Transcript Speech-Language Assessment in School Age Population Severe

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)