expedient fashion.
Now, we are ready to discuss what type of EF language-based goals, SLPs can target by simply playing this game.
1. Initiation: Student will initiate questioning during an activity in __ number of instances per 30-minute session given (maximal, moderate, minimal) type of ___ (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.
2. Planning: Given a specific routine, student will verbally state the order of steps needed to complete it with __% accuracy given (maximal, moderate, minimal) type of ___ (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.
3. Working Memory: Student will repeat clinician provided verbal instructions pertaining to the presented activity, prior to its initiation, with 80% accuracy given (maximal, moderate, minimal) type of ___ (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.
4. Flexible Thinking: Following a training by the clinician, student will generate at least __ questions needed for task completion (e.g., winning the game) with __% accuracy given (maximal, moderate, minimal) type of ___ (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.
5. Organization: Student will use predetermined written/visual cues during an activity to assist self with organization of information (e.g., questions to ask) with __% accuracy given (maximal, moderate, minimal) type of ___ (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.
6. Impulse Control: During the presented activity the student will curb blurting out inappropriate responses (by silently counting to 3 prior to providing his response) in __ number of instances per 30 minute session given (maximal, moderate, minimal) type of ___ (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.
7. Emotional Control: When upset, student will verbalize his/her frustration (vs. behavioral activing out) in __ number of instances per 30 minute session given (maximal, moderate, minimal) type of ___ (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.
8. Self-Monitoring: Following the completion of an activity (e.g., game) student will provide insight into own strengths and weaknesses during the activity (recap) by verbally naming the instances in which s/he did well, and instances in which s/he struggled with __% accuracy given (maximal, moderate, minimal) type of ___ (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.
There you have it. This one simple game doesn’t just target a plethora of typical expressive language goals. It can effectively target and improve language-based executive function goals as well. Considering the fact that it sells for approximately $12 on Amazon.com, that’s a pretty useful therapy material to have in one’s clinical tool repertoire. For fancier versions, clinicians can use “Jeepers Peepers” photo card sets sold by Super Duper Inc. Strapped for cash, due to highly limited budget? You can find plenty of free materials online if you simply input “Hedbanz cards” in your search query on Google. So have a little fun in therapy, while your students learn something valuable in the process and play Hedbanz today!
Related Smart Speech Therapy Resources:
In my previous post on this topic, I brought up concerns regarding the paucity of useful information in EI SLP reports for children under 3 years of age and made some constructive suggestions of how that could be rectified. In 2013, I had written about another significant concern, which involved neurodevelopmental pediatricians (rather than SLPs), diagnosing Childhood Apraxia of Speech (CAS), without the adequate level of training and knowledge regarding motor speech disorders. Today, I wanted to combine both topics and delve deeper into another area of EI SLP evaluations, namely, assessments of toddlers with suspected motor speech disorders.
Firstly, it is important to note that CAS is disturbingly overdiagnosed. A cursory review of both parent and professional social media forums quickly reveals that this diagnosis is doled out like candy by both SLPs and medical professionals alike, often without much training and knowledge regarding the disorder in question. The child is under 3, has a limited verbal output coupled with a number of phonological processes, and the next thing you know, s/he is labeled as having Childhood Apraxia of Speech (CAS). But is this diagnosis truly that straightforward?
Let us begin with the fact that all reputable organizations involved in the dissemination of information on the topic of CAS (e.g., ASHA, CASANA, etc.), strongly discourage the diagnosis of CAS in children under three years of age with limited verbal output, and limited time spent in EBP therapy specifically targeting the remediation of motor speech disorders.
Assessment of motor speech disorders in young children requires solid knowledge and expertise. That is because CAS has a number of overlapping symptoms with other speech sound disorders (e.g., severe phonological disorder, dysarthria, etc). Furthermore, symptoms which may initially appear as CAS may change during the course of intervention by the time the child is older (e.g., 3 years of age) which is why diagnosing toddlers under 3 years of age is very problematic and the use of “suspected” or “working” diagnosis is recommended (Davis & Velleman, 2000) in order to avoid misdiagnosis. Finally, the diagnosis of CAS is also problematic due to the fact that there are still to this day no valid or reliable standardized assessments sensitive to CAS detection (McCauley & Strand, 2008).
