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What Research Shows About the Functional Relevance of Standardized Language Tests

Image result for standardized language testsAs an SLP who routinely conducts speech and language assessments in several settings (e.g., school and private practice), I understand the utility of and the need for standardized speech, language, and literacy tests.  However, as an SLP who works with children with dramatically varying degree of cognition, abilities, and skill-sets, I also highly value supplementing these standardized tests with functional and dynamic assessments, interactions, and observations.

Since a significant value is placed on standardized testing by both schools and insurance companies for the purposes of service provision and reimbursement, I wanted to summarize in today’s post the findings of recent articles on this topic.  Since my primary interest lies in assessing and treating school-age children, for the purposes of today’s post all of the reviewed articles came directly from the Language Speech and Hearing Services in Schools  (LSHSS) journal.

We’ve all been there. We’ve all had situations in which students scored on the low end of normal, or had a few subtest scores in the below average range, which equaled  an average total score.  We’ve all poured over eligibility requirements trying to figure out whether the student should receive therapy services given the stringent standardized testing criteria in some states/districts.

Of course, as it turns out, the answer is never simple.  In 2006, Spaulding, Plante & Farinella set out to examine the assumption: “that children with language impairment will receive low scores on standardized tests, and therefore [those] low scores will accurately identify these children” (61).   So they analyzed the data from 43 commercially available child language tests to identify whether evidence exists to support their use in identifying language impairment in children.

Turns out it did not!  Turns out due to the variation in psychometric properties of various tests (see article for specific details), many children with language impairment are overlooked by standardized tests by receiving scores within the average range or not receiving low enough scores to qualify for services. Thus, “the clinical consequence is that a child who truly has a language impairment has a roughly equal chance of being correctly or incorrectly identified, depending on the test that he or she is given.” Furthermore, “even if a child is diagnosed accurately as language impaired at one point in time, future diagnoses may lead to the false perception that the child has recovered, depending on the test(s) that he or she has been given (69).”

Consequently, they created a decision tree (see below) with recommendations for clinicians using standardized testing. They recommend using alternate sources of data (sensitivity and specificity rates) to support accurate identification (available for a small subset of select tests).

The idea behind it is: “if sensitivity and specificity data are strong, and these data were derived from subjects who are comparable to the child tested, then the clinician can be relatively confident in relying on the test score data to aid his or her diagnostic decision. However, if the data are weak, then more caution is warranted and other sources of information on the child’s status might have primacy in making a diagnosis (70).”

Fast forward 6 years, and a number of newly revised tests later,  in 2012, Spaulding and colleagues set out to “identify various U.S. state education departments’ criteria for determining the severity of language impairment in children, with particular focus on the use of norm-referenced tests” as well as to “determine if norm-referenced tests of child language were developed for the purpose of identifying the severity of children’s language impairment”  (176).

They obtained published procedures for severity determinations from available U.S. state education departments, which specified the use of norm-referenced tests, and reviewed the manuals for 45 norm-referenced tests of child language to determine if each test was designed to identify the degree of a child’s language impairment.

What they found out was “the degree of use and cutoff-point criteria for severity determination varied across states. No cutoff-point criteria aligned with the severity cutoff points described within the test manuals. Furthermore, tests that included severity information lacked empirical data on how the severity categories were derived (176).”

Thus they urged SLPs to exercise caution in determining the severity of children’s language impairment via norm-referenced test performance “given the inconsistency in guidelines and lack of empirical data within test manuals to support this use (176)”.

Following the publication of this article, Ireland, Hall-Mills & Millikin issued a response to the  Spaulding and colleagues article. They pointed out that the “severity of language impairment is only one piece of information considered by a team for the determination of eligibility for special education and related services”.  They noted that  they left out a host of federal and state guideline requirements and “did not provide an analysis of the regulations governing special education evaluation and criteria for determining eligibility (320).” They pointed out that “IDEA prohibits the use of ‘any single measure or assessment as the sole criterion’ for determination of disability  and requires that IEP teams ‘draw upon information from a variety of sources.”

They listed a variety of examples from several different state departments of education (FL, NC, VA, etc.), which mandate the use of functional assessments, dynamic assessments criterion-referenced assessments, etc. for their determination of language therapy eligibility.

