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SPAA 210 > unit 2 > Flashcards

unit 2 Flashcards

1
Q

why use a screening tool?

A

Quickly & efficiently identify individuals who need further evaluation & those who don’t
Often used to evaluate a large group of individuals
-Kindergarten round-up
-3rd graders
-College students preparing for a profession with speech performance standards

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2
Q

informal screening

A

designed by the examiner
tailored to the population being screened
easy to designe
economical (no costly tests or forms to purchase)
No standardized administration procedures
No standardized norms to compare results
Examiner determines pass/fail criteria for the screen
“If in doubt, refer for further testing” rule

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3
Q

Informal Screening tasks - Children

A

Picture naming
Conversational speech
Results compared to speech sound development charts
In schools, parent permission is usually not required for a screening

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4
Q

Informal Screening tasks - Adults

A

Oral reading of sentences designed to elicit several productions of frequently misarticulated phonemes
Oral reading of a passage containing full phonetic repertoire
Informal conversation
Tasks allow informal screening of articulation, voice & fluency

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5
Q

My Grandfather (Van Riper, 1963) and The Caterpillar (Patel, 2013)

A

used to check speed of reading, intonation, pacing, speech intelligibility

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6
Q

Formal Screening Tests

A

Published elicitation procedures
Normative data and/or cutoff
scores available
Often related to or are part of a more comprehensive speech sound assessment
May screen phonology as well as other aspects of language

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7
Q

Fluharty Preschool Speech and Language Screening Test – 2nd edition

A

Designed for children ages 3 – 6 Speech sound assessment is 1
portion of the test
15 pictures objects elicit 30 target speech sounds
Standard scores & percentile ranks for the subtest are included

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8
Q

Assessment

A

The process that is followed and the procedures that are used to establish the presence of absence of a disorder

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9
Q

Diagnosis

A

Clinician’s judgment about the presence or absence of a disorder, including description of the severity and nature of the disorder

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10
Q

Assessment & Diagnosis Steps

A
  1. Conduct the assessment
  2. Score the tests & consolidate data
  3. Analyze the test results & relevant data
  4. Synthesize & interpret results
  5. Make a clinical diagnosis
  6. Make specific recommendations
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11
Q

Components of a Comprehensive Assessment

A
  1. Standardized articulation assessment
  2. Conversational speech assessment
  3. Stimulability testing
  4. Hearing screening
  5. Oral mechanism examination
  6. Additional tests
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12
Q

Pre-assessment – Written Case History

A

Typically conducted in outpatient settings (university clinic, outpatient clinic, private practice)
Caregivers are asked to complete written form in advance of evaluation, answering questions about their child’s development, birth, medical & educational history, and their description of the communication disorder
Information from case history can help clinician select appropriate assessment tools to meet needs of client

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13
Q

Pre-assessment - Interview

A

Supplements and clarifies information provided in the case history
Sample Questions
-Describe your concerns about your child’s speech
-How well do family members understand the child’s speech?
-Has the problem changed since you first noticed it?
What do you hope will result from today’s evaluation?

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14
Q

Standardized Articulation Tests

A

typically picture naming tasks

Assesses consonants in all 3 word positions (ignore vowels) some leave out the medial

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15
Q

advantages to standardized articulation tests

A

Relatively easy to give & score Intended production is known Provides a list of incorrect phonemes
Most provide standardized scores, to allow comparison to children of similar age
Scores can be used to document need for and progress in therapy

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16
Q

disadvantages to standardized articulation tests

A

Single word responses to selected words don’t give complete picture of a child’s speech sound abilities. Connected speech is not tested
Limited information about the child’s phonological system. Most don’t include phonological process analysis
Doesn’t assess all speech sounds
Only select consonant clusters evaluated Vowels typically not assessed

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17
Q

Articulation test procedures

A

Select test appropriate for client’s age & ability level
-Vocabulary & pictures
-Age range of standardized scores
Follow standardized test procedures
-Use verbal prompts provided as needed
-Use a direct verbal model (“say ___”) as a last resort

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18
Q

Whole Word Transcription

A

Gives detailed information on how phoneme was produced
Allows comparison of additional productions of sounds
Allows informal assessment of vowel production

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19
Q

Five-way scoring

A 
Correct 
Deletion/omission (-)
Substitution – transcribe phoneme produced
Addition – transcribe phonemes produced
Distortion – use diacritic marks
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20
Q

Goldman-Fristoe Test of Articulation – 2nd Edition (GFTA-2)

