exam 3 Flashcards
what is assessment
set of procedures that are used to gain a clear description of the speech sound production skills of a child – GOAL is to determine if there is a speech sound disorder
what is diagnosis
CONCLUSION you arrive at
1) determine if the child has clinically significant problem
2) describe the characteristics of problem
What are the speech screenings
-pass/ fail procedure that can be conducted quickly with a large number of individuals in a short period of time
EX:
-Ch: converse, say ABCs, COUNT to 10
-Adults : conversation, reading
in schools in California…
- we don’t automatically screen anymore
- it is all based on teacher and parent REFERRAL
in schools…
- put the child on “monitor” status
- she says to kindergarten teach that the child is still young and will recheck him again later on in the year
general principles of Assessment
a. Review the clients background
- written case history forms
- information from other professionals
- conduct interview
written case history forms
- what does the FAMILY THINK is the problem?
- speech, lang, developmental history
- prenatal and birth history
- medical history ( eating problems, ear infections)
- educational history
- social history (ch’s relations with others, discipline problems, is ch FRUSTRATED?
information from other professionals
- written release
- sometimes you have to ask around verbally
conduct an interview
- information gathering interview
- develop rapport
- orientation: what will happen in the assessment
- I understand from his file that …”
what do we need to ask?.
- do other make fun of ch?
- older client: are you bothered by this? IMPACT on your LIFE?
close the interview
- recap important points
- be sure to tell the person that you will share test findings with them
- thank them for their time
B. plan assessment session
- select appropriate tests
- prepare BRIBES (stickers, toys, games, prizes)
C. Prepare testing area
- clean and clutter free
- not distracting
D. Assess Related Areas
- hearing
- orofacial structures
- DDK syllable rate
- speech rate
- speech intelligibility
- level of stimulability.( cant imitate a model)
screen language
- give a RECEPTIVE VOCABULARY test (n bring in test and ask client to point at stuff)
- this works well if they are unintelligible
F. Administer tests
- get a spontaneous sample
- use standardized tests– some school districts demand norms
G. Discuss Findings and Make Recommendations
- share info
- be positive and clear
H. Write a report
-legal document - attorney
hearing screening
- SLPs can screen
- in schools, nurse usually does it
- pure tone air conduction thresholds at 20 or 25 dB
- refer to physician, audiologist if suspect a problem
Diadochokinetic syllable rates
- DDKs refer to the speed and regularity with which a person produces repetitive articulatory movements
- alternating motion - same syllable /p^p^p^p^/
- sequential motion - different syllables /p^t^k^p^t^k^/
- we are evaluating ORAL MOTOR COORDINATION
In evaluating oral motor coordination, we are looking for…
- speed
- accuracy
- sequencing problems
conducting an oral peripheral examination
A. Purpose
- helps differentiate: functional or organic
- functional: not associated with an organic or neurological impairment (have no idea)
- organic : some underlying structural , sensory, or neurological cause or related factor
B. supplies
- penlight, gloves, stopwatch, tongue depressors
- tasty tongue depressors are best
- Dr. R’s was ‘o guim technique
C. Assessment of structure and function of facial muscles
- general symmetry of face at rest– drooping? twitches?
- facial symmetry during smiling, opening mouth
- structural integrity of lips – drooping? mouth breathing?
- functional integrity of lips
- have client smile- symmetrical?
- is there adequate speed and range of motion?
- puff cheeks and hold in air
D. Assessment of structure and function of tongue
- structural integrity - normal color
- abnormal movements like fasciulations/tremors - Functional integrity
- stick out your tongue - does it come out far enough? deviate to one side?
- stick out your tongue and hold it (5)
- protrude your tongue, resist the tongue depressor
- elevate and lower tongue tip, side to side
E. Assessment of Hard Palate
- Normal color?
- normal height and width? (too narrow?)
- clefts?
F. Assessment of soft palate
- problems –> VPI (velopharyngeal incompetence)
- Bifid uvula –> submucous cleft?
- good oral-nasal resonance balance?
- prolong /a/ – does velum move up and back to meet pharyngeal wall?