But are the SLPs from across the country appropriately using the federal and state guidelines in order to determine eligibility? While one should certainly hope so, it does not always seem to be the case.  To illustrate, in 2012, Betz & colleagues asked 364 SLPs to complete a survey “regarding how frequently they used specific standardized tests when diagnosing suspected specific language impairment (SLI) (133).”

Their purpose was to determine “whether the quality of standardized tests, as measured by the test’s psychometric properties, is related to how frequently the tests are used in clinical practice” (133).

What they found out was that the most frequently used tests were the comprehensive assessments including the Clinical Evaluation of Language Fundamentals and the Preschool Language Scale as well as one word vocabulary tests such as the Peabody Picture Vocabulary Test. Furthermore, the date of publication seemed to be the only factor which affected the frequency of test selection.

They also found out that frequently SLPs did not follow up the comprehensive standardized testing with domain specific assessments (critical thinking, social communication, etc.) but instead used the vocabulary testing as a second measure.  They were understandably puzzled by that finding. “The emphasis placed on vocabulary measures is intriguing because although vocabulary is often a weakness in children with SLI (e.g., Stothard et al., 1998), the research to date does not show vocabulary to be more impaired than other language domains in children with SLI (140).“

According to the authors, “perhaps the most discouraging finding of this study was the lack of a correlation between frequency of test use and test accuracy, measured both in terms of sensitivity/specificity and mean difference scores (141).”

If since the time (2012) SLPs have not significantly change their practices, the above is certainly disheartening, as it implies that rather than being true diagnosticians, SLPs are using whatever is at hand that has been purchased by their department to indiscriminately assess students with suspected speech language disorders. If that is truly the case, it certainly places into question the Ireland, Hall-Mills & Millikin’s response to Spaulding and colleagues.  In other words, though SLPs are aware that they need to comply with state and federal regulations when it comes to unbiased and targeted assessments of children with suspected language disorders, they may not actually be using appropriate standardized testing much less supplementary informal assessments (e.g., dynamic, narrative, language sampling) in order to administer well-rounded assessments.  

So where do we go from here? Well, it’s quite simple really!   We already know what the problem is. Based on the above articles we know that:

  1. Standardized tests possess significant limitations
  2. They are not used with optimal effectiveness by many SLPs
  3.  They may not be frequently supplemented by relevant and targeted informal assessment measures in order to improve the accuracy of disorder determination and subsequent therapy eligibility

Now that we have identified a problem, we need to develop and consistently implement effective practices to ameliorate it.  These include researching psychometric properties of tests to review sample size, sensitivity and specificity, etc, use domain specific assessments to supplement administration of comprehensive testing, as well as supplement standardized testing with a plethora of functional assessments.

SLPs can review testing manuals and consult with colleagues when they feel that the standardized testing is underidentifying students with language impairments (e.g., HERE and HERE).  They can utilize referral checklists (e.g., HERE) in order to pinpoint the students’ most significant difficulties. Finally, they can develop and consistently implement informal assessment practices (e.g., HERE and HERE) during testing in order to gain a better grasp on their students’ TRUE linguistic functioning.

Stay tuned for the second portion of this post entitled: “What Research Shows About the Functional Relevance of Standardized Speech Tests?” to find out the best practices in the assessment of speech sound disorders in children.

References:

  1. Spaulding, Plante & Farinella (2006) Eligibility Criteria for Language Impairment: Is the Low End of Normal Always Appropriate?
  2. Spaulding, Szulga, & Figueria (2012) Using Norm-Referenced Tests to Determine Severity of Language Impairment in Children: Disconnect Between U.S. Policy Makers and Test Developers
  3. Ireland, Hall-Mills & Millikin (2012) Appropriate Implementation of Severity Ratings, Regulations, and State Guidance: A Response to “Using Norm-Referenced Tests to Determine Severity of Language Impairment in Children: Disconnect Between U.S. Policy Makers and Test Developers” by Spaulding, Szulga, & Figueria (2012)
  4. Betz et al. (2013) Factors Influencing the Selection of Standardized Tests for the Diagnosis of Specific Language Impairment

 

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Multicultural Considerations in Assessment of Play

As speech language pathologist part of my job is to play! Since play assessment is a routine part of speech language evaluations for preschool and early school-aged children, I often find myself on the carpet in my office racing cars, making sure that all the “Little People” get their turn on the toy Ferris Wheel, and “cooking” elaborate  meals in complete absence of electrical appliances.  In fact, I’ve heard the phrase “I want toy” so many times that I actually began to worry that I might accidentally use it in polite company myself.

