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Speech-Language Assessment in School Age Population Severe-Profound By Katie Broadbent, CCC-SLP History of Speech-Language Assessment • Different approaches to assessing and treating language disorders - Etiological-Categorical (McCormick and Schiefelbusch , 1984, 1990) describes language and communicative disorders associated with: - Motor disorders - Sensory Deficits - Severe emotional-social dysfunction - Cognitive disorders - Developmental-Descriptive (Bloom and Lahey, 1978) Identify five types of language disorders : - Difficulties learning language form - Difficulties conceptualizing and formulating ideas - Difficulties using language (pragmatics) - Difficulties integrating form, content and use - Delayed language (following typical patterns of a younger child) Clinicians frequently identify etiological-categorical patterns that apply to a student but actual assessment tends to focus on descriptive-developmental areas. History cont. • Issues in public education that have impacted how and where assessment should be completed and provided: Issue Impact Education of the Handicapped Act (1970) Programming needed for ALL children Education for All Handicapped Children Act (1975) Put schools in charge of “child find” and increased need for appropriate screening, assessment. Individuals with Disabilities Education Act (1990) “People first” language. New eligibility criteria (TBI and Autism) Transition planning to adult programs. Integration of students with severe disabilities into schools and community (inclusion) Assistive technology to be considered as part of IEP Free Appropriate Education SLP has role in determining what is “appropriate” for student’s communication needs. Least Restrictive Environment More emphasis on placement in the typical classroom with supports. Means teachers need to be able to support children with a greater span of needs, and SLPs need to work in conjunction with classroom goals and topics. Available Assessments (Just a few!) • The Assessment of Basic Language and Learning Skills (ABLLS-R) • Functional Communication Profile-Revised • Test of Language Development: Intermediate — Fourth Edition (TOLD:I-4) • Test for Auditory Comprehension of Language- Third Edition (TACL-3) • Peabody Picture Vocabulary Test, Fourth Edition (PPVT4) • Expressive and Receptive One-Word Picture Vocabulary Tests (EOWPVT, ROWPVT) Components of a SpeechLanguage Assessment • • • • • Language Non-Verbal Speech Oral Motor and function Augmentative and Alternative Communication Language • Receptive languageWhat the student understands (spoken, signed, written, symbols) • Expressive Language How the student uses language (verbal, sign, picture communication, voice output) Receptive Language • oral comprehension -At what level (words, sentences, phrases, conversation) -Vocabulary and language testing to determine level • Comprehension of basic concepts -Such as emotions, object function, size, color, prepositions, quantity, etc -Classroom evaluations will also include information for this area • Response to simple/routine commands and call for attention -Responding to name -Responding to stop, look (with various levels of prompt) Receptive Language cont. • Non-verbal comprehension -Does the student understand gestures, facial expressions, body language, intonation change ,etc. ? • Object Identification -Can the student identify objects with verbal request, gestures, exploration, or by function? • Two dimensional recognition -Does the student recognize photos, drawings, safety signs, community signs (McDonald’s, Walmart) Expressive Language • Mode of communication -non verbal, verbal, limited verbal, non-oral, total communication, no communication • Level of Expression - sound, single words, phrases, sentences, conversation • Methods of communication - vocalization, gesture, manipulating another person, word board, speech, facial expressions, actions, photos, AAC, sign, eye gaze, objects, writing, PECs, etc. Expressive Communication cont. • What does the Student use expressive communication for? -name, emotions, basic needs, social exchange, humor, share ideas/interests, experiences, echolalia, etc. • How well is the message delivered? - specifically, generally, vaguely, listener must infer message • When appropriate, testing will include information on: -type and size of vocabulary, grammar, sound production, narration, etc. Expressive Language cont. • Pragmatic and social language - - What is the communicative intent? - request, gain attention, greet, comment, provide information , etc. Does the student initiate communication with others? Does