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Clinical Evaluation

Mid term

What is the best course of action to take when assessing the speech of a culturally different child whose family speaks Southern Black English? Collect a spontaneous speech sample and analyze for intelligibility. Norm referenced tests only assess Mainstream English.
What is meant by a norm-referenced test? Designed to compare the performance of a child being tested to his peers. A 6 yr old’s performance is compared to other 6 yr olds. The test tells you nothing about what the child knows or can do, only how he compares to other children his age.
What is meant by a standardized test? Refers to the way the test is administered. All individuals must be given the test under the same, identical conditions.
How do you find out on whom (what age. cultural group, etc.) the test was normed and how do you learn about the standardized test procedures? You read the Examiners Manual. It will describe, in detail, the ages, ethnicity, socioeconomic level, etc. of the normative sample. It will also tell you not only how to administer the test, but what you can and cannot do when giving the test.
What are the Advantages for Norm Referenced Testing? •Objective •Individual skills can be compared to a large group of similar individuals •Efficient •Don't require a great degree of skill to administer & score, come with manuals. •Gives common ground for discussing an individual •Accepted for billing
What are the disadvantages for Norm Referenced Testing? •No individualization •Doesn't tell how a person learns •Tasks don't rep real-life •Will assess isolated skills, but no info about contributing or mitigating factors •Test must be given exactly as directed •Often not normed for non standard English
What are criterion-referenced tests -Tests do not compare an individual to any other individual or group but rather to what she can do as compared to a pre-defined criterion. -They look how a person’s performance compares to an expected level of performance.
What are criterion-referenced tests designed to tell you? -designed to tell you what a child knows and/or can do. -designed to tell you what skills are present, absent, or emerging.
What are the Advantages of Criterion Referenced testing? •Easy & efficient •Typically objective •Recognized enough to provide a common ground for discussion among a group of professionals serving the client •Can be used for third party reimbursement purposes •There is more latitude for individualization
What are the disadvantages of Criterion Referenced testing? •May not be rep real-life •Skills assessment tends to be isolated rather than considering contributing and/or mitigating factors •If test is standardized, individualization not be possible w/o invalidating the test •Must be given exactly as instructed
What are some of the advantages of pre-planning a speech-language evaluation? 1) Can get family history and family culture 2) Can find out what the primarily concerns are of various family members (may be different than clinicians) 3) Can learn the interests of the child.
What is emergent level? -Defined if skill occurs 50% of the time -tells where the child is in route towards mastery
What is Mastery level? -Defined if skill occurs 90% of the time (some experts say 75-80%)
Authentic Assessment •Non-traditional assessment •Identifies what a client can/not do in his natural environment •Emphasis on contextualized stimuli •Continues throughout the treatment phase •Assessment drives treatment & treatment informs assess •Requires great skill
How should you deal with a caregiver’s bizarre answers on a case history form? 1)Adjust reading level of form 2)Verbally go over form w/ caregiver
What is your first act upon completing your assessment? Before you do anything, review your findings with the parents. This should occur prior to writing the report, determining appropriate placement and services for the child, or discussing your findings with the child’s teacher and other professionals
After writing your report, to whom should it be sent? -parents and those individuals listed on the signed release form.
What are some of the risk factors for delays in speech and language development? -Family history of speech, language, learning, hearing problems or autism -Prematurity or low birth weight -Trauma at birth -Social factors: poverty, single-parent home, foster-care -Existing diagnosis (Down Syndrome, Fragile X) -Hearing loss -Male
What are some factors that do not place an infant or toddler for such delays? Otitis media is the most frequent reason a parent takes a small child to the pediatrician but, by itself, it is not associated with any risk factors in terms of communication development
When providing services to infants and toddlers, what is not required of SLPs? -Services do not have to be child directed -SLPs can work with the parents instead, training them to facilitate their child’s language development in a natural environment -Activities should be team based & culturally/ linguistically relevant.
