Chapter one

Foundations of assessment

• Assessment: Diagnosis
It is the process of collecting valid and reliable
information, integrating it, and interpreting it to
make a judgment or a decision about something. It
is the process of measuring communication
behaviors of interests.
Outcome of assessment: making a clinical
decision regarding the presence of absence of a
disorder, and the assignment of a diagnostic
label.
 Using information obtained through
assessment
• Make a diagnosis
• Identify the need for referral to other
professionals
• Identify the need for treatment
• Determine the focus of treatment
• Determine the frequency and length of treatment
• Make decisions about the structure of treatment
 Integrity of assessment
• Thorough: accurate diagnosis & appropriate
recommendations.
• Uses a variety of assessment modalities : Formal &
informal testing & client observation)
• Valid: Truly evaluates the intended skills
• Reliable: accurately reflects the client's
communicative abilities & disabilities. Repeated
evaluations of the same client should yield similar
findings.
• Tailored to the individual client: Assessment
materials that are appropriate for the client's age,
gender, skills level, and ethno cultural background
should be used.
 Psychometric concepts
• Validity: Truly measures what it claims to
measure.
• Reliability: Results are replicable.
• There are several types of validity and reliability.
• Relationship between reliability and validity
Reliable but not valid
Valid but not reliable
Valid and reliable
 Steps of assessment

• Obtain case history

• Interview
• Oro-facial examination
• Collect a representative speech/language
sample
• Hearing screening
• Draw conclusions/from a diagnosis
• Share clinical findings
 Standardization
- Standard/ formal tests provide standard
procedures for the administration and scoring of
the test.
- Standardization is accomplished so that test-giver
bias and other extraneous influences do not affect
the client's performance and so that results from
different people are comparable.
- Test developers are responsible for clearly
outlining the standardization and psychometric
aspects of a test.
 Test Manual
Each test manual should include information about:
• The purpose of the test
• Test construction and development
• Administration and scoring procedures
• The normative sample group and statistical
information derived from it.
• Test validity and reliability
• It is important to become familiar with this
information before using any standardized test.
Lack of familiarity with this information, or
inappropriate application of it, could render
results useless or false.
Assessment methods
• Norm- Referenced Tests

• Criterion-referenced tests

• Authentic assessment
 Norm- Referenced Tests
• Most of the commercially available tests used by
speech-language pathologists are normreferenced
tests.
• They are most commonly used for evaluating clients
for articulation or language disorders.
• Norm-referenced tests are always standardized.
• They allow a comparison of an individual’s
performance to the performance of a larger group,
called a normative group.
• Norm-referenced tests help answer the question,
“How does my client compare to the average?”
 Disadvantages of Norm-referenced
tests
1. Norm-referenced tests do not allow for
individualization.
2. Tests are generally static; they tell what a person
knows, not how a person learns.
3. The testing situation may be unnatural and not
representative of real life.
4. The approach evaluates isolated skills without
considering other contributing factors.
5. Must be administered exactly as instructed for the
results to be considered valid and reliable.
6. Test materials may not be appropriate for certain
populations, such as culturally and linguistically
diverse clients.
 Advantages of using norm-referenced
tests
1. The tests are objective.
2. The skills of an individual can be compared to those of a
large group of similar individuals.
3. Test administration is usually efficient.
4. Many norm-referenced tests are widely recognized,
allowing for a common ground of discussion when other
professionals are involved with the same client.
5. Clinicians are not required to have a high level of clinical
experience and skill to administer and score tests
(administration and interpretation guidelines are clearly
specified in the accompanying manual).
6. Insurance companies and school districts prefer known
test entities for third-party payment and qualification for
services
 Criterion-referenced tests
❖Criterion-referenced tests: they identify what a
client can and cannot do compared to
predefined criterion.
❖Are used most often when assessing clients
for neurogenic disorders, fluency disorders,
and voice disorders.
❖They may also be used for evaluating some
aspects of articulation or language.
❖May or may not be standardized.
 Advantages of using criterion-referenced
tests.

