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ASSESSMENTOFLANGUAGEDISORDERSINCHILDREN
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ASSESSMENTOFLANGUAGEDISORDERSINCHILDREN
RebeccaJ.McCauley
UniversityofVermont
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Copyright2001byLawrenceErlbaumAssociates,Inc.
Allrightsreserved.Nopartofthisbookmaybereproducedinanyform,byphotostat,microform,retrievalsystem,oranyothermeans,withoutthepriorwritten
permissionofthepublisher.
LawrenceErlbaumAssociates,Inc.,Publishers
10IndustrialAvenue
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CoverdesignbyKathrynHoughtalingLacey
LibraryofCongressCataloginginPublicationData
McCauley,RebeccaJoan,1952
Assessmentoflanguagedisordersinchildren/RebeccaJ.
McCauley.
p.cm.
ISBN:0805825614(cloth:alk.paper)/0805825622(pbk.:alk.paper)
1.LanguagedisordersinchildrenDiagnosis.2.Communicative
disordersinchildrenDiagnosis.3.Learningdisabledchildren
LanguageEvaluation.I.Title.
RJ496.L35M375200100050403
618.92855075dc21CIP
PrintedintheUnitedStatesofAmerica
10987654321
Pagev
Tomyparents,
FredandPriscillaMcCauley
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Contents
Preface xi
WhyIWroteThisBook
HowThisBookIsOrganized
Acknowledgments
1 Introduction 1
PurposesofThisText1
WhyDoWeMakeMeasurementsintheAssessmentandManagementofChildhoodLanguageDisorders?2
WhatProblemsAccompanyMeasurement?4
AModelofClinicalDecisionMaking7
Summary11
KeyConceptsandTerms11
StudyQuestionsandQuestionstoExpandYourThinking12
RecommendedReadings12
References12
PARTI:BASICCONCEPTSINASSESSMENT
2 MeasurementofChildrensCommunicationandRelatedSkills 17
TheoreticalBuildingBlocksofMeasurement17
BasicStatisticalConcepts24
CharacterizingthePerformanceofIndividuals30
CaseExample38
Summary43
KeyConceptsandTerms44
StudyQuestionsandQuestionstoExpandYourThinking46
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RecommendedReadings47
References47
3 ValidityandReliability 49
HistoricalBackground49
Validity51
Reliability66
Summary72
KeyConceptsandTerms73
StudyQuestionsandQuestionstoExpandYourThinking75
RecommendedReadings76
References76
4 EvaluatingMeasuresofChildrensCommunicationandRelatedSkills 78
ContextualConsiderationsinAssessment:TheBiggerPictureinWhichAssessmentsTakePlace79
EvaluatingIndividualMeasures88
Summary105
KeyConceptsandTerms106
StudyQuestionsandQuestionstoExpandYourThinking106
RecommendedReadings107
References107
PARTII:ANOVERVIEWOFCHILDHOODLANGUAGEDISORDERS
5 ChildrenwithSpecificLanguageImpairment 113
DefiningtheProblem113
SuspectedCauses116
SpecialChallengesinAssessment127
ExpectedPatternsofLanguagePerformance130
RelatedProblems132
Summary137
KeyConceptsandTerms138
StudyQuestionsandQuestionstoExpandYourThinking139
RecommendedReadings140
References140
6 ChildrenwithMentalRetardation 146
DefiningtheProblem147
SuspectedCauses149
SpecialChallengesinAssessment156
ExpectedPatternofStrengthsandWeaknesses158
RelatedProblems161
Summary161
KeyConceptsandTerms162
StudyQuestionsandQuestionstoExpandYourThinking163
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RecommendedReadings164
References164
7 ChildrenwithAutisticSpectrumDisorder 168
DefiningtheProblem169
SuspectedCauses173
SpecialChallengesinAssessment174
ExpectedPatternsofLanguagePerformance176
RelatedProblems178
Summary181
KeyConceptsandTerms182
StudyQuestionsandQuestionstoExpandYourThinking183
RecommendedReadings184
References184
8 ChildrenwithHearingImpairment 187
DefiningtheProblem188
SuspectedCauses196
SpecialChallengesinAssessment198
ExpectedPatternsofOralLanguagePerformance203
RelatedProblems204
Summary205
KeyConceptsandTerms205
