Diagnostics Test 1
Basic interpersonal communication skills
(BICS) social communication such as language used on a playground, lunchroom, party, or during sporting events. Social language occurs in meaningful context and is not cognitively demanding ~2 years to develop
Cognitive Academic Language Proficiency
(CALP) more formal academic language required for success in school. Cognitively demanding forms of communication with little to no help from context or shared experience 5-7 years to develop
standardized tests
(formal tests) tests that provide standard procedures for administration and scoring the test. Used to prevent extraneous influences from affecting client performance and that results from different people are comparable. Most of these are norm-referenced.
Transfer
(interference) occurs when communicative behaviors from the first language are transferred to second language
Stanine
(standard 9) a score that ranks an individual's test performance. Based on a 9-unit scale with 5 as the average.
Standardized test administration
*READ THE MANUAL* 1) Compute chronological age 2) Identify basals and ceilings 3) Accommodations 4) modifications
Nonverbal children assessment protocol
- a typical vocalization is _____________ for client. And in what context does it occur. - any true words or word approximations? - Any phonetically consistent forms (PCFs) (a vocalization that is stable and consistently produced in the context of certain objects, persons or situation-- usually consistent of vowels and cv combinations) - child imitative phonetic and basic language skills (do they imitate non-speech sounds, speech sounds, or simple words)
disadvantages of authentic assessment
- approach lack objectivity - procedures aren't standardized so reliability and validity are less assured - implementation requires a high level of clinical experience - approach is not efficient and requires a lot of planning - may be impractical in certain situations - insurance companies prefer known entities for qualification and payments
educational background
- attendance in daycare, preschool and school - name of school and length of attendance - does communication problem has interfered with academic or social performance - with p-k and early elementary, information on home literacy environment
avoid in interview
- avoid questions that can be answered with yes/no - avoid double barreled questions - avoid phrasing questions so that they inhibit freedom of response - avoid abrupt transitions or topic shifts - avoid talking too much - avoid concentrating on physical symptoms and etiological factors to exclusion of client's feelings and attitudes (WE TREAT PATIENTS NOT ILLNESSES) - Avoid providing information too soon - avoid qualifying and hemming/hawing when asking questions ("I appreciate all of your time answering these questions") - avoid negative, judgmental or moralistic responses - avoid allowing the interview to produce only superficial answers - avoid trusting to memory
dos and donts
- avoid superficial statements of reassurance - do not suggest outcomes that will precipitate more stress for the parent/giver - do not communicate any negative expectations regarding the outcome of therapy to the client. - try to remain emotionally neutral - try not to lecture to your parents or cg - err on the side of presenting too many examples rather than not enough - try to provide some form of action, "doing" something makes people feel better - say what needs to be said pleasantly, but frankly. don't beat around the bush - have tough love
medical hx
- caregiver reports any illness, accidents or hospitals - includes any disease that are of special importance to s-l development
developmental HX
- cg reports ages at which child reached variety of developmental milestones - information is helpful in determining if communicative disorder is part of larger physical, neurological or behavioral hx - not that developmental hx reported may or may not be all that reliable - in some cases information may not be available
Materials for oral facial exam
- gloves - penlight - tongue depressor (sucker, PB) - mirror - stopwatch
benefit of dynamic assessment
- helps determine baseline - identify appropriate goals and strategies for intervention - helpful for determining language difference vs language disorder - we get a better understanding of what they can actually do and best ways to support them
diadochokinetic task
- if child's speech errors are result of faulty learning or muscle weakness, these syllables rates may be slow and speech sound errors are more consistent across trials. - Typically calculated as "repetitions per second" - also must discuss accuracy and consistency with children - /p^t^k^/ - can substitute buttercup for kids
we use assessments for
- make professional dx and conclusions - identify the need for referral to other professionals - identify the need for treatment - determine the focus of TX - determine the frequency and length of treatment - make decisons about structure of TX (group vs. individual, etc.)