The benefits of play are well known and cataloged. Play allows children to use creativity and develop imagination. It facilitates cognition, physical and emotional development, language, and literacy.  Play is great!  However, not every culture values play as much as the Westerners do.

Cultural values affect how children play. Thus play interactions vary significantly across cultures. For instance, many Asian cultures prize education over play, so in these cultures children may engage in educational play activities vs. pretend play activities. To illustrate, Farver and colleagues have found that Korean preschool children engaged in greater parallel play (vs. pretend play), initiated play less frequently, as well as had less frequent social play episodes in contrast to Anglo-American peers. (Farver, Kim & Lee, 1995; Farver and Shinn 1997)

To continue, cultures focused on individualism stress independence and self-reliance.  In such cultures, babies and toddlers are taught to be self sufficient when it comes to sleeping, feeding, dressing, grooming and playing from a very early age. (Schulze, Harwood, and Schoelmerich, 2001) Consequently, in these cultures parents would generally support and encourage child initiated and directed play. However, in many Latin American cultures, parents expect their children to master self-care abilities and function independently at later ages.  Play in these cultures may be more parent directed vs. child directed.   These children may receive more explicit directives from their caregivers with respect to how to act and speak and be more physically positioned or restrained during play. (Harwood, Schoelmerich, & Schulze, 2000)

In Western culture, early choice making is praised and encouraged.  In contrast, traditional collective cultures encourage child obedience and respect over independence (Johnston & Wong, 2002).  Choice making may not be as encouraged since it might seem like it’s giving the child too much power.  It would not be uncommon for a child to be given a toy to play with which is deemed suitable for him/her, instead of being asked to choose.   The children in these cultures may not be encouraged to narrate on their actions during play but expected to play quietly with their toy.  Furthermore, if the parents do not consider play as an activity beneficial to their child’s cognitive and emotional development, but treat it as a leisure activity that helps pass the time, they may not ask the child questions regarding what he/she are doing and will not expect the child to narrate on their actions during play.

Consequently, in our assessments, it is very important to keep in mind that children’s play is affected by a number of variables including: cultural values, family relationships, child rearing practices, toy familiarity as well as developmental expectations (Hwa-Froelich, 2004).  As such, in order to conduct balanced and objective play assessments, we as clinicians need to find a few moments in our busy schedules to interview the caregivers regarding their views on child rearing practices and play interactions, so we could objectively interpret our assessment findings (e.g.,  is it delay/disorder or lack of  exposure and task unfamiliarity).

References:

  •  Farver, J. M., Kim, Y. K., & Lee, Y. (1995). Cultural differences in Korean- and Anglo-American preschoolers’ social interaction and play behaviors. Child Development, 66, 1088- 1099.
  • Farver, J. M., & Shinn, Y. L. (1997). Social pretend play in Korean- and Anglo- American pre-schoolers. Child Development,68 (3), 544-556.
  • Johnston, J.R., & Wong, M.-Y. A. (2002). Cultural differences in beliefs and practices concerning talk to children . Journal of Speech, Language, and Hearing Research, 45 (5), 916-926
  • Harwood, R. L., & Schoelmerich, A and Schulze, P. A. (2000) Homogeneity and heterogeneity in cultural belief systems. New Directions for Child and Adolescent Development 87,  41-57
  • Hwa-Froelich, D. A. (2004). Play Assessment for Children from Culturally and Linguistically Diverse Backgrounds. Perspectives on Language, Learning and Education and on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 11(2), 6-10.
  • Hwa-Froelich, D. A., & Vigil, D. C. (2004). Three aspects of cultural influence on communication: A literature review. Communication Disorders Quarterly, 25(3),110-118.
  • Schulze, P. A., Harwood, R. L., & Schoelmerich, A. (2001). Feeding practices and expectations among middle-class Anglo and Puerto Rican mothers of 12-month-old infants. Journal of Cross-Cultural Psychology, 32(4), 397–406.
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The Value of Multidisciplinary Collaboration and Follow -up among International Adoption Professionals: A Speech Pathologist’s Perspective

