Clinical Café by Tina Radichel, M.S., CCC-SLP
If speech development were easy, children wouldn’t need speech-language pathologists. But easy it is not. Speech production uses a set of arbitrary sounds and sound combinations that are based on an equally arbitrary set of rules (Kent, 1998, in Bernthal & Bankson, 1998). Unfortunately, children don’t always master these rules in the same way. Enter the need for speech assessment and time-consuming analysis and interpretation.
Looking at speech assessment on a continuum means knowing that each child may require a different level of sound analysis. At a basic level, simply counting errors on a set of single words and comparing that number to a set of national norms may be sufficient in a particular case. At the most complex level, a generative analysis of a child’s sound production in conversation offers a depth and breadth of data that can offer a rich description of the child’s individual sound system. More often than not, however, assessment needs will fall somewhere between these extremes.
How do you determine the place on the continuum that matches your particular child’s needs? Simply stated, it depends (sorry, no easy answers here). You may initially need to determine a cursory number of errors to get a general idea of severity. But then you want more information, so you choose to analyze this number of errors by type of error (substitution, deletion, distortion, or addition). Or you want to look at distinctive features (place, manner, and voicing changes, or labials vs. stridents, etc). Then you decide that information isn’t enough either; you would like to organize the child’s errors by phonological process (cluster simplification, velar fronting, stopping, etc.). And so it goes.
The ability to move easily between levels of information is key to effective assessment. For example, one of the reasons that the GFTA-2/KLPA-2 combination of tests is so powerful is that the continuum is integrated with one well-controlled, representative normative group. The combination of these two tools increases the validity and ease of moving through the continuum to deeper analysis without jeopardizing the reliability and validity of the data. What’s more, you can stop whenever you determine you have the information you need. It is this philosophical premise of a continuum of assessment and the necessity of flexibility that serves as the foundation of the tests, as well as the newly released, newly designed GFTA-2/KLPA-2 ASSIST scoring and reporting software.
Analysis and Interpretation of Formal Testing
Clinical decision-making in speech-language pathology has always been both an art and a science. Cliché, yes, but true. A formal test or a criterion-referenced checklist can provide you with a wealth of data, but you must then engage your “gray matter” and insert the data into the context of a child’s history, experience, life, and environment. At some point, the test data can tell you no more than a number or set of numbers. You must decide how those numbers fit together and “where to go from here.”
In short, you must use your clinical judgment!
“Egads!” you say. “Think? No, it’s summer! I can’t do that!”
Knowing that test scores tell you only a piece of what the child knows and can do, further dynamic procedures (e.g., the GFTA-2 Sounds-in-Sentences and Stimulability sections) can easily help you broaden the picture of the child’s sound system. These two sections of the GFTA-2 use consonant sounds in an authentic/dynamic way and provide more information for analysis and interpretation that is not possible through formal testing means. Best practices in speech-language pathology and educational psychology have long supported the use of a full range of assessment tools and information-gathering methods to complete an assessment that is valid and leads to intervention. (Feuerstein, 1979; Lidz, 1991; Moore-Brown & Montgomery, 2001; Paul, 1995; Schraeder, Quinn, Stackman, & Miller, 1999)
The bottom line of interpretation is simple: while each child’s speech system is unique, there are also a number of very common ways to talk about it. When making interpretive judgments about test scores, test manuals are invaluable resources for clinical decision-making and report-writing. In addition, software that can generate standard wording for describing test scores accurately can do much of the initial report-writing work for you! None of us have a lot of time these days, so efficiency is key to getting your professional interpretations down on paper. Both the GFTA-2 and KLPA-2 manuals offer excellent assistance in the analysis and interpretation of test scores, including special cases and considerations.
The rubber meets the road in clinical intervention. No assessment will make a good speech and language outcome, but excellent assessment tools can give you the necessary foundation for sound thinking in clinical practice. You make the difference in bridging the gap and making the data work for you clinically. Logic indicates that the deeper you go on the continuum of assessment, the more information you have for planning intervention. For example, knowing that a child may have 80 percent of his or her errors as substitution errors may help qualify a child for services and describe the test scores. Then you as a clinician must make the leap to determine what targets to pursue in therapy. On the other hand, if you know that those substitution errors are largely errors in the phonological process Liquid Simplification, you can determine if the errors are age-appropriate and on which targets to focus. The more depth of information you have up front, the easier and more effective intervention planning is after assessment. In this outcome-based world, there is no better reason for having an integrated continuum of assessment than better and more effective intervention!
While we can’t tell you what specific intervention activities will work with each individual child or group of children, we do want you to be able to spend more time on planning than on “crunching” the data and writing lengthy repetitive reports. Our new GFTA-2/KLPA-2 ASSIST software (brand new design too!) integrates scoring and reporting for both the GFTA-2 and KLPA-2. Check it out at http://ags.pearsonassessments.com/static/a11750.asp.
A Big Thanks!
As always, we’d like to thank you for your ongoing service to people with communication needs and remind you that we at AGS Publishing are here to support you with that effort. If you’d like to discuss this topic further, please feel free to use the SLP Forum Discussion Center as the vehicle for an ongoing discussion with your colleagues. Should you have questions regarding these or other Pearson Speech and Language products, we welcome your phone calls at 1-800-627-7271, or through our website contact form.
Enjoy the complexity of speech assessment!
Bernthal, J. E., & Bankson, N. R. (1998). Articulation and phonological disorders (4th ed.). Needham Heights, MA: Allyn and Bacon.
Feuerstein, R. (1979). Dynamic assessment of retarded performers: The learning potential assessment device, theory, instruments, and techniques. Baltimore: University Park Press.
Lidz, C. S. (1991). Practitioner’s guide to dynamic assessment. New York: Guilford Press.
Moore-Brown, B. J., & Montgomery, J. K. (2001). Making a difference for America’s children: Speech-language pathologists in public schools. Eau Claire, WI: Thinking Publications.
Paul, R. (1995). Language disorders from infancy through adolescence. St.Louis, MO: Mosby.
Schraeder, T., Quinn, M., Stockman, I. J., & Miller, J. (1999). Authentic assessment as an approach to preschool speech-language screening. American Journal of Speech-Language Pathology, 6, 195-200.