Standardized Assessments
- most commonly used for speech production, receptive and expressive language, and literacy - for many children, standardized assessments may be considered more supplemental - we know the advantages and disadvantages - purpose: Used to prevent extraneous influences from affecting client performance and that results from different people are comparable. Most of these are norm-referenced.
advantages of norm referenced tests
- objective - compared to a larger group - efficient - widely recognized - clinicians don't require high level of clinical experience to administer and score - insurance companies and school districts more likely to pay for services if have SS
advantages of criterion referenced tests
- objective - efficient - widely recognized, allowing for common ground of discussion when other professionals are involved with the same client - insurance companies prefer known test entities for qualification of services - with non-standardized tests there is an opportunities for individualization
family/ social background
- parents educational and occupational background - information on child's siblings - family constellation (fam dynamic) - how well child gets along with siblings and peers - strategies child uses to communication at home and in social situations - family language status
Flaws in case hx
- patient or cg may not understand aspects of the questions (terminology) - may not have enough time to complete the form - may not know the required information - time lapse could be evident and information could be limited - life events may alter recall - cultural differences could be present/ may interfere with accurate provision of information
strategies for using authentic assessment
- systematic observations - real-life simulations - language sampling - structured symbolic play - short answer and extended answer responses - self monitoring and self-assessment use of anecdotal notes and checklists - videotaping - audiotaping - involvement of caregivers and other professionals
disadvantages of criterion referenced tests
- testing situations may be unnatural and not representative of real life - the approach evaluates isolated skills without considering other contributing factors - standardized ones do not allow for individualization - standardized ones must be administered exactly as instructed to have reliable and valid results - clinician needs a high level of clinical expertise to elicit behaviors
disadvantages of norm referenced tests
- tests do not allow for individualization - tests are static and tells what person knowns NOT how they learn - testing situations are not natural and not representative of real life - evaluates isolated skills - tests must be administered exactly as instructed for results to be reliable and valid - test materials may not be appropriate for culturally diverse clients
advantages of authentic assessment
- the assessment is completed in a natural environment and most like the real world - client participates in self-evaluation and self-monitoring - approach allow for individualization and beneficial for culturally diverse clients - approach offers flexibility
parents
- they want to understand and know why something is happening to their child (medical model) - a diagnosis can sometimes give pieces or answers
assessment of nonverbal and minimally verbal children
- this assessment does not follow the basic outline due to unique concerns that need addressed - difference: begins with systematic observation and evaluation of the nonverbal communication strategies child exhibits - evaluation of AAC systems that will be beneficial to child
underlying intent from patient questions
- try to determine the purpose of their question (comfort, support, get rid of guilt) - pay attention to how the person asks (are they angry, are they daring you to push them) - pay attention to body posture, facial expressions
how to help child with dx process
- use play not small talk - help parents prepare the child - ask less and observe more - know what is typical for the age you are assessing - limit the choices you offer - don't ask if they want to do something - be flexible in use of tests - don't make promises you can't keep - whole assessments shouldn't be done at one time - monitor language complexity
gathering information
1. written case history 2. interview 3. collaboration/ information from others
interview
A face-to-face or telephone questioning of a respondent to obtain desired information. From caregivers, client, family, pediatrician, teacher, doctor, anyone that could have relevant information
referral source
A person who recommends services. Important because - child referred by physician likely to have medical or clinical HX that needs to be explored - type of physician referral may also provide insight into other deficits or areas of concern - critical to develop and maintain the professional relationship with referral sources
Awareness
A- are you aware of your own biases and personally held -isms (e.g. racism, sexism, classism)
norm referenced
An assessment that compares an individual's performance to the performance of a larger, normative group. - Most commercially available assessments we use - Answers the question: "How does my client compare to the average"
ASKED
Awareness, skill, knowledge, encounters, desire
Culturally and Linguistically diverse
CLD clients that are diverse in terms of SES, ethnicity, education, cultural-linguistic backgrounds and personal experiences
administering and scoring
Code of Fair testing practices in education - Follow standardized procedure - document accommodations/ modifications - protect security of test materials --> don't give away protocols - correct errors that affect interpretation - maintain confidentiality
informing test takers
Code of Fair testing practices in education - communicate information regarding test administration to client - inform client's parents their right to obtain copies of tests and protocols - explain confidentiality of scores and related information - identify potential issues (with what we saw during evaluation)
reporting and interpreting test results
Code of Fair testing practices in education - interpret test results in light of any modifications - only use tests for their intended purpose - avoid using a single test score as the sole basis for decisions - Share test results in a timely manner that can be understood (by parents, teachers, physicians, nurses)
Selecting appropriate tests
Code of Fair testing practices in education - use most appropriate test based on thorough review of information - review materials provided by test developers and choose clear, accurate, and complete tests (reliable and valid) - evaluate technical quality - evaluate representative samples - determine if modified versions are available if needed
Desire
D- do you have the desire to become culturally and linguistically competent?
