CSDS-110 Final

variables related to the Test & Examiner

- May have not had exposure to pictures of vocabulary in test Stories or topics that we typically use may not be interesting topics to those of different backgrounds

1. Memory

- auditory- series of numbers and tell them to repeat numbers back (backwards) or visual: show list or pictures that you place on the table & cover up Short term memory: can they remember what they had for breakfast, what visitors they had? Long term memory: strong area of memory, most regain all if not long-term memory (overlaps with orientation) Asking questions like: what are your kids names, are you married? What do you drive? Anything that was learned through experiences or academically

Variables related to the child & family

- many children may have limited experience taking of standardized tests - may not understand that they can ask questions - we give detailed verbal instructions vs. modeling or model guidance - may find the standardized testing threatening - TIMED tests Cultures that would discourage going fast & taking your time instead

Components of the Assessment as needed for minimal or non-verbal child

1. Case History 2. Interview 3. Orofacial Examination 4. Hearing Screening 5. Standardized and/or Criterion-Referenced Instruments 6. Systematic Quantitative and Qualitative Observations of Nonverbal Communication 7. Assessment of Receptive Language 8. Assessment of Verbalizations that Do Occur (many times 9. Prognosis for Developing Verbal Communication 10. Assessment for AAC Systems 11. Recommendations Postassessment Counseling

Ethnocultural factors affect appropriateness, fairness, and validity of methods of interviewing parents & collecting a naturalistic language sample:

1. Cultural barriers or differences in communication styles can restrict the value of information received. 2. People of certain cultural backgrounds may find it more difficult to share personal information with strangers. 3. A language barrier may interfere with effective communication.

General strategies for assessing Bilingual children

1. Determine Language Dominance: - If the child has 2 languages, always mostly the case, one language is stronger or more dominant than the other 2. Determine Language Proficiency: - May change as the child ages - Can shift back & forth - For assessment you want to do it in the dominant/first language - Do they have the language they need to function well given their daily activities - Includes evaluation of reading & writing skills - Assess for any dialectical You can use standardized tests - can be given in a dominant language, as long as it's appropriate, I would need to be dominant in that language (or interpreter) 3. Develop a Database of Languages Spoken in Your Area - variations Spanish influenced English - Asian influenced english

Assessment of Bilingual Children: Language Difference vs. Language Disorder

1. Diagnosis of communication disorders in children with limited English proficiency (LEP) because of their bilingual status requires evidence that a disorder exists in both languages (or in their primary language). Therefore, assessment needs to be done in both languages. 2. If the results of an assessment show that there is only a problem in the second language (English), then it is possible that the child does not have a speech or language disorder, but has not yet mastered the second language to the extent expected. What this child needs is an intensive English language instruction, not clinical intervention for a communication disorder. (speech language difference) 3. There may be dialectal differences between the child's speech and the clinician's speech. Standardized test items may not sample the child's dialectal differences, and the test (and the examiner) may require responses that are not in the child's dialectal repertoire. 2. In such contexts, poor performance on a test may reflect a language difference rather than a language impairment. If these differences are scored as "errors" on a test it may lead to over-identification of a disorder. On the other hand, a child who actually has a language impairment may be missed because it is mistakenly interpreted as a language difference. This can lead to under-identification.

Dynamic assessment

1. In dynamic assessment, clinicians provide brief periods of intervention to assess whether the child's performance can be improved on a given task. 2. The main objective of dynamic assessment is to understand how the child would perform on treatment tasks. 3. This tactic allows the clinician to observe what the child learns and how. 4. The clinician can experiment with various treatment techniques to determine the client's stimulability (your whole assessment) for improvement under intervention. 5. Provides valuable information for treatment planning. 6. May assist in differentiating those children who will require therapeutic intervention from those who do not. Children who show little to no change during the assessmentà (low modifiability) à if you're exposing them to all the treatment & you're seeing little to no changeà are more likely to need intervention to facilitate improved language; therefore, they would be good candidates for language treatment. On the other hand, children who improve significantly during the assessmentà (high modifiability) and maintain those improvements may not require intervention. 7. There are several dynamic assessment protocols that differ somewhat in how the selected skills are stimulated or taught. They generally fall into one of three categories: graduated prompting, testing the limits, and test-teach-retest.

Why are commonly used standardized tests inappropriate for minority cultures?

1. Many standardized tests have been standardized on samples drawn from monolingual, native, and standard English-speaking people of majority. 2. Children with limited English proficiency or children who are bilingual, but their English is influenced by their first language have not been included in the normative sample. 3. Minorities who speak a dialectal variation of English (e.g., the African Americans in the United States) have neither been sampled adequately nor are their language characteristics included in the test content. 4. Children from diverse language backgrounds tend to score lower on standardized tests and are often inappropriately placed in special education programs.

