Review the data
Mark is a 3-year, 8-month-old male attending pre-k 3 at Middle of Nowhere Charter School. He was referred for a speech-language evaluation due to concerns in the areas of connected speech, receptive, expressive, and pragmatic language skills. Mark is exposed to English in the school setting, Amharic, and English at home.
What type of assessment data is this?
What does the data reveal to us about the client?
What type of assessment data is this?
Referral/background
What does the data reveal to us about the client?
We will need to consider the cultural and linguistic differences. We may need a bilingual evaluation.
He will need a comprehensive evaluation. Articulation and language should be assessed.
You are completing an evaluation for Elsa and notice that she has significant difficulty writing her letters. She appears to spell the words correctly and her sentences are grammatically correct. However, it takes her a long time to formulate her letters and she becomes frustrated.
Should you provide writing intervention? If not, which team member will you refer Elsa to?
ASHA says
"An appropriate assessment and treatment of written language disorders often incorporates interprofessional education/interprofessional practice (IPE/IPP). Members of the interprofessional practice team may include, but are not limited to, the following:"
The struggle appears to be more of a fine motor issue. I would refer to the OT
https://www.asha.org/practice-portal/clinical-topics/written-language-disorders/
List the steps you would take to evaluate a four-year-old referred for speech and language concerns.
Case history, parent/teacher input, observations, hearing screening, oral mech, language test, articulation test, language sample
Tools for preschoolers
Preschool Language Scale–Fifth Edition (PLS-5)
CASL-2
CELF-P3
PLS-5
CAAP-2
GFTA-3
Naveah is a 6-year-old simultaneous bilingual speaker. English and Spanish are both spoken in the home. Naveah’s mom, Marisol is concerned about Naveah’s language development. Marisol has significant difficulty understanding her daughter in both languages. Naveah often uses incomplete sentences with incorrect grammar. She has difficulty using a variety of vocabulary in both languages. She frequently uses non-specific language words, such as “this/eso.” Naveah shared her concern with Marisol’s teacher Mrs. Pipper. The teacher stated the following “I think it’s the multiple languages. I am having trouble understanding her as well. She may be confusing the two languages. Maybe you should try to use more English at home.” Mrs. Pipper shared her conversation with you, the SLP.
Please state 1) Do you suspect a language disorder or language difference? 2) would you initiate an evaluation or monitor the student's development? Provide a rationale for your choice.
Yes, initiate. The parent is concerned, and the difficulty occurs in both languages. Provide some training to the teacher.
Based on Jay’s 2013 speech-language evaluation, Jay is a product of a multiple birth. He was born at 29 weeks gestation with a birth weight of 2lbs 7 ounces. He remained in the Neonatal Intensive Care Unit (NICU) for 4 months with his twin sister Kay. Jay has a history of asthma, frequent ear infections, and bilateral PE tube insertion. He has a family history of a fluency disorder.
What type of assessment data is this?
What does the data reveal to us about the client?
What type of assessment data is this ?
Case history/background/birth history
What does the data reveal to us about the client?
There might be articulation difficulties due to the history of ear infections and PE tubes.
We should probably pull out the SSI-4 to assess Fluency.
You are assessing 7-year-old, Tommy Pickle based on a referral for a speech-language assessment. You noticed during your eval that Tommy is unable to spell his name nor provide his date of birth. You attempt to administer the CEL-5 but Tommy struggles to understand the instructions. You suspect that there is more going on with Tommy besides language. You have a hunch that Tommy may have an intellectual disability.
Are you qualified to diagnose ID? If not, then which team member(s) will you reach-out to?
The school psychologist
ASHA says
Speech-language pathologists (SLPs) do not diagnose intellectual disability (ID) but play a key role in assessing the communication and language skills of individuals with ID. SLPs may be part of a team making a differential diagnosis between ID and autism spectrum disorder or other conditions.
SLPs also play a role in enhancing adaptive communication functioning, as many of the adaptive skill areas rely on communication abilities. For example:
List the steps you would take to evaluate an 18-month-old referred for communication concerns.
Use a family-centered approach.