Encounters
E- do you have meaningful and transforming encounters with people from cultures different from your own?
Oral Peripheral Exam
Examination of facial structures affecting speech production. Do it for everything looking at face, swallow, sometimes will be a given issue or something symmetrically wrong
Foundational integrity
Good assessments must adhere to five principles 1. thorough 2. uses a variety of modalities 3. valid: should try to evaluate the intended skills 4. reliable: consistent scores over time 5. tailored to individual clients
Knowledge
K- do you know the biological, cultural, linguistic diversity that exists in our society, and do you know the worldviews of different cultures
Health Insurance Portability and Accountability Act
Law created to improve the health care system by: 1) allowing consumers to transfer health insurance coverage after job change 2) Reducing health care fraud 3) Mandating industry-wide standards for electronic transmission of health care infor 4) protecting the privacy and confidentiality of health information
Skill
S- do you have the skills necessary to conduct a S-L assessment in a culturally sensitive manner?
Assessment Information
SLPs use the _________________ _________________ make professional diagnoses and conclusions, identify the need for referral to other professionals, identify the need for treatment, determine the focus of treatment, determine the frequency and length of treatment and make decisions about the structure of treatment (individual vs group)
standard score
Score that reflects performance compared to average and the normal distribution. Used to determine whether a test taker's performance is average, above, or below.
empirical rule
The rules gives the approximate % of observations w/in 1 standard deviation (68%), 2 standard deviations (95%) and 3 standard deviations (99.7%) of the mean when the histogram is well approx. by a normal curve
Diagnostics
This should always lend itself to a continuous flow and open-ended conversation with the patient and caregiver regarding the problem. - Families don't always understand what is the most important aspect of communication --> vital skill - It should always result in answers or partial answers that are always open to revisions
Is there a problem
We can do dx and the child not score within normal range, but it may not be a problem. EX: Pete that stuttered, but it didn't bother him from making friends or being successful in the classroom. If it is not a problem, then don't call attention to it unless it is detrimental to the child.
95
______ % of all outcomes will fall within two standard deviations of the mean (47.5% on each side)
68
______% of all outcomes will fall within one standard deviation of the mean (34% on each side)
99.7
______% of all outcomes will fall within three standard deviations of the mean (49.85% on each side)
test scores
_______ ______ are just scratching the surface, dx is so much MORE.
counseling
___________________ after the diagnostic - share results as you know them - does this suggest a comm disorder and if so what type - provide educational information on specific disorder - "watchful waiting" - recommendations for TX, medical follow up in necessary - respond to cg questions regarding results and recommendations
interdisciplinary
___________________ care is knowing when to refer to other specialties, knowing what other professionals do, letting other professionals know what we do and how we can help their clients
silent period
a 3-6 month period when a second language learner is actively listening and learning but speaking little
normal distribution
a bell-shaped curve, describing the spread of scores throughout a population. Its symmetrical, the height and weight are dependent upon the mean and the standard deviation
epidemiology
a branch of medical science that deals with the incidence, distribution, and control of disease in a population. The sum of factors controlling the presence or absence of a disease or pathogen
standard deviation
a computed measure of how much scores vary around the mean score. Number of "points" away from the mean ~SD=15 - determines the width or spread and represents the distribution away from the group average
obtain information
a goal of an interview in which we actively listen before we speak. Set the tone, ask the questions, and take in the nonverbal messages from the client
Z score
a measure of how many standard deviations the raw score is away from the mean. Useful because it shows where an individual score lies along the continuum of the bell curve and tells us how different the test taker's score is from the average
cultural broker
a person knowledgeable about the client's culture and speech-language community. They pass cultural/community related information between client and clinician in order to optimize services
linguistic broker
a person knowledgeable about the client's speech community or communication environment who can provide valuable information about language and sociolinguistic norms in their community
hearing screening
a quick procedure to determine whether a client can be assumed to have normal hearing or needs to be more thoroughly evaluated by an SLP. If client has recently had it done, ask for report
face validity
