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Why Do I Have to Tell You What’s Wrong with My Child? Or On the Importance of Targeted Assessments

A few days ago I received a phone call from a parent who was seeking a language evaluation for her child. As it is my policy with all assessments, I asked her to fill out an intake and a checklist to identify her child’s specific areas of difficulty in order to compile a comprehensive and targeted testing battery.  Her response to me was: “I’ve never heard of this before? Why do I have to tell you what’s wrong with my child? Why can’t you figure it out?” Similarly, last week, another parent has questioned: “So you can’t do the assessment without this form?” Given the above questions, and especially because May is a Better Hearing and Speech Month #BHSM, during which it is important to raise awareness about communication disorders, I want to take this time to explain to parents why performing targeted speech language assessments is SO CRUCIAL.

To begin with it is very important to understand that speech and language can be analyzed in many different ways beyond looking at pronunciation, vocabulary or listening and speaking skills.

Targeted areas within the scope of practice of pediatric school based speech language pathologists include the assessment of:

    • The child may have difficulties with pronunciation of sounds in words, stutter, clutter, have a lisp or have difficulties in the areas of voice, prosody, or resonance. For the majority of  the above difficulties completely different tests and testing procedures may be needed in order to appropriately assess the child.
    • Receptive Language
      • Ability to follow directions, answer questions, recall sentences, understand verbal messages, as well as comprehend orally presented text
    • Memory and Attention 
      • Also see executive function skills
    • Expressive Language
      • Vocabulary knowledge and use, formulation of words and sentences as well as production of narratives or stories
    • Problem Solving
      • Verbal reasoning and critical thinking skills are very important for successful independent decision making as well as for interpretation of academically based texts and complete assignments
    • Pragmatic Language 
      • Successful use of language for a variety of communicative purposes
        • Initiate and maintain topics, maintain conversational exchanges, request help, etc
    • Social Emotional Competence
      • Effective interpersonal negotiation skills, compromise and negotiation abilities, as well as perspective taking are integral to academic and social success. These abilities are often compromised in children with language disorders and require a thorough assessment
    • Executive Functions (EFs) 
      • These are higher level cognitive processes involved in inhibition of thought, action and emotion, which are located in the prefrontal cortex of the frontal lobe of the brain.  
      • Major EF components include working memory, inhibitory control, planning, and set-shifting. EFs contribute to child’s ability to sustain attention, ignore distractions, and succeed in academic settings. 
    • Phonological Awareness
    • Reading Ability
    • Writing
    • Spelling 

One General Language Test Does Not Fit All! 

Children with speech and language disorders do not necessarily display weaknesses in all affected areas but may only display difficulties in selected few.

To illustrate, high functioning students on the autistic spectrum may have very strong academic skills related to comprehension and expression of language but may display significant social pragmatic language weaknesses, which will not be apparent on general language testing (e.g., administration of Clinical Evaluation of Language Fundamentals -5). Thus, the administration of a general language test will be contraindicated for these students as it will only show typical performance on these tests and will not qualify them for targeted language based services that they need.  However, by administering to them a testing battery composed of tests sensitive to social pragmatic language competence will highlight their areas of difficulty and result in a creation of a targeted intervention plan to improve their abilities in the affected areas. 

Similarly, children at risk for reading disabilities will not benefit from the administration of general language testing either, since their deficits may lie in the areas of sound discrimination, isolation, or blending as well as as impaired decoding ability.  So the administration of tests sensitive to phonological awareness and emergent reading ability would be much more relevant. 

This is exactly why taking an extra step and filling out a simple form will result in a much more targeted and beneficial speech language assessment for the child.  The goal of any competent professional assessment is to eliminate the administration of unnecessary and irrelevant tests and focus only on the administration of instruments directly targeting the areas of difficulty that the child presents with.  Given the fact that assessment of language covers so many broad areas, it makes perfect sense to ask parents to fill out relevant checklists/intakes as a routine part of a pre-assessment procedure.  Otherwise, even after observations in school setting, I would still just be blindly ‘fishing’ for deficits without really knowing whether I will  ‘accidentally stumble upon them’ using a general test at hand.

Of course, even checklists need to be targeted by age and areas of functioning. Here’s how I use mine. When performing comprehensive fist time assessments I ask the parent to fill out the comprehensive checklists based on the child’s age.    These are broken down as follows:

However, oftentimes when I perform reassessments or second opinion evaluations, I may ask the parent to fill out checklists pertaining to specific, known, areas of difficulty. These currently include:

After the parent fills the checklist out, the child’s areas of difficulty literally jump out from the pages. Now, all I need to do is to choose the appropriate testing instruments, which will BEST help me determine the exact nature and cause of the child’s deficits and I am all set. I administer the testing, interpret the results and write a comprehensive report detailing which therapy goals will be targeted. And this is why pre-assessment checklist administration is so important.