1. The tests are usually objective

2. Test administration is usually efficient.
3. Some are widely recognized, allowing for a
common ground of discussion when other
professionals are involved with the same client.
4. Insurance companies and school districts prefer
known test entities for third-party payment and for
qualification for services.
5. With nonstandardized criterion-referenced tests,
there is some opportunity for individualization.
 Disadvantages of Criterion-referenced
tests
Disadvantages include the following:
1. The testing situation may be unnatural and not
representative of real life.
2. The approach evaluates isolated skills without
considering other contributing factors.
3. Standardized criterion-referenced tests do not
allow for individualization.
4. Standardized criterion-referenced tests must be
administered exactly as instructed for the results to
be considered valid and reliable.
 Authentic assessment
• Authentic assessment is also known as alternative assessment
or non-traditional assessment.
• It identifies what a client can and cannot do.
• The differentiating aspect of authentic assessment is its
emphasis on contextualized test stimuli.
• The test environment is more realistic and natural. For example,
when assessing a client with a fluency disorder, it may not be
meaningful to use contrived repeat-after-me test materials.
• It may be more valid to observe the client in real-life situations,
such as talking on the phone to a friend or talking with family
members during a meal at home. Another feature of authentic
assessment is that it is ongoing.
 Authentic Assessment
❖The authentic assessment approach
evaluates the client’s performance during
diagnostic and treatment phases
❖Using an authentic assessment approach
requires more clinical skill, experience, and
creativity than does formal assessment
because skills are assessed qualitatively.
 Authentic assessment
• Several strategies for evaluating clients using an
authentic assessment approach:
1. Systematic observations
2. Real-life simulations
3. Language sampling
4. Structured symbolic play
5. Short-answer and extended-answer responses
6. Self-monitoring and self-assessment
7. Use of anecdotal notes and checklists
8. Videotaping and Audiotaping
9. Involvement of caregivers and other professionals
 Authentic assessment
❖ Advantages of using an authentic assessment
approach:
1. The approach is natural and similar to the real
world.
2. Clients participate in self-evaluation and self-
monitoring.
3. The approach allows for individualization.
4. This is particularly beneficial with culturally
diverse clients or special needs clients, such as
those who use Augmentative or Alternate
Communication (AAC) systems.
5. The approach offers flexibility.
 Authentic assessment
❖ Disadvantages using this approach include the
following:
1. The approach may lack objectivity.
2. Procedures are not usually standardized; thus
reliability and validity are less assured.
3. Implementation requires a high level of clinical
experience and skill.
4. The approach is not efficient, requiring a lot of
planning time.
5. Insurance companies and school districts prefer
known test entities for third-party payment and
qualification for services.
 Chapter 3
Obtaining, Interpreting, and Reporting Assessment Information

Primary sources of preassessment

information include:
• A written case history (vclass)
• An interview with the client, parents,
spouse, or other caregivers
• Information from other professionals
Obtaining, Interpreting, and Reporting
Assessment Information
❖ Professionals in communicative disorders generally conduct
three types of interviews:
• Information-gathering,
• Information-giving,
• Counseling interviews
❖ The information-gathering interview, sometimes called an
intake interview, consists of three phases:
• The opening, the body, and the closing.
❖ The basic content of opening Phase:
• Introduction
• Describe the purpose of the meeting.
• Indicate approximately how much time the session will take.
Obtaining, Interpreting, and Reporting
Assessment Information
Body of the Interview
• Discuss the client’s history and current status in depth.
• Focus on communicative development, abilities, and problems,
along with other pertinent information such as the client’s
medical, developmental, familial, social, or educational history.
• If a written case history form has already been completed,
clarify and confirm relevant information during this portion of
the interview.

