Assessment of speech sound disorders

What do we want to figure out with a speech sound assessment?

-how the client says each speech sound -any sounds that aren't developmentally typically -What type of errors they are having -is there a pattern to the errors

What is an assessment?

the clinical evaluation of a client's disorder

What are the two phases to a speech sound assessment?

-appraisal -diagnosis

What is appraisal?

Collecting data about client and their speech sound productions

During the appraisal what are some examples of where data can come from?

•Case histories •School/medical records •Interviews with other professionals •Observations •Assessment measures

As a clinician, where do we get our data from?

-screenings -comprehensive evaluation

What is the goal of a screening?

identify clients that warrant further evaluation

A screening is typically, a quick ________ or ______ procedure

pass or fail

What should you be asking yourself during a screening?

"Do they need further testing?

What do screenings consist of?

limited sampling of speech sounds

Do screenings can establish a diagnosis?

NO

What are the types of screenings?

-informal -formal

Who designs informal screenings?

the examiner

What can an informal screening be tailored to?

a specific age group

What does an informal screening lack?

normative data

With an informal screening, who determines who passes or fails?

the examiner

What type of procedures do formal screenings follow?

structured elicitation procedures

What do formal screenings often have?

-normative data -cutoff scores

What might you screen in a formal screening?

-single-word articulation -phonology -language

What are some examples of informal screening tools?

-picture descriptions -single-word list -oral reading

What is an examples of a formal screening tool?

Fluharty Preschool Speech and Language Screening Test-2

Explain the Fluharty

•Ages 3-6 •15 pictures eliciting 30 target sounds •Standard scores and percentiles given

What are comprehensive evaluations?

series of activities that allows for a more detailed and complete collection of data

What is the core of our speech sound assessment?

comprehensive evaluations

What do comprehensive evaluations include?

•Single-word sampling •Conversational speech (in various contexts) •Hearing testing •Oral mechanism exam •Any additional necessary measures

What do single-word samplings typically involve?

involves elicitation of single words from pictures, often as part of a formal standardized test

What do we need to consider when we select articulation and phonology tests?

-Appropriateness of age -Whether or not test gives a standardized score -Sounds and context included in a given test -Test's analysis of sound errors

What are some advantages to standardized tests?

-Easy to administer -Quick to administer -Tell us which sounds are errored in various positions -May provide standardized scores

What are some disadvantages to standardized tests?

-Only look a single words -May not provide enough phonological info -Do not test all sounds in all contexts -Shows a snapshot of articulatory behavior

Why do we do conversational speech in assessments?

looking for clients to accurately produce speech sounds in conversation

What does conversational speech in assessments allow for?

•Assessment of overall intelligibility and severity •Determination of speech sound accuracy in a more natural context

What are some ways to get conversational speech?

-Provide objects or photos with target sounds in them -Plan appropriately for length of sample (50-100 words minimum) -Plan diverse contexts within your sample -Record sample -"gloss" the sample when necessary -Transcribe in real time and fill the gaps

What does it mean to gloss the sample as necessary?

-When recording the sample if you have a kid who is highly unintelligible -repeating the words that you might not get later but understand now

Why is it important to determine whether or not a client exhibits a loss of auditory function?

•If they can't hear a sound they might not be able to produce it correctly •Can lead to misdiagnosis

How do we typically screen for loss of auditory function?

Typically 20 dB threshold at 500, 1000, 2000, & 4000 Hz

What is an oral mechanism examination?

Evaluating structure and function of oral/facial structures

In an oral mech what are the main things you are checking for?

-symmetry -range of motion -strength -coordination

During an oral mech, what are some things you would look for in the face?

•Facial symmetry •Size/shape of head •Any other abnormalities

During an oral mech, what are some things you would look for in the lips?

•Resting posture •Evidence of cleft •Normality of length/size •Retraction •Protrusion •Labial seal

During an oral mech, what are some things you would look for in the jaw?

•Opening •Closing •Lateral motion

During an oral mech, what are some things you would look for in the teeth?

•Teeth present/missing/false •Occlusion type

What occlusion type is when the top teeth rest in front of the bottom teeth farther out then what would be typical?

overbite

What occlusion type is when the bottom teeth rest in front of the top teeth?

underbite

What occlusion type is when there is an opening/ gap between the top and bottom teeth when the jaw is closed?

open bite

What occlusion type is when the top and bottom teeth cross between with is in the front?

cross bite

During an oral mech, what are some things you would look for in the tongue?

•Color •Appearance at rest •Size •Movement at rest? •Protrusion •Retraction •Elevation •Lateralization

What is important to remember when assessing the tongue during an oral mech?

you want to assess coordination (have them do several movements in row)

During an oral mech, what are some things you would look for in the hard palate?

•Color •Palatal arch size/shape •Evidence of cleft

What are signs of submucous cleft palate?

-white or blue colored palate -darker triangle on the palate -bifid uvula

During an oral mech, what are some things you would look for in the velum/oropharynx?

•Symmetry •Uvula shape/size •Tonsil size •Abnormalities (like bifid uvula) •Velopharyngeal closure

During an oral mech, what are some things you would look for in the laryngeal function?

