Lecture 3 - Principle of Assessments PDF

Principles of Assessments Lecture 3 Objectives General Principles Of Assessment For Suspected DLD Goals of Assessment Assessment As Hypothesis Testing Multidisciplinary Team Members Purpose for Assessment Assessment Process  Beginning The Assessment Process  Cons...

Principles of Assessments Lecture 3 Objectives General Principles Of Assessment For Suspected DLD Goals of Assessment Assessment As Hypothesis Testing Multidisciplinary Team Members Purpose for Assessment Assessment Process  Beginning The Assessment Process  Considerations in Assessment Planning  What to Assess?  Assessing Collateral Areas Assessment Approaches & Methods Integrating And Interpreting Assessment Data  General Principles Of Assessment For Suspected DLD Language is hard to assess! WHY? 1. Everyone grows with different background; therefore, the definition of NORMAL Language is BROAD. 2. Language is influenced by other aspects of development(cognition, motor and social development). 3. Assessment of language components individually doesn’t give information on its use as whole. (integrated) 4. Children with DLD are still developing their language. (what was normal at one age is not in another). 5. Individual variability (you cannot use one way of testing on everyone). General Principles Of Assessment For Suspected DLD We saw in Chapter 1 that there are different ways of conceptualizing DLD the naturalist approach, which views DLD as an impairment or disease process within the individual that disrupts functioning, and the normative approach, which focuses more on societal expectations and obstacles to meeting those expectations In practice, we tend to blend the two perspectives together. Goals of Assessment 1. To decide whether the child has a significant impairment in language form, content, and use. 2. To describe that deficit in some detail relative to the normal developmental sequence of language acquisition. 3. To determine how this impairment will affect the child’s daily activities. 4. To understand how the child will function within his/her environment. 5. To create an individual profile that includes the child’s strengths & weaknesses. Assessment As Hypothesis Testing: HOW? Assessment As Hypothesis Testing: Form a hypothesis about the child’s strengths and weaknesses based on observations and initial information from caregivers. The hypothesis helps to develop an assessment plan. Select assessment materials and tools that can confirm or refute the hypothesis Based on the assessment results, the clinician may need to revise the assessment plan. This approach will provide a detailed description of the child’s communication strengths and needs.  Multidisciplinary Team Members: Speech-Language Pathologists Dietitians Physical Therapists Special Ed Teachers Occupational Therapists. Social Workers Orthopedics. Physicians. Psychologists Pediatricians Psychiatrists Neurologists Behaviorists Nurses Audiologists. Family Other Professions Purpose for Assessment: Measuring Establishing Establishing Screening Progress/Chan Baseline Goals ge  Why Assess? “Purpose of Assessment” 1. Screening:  Screening helps to identify children who are at risk of having language impairments.  A good screening tool should address a broad range of language and communication functions.  Maybe formal or informal, clinicians may develop their own screening tool  Pass or Fail criteria  Failing in screening DOES NOT mean that the child have a definite DLD. 2. Establishing Baseline Function:  It requires using different strategies and instruments.  It is important to assess all areas of communication to determine the child’s baseline functional level.  It requires to look at the child’s communication behaviors in different contexts and settings.  Assessment results in a profile of child’s strengths and weaknesses.  Why Assess? “Purpose of Assessment” 3. Establishing Goals For Intervention:  To identify appropriate targets and procedures for intervention  It requires identifying the specific areas in which the child is functioning below the average (i.e., weak areas)  It is important to consider both the normal language acquisition milestone and the priorities of the child’s parents, teacher, and the communication barriers to social and academic success.  Gathering comprehensive assessment data is critical for establishing intervention goals. 4. Measuring Change In Intervention:  Assessment is an ongoing process.  To evaluate the child’s progress throughout the course of the therapy.  It is important to determine whether the goals are met.  Modify treatment plan if goals have not been reached  It is important to decide when to end the therapy sessions. Assessment Process  Referral Diagnosis & Assessment Severity Interpretation Case history Statement Collecting Recommendations Information Prognosis Low structure Comprehensive Statement observations Assessment Language- communication sample  Beginning The Assessment Process The assessment start once the referral is received. As you prepare for the assessment protocol, make sure to spend some time to collect additional child’s background. This usually can be done through:  Case History Review → (will be given in the practicum session)  Observation  Parents interview  Other information from others, such as: teacher, pediatrician, etc.,  Considerations in Assessment Planning It is always wise to get much information about other language aspects even if the presenting problem is only in one aspect (e.g., articulation) It is important to think about the order of the assessments. Why?  