Closing Phase
• Summarize the major points from the body of the interview.
• Express your appreciation for the interviewee’s help.
• Indicate the steps that will be taken next.
 Questions Common to Most
Communicative Disorders
• During an interview:
• Closed-ended questions typically elicit short, direct
responses.
• Open-ended questions are less confining, allowing the
respondent to provide more general and elaborate
answers.
• It is usually best to begin an interview with open-ended
questions. This will help identify primary concerns that
often require further clarification and follow-up through
closed-ended questions.
• The following questions are often asked about most
communicative disorders during the body of the interview.
• Read from the book Questions Common to Specific
Communicative Disorders
 Questions Common to Most
Communicative Disorders
• Some or all of these questions may be used with clients, their
caregivers, or both. Select those that are appropriate and integrate
them into the interview.
• Please describe the problem.
• When did the problem begin?
• How did it begin? Gradually? Suddenly?
• Has the problem changed since it was first noticed? Gotten better?
Gotten worse?
• Is the problem consistent or does it vary? Are there certain
circumstances that create fluctuations or variations?
• How do you react or respond to the problem? Does it bother you? What
do you do?
• Where else have you been seen for the problem? What did they
suggest? Did it help?
• How have you tried to help the problem? How have others tried to
help?
• What other specialists (physician, teachers, hearing aid dispensers,
etc.) have you seen?
• Why did you decide to come in for an evaluation? What do you hope
will result?
 INFORMATION FROM OTHER
PROFESSIONALS
• Is necessary before commencing treatment (as in the
case of an otolaryngologic evaluation before the
initiation of voice therapy), and this information is often
helpful for understanding the disorder more thoroughly
before making a diagnosis.
• There are many sources for such preassessment
information, including other speech-language
pathologists, audiologists, physicians (general or family
practitioners, pediatricians, otolaryngologists,
neurologists, psychiatrists, etc.), dentists or
orthodontists, regular and special educators (classroom
teachers, reading specialists, etc.), clinical or educational
psychologists, occupational or physical therapists, and
rehabilitation or vocational counselors..
 INFORMATION FROM OTHER
PROFESSIONALS
❖ Information from other professionals may help identify:
1. The history or etiology of a disorder
2. Associated or concomitant medical, social, educational,
and familial problems
3. Treatment histories, including the effects of treatment
4. Prognostic implications
5. Treatment options and alternatives
❖ Be aware that information from other professionals can
potentially lead to a biased view of a client’s condition.
❖ It is important to maintain an objective position
throughout the assessment, relying primarily on direct
observation and evaluation results.
 Chapter 4
Reporting Assessment Findings
• Obtaining, interpreting, reporting, assessment
information
• Information giving interviews:
• Are conducted with the client and the client’s
caregivers it is usually consist three phases :
• 1)the opening
• 2)the body
• 3)the closing
 Information-giving conferences
Information-giving conferences usually consist of an
introduction, a discussion of findings, and a
conclusion.
Introduction:
1. Introduce the purpose of the meeting
2. Indicate approximately how much time the
session will take.
3. Report whether adequate information was
obtained during the assessment.
4. If reporting to caregivers, describe the client’s
behavior during the assessment.
 Information-giving conferences
Discussion
1. Discuss the major findings and conclusions
from the assessment.
2. Keep your language easy to understand and
jargon-free.
3. Emphasize the major points so that the
listener will be able to understand and
retain the information you present.
4. Provide a written reports that summarizes
findings.
 Information giving interview
• Listen carefully to the caregivers of the client
through the interview because they certainly
know their children better than we do.
• Illustrations to use when conveying
information is important because many
disorders results from physiological damage or
dysfunction .
• Visual illustration of the anatomic areas that
we provide during the information giving
interviews help the caregivers understand our
information .
 Information-giving conferences
Conclusion
1. Summarize the major findings, conclusions, and
recommendations.
2. Ask if the listener has any further comments or
questions.
3. Thank the person for his or her help and interest.
4. Describe the next steps that will need to be taken
(e.g., seeing the client again, making an
appointment with a physician, beginning
treatment).
• Be quick and to the point.
 Writing assessment reports