Case history
Parent interview
You would use a mixture of observation and parent input for formal/informal testing
Test in the child's natural environment if possible
Tools for Infants and Toddlers
Ages and Stages Questionnaire–Third Edition
Assessment, Evaluation, and Programming System (AEPS): For Infants and Children (Second Edition)
Battelle Developmental Inventory (Second Edition)
Bayley Scales of Infant and Toddler Development–III
Birth to Three Assessment and Intervention System (Second Edition)
Cognitive, Linguistic, and Social-Communicative Scales (Second Edition)
Developmental Assessment of Young Children–II (DAYC-II)
Developmental Profile III (DP-III)
Hawaii Early Learning Profile (HELP): 0–3
Mullen Scales of Early Learning
Preschool Language Scale–Fifth Edition (PLS-5)
The Vulpe Assessment Battery–Revised (VAB-R; V)
Vineland Adaptive Behavior Scales–II
Olive is a 5-year-old who recently transferred to PS828. Her family recently immigrated to the United States from Madagascar. Her parents speak both Malagasy and French in the home. Olive can speak both languages fluently. When communicating in the home, Olive and her siblings easily switch between languages. However, Olive often has trouble formulating complete sentences in both languages. Sometimes Olive forgets vocabulary in both languages, so her siblings often finish her sentences. Mr. Zeke has noticed academic challenges. Reportedly, Olive is misusing English grammar. She has trouble using a variety of vocabulary and independently answering comprehension questions. Olive’s teacher shared his concerns with you, the SLP.
Please state 1) Do you suspect a language disorder or language difference? 2) would you initiate an evaluation or monitor the student's development? Provide a rationale for your choice
Yes, initiate assessment. The difficulty is observed in both languages.
Ali was observed during her kindergarten virtual literacy block. At the time of the observation, Ali was receiving whole group instruction with approximately 23 students and 3 teachers present. Ali had an adult sitting beside her during the observation. Ali raised her hand to participate in the classroom discussion. She verbalized and used sign language (signed “milk”) when responding to questions in class. Ali appeared to be frequently distracted. She required prompting to redirect her attention to the screen. Based on the classroom observation, Ali demonstrated difficulty producing complete sentences and intelligible speech during classroom discussions.
What type of assessment data?
What does the data reveal to us about the client?
What intervention targets might you consider for this client?
What type of assessment data is this?
Classroom observation
What does the data reveal to us about the client?
Ali may have expressive language difficulties in the area of syntax and morphology. An articulation test may need to be administered and a speech sample should be collected.
What intervention targets might you consider for this client?
Formulating complete sentences
Increasing intelligibility during connected speech
Chuckie Finster is a preschooler referred to you for a language evaluation. The teacher is concerned about Chuckie's social skills and limited expressive language skills. You arrive to pick up Chuckie and notice signs that indicate ASD. You complete your evaluation and sure enough, Chuckie has severe social communication and social interaction challenges. You also notice repetitive behaviors.
In your summary and impressions, you provide a diagnosis of ASD.
Can an SLP diagnose ASD? If not, then what team member(s) might you reach out to?
It depends on the state and district laws. Typically an ASD diagnosis is a team decision.
ASHA says
Role of the SLP In Diagnosis
Interdisciplinary collaboration in assessing and diagnosing ASD is important due to the complexity of the disorder, the varied aspects of functioning affected, and the need to distinguish ASD from other disorders or medical conditions. (Hyman, et al., 2020)
Ideally, the SLP is a key member of an interdisciplinary team with expertise in diagnosing ASD. When there is no appropriate team available, an SLP—who has been trained in the clinical criteria for ASD and who is experienced in diagnosing developmental disorders—may be qualified to diagnose these disorders as an independent professional.
Additional Considerations
State speech-language pathology licensing boards do not always specify whether the diagnosis of ASD and other conditions are expressly within a licensee's scope of practice. Moreover, licensing agencies for other health professions, such as a state medical board, may set rules that prohibit SLPs from diagnosing ASD independently. School districts and employers in other settings may also have policies regarding the professionals who can establish the diagnosis. In addition, payers (Medicare, Medicaid, commercial, or private insurers) typically require a diagnosis by a physician, psychiatrist, or other medical professional for coverage of services. SLPs are responsible for understanding the requirements in place in their state, setting, and by payer so that appropriate services are not delayed. Please see ASHA’s state-by-state resources for state licensing requirements and contact information
List the steps you would take to evaluate a six-year-old referred for comprehensive evaluation due to a suspected diagnosis of ASD.
Case history, parent/teacher input, observations ( classroom, playground), formal/informal language testing. Be sure to assess social communication and social interaction skills.
Pragmatics checklists or scales (CELF-5), (CCC-2)
Norm-referenced test (TOPL-2)
Ms. Salford was a new SLP in an inner city school with about 90% African-American and Hispanic-American students. When she arrived, she noticed that the students rarely talked to adults unless they were directly asked a question. On the playground students did lots of talking, yelling, and arguing, but inside they were mostly sullenly silent. Teachers complained that the students had “poor verbal skills” and were “language delayed” and wanted large numbers of students included on Ms. Salford’s caseload for language intervention. Ms. Salford sat in on a few classroom sessions to learn more about the students’ communication skills. She noticed that the teachers frequently corrected their students, insisting that they use “proper” English when they talked. Students were often told that the teacher couldn’t understand them, that their speech was “sloppy.” Yet in her playground observations, Ms. Salford heard sophisticated verbal negotiations and a lot of creative use of language for ritualized, playful put-downs. She even heard students getting together in small groups in corners of the playground to add verses and make up new lyrics to their favorite raps. She began to suspect that there was a serious discrepancy between what she heard on the playground and what the teachers were reporting about the children’s language skills.
