Diagnostics in Speech-Language Pathology: Key Terms, Assessments, and Psychometrics

What is a communication disorder?

An impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal, and graphic symbol systems.

What is a speech disorder?

An impairment of the articulation of speech sounds, fluency, and/or voice.

What is a language disorder?

Impaired comprehension and/or use of spoken, written, and/or other symbol systems, involving the form, content, and/or function of language.

What is screening in SLP?

A brief process/measure used to identify individuals who may need further evaluation.

What is assessment in SLP?

A systematic collection of information.

What is evaluation in SLP?

The systematic process of collecting, integrating, and interpreting information to make clinical judgments.

What is diagnosis in SLP?

Identification/classification of a disorder based on evidence and diagnostic criteria.

What is differential diagnosis?

Considering and distinguishing among possible explanations for a presenting problem.

What is the difference between assessment and diagnostics?

Assessment is the systematic collection of information; diagnostics is the identification/classification of a disorder based on evidence.

Why must every SLP assessment include multiple sources of information?

A diagnostic decision should consider converging evidence from multiple sources.

What does 'the clinical question drives test selection' mean?

You select assessment tools based on what you need to know about the client given the information you have.

What does the Code of Fair Testing Practices include?

Select appropriate tests, administer and score tests accurately, report and interpret test results, inform examinees/family members in understandable language.

Which principle of the ASHA Code of Ethics emphasizes the welfare of persons served?

Ethics I.

Which principle of ethics emphasizes maintaining professional competence?

Ethics II.

What is the purpose of a case history form?

It is a record of relevant information pertaining to the client's past and current concerns.

What sections does a case history form typically include?

Developmental history, medical history, family history, professional evaluations, occupational or educational situation, and sociological data.

How can an SLP review a case history in preparation for an interview?

It helps identify topics that require further clarification and anticipate areas that will require assessment.

What does it mean that the case history is more than a form?

It provides the foundation of understanding the client, but information may be missing, conflicting, sensitive, or difficult to obtain.

What are internal influences that may affect communication?

Cognition/communication, motor abilities/strength, hearing, visual acuity, attention, fatigue, motivation/engagement.

What are external influences that may affect communication?

Family environment, linguistic factors, cultural factors, education/vocational, communication partners, social/environmental demands, access to resources.

How should missing information in a case history be handled?

Document what is known vs. unknown, ask about potential sources of information, and obtain relevant records when appropriate.

How should conflicting information in a case history be addressed?

Gather information from multiple sources and ask about different settings and communication demands.

What should be considered regarding access and consent issues?

Identify who has relevant information, who can provide consent, and whether the SLP needs the information.

How should communication barriers be addressed?

Use a qualified interpreter, clarify rather than assume, and make the process accessible to the family.

How should sensitive information be handled?

Explain relevance, ask respectfully, maintain confidentiality, and document objectively.

What four questions should guide you with a complicated case history?

What do I know, what don't I know, what do I need to know, could this information change assessment procedures?

What are the best practice guidelines for conducting an interview?

Balance open and closed questions, encourage sharing, start with the right tone, transition smoothly, prepare for questions, record effectively, ask neutrally, check discrepancies, investigate answers, and close gracefully.

What is an example of a leading question?

'Your child gets frustrated when not understood by others, right?'

What is a superfluous answer and how to follow up?

'He talks fine at home.' Follow up with, 'Can you tell me about a recent conversation you had with him?'

What may facial spasms indicate?

A motor-control disorder

What does deviation of the jaw during opening suggest?

Unilateral muscle weakness or joint issues

What does lip weakness indicate?

Neurological impairments

What does uvula deviation suggest?

Vagus nerve involvement

What does tongue weakness indicate?

Neurological impairments (dysarthria)

What do tongue groping movements warrant?

Further assessment of motor planning

What does facial asymmetry indicate?

Neurological impairment, weakness, structural differences, or other causes

What can consistent mouth breathing suggest?

Enlarged tonsils/adenoids, nasal obstruction, or chronic airway issues

What may a high and narrow hard palate be linked to?

Oral habits (thumb sucking) or syndromes

What does tongue deviation to one side indicate?

Neurological involvement

What do abnormal tongue colors indicate?

Issues such as muscular paralysis, excessive vascularity, or oral cancer

What is a deep bite?

Severe overbite

What is excessive spacing in dental bites?

Noticeable gaps between upper and lower jaw

What is an over jet?

Teeth protrude too far, causing problems closing lips

What is an open bite?

Open in front

What is a crossbite?

One or more upper teeth bite inside the lower teeth

What is crowding in dental bites?

Teeth are spaced too close together

What is an underbite?

