Module 3: Principles of Assessment

• Change or eliminate the underlying problem

• Change the disorder

• Teach compensatory strategies

• Environmental modification

What are the 4 purposes of intervention?

Change or eliminate the underlying problem

• Most of the children that we treat have a language disorder that is unknown in origin and is often times incurable

• As an SLP, it is typically our goal to max out the child’s therapy potential and settle and be ok that this child will never be a typical language learner

Change the disorder

• Using the intervention to improve aspects of the language function by teaching specific behaviors

• This can beam using language more flexibly to allow the child to become a better communicator

• This is probably the most common purpose of intervention for children with developmental language disorders

• This does not guarantee that the child will not need further intervention later, but it does guarantee change and improve the child’s quality of life at that current moment in time

Teach compensatory strategies

We are not working to make the child’s language normal; our goal is to give them tools to function better with their current deficits

Environmental modifications

• This is were the clinician attempts to influence the context where the child functions best rather than making the actual changes to the child

• Often times, this purpose of intervention is paired with one of the other purposes of intervention to maximize the child’s potential

• Intended products / objectives of intervention

• The process used to achieve objectives

• The context / environment in which we are using to achieve these objectives

What are the 3 primary things that we need to consider when developing an intervention plan?

Well-developed intervention plan

What is important to have when we are providing intervention for children with developmental language disorders?

Evidence based practice

This is defined as the consciousness, explicit and unbiased use of current, best research results in making decisions about the care of individual client’s by integrating clinical expertise with the best available external, clinical evidence from systematic research

Internal evidence

This comes from the characteristics of hte client and their family and this can include;

• their willingness to participate in certain treatment approaches

• Their preferences

• Your competencies as a clinician

• Information from expertise

• All research is not created equally

• Keep a critical eye on evidence that we are using in our practice

What are 3 principles to look at when we are looking at external evidence?

Information from expertise

This is where you do this with caution and should be done based on the strategy as well as the implementation

• Formulate your question

• Use internal evidence

• Find external research

• Grade the studies

• Integrate internal and external evidence

• Evaluate the decision

What are 6 areas that we have to look at when incorporating EBP?

Patient or problem

What is the P in our PICO question?

What interventions are being considered?

What is the I in our PICO question?

Can you compare this intervention outcome to another?

What is the C in our PICO question?

What are the desired outcomes?

What is the O in our PICO question?

Our internal evidence

Once we formulate our question, what do we have to find?

Finding internal evidence

• This is where we come up wit a plan to address the current patient

• This is the moment where you want to try something to see if ti is beneficial or not

Our external research

After using internal evidence, we wnat to find what?

Find out external evidence

• This is where you hit the literature with a keen eye

• Select some materials that are peer-reviewed and attempt to use these materials if they are less than 10 years old if possible

• You can use the practice portal on ASHA to see if an intervention would be good to use on this child

Provide modeling

Through this process, you will learn that what is the most effective method to begin building functional communication?

Grade the studies

Once we figure out the patient with the problem and the evidence being considered, we need to use our critical eye to do what?

• See if they are relevant to our question

• If the level of evidence is provided by the study based on the design and the quality how those filter in

• Look at the direction and strength as well as the consistency of the observation used

What are 3 ways to grade the studies?

Integrate our internal and external evidence

What do we do after we grade the studies?

Integrate our internal and external evidence

• This is where you ask yourself if what you have read supports your goals and the families mission

• Take the information from the articles and begin to implement them in treatment to determine if this is an effective fit for you patient

Evaluate our decision

What is the last step when we incorporate EBP?

• Documenting outcomes

• Compare baseline data to what is collected in treatment with new treatment method

What are 2 ways that we can evaluate our decision?

• Purposes of Intervention / Principles of EBP

• Identify Goals for Communication Intervention

• Describe Intervention at Various Points on the Continuum of Naturalness

• Contexts for providing Intervention

• Methods of Evaluating Treatment Outcomes

What are the 5 areas regarding principles of assessment?

• Basic Goals

• Intermediate Goals

• Specific Goals

Goals are broken down into what 3 levels?

Basic goals

• These goals are those long-term objectives

• They are often thought of as our general goals

• These areas are selected because they help with functionality and are important

• They are chosen based on severity deficits

Severity deficits

Basic goals are chosen based on what?

Intermediate goals

• These goals are more specific than basic goals

• They are correlated with those basic goals, but they are a little bit more narrow

Specific goals

• These goals are from instances of language form, content, or use that are identified in the intermediate goal

• These goals are through of as more stepping stones to get us to the intermediate goal which then push us to achieving that long-term or basic goal

Zones of Proximal Development

• This is the distance between the child’s current level of independent functioning and the child’s potential level of performance

• This theory tells us when the child is ready to learn and what the child is ready to learn with some supported scaffolding

Detailed assessment data

The probable range of the ZPD is based on what?

Where the child is already functioning

What does the detailed assessment data pinpoint?