Explain how you would handle this situation. Would you screen her entire class?
You would not screen the entire class. You should provide the classroom teacher with info on the features of AAE and cultural differences.
An interview was conducted with Darnel regarding his strengths, weaknesses, and future goals. He expressed the desire to improve his ability to recall information. He stated the following “I wish the stuff I remember could stay in my brain”. He stated that he used to write in his notebook or on his phone as a strategy to remember information. He stated that his goal is to stay organized and to remember. In the area of social skills, he stated that he has good relationships with his peers and that he does not have any difficulty communicating with others. When asked about his future after high school, he shared that he desires to graduate and obtain a job.
What type of assessment data?
What does the data reveal to us about the client?
What intervention targets might you consider for this client?
What type of assessment data is this ?
Student Interview
What does the data reveal to us about the client?
The student struggles with recalling information. His receptive and executive functioning skills seem to be impaired. Based on this information I would be sure to select assessment tools that will assess memory.
What intervention targets might you consider for this client?
I may consider working on:
compensatory strategies to assist with his memory challenges
organizational skills
perhaps word-finding
Can an SLP diagnose selective mutism? If not then what team member(s) are involved?
Yes, we can diagnose SM. However, an interdisciplinary team is best. Counselors, psychologists, social workers, parents, teachers, etc.
ASHA Says
The SLP's role on the evaluation team is to identify and describe (a) the child's communication skills and coexisting communication disorders and (b) the their impact on the child's ability to consistently participate in various settings (Kotrba, 2015). If the SLP is the first professional that a family encounters, it may be important to provide referrals to behavioral health professionals with training and experience in working with children with anxiety disorders, behavioral therapy, cognitive therapy, and integrated treatment approaches that are broader than the speech-language scope. Staying in regular contact with the behavioral health professional of the individual with selective mutism is particularly important in optimizing outcomes and promoting generalization.
Interprofessional practice (IPP) and family involvement are essential in assessing and diagnosing selective mutism; the SLP is a key member of a multidisciplinary team. In diagnosing selective mutism, it is important that clinical experts agree on assessment results being consistent with the diagnostic characteristics of the disorder.
There is no single preferred, consistent diagnostic category. However, within the public school setting, eligibility for special education services under the Individuals With Disabilities Education Act of 2004 (IDEA, 2004) could be determined to fall within the disability categories of Other Health Impairment, Speech-Language Impairment, or Emotional Disturbance/Disability. If the child does not qualify for an individualized education program (IEP), then consider whether a 504 plan would meet some of the child's needs in the classroom.
List the steps you would take to reevaluate a 14-year-old who receives speech-language services for difficulties in the areas of; vocabulary, listening, and reading comprehension.
Review files and past evaluations, teacher, parent, and student input.
Review current therapy data and progress
Observations
Administer formal and informal assessments.
Possible assessment tools
CELF-5, CELFF-5 Reading and Writing Supplementary, CELF-5 Metalinguistics
CASL-2
TOPS
RWOPVT/EWOPVT
PPVT-5/EVT-3
Oral and Written Language Scales
Joey had been a difficult baby. He’d cry inconsolably for hours on end, and the only way his parents could calm him was to put him in his car seat and drive around. Even at 6 months old, when most babies have outgrown their colicky stage, Joey continued to be extremely irritable and unable to find comfort in his parents’ cuddling and attention. He sat up at only 4 months old, walked at 11 months old, and at that time began to take an interest in objects that bounced or sprang. He spent long periods playing with rubber bands. He was quiet, too, and didn’t seem to babble as much as his parents’ friends’ babies. When he was 18 months old, he said a few phrases, usually echoes of what he’d heard before, such as “Go, dog, go,” or “I’m lovin’ it.” He didn’t seem to be learning a lot of new words, though, and he didn’t seem to listen when people talked to him or even turn when they called his name. Still, he was very good at letting people know what he wanted. He would take adults’ hands and lead them to things. It didn’t seem to matter much who the adult was, though. Once he got what he wanted, he was content to play with it alone for long periods. Everyone told his parents there was nothing to worry about; Joey was just a “late bloomer.” When he had his second birthday, Joey’s mother took him to the pediatrician for a checkup. The doctor asked about Joey’s speech, and his mother reported that he said a few things. She commented that Joey’s brother Bobby had talked a blue streak when he was 2, and said she remembered taking him to an amusement park for his second birthday present. She recalled that he’d known the names of all the animals on the merry-go-round and had labeled each one as it went past. She knew that all children were different, but maybe Joey really was slow in his speech. She expressed her concern to the doctor. Her pediatrician recommended that Joey have his hearing tested. When the test came back within normal limits, the pediatrician reassured her that Joey would probably grow out of his slow start in speech.