Entire under dental arch is sitting forward compared to the upper dental arch

What indicates velopharyngeal insufficiency?

Nasal emission

Why might a high, narrow hard palate be a concern?

It can affect articulation

What is psychometrics?

The science of measuring human traits, abilities, and processes

What is a construct in psychometrics?

An explanation of a behavior or attribute based on empirical observation and knowledge

What reflects the accuracy of a test in measuring what it claims?

Face validity

What reflects the consistency/stability of a test?

Internal consistency

What types of reliability can be identified?

Test-retest reliability, internal consistency

What types of validity can be identified?

Face validity, content validity, construct validity, criterion validity, concurrent validity, predictive validity

Can a test be valid if it is not reliable?

No, if a test is not reliable it cannot be valid

What does a dartboard example illustrate about reliability and validity?

Reliable and valid: darts tightly clustered and on target; reliable but invalid: darts consistently off-target; unreliable but valid: darts scattered but centered; unreliable and invalid: darts scattered and off-target

Why do reliability and validity matter for SLPs?

To ensure tests measure what they claim and to replicate results

What is a norm-referenced test?

Standardized test that allows comparison to the average

What is a criterion-referenced test?

Identifies what a client can and cannot do compared to a predefined criterion

What are the advantages of norm-referenced tests?

Objective, evidence-based, allows comparison to large groups

What are the disadvantages of norm-referenced tests?

Inherent margins of error, does not allow for individualization, cannot tell functional impact

What do standardized tests mean?

Formal tests with specific requirements for administration and scoring

What are non-standardized tests?

Assessment methods not designed for direct score comparison across groups

What is the importance of confidence intervals?

They indicate a range of scores where the test taker's true score is likely to be

What are the four misuses of norm-referenced tests?

Planning treatment goals based on test items, using test scores as sole summary, describing impairment patterns, retesting to track progress

What is part of the Code of Fair Testing Practices?

Administer and score tests accurately, select tests for the right reason, report and interpret test results clearly

What does reliability refer to?

Whether a test measures what it is supposed to measure

What should an SLP do if there is a concern about undiagnosed hearing impairment?

Ensure hearing is tested before any speech or language testing

What analogy best describes the assessment process?

Collecting the 'clues'

What contributes to the formulation of the clinical diagnostic question?

Referral concern, missing information, existing information

What type of test is used to see if a child can use the past tense morpheme -ed?

Criterion-referenced testing

True or False: Standardized tests allow comparison of individual performance to peers.

True

What psychometric principle is concerning if a test requires writing but claims to measure spoken language?

Validity

True or False: Reliability refers to whether a test measures what it is supposed to measure.

False

True or False: An SLP can ask peers or family to review a diagnostic report for accuracy.

True

Is it appropriate for an SLP to ask peers or family members to read a diagnostic report for accuracy?

True

What is the best follow-up question for a parent discussing their child's school performance?

Are there any subjects or classes that are easier or harder for him?

What is required to obtain information from other professionals during the assessment phase?

Permission of the client or primary caregiver.

What is the case history in the context of speech-language pathology?

A form and a process.

What did the SLP omit when closing an interview?

A final opportunity to add anything else.

What type of question is best to start an interview?

An open-ended question.

What is an appropriate question to ask about a child's activities at home?

What does your child like to do when he is at home with you?

What should an SLP use after a patient describes communication difficulties?

Specific, open-ended follow-up questions.

Can a standardized test be administered flexibly?

False.

What can reading passages like 'My Grandfather' assess?

Articulation, voice, fluency, and reading ability.

What question does a norm-referenced test answer?

How does this person compare with others?

Is the CELF a criterion-referenced test?

False.

Why do SLPs conduct oral-mechanism exams?

To evaluate structural integrity, strength and tone, and functional range of motion.

Can charting behaviors be used for both diagnostic and therapy activities?

True.

What should be an appropriate therapy goal for a child with low semantic knowledge?

Categorize common household objects into functional groups with 80% accuracy.

What might weak tongue strength and coordination indicate during an oral-mechanism exam?

Possibly a neurological impairment.

What measures assess a person's motor and speech-planning ability?

Diadochokinetic rates.

What does a standard score of 85 correspond to in percentile rank?

16th percentile.

What is a leading question in an interview about a child's communication skills?

Does your child have trouble pronouncing certain sounds?

Is written language sampling appropriate across ages and disorders?

True.

What are you assessing when conducting an oral mechanism exam in acute care?

Speech.

What does the SSI-4 assess in a stuttering evaluation?

Speech.

What does having a person read from a passage primarily provide information about?

False.

What is an appropriate interview question about non-verbal communication?

What are some ways that your son communicates without using words?