What thought or considerations should go into selecting speech-language tests? -Will your therapy be child or family focused? -Choose test that mirrors your therapy approach
What do we know about the reliability of parents when it comes to describing their child’s developmental skills? -Parents tend to be quite accurate in describing their child’s skills. -Info on a child milstones can suggest risk but tell very little about whether a child has a problem or not (e.g. the on set of cooing)
What should SLPs consider when collecting language samples? -observing parent-child interactions often provide the best representative sample of a child’s communication skills.
What should you look for when analyzing an infant or toddler's phonological development? We should look at what phonological skills the child exhibits. 1) what classes of sounds (e.g. stops, fricatives, affricates, glides, liquids, nasals) are present 2) what syllable structures are present (e.g., final consonants, consonant clusters).
What are the things we should consider when developing an informed clinical opinion of an infant/toddler’s communication skills Understanding normal development, knowing the research, and tapping your own clinical experience helps you develop an informed clinical opinion.
What are the benefits of having your therapy focus on functional outcome? These type of goals help promote: 1) more active participation in daily activities and 2) more interaction that involves parents/primary caregivers.
What is an Individual Education Plan (IEP)? The intervention plan developed for children receiving special services in the public schools (beginning at the age of 3)
What is an Individual Family Service Plan (IFSP)? -intervention plan developed for children below the age of 3 -In this type of plan caregivers are expected to play an important roll in both the intervention planning as well as its implementation
What are some the main points of ASHA’s Position Statement on the Roles and Responsibilities of Speech-Language Pathologists in Early Intervention? Services should be: -team based w/ other pros (OT, PT, etc.) -occur in a natural environment (i.e. home) -parent-child based NOT child centered -appropriate for child’s development level -evidence based -appropriate for child’s culture/language
What is Phonemic Awareness? Refers to the ability to recognize that words are made up of sounds. e.g., What sound does the word “dog” start with? It requires no knowledge of any of the letters in the word “dog,” just the sounds.
Orthographic Pattern Awareness Refers to understanding about how letters are used to represent speech
Morphological Awareness Shown when a child is able to modify a base word by adding a suffix.
Semantic Awareness Exhibited when a child recognizes that words that sound the same, but have different spellings, have different meanings (e.g., seen vs. scene)
What is the Repertoire Theory of Spelling aka Overlapping Waves -Suggests devlpmnt not rigid, but continuous process that's influenced by multiple factors(linguistc awarnes skills)whose contribution to development vary in degree over time & task -Suggests that children use a variety of awrness skills from beginning
What is the Stage Theory of Spelling -Children progress through a series, marked by little understanding of written language, to the successive use of phonemic awareness, orthographic pattern awareness and morphological awareness.
What do norm-referenced measures of word-level reading typically assess? -These test assess both sight-word reading and nonsense word reading. -Provides information about which words the child knows, as well as their ability to apply strategies to unknown words (trouble with silent e, can decode sounds but not put together)
What is the Miscue Analysis This analysis determines the type of errors made when reading & why those errors may occur – Shows student’s view of reading – Shows effect of text & student’s view of texts on reading outcomes -evaluates strategies children use during reading
What is a phonemic segmentation task? -follow up test used to determine why a child is having difficulty with phonemic awareness. -Can use standardized or non-­‐standardized measures. -Most helpful if geared toward student’s errors
Writing involves three processes. What are they? This process involves planning, production, and evaluation
What is the major problem with norm-referenced measures of writing? Theses assessments examine specific components involved in writing, such as punctuation, spelling, etc., but they do not actually measure the process of writing.
