Unit 2 Language Disorders

Naturalist vs Normative

Naturalist - focuses on interpretation of standardized tests• Normative - focuses on understanding how the deficit influences daily activities and interactions. Reality, most SLPs use a mix of both approaches to assess individuals with suspected DLD

Goal of Assessment

1. Determine if there is a substantial deficit in form, content,or use

2. Describe the deficit compared to normal developmental sequence

3. Determine how the deficit will impact the child's daily activities.

Assessments involve making hypotheses and testing them to determine their accuracy.

One Approach to the Diagnostic Process

1. Observation (collect referral, review case history/reports, etc.)

2. Formulate hypotheses (always generate more than one)

3. Select your tools (tests)

4. Collect the data (administer tests)

5. Analyze the data (score/interpret tests)

6. Accept/reject hypotheses (if reject- repeat steps 1-5)

7. Generalize from the data (What have you learned? How can you grow as a professional?))

Methods of Assessment

SLPs use multiple methods of assessment• Screening, Comprehensive Language Assessment (Standardized Norm-Referenced Tests, Criterion-Referenced Assessments, Observations, Interviews, Work Samples).

Assessment methods can be categorized in several ways. Formal - standardized. Informal - non-standardized, criterion-referenced, interviews, observations, language samples, dynamic assessments, etc.

Calculating Chronological Age

We need to know a child's chronological age to accurately assess their skills. Start with the current year, month, date on top and line up the year, month, date of their birthday underneath. Start your math with days (on the right side). Don't round up. Use 30 days in a month and 12 months in a year to borrow and carry if needed. Some standardized assessments will dictate that you only use year and month (no days). In this case, it is calculated the same, just one less step. Example: Test Date 2021-11-10Birthday 2016-12-20

Why

SLPs may need to assess for various reasons

1. Screening

2. Establishing Baseline Function

3. Establishing Goals for Intervention

4. Measuring Change in Intervention

Screening

Screening of spoken language skills is conducted if a language disorder is suspected. Screening does not result in a diagnosis, but rather indicates the potential need for further assessment. Meant to identify children who may be "at risk". Many screening tools are criterion-referenced. Cut off score based on chronological age. Results in pass, rescreen, refer - BUT we still have to use clinical judgements.

Screening Procedures

gathering information from parents and/or teachers regarding concerns about the child's languages and skills in each language; conducting a hearing screening to rule out hearing loss as a possible contributing factor to language difficulties; administering formal screening assessments that have normative data and/or cutoff scores and demonstrated evidence of adequate sensitivity and specificity; using informal measures, such as those designed by the clinician and tailored to the population being screened (e.g., preschool vs. school age/adolescence); screening of nonverbal cognition/articulation/voice/fluency, if indicated.

Screening Recommendations

complete audiologic assessment; comprehensive language assessment; comprehensive speech sound assessment, if the child's speech sound system is not appropriate for his/her age and/or linguistic community. comprehensive voice assessment. comprehensive fluency assessment. assessment by other professionals (pediatrician, OT, PT, psychologist, etc.)

Baseline Function

Baseline - current level of functioning without intervention. Baseline data is essential for documenting progress within therapy. Baseline data should be collected on all aspects of language and communication. Baseline data can consist of different types of data such as informal observations, standardized tests, criterion-referenced assessments, interviews, response recording, etc. Should incorporate both strengths and weaknesses

Establishing Goals for Intervention

To determine appropriate goals, you have to compare the child's baseline levels to what is expected in typical development of their chronological and developmental age. How do you prioritize goals for therapy?Most delayed?Delayed, but closest to overall level of functioning?Parent/family priority?Biggest impact on functioning? - it depends per child - all are good options

Measuring Change in Intervention

Assessment should be an ongoing process. The only way we know our intervention is working is if we periodically assess to monitor progress. Timeframe varies based on setting. It is important to have an idea of how long you expect to wait before you see the effectiveness of an intervention. If no change is seen in that time frame, you need to modify what you are doing. Ongoing assessment is also important for determining when to dismiss a child from therapy

Measuring Change in Intervention

In therapy, we spend most of the time teaching AND taking data. Ongoing assessment could involve taking away the support of the "teaching" and conducting probes while taking data. If your probes show that the client has made progress, you may want to conduct more formal assessments to have multiple types of data to document the change. Always remember to consider if the client is generalizing the skill and can use it outside of therapy

Comprehensive Language Assessment

Assessment of language skills should be culturally relevant and functional and involve the collaborative efforts of families/caregivers, classroom teachers, SLPs, special educators, and other professionals as needed. Goal is to understand and describe how the child's individual strengths and weaknesses affect their ability engage in daily life. A comprehensive assessment should identify an overall profile of skills

Goal of Comprehensive Language Assessment

Be comprehensive - give information regarding specific areas of concern as well as "collateral" areas. Be valid and reliable. Identify strengths as well as weaknesses. Allow for establishing intervention targets. Identifying need for referral to other disciplines/resources. Include both standardized and criterion-referenced testing. Include severity statements. Include a prognostic statement. Include specific recommendations

Assessment Team

SLPs rarely work in complete isolation during assessments. (Assessment Team Dynamics) Multidisciplinary - professionals from different disciplines, each working independently of each other.

Interdisciplinary - team of different professionals but a formal communication is established, and efforts are coordinated- may use a case manager.

Transdisciplinary - team of different professionals each encouraged to share information and skills across disciplines. Assessment and treatment are shared (role-release). One individual may do all the intervention.

What to Assess in a Comprehensive Language Assessment

*Not all areas are assessed equally. Hearing

Vision

Cognition

Motor development

Gross Motor

Fine Motor (especially oral motor)

Assessing Language Content

Lexical receptive and expressive vocabulary. Word relations/associations. Auditory comprehension- ability to answer questions and follow commands

Assessing Language Form

Morphology (receptive and expressive).

Syntax (receptive and expressive).

Phonology/Articulation (including oral peripheral examination)

Assessing Language Use

Pragmatics (receptive and expressive skills for speech acts and social interaction).

Emergent Literacy/Literacy is also assessed but not included in content, form, or use

Steps for Completing a Comprehensive Language Assessment

1. Collect Referral

2. Case History

3. Determine Formal Assessment Plan* (Can include any combination of the following: standardized tests, informal observations, language samples, interviews, criterion-referenced assessments...etc.)

4. Analyze Assessment Results

5. Document Assessment Results

6. Make Appropriate Recommendations

Case History

Birth and medical history; Current medical status. Developmental milestones. Behavioral information. Family history of speech, language, reading, or academic difficulties; Family's concerns about the child's language (and speech). Languages and/or dialects used in the home, including. Age of introduction of a second language, as appropriate. Circumstances in which each language is used. Teachers' concerns regarding the impact of child's language difficulties in the educational environment

Tips for Collecting Case History

When interviewing parents for case history information: Have parents complete written case history form first and use the interview to confirm/refuse/supplement the info provided, Keep cultural background in mind, Start with a general script, but don't be afraid to go where the conversation leads, Explain "why", Listening is your first priority - employ active listening, Ask open-ended questions, Avoid loaded questions or judgments, Always ask their primary goals and outcomes family-centered

Formal Assessment Plan

The timing of developing the formal assessment plan can vary. Formal assessment plan is basically your hypotheses that you are going to be testing- Examples: This child has a mixed receptive-expressive language disorder, possibly with pragmatic involvement, typical cognition. Based on your hypotheses, you make a plan for what methods of assessment are most appropriate. Formal vs. informal vs. both. Formal - which tests are appropriate?

Informal - what measures are appropriate?

Tips for Formal Assessment Plan

Remember, your assessment should always include multiple types of data over several time frames. Always want to plan your assessment to figure out both the child's strengths and weaknesses. Consider the order of assessments administered. Consider their chronological age, but also their developmental age. Don't be intimidated by the "formal" part of Formal Assessment Plan. The most important part is that you made a well-thought out plan based on the information you have already gathered

Informal Observations

Observing the child in low pressure situations is helpful. During free play, interacting with family, classroom, etc. Use this time to informally assess receptive and expressive language, pragmatics, play, cognition, hearing, speech sounds, fluency, voice, motor skills...etc. May be helpful to start with a checklist of things to look for during this time. Always take detailed notes - write everything down

Language Sampling

Language samples can provide more natural, informal contexts to assess a child's language skills. Can assess semantics, morphology, syntax, phonology, and pragmatics. MLUw and MLUm are most common criteria used for assessment. Can also use semantic roles, communicative attempts, etc. Can use computer programs like SALT (Systematic Analysis of Language Transcripts) to analyze the sample. More valid method of assessment for children from CLD backgrounds. Should be a key component of a comprehensive language assessment

Language Sampling

Variables to Control in Conversational Language Sampling-

1. The nature of the interaction

2. Setting - more than one setting is optimal

3. Materials

4. Sample size - Optimally 100 utterances, but 50 is frequently seen in clinical settings

5. Method of Recording

Nature of the Interaction - Language Sampling

Children produce different amounts of language in response to different conversational partners, so the most representative samples will involve various participants. The conversational partner must keep direct questioning to a minimum and must encourage the child to take the lead. Begin with parallel play and parallel talk. With a young child at the one word stage, imitate verbalizations and use many animal sounds and vehicle noises. With a child, older than 2 years, talk about what you are doing as you play using role-playing dialogue (e.g., "I'm gonna make my guy drive. Here's a tractor for him. 'Wow, what a big tractor. I'm gonna go fast'").

Nature of the Interaction - Language Sampling

Move the child into interactive conversation. With the young child, use some routine questions (e.g., "What's a doggie say?") and elicit finger plays (e.g., Let's play patty-cake").With the older child, invite him to participate in play (e.g.,"You be the service station guy. I'll bring my car in. It needs fixing"). Continue in role-playing dialogue, unless establishing rules for play. Encourage the child to participate in plans for play, including what toy people/animals will be doing (e.g., "Hey, how about having a picnic?).

Nature of the Interaction - Language Sampling

Continue the child's topic. If he is role-playing, stay in the role. If he shifts out of role, follow his lead. Respond to questions, acknowledge comments, and solicit more information about a topic. Attempt to restrict your use of questions to approximately one question every four turns. Too many questions can reduce the length of the child's utterances. The often suggested, "Tell me about this." Can also break down the conversation and result in descriptive strings from the child. Instead, carry on a conversation with the child at the child's level.

Nature of the Interaction - Language Sampling

Give the child options represented as alternative questions (e.g., "Should we play gas station or have a picnic?). Use utterances that are, on average, slightly longer than the child's utterances. Keep the number of utterances per turn to approximately the same number as the child's. Learn to be comfortable with pauses in conversation. If you are too quick to take a speaking turn in order to fill a pause, you deny the child an opportunity to take a turn. If a pause becomes too long (longer than 8 seconds), continue with parallel play and parallel talk until the child moves back into interactive conversation.

Nature of the Interaction - Language Sampling

Have a variety of materials present- cars, trucks, people, farm sets, kitchen sets, markers, pens, play-doh, and items for making a snack. Do not be afraid to be silly and have fun. Ask silly, obvious questions (e.g., "Those are great shoes. Can I wear them?) or make silly comments (e.g., "There's a mouse in your pocket").

Materials - Language Sampling

Use new and unique toys. Avoid construction toys and arts and craft activities as children get involved with the motoric aspects of the activity and do not produce as much language. Broken toys and toys that a child needs help to operate will be likely to get requests for information and requests for assistance. Books can also be useful in generating descriptive language and narrative language from older preschoolers.

Methods of Recording - Language Sampling

Audiotaping is mandatory; videotaping is even better. If you can't videotape and must use only an audio recording, make notes on the context as this will assist in interpreting utterances. In both cases, keep a written record of utterances that you think will be hard to interpret from a recording. To assist in later transcription, repeat the child utterance verbatim.

Language Sampling

How do you get the reluctant talker to talk? 1. Keep the focus off your attempt to get the child to task.

2. Don't talk too much- don't be afraid to allow silent pauses.

3. Select materials appropriate to the child's level.

4. Toys with detachable or moveable parts and broken toys generally stimulate interest.

5. Take advantage of children's natural curiosity.

6. If a child initiates conversation about your materials , let him or her take the lead.

Language Sampling

How to get the reluctant talker to talk (cont'd)

7. If the child does not initiate conversation, make comments yourself about your materials and ask open-ended leading questions, such as "That looks broken. I wonder what happened to it?"

8. If statements or questions trigger no reaction, demonstrate what you expect of the child

9. If the child is reluctant to talk about pictures or tell stories, go first and set the stage.

10. Include another person in the elicitation procedure

Narrative Sampling

Personal event narrative with or without model. Fictional story- story telling or story retelling (wordless picture book, sequence pictures, single problem-based action picture, Story stem). Decide ahead of time what allowable prompts you will use. Recommended: Wow, really, Tell me more, Is there any more to your story? Not recommended: What happened next? Then what did s/he do?

Standardized Assessments

AKA norm-referenced. Empirically developed evaluation tools with established reliability and validity. Formal. Decontextualized. Compares subject performance to a norm (large group of "typical" individuals). Well-constructed and allow for comparison of performance among children

Standardized Assessments

Most formal and decontextualized format for assessing the language function. They are developed by devising a series of items that are given to large groups of children with normal language development and then computing an acceptable range of variation in scores for the age range covered by the test. Has well-specified psychometric properties (Validity, reliability, sensitivity, specificity). Identifies the broad characteristics of language functioning for diagnostic purposes but should not be used solely to make the diagnosis of DLD

Standardized Assessments

Clear administration and scoring criteria. This is what makes the test standard. It is given in exactly the same way no matter who is administering it. Have to read the manual to know what the standardization procedures will allow. Not as helpful for treatment planning. Standardized on a known population or norming (normative) sample. Characteristics of the norming sample are very important when evaluating a standardized tests - size, representativeness and use of a sample of children

Validity

Refers to the extent to which a test measures what it says it measures. A testis considered valid if its systematic error, or bias, is small. There are different forms of validity

Reliability

a test is reliable if it yields consistent and accurate (near to "true") results. Can be assessed in several ways

Procedures for Administering Standardized Assessments

Determine chronological age- *Make sure selected tests have included this age in the norming sample. Determine starting point. Review basal and ceiling criteria. Know all considerations for testing (Seating considerations, allowable prompts, can you repeat items, etc). Begin testing. Establish basal. Continue until ceiling is reached or all items are presented

Procedures for Administering Standardized Assessments

Take time to make sure ceiling and basal were established and no items were skipped! Calculate raw score (usually ceiling item minus all items missed-double/triple check!)• In test norms book, look up standard score, percentile, and age equivalents. Determine confidence interval around standard scores and percentiles. Do this for subtests and composites (if test includes these). Conduct item analyses. Integrate information with other test/case history/observation information

Scoring Standardized Assessments

Measurement of central tendency. A large normal population will form a bell-shaped curve (a normal distribution). An arithmetic mean for the population's scores is plotted. Most scores will fall around this mean. Standard deviations represent how all scores of a population fell in relation to the mean. 68% of the scores will fall within 1SD, 95% will fall within 2SDs of the mean. Where an examinee's score falls determines if he/she is performing significantly different from the norming population

Scoring Standardized Assessments

Norm referenced scores - raw scores can not be interpreted without reference to the norms given in the test manual. Makes the scores meaningful. 3 types of comparisons can be made: 1. Standard comparisons 2. Percentile ranks 3. Equivalent scores

Scoring Standardized Assessments

Standard scores - mean of 100 with an SD of 15. Scaled scores- mean of 10 with a SD of = or - 3. Stanines (standard nines)- mean of 5 and a SD of 2. Z-scores- a standard score with a mean of 0 and a SD of 1. T-scores- standard score with a mean of 50 and an SD of 10. Normal curve equivalents - often used by state education departments; also known NCEs - range from 1 to 99, mean of 50 with a standard deviation of 21.06. NCEs of 1, 50, 99 corresponds to percentiles of 1, 50, 99 but the other NCEs don't match up the same way. Percentile Ranks: Tells what portion of the population are above or below a certain score. Mean score should be at the 50% percentile. Percentile ranks are easy to understand and interpret, but do not represent an equal interval scale, the distance between ranks can not assumed to be equal.

Equivalent Scores

Classify raw scores according to a level such as age or grade. An equivalent score represents the median or middle score earned by subjects in a norming sample who were of a particular age or grade. It is important to note that the child is not being compared to a child of the same age or grade. Instead the child's raw score is assigned to the level representing the age or grade at which that raw score was typical. So a child that scores a raw score of 39 on the PPVT-III would receive an age equivalent of 4 years, 4 months. If the child is actually 7 years old, they will not be compared to other 7 year olds when this score is reported. Equivalent scores do represent equal intervals. One year difference for a 3 year old is not the same as a one year difference for a 9 year old.

Standard Error of Measurement (SEM)

Actual scores are really only estimates of true score. We can never know with 100% confidence the true score -there is always measurement error involved because human behavior is never constant. We use SEM to determine confidence bands (confidence intervals) when we report scores

Predictive Ability

Sensitivity- The sensitivity of a test refers to the ability of the test to correctly identify those individuals with a disorder. Specificity- The specificity of a clinical test refers to the ability of the test to correctly identify those individuals without the disorder.

Predictive Ability of Standardized Assessments

True positive: the test results suggest the individual has a disorder and the individual does in fact have a disorder. False positive: the individual does not have a disorder but the test results suggest they do. True negative: the individual does not have a disorder and the test results suggest they do not have a disorder. False negative: the individual has a disorder but the test results suggest they do not have a disorder

Helpful Hints

Practice the test before administration. Keep manual handy! Use sticky notes. Have token reinforcers available. Monitor behavior for examinee fatigue (and consequent loss of effort). Watch pacing. Monitor use of paralinguisitics. Make sure you have a clipboard. Write everything down verbatim! Record the evaluation

Criterion Referenced Assessments

Designed to assess a child's performance on a certain skill in relation to a criteria set by the examiner rather than comparing the child's performance to other children. Not used to diagnose but to establish baseline and identify targets for intervention for a child that has been identified as having a significant deficit on standardized testing. Designed to look at specific communication deficits in depth. Some criterion-referenced measures are available in published form, but most are generated by the clinician.

Criterion Referenced Assessments

These are more informal measures. Not bound by rigid procedures and standardization rules. Allow more in-depth analysis of specific skills related to either comprehension or expression skills. One benefit of criterion-referenced measures is that we can determine how responses to elicit to ensure we are getting an adequate sample

Criterion Referenced Assessment of Language Comprehension

Specifying an appropriate response- Naturalistic responses, Behavioral compliance, Answering questions, Contrived responses- similar to items on standardized testing, ex. point to________, show me_______, judgement tasks- what would okay-looking lady versus what would silly-looking lady say (appropriate only if child is over 5). Cautions when testing comprehension. Avoid over interpretation, Control linguistic stimuli

Criterion Referenced Assessment of Language Comprehension

Types of criterion-referenced assessment of production language. Elicited Imitation- ex. "Say what I say." Elicited production- Patterned elicitation- ex. "She is running. She is jumping. She is _________________.". Role-pay and games- Child is the "shy doll's" parent. I spy______. Guess Who. Narrative sampling. Structural Analysis -conversational sampling

Criterion Reference Age Ranges

12-30 months- child centered conversation on here and now topics. 30-48 months- child centered conversations on both here and now and there and then topics. 4 years and older- object description, picture description, narration of personal experiences. 5 to 10 years- personal narratives, story retelling or generation form

Additional Methods for Criterion Referenced

Observation. Dynamic Assessment - How does the child approaches tasks; error patterns and self-monitoring behaviors? Functional Assessment (think of WHO framework). Curriculum-based Assessment- if child are in school-environment, are language abilities adequate for curricular demands?

Formative vs Summative Assessment

Formative Assessment - Low stakes testing, informal in nature. Often meant to stimulate learning. Embed into learning process. Provides specific feedback. Ongoing. Timely. Summative Assessment - High stakes testing, formal in nature. Often used for diagnostic purposes.

Making Prognostic Statements

Can also help demonstrate effectiveness of intervention. Usually good, fair, guarded, poor. Many factors go into a child's prognosis. Severity levels. Age. Family support. Previous response to therapy. Motivation. Temperament. Comorbidities. Only a best guess - we can't see the future

Documenting in Assessment Report

It is necessary to document your assessment in a written report. If you don't document it, it didn't happen. Generally, the report follows a standard template. Need to document in a way that parents and other professionals can read and understand, but also accurately describe deficits. Be careful with jargon. Doesn't need to be unnecessarily long. More complex cases/assessments lead to longer reports, but generally the goal is to be as concise as possible while still being thorough

What to Include in Assessment Report

Assessment description - a brief description of the purpose of the assessment used and scoring (if appropriate). Standard scores - include scores based on SD with confidence intervals. Percentile ranks - shows position relative to normative sample. Severity levels - provide severity level of scores AND a description of what that means. Composite scores - more reliable than individual subtests. Modifications to standardization - any variance must be reported as it may invalidate your scores

practicing scores

1 standard deviation below mean- standard deviation of 85, scaled score is 7, percentile rank is 16.

2 standard deviations below the mean- standard deviation is 70, scaled score is 4, percentile rank is 2.

-1.5 standard deviation below- standard deviation 77, scaled score is 5, percentile rank is 7.

Percentile rank of 84- standard score is 115, scaled score is 13.

Standard score of 55 which is 3 standard deviations below- scaled score is 1, percentile rank is

Severity Label for Language Disorders

one to 1 1/2 SD below the mean - Mild (around 85-77)

1 1/2 to 2 SD below the mean - Moderate (77-70)

More than 2 SD below the mean - Severe (69-lower)

Clinical Evaluation of Language Fundamentals - Fifth Edition (Celf-5)

Pearson (2013) CELF-5 is an individually administered standardized test designed for identifying, diagnosing, and following up on language evaluation in children 5-21 years old. Comprehensive language assessment covering receptive and expressive areas of semantics, morphology, syntax, and pragmatics. Test kit includes an examiner's manual, technical manual, 2 stimulus books, protocol forms. Will provide scaled scores for each subtest; standard scores for Core Language, Receptive Language, Expressive Language, Language Structure, and Language Content. Percentile ranks, age equivalents for all subtests and composite areas. Normed for ages 5:0-21:11. There is a CELF-Preschool for younger children. There is also a CELF-5 Screener. Completion time estimated at 30-45 minutes for Core Language subtests only. Very comprehensive assessment.

Preschool Language Scales - Fifth Edition (PLS-5)

Pearson (2011). The PLS-5 is an individually administered comprehensive developmental language assessment with items ranging from pre-verbal, interaction-based skills to emerging language and literacy. The test kit includes an examiner's manual, administration and scoring manual, stimulus book, home communication questionnaire, manipulatives (ball, 8 blocks, 2 books, 3 bowls, box with lid, bubbles, 2 cars, teddy bear, cloth, comb, 8 crayons, 3 cups, duck, 3 keys, paper, pitcher, sealable bag, spoon, squeaky toy, infant toys, rattles, windup toys, and stopwatch), and protocols. Two subtests include Auditory Comprehension and Expressive Communication which combined yield a Total Language Score. Each subtest/composite yields a standard score, percentile, and age equivalent. Birth - 7:11. Completion time estimated at 45-60 minutes. Very comprehensive assessment

Structures Photographic Expressive Language test - Third Edition (SPELT-3)

Pro-Ed (2005) The SPELT-3 is an individually administered assessment of morphology and syntax skills in children from ages 4:0-9:11. The test kit includes an examiner's manual, photographic stimulus book, and protocols. The test contains 53 items which are all administered to yield a standard score, percentile rank, and age equivalent. All items presented with picture stimuli. Where is the cat?prepositional phrase "under the chair" Tell me about this picture plural /s/ "two books"What are the girls doing? plural aux. + present progressive "They are brushing their hair". Normed for ages 4:0-9:11. There is a SPELT-P2 for younger children. Completion time estimated at 30 minutes. Gives specific information about morphosyntax, but not other aspects of language or communication

Peabody Picture Vocabulary Test - Fifth Edition (PPVT-5)

Pearson (2018) The PPVT-5 is an individually administered standardized test designed to evaluate receptive vocabulary in individuals 2-90+ years old. Test kit includes manual, stimulus book, protocol forms. Comes in Form A/Form B. Will provide standard score, percentile rank, stanine, age-equivalent. Can be combined with the EVT-3 (co-normed) for comparison of receptive vs. expressive vocabulary. Four pictures on the page and the examiner says "ball" "swimming" "gigantic" "encumbered" "dromedary" "cupola". Normed for ages 2:6-90+ years. Good for assessment of receptive single word vocabulary but doesn't give a bigger picture of language skills. Will provide standard score, percentile rank, stanine, age-equivalent. Completion time estimatedat 10-15 minutes

Examples of Stimuli - CELF-5

-Word Classes: Examiner presents pictures (some without) and gives a list of 3-4 words. The child has to tell the two that go together best. Comb, soap, brush, tissue.

-Following Directions: Examiner presents pictures and gives oral directions. The child has to follow the direction in the same order and waiting for the direction to begin. Point to the X first, then point to the last square. Go.

-Formulated Sentences: Examiner presents pictures and gives a target word. The child has to formulate a grammatically correct sentence about the picture using the target word. when (picture of a girl that has fallen off a bike and got hurt)

Examples of Stimuli - CELF-5

-Recalling Sentences: Examiner orally presents sentences of increasing complexity. The child has to repeat back the sentence verbatim. Before they walked across the stage for graduation, the students lined up in alphabetical order.

-Understanding Spoken Paragraphs: Examiner reads an oral passage then asks questions about the information. Includes questions surrounding main idea, details, sequencing, inferencing, pragmatics, and problem solving. Andy liked to visit his grandfather who lived on a farm in the county... Why was Andy excited? What happened after breakfast?

-Word Definitions: Examiner presents words and asks the child to define the word. The word is "alone" as in "The girl said, 'I want to be alone.'" Define the word "alone"

Examples of Stimuli - CELF-5

-Sentence Assembly: Examiner presents visual pictures of sentence fragments and instructs the child to form two different grammatically correct sentences with the fragments. the teacher assign homework didn't. The teacher didn't assign homework. AND Didn't the teacher assign homework?