In March 2017, Dr. Edythe Strand wrote an excellent article for the ASHA Leader entitled: “Appraising Apraxia“, in which she used a case study of a 3-year-old boy to describe how a differential diagnosis for CAS can be performed. She reviewed CAS characteristics, informal assessment protocols, aspects of diagnosis and treatment, and even included ‘Examples of Diagnostic Statements for CAS’ (which illustrate how clinicians can formulate their impressions regarding the child’s strengths and needs without explicitly labeling the child’s diagnosis as CAS).
Today, I’d like to share what information I tend to include in speech-language reports geared towards the assessing motor speech disorders in children under 3 years of age. I have a specific former client in mind for whom a differential diagnosis was particularly needed. Here’s why.
This particular 30-month client, TQ, (I did mention that I get quite a few clients for assessment around that age), was brought in due to parental concerns over her significantly reduced speech and expressive language abilities characterized by unintelligible “babbling-like” utterances and lack of expressive language. All of TQ’s developmental milestones with the exception of speech and language had been achieved grossly at age expectancy. She began limitedly producing word approximations at ~16 months of age but at 30 months of age, her verbal output was still very restricted. She mainly communicated via gestures, pointing, word approximations, and a handful of signs.
Interestingly, as an infant, she had a restricted lingual frenulum. However, since it did not affect her ability to feed, no surgical intervention was needed. Indeed, TQ presented with an adequate lingual movement for both feeding and speech sound production, so her ankyloglossia (or anterior tongue tie) was definitely not the culprit which caused her to have limited speech production.
Prior to being reevaluated by me, TQ underwent an early intervention assessment at ~26 months of age. She was diagnosed with CAS by an evaluating SLP and was found to be eligible for speech-language services, which she began receiving shortly thereafter. However, Mrs. Q noted that TQ was making very few gains in therapy and her treating SLP was uncertain regarding why her progress in therapy was so limited. Mrs. Q was also rather uncertain that TQ’s diagnosis of CAS was indeed a correct one, which was another reason why she sought a second opinion.
Assessment of TQ’s social-emotional functioning, play skills, and receptive language (via a combination of Revised Westby Play Scale (Westby, 2000), REEL-3, & PLS-5) quickly revealed that she was a very bright little girl who was developing on target in all of the tested areas. Assessment of TQ’s expressive language (via REEL-3, PLS-5 & LUI*), revealed profoundly impaired, expressive language abilities. But due to which cause?
Despite lacking verbal speech, TQ’s communicative frequency (how often she attempted to spontaneously and appropriately initiate interactions with others), as well as her communicative intent (e.g., gaining attention, making requests, indicating protests, etc), were judged to be appropriate for her age. She was highly receptive to language stimulation given tangible reinforcements and as the assessment progressed she was observed to significantly increase the number and variety of vocalizations and word approximations including delayed imitation of words and sounds containing bilabial and alveolar nasal phonemes.
For the purpose of TQ’s speech assessment, I was interested in gaining knowledge regarding the following:
TQ’s oral peripheral examination yielded no difficulties with oral movements during non-speaking as well as speaking tasks. She was able to blow bubbles, stick out tongue, smile, etc as well as spontaneously vocalize without any difficulties. Her voice quality, pitch, loudness, and resonance during vocalizations and approximated utterances were judged to be appropriate for age and gender. Her prosody and fluency could not be determined due to lack of spontaneously produced continuous verbal output.
However, by this time I had already formulated a working hypothesis regarding TQ’s speech production difficulties. Based on her speech sound assessment TQ presented with severe phonological disorder characterized by restricted sound inventory, simplification of sound sequences, as well as patterns of sound use errors (e.g., predominance of alveolar /d/ and nasal /n/ sounds when attempting to produce most word approximations) in speech (Stoel-Gammon, 1987).