To provide the client with some variety and maximize his/her potential for success. Start the assessment with a low-structured activity (e.g., pretend play observation) Why? Be careful not to put all the difficult assessments at the beginning or the end of the assessment. For some children, it might be important to use visual aids (e.g., schedule to inform them what to have next) The most important thing about an assessment plan is that it must be PLANNED.  What to Assess? Make sure that the assessments include measures of language form, content, and use. In the assessment, consider these domains of language in at least two different modalities: Comprehension & Production. Once the DLD is determined, we need to assess other aspects of development that may affect language functioning or that may need to be taken into consideration when planning the therapy goals. Other areas like minimum hearing, oral motor function, cognitive abilities, and social skills.  What to Assess? Domains of language (In at least two modalities: comprehension and production) Form Content Use Syntax Knowledge of basic concepts Appearance of appropriate range of Morphology underlying language communicative functions Phonology Semantic relations among words and Discourse management clauses Flexibility of language for different Understanding ambiguity and listeners and social situations multiple meanings Clarity, cohesion, and coherence in Understanding figurative language discourse use  Assessing Collateral Areas: Hearing:  Hearing Screening, or referral to the audiologists Oral-Motor Mechanism  To assess the structure and the function of the articulatory system Nonverbal Cognition  To assess the child’s ability to solve problems without using language.  Referral to the psychologist Social Functioning  Communication is an interactive process; therefore, we need to assess the social functioning.  Observations: play skills, child-parent interaction, child-peer interaction, etc.,  Using assessment tools for specific areas and may need referral to psychologist.  Assessment Approaches & Methods There different assessment approaches, such as:  Psychometric Approach  It is the traditional language assessment approach with an emphasis on ranking individuals according to norms.  Performance is summarized by using percentile ranks and standard scores.  Example: Standardized tests, Norm-referenced tests.  Descriptive Approach  It is an authentic assessment method with the focus on describing behaviors and comparing them with past performances.  Example: Spontaneous speech sampling / observation  Involves using language sample analysis and observation of the patient in naturalistic settings.  Integrated Approach  Combines aspects of both psychometric and descriptive approaches.  Recommended approach.  Psychometric Approach: Standardized Tests Pros:  Time-efficient  Objective, valid, and reliable:  a well standardized test can give an idea about the child’s strengths and weaknesses and compare them to each other. Also, it allows to compare different language subtests to each others.  Typically norm-referenced and will help determine whether there is a problem or not. Cons:  Do not assess the complex, multidimensional aspect of language  Not always appropriate for patient’s.(profiles of the patient doesn’t match that of the norms)  It is important to note that abilities beyond language (for example, hearing, vision, attending, compliance) may be contributing factors when an individual earns a low score on a norm- referenced language test.  Descriptive Approach Pros:  Allows the clinician to determine whether the impairment is affecting the child’s daily interactions. Cons:  Time consuming.  Reliability and validity relies on different variables; which are:  the clinician’s experience,  the child’s mood,  clinician-child rapport,  Integrative Approach It combines between the psychometric and the descriptive approaches. It is the most recommended approach. Ongoing process of assessment as the earlier information at the beginning of the assessment may inform later assessment choices.  Example: Parent interviews & observation may help to choose the appropriate standard assessment tool. Also, the findings in the standard assessment may lead the clinician to informally look for further data about specific language aspects.  Standardized Tests: ”Psychometric”  They are also known as formal tests.  Decontextualized format for assessment  These tests provide a meaningful comparison of performance among children because they include the following properties:  Clear administration and scoring criteria.  Validity: refers to the extent to which a test measures what it aims to measure.  Reliability: measurements are consistent and accurate.  Standardized Tests: ”Psychometric”  Diagnostic accuracy:  Sensitivity: the degree to which test accurately identifies that a child has the disorder.  Specificity: the degree to which test accurately identifies a child as not having the disorder.  Standardization: set of studies carried out to determine how the instrument works in a known population or norms (i.e., sample must be big enough, e.g., 100 and above, and representative: geographic regions, SES, gender)  Measures of standard errors, and central tendency: normal bell-shaped curve and all sample fill within it, with a range of standard deviations (SD)  SD: the average difference of scores from the mean score.  