a test looks like it assesses the skills it claims to assess based on appearance along and not a true measure of validity - a layperson can make this judgement, not a valuable measure of validity because it is based only on appearance
case history
a thorough description of a person, including abilities and disabilities, medical condition, life history, unusual experiences, and whatever else seems relevant. - developmental, family, birth, about the client and caregivers (similar issues in other family members), adoptions (birth mom)
protocol
a written procedural method or plan that includes ALL of the details of the assessment process. - Preparation (review hx if have it, phone interview, gather all paperwork required, make sure you understand all paperwork, plan DX) - actual diagnostic (consent forms, hx/medical hx/interview, hearing screening, oral motor exam, speech- language sample), formal testing (speech, language, cognition, reading/writing, voice, fluency, dyphagia) - information giving sessions (depends on setting-- schools don't share results until a meeting is scheduled, SNF, acute, and rehab-- have to give the results almost immediately ) -reporting the assessment results
adjusted age
adjustment made in age of child if born prematurely. Considers the gestational development that was missed due to premature delivery
adolescents
age group that is often difficult to examine and resistant to treatment. - acquire an understanding the complexity of pressures and changes teens are experiencing - may be covering up true feelings - be yourself - approach with tolerance and humor - explain the diagnostic process - maintain confidentiality of teen - discuss results of assessment with teen before talking with parents
older adults
age group where "older" is a relative term - treat with respect-- acknowledge memories, experiences - do not call by first name unless they request it - be careful of volume and pitch - don't overgeneralize that they have hearing loss, fatigue, short term memory or need increased response time
interviewing
an essential component of a complete analysis, can be completed when clinicians ask questions to client or cg. Interview sets you up to be successful with client and their families to get first impression and establish rapport. clients might still be going through stages of grief so we have to use critical thinking skills to understand what they are talking about. Questions are often generic, clients may ignore certain questions or omit critical information, or could be misinterpreted.
Disturbance
an event that produced a breakdown in the message of communication
give information
another goal of interviewing in which we as the clinician summarize findings of clinical exams in simple, nontechnical language, using common terms compatible with client's background and using examples or analogies whenever possible
provide counseling
another goal of interviewing in which we help the client and family sort out information and options. Anticipate "emotional" experiences, view interviews as a continuum-- every client will need different levels of support
test teach retest
approach of dynamic assessment where 1) a test is administered without prompts or cues to determine current performance (baseline). 2) Then the clinician teaches strategies specific to the skills being evaluated, observing the client's response to instruction and adjusting teaching accordingly (*Mediated Learning Experience or MLE*) 3. The test is re-administered and results from the pre- and posttest are compared
statement of the problem
ask parents or cg to "describe the problem". Record this in cg's own words. This may help you prepare for a specific type of assessment or level of severity. Helps us determine what the cg's primary concerns are and their level of knowledge regarding the child's communication problem
Diadochokinetic task
assesses production of rapidly alternating speech sounds. observes rate, accuracy, and consistency of child's speech production during tasks. Especially helpful in differential dx of apraxia
Authentic Assessment
assessment that identifies what a client can and cannot do. also known as an alternative or nontraditional assessment - it emphasizes contextualized testing that is more natural and realistic - ongoing assessment--> evaluates during diagnostic and treatment phases - assessment information is maintained in a client portfolio which holds broad information of the client's skills across time and different settings - requires more clinical skills, expertise, experience and creativity than formal assessments. - testing environments are manipulated to elicit desired behavior
mean
average determines the peak of the bell curve and represents the average performance of scores
Preassessment knowledge
before conducting an evaluation, a clinician needs to understand the client's culture, normal communicative development associated with the culture and the client's personal history (culture history, normal comm patterns of their language, and normal patterns of second language acquisition). Without this knowledge, assessment procedures may be inappropriate, and diagnostic conclusions may be incorrect
written case histories
can either be completed prior to DX session or completed via interviewing format. Anyone with accurate and relevant information can give one of these (patient, grandparent, parents) if completed prior to DX, it is *OUR* responsibility to critically think through areas that need further clarification.