4 critical components of AAC

1. The symbol type (aided/unaided) 2. AAC Aid (device they're going to use) any device that helps a person convey or receive the message, this can be very low tech (pictures that they're handing to somebody, ex: ipad apps) 3. AAC Technique refers to the various ways that the message can be selected or identified (or transmitted) Also includes the types of display 4. AAC strategy what can we do to make it the most efficient communication possible? (most efficient way for the person to convey their message, how quickly can, how many? how timely, are they cognitively strong enough for them to choose one picture and it produces a whole sentence?)

language loss or attrition

A temporary first language loss or attrition may be found in some children learning a second language some children learning two languages simultaneously may appear to have lost the first language while not yet being proficient in the second Other children may instead experience an attrition, in which the first language is not lost, but does not advance.

10. Assessment for AAC systems

AAC: a set of procedures & processes by which an individuals communication skills (both comprehension & production) can be maximized for functional communication AAC has 3 phases pf assessment: 1. INITIAL ASSESSMENT: FOR TODAY, you're trying to match your client's current need & capabilities, we want to try to meet their communication needs & facilitate/promote more interactions with people 2. FOR TOMORROW: start to investigate & find a system that will help support client in a variety of environments (school, work, clubs) 3. FOLLOW-UP: ongoing & dynamic- throughout their life they need to constantly be re-assessed to make sure that the system that is in place is still meeting their needs

code switching

An alternation of two languages in the same conversational episode.(they produce one sentence in Spanish/ next sentence in english)

Aphasia tests

Boston diagnostic Aphasia exam Western Aphasia Battery Boston Assessment of Severe Aphasia

2. interview

Conduct the interview in the traditional format for the most part, EXCEPT that the clinician would make some modifications: daily activities, favorite books, how do they play with their peers or family members? Communication styles? What type of activities? Do they have siblings, books at home? any academic strengths and limitations? traditional format: Opening phase 2-4 min. Introduction time frame reiterate why they are there plan you have easing anxiety Maybe small talk Content Phase "body" of interview Actually gather information Set of Q's you want to talk about No more than 10-15 min Closing phase Quick Couple of minutes Summarize major points/repeat them If there's something you want them to remember REPEAT them Inform them if there will be treatment Any questions? say thank you and walk them out.

Dysarthria error types

Distortions omissions substitutions Imprecise articulation/slurred Big range of severity

3. Problem solving

Functional problem solving: what would you do if you fell out of bed? What would you do if you need assistance & can't push the nurse button? What would you do if you get lost on your way to the dining room? Foundational skills: (sequencing categories) Steps of somebody getting dressed Categories: convergent- list three items, and they tell you the category

Language Activity Resource Kit (LARK box/kit)

INFORMAL ASSESSMENT manipulatives designed for adults there is many common objects, comes with a little box with a photo that matches each item, also an action photograph, (the object being used), B&W line drawing of each item (one side drawing, other side drawing with the word), printed word for each item, sentence completion for each word, descriptive sentence Also an open-ended question Ask them to give you a description Gestural communications (show object, they show you how they would use it)

Differential diagnosis of Apraxia vs. Dysarthria

If they have a speech disorder it's most likely apraxia or dysarthria (they could have both going on) We can use the orofacial examination, DDK tasks, articulation tests, and spontaneous speech sample to look for the following characteristics: DYSARTHRIA: A speech production disorder caused by neuromotor damage to the central or peripheral nervous system. May involve deficits in respiration, phonation, resonation, articulation, and prosody associated with muscle weakness (tone issues) and incoordination. Damage may occur in various parts of the brain causing various types of dysarthria. Speech errors tend to be more consistent, whether the utterance is long or short. Speech errors tend to be more consistent, whether the utterance overlearned/automatic or not. Searching, effortful groping, and articulatory posturing are less likely to occur in Dysarthria APRAXIA OF SPEECH(AOS): A speech production disorder caused by motor programming, sequencing, or planning problems. The strength, ROM, tone, and coordination of the speech musculature is usually WNL. Primarily impacts speech production and prosody. Usually associated with left hemisphere, lower-frontal, or parietal lobe damage. Speech (articulation) deteriorates as the length and complexity of the utterance increases. Automatic and reactive (emotional) speech is often produced normally or more clearly. Searching, effortful groping, and articulatory posturing are more likely to occur in Apraxia. AOS occurs more frequently with Aphasia than dysarthria does.