Do you agree with the pediatrician? Should the parents wait and see? Do you suspect a language delay? What is your recommendation? Provide a rationale.
No, disagree with the pediatrician. Initiate assessment. Joey is not following typical patterns of development.
Alex was evaluated face to face inside a classroom at his school Nowhere PCS. The evaluator came into Alex’s Pre k-3 classroom to escort him to the evaluation room. Alex was seated on the carpet creating a train with the toy blocks. When the evaluator approached Alex and greeted him, Alex looked away from his blocks briefly and then returned his focus back to playing without returning the greeting. The evaluator asked Alex to stand up verbally and with gestural cues. Alex did not independently stand up and required hand-over-hand assistance. The evaluator allowed Alex to take some blocks with him to the evaluation room. Alex continued to line up the blocks to form a train during the first 5 minutes of the evaluation. The evaluator attempted to engage him with several toys to gain joint attention. When the evaluator presented Alex with a wind-up toy, he laughed and engaged with the evaluator. He used hand-over-hand to request for the evaluator to wind up the toy. Throughout the evaluation Alex’s verbalization and joint attention were limited.
What type of assessment data is this?
What does the data reveal to us about this client?
What intervention targets might you consider for this client?
Behavioral Observation.
This tells us a great deal. We can automatically note concerns in the area of pragmatic and expressive language. There are also characteristics observed that point to ASD.
Targets
Joint attention
Requesting
Following direction
You completed an evaluation for Crystal, a 13-year-old middle schooler. Based on her scores she demonstrates a mild language disorder. However, Crystal is struggling academically with reading and writing. You suspect that Crystal may have a learning disability and would like additional academic testing to determine the proper diagnostic label.
Can you as the SLP assess and diagnose SLD? If not, what team member(s) should you reach out to?
If you specialize in reading disorders then perhaps you can diagnose SLD. It depends on your state and district and the experts available.
Typically the school psychologist will conduct a psychoeducational evaluation to determine if a learning disability exists.
The SLP is trained to assess language. We play a role in determining if there is a language disorder.
List the steps you would take to evaluate a seven-year-old, AAE speaker referred for a speech-language evaluation.
Conduct a culturally and linguistically appropriate assessment.
Consider completing a dynamic assessment
Case history, parent/teacher input, observations, language test (with linguistic considerations), articulation test (with linguistic considerations), and language sample.
Consider using the Diagnostic Evaluation of Language Variation™ — Norm Referenced (DELV™–Norm Referenced)
Jerry was the third child in the family, so when he was a little slower than his sisters to get started talking, no one thought much about it. But when he entered preschool at age 4, his teacher, Mrs. Hamilton, noticed that his speech seemed immature. He made mistakes that other 4-year-olds in the class didn’t make, such as leaving out the little words and endings in sentences. He’d say, “Me a big boy,” and “I want two cracker.” He seemed not to know the words for many things other children could name, and he often used vague or idiosyncratic labels to refer to common objects. For example, he called a pineapple a “spiky.” Some of his words were hard to understand too. He made some errors, such as saying /f Λ m/ for thumb, that were like those made by lots of 4-year-olds, but he also left out sounds and parts of words in ways that weren’t typical of children his age. He said “mato” for tomato and /b Λ/ for bug. All these errors combined made his speech difficult to understand at times. Mrs. Hamilton noticed that when Jerry had trouble making himself understood, he often became angry, sometimes hitting or pushing the child who did not get his message.
At the parent conference that fall, Mrs. Hamilton told Jerry’s parents that she felt Jerry was a bright child but that he was having some trouble with his communication skills. She explained that these problems might go away by themselves in time, but at present, they were causing Jerry some frustration and interfering with his ability to get along with other children and succeed in the classroom. She recommended that Jerry’s parents consider having a speech-language pathologist (SLP) evaluate Jerry’s language skills and determine whether some intervention would help him navigate this period of his development.
1. List all pertinent questions you need to ask when obtaining the case history.
2. Describe your methods of assessment for this child. What standardized test will you use? What supplemental testing methods will you employ?
Varies