•Vocal fold closure (listen to their vocal and have then clear their throat) •Consistency of vocal fold vibration

What are diadochokinetic rates also called?

DDKs

What are DDKs?

Functionally assess movement of the speech mechanism

When doing DDKs what should you ask yourself?

•Can the client complete the task? •Is the ROM sufficient? •Are movements smooth? •Is the speech WNL?

How do you determine how someone did with DDKs?

repetitions/ seconds -and compare to norms

Sometimes, we want additional information as part of a speech sound evaluation, such as __________ _________

perception tasks

perception tasks help with differential diagnosis, why?

-help us learn if the client doesn't know the difference between two sounds (phonological issue)

In Perception tasks you look at other parts of Speech language pathology also. What are some areas you would looks at?

-language -cognition -voice -etc

Once you have completed the data collection, What should you see if you can do?

prompt the client to more accurate produce a misarticulated sound

Once you have completed the data collection, you should prompt the client to more accurate produce a misarticulated sound. What is this called?

stimulability

What important information can you get from testing stimulability?

•Can tell you what cues they have or methology •To find the right level of challenge •Can use it figure out prognosis •Creating goals and see what to target first

When analyzing our finding, what do we want to figure our from the data collected during the evaluation?

•Is there a problem that warrents intervention? •How severe is the problem? •What is the nature of the problem? •What should be targeted in intervention?

What are the steps to analyzing your findings?

•Score standardized assessments •Determine intelligibility and severity •Analyze patterns of errors •Assess eligibility •Select treatment targets

When scoring a standardized assessment, where can you find instructions to follow?

follow instructions detailed in examiner's manual

What information do you need to fine to correctly score a standardized assessment?

-standard score -percentile rank -other necessary measures

What should the score of a standardized assessment give you an idea of?

where a client is in comparison to their peers

Why should you be careful with age-equivalents?

-can be really scary for caregivers because when you tell someone that they or the child is years behind -It can become the sole focus

Intelligibility is a ____________ _____________ by a listener

perceptual judgment

What is intelligibility affected by?

•Level of production (e.g., word, sentence, etc.) •Topic/context •Rate •Familiarity of listener

In terms of speech sounds errors, what can affect intelligibility?

the frequency, consistency, and type of errors

____________ affect intelligibility more than distortions and substitutions

deletions

What is frequency of errors?

how often it happens

What is consistency of errors?

-is it every time? -is there a pattern?

When determining intelligibility, Norms from Coplan and Gleeson state that individuals should be ~25% intelligible by age ____

one

When determining intelligibility, Norms from Coplan and Gleeson state that individuals should be ~50% intelligible by age ____

Two

When determining intelligibility, Norms from Coplan and Gleeson state that individuals should be ~75% intelligible by age ____

three

When determining intelligibility, Norms from Coplan and Gleeson state that individuals should be ~100% intelligible by age ____

four

Gordon-Brennan & Hodson (2000) suggested that if someone is _____% intelligible by age 4, they should receive intervention.

<66%

Do you need to have every speech sounds correct to be intelligiible?

no

What are three general approaches for determining intelligibility?

•Open-set word identification •Closed-set word identification •Rating scales

What is open-set word identification?

-calculating the number of words understood in a speech sample. -Words understood / Total words x 100 = % intelligible

Why might one-set word identification be tricky?

-different listeners may understand different amounts -if someone is super unintelligible it can be hard to count the number of total words

If someone is super unintelligible it can be hard to count the number of total words, How could you address this?

give them a passage to read to you know the number of words

What is closed-set word identification?

•Client imitates a list of words after the examiner's model •Responses are recorded, and a listener tries to identify the words. •Percentage is calculated from how many words are correctly identified.

What is an example of a closed-set word identification?

Children's Speech Intelligibility Measure

Can you be the listener in closed-set word identification?

NO

Who is closed-set word identification really good for?

unintelligibility

What are rating scales?

•Listener assigns ratings to client's speech

What is an example of a rating scale?

•Intelligibility in Context Scale (McLeod, Harrison, & McCormack, 2012)

What is good about rating scales?

baselines over time

What does severity tell us about?

the significance of speech errors

What are severity rating?

-mild -moderate -severe

In some contexts, what can severity help you determine?

length/frequency of services

Determining severity is often _________

subjective

Determining severity is often subjective, but there are more standardized methods like....

Percentage of Consonants Correct (PCC)

What is PCC?

, it's # of correct consonants / total consonants x 100

How do you interpret PCC?

•85-100% = Mild •65-85% = Mild/Moderate •50-65% = Moderate/Severe •<50% = Severe

What is the issue with PCC?

100% is still consider mild

What are some assessments that come with build-in pattern analyses?

•Hodson Assessment of Phonological Patterns •Bankson-Bernthal Test of Phonology •Clinical Assessment of Articulation and Phonology •Diagnostic Evaluation of Articulation and Phonology •GFTA + Khan-Lewis Phonological Analysis

What are some assessments that come with manual pattern analyses?

•Place-manner-voicing analysis •Phonological process analysis