Pediatric & Adolescent Clinic Evaluation (PACE): Assessing Children’s Speech and Language

1. Pediatric & Adolescent Clinic Evaluation (PACE): Assessing Children’s Speech and Language Getting on the same page

2. Areas of Discussion • Website • Coming soon…. • Overview • link at bottom of PACE home page

3. Areas of Discussion • The Assessment • Language Comprehension • Language Expression • Articulation/Phonology • Phonemic Awareness/Preliteracy • Play • Structural-Functional/Oral-Motor Exams

4. Areas of Discussion • Making Recommendations • To treat or not to treat? • What is normal? • Is the person functional without treatment? • Are they ready for treatment? • What do I recommend? • Reports • Tutorials • Assignments

5. Assessing Language Comprehension over the Childhood Years

6. Assessing Language Comprehension • You must do both formal and informal assessments. • Formal • Standardized tests • Informal • Observation in low structured contexts • But, you must set up the opportunities!

7. Assessing Language Comprehension You must determine if the data collected support one another. If they are discrepant, you must ask yourself “Why?” You will need to try to figure out why and talk about it in the report.

8. Formal Assessment of Comprehension • Formal assessment measures • Know what they assess • Know how they assess (e.g., pictures, objects, toys, etc.) • Know age ranges

9. Informal Assessment of Comprehension – 0 ~ 4 years • Areas to consider: • Ability to engage in joint attention • Following directions with/without gestures – some general age ranges to keep in mind: • 12-18 months – follows simple 1 step command • 24 – 30 months – carries out a series of 2 related commands • 3 – 3;6 years – responds to commands involving 2 actions and responds to commands involving 2 objects. • 3;6 – 4 years – responds to commands involving 3 actions • Answering simple yes/no, wh-questions (age ranges for these) • Responding to various semantic relations • Understanding developmentally appropriate locatives

10. Informal Assessment of Comprehension – 3 years and up • Areas to consider: • Answering wh-questions • Understanding developmentally appropriate concepts • Following multi-step directions in the absence of cues (e.g., Simon Says…) • Making inferences (~4 + years) • See selections from The Clinical Assessment of Language Comprehension

11. Assessing Language Expression over the Childhood Years

12. Expressive Language – Areas to Consider • Expressive Language • Form • Content • Use Form Content Use These are separated for simplicity’s sake. But keep in mind there is overlap between the three areas and they must all be considered. The interaction between the three also must be kept in mind.

13. Expressive Language – Form • Form    • MLU • syntactic structure • grammatical morphemes • complex sentences • speech sound production* • intonation, prosody, inflection *We will talk about the speech sound production aspects in a separate section

14. Content • topics discussed (here/now; past, present, future events) • appropriateness of language to context vs tangential or echolalic language • perseverative language • semantic relations • vocabulary • narrative skills

15. Use • communicative intentions • eye contact/physical proximity and body language • topic initiation, maintenance, conclusion • turn taking skill • Language use is context and partner dependent and is best done via informal, careful observation.

16. Formal measures • Many formal measures have subtests that primarily assess in one ‘domain’ – PLS-4, CELF-P:2/CELF-4 – to help you diagnostically, BUT • Do not forget to look at the ‘whole’ picture!

17. Informal Assessment • Low-structured language sampling • Play-based • Show-n-share • Conversation • Must set up opportunities to discuss a variety of topics including things in the past, present and future • Must provide opportunities for child to maintain a conversation initiated by you • Must provide opportunities for child to initiate conversation • See also • Owens (3rd ed.) (computer lab) • Chapters 5, 6 and 7 for ‘How To’s’ and ways to analyze the samples • Appendix F for specific “Indirect Elicitation Techniques” to elicit various types of expressive language

18. Narratives: Why Assess Them • Predictor of persistent language disorder • Have ecological validity – natural part of daily interaction • Test of language content, form and use; an interaction between the 3 areas. • Can set up opportunities for dynamic assessment – add supports to see if they help the child.

19. Narratives • Discourse (narrative or expository) • Story retelling • Story generation with a picture • Story generation with a series of pictures

20. Narrative Samples Spontaneous Elicited Personal Fictional Personal Script Fictional Story Generation Story Retelling Hierarchy of Procedures for Collecting Narratives From The Guide to Narrative Language

21. Eliciting Narratives • Narratives • Discourse • Low-structured play for 0 – 4 years • Show-n-tell for 4 years +

22. Eliciting Narratives • Narratives • Story Retelling with visual support • Bus Story (story retelling) for 3;9 - 8;3 – with caveats • Sequence Cards (2, 3, 4, 5, 6 step) • See Make-A-Book in materials room • Story Retelling without visual support • Strong Narrative Assessment Procedure (SNAP) for K through 8 • Story Generation with visual support • Expression Connection (notebook) – 6 years +

23. Narrative Test • Test of Narrative Language – The tiny nutshell description: • Story Retell (no picture) • Story generation with sequence pictures • Story generation with a single picture

24. Speech – Formal Assessment of Articulation/Phonology • Connected speech sample (for all ages) • Consonant and vocalic repertoires • Syllable shapes • Stress patterns • Consistent or inconsistent consonant or vocalic errors • Can also judge rate, prosody, intonation, inflection, etc. as appropriate

25. Speech – Informal Assessment of Articulation/Phonology • Use a language sample during play/conversation or… • CPAC provides story-retelling contexts to set up opportunities for speech sounds • Compare errors in connected speech samples to performance on standardized tests (do they match?) • Determine intelligibility rating from connected speech

26. Speech – Formal Assessment of Articulation/Phonology • There are some articulation tests that are standardized down to age 2;0 The question is, how easy is it to get a 2-year-old to sit for your test?