Forms
can use one of these that is pre-established, can create your own, but make sure that it covers all of your bases. Not all of them are going to fit the needs of every clinician and their population. Based on setting and population we work with, might have to tailor to what is needed
Modifications
changes to test administration protocol. EX: rewording instructions, allowing extra time on timed tests, repeated prompts
age
client age can present unique diagnostic challenges for children, adolescents and adults. Its not as simple as "talking one way to a child and another to an adult"
identifying information
client's name, DOB, age, address, number, parents names, ages address, number, child's physician and contact information
Diagnosis
comes from the greek- to distinguish- we distinguish a person from the large field of potential disabilities. "to distinguish or to know" - the clinical decision regarding the presence or absence of a disorder - possibly the assignment of a DX label. Usually the outcome of the assessment
speech or language sample
conducting a sample of both speech and language from the client. In articulation, language (expressive and receptive), fluency, voice. Unless not appropriate for the client. Comment on it in the report even if it is not the reason they came to appointment (observe and document "within normal limits")
Reliability
consistency of measurement. Result are replicable on repeated administrations or with different interpreters judging the same administration
teaching strategies
cuing (verbal, visual, tactile or auditory), graduated prompting, making environmental adjustments, conversational teaching (asking questions such as "why did you...?" and "Ah, I see..." ), modifying directions, taking away time limits, what happens if teach part of assessment
language disorder
diagnosed only when a CLD client demonstrates difficulties in all of his languages
Ethnography
different from traditional interviews because it gives the client the opportunity to select the important information to share. We don't always understand their POV and need to encourage them to set the agenda
Difference
does a problem with language or communication affect the person at only certain times (when) and in what contexts?
Disorder
does this language or communication problem occur in the life situation and create problems for the client
oral facial exam
evaluates structural and functional adequacy of oral mechanism
dynamic assessment
form of authentic assessment to evaluate a client's learning potential based on his or her ability to modify responses after the clinician provides teaching or other assistance - an appropriate strategy when assessing clients with cognitive communication disorders or those from culturally and linguistically diverse backgrounds - assists with baseline and identify strategies for intervention
goal of ethnographic interview
goal is for clients to provide a vivid description of their life experiences. descriptive questions are borad and general, to allow people the opportunity to describe their experiences, their daily activities, and objects and people in their daily lives. these descriptions provide the interviewer with a general idea of how individuals see their world
Reliable
good assessments must be ______________ to have foundational integrity. Getting consistent results and similar scores. Some assessments might say they are assessing the same skills, but look at different tasks. Assessment only provide us a snapshot of what they can actually do and if we give them only at certain times of the day they may perform less well than other times
thorough
good assessments must be ______________ to have foundational integrity. It does not mean giving every assessment available, it means getting as much relevant information (assessing a 2 yr vs 62 yr--> don't always need developmental history)
individualized
good assessments must be ______________ to have foundational integrity. The assessment must fit the needs of the client, not just a box to fill on the IEP
valid
good assessments must be ______________ to have foundational integrity. Truly evaluates the inteded skills. Tests what it says its testing. We have to understand what we are assessing
Variety of Modalities
good assessments must use a ________ ___ ________________ to have foundational integrity. When we assess we aren't just giving the assessment we are looking at their face, watching their behavior, doing different criterion referenced, authentic, or norm-referenced assessments
Code of Fair Testing practices in Education
guidelines that were developed primarily for use with commercially available and standardized tests, although many of the principles apply to information test situations also
Cultural competence
having the necessary level of knowledge and skills to provide effective intervention/care to a client from a cultural group
functional adequacy
how do these mouth structures move and perform during speech production. Clinician notes any irregularities in the strength, range, coordination, consistency of movement
History
in addition to questions asked as part of traditional case history, there are questions particularly relevant to the assessment of CLD clients - best to do orally, bc may have limited English proficiency or understand the written the questions - may require assistance from interpreter
goals of interviewing
information gathering, information giving, and counseling interviewing
raw score
initial score obtained based on the number of correct or incorrect responses. Some tests award more than one point for a correct response. Incorrect calculations of raw score will skew findings and make test results inaccurate. They are not meaningful until converted to other scores or ratings
Elective treatment
interventions limited only in private practices that clients are choosing to receive to help with communication differences such as modification of accents
Know the normal communication patterns of the client's dominant language
it is important to be familiar with normal comm patterns associated with cultural groups, if not it will be difficult to determine whether a client is demonstrating a communicative disorder or a communicative difference - there is not publish data for this - cannot determine if it is a disorder or difference unless you know the normal comm patterns of their dominate language - what may seem atypical for us, might be typical in that culture
meaningful
it is not always helpful to compare a client's speech and langauge skills to a normative group, it is much more _______________ to compare the client's abilities to a clinical expectation
Knowing the culture of the client
knowing their behaviors: - of the children in presence of adults - use of eye contact - views of time - expressing disapproval - personal space - use of "small talk" - generalized mistrust of other cultural groups realizing the degree to which a client has been accumulated to social rules here
discussion
lengthiest part of information giving session that provide a written report and discuss the major findings and conclusions. Emphasize the major points, use jargon-free language to help listener understand/ retain as much information as possible. - discuss everything --> hearing screening, oral mech, language testing, speech testing, overall observations - start with observations
rater reliability
level of agreement among individuals rating a test; two types: intra and inter rater reliability
Briefing
meeting with the clinician and interpreter that takes place prior to meeting with the client. Meet to review the agenda and purpose of meeting, discuss technical information like terminology, and train interpreter to administer any tests.