As a speech language pathologist who works with internationally adopted children, I often encounter difficult cases on which I require multidisciplinary collaboration from other professionals such as pediatricians, neurologists, psychologists, occupational therapists and other related specialists. However, over the years of working with this unique population, I have noted that among adoption professionals and adoptive parents this practice is not as popular, as I would like it to be, despite evidence based practice recommendations (Catlett & Halper, 1992; Ellingson, 2002; Hwa-Froelich, Pettinelli, & Jones, 2006; Tzenalis & Sotiriadou, 2010). Oftentimes, medical professionals may initially examine a child post adoption, recommend a related service (e.g., “you child needs speech therapy”) but will not follow up with the related service provider regarding the child’s progress or lack of thereof.  Of course the same goes the other way, I have also encountered cases where a related services provider (e.g., OT, ST) had made clinically relevant observations and did not find it “important” to follow up with relevant medical professional/s regarding the findings.  I’ve also encountered numerous adoptive parents who did not follow through on specific recommendations regarding related services provision (speech or occupational therapy services) or psychiatric/neurological referrals.

Consequently, for the purpose of this article I would like to demonstrate to both adoptive parents and professionals two case examples in which multidisciplinary and parental collaboration was key to confirming specific relevant to social and academic functioning diagnoses, which then in turn supported the provision of relevant services for the children in question, to help them function appropriately.

Last year a received a private referral to perform a speech-language evaluation on a preschooler, 8 months post adoption.  He had previously underwent a post adoption assessment at a prominent hospital in my area,  where a neurologist had noted his small head circumference and significantly reduced language abilities and made a general referral for the child to be evaluated by a speech pathologist but did not emphasize the importance of follow-up to the adoptive parent.  Fast forward 8 months later, this child was still presenting with significant language delay as well as behavioral outbursts, when he was reluctantly brought in for an assessment by his parent based on a recommendation of a privately seen psychotherapist.

During the course of my assessment I noticed his atypical facial features.  He had a very small head, inward set eyes, and widely set ears.  At that time, even though this boy had already seen a number of other adoption professionals. I still documented my findings and referred him for a second opinion due to a number of additional red flags, which included his significantly decreased play skills, severely impaired language ability, as well as significant social emotional and behavioral difficulties.  This time around the second opinion consultations “paid off”, and yielded a diagnosis of Fetal Alcohol Spectrum Disorder, which allowed this child to be placed in preschool disabled classroom as well as to receive appropriate accommodations and related services to improve his language abilities and social emotional functioning.

While many professionals might consider this a successful conclusion to this story I would like to point out that this child presented with significant unrecognized and unaddressed deficits for 8 months post adoption due to lack of consistent collaboration and follow through in his case. Had the collaborative process been more cohesive this child could have been receiving relevant and necessary services since adoption, and could have feasibly improved his abilities by the time 8 months had passed.  

Here’s another case example in which the collaborative process was equally important.  A number of months ago during presentation preparation with two of my colleagues, a pediatrician and a clinical social worker, the conversation turned to progress of our mutual clients.   At that point I expressed frustration with halting and inconsistent progress of one of my clients, who was receiving weekly private speech therapy from me as well as private tutoring three times a week, and whose issues with attention and cognition persisted, despite the absence of a particular diagnosis (e.g., ASD).

After, I shared my concerns with my colleagues; the pediatrician stated that she has long been concerned with the presence of café au lait spots on this child’s skin and has sent him out for blood work but have not heard anything from his parents since. Though the pediatrician was not stating her suspicious explicitly, café au lait spots on the skin are often indicative of neurofibromatosis, a neurocutaneous syndrome that leads to benign tumor growths in various parts of the body, can affect the brain, spinal cord, nerves, skin, and other body systems as well as cause cognitive deficits and learning disabilities that affect appropriate knowledge acquisition and retention.  In this situation, it was very important to make sure that the parent was “on the same page” as the other professionals and followed through on their recommendations, in order to coordinate appropriate services and supports for this child both privately and through his school.

I use these examples to emphasize the value and importance of working as part of a team to treat the “whole” child.  Those adoption professionals who specialize in working with children on the spectrum are most familiar with being part of a team, since they are just one of many professionals such as behaviorists, OT’s, psychologists or neurologists who are working with a child.  Being part of a team is also a much more acceptable practice when a child is treated in a hospital or a rehab setting and presents with a complex disorder (e.g., has a genetic syndrome, etc).