Individuals selected as interpreters should meet certain requirements:

Interpreters must be proficient in both the languages targeted for assessment; they typically involve the clinician's and the family members' language or languages. Interpreters must understand and appreciate the cultural differences of both the parties. Not understanding the values, beliefs, and patterns of interaction associated with a particular culture may lead to miscommunication and misinformation about the child and the family. Interpreters should receive training specific to the assessment being done. They should be familiar with professional or unfamiliar vocabulary that might be used, the purpose of the evaluation, standardized test administration procedures, the interview format, and paperwork requirements. Interpreters should have a basic knowledge of the process of speech and language acquisition and second language acquisition. · Interpreters should follow professional ethical principles and understand his or her role in the assessment process. Family members, neighbors, or the child should not serve as interpreters. Lacking in training, they may not play the role of a professional interpreter. They may induce data distortions by faulty translations or interpretations.

advantages of authentic assessment

It may help the speech-language pathologist arrive at a valid diagnosis with fewer false positives (less over identification) Speech-language samples collected in a familiar, natural context may be more representative of the child's skill level than those evoked during contrived circumstances There is no need for expensive standardized tests It can be used to assess children of different cultural backgrounds

disadvantages of authentic assessment

It usually takes more time than the traditional, standardized test-based assessment The results may be more subjective Results obtained from authentic assessment procedures may not always fit neatly into the criteria utilized by some institutions for qualifying a child for clinical services

Systematic Quantitative and Qualitative Observations of Nonverbal Communication

MAIN THING you will use in this population, primary tool, systematic approximation of their behaviors USED IN EXPRESSIVE LANGUAGE - Expressive & receptive quantitative protocol (engage the client in spontaneous play) most children are using some type of vocalization, gestures, facial expressions, can be very subtle go in ahead of time, change the room (put stuff in the clear drawers, ex: bubbles and put them out of reach). Might be helpful to have a sibling or friend to get them to engage - Does the child get upset? - do they demonstrate joint attention? - how do they protest? - How do they request a desired object? - Does the child seek out attention? - Does the child initiate communication? - How does the child respond to modeling? Huge prognostic indicator if YES!

3 areas that we assess

Memory (auditory or visual, short/long term) Orientation (person, circumstance, place, time) Problem solving

Right hemisphere tests

Mini inventory of Right brain injury (MIRBI)

2. Orientation

Person: are you married; do you have children? What kind of work do you do? Did you go to high school? Circumstance: do you know why you're here; do you know what happened to you? (most don't) we reorient them by telling them what happened to them as they're getting out of coma Place: where are you at right now? Hospital or home? Do you know your room #, where the bathroom is? Name of hospital? Are you in Fresno or Clovis?

Transdisciplinary

Professionals become proficient across disciplines, this means assessment and goal setting are done collaboratively.

How to assess receptive language

Receptive Language (what can the patient understand?) simple to complex - Name recognition - One word-level (body part ID, object/picture ID) - 2-word level (point to ball and car) - Phrase/sentence level (show me what you wear on your foot) - Picture by description- follow directions (1-part/concrete, multi-part/complex) - Y/N Questions (have to be correct both times) How verbal are they? If they're able to do so we can go into open ended questions & a conversational level

4 areas we're going to assess for aphasia are

Receptive language Expressive language Reading Writing

1. case history

Retain the case history format more or less in the traditional manner General information (client's name, DOB, age, address) Referral Sources (Child being send by a Medical doctor (medical issues?) Child being sent by SLP, more therapy, different type of therapy?) Family Physician (Some insurances don't cover speech unless doctor approves Allows SLP to network with people in the field) Other specialists who have seen the child (Helps determine if the child's communication difficulties may be a part of hearing loss, physical, neurological, behavioral?) Statement of the problem (VERY IMPORTANT) (Presenting complaint Helps prepare for assessing level of severity Helps clinician determine caregivers primary concern & knowledge) Birth & Developmental History (Good to have parent identify age that milestones were reached) Medical History (illnesses, accidents, hospitalizations?) Family & Social Background/School History (Home environment, primary language at home, social issues, temper problems, day care?school?) Speech, Language and Hearing Behavior (Identify HOW they respond to sound, how does child usually communicate?)

4. Hearing screening

Retain the hearing screening more or less in the traditional manner A hearing screening is typically administered at 20 or 25dB for the frequencies of 500, 1000, 2000, and 4000 Hz. A child who fails the hearing screening (does not respond to one or more of the tones presented) should be referred to an audiologist for further evaluation can be challenging to get for these individuals (behavior issues/following directions)

3. Orofacial examination

Retain the orofacial examination more or less in the traditional manner is designed to evaluate the structural and functional adequacy of the oral mechanism can be challenging to get for these individuals

TBI/Cognitive assessments

Ross Information Processing Assessment (RIPA)

silent period

Some children in the early stages may be relatively unexpressive in the second language because they tend to concentrate on comprehension rather than production.

fossilization

Some unusual expressions or grammatical errors in the second language become fixated, resulting in idiosyncratic errors. Occurs in children and adults who have mastered the two languages.

Characteristics associated with (L)eft-CVA

Speech: possible dysarthria Apraxia Language: Aphasia (Receptive/Expressive) Includes problems with reading & writing *Good pragmatics* Visual spacial: No visual spatial problems Cognitive deficits: Not a priority Dysphasia: Is minor & temporary

Characteristics associated with a TBI

Speech: possible dysarthria May have apraxia Language: Not likely to have a full-blown aphasia syndrome -word retrieval problems **terrible (worst) pragmatics* Visual spatial: Visual spatial problems are likely to affect reading & writing Cognitive deficits: Are PRIMARY issue Dysphasia: Often an issue

Characteristics associated with (R)IGHT-CVA

Speech: possible dysarthria No apraxia Language: No aphasia *pragmatics are terrible** Visual spatial: Visual spatial problems are likely to affect reading & writing Cognitive deficits: Cognitive issues associated with memory OR problem solving Dysphasia: May occur

A comprehensive & integrated Assessment approach (9 steps)

Suggested steps: 1. Retain the case history format, orofacial examination, and hearing screening more or less in the traditional manner. 2. Conduct the interview in the traditional format for the most part, except that the clinician would make some modifications: (daily activities, favorite books, how do they play with their peers or family members? Communication styles? What type of activities? Do they have siblings, books at home?, any academic strengths and limitations?) 3. Select standardized tests (reliable, age appropriate, representation) prudently, use them sparingly, and interpret the results cautiously. The clinician would select standardized tests that are highly reliable, valid, and have included in the normative sample children of the ethnocultural background the child is being served: 4. Sample speech and language through client-specific and criterion referenced measures. (have in mind some behaviors we will try to evoke, tests can be modified) The clinician would take naturalistic language samples, record language samples in classrooms or the child's home, sample ordinary and everyday language usage, have the child narrate stories from his or her own books or experiences, repeat samples, and offer multiple opportunities to produce each target skill (as against just one or two opportunities that typify standardized tests) to enhance reliability and validity of measures. 5. Design client-specific(avoiding alternative & standardized tests) stimulus materials to evoke speech and language samples. The clinician may ask parents to supply stimulus materials from home(more culturally appropriate); have parents bring the child's favorite toys, books, and play materials to the assessment session; and write multiple exemplars of phoneme and language structures to be evoked with the help of the child's own stimulus materials. Criterion reference: (KNOW THIS) use them to alter a test 6. Expand the traditional child's clinical folder to include materials typically not included in it. (include some language samples, that we can refer to after)(try to integrate school coursework without therapy, working on with whatever units they're working on in the classroom) The clinician may place in the child's folder the entire transcribed interview, or an interview protocol that may have been used with the parents with additional notes taken during the interview. The clinician may include such other items: ex: target fluency à child will be having a class presentation 7. Make emergent literacy and literacy skill assessment a part of speech-language assessment. Although not a part of any specific alternative assessment approaches, a comprehensive assessment of communication disorders in children should now include literacy skills with a view to later integrating literacy and academic skill training with speech and language training. (ex: read some words, read a book)-do they know the alphabet? 8. Offer postassessment counseling in which the results of assessment are described to the parents and the child (to the extent appropriate). The clinician would offer a tentative diagnosis, state a reasonable prognosis, and describe recommended evidence-based treatment options. 9. Write an integrated clinical report.

12. Post-assessment Counseling

Takes place after assessment is completed. Offer postassessment counseling in which the results of assessment are described to the parents and the child (to the extent appropriate). The clinician would offer a tentative diagnosis, state a reasonable prognosis, and describe recommended evidence-based treatment options

Testing the limits

The clinician modifies traditional test procedures by providing elaborated feedback to the child on his or her performance on test items. Elaborated feedback may include commenting on the correctness of a response, providing the reasons why the answer was correct or incorrect, and explaining the principles involved in a task. Task variability may involve other modifications in the way a test is administered, such as using a more naturalistic environment or letting the child demonstrate a skill. are they responding to the feedback?? Or not?

During Assessment the clinician should modify his/her style of interaction, for instance:

The clinician should speak directly to the child or family members, not to the interpreter. The clinician should avoid professional or technical jargon and figurative language that might be difficult to translate or lead to misunderstanding. (ask them to rephrase or ask them a question, wait periodically & ask if they have any questions?) · The clinician should check the client's or informant's understanding of information and exchange of information throughout the assessment. The clinician should review the information and "debrief the interpreter" (Lynch & Hanson, 1992). A debriefing session is a brief meeting, following the assessment, in which the interpreter and clinician can review the information collected and discuss any problems with the interpreting process. This is also an opportunity for the interpreter to share his or her impressions regarding the family's emotions or reactions during the session. Although subjective, these impressions might provide valuable insight regarding the family's acceptance of the problem and their understanding of the clinical process.

graduated prompting

The clinician uses a predetermined hierarchy of prompts designed to facilitate the child's responses during the assessment. The clinician analyzes the number and level of prompts needed to evoke a target response and to facilitate generalization of learning to a new task. ex: phoneme--> if the child doesn't produce It correctly --> modeling--> visual placement cue--> move the articulators--> shape it from another sound --> chart the level of cuing that was needed, you will see if they can do it in a different context Ex: vocabulary-->put it in a sentence completion--> read a b -->read a bu--> read a book -->have them imitate -->document what level of hierarchy it takes to evoke a response

Test-Teach-Retest

The clinician: (1) administers a pretest to identify deficient or emerging skills, (2) provides an intervention designed to modify the client's level of functioning in a given skill, (3) administers a posttest to assess the modifiability of the client's skill level as a function of intervention. Test-teach-retest procedures have been found to be useful for assessing children with disabilities, and in differentiating language disorders from culturally based language differences in children from diverse ethnic groups

contrastive analysis

The goal of contrastive analysis is to separate dialectical speech and language differences from clinically significant speech and language errors 4 components of contrastive analysis: 1. The clinician needs to become familiar with the dialect spoken by the client. 2. A speech-language sample is collected. 3. The sample is evaluated to identify any differences from Standard American English. 4. Based on knowledge of the client's dialect, the clinician determines if the identified differences are dialectical variations or "true errors."(highlight grammatical errors--> differs from normal English grammar) and then contrasting that with the dialect to determine if it's a true error

interference

The influence of the first language on English may cause omissions and substitutions of English speech sounds or English morphologic features.

advantages of the dynamic assessment approach include:

The test-teach-retest approach will assist the clinician in assessing the child's learning process and help determine the type and intensity of treatment that might be needed The performance on the posttest phase of the test-teach-retest format may be an indicator of the child's modifiability and ability to carryover new learning (do they need treatment at all?) Assessment of response modifiability may help identify children who do not need treatment because of their ready response to treatment, even though they show some skill deficiencies at the time of assessment The testing-the-limits variation of dynamic assessment allows the clinician to use standardized tests in a flexible manner.

Advantages of client-specific or criterion-referenced approach

The two approaches avoid the pitfalls of standardized tests(there is no normative sample) The behaviors to be assessed are sampled more adequately in all children (15-20 trials) The results of assessment are uniquely relevant to the child being assessed (selecting skill we are going to assess & testing materials- advantage) The assessment results directly lead to treatment planning (administered a baseline because we did 15-20 trials already) The approach provides more reliable and valid data than standardized tests and even several alternative approaches.

Potential Disadvantages of client-specific or criterion-referenced approach

The two approaches will not allow a comparison of an individual child's performance with the performance of a normative sample; indeed, the approaches were designed to avoid this comparison The approaches do not allow for a diagnosis of a disorder made strictly on the basis of normative comparison of an individual child's performance; this may be a significant limitation if the education policy of schools require such a diagnosis to qualify children for services The approaches are, at least initially, more time consuming than the standardized test-based assessment because they require a more time to prepare or select stimulus materials for assessment.

how to assess writing

Tracing? Too easy? copy - Can they write or print their name? - Can they draw shapes, numbers, letters? - Are they able to write words to dictation (show pic/object) can they write the word for that? - Words to Phrases and sentence - Highest level is functional writing à filling out a form etc.

Apraxia of speech error types

Transpositions Additions Prosody (more specific prosody issues) Most common: decreased rate, inappropriate pauses, issues controlling their loudness Big range of severity

Disadvantages of the dynamic assessment approach include:

Variability that exists within the approach creates a reliability problem. Many of these procedures have high face validity but their reliability is difficult to establish. (valid but not reliable) The procedures demand extraordinary time and effort because assessment is not completed unless some treatment is executed. Modification of procedures prescribed for standardized test administration may make it difficult to interpret the results. Clinicians in many public schools may face a dilemma: treatment, even if experimental, may not be authorized unless a valid diagnosis justifies it; a valid diagnosis within the approach cannot be made unless some treatment is offered. (can't treat unless they qualify for treatment after an assessment) There is insufficient evidence to fully accept the claim that children whose speech-language errors or deficiencies are modifiable within dynamic assessment do not need further intervention; if this claim is not supported by evidence, the rationale for dynamic assessment is eliminated. To support the claim, we need predictive studies that take time to complete. The claim may eventually prove to be unsupported but in the vi. meanwhile, many children may be denied needed services.

Ross Information Processing Assessment (RIPA)

We administer this test when patients are still in the hospital - need in nursing facilities RIPA-G(geriatric) - tweaked questions to be specific to a skilled nursing setting (same areas, same level of Q's, scored the same) Requires patients to have verbal skills Assessment for cognition: memory, orientation, problem solving 10 Q's on immediate memory: repeat series of numbers back to you Recent memory: how many children do you have? Orientation: person, place & time Q's Recalling general information Problem solving: what would you do if you lost your wallet? They're going to score normal if they are mild (high functioning patients) Language organization, recall, & reasoning (problem solving) IT IS GOOD FOR HIGH FUNCTION PATIENTS Cognitive Linguistic Quick Test: Language organization Visual spatial skills good overall test (is used a lot)

global aphasia

When both production and understanding of language is damaged ex: Brocca's aphasia & Wernicke's aphasia

Underidentification

a child who actually has a language impairment may be missed because it is mistakenly interpreted as a language difference

Overidentification

a language difference rather than a language impairment. If these differences are scored as "errors" on a test it may lead to overidentification of a disorder.

AAC

a set of procedures & processes by which an individuals communication skills (both comprehension & production) can be maximized for functional communication

Apraxia

also known as VERBAL apraxia Speech production disorder, motor speech disorder, caused by motor programming or sequencing problems

Aphasia

an acquired language disorder due to some type of brain injury Most common cause: is a stroke or CVA (cerebrovascular accident) Less common causes of aphasia: TBI's, certain types of brain tumor, infections that impact the brain (Encephalitis). Exposures to some type of toxicity (causes brain damage). RECEPTIVE: person has trouble understanding/comprehending language EXPRESSIVE: difficulty formulation words/getting message out An individual can have a combination of both, (produce jargon) this is called global aphasia

how to assess reading

can they recognize their written name? - Object to picture matching? (O to O, O to P, P to P) - Object to object ex: they have to match object holding to that one on the table - Object to word - Picture to word - Word to word Written sentence that says: you use this to brush their teeth, then they find the picture or object Follow written directions & answer written Y/N questions Highest level functional reading activities Paragraph level reading: have them read a paragraph and demonstrate Y/N questions

Aided symbol (strategy):

client is going to require some type of transmission (external) device or tool, need something outside of their body that helps them transmit their message (ex: pictures, objects (pointing to one), drawings, words, communication boards)

INFORMAL procedures for assessing receptive language

comprehension level basic concepts (plan for this -- use objects client can use we don't ask to say or label anything- only identify ex: give me the block(s) singular vs. plural You can use pictures comprehending single questions(yes/no q's) following basic directions (stand up, sit down etc) if they do well you can try multiple step commands

Mini Inventory of Right Brain Injury (MIRBI)

covers sections on visual processing (scanning, tracking) section for language processing but it's really covering abstract language & emotional language

AAC: the way messages are transmitted (direct/scanning)

direct vs scanning direct selection: set of picture/word & that would convey the message scanning type: in a software option, kind of like word prediction, scans across as soon as it gets to the word they want they hit the switch & it selects it

AAC: type of displays (fixed/dynamic)

fixed vs dynamic display fixed: you have a set display of pictures, phrases, words, but it doesn't change dynamic: constantly changing & evolving as you select one word, it shifts to another screen with another set of words, pictures, or phrases.

BURNS

has 3 screenings really focuses on visual spatial skills, language, complex neuro Orientation and memory, attention and memory, visual attention & memory Used by themselves or mixed and matched to meet the needs of the client In less than a half hour. left hemisphere inventory: receptive, expressive, reading & writing) right hemisphere inventory: all visual spacial, abstract language, prosody, and pragmatics complex neuropathology inventory: more designed for TBI patients- covers orientation, attention, memory, and visual perceptual

Boston Diagnostic Aphasia Exam (BDAE)

has a short & long version Starts off with a conversational speech sample First is auditory comprehension: one-word comprehension, asking them to identify some body parts, then goes right into 2 parts, ex: put the pencil on top of the card and then put it back ORAL EXPRESSION: automatic speech, days of the week ,count, happy birthday song, has them repeat words, spontaneous meaning (what do you use to tell time?) say a word, match the word, reading at a sentence level, reading comprehension for paragraphs WRITING: asked to write name, letters, numbers, words. Shown a sentence and asked to copy it, show them a picture with a lot going on Will help with diagnosing for each of the 4 areas look at where they plateau and start with treatment there. Can be administered to patients in a broad range

sequential bilingualism

he child has mastered one language, & now they are learning a second language

Assessment team

in terms of people involved of assessing nonverbal & minimally verbal children consider: Occupational therapy Applied behavior Physical therapy Teacher/AID Respiratory therapist Parents AuD (Team can be very large in some cases)

foreign accent

is a pervasive effect of the first language on the production of the second language --> phonological production/speech

