Principles Of Assessment Flashcards
What is assessment?
Process of collecting valid and reliable information, and then integrating and interpreting it to make a judgment or a decision about something
What is reassessment?
Appropriate when the patient exhibits a change in functional speech and language communication skills.
What is discharge?
Ideally occurs when the individual, family, or designate guardian, and speech-language pathologist as a team conclude that the communication or feeding and swallowing disorder is remediated or when compensatory strategies are successfully established.
What is management? Also known as? What is its correct progression?
AKA treatment or intervention
It is a dynamic process that follows a systematic progression
Diagnosis → selection of appropriate therapy targets → training procedures → mastery of behaviors
What is screening? Where does it most commonly occur?
Purpose: To quickly identify those individuals who communicate WNL vs comm dsco
Latter: Referred for a complete evaluation
It is not in-depth assessment and should not take more than a few minutes
Most commonly occur in schools
What is diagnosis?
Clinical decision regarding the presence or absence of a disorder and, often, the assignment of a diagnostic label
What is the purpose of assessment?
Assessing, describing, and interpreting an individual’s communication ability (ASHA)
What is a good assessment?
- A good assessment is thorough
- A good assessment uses a variety of assessment modalities
- A good assessment is valid
- A good assessment is reliable
- A good assessment is tailored to the individual client
According to this model, the PWDs or viewed as victims or as the problem–sees them as their disorder. Attitudes: pit, sympathy, charity
Charity Model
What is the medical model?
- Focuses solely on diagnosing and treating the health condition itself, often ignoring broader social or environmental factors
- PWDs need to be cured and they are passive recipients of care. The aim is to make them “normal”, implying that they are abnormal.
It is a framework for understanding and treating health and illness, primarily focusing on the biological and physiological factors that contribute to a patient’s condition. It operates on the assumption that health issues are rooted in physical causes—such as genetics, infections, biochemical imbalances, or physical injuries—and that treatment should aim to correct these biological abnormalities
What is the social model?
Emphasizes that societal barriers create disability
It is a framework for understanding a wide range of social issues, particularly focused on how society and its structures affect individuals, especially in relation to disability, health, and well-being. Unlike models that emphasize individual pathology or biological determinism (like the medical model), the social model centers on how external, societal factors contribute to challenges people face and how societal changes can improve individual outcomes
What is a rights-based model?
Focus: Fulfillment of basic human rights
This framework emphasizes the importance of recognizing, protecting, and promoting the rights of individuals and communities as a fundamental aspect of addressing social, economic, and political issues. It is often applied in fields like development, human rights, healthcare, disability advocacy, and education. Unlike other models that may focus on needs or charity, the rights-based model focuses on individuals as rights holders with entitlements, and governments or institutions as duty bearers responsible for fulfilling those rights. The model is grounded in the idea that all people are born with certain rights that are inherent, universal, and non-negotiable These rights cannot be given or taken away and apply to all people, regardless of nationality, race, gender, or economic status.
ICF Model (Difference of activities and participation)
Activity is the skill or activity itself, participation is applying that skill to be able to participate in society.
This model is used across multi-disciplinary care. It helps healthcare professionals develop personalized care plans that focus on improving a person’s functioning, rather than just treating the medical condition. The ICF is essentially a biopsychosocial model, integrating biological, psychological, and social factors in understanding health and disability. It takes into account not just the health condition but also the broader context of a person’s life, including environmental and personal factors. The focus on participation encourages social inclusion and the removal of societal barriers.
ICF Model
What are the three different barriers to participation?
Attitudinal, environmental and institutional
What are the basic components of a rights-based model?
Empowerment of PWDs and accountability of the government and other institutions
What are the factors of the ICF Model?
Body function/body structure
Activities
Participation
Environment factors
Personal factors
These tests are always standardized. It allows a comparison of an individual’s performance to the performance of a larger group, called a normative group. Ask the question, “how does my client compare to the average?”
Norm-referenced tests
What are the advantages of norm-referenced tests?
Objective; comparison to a large group of similar individuals, test administration is usually efficient, widely recognized, common ground of discussion with other professionals, clinicians are not required to have a high level of clinical experience and skill (guidelines in manual). Preferred for insurance, schools
What are the disadvantages of norm-referenced tests?
