BR3L3 Pediatric Assessment.pdf

BR3 L3 Pediatric Language Assessment 1. Norm referenced tests a. Always standardized b. Allow comparison of an individual’s performance to the performance of a larger group (normative group) 2. Answers: how does my client compare to the average 3. Used to identify what is ‘average’ gi...

BR3 L3 Pediatric Language Assessment 1. Norm referenced tests a. Always standardized b. Allow comparison of an individual’s performance to the performance of a larger group (normative group) 2. Answers: how does my client compare to the average 3. Used to identify what is ‘average’ given a test a. Often depicted using a bell-shaped curve b. Key features: i. Symmetrical ii. Height and width are dependent on mean and standard deviation 4. Peak= Average performance aka Median and Mode a. Mean- average b. Median- middle distribution c. Mode- most frequently occurring score 5. Also known as the 65-95-99 rule; almost all observed data will fall within three standard deviations of the mean or average a. 68% of all outcomes will fall within one standard deviation of the mean (34% each side) b. 95% of all outcomes will fall within two standard deviations of the mean (47.5% each side) c. 99.7% of all outcomes will fall within three standard deviations of the mean (49.85% each side) 6. Advantages a. Objective b. Individual can be compared to larger group of similar individuals c. Efficient test administration d. Mostly widely recognized e. Does not require clinician to have high level of clinical experience and skill to administer test (since there are manuals) f. Preferred by insurance companies and schools for service qualification 7. Disadvantages a. Does not allow for individualization b. Tests are static; tells what person know not how they learn c. Unnatural testing situation; not representative of real life d. Evaluation of isolated skills without considering contributing factors e. Must be administered exactly as instructed to be valid and reliable f. May not be appropriate for certain clients (e.g. culturally and linguistically diverse clients 8. Criterion-Referenced a. Do not attempt to compare an individual's performance to others b. Identify what a patient can and cannot do compared to a predefined criterion c. Answers: How does my patient’s performance compare to an expected level of performance? d. Assumes that there is a baseline level of performance to be met for behavior to be acceptable  e. Mostly used to assess for neurogenic disorders, fluency disorders, voice disorders and some articulation and language f. May or may not be standardized 9. Factors: a. Avoid overinterpretation i. We are not observing comprehension directly. What we observe and analyze is the behavior they show ii. Use less conventionally expected stimuli (ex. When box is a stimuli it often is expected that we need to put something inside so instead use “put the ball in the shoe”) b. Controlling the linguistic stimuli i. Take into consideration the child’s vocabulary and sentence length they are able to comprehend. Assessing vocabs the child does not have is not representative and truthful of the child's skills c. Specifying an appropriate response i. What we observe needs to be thought about carefully. ‘What are we looking for?’ ii. Is the child acting because of the linguistic stimulus or because of the normal expectations for the situation? iii. Naturalistic Response- Answer to questions iv. Contrived Response- similar to standardized testing (ex. Child choosing from presented objects that spontaneous) d. Some ways: i. Elicited imitation- ‘say what i say’ ii. Elicited productions 1. Patterned elicitations- We say a certain phrase and the child needs to fill in the blank “you eat with a fork, you dig with a shovel, you drink with a___?” 2. Roleplay- Setting up scenario on a context that is supposed to elicit related utterances 3. Narrative- The child is told a simple story that he needs to retell iii. Structural Analysis- Language Sampling Analysis- We tae the child’s utterances and at a later time analyze it for its context 10. Advantages a. Usually objective b. Usually efficient test administration c. Many C-R tests are widely recognized d. Opportunity for individualization e. Preferred by insurance companies and schools for service qualification 11. Disadvantages a. Unnatural testing situation; not representative of real life b. Evaluation of isolated skills without considering contributing factors c. Standardized criterion-referenced tests do not allow individualization; ust be administered exactly as instructed to be valid and reliable 12. Authentic assessment a. Aka Alternative assessment or Nontraditional assessment b. Identifies what a patient can and cannot do c. Emphasizes on contextualized testing; environment plays a big role; more realistic and natural test environment d. It is ongoing; this approach evaluate the patient’s performance during diagnostic and treatment phases e. It requires more clinical skill, experience and creativity than formal assessments as it assesses skills qualitatively.  