Boston Assessment of Severe Aphasia (BASA)

may have global aphasia Not able to communicate functionally at all (client) You can score the patients responses through verbal/& gestures Simple, basic, quick, can help you identify gestural strategies They assess, what can they do with their auditory comprehension: - Oral/verbal apraxia- do they have any limb apraxia? - Looks at oral gestural expression - Visual/special issues

criterion referenced approach

may use existing nonstandardized assessment tools and interpret data in terms of whether the measured skills meet certain mastery criterion (e.g., morphologic or phonemic productions at 90% accuracy). When appropriate, a criterion-referenced approach may use items from a standardized test, but the results may still be analyzed in terms of mastery level, not the test's norms

dysarthria

motor speech disorder, occurs as a result of muscle tonicity issues (CP for children)

3 types of assessment team formats

multidisciplinary team interdisciplinary team transdisciplinary teams

positive transfer

one language has a positive effect on the second language usually occurs when you have two languages that share some common features ex: regular plural -s occurs in both Spanish & English - child who has learned Spanish first, already has that rule, so it will facilitate it

dialect

refers to a variation in speech, language and even prosody that is being impacted NOT a second language issue, still the SAME language, variation of the original language ex: African American English

minimal competency score (MCC)

reflects the least amount of linguistic skill or knowledge that a typical speaker would display for a given age and context

Unaided symbol (strategy):

require only the person's own body to produce communication (ex: ASL, gestures, facial expressions)

simultaneous bilingualism

the child is exposed to the language at the same time, and masters them at the same time

In the case of children who belong to ethnoculturally diverse backgrounds and are bilingual and bidialectal, the clinician would take additional steps to make the assessment meaningful, fair, and appropriate

the clinician would: 1. Further limit the use of standardized tests or altogether eliminate their use. Most stimulus materials used in assessment will be child-specific 2. Alternatively (DYNAMIC TYPE OF ASSESSMENT), refrain from giving feedback to the child on his or her performance and then à provide such feedback to contrast the performance under these two conditions. This would be done only when client-specific stimulus materials are used, not when items from standardized tests are used; most likely standardized test items will not be used. 3. Not analyze the assessment results in terms of statistical norms, but only in terms of the individual child's performance levels and the academic and social demands made on the child. The clinician may: - analyze the child's speech and language skills in the context of the child's primary (home) language or primary social dialect -use the skill mastery criterion; for example, consistent with the client-specific and criterion-referenced approaches, the clinician may calculate the percent correct for each of the target skills assessed (calculating the percent correct) -use the minimal competency core concept (check them off) -make a contrastive analysis (main purpose is to determine whether the things the child is doing are typical of a dialect -(DYNAMIC ASSESSMENT) disorder? Or a language difference? conduct informal teaching experiments to see if the lacking skills are modifiable; this is similar to the traditional stimulability test; however, this test-teach-retest feature of dynamic assessment goes beyond the traditional stimulability assessment and the clinicians need to seriously consider the limitations of dynamic assessment before adopting it.

interdisciplinary

the different members also independently assess the child, BUT then meet as a team to collaborate and develop their recommendations going forward

multidisciplinary

the different specialists independently assess the child and they make their own discipline specific recommendations and often treat the child independently

how to assess expressive language

the very simplest act- lowest level of the hierarchy - Can they produce automatic speech? - ABC song - Consider any attempts of gestural communication Next level- imitation: are they able to imitate words, sounds phrases - Spontaneous productions: - one-word level, to assess have them name pictures or objects -phrases/sentences- having them describe an object, have them answer questions or describe a picture - highest level: conversation - To see where the patient is starting to struggle

CVA/stroke

there's 2 types of strokes Ischemic & hemorrhagic ischemic: when the blood supply is cut off from part of the brain because of a clot (thrombosis). Embolus is a clot that is traveling and moving around Hemorrhagic: an active bleed/aneurism of blood leaking into the brain & damages cells and blood supply to other cells

TBI (traumatic brain injury)

traumatic brain injury mild brain injury (mTBI): concussion Moderate to severe: cognitive/linguistic problems- short/long term depending on severity - We concentrate on memory, orientation, attention & problem solving, + pragmatic issues