TQ’s difficulties were not consistent with the diagnosis Childhood Apraxia of Speech (CAS) at that time due to the following:
I felt that the diagnosis of CAS was not applicable because TQ lacked a verbal lexicon and no specific phonological intervention techniques had been trialed with her during the course of her brief therapy (~4 months) to elicit word productions (Davis & Velleman, 2000; Strand, 2003). While her EI speech therapist documented that therapy has primarily focused on ‘oral motor activities to increase TQ’s awareness of her articulators and to increase imitation of oral motor movements’, I knew that until a variety of phonological/motor-speech specific interventions had been trialed over a period of time (at least ~6 months as per Davis & Velleman, 2000) the diagnosis of CAS could not be reliably made.
I still, however, wanted to be cautious as there were a few red flags I had noted which may have potentially indicative of a non-CAS motor speech involvement, due to which I wanted to include some recommendations pertaining to motor speech remediation.
Now it is possible that after 6 months of intensive application of EBP phonological and motor speech approaches TQ would have turned 3 and still presented with highly restricted speech sound inventory and profoundly impaired speech production, making her eligible for the diagnosis of CAS in earnest. However, at the time of my assessment, making such diagnosis in view of all the available evidence would have been both clinically inappropriate and unethical.
So what were my recommendations you may ask? Well, I provisionally diagnosed TQ with a severe phonological disorder and recommended that among a variety of phonologically-based approaches to trial, an EBP approach to the treatment of motor speech disorders be also used with her for a period of 6 months to determine if it would expedite speech gains.
*For those of you who are interested in the latest EBP treatment for motor speech disorders, current evidence supports the use of the Rapid Syllable Transition Treatment (ReST). ReST is a free EBP treatment developed by the SLPs at the University of Sydney, which uses nonsense words, designed to help children coordinate movements across syllables in long words and phrases as well as helps them learn new speech movements. It is, however, important to note for young children with highly restricted sound inventories, characterized by a lack of syllable production, ReST will not be applicable. For them, the Integral Stimulation/Dynamic Temporal and Tactile Cueing (DTTC) approaches do have some limited empirical support.
I also made sure to make a note in my report regarding the inappropriate use of non-speech oral motor exercises (NSOMEs) in therapy, indicating that there is NO research to support the use of NSOMEs to stimulate speech production (Lof, 2010).
In addition to the trialing of phonological and motor based approaches I also emphasized the need to establish consistent lexicon via development of functional words needed in daily communication and listed a number of examples across several categories. I made recommendations regarding select approaches and treatment techniques to trial in therapy, as well as suggestions for expansion of sounds and structures. Finally, I made suggestions for long and short term therapy goals for a period of 6 months to trial with TQ in therapy and provided relevant references to support the claims I’ve made in my report.
You may be interested in knowing that nowadays TQ is doing quite well, and at this juncture, she is still, ineligible for the diagnosis CAS (although she needs careful ongoing monitoring with respect to the development of reading difficulties when she is older).
Now I know that some clinicians will be quick to ask me: “What’s the harm in overdiagnosing CAS if the child’s speech production will still be treated via the application of motor speech production principles?” Well, aside from the fact that it’s obviously unethical and can result in terrifying the parents into obtaining all sorts of questionable and even downright harmful bunk treatments for their children, the treatment may only be limitedly appropriate, and may not result in the best possible outcomes for a particular child. To illustrate, TQ never presented with CAS and as such, while she may have initially limitedly benefited from the application of motor speech principles to address her speech production, shortly thereafter, the application of the principles of the dynamic systems theory is what brought about significant changes in her phonological repertoire.
That is why the correct diagnosis is so important for young children under 3 years of age. But before it can be made, extensive (reputable and evidence supported) training and education are needed by evaluating SLPs on the assessment and treatment of motor speech disorders in young children.
References: