Smith test 1

DIAGNOSIS: to DETERMINE the nature of a disease through examination

- Evaluation: the PROCESS

o Formal

o Informal/observation

o Trial therapy

o Generalization

- GOALS of evaluation: DIAGNOSIS and monitor/describe CHANGE

CLIENT as a factor: young children- flexibility, observation/play, ongoing; adolescents: explanation, age related issues; older adults- respect, fatigue, listen

PROCEDURAL CODES (CPT- current procedural terminology)

ICD-10 (DIAGNOSITIC code)

ROLES of diagnostic session:

- Diagnosis should drive eligibility (do NOT change diagnosis to meet eligibility requirements)

- Etiology is not always clear; be careful providing a cause if it is unknown

o Predisposing variables: put one at risk for disorder

o Precipitating variables: might trigger onset of disorder

- 3 factors:

o DIFFERENCE: not disordered; may be dialectical or cultural

o DISTURBANCE: message is affected (unintelligibility, disfluency, vocal issues, articulation issues, etc.

o HANDICAPPING: difference or disturbance is handicapping from DAILY LIFE/learning standpoint

- What will help the client improve? Management, therapy, etc.

- Diagnosis as a science AND art: standardization, being flexible, observational skills

Using evidence-based practice (EBP) with assessment (psychometrically sound) AND treatment (backed up by EBP)

- EBP: ability to evaluate the efficacy, effectiveness, and efficiency of assessments

Dynamic assessment: use of evaluation time to gain info for TREATMENT tasks; ZPD: determining what is too easy/too hard for client

RTI: use of tiered work

- Response to intervention; limited, intense periods of treatment to determine if the child can benefit from additional assistance

ICF: FUNCTIONAL levels; NOMS: national outcome measurements; FCM: functional communication measurements; PPP: preferred practice patterns- acceptable clinical approaches to assessment and treatment; activities of daily living (ADL)- common activities (eating, communicating, etc.)

PROGNOSIS: prediction of the outcome of a course of treatment, how effective the treatment will be, and how far we can expect the client to progress

INTERVIEW: verbal and nonverbal exchange between the professional, parent, and client

- Obtain information, provide information, counsel

- OPEN ended questions!!

- 80% of talking should originate with the client

- Summary probe: periodically summarizing what the client has said, ending with a request for clarification, if needed; keeps interview MOVING

ORAL PERIPHERAL EXAMINATION (oral motor exam, oral mechanism exam)

- Systematic assessment of structures and functions necessary for speech production

- TOOLS: pen light, tongue depressor, gloves, cotton gauze pads, candy suckers, mirror, stopwatch

Face, lips, tongue, jaw, teeth, hard palate, soft palate, velopharyngeal closure, fauces

Diadochokinetic rate assessment (DDK): alternating (puh puh puh) OR sequential (puh tuh kuh)

- Count-by-time: how many syllables will my client produce in 10 seconds?

- Time-by-count: how many seconds will it take for my client to produce 10 syllables?

OSMSE-3, STDAS-2 (apraxia), DEAP (until age 8), FDA-2 (dysarthria)

Potential referrals: dentist, pediatrician/primary care, oromaxillofacial specialist, otolaryngologist, neurologist

PSYCHOMETRIC considerations

VALIDITY: does the test measure what it is supposed to measure?

- Construct: theorical construct of what it should measure

- Content: all aspects of concept being measured

- Criterion: external criterion (real-world outcomes)

RELIABILITY: is the test consistent over time?

- Interjudge reliability: agreement of two judges assessing the same thing

- Test-retest reliability: consistency of a test OVER TIME

- Internal consistency: consistency of items within the test

STANDARDIZED: administered and scored in the SAME MANNER across all individuals

NORM-REFERENCED: determine if an individual obtains a score similar to the group average or how far away from average the individual’s score is

FORMAL TEST SCORES

- Raw score: usually number of correct answers earned on a test

- Percentile rankings: percentage of people who scored lower than a given score

- Standard score: mean of 100, SD of 15, transports raw scores to allow for comparison

- Subtest scaled score

- Age/grade-equivalents: do NOT take into account the range of normal performance; leastuseful

- Stanines: divide distribution into 9 parts

STANDARD ERROR OF MEASUREMENT: susceptibility to error; estimate of reliability, mean and standard deviation, observed score

CONFIDENCE INTERVALS: how sure are we that we found the true score? 90%-95%

SENSITIVITY: client has the disorder = test says client has the disorder

- TRUE POSITIVE

SPECIFICITY: client does NOT have the disorder = test says the client does NOT have the disorder

- TRUE NEGATIVE

SELECTING standardized tests: expense, caseload needs, test administration and scoring, reliability, standardization sample, validity

COMMON ERRORS: measuring treatment progress with norm-referenced tests, analyzing individual test items for treatment target selection, forgetting that formal tests distort what they are designed to measure, ignoring the cultural makeup of the normative sample

Basal and Ceiling rules: check specific rules for each test; entry point and discontinue point

Code of Fair Testing Practices in Education and Rights and Responsibilities of Test Takers: Guidelines and Expectations

BIAS: presence of some characteristic that results in differential performance for two individuals of the SAME ability but DIFFERENT ethnic, sex, cultural, or religious groups

OFFENSIVENESS: may obstruct the purpose of the test, produce negative feelings and attitudes towards testing

STEREOTYPING: consistent representation of a given group in a particular light (which may be offensive)

Improving reliability: standardize instructions, increase number of items, remove unclear items, do not make test too easy or too hard, reduce effects of external distractions

Improving validity: consult content expert, examine selected criteria, look at rationale that underlies the test

KEY POINTS:

- Standardized test score does NOT equal diagnosis

- Results depend on careful selection, preparation, administration, scoring, interpretation

- Both tests and testers are susceptible to error

- Compare test scores to informal assessment data, case history info, and interview info

- Agency guidelines do not equal diagnosis

- Not all results can be obtained during brief interactions

- No test is better than GOOD CLINICAL JUDGEMENT

DIAGNOSTIC REPORT

- Written record that summarizes the relevant info a clinician OBTAINED, HOW they obtained it, and the professional INTERACTION with a client

- Art and science, extension of the professional, vary depending on setting

FUNCTIONS: acts as a guide for additional SERVICES, communicates findings to OTHER PROFESSIONALS/FAMILY, DOCUMENT for research purposes

COMPONENTS: routine information, statement of problem, historical information, evaluation, clinical impressions, summary, recommendations

Current Procedural Terminology (CPD) code: describes PROCEDURES or SERVICES that are conducted with the client

International Classification of Diseases-10 (ICD) code: reports DIAGNOSES, DISEASES, and DISORDER classifications

CONFIDENTIALITY: Health Insurance Portability and Accountability (HIPAA); Family Educational Rights and Privacy Act (FERPA)