It is static and does not allow individualization. It tells what a person knows, not how a person learns. Testing situation may be unnatural and not representative of real life. It also evaluates isolated skills without considering other contributing factors. Considerations for culturally and linguistically diverse clients. Must be administered exactly as instructed for the results to be considered valid and reliable.
What are criterion-referenced tests?
Identifies what a client can and cannot do compared to a predefined criterion. It answers the questions, “How does my client’s performance compare to an expected level of performance?” It assumes that there is a level of performance that must be met for a behavior to be acceptable; any performance below that level is considered deviated. This may or may not be standardized. Furthermore, it is used most often when assessing client for neurogenic disorders, fluency disorders, and voice disorders; some aspects of articulation or language
What are the advantages of criterion-referenced tests?
Usually objective, test administration is usually efficient. It is widely recognized; common ground of discussion with other professionals. Preferred for insurance, schools. With non-standardized criterion-referenced tests, there is some opportunity for individualization
What are the disadvantages?
Standardized criterion-referenced tests do not allow for individualization, and must be administered exactly as instructed for the results to be considered valid and reliable. It evaluates isolated skills without comparing other contributing factors. Testing stimulation may be unnatural and not representative of real life.
How to know if a test is norm- vs. criterion-referenced tests?
Test purpose and scoring
Norm-referenced tests use percentile, while criterion-referenced tests uses scoring systems such as pass or fail or mastery levels
Test content and administration
**Criterion-referenced tests it’s more likely to focus on specific skill sets **
Test manuals and resources
Check publisher websites and professional association
Also known as alternative assessment or nontraditional assessment. Also identifies what a client can and cannot do; differentiating aspect: emphasis on contextualizing testing, so the test environment is more realistic and natural (e.g., client with social comm disorder: clinic vs. real life situations). This is ongoing as it evaluates the child’s performance during diagnostic and treatment phases.
Authentic assessment approach
What strategies can you use in an authentic assessment approach?
Systematic observation, real-life simulations, language sampling, structured symbolic play, short-answer and extended-answer responses. Self-monitoring and self-assessment. Involvement of caregivers and other professionals.
What are the advantages of an authentic assessment approach?
It is more natural; most like the real world
Clients participate in self-evaluation and self-monitoring
Allows for individualization
Particularly beneficial with culturally diverse clients or special needs clients
Offers flexibility
Disadvantage of authentic assessment approach?
May lack objectivity
Procedures are not usually standardized; thus, reliability and validity are less assured
Implementation requires a high level of clinical experience and skill. Approach is not efficient, requiring a lot of planning time. May be impractical in some situations. Insurance companies and school districts prefer known tests entities for third-party payment and qualification for services
True or False. Dynamic assessment is a form of authentic assessment?
True
What is the purpose of dynamic assessment?
Purpose is to evaluate a client’s learning potential based on their ability to modify response after the clinician provides assistance. Especially appropriate when assessing clients with cognitive communication disorders, clients from culturally and linguistically diverse backgrounds (language disorder vs language difference)
What is language disorder?
Difficulties in all of the client’s languages. There is significant difficulty in acquiring or using language skills compared to others of the same age and background.
What is language difference?
Difficulties only while speaking one language.
It is not a deficit. In most settings, clinicians cannot recommend therapy for clients who exhibit only communicative differences, but acceptable to provide therapy to clients who are electively receiving therapy for them (example: to modify a foreign accent)
What is language delay?
Slower than expected development of language skills compared to age-appropriate milestones. It doesn’t necessarily indicate a permanent issue. Can have various causes, including environmental factors, developmental delays, etc.,
What is language impairment?
Language impairment is an umbrella term that can encompass both language delays and disorders.