StudyQuestionsandQuestionstoExpandYourThinking206
RecommendedReadings207
References207
PARTIII:CLINICALQUESTIONSDRIVINGASSESSMENT
9 ScreeningandIdentification:DoesThisChildHaveaLanguageImpairment? 213
TheNatureofScreeningandIdentification214
SpecialConsiderationsWhenAskingThisClinicalQuestion216
AvailableTools236
PracticalConsiderations240
Summary242
KeyConceptsandTerms243
StudyQuestionsandQuestionstoExpandYourThinking244
RecommendedReadings244
References244
10 Description:WhatIstheNatureofThisChildsLanguage? 250
TheNatureofDescription251
SpecialConsiderationsforAskingThisClinicalQuestion252
AvailableTools 255
PracticalConsiderations280
Summary283
KeyConceptsandTerms284
StudyQuestionsandQuestionstoExpandYourThinking286
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RecommendedReadings286
References287
11 ExaminingChange:IsThisChildsLanguageChanging? 293
TheNatureofExaminingChange294
SpecialConsiderationsforAskingThisClinicalQuestion296
AvailableTools311
PracticalConsiderations317
Summary321
KeyConceptsandTerms322
StudyQuestionsandQuestionstoExpandYourThinking323
RecommendedReadings324
References324
AppendixA 328
AppendixB 334
AuthorIndex 339
SubjectIndex 353
Pagexi
Preface
WhyIWroteThisBook
HowThisBookIsOrganized
Acknowledgement
WhyIWroteThisBook
Youcantkillanyonewithspeechlanguagepathology.
IcametospeechlanguagepathologybywhatwasthenanunconventionalrouteaPh.D.inanonclinicalspecialitywithinbehavioralsciences,followedby
postdoctoralstudy,clinicalpracticum,andaclinicalfellowshipyear.Thus,Iwasunschooledinthehumorouswisdomthatispassedalongwithmorestandardfareto
speechlanguagepathologydoctoralstudentsthroughtheyears.Iwasabletogleanonlyoneortwosuchaphorismsfrommycontactswithamoreconventionally
trainedandclinicallysavvycolleague.
Youcantkillanyonewithspeechlanguagepathology,shesaid.Abalmtotheanxietiesofabeginningclinicianwhoknowsthatthereissomuchshedoesnotknow.
Abitofhumortohelpyouwhileyoulearn.However,themoreclientsIworkedwith,themoreIwashauntedbythisaphorism.Certainly,killingwasexceedinglyrare
tononexistent,butloominglargewerethespectersofunfulfilledhopesandwastedtime.Thepossibilityforimprovingchildrenslivesbecameeverclearer,butsodid
thepossibilityoflessdesirableoutcomes.
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Initiallymyclientswerepreschoolerswhoseparentswerebaffledbytheirchildrensfailuretoexpressthemselvesclearly,ortheywereschoolagedchildrenwhowere
diagnosedwithbothlanguagelearningdisabilitiesandseriousemotionalproblems.Morerecently,myclientshaveincludedunintelligiblechildrenwhoseproblemswere
largelylimitedtotheirphonologyaswellaschildrenwhoseproblemsencompassednotonlythatoneaspectoflanguage,butalmostallotherareasonemightexamine.
Alloftheseclientslikethosewithwhomyoucurrentlyworkorwillsoonworkpresentuswithpuzzlestobesolvedandresponsibilitiestobemetifwearetohelp
them.
Thepuzzlepresentedbychildrenwithlanguagedisordersisthearrayofabilitiesanddifficultiesthattheybringtolanguagelearninganduse.Iusethewordpuzzle
because,likepuzzles,theirproblemsatfirstsuggestmanyalternativemodesofsolutionsomebetter,someworse,andsomeprobablyofnovalueatall.Thus,
responsibilitiesfollowfromourprofessionalobligationtohelpchildrenmaximizetheirskillsandminimizetheirproblemsintheprocessofdecipheringtheparticular
patternofintricaciestheypresent.
Inshort,thereasonIwrotethisbookwastohelpidentifybetterwaysofdealingwiththepuzzlesandresponsibilitiesthataresofrustratinglylinkedinourinteractions
withourclients.Byfindingthebestwaysofdealingwiththesepuzzlesandresponsibilitieswecanavoidtheharmimpliedbytheaphorismquotedearlierandcan
insteadenrichtheirlivesbyhelpingthemimprovetheircommunicationwithothers.