Dynamic assessment

The use of this technique can help us establish the ZPD and how that can be helpful

A particular form that is used infrequently or maybe not used at all

Through dynamic assessment, you can identify what?

Diagnostic teaching

This can be used to probe to determine if the scaffolding provided by the SLP makes it possible for the child to use this form more accurately

Generalization

If you continue to address these goals longer, through the theory of ZPD, it helps to promote what?

• Understand normal language development

• Consider evidence-based targets

• Treatment tips to enhance targets

What are 3 things you should take into consideration when selecting evidence based targets?

Normal sequence of language development

In order to know what goals should be addressed, clinicians should have an understanding of what?

Complex sentences and grammatical therapy

Studies have shown that using these 2 things can be very beneficial

• Elaborating noun phrase

• Elaborating verb phrases

• Conjoining and embedding sentences

What are 3 ways to make sentences more complex?

Elaborating noun phrase

This is done by using adjective paired with a noun (ex. Big ball), determiners (ex. This chair), Prepositional phrases (dog with spots), and relative clauses (hat that has black and white stripes)

• Using an adjective paired with a noun

• Determiners

• Prepositional phrases

• Relative clauses

What are 4 ways to elaborate a noun phrase?

Adding grammatical morphemes

What is one way to elaborate verb phrases?

• Adding clauses by combining (ex. Max wants chocolate, but Jaime wants vanilla)

• Embedding clauses (ex. Max wants to have chocolate after dinner)

What are 2 ways (with examples) on how to conjoin and / or embed clauses?

Trained conversationalist

Why is using complex sentences and grammar structure important?

• Tier 1 Words

• Tier 2 Words

• Tier 3 Words

Vocabulary can be classified into what 3 different categories?

Tier 1 words

These are basic vocabulary words that do no require instruction because they are heard at such a high frequency

Tier 2 words

• These are also high frequency words, yet they are not heard in everyday conversation

• Think about these as the value that they could have to helping a child understand complex sentences from stories that they might hear in school

Tier 3 words

• These are low frequency words

  • They are super content specific (ex. Saying “cumulus clouds”)

Tier 2

When thinking about these 3 tiers, what tier is going to help the child in the classroom?

Tier 2

This tier has content in actual stories that is provided by the teacher, and is going not capitalize your treatment efforts when you are targeting those words in this tier for those school-aged children

Continuum of naturalness

This is the idea that represents the extent to which the setting and activities intervention resemble real life outside of the therapy room

Fluid

The use of approaches through the continuum of naturalness can be what?

• Clinician-directed approach

• Child-centered approach

• Hybrid approaches

What are the 3 types of intervention approaches?

Clinician-directed approaches

This is where the clinician specifies

• The materials

• How the client will use those materials

• Type and frequency of reinforcement

• The form of responses that are accepted as correct in order of activities

Drill or discrete trial intervention

Clinician-directed approach is also known as what?

The drill at hand

As the clinician in the clinician-directed approach, we are peeling away the context and focusing on what?

It creates a high number of reps for a particular target

What is one advantage of the clinician-directed approach?

• Drill

• Drill play

• Modeling

What are 3 main clinician driven approaches?

Engage with the clinician and clinician driven activities

Sometimes, a clinician led approach can be challenging with children who refuse to do what?

Child-centered approach

This is where the clinician arranges an activity so that opportunities for the child to provide the target responses occur as a natural part of play and interactions

Play

The child views a child-centered approach as what?

Those who struggle to follow clinician-directed activities

Child-centered approaches are typically beneficial for what kind of patients?

• Indirect language stimulation

• Language facilitation

• Facilitation play

• Developmental approaches

• Pragmaticism

Child-centered approach can go by what other names? (Hint: 5 other names it can be)

Verbal techniques

It is our job to utilize this to respond to the child to enhance their language abilities

• Self-talk

• Parallel talk

• Expansion

• Extension

• Buildups and breakdowns

• Recast sentences

What are 6 language techniques to enhance the child’s language abilities?

Self-talk

• This is where we describe our actions during parallel play

• Think about this as copying what the child is doing then describing it

• This provides as simple and clear match between actions and words, and it a great way to model comments

Parallel talk

• This is where we provide self-talk for a child

• Instead of expanding their use of language, we can imitate the child in an attempt to have some verbal turn-taking

• There is a time and place for this strategy, so do not fly into a session with this strategy

Expansion

• This is when you are working to expand the child’s utterances and enhance grammatical markers

• For example, the child can say, “feed baby” and you can say, “yes, you are going to feed the baby her breakfast.”

• In this way, you are expanding what the child said and this strategy has a strong grammar development implication

Extension

• This is where you extend the child’s remarks

• If the child says, “doggy house”, you can say, “yes, he went inside”

• This provides more of a linguistic form example for the child in an attempt to show them where they are headed next with their language

Buildups and breakdowns

• These are the sequences where you take the child’s utterance, and you expand it then break it down into smaller phrase-size pieces before building it back up again

• For example, if the child says, “doggy house”, you can say, “yes, the doggy is in the house. House, he has the house. House, the doggy is in the house. The doggy. The doggy is in the house.”