Helpful Resources

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App Review and Giveaway: Social Norms

Today I am reviewing “Social Norms” a brand new app developed by the Virtual Speech Center to improve social skills in children with autism spectrum disorders. 

This app can be used by parents, educators, and SLPs. The users can customize it to add their photos, text, and audio to create individualized stories that teach specific skills to children with ASD with significantly impaired language abilities. It includes 53 stories on the following topics: Continue reading App Review and Giveaway: Social Norms

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New Product Giveaway: Social Pragmatic Deficits Checklist for Preschool Children

preschool pragmatic checklist When it comes to assessment of social pragmatic abilities, the majority of SLP’s often worry about their school age students. Yet social-emotional disturbances and behavioral abnormalities in preschool children (<5 years of age) are more common than you think. —

Egger & Angold (2006) found that “despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. (p. 313)” Continue reading New Product Giveaway: Social Pragmatic Deficits Checklist for Preschool Children

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Birthday Giveaway Day Six: Eliciting Language In Pre-verbal Children with ASD

Eliciting Language in pre-verbal ASD-thumbnailToday it is truly my pleasure to bring you a giveaway from Maria Del Duca of Communication Station Blog entitled: “Eliciting Language In Pre-verbal Children with ASD: A Review of Behavioral and Naturalistic Therapy Techniques“.

This is a wonderful 64 page presentation which reviews the research supporting the current behavioral and naturalistic therapy techniques for pre-verbal children with ASD and explains how they are used to elicit verbal communication.  It’s great for any educator who needs a detailed and highly comprehensive introductory crash course on the multitude of therapy techniques used with nonverbal children ASD.

Intended audiences:

  • Graduate SLP students
  • Clinical Fellows
  • New SLP clinicians
  • Mid Career Switch Clinicians
  • Ancillary educational and health professionals
  • Parents of children with ASD interested in learning more regarding research based therapy techniques

Select techniques discussed in this presentation:

  • Applied Behavioral Analysis
  • Discrete Trial Training
  • Verbal Behavior Analysis
  • Rapid Motor Imitation Antecedent
  • Milieu Communication Training
  • Pivotal Response Training
  • Total Communication
  • Picture Exchange Communication System
    • And much much more

I remember when I was just starting out in the field and worked with non-verbal children with ASD, I spent inordinate amount of time looking for and reading much of the research articles listed in Maria’s presentation to learn more re: these approaches. Have I had this material it would have saved me a huge amount of time and effort. The way its written is logical, informative and clear. I like how the limitations are included with each technique’s review, which is a bonus since to read about each technique’s limitations one typically needs to locate even MORE articles, thereby spending even more time on this endeavor.

You can find this wonderful product in Maria’s online store  30% off for the next two days (October 7 and 8) by clicking HERE or you can enter my one day giveaway for a chance to win.

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Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers

emd toddlersToday I am exited to tell you about the new product I created in honor of Better Speech and Hearing Month. 

It is a 45 slide presentation created for speech language pathologists to explain the connection between late language development and the risk of social emotional disturbances in young children 18 months- 6 years of age.

Learning Objectives:

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Being Functional is APP-ealing!

apfun sampleIf you’ve been following my blog for a while ,then you know that I place a lot of emphasis on function. This is reflected in the assessments I select and the materials I choose. I want them to be practical, multifaceted, and useful for a wide variety of clients.  My caseload at the hospital and in private practice is pretty varied with diagnoses ranging from über verbal high functioning Asperger’s to non-verbal autistic clients.

It is for the latter clients that I am always in search of more materials, since it is much easier to find/adapt materials for the high functioning verbal students then for the low-functioning non-verbal ones. Especially because you want to make sure that whichever materials you select are not just educational and functional but also fun and easy to interact with.  That is why I was so excited when I got the opportunity to review Teach Speech 365 APP-ealing Functional Communication Packet. Continue reading Being Functional is APP-ealing!

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App Giveaway: Are you Sleeping?

Today Thanks to the generosity of Lavelle Carlson of I am giving away multiple copies of their newest app “Are You Sleeping”.

Continue reading App Giveaway: Are you Sleeping?

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IGetItApps Giveaway: I see-quence Social Skills Stories, My Shedules at School and at Home

Thanks to the wonderful generosity of Amy from IGetItApps I am able to bring you the following Mega Giveaway:

3 copies of I see-quence Social Skills Stories

3 copies of  I see-quence My schedules at School

3 copies of I see-quence My schedules at Home

So enter the Rafflecopter Giveaway below and don’t forget to comment on which app you would like to receive if you win! Continue reading IGetItApps Giveaway: I see-quence Social Skills Stories, My Shedules at School and at Home