• Clinician can develop his own style of

writing assessment reports, but most
assessment reports have a similar format.
• ASSESSMENT REPORT (vclass)
Other Types of Reports:
• Therapy Progress Report.
• Discharge Report
• Treatment Plan
 IFSPs and (IEP)
• The Individualized Family Service Plan (IFSP) and Individualized
Education Plan (IEP) are written documents specific to children from
birth through high school.
• They outline the disabilities and needs of an individual child, describe
services to be provided, and emphasize the importance of family
participation in the child’s well-being.
• An IFSP is typically for infants and toddlers and should transfer
somewhat seamlessly to an IEP at age three.
• IFSPs Early intervention is provided to infants and toddlers with a
disability or developmental delay, and their families.
• The IFSP is developed by a team, which includes, at minimum, the
child’s parent or parents, the service coordinator, one or more
professionals who evaluates the child and family, and one or more
professionals who provide early intervention services if needed.
• Professionals involved may be medical specialists, speech-language
pathologists, occupational therapists, physical therapists, audiologists,
nutritionists, psychologists, social workers, and others.
 Information included in every IFSP:
• The child’s present levels of functioning and needs in the
areas of physical, cognitive, social/emotional,
communicative, and adaptive development
• The parent’s or legal guardian’s concerns, priorities, and
resources
• Description of intervention services the child will receive
• Results and outcomes expected
• Start date, frequency, duration, and location of services to
be provided
• The name of the service coordinator
• At the end of the IFSP period (usually age 3), transitional
steps out of the early intervention and into another
program if needed
• Written consent for services from the parents or legal
guardian
 IEPs
• The IEP is the written document that describes
the services and educational goals that will
best meet the child’s individual needs.
• It is written by a team that includes the child’s
parents, the child’s regular and special
education teachers, other professionals with
particular knowledge or expertise related to
the child (such as a speech-language
pathologist), and, when appropriate, the
student for whom the IEP is provided.
Each child’s IEP contains the following
information:
• The child’s present levels of functioning and academic achievement,
particularly relating to his or her success in school
• Measurable annual goals. Benchmarks or short-term objectives are
required for those who take alternate assessments aligned to alternate
achievement standards.
• Description of how progress toward meeting goals will be measured
and when periodic progress report will be provided
• Description of special education or other services the child will receive
• Amount of time per school day the child will receive special education
or special services separate from nondisabled peers
• Written consent for services from the parents or legal guardian
The IEP is reviewed annually; goals and services are updated to address
changing needs.
During the transition to adulthood, which starts when the child reaches
age 16, the child becomes a mandatory member of the IEP team.
 Clinical correspondence
• Sending reports to other professionals is a common
clinical practice. Recipients of clinical information
may include physicians, social workers, mental
health professional.
• Written correspondences vary in length and scope
depending on the: Client, Findings, and Recipient.
• Many professionals, particularly physicians, prefer a
short report that simply gets to the point without
excessive background or verbiage.
• Three sample correspondences:
• 1- Brief.
• 2- Moderately detailed.
• 3- Very detailed.
• Referral letter (vclass)
 SOAP notes
• SOAP is an acronym for:
• Subjective: contains non-measurable and historical
information. Summarize the problem from the clients
or caregiver's point of view. Include the current
complaint and relevant past history and recent
history. Include information about the client's level of
concern, degree of cooperation, and overall effect.
• Objective: contains measurable findings.
For an initial diagnostic session document the
examination results.
For a treatment session, document objective
performance measures on treatment tasks.
 SOAP notes

• Assessment: is a synthesis of the information

in the subjective and objective section.
• For diagnostic session, write your conclusion
and recommendations.
• For treatment session, record the client's
current status in relation to his or her goals.
• Write the note in such a way that other
professionals will understand the outcome of
the session.
• Plan: Record your plan of action.
 Writing SOAP notes
• Are often used in medical settings for reporting
client information.
• Used to facilitate communication among
professionals, such as doctor, nurses, and other
therapists, who are involved with same client.
• Is used on an ongoing basis during the evaluative
and treatment phases of a client's care and is
written immediately after working with a client.
• The notes are part of the client's legal medical
records.
 Chapter 6
Assessment procedures
Oral-facial examination
• What is the oral – facial exam?
• OFE is an important component of a complete speech
assessment.
• Its purpose is to identify or rule out structural or
functional factors that relate to a communicative disorder.
• Tools are used in the OFE: Disposable gloves, Stopwatch,
Small flash light and Tongue depressor (a sucker may be
used instead of the tongue depressor or toothette).
• For some clients may need: Bite block, Cotton gauze,
Applicator stick and Toothette or a mirror.
 Oral-facial examination

• Food used: Peanut butter, Applesauce, etc.