accommodations
minor adjustments to testing situations that do NOT compromise the test's standardized procedure. EX: large print or pictures for students that can't see well
assessments
most disorders of communication in adults are due to aging and related disease processes that affect previously mastered speech-language skills most disorders in children are due to factors that tend to disrupt the learning of speech and language
structural adequacy
normal development of orofacial structures and their relationship to each other-- also any irregular structures is affecting speech production.
bell curve
normal distribution of scores in which the bulk of the scores fall toward the middle, with progressively fewer scores toward the "tails" or extremes. No matter what the mean and SD are, all normal distributions have the same basic shape
code switching
occurs when a speaker alternates between two languages within the same utterance or discourse
interlanguage
occurs when a speaker develops a personal linguistic system while attempting to produce the target language. it is constantly changing as the speaker becomes more proficient in the second language
Fossilization
occurs when specific second-language errors become ingrained even after the speaker has achieved a high level of second-language proficiency
introduction
of information giving session that states the purpose of the session, explain the structure of the session, state whether sufficient data were obtained, and if reporting to cg provide brief statement about the client's behavior
evaluate data
part of assessment where the SLP is evaluating the data, determining impressions, diagnosis/ conclusions, prognosis and recommendations
conclusion
part of information giving session where we thank the client for participating, ask for final comments, provide a summary of the major findings, conclusions, and recommendations
body
part of intake interview that comprises most of the interview. Major content areas are discussed. Clarify and confirm relevant information from written case HX. Take history and current status. Communication development, abilities, problems and concerns. Clarify medial, developmental, familial, social and education HX
closing phase
part of intake interview that summarizes major points from body of interview, express appreciation for interviewees help and what the next steps are
opening phase
part of intake interview when introductions are made, describe the purpose of the meeting, and explain the structure of the meeting
debriefing
part of the process when working with interpreters that is a meeting with only the clinician and interpreter that takes place after the interaction to discuss any difficulties, their impressions, review assessment, plan a follow-up meeting or provide additional training.
Interaction
part of the process when working with interpreters that takes place when everyone is present, explain the process, remain in the room, guide the interpreter through process, talk to client not to interpreter/ family, but don't exclude the patient
share clinical findings
part of the steps of assessment where the data is shared through reports. Goes to families, insurance, doctors, social work, teachers, IEP meetings, or care plan meetings (ex verbally sharing preliminary results). Depending on audience and using less jargon
Interpreter
persons who translate from one language to another verbally and immediately. An ideal one: - is proficient in English and the language of the client - experienced and trained in cross-cultural communication - has knowledge of SLP things - avoid using a child as an interpreter when communicating with adults - avoids using client's family as interpreters
Speech- Language Sample
primary means of assessing a client's speech and language production. Must be representative of child's "typical" language as possible. Uses this sample to assess child's speech, language, fluency, and voice production.
risk factors
protective factors have to do with SLP such as family histories, environmental factors, multiple children, low SES, single family home To reduce these we use preventative measures and make sure they are engaging in safe environments
basal
refers to starting point for test administration and scoring. Usually suggested according to client's age and then established by eliciting a certain number of consecutive correct answers
ceiling
refers to the ending point of test administration. Usually determined by a certain number of consecutive incorrect responses
psychometrics
refers to the measurement of human traits, abilities, and certain processes. The science of psychological assessment, and is a foundation of assessment and measurement
evaluation
refers to the process of arriving at a diagnosis after the assessment
written assessment results
reports vary greatly across settings-- but have to make sure all relevant information included, organized, check for redundancy, too wordy?, terminology used correctly?, is report written objectively?, written about facts?, emphasis on major aspects are over or under emphasized?, any ambiguities, logical progression and MECHANICS
HIPAA requirements that affect SLPs
requirements of SLPs: - must obtain National Provider Identifier (NPI) - All clients must be given a copy of privacy practices - Maintains confidentiality of client's health information - National standards for electronic health care transactions must be followed - Must maintain a list of disclosures - Related personnel must comply with HIPAA
interrater reliability
results are consistent when more than 1 person rates the test
Intrarater reliability
results are consistent when the same person rates test on more than 1 occasion
scaled score
score that reflects performance compared to the normative sample. But does not necessarily follow a normal distribution. These scores allow the tester to compare the abilities of the the test taker to the appropriate normative sample (as defined by the test designer in terms of age, gender, ethnicity).