HowThisBookIsOrganized
OverallOrganizationoftheBook
Thisbookisdividedintothreemajorsections.InPartI,conceptsinmeasurementareexplainedastheyapplytochildrenscommunication.Althoughsomeofthese
conceptsarequantitativeinnature,othersrelatetothesocialcontextinwhichmeasurementsaremadeandused.Specialemphasisisplacedontheconceptsofvalidity
andreliabilitybecauseallothermeasurementcharacteristicsareultimatelyofinterestbyvirtueoftheireffectsonreliabilityand,moreimportantly,onvalidity.Thispart
ofthebookconcludeswithachapterprovidingdirectadviceregardingtheexaminationofmaterialsassociatedwithmeasurementtoolsforpurposesofdetermining
theirusefulnessforaparticularchildorgroupofchildren.
InPartII,fourmajorcategoriesofchildhoodlanguagedisordersarediscussed:specificlanguageimpairment(chap.5),languageproblemsassociatedwithmental
retardation(chap.6),autismspectrumdisorders(chap.7),andlanguageproblemsassociatedwithhearingimpairment(chap.8).Thesefourcategorieswereselected
becausetheyarethemostfrequentlyoccurringchildhoodlanguagedisorders.Althoughchildrenacrossthesedisordercategoriessharemanyproblems,eachgroupalso
presentsuniquechallengestoassessmentandmanagement.Someofthesechallengesrelatetotheheterogeneityoflanguageandotherabilitiesshownbychildreninthe
category,therelativeamountofinformationavailableduetotherarityoftheproblem,andtheoftendiversetheoreticalorientationsofresearchers.Eachofthese
chaptersprovidesabarebonesintroductiontothedisordercategory:itssuspectedcauses,
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specialchallengestolanguageassessment,expectedpatternsoflanguageperformance,andaccompanyingproblemsthatareunrelatedtolanguage.Afulldescriptionof
anyoneofthesedisorderswouldrequireseveralbooksaslongasthisone.Consequently,readersaredirectedtomorecomprehensivesourcesforfurtherlearningbut
aregivensufficientinformationtoanticipatehowlanguageassessmentwillneedtobefocusedinordertobegintorespondtothespecialneedsofeachgroupof
children.
InPartIII,threemajortypesofquestionsthatserveasthestartingpointsforassessmentareintroducedandthenpursuedindetailfromtheoreticalunderpinningsto
currentlyavailablemeasures.Themajorquestionscorrespondtostepsintheclinicalinteraction.First,theclinicianmustdeterminewhetheralanguageproblemexists
second,heorshemustdeterminethenatureoftheproblembothintermsofspecificpatternsofimpairmentacrosslanguagedomainsandmodalitiesandintermsof
specificproblemareaswithineachdomainandmodality.Finally,heorshemusttrackchange,determininghowtheclientsbehaviorsarechangingandwhether
treatmentseemstobethecauseofidentifiedimprovements.Inthecourseofaddressingeachofthesequestions,thereaderistakenthroughthestepsrequiredtomove
fromthequestiontothetoolsavailabletoansweritforanygivenclient.
OrganizationwithinChapters
Eachchaptercontainsseveralfeaturesdesignedtoassistreadersinmasteringnewcontentandinsearchingthetextforspecificinformation.Chapteroutlinesand
enumeratedsummariesofmajorpointsaidreadersinterestedinobtaininganoverviewofchaptercontent.Tohelpreaderswithneworunfamiliarvocabulary,keyterms
arehighlightedinthetext,definedwhenofparticularimportance,andlistedattheendofeachchapter.Finally,alistofstudyquestionsandrecommendedreadingsis
designedtoallowreaderstopursuetopicsfurther.
Acknowledgments
Whereastheflawsofthisbookarecertainlyofmyowndoing,itsvirtuesowemuchtothehelpIhavereceivedfromcolleaguesandfriends.Numerouscolleaguesin
Vermontandelsewherereadsectionsofthebookandcontributedgreatlytomyunderstandingofthediversegroupofchildrendescribedinitanddeservemy
considerablethanks.AmongthemareMelissaBruce,KristeenElaison,LauraEngelhart,JulieHanson,andJulieRoberts.Inaddition,Iowespecialappreciationto
BarryGuitar,whoseexperiencewithhisownbookshelpedhimprovidethemostmeaningfulencouragementandadviceonallaspectsoftheproject.Iamparticularly
gratefulforhisabilitytotemperconstructivecriticismwithegoboostingpraise.MylongtimecolleagueandfriendMarthaDemetrastookonaheroicandmosthelpful
readingofanearfinalformofthebook.ShealongwithFrancesBilleaud,BernardGrelaandElenaPlantereadsomeofthemostchallengingsectionsandtriedtohelp
keepmeontrack.AtLawrenceErlbaumAssociates,SusanMilmoe,KateGraetzer,JennyWiseman,andEileenEngelhavehelpedmecountlesstimesthroughtheir
expertiseandpatience.IreneFarrartookmygraphicsandmadethembothclearerandmoreinter
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estingandKathrynHoughtalingmadethecoverallIcouldhavehopedfor.ShedidthiswithhelpofthephotographerHollyFavroandhermostgracefulnieceSara
Faust.