Norm-referenced scores: Standard scores, Percentile Ranks, etc.,  Percentile rank tells you what proportion of the normative population scored lower than the subject taking the test Normal Standard Distribution  Standard/Formal Tests’ Use: Use:  To demonstrate a client is significant different from others  To establish eligibility for services Issues in the use of standardized tests  Fairness  Need to determine what level of difference is clinically meaningful  Not ideal for detailed description of particular forms and functions  Need to be supplemented with other methods when planning intervention program  Criterion-References Procedures Examine a particular form of communicative behavior to determine whether a child can attain a certain level of performance. Child’s performance is evaluated individually. Usually used to establish baseline function and identify targets for intervention. Could be created by clinicians. Formal or informal May be used to monitor change in response to probes over the course of intervention Will be discussed further in practicum  Criterion-References Procedures Example: Rosetti Infant-Toddler Language Scale (Rosetti, 2006)  Informal Tests: Informal tests are not standardized. They are descriptive tests.  No standard grading scale. These tests allow to assess areas of language deeper than standardized tests. They depends on the SLP’s expertise and creativity. Informal tests depend on different strategies and techniques, which vary depending on different factors such as: child’s age, current linguistic abilities, culture or specific behaviors the SLP wants to assess. They also assess the components of language receptively & expressively.  Dynamic Assessment Dynamic opposite to “static,” so dynamic assessment is designed to manipulate context in order to support the child’s performance. WHY?  So optimal level of achievement can be identified. It takes pretest-intervene- posttest format where the clinician actively attempts to promote change and observe the child’s learning process  The clinician actively engages a child in a learning process and then attempts to promote a change. The outcome of the dynamic assessment is not a score! Dynamic assessment allows the SLP to observe the child to obtain information about the following:  How the child approaches tasks, error patterns, and self-monitoring, and learning process.  The degree to which the child’s behavior can be modified in response to intervention (i.e., stimulability)  Intervention styles and methods that have the greatest potential to promote change.  Functional Assessment Functional assessments: measure in a structured way the impact of communication impairment on the ability to participate in activities or experiences + provide information on contextual factors that support or hinder communication progress. Functional assessment- the evaluation of the ways in which newly learned communicative behaviors increase a child’s level of autonomy in real life situations Functional Assessment 1 3 4 5 (Never) (Sometime (almost (always) s) always) Your child attempts to say words Your child’s speech can be understood by unfamiliar listeners. Curriculum-Based Assessment Curriculum-based assessment are usually used in school settings. Assessments that reflect the content of the curriculum They are used to assess the curriculum-based language use. They are more sensitive to cultural and linguistic diverse backgrounds. Other terms- authentic assessment, performance assessment Used for school-age children.  Integrating And Interpreting Assessment Data Once the comprehensive test is completed, the following task is to interpret the assessment data. Both formal and informal data must be gathered and combined for analysis and interpretation following different scoring rules and criteria to:  Determine whether a child has a significant deficit in communicative performance  Establish baseline functioning and profile of strengths and weaknesses. Once the child’s profile has been established, and the baseline level of functioning has been outlined, the information is used to complete the final 3 parts of the assessment protocol:  Determining the severity of the disorder.  Making a prognostic statement.  Making recommendations for an intervention program.  Severity Statement Severity ratings are important because:  They help establish priorities for intervention  To have a benchmark for evaluating the effectiveness of the intervention. Severity Classifications Classifications Descriptions Mild Some Impact on performance but doesn’t preclude participation in age-appropriate activities. Able to communicate independently. Moderate Significant degree of impairment that require accommodations. Severe Extensive support required to function in mainstream settings. May demonstrate functional skills with supervision Profound Few functional skills. Requires maximum support with basic activities.  Prognostic Statement Prognostic statement includes the SLP’s prediction about the child’s communicative outcome after intervention. It can be predicted based on several factors; such as:  Severity of the impairment  Child’s age  Family support  Presence of other disorders or medical problems  motivation  cultural background, and other factors It is advisable to make short term prognosis, with measurable outcome in a specified time. Why?  SLP must be cautious when making the prognostic statement to avoid any family resistance.  Recommendations Recommendation is the last part of the diagnostic process. Recommendations are obtained from the assessment data. Based on the assessment findings, the SLP must state different recommendations to facilitate the intervention process. In the recommendations, the SLP will state the following:  What services the child may need.  The duration of the intervention process.  The amount of the therapy sessions (e.g., twice or three times a week)  More specific therapy objectives (e.g., Enhance the child’s expressive language skills)  any suggestions of different methods, approaches activities, reinforcement, or other information that may help in the intervention process.  Clinical Report Main parts  Identifying information  Presenting problem  Historical information  Examination findings  Impression  Summary  Recommendations Questions???