Week 2 Principles of Pediatric Assessment Flashcards
What is the purpose of assessment?
Identify
Identify whether there is an impairment in the form, function or use of the child’s language. Is there a problem?
Describe
Describe the deficits in language form, content and use; compare with developmental expectations. What is the problem?
Determine
Determine the impact of the deficits on the child’s daily life. What is the impact on the child’s daily life?
Naturalist vs. Normative model?
Normative – comparing to a reference point; focused on societal expectations and obstacles. Functional
Naturalist – impairment or disease process within the individual that disrupts functioning. Medical
Why do we assess?
Screening- Do you need more information on the child?
Establishing Baseline Function- Comparing child to others (the norm) and themselves after some time
Establishing Goals for Intervention- Needs to be realistic for child
Measuring Change in Intervention- Is your intervention working?
How do we assess?
Language sampling: “gold standard,” authentic and contextualized assessment
Norm-referenced tests: not contextualized
Parental reports: contextualized
Screening process?
Child was identified by teachers or caregivers
Screening procedures depend on setting:
Private practice/outpatient - do not typically screen on site
Early intervention – Call AzEIP and request
Schools – Child Find preschool screening; Teacher or caregiver request;Annual screening events or grade-specific screenings (e.g. Kindergarten)
Multidisciplinary/Team Based Assessment members?
Family/Caregivers
Audiologist
ENT
Geneticist
Learning disabilities/literacy specialist
Neurologist
Nutrition specialist
Occupational therapist
Pediatrician
Physical therapist
Psychiatrist
Classroom/Mainstream teacher
Special education teacher
Beginning of the assessment?
Referral
Case review
- caregiver interview
-teacher interview
Observation
Low structure observation?
Use to build rapport if the child will engage with you
Depends on setting
Child with caregiver
Child with peers or siblings
Video recording from caregiver
Language or communication sample?
Record to use later
Ask caregiver to provide a recording if child can use verbal language but is reluctant
Funds of Knowledge?
Learning about the knowledge and abilities of clients and families and drawing on these life experiences as resources to advance student learning in the classroom.
~Ethnographic interviewing
Routines-Based Interviewing
Purposes:
1. To develop a list of functional out-comes
2. To assess child and family functioning
3. To establish a positive relationship with the family
Six steps:
1. Beginning statements
2. Routines as the agenda
3. Information from routines
4. Satisfaction with routines
5. Concerns and priorities
6. Outcome writing
Mapping the Plan
Use converging evidence from interviews, observations and case history to hypothesize the problem and choose evaluation tools
Establish baseline abilities:
Hearing function
Oral-motor function (Do an OME)
Intelligibility
Expressive & receptive language skills
Other areas based on concerns (e.g., play skills, social pragmatics)
Make referrals as needed
Refer to Audiology/OT/PT/etc. based on information gathered
Mapping the plan: Assessment should cover…
Domains of language:form, content and use
Modalities of language: production and comprehension
Collateral areas: Hearing,oral-motor,nonverbal cognition, and social functioning
Mapping the Plan: Assessment with CLD (Culturally and Linguistically Diverse) Children…
Identify and reduce bias
Individualize timing of assessment
Consider L1 and L2 abilities and needs (past, present and future)
Look beyond language dominance
Gather data using multiple measures and multiple sources
Standardized tests?
Most formal
Decontextualized
Norm-referenced
Do not “stand alone”
Standardized Tests – Cultural, Linguistic and Socioeconomic Bias
Overidentification
Dual language learners (DLLs) make similar errors in English to children with DLD (e.g., tense marking and inflectional morphology)
Use of biased standardized tests when the child’s background is not represented in the normative sample
Under-identification
“Wait and see” approach; assuming language problems are due to DLL status/English proficiency
SLPs with limited training in assessment of DLLs
Dominance
Isability in either language static?
Can you compare assessment results from one year later based on “dominance”?
Consider normal aspects of bilingual development
Language attrition
Protracted development
The proficiency levels in each language are changing dynamically based on usage
Assess in BOTH languages
Assessment in L1/home language -
Same considerations for standardized tests (e.g., PLS-5 Spanish)
Caregivers are a fantastic source of information!
Use interpreters
Assessment in L2/English
Critically choose standardized tests – especially vocabulary!
Language Sample Analysis – gold standard
Learn the expected influence from the child’s home language
Criterion Referenced Procedures
Looking at only this child; not compared to others
Test the child’s level in certain areas
Establish baseline function
Determine if goals have been met
Check in structured and naturalistic situations
(contextualized anddecontextualized)
Some commercialized tools available
Useful with CLD children when standardized tests aren’t available.
Nonword repetition, sentence repetition
Narrative elicitation
Processing dependent measures (e.g., number repetition)
Comprehension vs. Production
Comprehension (private)
Carefully consider stimuli + expected responses
Answering questions
Contrived responses
Production (less private)
Less inferencing needed from us
Carefully consider task
Elicited imitation
Elicited production
Structural analysis
Behavioral observations
For description. Not comparing the child with any preset criteria
Often involve checklists or rating forms
May be clinician-designed
Sometimes are an extra component of a standardized test
Dynamic assessment
Pretest-intervention-posttest
Observe, intervene, and report: Support/Scaffolding, Modifiability,what strategies worked?
Good for CLD populations
Functional assessment
Looks at functional (real life) outcomes (recommended by WHO ICF-CY)
Curriculum-based assessment
Typically used in school settings
Able to grasp info that they’re learning in class
WHO ICF-CY Model: Focus on Functional Impact
How does a language disorder impact a child’s life?
Health condition (disorder or disease)
Body functions and structures
Activities
Participation
Environmental factors
Personal factors
Formative vs. Summative Assessment
Formative
Informal
Provides feedback that leads to behavioral change
Embedded into learning process
Ongoing
Summative
Typical for diagnostic measures
Used to measure baseline performance and change after a period of intervention
Usually more structured or standardized assessment material + systematic administration
Putting it all together!
Is there a significant deficit in any or all areas of language (form, content, use)?
Is there a significant deficit in either or both modalities of language (comprehension, production)?
How severe is the deficit?
What is the baseline level of functioning?
What further information do we need?
Factors in clinical decision?
Parents, teachers, and/or clinician concern ratings
Standardized speech and language assessment tasks
Connected speech and language production
Observation of learning
- Determine the severity.
- Make a prognosis.
- Make recommendations for the intervention program.