However, in the field of adoptive services, even outside of specialty settings (hospital/rehab) we are frequently confronted with clients who stump our thinking processes, and who require the team approach.  Yet oftentimes that creates a significant challenge for many professionals isolated in private practice.  Being part of a team when one is sole practitioner is a much more difficult feat, especially when select adoptive professionals are just striking out on their own for the first time.

Yet, both interdisciplinary and multidisciplinary teamwork is oftentimes so crucial in our field. Working as part of a team allows us to collectively pursue common goals, combine our selective expertise, initiate a discussion to solve difficult problems, as well as to have professional lifelines when working on difficult cases.   Different providers (neurologist, SLP, OT, psychotherapist) see different symptoms as well as different aspects of the patient’s disorder. Consequently, different providers bring different perspectives to the table, which ultimately positively contributes to the treatment of the whole child.

So how can we develop productive professional relationships with other service providers which go beyond the initial referral? I’ll be the first one to admit that it is not an easy accomplishment especially which it comes to physicians such as psychiatrists, neurologists, geneticists, or developmental pediatricians.  I can tell you that while some of my professional relationships came easy, others took years to attain and refine.

When I first started working with internationally adopted children in private practice, in a fairly short period of time I ended up having a number of clients with complex diagnoses and no one to refer them to.  What complicated matters further was that some parents did not bring their child to pediatrician specializing in adoptions post arrival (the child just saw a regular pediatrician), but simply brought their child to me when the child’s most “visible issues” speech language deficits, became evident. I had to be the one to initiate the referral process to suggest to their parents relevant medical adoption professionals, which needed to be visited in order to figure out why their children were having such complex language difficulties (among other symptoms) in the first place.

Consequently, I’ve compiled some suggestions for adoption professionals on how to initiate and maintain professional relationships with other relevant adoption providers. Adoptive parents can also benefit from these, since it can help them to initiate the process of obtaining appropriate services for their adopted child.

Start by doing a little reconnaissance.  Become a member of select adoption forums, poke around for advice in support groups, subscribe to relevant adoption publications, network with adoption professionals on LinkedIn,  ask around locally based colleagues, talk to other client’s parents who already did the necessary legwork, or find out whether there are any good international adoption programs/professionals in the local area hospitals.  Personally, when word of mouth failed to do the trick, I turned to “Google” to provide me with desired results.  Surprisingly, simply typing in a string search containing the words adoption as well as “best _______ (profession) in _____ (name of state)” frequently did the trick and allowed me to locate relevant professionals, after browsing through the multitude of web reviews.

Of course depending on the length of client treatment, you will have different relationships with different adoption professionals.   You may collaborate for years with some (e.g., pediatricians, psychiatrists), and only infrequently speak with select specialists (geneticist, otolaryngologist, pediatric ophthalmologist).

Typically, when I refer a client for additional testing or consultation, in my referral letter, I request to receive the results in writing, asking the adoption professional to also include relevant recommendations (if needed). Oftentimes, I also try to set some time to discuss the findings in a phone call in case I have any additional questions or concerns. Of course, I also send out to others, relevant information from my end (progress reports, evaluations) so all of professionals on a specific case will have a more comprehensive profile of the client’s disorder/deficit.

After all, ST’s, OT’s and PT’s are not the only ones who are dependent on information from doctors in order to do our work better. There are times when physicians need information from related professionals in order to move further in treatment such as order specific tests. For example, just recently a pediatrician used my therapy progress report in conjunction with another provider’s, to order an MRI on our mutual recently adopted client.  The pediatrician had significant concerns over client’s development and presenting symptomatology, and needed to gather additional reports supporting her cause for concern in order to justify her course of action (ordering an MRI) to the HMO.

As mentioned previously there are numerous benefits to teamwork including the fact that it allows for appreciation of other disciplines, creation of functional goals for the child,  integration of interventions as well as “brings together diverse knowledge and skills and can result in quicker decision making” (Catlett & Halper, 1992).

Given the above, I highly recommend that adoptive parents and professionals attempt to coordinate care and maintain relationships throughout the duration of the child’s treatment.  This will improve decision making, allow the professionals to address the child’s deficits in a holistic manner, an even potentially expedite the child’s length of stay in therapies.