f. Clients Portfolio- offers a broad portrait of the client’s skills across time and in different settings g. Testing environments are manipulated to elicit desired behavior but not so much that the authentic aspect of the client’s responses is negated 13. Some strategies a. Systematic observations b. Real-life simulations c. Language sampling d. Structured symbolic play e. Short-answer and extended answer responses f. Self-monitoring and self-assessment g. Use of anecdotal notes and checklists h. Videotaping i. Audiotaping j. Involvement of caregivers and other professionals 14. Advantages a. Natural and most like the real world b. Client participates through self-evaluation and self-monitoring c. Allows for individualization d. Beneficial for culturally diverse or special needs clients e. Offers flexibility 15. Disadvantages a. May lack objectivity b. Not usually standardized; less assurance on reliability and validity c. Requires high level of clinical experience and skill d. May not be efficient and requires a lot of planning time e. May be impractical in some situations f. insurance companies and schools prefer known assessment tools for service qualification 16. Dynamic assessments- evaluates a client’s learning potential based on his or her ability to modify responses after the clinician provides teaching or other assistance (stimulability) 17. Test -> Teach -> Retest a. Test- without prompts or cues to determine baseline skills/ current performance b. Teach- MLE (mediated learning experience)- specific strategies are taught for the skill being assessed. Observed the patient’s response and adjust accordingly c. Retest- Readminister the test and compare the results of pretest and posttest 18. Strategies a. Cueing b. Graduated Prompting c. Environmental Modification d. Conversational teaching 19. DA allows to determine baseline ability and identify appropriate goals and strategies for intervention 20. Language Impairment vs. Language Difference a. Language impairment- clients who do not demonstrate improvement following teaching b. Language Difference- client is able to make positive changes immediately after brief teaching experiences 21. Functional assessment- used to measure impact of language impairment on the child’s ability to participate in activities or experiences in a structured way a. Uses the ICF b. Identify prognosticating factors (contextual factors that support or hinder child's communicative progress) 22. Functional communication profile a. Functional assessment that evaluates the ways in which these newly learned communicative behaviors increase a client’s level of autonomy or independence in real-life situations 23. ASHA’s Functional Assessment of Children’s Communicative Adaptation to Real-life Situations a. A 7-point rating scale capturing perceived improvement in communication in terms of broad functional outcomes b. 1 as the most functional and 7 as the least functional 24. 25. Referral information a. Referral letters or supporting documents b. It allows us to know what to focus on during the assessment 26. Case history a. An interview with caregiver/ teacher to collect further information regarding the patient’s case; there should be a specific purpose in mind b. Sensitive Interviewing- be clear to the client as to why we are having this interview  c. Ask clear and open ended questions d. Highlight the family’s concerns e. Acknowledge, Sympathize and then move on to a neutral topic f. Subcategories of CHx i. Developmental history ii. Medical History iii. Educational History iv. Social and Family History v. Communication concerns and development vi. Prior evaluations and interventions 27. Types of observation can be based on structure or participation? a. Based on Structure i. Unstructured observation- this involves observing learners in natural settings without a predetermined focus (ex. Free play) ii. Structured observation- involves observing learners in specific situations with a clear focus on particular language features (ex. Observing child reading a story out loud- focus on sentence structures) b. Based on participation i. Participant observation- the observer becomes part of the group being observes ii. Non-participant observation- The observer remains detached (ex. A class visit) 28. Specific observation methods a. Anecdotal Records- brief informal notes on specific incidents and behaviors b. Checklists- predetermined list of behaviors that is being checked c. Rating Scales- scale used to evaluate level of particular skill d. Video or audio recording 29. The Speech Processing Language Model (SLPM)- A framework that aims to organize different processes that take place in communication. 30. Components of SLPM a. The speech and language environment component b. The speech and language processing component c. The speech and language product component 31. speech and language environment component puts emphasis on the environmental events; explains everything that happen externally from the individual and how it affects their current development and use of speech and language a. It should be kept in mind that the speaker functions in a multidimensional environment 32. Two main divisions a. Speech and language input i. The task of the person is to be able to speak at the same level with others in the environment ii. They should be exposed to all parameters and level of speech and language 1. Speech: Vocal tone, resonance, voice, phonetic structure, and prosody 2. Language: Pragmatic, Semantic, Syntactic, and Phonological Levels b. Time Dimension i. It is a continuum  ii. Divided into 2: 1. Historical Speech- talks about everything that happened in the past and how it contributed to the current performance of the child 2. Immediate speech and language environment- present diagnostic situation 33. speech and language processing component focuses on the underlying anatomy and processing events that occur when the individual uses speech and language; takes place at different anatomic levels within the human body; Disruption in here results in a speech and/or language disorder a. Three segments i. Auditory Reception Segment- In relation to the auditory modality ii. Central Language Thought Segment- Brain structures iii. Speech Production Segment- Speech Modality 34. Auditory Reception Segment- Primary Recognition System; Prelinguistic Processes- recognizes heard sound but there