age equivalence
score that reflects that average raw score for a particular age (or grade). Least useful and most misleading. Not considered a reliable measure and should generally not be used
criteria for selection of standardized tests
select a test that: - has a detailed and comprehensive test manual - based on a large and diverse normative sample - samples the skills adequately - has been revised and thus provide current normative data - has strong reliability and validity - has appropriate stimulus items - you are well trained in to administer - will yield useful DX information and help design TX goals or procedures
collecting
several methods and approaches for validly and reliably _________ data. No matter the methods used, ALWAYS use most recent edition of a published test. Its best practice and required by law and insurance
SES
socioeconomic can change diagnostics by not being exposed to as much as high income families. - What are their needs to keep the family functioning--> family must work, so scheduling testing/taking time off word is more detrimental. - Higher SES have more opportunities for educational things (library, zoo, experiences) - whether they show up for testing (transportation might not be available)
education
some families that have more education understand the important of language development. - Don't use jargon and must adjust terminology used - sometimes parents don't have a positive educational experience and it can affect their perception of you and therapy
apraxia
speech errors often inconsistent and speech often breaks down as length and complexity of utterance increases. Sound-syllable transpositions, repetitions, or additions are more likely to occur. Grouping and searching behaviors may be observed
planning assessments for CLD
standardized tests are not usually ideal bc the norm groups are culturally biased. The best way to do an assessment is an Authentic Assessment. It allows for evaluation of client in real-life situations and contexts. We have to looked and see what additional things will help determine if it a true language disorder or language difference. Must give assessments in dominant language and in English. We focus on client's ability to learn vs what they already know.
Critical steps in completing an assessment
steps: - obtaining historical information - interviewing - evaluate structure and function of oral-facial mechanism - sample and evaluate client's speech and language in certain areas - screening hearing and or obtain hearing history - evaluate assessment data and determine impressions, diagnosis/ - conclusions, prognosis and recommendations - share clinical findings
Prevention
taking action to avoid disease, injury, and other negative health outcomes. EX: masks, socially distancing, flu shots, helmets for TBIs - most important thing we do as SLPs - if we don't engage in some type of this within the community, then we are not doing our jobs to the fullest potential
content validity
test contents are representative of the content domain of the skill being assessed. A valid artic test should elicit all phonemes
criterion validity
test is related to an external criterion in a predictive or congruent way; 2 types of criterion validity (concurrent validity and predictive validity)
construct validity
test measures a theoretical construct it claims to measure ex preschooler's language skills improve with age so a valid test for that age will show improved language skills with progressively increasing ages. Early skills in the beginning of tests and later skills in the assessment
predictive validity
test's ability to predict performance in anther situation or at a later time ex: college entrance exams, GRE, Praxis
test retest reliability
test's stability over time. Determined by administering the same results multiple times to the same group, then comparing the results
alternate form reliability
tests correlation coefficient with similar test. AKA parallel form reliability. Determined by administering Test A and Test B to same group of people and PPVT-5
split half reliability
tests internal consistency. Scores from one half of the test correlate with results form the other half of the test. Halves must be comparable. Might use odd/evens.
criterion referenced tests
tests that identify what a client can and cannot do compared to a predefined criterion or expected level of performance - assume that there is a level of performance that must be met for a behavior to be acceptable --> anything below that is considered deviant ex: Rossetti, PLS-5
confidence interval
that range of values that represents the degree of certainty on the part of the test developer that the statistical values obtained are true. Allow for natural human variability to be taken into consideration. A 95% or 90% of these provides a range of reliable scores, not just a single reliable score.