References:

  • Catlett, C & Halper, A (1992) Team Approaches: Working Together to Improve Quality. ASHA: Quality Improvement Digest.http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf
  • Ellingson, L (2002) Communication, Collaboration, and Teamwork among Health Care Professionals. Communication Research Trends 21(3) 1-43.
  • Hwa-Froelich, D. A., Pettinelli, J. D., & Jones, S. (2006). Multidisciplinary Collaboration  with Internationally Adopted Children. Perspectives on Communication  Disorders in Culturally and Linguistically Diverse Populations, 13(3), 8-16.
  • Matsuo, H. Hwa-Froelich, D. A., Pettinelli, J. D., Pryor, C., & Sessions, L. (2006).   Constructing Shared Realities: Multidisciplinary Collaboration of Internationally   Adopted Children’s Clinic. Presentation at the Second International Congress of  Qualitative Inquiry, Urbana-Champaign, IL.
  • National Institute of Neurological Disorders and Stroke (NINDS) Neurofibromatosis Information Page http://www.ninds.nih.gov/disorders/neurofibromatosis/neurofibromatosis.htm
  • Pettinelli, D. J., Matsuo, H., & Hwa-Froelich, D. A. (2006). Supervision in   multidisciplinary collaboration. Presentation at the Missouri Family Therapy   Conference, St. Louis, MO.
  • Tzenalis, A & Sotiriadou, C (2010) Health Promotion as Multi-Professional and Multi-Disciplinary Work.  International Journal of Caring Sciences 3(2)49-55

Frequently Asked Questions

Do you accept insurance reimbursement?

Unfortunately we do not.  We are an out of network insurance provider.

How do I submit for out of network speech therapy reimbursement?

You will be provided with an invoice to submit to your insurance company.  It will contain the necessary information including: diagnosis and treatment codes, session times, fees paid, description of services provided, as well as pertinent practice information (tax id, license number, etc). We will also provide you with assessment and therapy progress reports to submit to your insurance company along with the invoice.

What are your assessment fees? 

Our assessments are varied and highly individualized.  Assessment fees are based on our hourly rates and are dependent on a number of factors (e.g., face to face time spent with the client, report writing time, etc).  Prior to assessment parents are asked to fill out detailed intake and referral forms for their child in order to determine which testing instruments need to be administered.

Do you conduct in home assessments and treatment?

Unfortunately due to time constraints all services are provided on-site only.

 What are your hours of operation?

We try to accommodate all our busy customers by offering weekday afternoon and evening, as well as weekend hours.

How do I initiate assessment and/or therapy?

 Please call us for a free consultation at the number listed on our website.  Once we determine that our services are right for your child, you will receive a password to download the appropriate forms and releases.

How long do your assessments typically last?

Comprehensive assessments for younger children (infants, toddlers, preschoolers and early school age children) typically last between 2-3 hours and are performed during 1 visit. Comprehensive assessments for older school age children may last between 4-5 hours and are usually broken into 2 sessions over a period of several days. All assessments are highly individualized and are dependent on the client’s unique needs (e.g., is assessment needed to qualify the child for in district school therapy services, are parents seeking an independent evaluation to be used in a court case, etc)

What can I expect as a result of my child’s speech language assessment?

Two weeks subsequent to the last assessment date you will receive a comprehensive speech language report detailing your child’s performance on administered formal and informal testing.  It will contain performance scores (if applicable), detailed descriptive summary of performance strengths and weaknesses, impressions, recommendations, referral for additional professional consultations (if needed), treatment goals and objectives as well as suggested remediation methods, techniques, and strategies.

If you perform the assessment, but we are unable to come to you for treatment, what options are available to us?   

We offer comprehensive assessments and reassessments for out of state and out of county clients.  Our subsequent recommendations within the body of the report are very detailed, supported by the latest evidenced based research, and are very easy to follow.  Out of state comprehensive  re/assessments are often requested by parents due to the absence of qualified and highly trained professionals in their specific geographic area.  Such assessments are especially relevant for a select group of older internationally adopted OR functionally bilingual Russian speaking children with complex diagnoses/disabilities (Fetal Alcohol Spectrum Disorder, Mental Retardation, Genetic Disorders, Autistic Spectrum Disorders, etc), who attain limited success in therapeutic setting despite years and years of therapeutic intervention provision.

Other times we are asked to perform assessments with children who fail to qualify for intervention services within their state school system, due to limited assessment practices (therapist may administer select subtests from a general language test but does not assess the child’s social pragmatic skills, auditory processing skills, executive function, or critical thinking abilities), despite the child presenting with a number of profound linguistic, critical thinking, and social pragmatic deficits.