Althoughnotinvolvedwiththisprojectdirectly,thereareseveralmentorswhohaveshapedmyinterestinthetopicsdiscussedhereandcontributedsubstantiallytomy
abilitytotacklethosetopicsaswellasIhave.Theyhavemyrespectandgratitudealways:RalphShelton,LindaSwisher,BettyStark,DickCurlee,andDaleTerbeek.
Finally,Iowegreatthankstomyparents,whoeachreadandcommentedonsomeportionofthebookandwhoprovidedencouragementalongtheway,notto
mentionthefoundationthatledmetowanttopursuethisproject.
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CHAPTER
1
Introduction
PurposesofThisText
WhyDoWeMakeMeasurementsintheAssessmentandManagementofChildhoodLanguageDisorders?
WhatProblemsAccompanyMeasurement?
AModelofClinicalDecisionMaking
PurposesofThisText
Thedistraughtparentsofa3yearoldwithdelayedcommunicationarriveattheofficeofaspeechlanguagepathologist,youngsterintowandanxietyemanatingalmost
palpablywitheveryword:Doesourchildhaveaseriousproblem?Whatcanbedonetocorrectit?Howeffectivewilltreatmentbe?
Althoughthechildrenandthespecificquestionschange,thesceneremainsthesame:Achildsparentsorteacherturntoaspeechlanguageclinicianforhelpthatwill
includeanswerstospecificquestionsaboutwhetheralanguageproblemexists,itsnature,andhowtointervenetominimizeorremoveitseffects.Thisbookfocuseson
basicelementsofmeasurementofchildhoodlanguagedisordersasthemeansofprovidingvalidclinicalanswerstothesequestionsbecauseonlywithvalidclinical
answerscaneffectiveclinicalactionbetaken.
Specifically,thisbookisdesignedtopreparereaderstoselect,create,andusebehavioralmeasuresastheyassess,manage,andevaluatetreatmentefficacyforchil
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drenwithlanguagedisorders.Althoughitisdesignedtoprovideguidanceforthoseworkingwithchildrenwithanylanguagedisorder,thegreatestattentionispaidto
specificlanguageimpairment,autism,andlanguagedisordersrelatedtomentalretardationandhearingimpairment.
Thisbookisintendedprimarilyforgraduateandundergraduatestudentswhoexpecttoenterthefieldofcommunicationdisorders.Itmayalsoserveasarefresherfor
professionals,suchaspracticingspeechlanguagepathologistsorteachers,whohaveneverbeenformallyintroducedtosomeofthebasicconceptsbehindthewide
rangeofmeasuresusedintheassessmentofchildhoodlanguagedisordersorwhowouldlikeanintroductiontothelatestdevelopmentsinthisarea.
Unfortunately,thetopicofmeasurementinchildhoodlanguagedisordershasthereputationofthreateningcomplexity.Indeed,measurementoflanguage,or
communicationmoregenerally,iscomplexbothbecauseofthewealthofabilitiesandbehaviorsunderlyinglanguageuseandbecauseofthevarietyofmeasurement
orientationsonwhichspeechlanguagepathologyandaudiologydraw.Althoughdirectrootsineducationalandpsychologicaltestingtraditionsareparticularlyrobust,
therearealsoconnectionstomeasurementtraditionsinlinguistics,personnelmanagement,medicine,publichealth,andevenacoustics.Theapproachtakenhere
attemptstoblendthebestofthesetraditionsandalertreaderstotheelementstheyshare.
Forallreaders,thetextisintendedtoachievethreegoals.First,readerswilllearntorecognizethebondthattiesthequalityofclinicalactionstothequalityof
measurementusedintheprocessofclinicaldecisionmakingforchildrenwithsuspectedlanguagedisorders.Second,theywilllearnhowtoframeclinicalquestionsin
measurementtermsbyconsideringtheinformationneededandthespecificmethodsavailabletoanswerthem.Third,theywilllearntorecognizethatallmeasurement
opportunitiespresentalternativesattimesalternativesofcomparablemerit,butmoreoftenalternativesthatvaryintheirabilitytoanswertheclinicalquestionathand.
