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Appraisal + Diagnosis=

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Assessment

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Types of Appraisals

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Informal and Formal

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Screening

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quickly identifies whether or not a person may have a communication disorder; activities or tests that identify individuals who merit further evaluation

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Informal Appraisal

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speech sample, read a passage; Swimming, Grandfather, Rainbow passage

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Formal Appraisal

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Fluharty Preschool Speech and Language Screening Test (2nd Edition), Diagnostics Evaluation of Articulation and Phonology (DEAP), Joliet 3-minute Speech and Language Screen (Revised)

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Appraisal

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collection of data

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Diagnosis

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represents the end result of studying and interpreting these data

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Assessment

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clinical evaluation of the client's disorder, can be divided into appraisal and diagnosis

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Phonetic/Phonemic Inventory

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all sounds child can produce and all sound they can use contrastively that conveys meaning

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Phonetic/Phonemic Inventory

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hearing test, speech sound test (words and conversational speech), stimulability measures, related areas: language, phonological awareness, speech sound perception/discrimination, special considerations (co-morbid; co-existing diagnosis, Down syndrome), oral mech exam

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Advantages of Artic Tests

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standardized scores, inventory of errors in different word positions, standardized administration, detailed scoring procedures (child to child, clinician to clinician)

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Disadvantages of Artic Tests

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may not provide a representative sample (Goldman-Fristoe only looks at consonants in the initial, middle, and final position), may not provide a reliable sample, some tests are designed to just assess speech sounds, not phonological processes, may not assess all sounds in all contexts

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When selecting the assessment measure, look at the

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age of child, suspected problem, adequate sample of speech sounds, need for standardized scores (qualifying for services), type of sound error analysis, specificity/sensitivity (how well does the test do what is is supposed to do)

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False/Positive

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child has disorder when they really do not

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False/Negative

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identifying child is typical when they really have disorder

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When using speech sound disorder tests, you should...

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if there is an error, transcribe the entire word (minimally broad; narrow if necessary), record a continuous speech sample, elicit additional examples of error sounds (additional sounds in different positions; conversational speech)

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Speech Sound Assessments at NCCU

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GFTA 2, Khan-Lewis Phonological Analysis 2, Clinical Assessment of Articulation and Phonology (CAAP), Bankson-Bernthal Test of Phonology, Slosson Articulation Language Test with Phonology, Kaufman Speech Praxis Test for Children, Photo Articulation Test (PAT-3)

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Arizona Articulation Proficiency Scale-III

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good for older clients, pictures are more mature (black and white), sentence test capability (sound production in sentences), severity rating description, vowels and consonants are scored

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Diagnostic Evaluation of Articulation and Phonology (DEAP) includes:

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screening, diagnostic, oral mech exam, articulation measure, phonological disorders measure, good sensitivity and specificity

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Hodson Assessment of Phonological Patterns-III

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preschoolers, elicits and requires transcription of 55 utterances using toys instead of pictures (more of a spontaneous speech sample with showing pictures), both a comprehensive evaluation and screening test, The Phonological Evaluation can be administered in 20 minutes and contains objects and pictures to elicit 50 stimulus words

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Describing Error Patterns

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two-way scoring, five-way scoring, five-way + phonetic transcription of errors

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Two-way scoring

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screenings or during therapy (incorrect/correct)

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Five-way scoring

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omission or deletion, substitution, distortion, addition, correct

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Stimulability testing

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examine ability to produce a misarticulated sound in an appropriate manner, not a formal procedure, "Watch, listen, say what I say", move from isolation to CV to CVC to word level for each sound in error (coarticulation affects that helps child produce sound or hinders child's ability to produce sound), at least two or three trials each, possibly in each position

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How do we use stimulability information?

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sounds that are highly stimulable should be targeted for intervention or sounds that are highly stimulable should NOT be targeted for intervention (if a child is stimulable for a sound, then that should is already in the child's phonetic/phonemic inventory, priority may be sounds that are not in the child's inventory)

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Language

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80% of children with SSD have poor language skills

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Language

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screen at minimum, children with significant speech sound errors may need a comprehensive language assessment, monitor language development -reassess speech as language improves (ex. 3-4 yr old, non-verbal, 1-2 words, 3-4 word sentences; the more they tried to talk, the more speech sound errors they tried to produce; if you have more verbal production, then you have more of what the child can produce)

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Triangle levels

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bottom-metalinguistics, middle-metaphonology, top-phonological awareness

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Metalinguistics

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ability to use language as a tool, ability to manipulate language, see language as a big picture (looking at a word and seeing that it is made of smaller parts)

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Phonological Awareness

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ability to reflect on and manipulate the structure of an utterance; rhyme knowledge, blending (sounds together), segmentation (sounds apart), manipulation of syllables, clusters and phonemes (What is the first sound in the word sit?), children with speech sound disorders perform poorer on these tasks

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Speech Perception/Discrimination

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Does a child have the ability to discriminate sounds to produce them?, research results are inconclusive or indicate the answer no, speech sound discrimination conducted for children who are collapsing at least two phonemes into a single sound (child substitutes -/s/ for /z, sh, 3, tS/

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Highly unintelligible children

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when eliciting a conversational sample, select the topic and provide a structure, give child specific topic (you know what the child may talk about), gloss the child's utterance (repeat what they said; important if you are recording)

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Young children/children with emerging phonological systems