G. assessment of teeth
- LABIOVERTED- tilt outward towards lips
- LINGUAVERTED- tilt inward toward tongue
- MALOCCLUSION
- OPEN BITE- lack of contact between upper and lower teeth
- CROSS BITE: lateral overlapping of upper and lower dental arches
Obtaining a spontaneous sample
- ideal- representative of daily life
- collect 50-100 utterances
- time-consuming, hard with highly unintelligible children
practical tips
- family member, friend if needed
- no loud toys
- let them hear themselves
administering standardized tests
A. introduction
- advantages
- quick (15-20 min)
- sample all consonants
- you know what the highly unintelligible ch Should be saying
Disadvantages of administering standardized tests
- just single words, not connected speech
- ch w/ oral motor probs. do better in single words
- each phoneme sampled only once in each position (false negative, false positives)
B. obtaining responses
-direct vs. delayed imitation
C. recording responses
- plus/minus technique
2. whole word transcription
- record type of error
a. omission (-)
b. substitution t/k, d/g, w/r
c. Distortion - D or D1-D3
d. Addition - transcribe whole word
D. Commonly-used tests: phonological process.
ASSESMENT OF PHONOLOGICAL PROCESSES
-severity rating
-nationwide! (do by hand or computer version, might be true or false question)
KHAN- LEWIS PHONOLOGICAL ANALYSIS
Our clinic use the CAAP
clinical assessment of articulation and phonology
commonly used tests: articulation
- Arizona articulation Proficiency Test-3
- Photo Articulation Test (PAT:3)
- Goldman- Fristoe Test of Articulation:2 (nationwide, year 200)
When you record
-be sure to gloss or restate the child’s attempt into the recording
(record and repeat what the child says)
other types of assessment
A. Speech discrimination testing
-minimal pairs
B. Stimulability Testing
-child’s tendency to make a correct or improved production of a misarticulated sound when given a model or additional stimulation by the examiner
C. Contextual Testing
- McDonald’s Deep Test
- SEcond Contextual Articulation Test (S-CAT)
- special procedure that can help ID a FACILITATIVE PHONETIC CONTEXT for correct production of a particular phoneme
Analyzing and interpreting assessment information
A. Analysis of speech sound production
- independent analysis: childs production transcribed without reference to adult model
- ID sounds that are in the childs phonetic inventory
- relational analysis: compare childs production to standard/adult form
C. traditional Analysis
`1. errors IMF
2. Error types– omission, distortion, substitution, addition
D. developmental analysis
compare childs production to norms for CA (public schools)
E. pattern Analysis
- distinctive Features :(
- place-voice-manner :)
- PVM: teach exemplars in the sound class –> generalization
- teach /k/ -> ‘/g/
- (fricatives) Teach /f/ –> /s/
- Phonological process analysis
- analyze PPs in terms of frequency, PERCENTAGE OF OCCURENCE
- Total # of occurrences of final cons. deletion =10
- Total # of opportunities for the process=50
- Total= 20% occurrence
F. Linear Phonological error pattern analysis
-
G. Phonetic Inventory analysis
-does the client have the motor ability to make the sound?
Intelligibility analysis
- 60 intelligible words out of 170 words= 35% intelligibility
- 30 intelligible words out of 56 words = 54% intelligibility
- Usually –SUBJECTIVE STATEMENT “ this examiner ESTIMATES that in a known context with an unfamiliar examiner, joey is 50 % intelligible in connected speech “
Making a diagnosis.
A. Typical Speech Skills
- errors- normal age range
- errors –> L1 transfer
- errors, but don’t interfere with life
B. Disorders-articulation Disorder
- Errors associated with organic, structural , or neurological origin.
- errors not typical of same age peers
- no patterns to errors
- errors don’t significantly compromise intelligibility
- errors on only a few sounds
C. Disorders- phonological disorder
- highly unintelligible speech
- MULTIPLE MISARTICULATION
- restricted phonetic inventory
- PATTERNS of errors (e.g., final consonant deletion, cluster reduction)
D. Severity Estimate– disorder is
- mild
- mild-moderate
- moderate
- moderate-severe
- severe
- profound
E. Diagnostic Statement
- a SUMMARY – one of the last portions in a written report
- its very important that this be well done, because it all most people ever read ) parents, principles, pediatricians)
Determining prognosis
-prognosis: estimated course of a disorder under specified conditions
EX: what will happen if teaching is offered– or not?
-variables contributing to prognosis (pg 301 know for exam)
Roseberry
under-promise and over deliver
Major components of a good prognostic statement (pg 302)
- GOAL STATEMENT: skills ch expected to achieve- be specific (fair, good, excellent)
- JUDGEMENT OF SUCCESS
- PROGNOSTIC VARIABLE - that justify the judgment
Making Therapy Recommendation
- Ch has SSD- Recommend treatment
- Ch has errors, but age appropriate - no treatments, re-eval later
- Typical speech-no treatment- maybe 1st lang transfer, or subtle problems that don’t impact life
- Ch has SSD, but no immediate treatment (motivation is structure)
Concluding the Assessment Process
- diagnostic report
- conduct information giving interview
information-giving interview
- begin with positives
- Summarize findings, conclusions, recommendations-next steps
- don’t fear the butter
Diagnostic report
- legal document- could end up in hands of a lawyer w/o your permission
- typos, other errors are death
- peoples first impressions of you