-Semantic Relationships: Examiner presents oral questions along with visual representations of answer choices. The child has to pick the two answers that best answer the question. Teenagers are younger than: a) infants, b) adults, c) grandparents, d) children

-Pragmatics Profile: The examiner completes the checklist by either 1) observing the child in natural environments or 2) interviewing those closest to the child. The student demonstrates culturally appropriate use of language when participating instructured group activities (never, sometimes, often always)

Prompts

The primary verbal stimuli presented to evoke a response to the stimulus. They essentially "ask" the client to respond to the stimulus, as in asking "What's this?"while presenting an object. Prompts may be systematically adjusted to include additional cues (discussed below) that are specific to the target response. For example, to evoke a response containing the past tense inflection the prompt might include as more cues for contextual support, as in "Yesterday, these people worked. What happened in this picture" or essentially no cues for contextual support as "Tell me about this picture."

Cues

Auditory, visual, and/or tactile/kinesthetic stimuli provided in addition to the primary stimulus to promote/facilitate/support correct responding by the client. For example, as a "reminder" to include the plural inflection the clinician might provide a lead—in phrase such as "Here is one coat, here are MORE __________(verbal cue); or the clinician may place an additional card with an 's' on it (visual cue) to the right of the stimulus picture; or the client may even be told to place a finger on the 's' card as a reminder (tactile cue) while producing "plural" responses.

Stimuli

The primary object/event/relationship in whose presence a specific language behavior is the expected response. For example, when presented with a picture of several coats the expected response should include the plural inflection /s/ -the picture is the stimulus that provides a context for the target response.

Purpose of Intervention

Change or eliminate the underlying problem (this involves changing cognitive functions or sensory acuity). Change the disorder (e.g., receptive/expressive disorder now just an expressive disorder; a disorder across all component areas of language now just a disorder of morphosyntax; a stuttering and expressive language disorder is now just a stuttering disorder). Teach compensatory strategies (e.g., use of augmentative communication; use of visual cues; peer helpers; teach child to request processing time). Change the environment (help parents and teachers to reduce communicative demands)

Developing Intervention Plans

Intervention plans need to be carefully considered and planned in detail before starting implementation. Three main aspects of intervention plans 1. Intended goals (objectives) of the intervention 2. Processes used to achieve these goals 3. Contexts (environments) in which the intervention takes place. We need to make sure that what we are doing in intervention involves the best available plans - evidence-based practice (EBP). Evidence-based practice: "is integration of best research evidence with clinical expertise and patient values"

Evidence Based Practice (EBP)

is the "conscientious, explicit, and unbiased use of current best research results in making decisions about the care of individual clients." Three points of EBP: 1. Client Perspectives 2. Evidence 3. Clinical Expertise

Types of Evidence

Internal: Combination of clinical expertise, family preferences, and clinician data. External: Primarily defined as published literature (research). Approach external evidence using 3principles 1. The opinions of expert authorities should be viewed with skepticism. 2. All research is not created equal. Some studies are better than others. 3. SLPs need to be critical about the quality of evidence.

Levels of External Evidence

Ia- systematic meta-analysis of multiple well designed RCTs.

Ib- a well conducted single RCT.

IIa- systematic review of non randomized quasi experimental trials or systematic review of single subject experiments with consistent outcomes.

IIb- one well designed quasi experimental study, lower quality RCT, single subject experiment with consistent outcomes.

III- observational studies with control.

IV- observational studies without controls.

V- expert opinions without critical appraisal or theoretical background or basic research

Incorporating EBP into Clinical Practice

1. Formulate Clinical Question. PICO - Population, Intervention, Comparison, Outcome

2. Use internal evidence to make initial intervention recommendations

3. Find external evidence

4. Critically appraise external evidence

5. Integrate internal and external evidence

6. Evaluate the effectiveness of intervention (clinical decisions) by documenting outcomes

Setting Intervention Goals

Goal selection is one of the most important parts of what SLPs do. Assessment data is a great starting point for determining appropriate goals. Are there other considerations?Intervention goals can be determined using several different approaches

1. Empirical

2. Developmental

3. Functional

Empirical Approach to Goal Selection

Empirical approach: Based on observable behavior and data• Similar to Vygotsky's Zone of Proximal Development. Goals selected on hierarchy of highest-lowest priority (Box 3.1). Highest Priority: forms and functions clients use in 10-50% of required contexts. High Priority: forms and functions clients use in 0-10 of required contexts but understand in receptive tasks. Lower Priority: forms and functions used in 50-90% of required contexts. Lowest Priority: forms and functions the client does not use at all and does not understand in receptive tasks

Developmental Approach to Goal Selection

Developmental approach: Based on which forms and functions would appear first in typical language development. Goals are selected in chronological order of typical age of acquisition. For example, a child age 4:10 does not use regular past tense -ed, plural /s/, contractible auxiliary, and present progressive -ing. Developmentally, we know that these should be acquired in order of present progressive -ing, plural /s., regular past tense -ed, contractible auxiliary. Using the developmental approach to goal writing, the highest priority target would be present progressive -ing and the lowest priority would be contractible auxiliary