Thislastgoalwillenablereaderstoactascriticalconsumersanddiscriminatingdevelopersofclinicaltoolsforlanguagemeasurement.Caseexamplesareused
frequentlyinthetexttohelpreadersapplynewconceptsandmethodstospecificproblemslikethosetheycurrentlyfaceorwillsoonencounter.
WhyDoWeMakeMeasurementsintheAssessmentandManagementofChildhoodLanguageDisorders?
Thefollowingthreecasesillustrateavarietyofoccasionsinwhichmeasurementservesasthebasisforclinicalactionsinvolvingchildrenwithvariouslanguage
difficulties.
TwoyearoldCameronhasbeenscheduledforacommunicationevaluationbecauseofparentalconcernsthatheusesonlytwowordsanddoesnotappear
tounderstandaswellashisoldersisterdidatamuchyoungerage.Additionally,hegenerallyavoidseyecontact,whichhisparentsfindparticularly
alarmingbecauseofrecentexposuretoatelevisionshowonautism.Thus,theyhavespecificquestionsaboutwhethertheirchildhasautismandwhatthey
candotoimprovehisabilitytocommunicatewithothermembersofthefamily.
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Alejandro,adiminutive9yearoldwhohardlyseemsimposingenoughforsuchadistinguishedname,movedfromMexicototheUnitedStatesayearago,
hasjustmovedintoanewschooldistrict.Althoughhehasbeendiagnosedwithalanguagedisorder,noinformationconcerningtherelationofthat
languagedisordertohisbilingualismhasaccompaniedhimtohisnewschool.Decisionsregardinghisschoolplacementandaccesstospecialserviceswill
hingeonthatinformation.
FouryearoldMaryBethhasbeenreferredbyherpediatriciantoyourprivatepracticeforacompleteevaluationofhercommunicationskills.Althoughshe
hasbeenreceivingspeechlanguagetreatmentsinceshewas2yearsofagebecauseofDownsyndrome,MaryBethhasnotmadeprogressattherate
expectedbyherregularspeechlanguagepathologistordesiredbyherparents.Infact,sheappearstohavemadealmostnoprogressinthepastyearand
maybelosingskillsinsomeareas.
Thesethreecasesillustratethevariedproblemsfacingchildrenandfamilieswhoturntospeechlanguagepathologistsforsolutions.Theyalsoillustratethespeech
languagepathologistsroleaspartofalargerteamofprofessionals.
First,Cameronsparentsarefacedwithachildwhoappearsquitedelayedinhisexpressiveandreceptivelanguageandwhomayalsoevidencedifficultiesinthe
nonverbalunderpinningsofcommunication.Addressingtheirchiefconcernwillrequireaninterdisciplinaryeffortinvolvingseveralprofessionals(includingpossiblya
psychologist,aneurologist,adevelopmentalpediatrician,andasocialworker)designedtoyieldadifferentialdiagnosis.Ifautismisdiagnosed,theneedfor
interdisciplinaryeffortswillcontinuebecauseofthearrayofproblemsoftenassociatedwithautismrangingfrommentalretardationtosleepdisorders.Thefamilys
needs,aswellasthechilds,maybeintense,withtheresultthatthespeechpathologistsfocusonthechildscommunicationmaybroadentoencompassthefamily
communicationcontextaswellasthecoordinationofeffortsaimedatthechildsoverallneeds.
Alejandropresentsthespeechlanguagepathologistwiththedifficulttaskofdeterminingtowhatextenthislanguagedifficultiesaredifferencesnotunlikethosefacing
anyonewithundevelopedskillsinanewlanguageversustowhatextenttheyreflectanunderlyingdisorderinlanguagelearningaffectingbothhisnativeandsecond
languages.Inadditiontodecisionsregardingthenatureofdirecttherapythatheshouldreceive(includingwhetheritshouldbeconductedinSpanishorEnglish),critical
decisionsregardinghisclassroomplacementsarepressing.Notonlywillthespeechlanguagepathologistneedtoworkcloselywithhisfamilyandteacherstoreach
thesedecisions,heorshemayalsoneedtoworkwithatranslatororculturalinformanttoarriveatthebestdecisionsforAlejandrosacademicandsocialfuture.
