Transcript SPHS 5780 Diagnostics Lecture 02

THE NATURE OF
DIAGNOSIS AND EVALUATION
THE NATURE OF DIAGNOSIS AND EVALUATION
We pose questions, then seek and propose answers
to them, to better understand the nature of the
client’s communication disorder
Some think of this as a “problem-solving,” “puzzlesolving”, a “detective-like” process, or “conducting
research”.
Which metaphor do you prefer?
THE NATURE OF DIAGNOSIS AND EVALUATION
Note that the first step is…. posing your
questions!
Which metaphor
for the diagnostic
process is
Tomblin using
here?
THE NATURE OF DIAGNOSIS AND EVALUATION
We pose questions, then seek and propose
answers to them, to better understand the
nature of the client’s communication disorder….
Formulate some example questions.
UNDERSTANDING THE “NATURE OF THE
CLIENT’S COMMUNICATION DISORDER”
UNDERSTANDING THE “NATURE OF THE
CLIENT’S COMMUNICATION DISORDER”
World Health Organization (WHO)
Let’s discuss some examples.
The nature of the client’s communication disorder
includes all of these, as well as dynamic changes
over time.
UNDERSTANDING THE “NATURE OF THE
CLIENT’S COMMUNICATION DISORDER”
The “diagnostic model” of your work setting will
make assumptions about how to understand “the
nature of the client’s communication disorder”
-- Medical model
-- Behavioral model
-- Systems/social model
MODEL
Medical
Setting
Goal of the
diagnostic
process
Where
does the
problem
rest?
How do
we
attempt
to make
changes?
Hospital
Find cause,
categorize
problem
In client
Address
cause
Characterize
performance
within setting
In client
Change
behavior
Behavioral Schools
Systems/ At home, in Figure out which Mismatch Change
classroom context promotes b/w client context
Social
(natural
context)
successful
performance
and
context
UNDERSTANDING THE “NATURE OF THE
CLIENT’S COMMUNICATION DISORDER”
This “understanding” is the goal we constantly
strive toward, but this goal is rarely attained.
Why?
UNDERSTANDING THE “NATURE OF THE
CLIENT’S COMMUNICATION DISORDER”
Factors that complicate and challenge our understanding
Clients are dynamic and complex
Time is limited
Information is incomplete or unreliable
Data conflict with each other
Inferences are flawed
We make mistakes
Our experiences may “garden path” us
We are biased as humans (e.g., culturally)
Let’s discuss some examples that you’ve
experienced.
UNDERSTANDING THE “NATURE OF THE
CLIENT’S COMMUNICATION DISORDER”
How to overcome complications and challenges to our
understanding
Plan ahead, but be ready to change your plan
Recognize and acknowledge when we
don’t know….then follow through on
finding an answer.
Maintain a sense of curiosity
Be flexible, and ready to adapt your inferences
Summon your creativity and innovations to solve
problems
UNDERSTANDING THE “NATURE OF THE
CLIENT’S COMMUNICATION DISORDER”
Discuss how you might address each of these challenges.
 You are seeing your first diagnostic client with aphasia, and you haven’t had Lang III.
 Your diagnostic session is limited to one hour, and you need more time.
 Your client with suspected stuttering did not complete his written questionnaire.
 You don’t understand what all the numbers on the CELF mean when you score it.
 Your client is Hmong and illiterate.
 The client asks you a question, and you don’t know the answer.
 The client who was referred for an “articulation disorder” appears to be an autistic child
with a hearing loss.
 Your client’s diagnostic profile is so complex that you cannot come up with a diagnosis.
 You make a Dx of spastic dysarthria and your co-clinician makes a Dx of flaccid dysarthria.
 The client’s medical reports state that he has a left hemiplegia, and when he arrives, he
has a right hemiplegia.
 There is no standardized test available for testing the vocal quality of your voice client.
 You want to assess a child’s functional communication at home, but you can assess the
child only in the clinic.
THE EVALUATION PROCESS
THE EVALUATION PROCESS
 Pose _______________________
 Gather information
 Synthesize findings (through process of inference)
 Disseminate conclusions and act on them
 Counsel
Look for these process components on your
syllabus
THE EVALUATION PROCESS
Look for these process components on your
syllabus
THE EVALUATION PROCESS
 Pose question
 Gather
information
 Synthesize
findings
 Disseminate
conclusions and
act
 Counsel
Where do our original “step” fall in the evaluation
process?
THE EVALUATION PROCESS
Although these look like sequential “stages”, each
part of the process is happening simultaneously,
throughout the evaluation process.
INFORMATION GATHERING
(ONE PART OF THE EVALUATION PROCESS)
INFORMATION GATHERING
Note that the first step in the informationgathering process is….posing your questions!
Pose
question
(1)
Find
answer
(6)
Could we take steps 2-5 without step 1?
Which of these steps are you doing in your
diagnostic practicum right now?
INFORMATION GATHERING
The first step is…posing your questions!
Change each of these possible diagnostic goals into a question for your
current case. Make the question as specific as possible.
 Determination of the complaint
 Determining the existence of a communication disorder
 Determining client and family reactions and attitudes to the disorder
 Identifying associated problems
 Determining the factors causing or exacerbating the problem
 Determining the course of the problem (historical, over time, prognostic)
 Determining eligibility for therapy
 Determining therapy approach
 Determining the client’s use of his/her communication skills
 Determining how the client functions in his/her daily contexts
INFORMATION GATHERING
Look for these process components on your
syllabus
INFORMATION GATHERING
Look for these process components on your
syllabus
INFORMATION GATHERING:
FORMAL VS. INFORMAL TESTING
…AN INTRODUCTION
INFORMATION GATHERING:
FORMAL VS. INFORMAL TESTING
Formal: Norm-referenced testing
Informal: Criterion-referenced testing
PURPOSE OF FORMAL VS. INFORMAL TESTING
Formal: Determine eligibility for services
Informal: Determine nature of services
PURPOSE OF FORMAL VS. INFORMAL TESTING
NATURE OF FORMAL VS. INFORMAL TESTING
Formal: Establish groups of scores against which client is
compared. Uses converted scores to characterize
broad trait.).
100
85
Measure of central
tendency
Normal variability of
performance around
that measure of
central tendency
(sometimes
expressed as
standard score)
Where does my client’s score fall in the range of
scores for a large group of similar people?
Above or below measure of central tendency?
How far above or below the measure of central
tendency?
NATURE OF FORMAL VS. INFORMAL TESTING
Informal: Establish performance standard (criterion) against
which the client is compared. Expressed as Y/N (+/-).
Uses raw scores to characterize in high detail.
Examples:
Does child have any hypernasity?
Does the child display a phonological process of fronting?
Does the child understand vocabulary needed for success in a second-grade
classroom?
Does the child have MLU in the normal range for his age?
Does the adult with aphasia phone a merchant for information?
Is the child at least 80% accurate in his producion of /r/ in discourse contexts?
Is hearing sensitivity at least 25 dB in the speech range for both ears?
The standard could be based on:
1) Client’s previous performance)
2) Normal level of mastery
3) Clinician knowledge and experience
INFORMATION GATHERING:
CASE HISTORY TAKING
INFORMATION GATHERING:
CASE HISTORY TAKING
Written case history
Interview-based case history