• There is a lot of repetition using the same words in a variety of different ways

Recast sentences

• This is similar to expansion

• This approach is not entirely statement based

• We provide alternative sentence types

• If the child says, “doggy house”, you could say, “is the doggy in the house?” or “the doggy is not in the house”

• Don’t think of it as correcting the child’s form, more of a model for the child as far as recasting and expansion

Less than a 3-word phrase level

When we think of a child-led approach, they are especially useful for children who are functioning at what kind of level?

Hybrid approach

• This is where you combine a clinician-directed and child-centered approach

• The clinician maintains control by selecting the activity and the materials, but does so in a way that consciously tempts the child to make spontaneous types of utterances

• Focused stimulation

• Vertical structuring

• Milieu Communication Training

• Script therapy

What are 4 types of hybrid approaches?

Focus stimulation

• This is where the clinician arranges the context of the intervention so that the child is tempted to talk and produce the target utterance

• The clinician and the child play, while the clinician provides a lot of modeling

• By modeling the target in a variety of ways, it helps build comprehension in an attempt to elicit expression of the target word

Vertical structuring

• This is a form of expansion similar to the focused stimulation

• This is where you are eliciting language from the child and taking the fragmented produced by the chid and making them into a complete sentence

Milieu Communication Training

Environmental arrangement, responsive interaction, and conversation based context use the child’s interest and initiation as opportunities for modeling and prompting communication in an everyday setting

• Environmental arrangement

• Responsive interaction

• Conversation based context

What are the 3 components in milieu training?

Script therapy

• This is where the clinician develops a routine or scripts with the child in the intervention contexts

• This reduces the cognitive load of language training since you are embedding it into a familiar routine

• In this intervention, the known script is disrupted or challenged which makes the child want to communicate

• This can be done in everyday activities, songs, and books and they are all part of the child’s typical routine

• Literature based scripts is a subtype of script therapy that provides a nice routine

Small group or classroom settings

Hybrid approaches are best used in what kind of group?

• Universal Design for Learning

• Make the language informative

• Increase the Motivation to Communicate within the task

• Use cohesive text

• Move from here and now to there and then

What are the 5 areas when using the continuum of naturalness?

Universal design for learning

• This aims to provide equal learning opportunities for all students by choosing or modifying strategies to address a wide range of individual differences

• This could mean multiple means of representation and this would provide the child with a range of access to gain insight in books, recording of lecture, audiobooks, or other digital media

• This allows kids to access the content a little bit different than their peers

Multiple Means of Expression

• This is how children can participate and respond in instructional activities through a range of media

• This could be done through the use of an AAC device or capturing a paper using speech to text

Multiple Means of Engagement

• This is using varied methods to allow students to learn via large group, small group, and individual activities along the continuum

• This is often written in the accommodation section in an IEP

Make the Language Informative

• In this activity, you show the client two pictures and describe one and have the child point to the one that you are talking about

• You would then have them take a turn being the teacher and describe while you point

• There is something about having the child take the lead and make this an informative process for them

Increase the motivation to communicate within the task

• You need to be the most exciting thing in the room during therapy if children want to communicate with you

• When we want them to initiate in communication with a clinician, this can be challenging

• We need to think about how we can set up the room for success

• One strategy is to put a barrier and sit back to back and to talk on a toy telephone to get them to initiate communication

Use cohesive text

• In this clinician directed activity, we want everything to be related

• Rather than showing a variety of pictures to elicit the verbs, we want to show the same girl throughout the book doing a variety of tasks in attempt to elicit the verbs

• That way, you are having a cohesive moment with the same character throughout and it becomes less drill based

Move from here and now to there and then

• This technique comes into play when we are trying to teach children to use language to accomplish things that otherwise could not be accomplished

• We are trying to get them to harness that power of communication

• A basic function of language is to tell people about things that they do not already know and one way to accomplish this is to talk about events outside of the immediate context

Higher

Do children with developmental language disorders need a higher or lower number of learning episodes than children with typically developing language

Few weeks

Treatment sessions should be spaced out over a few weeks or a few days?

Once a week for 30-40 minutes

What amount of time (daily vs weekly; time frame) is a sufficient time and optimal for language gains for children with developmental language disorders?

Focused and targeted intervention

During weekly sessions, what 2 types of intervention should be used at least half of the allotted time?

Half of the allotted time

During the weekly session, focused and targeted intervention should last at least how long during the session?

• We need to think carefully about the input we are providing to the child

• The input can be manipulated in many ways and has strong influence on a child’s language use

• Through careful selection of our linguistic stimuli, we can provide a more efficient and more effective form of linguistic input as compared to an untrained conversationalist

As a clinician, you have to modify your linguistic signal in what 3 ways?

To have a child produce a whole sentence as a response

What is the objective for the child during a session?