Western Aphasia Battery (WAB)

uses adult manipulatives (Boston does not) COVERS ALL AREAS spontaneous speech sample, auditory verbal comprehension, following directions expressive language repetition automatic speech (informally) naming/word finding (naming objects & pictures), how fluently, sentence completion activities original DOES NOT INCLUDE READING & WRITING Concentrates on auditory comprehension & oral expression Severity of aphasia May want to do informal assessment of reading and writing to supplement for those areas

9. Prognosis for developing Verbal communication

what is their prognosis for developing communication in the near future? BASED ON CRITERION (AAC assessment may be needed) Prognostic indicators that verbal communication may be limited: 1. Is there a primary diagnosis that we know of that is typically associated with a lack of speech & language development 2. Is there a history of regression? (poor prognosis, indicators of the more severe forms of autism 3. Poor stimulability for oral speech as indicated by an inability to imitate verbalizations (could be words, sounds, not imitating can be a red flag) 4. They have no or few canonical vocal communication acts (they're not putting consonant vowel combinations together) 5. Few verbal/nonverbal communication acts that direct an adult's attention to a shared object or event (joint attention) (autism) 6. Age of the child (the older they are, the poorer prognosis for verbal communication)

authentic assessment

when students are expected to perform, produce, or otherwise demonstrate skills that represent realistic learning demands the contexts of the assessment are real-life settings in and out of the classroom without contrived and standardized conditions In making an authentic assessment, standardized tests are avoided. Instead, a sample of the child's speech and language is collected in such familiar environments as the classroom or home. Preferably, the sample is collected during an everyday activity resulting in naturally occurring communication. This sample is then analyzed to determine if there is a need for intervention. Therefore, authentic assessment depends mostly on language samples recorded in naturalistic contexts. Two major concerns regarding language sample analysis (LSA) are that it lends itself to subjective analysis and that the collection and analysis of the samples are time-consuming

11. Recommendations

when talking to parents about using AAC, it is usually not thought of as good news and it's hard for them. 3 things to keep in mind for AAC when talking to parents: 1. we are not giving up 2. it facilitates communication 3. Once the child is ready, they will shift over

negative transfer

when the first language has a negative effect on the second language (interference is used more often) ex: speech sounds that were missing in the first language may make it more difficult to learn those sounds in the second language

5. Standardized and/or Criterion-Referenced Instruments

will not work well with this population, because they don't have enough expressive language, Receptive may be great, they just can't formulate words (may be able to administer) This is when developmental inventories can be helpful (feedback from parents) some are specifically for assessing AAC fundamentals & help make a selection Standardized tests can be used if they ADAPT TO THEM

client specific procedures

will simply avoid all standardized tests as well as individual items from tests, even when assessing the skills of a child for whom appropriately standardized tests are available. The client-specific procedures are strictly developed for a given client, in view of what needs to be assessed. (ex: we want to know if a child has a plural -s) how many trials is that child gonna have to produce plural -s, to try to evoke the -s) Care is taken to ensure that each skill is assessed with sufficient exemplars (typically 15 to 20 opportunities), instead of asking the child to produce given grammatic morphemes or phonemes in the context of just one or two (or only a few at the most) words, phrases, or sentences. The client specific approach requires that the clinician develop stimulus materials that are especially relevant for the child. This approach is appropriate for any child, including mainstream children for whom standardized instruments are available. - age appropriate? -most commonly used To qualify for services, you need to go into norms

7. Assessment of Receptive Language

with this population their receptive language may be MUCH HIGHER or normal compared to expressive assess basic vocabulary Want to know if they understand basic concepts (big vs. little) Single vs plural (block vs. blocks) Pronouns (her shoe, his shoe) Questions: are they understanding them? Can they follow simple directions: stand up, point to the window (one step directions) turn off the light (2 step directions)

8. Assessment of Verbalizations that do occur

(communication attempts) Phonetically consistent forms: a vocalization that is stable and consistently produced in the context of a certain object, person, or situation Usually consists of a vowel A label that the child has created that they use every time they see that person/object or situation, feeling, pain Anything they use consistently Ex: "Biba" for their dog *want to assess their imitation skills*

ASHA's position on Social dialects

(i) No social dialect of English is a communicative disorder. These dialects are a legitimate variety of English used for communication and social solidarity. (ii) A person speaking a dialect of English may also manifest a clinically significant communicative disorder that is unrelated to the dialect. (iii) The speech-language pathologist must possess competencies to distinguish between communicative disorders and dialectical differences. (iv)Speech-language pathologists must be familiar with procedures for culturally unbiased testing. Therefore, speech-language pathologists have an ethical responsibility to familiarize themselves with the various English dialects, especially those that are spoken in their service area. To minimize cultural bias, these dialectical differences should be taken into account when selecting assessment procedures, diagnosing a disorder, and planning treatment.