How to assess a person's written composition process? • Ask person to write a composition – Consider topic, medium, time allotment... • Obtain info on process – How did u plan – What r u doing now – What did u do when finished – Ask to see everything they used to write •Obtain an untainted sample
What two processes have a major impact a student’s performance during writing tasks? Executive Functions and Self Regulation
What are the writing demands? Cognitive linguistic demands –prior knowledge, executive function/self-­‐regulation, syntax •Text production demands –Grapho-­motor skills, output speed • Social demands –Knowledge of audience •Affect/motivation demands –Goals, mind-set, selfesteem
The 2001 ASHA statement Roles & Responsibilities of Speech-Language Pathologists With Respect to Reading and Writing in Children and Adolescents makes what recommendations? SLPs should be involved in: 1.Preventing written language problems by facilitating language acquisition & emerging literacy 2.Identifying children at risk for reading & writing problems 3.Assessing, providing intervention and documenting outcomes
What is Response to Intervention? -A multi-tiered approach where the type and intensity of intervention increases as the student progresses through the various tiers.
Why was Response to intervention developed? RTI was developed to avoid two things: 1)The over identification of children labeled as “learning disabled” 2)The “wait till they fail” approach (delaying intervention until third grade).
Prior to third grade, how are children’s reading comprehension skills assessed? Through tests measuring word recognition
What is the relationship between children’s listening comprehension and their performance on norm-referenced reading comprehension tests? -There is a direct relationship -Listening increases as they progress through the school grades
Children who earn low scores on standardized reading comprehension tests in the early grades (k-3) typically belong to what two subgroups? Dyslexic and Mixed
Children in middle to upper grades who perform poorly on reading comprehension tests typically belong to what two subgroups? Mixed and Specific Comprehension Deficit
A child with moderate oral language deficits in primary grades may, at first, appear to be an adequate reader. However, if this child develops reading problems in the upper grades, he/she would most likely meet the criteria for what subgroup? Specific Comprehension Deficit
What areas would you target with a child with dyslexia? 1) phonemic awareness 2) building vocabulary knowledge 3) morphological awareness
What would you least likely target with a child with dyslexia? narrative text structure
What would you target with a child with a specific comprehension deficit? 1) vocabulary knowledge 2) morphological awareness 3) narrative text structure
What would you least likely target with a child with a specific comprehension deficit? phonemic awareness
You're an SLP in a public school that has adopted a new phonological awareness assessment for k students. You remember that many phonological awareness assessments show floor effects when used with children prior to first grade. What does this mean? Individuals may be able to score within normal limits by answering very few test items correctly
How can you improve the accuracy of phonological awareness test for K students and buffer too many false positives or negatives? consider other risk factors, e.g., family history, other language skills, etc.
How are Phonological awareness and word reading skills related? They are reciprocally related – Phonological awareness helps pre-­readers learn letter-­sound correspondence
Fr a patient with Silibant distortions, what should go into the diagnostic report? Information on the client's 1) articulation, 2) language, 3) fluency, and 4) oral mechanism examination.
Which of the following factors can affect a child’s test performance and should be included in the diagnostic report: 1) the child’s behavior 2) standard scores 3) suspected diagnosis 4) previous test results? The Child's behavior The other three, while perhaps important, do not affect a child’s test performance
Where, in the report, should you include your observations of the child and his/her behavior? The Interpretation section
What are the sections of a diagnostic report? 1)Medical History 2)Concerns (Patient's,fam, education, community) 3)Test Results (lang, speech, hearing, oral) 4)Interpretation (Affects on Speech & Lang, Areas to address, Behavior, Attention, Strengths & Needs,observations, FCM 5)Recommendations
What are Functional Communication Measures? -A series of disorder-specific, 7-point rating scales designed to describe the change in an individual's communication/swallowing ability over time -Done on admission & discharge to depict amount of change in communication and/or swallowing abilities
What is your role regarding a suspected diagnosis? Only diagnose what is within the scope of practice of an SLP. You may describe the patient’sactions and refer to the appropriate professional.
What rationale should we include in the report’s recommendations? evidence-based practice
What is the principal difference between an initial evaluation and a re-evaluation? Typically, your re-evaluation focuses on the primary of concern. It is not as broad based an assessment as the initial evaluation.
Created by: aramos139



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