A

Most widely used articulation test
Evaluates consonants & some clusters
Sounds-In-Words subtest (picture naming)
Sounds-In-Sentences subtest (story retelling)
Stimulability assessment
Standardized norms for ages 2;0 – 21;11 for word portion of test

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21
Q

Arizona Articulation Proficiency Scale – 3rd Edition (Arizona-3)

A

**Good articulation test for older children, especially those with /r/ misarticulations
Evaluates consonants, some clusters & some vowels
Picture naming test using line drawings
Standardized norms for ages 1;6 – 18 years
Includes severity rating & speech intelligibility estimate

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22
Q

Clinical Assessment of Articulation & Phonology, 2nd Edition (CAAP-2)

A

Assesses both articulation & phonology Evaluates initial & final, some consonant
clusters for /r, s, l/ & few multisyllabic words
Picture naming test with colorful drawings
Standardized norms ages 2;6 – 11;11
Updated norms for new edition
Improved concurrent validity studies (when comparing scores to GFTA-2)
Available as an iPad App

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23
Q

Conversational Speech Assessment – Why is it important?

A

Significantly higher number of errors in connected speech than single word speech samples
35% of errors in connected speech were produced differently than at single word level
Higher incidence of phonological processes in connected speech

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24
Q

Conversational Speech Sample – What can be analyzed?

A

Sound productions in connected speech

Phonological processes Phonetic inventory Syllable structures Speech intelligibility

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25
Q

Conversational Speech Sample – How to elicit it

A

If possible, try to gain information about child’s interests
Prepare the clinical setting with toys & games
Resist urge to bombard the child with questions right away
Engage in parallel play & wait for child to initiate speech
Ask open-ended questions

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26
Q

Conversational Speech Sample – What to do with it

A

Record the sample for later analysis
Be sure to watch the child’s mouth during sound production – this won’t be on audio recording
Make notes during conversation
You need about 200 words, taking about 10 minutes to obtain
Write/type out utterances Use XXX to note unintelligible utterances
Transcribe errors
Analyze articulation errors – omissions, substitutions, additions, distortions
Analyze active phonological processes, using a list of production errors
Make list of phonetic inventory – sounds produced correctly by the child
Analyze syllable structures used
Estimate what % of the time you could understand child’s speech

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27
Q

Stimulability

A

“the client’s ability to make a correct or improved production of a misarticulated sound when given a model or additional stimulation by the examiner”

28
Q

Stimulability Assessment

A

ncluded with some articulation tests ◦ GFTA-2
◦ Test of Minimal Articulation
Competence
Can also be done informally
◦ Clinician identifies sounds produced in
error on articulation test to further probe with stimulability assessment

29
Q

Sound Selection

A

If only a few phonemes are in error, than stimulability testing usually evaluates all of them
If many sounds are in error, the clinician limits testing to those sounds that are potential therapy targets, considering:
◦ Age of client
◦ Developmental skills
◦ Type of errors
◦ Impact on speech intelligibility

30
Q

Instructions for Stimulability

A

he clinician instructs the client, “Watch my mouth and listen to me closely. I want you to say exactly what I say….”
After providing a model of the target sound (in isolation, syllables or words), the clinician instructions the client, “make the sound just like I made it.”

31
Q

How to stimulate correct sound production

A 
1. Verbal model
(clinician says it, client imitates it)
2. Visual cue
(uses mirror, show how to make it)
3. Placement cue
(clinician tells client how to make sound)
4. Tactilecue
(use tongue depressor to assist placement)
32
Q

Stimulability levels

A

Isolation, syllables, words, sentences

33
Q

Documenting & report results of stimulability

A

Typically scored as +/- for targeted sound

Results often indicated as % correct

34
Q

hearing screening

A

Should be completed for all speech sound assessments
SLPs are permitted to screen hearing, but not to perform full audiological evaluations
SLPs can’t diagnose hearing loss
Air-conduction screening for school- aged children is performed at
-1000, 2000, 4000 Hz at 20 dB bilaterally Using portable audiometers
-In a quiet environment
-Child should be facing away from tester
Child is instructed to raise hand when tone is heard
Preschool age children may need some play-based audiometry (toss small toy/block in bucket when sound is presented)
Screening is judged as pass/fail
◦ Pass - Must respond to all tones presented to
pass
◦ Fail – doesn’t respond to one or more tones
presented
If child fails screening:
◦ Rescreen in 1-2 weeks
◦ If fails again, report results to parent
◦ Recommend complete audiological evaluation

35
Q

IN State Guidelines hearing screening

A

Schools must screening hearing for:
Students in grades 1, 4, 7, and 10.
A student who has transferred into the school corporation.
A student who is suspected of having hearing defects.