Functional Approach to Goal Selection

Functional Approach: Based on what would make the greatest impact on the child's functioning and participation in their daily life. Heavily influenced by what the client and caregiver(s) prioritize as most important. May not choose targets based on empirical or developmental approach, but focus more on the targets that would improve the child's overall level of functioning, quality of life, and participation in all environments. May combine the "functional" approach with other approaches to pick targets based on what is best for that individual child

Other considerations for Goal Selection

Cognitive ability (Are all precursor skills in place?). Communicative effectiveness. Introduce new forms to express old functions or teach new functions using old forms (in other words, only one new thing at a time). Consider phonological abilities. Consider teachability

68

In a normal distribution, what percentage of individuals will score between -1 and +1 standard deviations from the mean?

severe language disorder

A child achieves a standard score of 65 on a language test that has a mean of 100 and standard deviation of 15. This score is interpreted as a

moderate disorder

Remember percentile equivalents correspond with specific standard scores. A percentile equivalent of 5 indicates a

is approximately 1 1/2 standard deviations from the mean

A child achieves a standard score or 78 on a test that has a mean of 100 and a standard deviation of 15. This score

30

a standard score of 90 corresponds to a percentile equivalent of

93

a standard score of 120 corresponds to a percentile rank of

the percentile equivalent

You receive an evaluation report from a fellow SLP that includes the following scores on a vocabulary test: Standard score =85, Percentile equivalent=30, Stanine = 3. Which score do you suspect was recorded incorrectly?

severe disorder

Remember percentile equivalents correspond with specific standard scores. A percentile equivalent of 1 indicates a

in the average range

a standard score of 110 reflects performance that is

< 1%

what percentage of a normal distribution will perform more than 3 standard deviations from the mean

Developmental: present progressive -ing, preposition "in" and "on", irregular past tense, possessive /s/, regular past tense

Empirical: irregular past tense, regular past tense, possessive /s/, present progressive -ing, prepositions

Functional: present progressive -ing, irregular past tense, regular past tense, possessive /s/, prepositions

You just finished collecting baseline data for your 3:8 client. The data indicate they produced irregular past tense verbs with 30% accuracy, prepositions including "in, on" with 70% accuracy, possessive /s/ with 5% accuracy, regular past tense verbs with 25% accuracy, and present progressive -ing with 0% accuracy. Data show that the client understands all targets in receptive tasks. The mom indicates that the child gets very frustrated when telling stories because the child is unable to accurately express current, past, or future tense in the stories. Rank the goals from 1-5 (highest-lowest priority) for each of these approaches

Developmental: uncontractible copula, uncontractible auxiliary, contractible copula, contractible auxiliary

Empirical: uncontractible copula, contractible copula, contractible auxiliary, uncontractible auxiliary

Functional: uncontractible copula, uncontractible auxiliary, contractible copula, contractible auxiliary

You just finished collecting baseline data for your 6:1 client. The data indicate they produced contractible copula with 10% accuracy, uncontractible copula with 30% accuracy, uncontractible auxiliary with 70% accuracy, and contractible auxiliary with 0% accuracy. Data show that the client understands all targets in receptive tasks. The mom indicates that you are the professional and she trusts your recommendations. Rank the goals from 1-4 (highest-lowest priority) for each of these approaches.

Developmental: followed one step directions, labeling actions, prepositions, past irregular, wh- questions

Empirical: follow one step directions, label actions, wh- questions, past irregular, prepositions

Functional: labeling actions, irregular past tense, follow one step directions, answer wh- questions, prepositions

You just finished collecting baseline data for your 4:5 client. The data indicate they labeled actions with 35% accuracy, used prepositions in/on with 20% accuracy, followed one step directions with 40% accuracy, past irregular with 0% accuracy, and answered wh- questions with 10% accuracy. Data show that the client understands all targets, except for prepositions, in receptive tasks. The mom indicates she wishes the child could describe what is happening around them better. Rank the goals from 1-5 (highest-lowest priority) for each of these approaches

Brown's 14 Grammatical Morphemes

1. Present Progressive -ing

2. Preposition "in"

3. Preposition "on"

4. Plural 's

5. Irregular Past Tense

6. Possessive /s/

7. Uncontractible

Copula

8. Articles

9. Regular Past Tense

10. Regular 3rd Person

11. Irregular 3rd Person

12. Uncontractible 14. Auxiliary

13. Contractible Copula

14. Contractible Auxiliary