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consider overall development of child, supplement measures with information from caregivers (target words, language at home, objects that child has attempted to label at home, if there is any intent), conduct an independent analysis (look at child's production on it's own, do not compare child to norms)

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Independent analysis

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only analyzes the child's speech production; does not compare child to adult model; does not matter if sound is produced incorrectly in relation to an adult target, some have a rule that sound must appear twice

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Relational analysis

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compare child's production to adult model, traditional but may not be appropriate for this population

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Bernthal et al (2009)

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suggests an expressive vocabulary of at least 50 words (if they are having difficulty saying words, they will not be able to do the Goldman-Fristoe)

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Independent analysis

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inventory of speech sounds; consonants and vowels, word positions, articulatory features, inventory of syllables and word shapes (syllable constraints-are there any syllable shapes they cannot produce); CVC words --> CV

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Goldman-Fristoe Test of Articulation

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Relational Assessment Measure; comparing child's speech productions

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Inventory of speech sounds

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list of speech sounds that client can produce correctly

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After collecting data across multiple context,

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next step is to analyze and interpret the information

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At the end of your appraisal,

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you should have the following (collected in multiple contexts); list of where correct and error productions occur, syllable shapes, initial, medial, and final, prevocalic, intervocalic and postvocalic consonants

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prevocalic

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consonant before the vowel

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intervocalic

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between two vowels, before and after

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postvocalic

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consonants occurring after the vowel

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You may not get every consonant in EVERY position!

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..

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hat

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/h/ initial, pre /t/ final, post

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shoe

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/sh/ initial, pre

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yellow

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/j/ initial, pre /l/ medial, intervocalic

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pajamas

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/p/ initial, pre /d3/ medial, intervocalic /m/ medial, intervocalic /z/ final, post

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Remember..

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when giving a test, loot at test manual and see how they define a consonant in a middle position; if there are more than two syllables, then looking for the medial consonant is unreliable

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At the end of your appraisal you should have,

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distribution of speech sounds, inventory of speech sounds (phonetic and phonemic)

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Phonetic Inventory

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list of speech sounds that client can produce correctly (accuracy may vary according to context)

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Phonemic Inventory

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all the sounds the child can produce contrastively to differentiate meaning (use in different contexts, use different sounds with different words)

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Phonemic Inventory

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analyze errors to determine what sounds are being substituted, deleted, etc., does the child always say /w/ for /r/ or others sounds too? does child substitute /w/ for /l, sh, r/? - substitution patterns

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Phonemic Inventory

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can use minimal pairs to see if child can use sounds contrastively; /wEd/ -/rEd/ (target) child produced /wEd/ for both productions, /wEd/ - /lEd/ (target) child produced /wEd/ for both productions, /rEd/ - /lEd/ (target) child produced /wEd/ and /lEd/ - Child does not know the differene between /w/ and /r/ or /l/; knows that there is a difference between the /r/ and /l/. he is trying to use it contrastively and differentiate sounds

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Does the child know the difference between producing a /w/ for /r/?

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He does not contrastively know the difference between these two sounds but realize that there is a difference between /r/ and /l/. It is possible to produce a sound incorrectly in 9/10 contexts but still get one right; you need to see more of a pattern (2 to 3 times in a sample)

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Articulation disorder

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there are phonemic contrasts - differentiate between sounds, problems are motor-based, speech sound errors are consistent (same error across positions)

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Phonological disorder

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review inventory and distribution of speech sounds, examine syllable shapes and constraints, examine phonological error patterns (15 patterns); place, manner, voicing or phonological analysis (Kahn-Lewis assessment)

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Phonological Error Pattern Analysis

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phonological process analysis is the most common type of phonological error pattern analysis, describe the type and frequency of the phonological processes, child could use a phonological process but not have a disorder (depends on age of child); ex. 20 month old deleting final consonants (expected for 2 yr old, but would not address in therapy), can use standardized test measures (Kahn-Lewis)

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Phonological processes

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standardized test may define a phonological process differently from another; need to use definition presented in test manual, may invalidate the norms if you do not follow directions in manual, idiosyncratic processes-unusual or individually distinct, processes for vowels too

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idiosyncratic processes

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things that no one has see before; unique to that child

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Need for Intervention

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Is there a speech sound disorder?, What is the nature of the problem?, How does it impact communication, intelligibility or severity? (school-system)

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Intelligibility

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perceptual judgment (not exact science), takes into account the number, type, and consistency of errors; vowel or consonant errors

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Three common measures of intelligibility

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open-set, closed-set, rating scale

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Open-set

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transcribe a speech sample and determine the percentage of words identifiable; use stars and checks for positive marks

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Closed-set

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client repeats words or reads from a word list or passage; determine the percentage of words identifiable; Rainbow passage

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Rating scale

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Level 6-Sound errors are occasionally noticed in continuous speech Level 5-Speech is intelligible, although noticeably in error Level 4-Speech is intelligible with careful listening Level 3-Speech intelligibility is difficult Level 2-Speech is usually unintelligible Level 1-Speech is unintelligible

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Percentage of Intelligibility

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number of words understood/number of words understood + number of unintelligible words x 100 ex. 50/150 x 100 = 33%

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Typical intelligibility

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3 yr old - 75% intelligible 4 yr old - 85% intelligible 5 yr old - 95% intelligible

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Severity

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conveys the significance of the impairment, percentage of consonants correct (PCC is one of the most commonly used measures (only consonants correct)

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PCC

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mild - 85-100% mild-moderate - 65-85% moderate-severe - 50-65%

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