We perform the necessary testing based on presenting symptomology and then we’ll provide you with a comprehensive report detailing the subsequent requirements for treatment/referrals (if needed), which other therapists can then implement in the child’s home state/county.

 What if another therapist conducted the assessment do I still have to repeat the evaluation process?

In most circumstances testing will only need to be repeated if it’s significantly outdated.  Typically if the assessment was done within the past year, and the results are still accurately representative of the child’s present performance, therapy may be initiated immediately.  However, there may be a number of instances when the clinician may suggest a reassessment.  Below are some examples:

·         Testing report is outdated/not accurately representative of child’s present performance

·         Testing instruments used were outdated/no longer relevant to the child’s present needs

·         Testing was not comprehensive enough (child is scoring within normal limits on a specific test but still presents with significant deficits in other areas)

In such instances a partial/full reassessment may be recommended in the context of initial therapy sessions, in order to establish a baseline for intervention provision.

 What is the average therapy frequency and duration?

Average therapy frequency is 1 time per week for a duration of 1 hour.  Select clients receive higher therapy frequency and lower therapy duration; still others come in on biweekly or monthly basis to maintain skill level/abilities.

 What type of service delivery do you provide?

Vast majority of sessions are provided on individual basis.  Group sessions are subject to availability. Peer tutoring/coaching is often implemented when working on social language skills.

 How long will my child attend speech therapy?

Therapy duration is dependent on a number of factors:

·         Type and level of impairment (clients with significant disabilities such as mental retardation or autism spectrum disorders receive ongoing support and treatment vs. clients with articulation disorders, who are in therapy for a short number of weeks/months)

·         Presence of maintaining factors (e.g., psychiatric diagnosis, other structural/functional deficits)

·         Existence of additional support services (is the child receiving school based therapy, resource room, reading recovery, etc)

·         Parental involvement (supervision of homework, reinforcement of current skills)

·         Client motivation

How do you determine when the child is ready to be discharged from therapy services?

Client progress is charted on an ongoing basis. Frequent reassessments of deficit areas are administered during the course of treatment.

Additional Links:

Please see the following FAQ links from American Speech-Language-Hearing Association (ASHA) for further information:

Speech and Language Disorders in the School Setting: http://www.asha.org/public/speech/development/schoolsFAQ.htm

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Forms for Back to School Assessment Preparation

Back to school time is just around the corner and if your job is anything like mine then you are getting ready to perform a number of speech language screenings and assessments after the kids get back to school in September.  In order to optimize the assessment process I’ve created a number of checklists and forms for my (and your convenience). They allow for quick and efficient determination of whether the preschool/school age monolingual/bilingual student in question requires any speech language services including: screening, assessment, future follow-up, or on-going monitoring. Please note that for bilingual students it is recommended that parents mark whether the child presents with deficits in one language or in both on the checklists (e.g., mark R, E, or B – Russian, English or both).

  • R  difficulty following 3+step directions containing concepts of time or location (before/after/to the left)
  • E  difficulty understanding basic concepts in the classroom
  • B  difficulty responding appropriately to simple questions (who/what/where/when)

Speech Language Assessment Checklist For A Preschool Child is a 9 page guide created to assist speech language pathologists in the decision making process of how to select assessment instruments and prioritize assessment for preschool children 3:00-5:11 years of age. The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the areas of difficulty that the child presents with.

It contains:

  • Page 1 Title
  • Page 2 Directions
  • Pages 3-5 Checklist
  • Pages 6 Suggested Speech-Language Test Selection for Preschool Children
  • Page 7  Select Language Testing Battery Suggestions
  •  Page 8-9 Supplemental Caregiver/Teacher Data Collection Form

Checklist Target Areas:

  1. Receptive Language
  2. Memory, Attention and Sequencing
  3. Expressive Language
  4. Speech
  5. Voice
  6. Resonance
  7. Phonological Awareness
  8. Problem Solving
  9. Pragmatic Language
  10. Social Emotional Development
  11. Executive Functions

Speech Language Assessment Checklist For A School-Aged Child is a 12 page guide created to assist speech language pathologists in the decision making process of how to select assessment instruments and prioritize assessment for school age children. The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the areas of difficulty that the child presents with.