36
Q

Oral Mechanism Exam

A

Important part of a comprehensive assessment

Helps to determine if the speech sound disorder is functional or organic in nature

37
Q

Organic Disorder

A

underlying structural, sensory or neurological cause can be identified

38
Q

Functional Disorder

A

those disorders for which a cause could not be determined

39
Q

what you are evaluating in oral mechanism exams

A

Face, Lips, Teeth, Tongue, Hard Palate, Soft Palate,

Appearance, Symmetry, Function, Range of Motion, Strength

40
Q

Exam Supplies for oral mechanism exam

A

Flashlight or penlight Tongue depressor Exam gloves

Oral mech. Exam form Pen/pencil

41
Q

General Advice for oral mechanism exam

A
  • Wear glove on hand that will be holding tongue depressor; operate flashlight and write with other hand
  • Give simple, clear verbal instructions & demonstrate the movement if child doesn’t respond to verbal command
  • Be sure to have a clear view of the child’s oral structures. To evaluate soft palate function, you will want to be eye level with the child’s mouth – don’t have them tilt their head back
42
Q

Diadochokinetic Rates (D-rates)

A

Designed to evaluate speed of movement of the articulators & assist in diagnosing motor speech disorders
In general, rates increase with age. Not usually evaluated in children under age 5
Alternating motion rate
 [pʌ-pʌ-pʌ], [tʌ-tʌ-tʌ], [kʌ-kʌ-kʌ]
Sequential motion rate [pʌ-tʌ-kʌ]
Measured in # of repetitions per second

43
Q

Reporting Results – Sample

A

“An Examination of the Oral Speech Mechanism was performed to determine if oral structure and function are adequate for speech
production. ___________errors/concerns were noticed during the exam. The child was ________________ to perform all tasks required and diadochokinetic rate was _________________. Oral motor structure and functions were judged to be ________________ for speech production.”

44
Q

Contextual Testing

A

Used to further assess error sounds
Searching facilitative phonetic context for correct production of the targeted phoneme
May help to find a key word to use in therapy
Can be informal probe (word list) created by clinician
May be a commercially available instrument (Clinical Probes of Articulation Consistency C-PAC)
2 way scoring (+/-) most often used
/r/ and /s/ frequently need contextual testing to determine starting point of therapy focus
Typically involves examining the error sound before & after most vowels and in more complex contexts, such as in long words and in clusters
Usually administered by direct imitation without need of pictured words. However, words should be familiar to young children and not contain more than 1 occurrence of the target sound per word

45
Q

facilitative phonetic context

A

surrounding sound or group of sounds that has appositive influence on the productive of the misarticulated phoneme

46
Q

key word

A

word in which a typically misarticulated sound is made correctly. Can be used in therapy to stabilize production of the sound across words.

47
Q

Auditory Perceptual Testing

A

a.k.a. Speech Discrimination testing
Completed when child demonstrates collapse of 2 or more phonemic contrasts into a single sound
E.g. /w/ for /l/ & /w/; /t/ for /t/ & /k/
Determines if child perceives the difference between the contrasts when spoken by clinician, even if he/she doesn’t produce them
Typically uses minimal pairs E.g. wake/lake, tea/key
Create a list of minimal pairs containing error and target sound
Find pictures to represent each word Place pair of pictured words in front of
child
Name both pictures to be certain child is familiar with the name
Cover your mouth and ask child to point to the named word
Complete several trails for each pair

48
Q

Language Screening Test

A

Research has demonstrated many children (more than 50%) with a speech sound disorder also have a language disorder
Many standardized language tests have screening versions of the test, designed to briefly evaluate receptive (understanding) and expressive (speaking) aspects of language
Expressive language deficits can also be identified during the conversational speech sample

49
Q

Diagnosis of Speech Sound Disorders- questions to answer

A 
does the child exhibit a speech sound disorder at this time
if yes:
describe the disorder
-type of problem (articulation vs. phonological)
-speech intelligibility estimate
-severity of the disorder
what further testing may be needed?
what is recommended for treatment?
what is the prognosis for improvement?
50
Q

Diagnosis of Speech Sound Disorders- Data Collected (Appraisal)