27. Speech – Formal Assessment of Articulation/Phonology • For children over the age of 3, any (age-appropriate) articulation or phonology test (e.g., SPAT, Goldman-Fristoe, HAPP-3) will do.

28. Speech – Issues in the Assessment of Articulation/Phonology • Developmental articulation delay • See age ranges of normal consonant development to determine if the child has a problem. • Phonological Delays/Disorders • Use information you learned in Articulation and Phonological Disorders class.

29. Speech – Issues in the Assessment of Articulation/Phonology • Dyspraxia • For motor planning problems • Hierarchy for Motor Speech Examination • Motor Speech Examination form – any one that you like as long as it is comprehensive

30. Speech – Issues in the Assessment of Articulation/Phonology • Determining if a child needs speech treatment depends on a variety of factors: • Age-appropriateness of errors/patterns • Typical vs atypical errors/patterns • Effect of errors on intelligibility • Level of stimulability • Child’s (not parents’) awareness and distress

31. Stimulability • Purpose: • Brief trial teaching to determine client’s ability to produce a correct (or improved) production of an erred sound. Indicates readiness to learn (important prognostic indicator). • Also consult “Eliciting Sounds: Techniques and Strategies for Clinicians, 2nd Edition,” by Secord et al

32. Stimulability • It is highly advisable to practice teaching stimulabilty techniques with your colleagues before you actually try to do it on a client. • This will help you know what types of prompts and cues that you can use to help elicit a sound, so you won’t “freeze up” in the eval.  • Only do stimulability on sounds actually in error (not just because the parent wrote it on the form).

33. Assessing Phonemic Awareness

34. General Information about Phonemic Awareness • Standardized Tests • CTOPP (Clinical Test of Phonological Processing) • PAT (Phonological Awareness Test) • CELF-P:2 & CELF-4 - • have PA screening subtests

35. Assessing Play

36. Assessment of Play • Play is considered a “window into cognition” • As one of our previous students wrote in a report: • “Informal play assessments provide an opportunity to examine a child’s understanding of objects and events, and their relationship. As knowledge of objects and events grows, so does the foundation for acquiring language.”

37. Informal Assessment of Play • Resources: • Assessing Linguistic Behaviors (Carpenter’s Play Scale, in computer lab) • “Observation of Cognitive Development” from Transdisciplinary Play-Based Assessment (notebook)

38. Structural-Functional/Oral-Motor Exams

39. After the Information is Collected:Making Recommendations

40. Making Recommendations: To Treat or Not to Treat • Is treatment warranted? • Consider developmental norms – is the child within normal limits? • Functionality • Readiness to learn

41. What is Normal?? Test Scores and What they Mean

42. SCORE INTERPRETATIONS RELATIVE TO THE NORMAL CURVE

43. Scores and Informal Observations • You must consider test scores within the context of what the child is actually doing with communication. • Do the scores and what you see the child doing match? • If they don’t, why not?

44. Functionality • Do the areas of difficulty determined by the assessment impair the child’s ability to • Interact with family and peers? • Do well in school? • If so, treatment may be warranted. • In articulation treatment – sometimes our test scores indicate a serious delay, but if you look at the qualitative data, treatment may actually not be warranted.

45. Readiness to Learn • Stimulability or Dynamic Assessment • Is the child ready to learn these new behaviors? • Cognition can play a big role in this. • If not, it may make more sense to wait a little for treatment, or consider a different approach • e.g., Parent training

46. So treatment is warranted: What do I recommend? • This will be unique to each case. • You will need to draw on all your knowledge gained from previous classes to make educated suggestions. • Your recommendations will need to match the needs of the family. • Some families will want to know where to go to get help. • Some families will want to specifically know what they can be doing to help. • Some families do not want help.

47. What Goes in the Recommendation Section? Since this practicum is focused on clients who have already been accepted into our program for the summer, we will recommend treatment. • What should be the focus of treatment? • What are some broadly written behavioral objectives?

48. What Goes in the Recommendation Section? Suggestions for parents or other professionals to help with child’s needs Parent Articles Recommended books Recommended websites

49. During the assessment… • During the assessment, we try to stay out of the room unless we see you struggling. • Please do not be offended if we come in to help you. • If you are struggling but for some reason we have not come in, please call for us. • Do your best. • Make no assumptions and ask lots of questions.

50. Tutorials There are a number of tutorials that you should carefully review: • Preplanning * • Day of Evaluation * • Hearing Screening * • Interviewing * • PACE Reports • Report Writing Hints * Please be sure to review these before your first evaluation session.