It contains:

  • Page 1 Title
  • Page 2 Directions
  • Pages 3-6 Checklist
  • Pages 7-8 Suggested Speech-Language Test Selection for School-Aged Children
  • Page 9  Select Language Testing Battery Suggestions
  •  Page 10-12 Supplemental Caregiver/Teacher Data Collection Form

Checklist Target Areas:

  1. Receptive Language
  2. Memory, Attention and Sequencing
  3. Expressive Language
  4. Vocabulary
  5. Narrative
  6. Speech
  7. Voice
  8. Resonance
  9. Phonological Awareness
  10. Problem Solving
  11. Pragmatic Language
  12. Social Emotional Development
  13. Executive Functions

Auditory Processing Deficits Checklist for School Aged Children was created to assist speech language pathologists (SLPs) with figuring out whether the student presents with auditory processing deficits which require further follow up (e.g., screening, comprehensive assessment). The SLP should provide this form to both teacher and caregiver/s to fill out to ensure that the deficit areas are consistent across all settings and people.

Checklist Categories:

  • Listening Skills and Short Term Memory
  • Verbal Expression
  • Emergent Reading/Phonological Awareness

  • General Organizational Abilities

  • Social Emotional Functioning
  • Behavior
  • Supplemental* Caregiver/Teacher Data Collection Form
  • Select assessments sensitive to Auditory Processing Deficits

Social Pragmatic Deficits Checklist for School Aged Children was created to assist speech language pathologists (SLPs) with figuring out whether the student presents with social pragmatic language deficits which require further follow up (e.g., assessment). The SLP should provide this form to both teacher and caregiver/s to fill out to ensure that the deficit areas are consistent across all settings and people.

Checklist Categories:

  • Listening/Processing
  • Verbal Expression
  • Problem Solving
  • Pragmatic Language Skills
  • Social Emotional Development
  • Behavior
  • Supplemental* Caregiver/Teacher Data Collection Form
  • Select assessments sensitive to Social Pragmatic Deficits

You can find these products by clicking on the individual links above. You can also find many other educational products relevant to assessment and treatment in speech language pathology in my online store by clicking HERE.

Happy and successful new school year everyone!

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Comprehending Reading Comprehension

Image of three books open on a table with stacks of books in the background.How many parents and professionals have experienced the following scenario? The child in question is reading very fluently (Landi & Ryherd, 2017) but comprehending very little of what s/he is reading.  Attempts at remediation follow (oftentimes without the administration of a comprehensive assessment) with a focus on reading texts and answering text-related questions. However, much to everyone’s dismay the problem persists and worsens over time. The child’s mental health suffers as a result since numerous studies show that reading deficits including dyslexia are associated with depression, anxiety, attention, as well as behavioral problems (Arnold et al., 2005; Knivsberg & Andreassen, 2008; Huc-Chabrolle, et al, 2010; Kempe, Gustafson, & Samuelsson, 2011; Boyes, et al, 2016;   Livingston et al, 2018). Continue reading Comprehending Reading Comprehension

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Spotlight on Syndromes: An SLPs Perspective on CHARGE Syndrome

Today’s guest post on genetic syndromes comes from Rebecca Freeh Thornburg, who is contributing on CHARGE Syndrome.

Overview:

CHARGE Syndrome is an extremely complex genetic condition encompassing anomalies of multiple systems. CHARGE affects approximately 1 in every 9 to 10,000 live births, worldwide. Respiratory issues and complex cardiac defects often require early and frequent hospitalization and surgical intervention. Characteristic hearing and vision impairments also contribute to delays in development.  Early and ongoing intervention by speech-language pathologists and other members of a multi-disciplinary care team is critical in achieving best outcomes for children affected by CHARGE. Continue reading Spotlight on Syndromes: An SLPs Perspective on CHARGE Syndrome

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Test Review: Clinical Assessment of Pragmatics (CAPs)

Today due to popular demand I am reviewing the Clinical Assessment of Pragmatics (CAPs) for children and young adults ages 7 – 18, developed by the Lavi Institute and sold by WPS Publishing. Readers of this blog are familiar with the fact that I specialize in working with children diagnosed with psychiatric impairments and behavioral and emotional difficulties. They are also aware that I am constantly on the lookout for good quality social communication assessments due to a notorious dearth of good quality instruments in this area of language. Continue reading Test Review: Clinical Assessment of Pragmatics (CAPs)