A 
Case history and parent interview information
Oral mechanism examination findings
Standardized articulation test results
Stimulability assessment results
Contextual/deep screening probe results
Conversational speech sample results
51
Q

Case History & Parent Interview

A

Parents’ concerns about the child’s speech
Second language or dialect influence
Developmental milestones First words & 2 word phrases Crawling, walking, etc..
Medical issues – potentially related to speech Comparison of child’s speech to siblings & peers Academic performance
Information from other professionals

52
Q

Oral mechanism examination findings

A 
Reduced, absent or asymmetrical movements
Reduced strength
Tongue size relative to oral cavity
-Microglossia
-Macroglossia
Evidence of structural deviations to hard/soft palate
-Missing or misaligned teeth
-Ankyloglossia
53
Q

Microglossi

A

(tongue is too small)

54
Q

Macroglossi

A

(tongue is too large)

55
Q

Ankyloglossi

A

(short or restricted lingual frenum-the part of skin that attaches the tongue to mouth)
-Can child elevate tip of tongue to the alveolar ridge?

56
Q

Standardized Articulation Test Result Analysis - Traditional

A

Traditional Analysis
Misarticulations by word position
 (initial, medial, final)
Type of errors made
(omissions, distortions, substitutions, additions)
Typical of single word articulation tests
Most appropriate method for children with few
articulation errors and relatively good speech
intelligibility
Nature of problem tends to be articulation rather than phonology

57
Q

Standardized Articulation Test Result Analysis - Patterns

A

Pattern Analysis – Identification of patterns in child’s
Most appropriate for a child with multiple misarticulations
Place-Voice-Manner Analysis – using consonant chart
Phonological Process Analysis
Report % of occurrence (+/= 40% active)
Note unusual or abnormal phonological processes
Compare results to developmental information on processes

58
Q

Conversational Speech Results

A

How does child’s errors compare to articulation test results?
Are the same error patterns noted in conversational speech?
Are additional errors noted in connected speech that didn’t occur in single word responses on the articulation test?
What % of child’s speech can be understood by the listener?
What is the child’s phonetic inventory?

59
Q

Estimating Speech Intelligibility- Rating Scales

A

3-point or 5 point scale

Percentage based clinical impression: 0, 25, 50, 75, 90, 100%

60
Q

Estimating Speech Intelligibility- Objective Analysis

A

Collect & record connected speech sample
Transcribe the sample
Use a symbol to note unintelligible words (eg. XXX) Calculate % intelligibility
# of words understood/total # of words spoken

61
Q

Stimulability assessment results

A

Identify which sounds are stimulable What linguistic level ?
(isolation, words, phrases)
What type of prompt was successful? In what word position?
Information is used in selecting treatment targets

62
Q

Contextual/deep screening probe results

A

Doesn’t help determine need for therapy Does help establish a possible starting point in
therapy
May reveal facilitative context for correct production of sound, which can be used in therapy
Can identify key word, which can be used as treatment approach

63
Q

Pulling it all together

A

Does child have a speech sound disorder?
What data supports the presence of a speech sound disorder?
Standardized test score Analysis of phonemes produced Phonological process analysis Speech intelligibility estimate
Is the disorder predominately articulation or phonological in nature?

64
Q

guidelines for articulation disorders

A

Child is + 5 years old
Predominately DISTORTIONS & common developmental substitutions (w for r or w for l)
Often /r/ and /s/ errors
Good speech intelligibility, but errors are noticeable
Usually not stimulable on error sounds

65
Q

guidelines for phonological disorders

A

Child is 5 years old or younger
Predominately omissions & substitutions.
Many PHONOLOGICAL PROCESSSES ACTIVE
Limited phonetic inventory (a lot of sounds missing)
sound system collapse (one sound used in place of many)
Fair to poor speech intelligibility
compared to same age peers
Often stimulable on error sounds

66
Q

What is the severity of the disorder?

A

Typically report severity as mild, moderate, severe
Consider:
Standardized test score – compare to normal curve  Nature of misarticulations (distortions vs. substitutions or omissions)
Impact on speech intelligibility
Age of child & developmental speech norms Active phonological processes compared to age

67
Q

Recommendations

A

Does child need further testing ? (language, literacy)
Does child need referral to audiology for hearing
evaluation?
Is therapy recommended?
Will focus of therapy be articulation or phonological treatment?
What are potential therapy targets (phonemes, phonological processes)?

SPAA 210 (3 decks)

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