prevalence
the *TOTAL* rate or proportion of cases in a population at or during a specified time - different seasons can affect this (EX: summer has the most TBIs bc prom, summer, graduation, etc)
Primary Prevention
the *elimination* or inhibition of the onset and development of a communication disorder by *altering susceptibility* or reducing exposure for susceptible persons - an exposure means presence of a risk factor (immunizations to prevent infectious diseases, ear protection in noise, seat belts)
wellness
the development and maintenance of an optimal level of competence appropriate to any given stage of the life cycle
secondary prevention
the early detection and treatment of communication disorders. *Early detection* and treatment may lead to the elimination of the disorder or the retardation of the disorder's progress, thereby preventing further complications - EX: screenings --> kindergarten round up, new residences in SNFs, hearing issues, cognitive issues to find them all quickly and help treat
end
the experienced diagnostician does not look at objective scores of various assessment batteries as an ________; rather as an aspect of an individual's communication ability
foundational integrity
the foundation or the pieces of an assessment that make it a good, strong, steady assessment. - similar to a bridge - reliable and valid - mission and values - Longevity
Ethnography
the investigation of a human situation and the study of the rich complex matric of social life and culture (Keegan, 2012) - the study of culture --> much more than just an interview. Taking into consideration how this disability is affecting your life and culture - can ask the client to share about his culture - consult other professionals who work with that group - read and research
median
the middle score in a distribution; half the scores are above it and half are below it
mode
the most frequently occurring score(s) in a distribution
percentile rank
the percentage of people scoring at or below a given score. Scoring in the 75th percentile means the test taker scored higher than 75% of the people taking the same test.
at risk
the potential to develop a disorder based on specific biological, environmental, or behavioral factors. Can apply to asymptomatic populations
assessment
the process of collecting valid and reliable information, and the integrating and interpreting it to make a judgement or decision about something. Purpose is to draw a conclusion about an individual's communication abilities. We have to practice these. - There will be times when we have to do this, score it, and then tell the family immediately. - It can be very easy to mis-score assessments
incidence
the rate of *NEW* occurrence of a condition/disorder in a population within a specified time period
tertiary prevention
the reduction of a disability by attempting to restore effective functioning. The major approach is *rehabilitation* of the disabled individual who has realized some residual problem as a result of the disorder - the history of communication disorders professions has been this type of prevention - we most commonly provide this level of prevention by intervention for our clients to maximal levels of function within the constraints of the preexisting conditions
Cultural groups differ in
they can differ in: - views of disability and intervention - views of the role of women in society - views of familiar authority - names and titles (knowing who the overall contact person is, who is "mom") - comfort with interviewing and case history questions (many families have a lot of baggage and this is the first time they have been asked these questions. Could be very personal questions) - basic testing practices - individual achievement
young children
this clientele can fear the clinical situation and environment - they lack preparation about exams by parents - unsure what clinicians do - previous memories of other visits to doct, dentist - they can feed off anxiety from parents - stress and conflict because of how others may have reacted to speech, lanaguge
language loss
this is a decline in a speaker's first language proficiency while a second language is being learned
diagnostician role
this role is one of the *most comprehensive* and *difficult* tasks of the SLP. - requires *careful synthesis* of the entire scope of practice - requires *scrutiny* of ALL aspects of behavior (starting even before the actual assessment occurs)
criterion referenced tests
this type of test is used most often when assessing clients for neurogenic disorders, fluency disorders, and voice disorders May or may not be standardized
translator
translates a language in written form
Why complete diagnostics
two major reasons: 1) to arrive at a good *understanding or diagnosis* of the client's problem 2) to *monitor the client's progress* in treatment and describe changes in the communication problem - important bc it relates to how the client is presenting in front of you - difficult, but critical for our job
hearing screening
typically administered at 30 dB. 500, 1000, 2000, 4000 Hz. Fail= does not respond to one or more tones presented - may rescreen or refer onto pediatrician or ENT
concurrent validity
validity that is established by use of external criterion. Newer tests may be compared to already established tests
dialect
variations in grammatical and phonological rules that adhere to by identifiable groups of people. NOT a disorder
communicators
we diagnose ___________; not communication. Scores don't always show the whole picture --> doesn't show how they learn, how they got the answer, what could have done to help them get the answer (learning style --> chunked, repeated directions, extended time), modifications for a classroom, how the environment should be set up
other specialists
we need to obtain background information from others that have seen the client about previous TX (when and where). If client has a long list of SLPs they might be "shopping" parents
epidemiologists
we work with them to help us pinpoint the cause of a particular disorder. - incidence of communication and swallowing disorders is 7.7%
language difference
when a CLD client is only demonstrating difficulties in the new language he is learning, not his dominant one
Validity
when a test truly measures what it claims to measure