Any limitation or difficulty with language skills
In dynamic assessment, clinician pays particular attention to teaching strategies that were effective at improving the client’s success; may include use of:
- Cueing,
- graduated prompting,
- environment adjustments,
- conversational teaching
Dynamic assessment allows the clinician to determine __________________________
Baselines ability and identify appropriate goals and strategies for intervention
If the problem is language difference, the child will demonstrate ____________________
Improvement following teaching
If the problem of the child is language impairment, the chill will ____________________
Not demonstrate improvement following teaching
The emphasis of the authentic assessment approach is on
Contextualize testing
True or false. The authentic assessment approach only occurs in the initial evaluation stage
False. It is an ongoing process
What is the raw score?
Initial score obtained based on the number of correct or incorrect responses
The raw score is not meaningful until it is ________
Converted to other scores or ratings
What is the standard score?
- Reflects performance compared to average and the normal distribution
Used to determine whether a test taker’s performance is: average, above average, below average
Test developers calculate the __________ of the normative sample and assign it a value
Statistical average
The most common standard score average value is ________ with an SD of?
100 (with a standard deviation of 15)
This reflects the variation within the normal distribution; how spread out the values are. This determines what is average, below, average.
Standard deviation
____ to ____ below the mean is usually considered significantly below average and is clinically a cause for concern
-1.5 to -2 SD
This tells the percentage of people scoring at or below a given score.
Percentile rank
Usually cause for concern if a client performs near ________ of the normal distribution
Near the bottom 7%
This is the degree of certainty of the test developer that statistical values obtained are true. It allows the clinician to obtain a range of possible scores in which the true value of the score exists 95% of the time. The higher the better. This allows for natural human variability.
Confidence interval
Standard nine. Method of ranking an individual’s test performance. Score based on a 9-unit scale.
Stanine
This reflects the average raw score for a particular age (or grade). Least useful and most misleading scores obtained from a standardized test. Not considered a reliable measure and should generally not be used.
Age equivalence / grade equivalence
The higher the confidence interval the less likely the score of the client will fall within that range. True or False
Things to know or consider for assessment
- Know the culture of the client
- Know the history of the client
- Know the normal communicative patterns of the client’s dominant language
- Know the client’s cognitive level, and information about sensory integration
Who is part of our team when we do an assessment?
SLP, parents, SPED teacher, Psychologist, Occupational therapist, Physical therapist, Nutritionist, Neurologist, Developmental Pediatrician
How to choose appropriate assessment tools for age and skills?
- Formal test manuals
- Clinical judgment: Dynamic assessment
Which assessment procedures to do first and last?
Consider: rapport, invasiveness, comprehensiveness of test, priority regarding: chief complaint, merging/getting information about multiple areas in a singular test, usually do case history first
Assessment procedures common to most communicative disorders
Orofacial examination
Why do we assess the child’s OPM structures?
To identify any structural issues that could potentially impact their speech, feeding, and communication.
This is to measure a client’s ability to make rapidly alternating speech movements
Diadochokinetic (DDK) syllable rate
Alternating motion rate
Single syllable /pa/
Sequential motion rate
Sequence of syllable /pa-ta-ka/
Why do we assess the DDK?
Provides information about a client’s motor and speech-planning ability: ability to sequence same and different syllables, accuracy of productions, fluency, rhythm, voicing, rate, coordination of respiration, phonation, and articulation
There are two ways to measure DDK. What are they?
Counting the syllables produced within a predetermined number of seconds
Measuring the seconds it takes to produce a predetermined number of syllables.
What is speech and language sampling?
- Provide important information about speech and language abilities in a narrative or conversation context
- Most time consuming components of a speech-language evaluation
Purpose of speech and language sampling
Identifying sound errors in connected speech
Comparing sound errors from an articulation test and connected speech
Determining intelligibility
Assessing imitation
Evaluating rate of speech
Determining the mean length of utterance
Assessing comprehension
Assessing semantic, syntactic, and morphologic skills, and combined linguistic complexity
Assess narrative skills
Assessing vocal quality and resonance
Assessing pragmatic skills such as eye contact, topic maintenance, turn taking, perspective taking, and gauging partner interest
A truly representative sample is a minimum of __ to __ distinct utterance, if possible, continue until 200
50 - 100 distinct utterances
Strategies on how to get speech and language sampling
Establish a positive relationship before collecting a sample
Be as unobtrusive as possible; minimize interruption and distractions
Be willing to wait for the client to talk. Do not talk to fill the sentence
Preselect materials and topics that will be interesting to the client, and follow the client’s lead in elaborating or changing topics
Vary the subject matter of the sample
Seek out multiple environments (e.g., clinic, playground, home, workplace)
Alter the contexts (e.g., conversation, narratives, responses to pictures)
Avoiding yes/no questions or other questions that can be answered with only a few words
Ask questions that elicit lengthy responses, such as “tell me about…” “what happened” “why?”