the student answer questions (who, what, where, when , why, how?) Does the student answer yes/no questions? Does the student ask questions? Who does the student communicate with? - family, teachers, peers, community What does the student converse about? Does the student take turns in a conversation? Speech • If a Student is verbal: - What is the level of intelligibility? - easily understood by others, minimal/moderate/severe unintelligibility, not intelligible - Who are they understood by? - all listeners, average listener, trained listener, familiar listener - Can the student make adjustments to be better understood? Speech cont. • Specific information on speech sound production including: - Speech sound production and errors Oral motor abilities • Vocal qualities - loudness, vocal quality, pitch • Oral - breathing, drooling, tongue, dentition, swallowing/diet, feeding safety • Fluency - Rate of speech, rhythm/intonation Non-Verbal Communication • How can a person communicate without words? - Facial expression Body posture Different cries, sounds Eye gaze Augmentative and Alternative Communication (AAC) • Non-aided -pointing -gesture -sign • - Aided Objects Pictures Voice output Components of AAC evaluation and considerations for appropriate selection • Many schools will contract out to a group that specializes in AAC evaluation and training. • These groups will take into consideration: - - previous speech-language evaluation (receptive/expressive, functional communication) Previous cognitive/Linguistic abilities Academic/ classroom evaluations In Portland some groups that are often accessed include: • Pine Tree Society for Handicapped Children and Adults, IN (www.pinetreesociety.org) • Spurwink Services (www.spurwink.org) • Mark Hammond Associates (mrhassociates.com) Considerations cont. • Motor Abilities: - seating/positioning Is the student in a wheel chair or ambulatory? - Head/trunk control does the student have volitional control? Is the student going to fatigue, decreasing ability to access or requiring position changes in AAC - Upper extremity coordination and functional abilities How does the student use their hands, fingers? Can they use a point, or need to use whole hand to access? Is movement of upper extremities controlled and purposeful? - Muskuloskeletal/Range of Motion Is the student’s ROM limited? Do we need to consider weight, movement of AAC? Considerations cont. • Sensory Abilities - Vision Normal vision? Do we need to consider Size of materials, color of materials, amount of stimuli presented at one time? - Hearing Normal hearing? Sensitive to sound, pitch, volume? - Tactile Can the student pick up objects, manipulate them effectively? Is the student tactilely defensive to texture? Will the student tolerate objects on their wheel chair tray? Considerations cont. • AAC devices or materials can be expensive or time consuming to set up. Many agencies will allow a trial period for a device or equipment (switches) to determine success before the material is purchased for a student • There are many forms of documentation and data that need to be presented to funding agencies (Medicare, insurance, school system) to demonstrate that the device is a good fit, will benefit the student and is a necessity for academic success. What does this mean in the classroom? • Teacher input: - How does the student use skills in classroom to get needs met, participate in activities, create relationships - Is the student always able to use their skills or does the environment, communication partner affect ability? - What happens when communication breaks down? - Is there a scaffold in place to support the student through these breakdowns? - What supports are available in the classroom for students with communication difficulties and how do they aid in successful engagement, participation and learning? Additional Information/Resources • Shipley, K. G., McAfee, J. G. (1998). Assessment In Speech-Language Pathology: A resource Manual (2nd ed.). San Diego, CA: Singular Publishing Group, Inc. • Moore-Brown, B. J., Montgomery, J.K. (2001). Making a Difference for America’s Children. Eau Claire, WI: Thinking Publications. • Lund, N.J., & Duchan, J.F. (1993) Assessing children’s language in naturalistic contexts (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall. • Owens, R. E. (1996). Language disorders: A functional approach to assessment and intervention (2nd ed.). Needham Heights, MA: Allyn & Bacon. • Wiig, E. H., & Semel, E. (1984). Language assessment and intervention for the learning disabled (2nd ed.). Columbus, OH: Merrill. • American Speech-Hearing-Language Association (ASHA.org)