• Both can be strategically placed in the oral
cavity to help us assess lips and tongue
movement.
• Some children are allergic to certain foods.
• Need to make sure about obtaining parental
permission before giving a child a food
product.
 Precautions that should be followed in OFE
• Sterilize all equipment that is used in
the mouth
• Wash hands before and after contact.
• Wear gloves if there will be any contact
with body fluids, mucous membranes, or
broken skin.
• Remove gloves without touching the
outside of them, and then safely dispose
of them
 Precautions that should be followed in OFE

• Wear eye and mouth protection if any body

fluids are likely to splash or spray.
• Wear a gown and shoe covering if clothing is
likely to come in contact with body fluids.
• Change your clothing if another person’s blood
or body fluids gets into your clothes.
• Follow facility or campus infection control
policies regarding procedures for disinfecting
and cleaning various surfaces and instruments.
 Interpreting the OFE
• Abnormal color of the tongue, palate, or pharynx:
1. Grayish color __muscular paresis or paralysis
2. Bluish tint __excessive vascularity/bleeding
3. Whitish color along the border of the hard & soft palate
_submucosal cleft
4. Abnormal dark or translucent color on the hard palate _
may be palatal fistula/cleft
5. Dark spots _oral cancer
• Asymmetry of the face or palate:
Neurological impairment/muscular weakness
Pt. may exhibit concomitant aphasia and/or dysarthria
 Interpreting the OFE
• Abnormal height or width of the palatal arch:
1. Difficulties with palatal-lingual sounds_ the
palatal arch is especially wide/high
2. Consonant distortion : abnormally low/narrow
arch in the presence of a large tongue
• Deviation of the tongue/uvula to the left/right -
neurological impairment. Tongue -- to the
weaker side, uvula--to the stronger side (on
phonation)
• Missing teeth: depends on which teeth are
missing. In most cases especially in children
missing teeth do not affect articulation. But its
important to know if it is the primary cause of
or a contributor to the com. Disorder.
 Interpreting the OFE

• Enlarged tonsils: may not affect at all, but, in some

cases, however, enlarged tonsils interfere with
general health, normal resonance, hearing acuity
( if E.T is blocked). A forward carriage of the
tongue may also persist --abnormal articulation

• Mouth breathing: the pt. may have a restricted

passageway to the nasal cavity.
Mouth breathing may be associated with anterior
posturing of the tongue at rest.
If the pt. have a hypo nasal speech &the problem
persistent --need for a referral to a physician.
 Interpreting the OFE
• Poor intraoral pressure:
• Poor maintenance of air in the cheeks
==labial weakness OR velopharyngeal
inadequacy:
• Velophayrengeal insufficiency (structural
problem)
• Velophayrengeal incompetency (functional
problem)
• Check: nasal emission/air escaping from
lips.
• Client may have dysarthria or/and
hypernasality
 Interpreting the OFE

• Prominent rugae may indicates:

• Abnormally narrow/ low palate or both
• Abnormally large tongue in relation to the palatal
areas
• May be associated with tongue thrust
• Short lingual frenum: This may result in an
articulation disorder.
• If the client is unable to place the tongue against
the alveolar ridge or teeth to produce sounds such
as /t/, /d/, etc.
• The frenum may need to be clipped by a physician.
Prominent rugae and lingual frenum
 Interpreting the OFE
• Weak or absent gag reflex: Neurological
impairment may be present ( some clients
have a very high tolerance for gagging).
• Often indicates muscular weakness in the
velopharyngeal area.
• Weakness of the lips, tongue, or jaw:
common with neurological impairments
( aphasia, dysarthria, or both)
 Assessing diadochokinetic syllable rates:
• Diadochokinetic syllable rates, alternating motion
rates (AMRS) or sequential motion rates (SMRs) ,
are used to evaluate a client’s ability to make
rapidly alternating speech movement .
• There are two primary ways to obtain these
measures.
• The first is by counting the number of syllable
repetitions a client produces within a
predetermined number of seconds. For example,
how many repetitions of /pa/ can the client
produce in 15 seconds?
• The second method is timing how many seconds it
takes the client to repeat a predetermined number
of syllables. For example, how many seconds does
it take to produce 20 repetitions of /pa/