Make natural contributions to the conversation
Consider the client’s age and cultural background; avoid questions that could be considered demeaning or offensive
Conversation starters for elicit a speech-language sample
- Sample conversation prompts
- Pictures
- Narratives
Reading passages allows the clinician to
Observe the client’s articulation, voice, fluency, and reading abilities
Compare oral reading results with single-word, short-phrase, conversational speech samples
Rainbow Passage, Grandfather passage, other passages appropriate to specific age ranges
This can directly affect articulation, intelligibility, voice production, and fluency
Speech rate
May be necessary as a measure of improvement over time (e.g., fluency) or deterioration (e.g., myasthenia gravis)
Evaluating rates of speech
Purpose of evaluating the rate of speech
Allows the clinician to evaluate rate’s effect on client’s communicative abilities
What are the steps to evaluate the rating of speech?
Record a sample of connected speech (devoid of significant pausing) in: Oral reading, conversational speech, or both
Count the number of words produced and divide by number of minutes
Time the sample (e.g., 20 seconds)
Count the number of words produced (e.g., 62 words)
Divide the number of seconds in a minute (60) by the number of seconds the sample (20 seconds in the sample): 60 / 20 = 3
Multiply the number of words in the sample (62 in the example) by the number in Step 3 (3 in the example): 62 x 3 = 186. The wpm (words per minute) is 186.
The more samples you get the greater the reliability. True or False
True
Steps when evaluating rates of speech when you have several samples
Example: Three samples are 20, 25, and 30 seconds, which equals a total of 75 seconds
The number of words in the respective samples are 15, 20, and 25 which equals a total of 60 words.
The number of seconds in 3 minutes (60 seconds per minute times three samples) is 180 seconds. Divide the number of seconds (180) by the number of seconds in the three samples. 75: 180 / 75 = 24
Multiply the number of words in the sample (60) by the number in Step 3 (2.4): 60 x 2.4 = 144. The wpm is 144
Speech sample used must be an adequate, representative sample of the client’s speech to obtain a valid intelligibility rating. True or False
t
Factors that can negatively influence intelligibility
The number of sound errors
The types of sound errors
Inconsistency of errors
Vowel errors
The rate of speech, especially if it is excessively slow or fast
Atypical prosodic characteristics of speech, such as abnormal intonation or stress
The length and and linguistic complexity of the words and utterances used
Insufficient vocal intensity, dysphonia, hypernasality, or hyponasality
Disfluencies particularly severe disfluencies that disrupt context
Laco of gestures or other paralinguistics cues that assist understanding
The testing environment (such as at home vs in the clinic)
The child’s anxiety about the testing situation
The client’s lack of familiarity with the stimulus materials
The client’s level of fatigue
Very young children
Elderly clients
Clients with certain neurological disorders
The clinician’s ability to understand “less intelligible” speech
This is especially valuable for: evaluating stimulability, assessing the maintenance of newly learned target behaviors in the clinical setting, determining the client’s maximum phrase length for primal speech production. Versatile and can be used with different disorders: articulation, rate, prosody, inflection, and intonation.
Syllable by syllable stimulus phrases
Clinical questions to ask in syllable by syllable stimulus phrases?
Can fluency be maintained in increasingly longer phrases?
Assessment of SSD
Screening
Formal tests
Sound error analysis
Descriptive features of phonemes
Distinctive features of consonants
Frequency of occurrence of consonants
Developmental norms for phonemes and consonant clusters
Phonological processes
Stimulability
Childhood apraxia of speech
Assessment for spoken language in children
Review:
Assessment approaches
Components of language
Normal language development
Language disorder categories
Screening
Assessment of early intervention
Assessment of school-age children
Language sampling analysis