is no understanding yet a. Auditory Acceptance-Transduction: Accepts and transduces acoustic energy i. Transduction Process: acoustic to mechanical to hydraulic to electrochemical energy ii. Outer ear to hair cells in the cochlea b. Auditory Analysis- Transmission; Prelinguistic neural coding i. Analyzes frequency, intensity and duration ii. Cochlea to auditory pathway to primary auditory cortex c. Auditory Reception Analysis d. Auditory Programming I i. Information is sent to the Wernicke’s Area ii. Identification of speech and non-speech sounds iii. Sounds are now transformed to phonetic patterns 35. Physical Processes Sensation Perception Passive Active Acceptance-Transduction to Reception Analysis Auditory Programming I Ability to hear sounds Ability to differentiate between speech and non-speech sounds Cortical activation but no meaning Sound localization, Memory (ex. have i heard this before?) 36. Central Language-Thought Segment- linguistic-cognitive processing system: Building up representational forms within the central language-thought segment is developmental; Schemas are stored here a. Auditory Programming II- Wernicke’s area interacts with remainder of auditory association cortex i. Phonetic features to phonemes and phonological sequences ii. Encoding of phonological patterns and certain syntactic units; words are not yet identified (non-word repetitions listening to and  immediately repeating multisyllabic nonsense words that match the phonological rules of a specific language but doesn't mean anything [since words are not decoded in here yet]) b. Language Cognitive Representation i. Angular and Supramarginal Gyri in interaction with auditory, visual, somesthetic association areas ii. Language decoding, integration and encoding; linguistic processing and higher order language cognitive interpretation (ex. Answering question, following commands) happens here; association cortex retrieves previously experienced sensory stimuli that co-occurred with the symbol in specific contexts of communication c. Speech Programming I i. Broca’s area interacts with auditory association areas and the primary motor cortex ii. Changes auditory program to motor program; speech sounds to motor act for coarticulation iii. Incorporates phonologic and prosodic features 37. Physical Processes Comprehension Decoding of auditory patterns to linguistic information for comparison to stored data regarding phonology, syntax, semantics Integration Most complex form of message interpretation Comprehends meanings that are beyond the linguistic structure Forming types of relationships Formulation Linguistic structuring in accordance to language community standards; should be acceptable for age and the society Active creation and planning of message in all linguistic levels before it is produced ○ Pragmatic to semantic to syntactic to phonologic Repetition Types: Meaningful- can be understood- still goes through the whole slpm pathway Non-Meaningful- completely bypasses the language cognitive-representation (from auditory directly to speech programming) 38. Speech Production Segment-Primary Production System: Post-linguistic a. Speech Programming- Interaction of association areas with Broca’s Area via arcuate fasciculus i. The formulation of the motor act ii. Incorporates prosodic and phonological features iii. Phonologic program to motor speech program iv. Motor ideation and motor planning; v. Commonly disrupted in Apraxia of speech b. Speech Initiation- neural impulses are sent to primary motor cortex i. Reads motor program and turns it into sequential neuromotor impulses for speech components (i.e.segmental- phonetic patterns, word features; suprasegmental-rhythm, stress, intonation)  ii. Initiation of motor control c. Speech coordination-transmission: Cerebellum, basal ganglia, supplementary motor area i. Control of the neuromotor impulses ii. Goal is to have smooth target movement of speech iii. Commonly affected in Parkinson’s and Cerebral Palsy d. Speech actualization- muscles involved in speech i. Sequential activity of the muscle ii. Goal is organized, controlled, and coordinated muscle movement iii. Internal feedback mechanism- proper force, timing, speed of contractions, and the range and directions of movements are monitored iv. Commonly affected in dysarthria 39. Physical Processes a. Sequencing i. Order of motor abilities ii. Include flow, timing, ordering of phonemic and syllabic strings b. Motor Control i. Precise movement of articulators 40. speech and language product component- the observable parameters of speech and language behavior that result when an individual speaks a. Parameters of speech product i. Vocal Tone- loudness, pitch quality ii. Resonance- Nasality, Oral or Pharyngeal iii. Voice- Quality of voice iv. Phonetic Structure- physiologic, perceptual, acoustic aspect of it; is it clear at those levels? v. Prosody- stress, intonation and rhythm b. Parameters of language product i. Phonologic ii. Syntactic iii. Semantic iv. Pragmatic 41. Basal- refers to starting point of test administration and scoring 42. Ceiling- refers to starting point of test administration and scoring 43. Accomodations- adjustments done to the testing situation that doesn't affect the standard procedure. Helps the test taker understand the assessment better (ex. Large print versions; aids that will record response) a. Content of assessment should not be altered; administration of the test must be consistent with manual’s instructions 44. Modifications- changes to the test administration protocol (ex. rewording/simplifying instructions, repeated prompts a. Invalidates the norm-referenced scores b. No longer considered as standardized assessment but still helps with diagnosis