Finally,MaryBethsparentsandpediatricianareinterestedinreceivinginformationthatwillshedsomelightonherlackofprogressinspeechlanguagetreatment.Such
informationcouldhelpguidehersubsequenttreatmentbyprovidingherparents,pediatrician,andregularspeechlanguagepathologistwithabetterunderstandingofher
currentstrengthsandweaknessesand,consequently,abetterunderstandingofreasonablenextsteps.Itshouldbenoted,however,thatMaryBethsparentsmightalso
usethisinformationastheyconsidersuingthespeechlanguagepathologistresponsibleforhercare.Althoughthisprospectisremote,itisnonethelessanincreasing
possibility(Rowland,1988).
Thesethreecasesrevealthatspeechlanguagepathologistsareaskedtoobtainanduseinformationtohelpchildrenfromavarietyofculturalbackgroundsandarange
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ofcommunicationproblems.Althoughtheyobtainmuchofthatinformationdirectly,theymustoftenworkwithfamiliesandotherprofessionalstostandachanceof
gettingthefacts.Speechlanguagepathologistsusesomeofthisinformationthemselves,suchaswhentheyidentifyanddescribealanguagedisorderorplantheirrole
intreatment.Theyalsoshareinformationwithothers,includingdoctors,teachers,andotherindividualswhoworkwithpersonsexperiencingacommunicationdisorder.
Inbrief,then,speechlanguagepathologistsgenerate,use,andshareinformationhavingpotentiallyvitalmedical,educational,social,andevenlegalsignificance.
Sohowdoesmeasuremententerintothestrategiesusedtoaddresschildrensneeds?Putsimplyandintermsspecifictoitsuseincommunicationdisorders,
measurementcanbeseenasthemethodsusedtodescribeandunderstandcharacteristicsofpersonsandtheircommunicationaspartofclinicaldecisionmaking,
theprocessbywhichthecliniciandevisesaplanforclinicalaction.Thus,itistheconnectionbetweenclinicaldecisionsandclinicalactionthatmakesmeasurement
matter(Messick,1989).Cliniciansmakenumerous,almostcountlessdecisionsaboutachildinthecourseofaclinicalrelationshipfromdeterminingthata
communicationdisorderexists,toselectingageneralcourseoftreatment,toexaminingtheefficacyofaveryspecifictreatmenttask.Becausetheclinicianbasesher
actionsatleastinpartonmeasurementdataobtainedfromtheclient,thequalityoftheactionwillbecloselyrelatedtothequalityofthedatausedtoplanit.Thesection
thatfollowsconsidersseveraldecisionpointsthatofferopportunitiesforsuccessesorfailuresinclinicaldecisionmaking.
WhatProblemsAccompanyMeasurement?
Table1.1listsfivedifferentkindsofdecisionsoccurringinthecourseofaclinicalrelationshipaswellassomeofthemeasuresthatmightbeusedtoprovideinputto
eachdecision.Thislistingisintendedtoillustratethevarietyofdecisionstobemaderatherthantolistthemexhaustively.Asillustratedinthetable,decisionmaking
beginsevenpriortotheinitiationofanongoingclinicalrelationship,asthespeechlanguagepathologistscreenscommunicationskillstodeterminewhetheradditional
attentioniswarranted.Subsequently,theclinicianwillrequiremoreinformationtounderstandthenatureoftheproblempresentedandtoarriveatdecisionsabouthow
besttomanageit.Onceaprogramofmanagementisinplace,ongoingmeasurementisrequiredtorespondtotheclientschangingneedsandaccomplishments.Even
theendoftheclinicalrelationshipisbasedonthecliniciansuseofmeasurementwithdismissalfromtreatmentusuallyoccurringwhencommunicationskillsare
normalized,maximumgainshavebeeneffected,ortreatmenthasbeenfoundtobeunsuccessful.Ateachofthepointsofdecisionmaking,thepotentialforharmenters
handinhandwiththepotentialforbenefit.
AbriefreconsiderationofthecaseofMaryBethcanbeusedtoillustratethepotentialforclinicalharmaswellastointroduceamethodforevaluatingtheeffectsof
differentkindsoferrorsindecisionmaking.RecallthatMaryBethhasreceivedspeechlanguagetreatmentfor2yearsbecauseofanearlydiagnosisofDown
syndrome.Herlackofanyprogressinspeechandlanguageoverthepastyear,orworseyet,herlossof
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Table1.1
ClinicalDecisionsinSpeechLanguagePathology
l Referforcompleteevaluation
l Clientandfamilyinterview
l Counselclientandfamily
Screeningforalanguagedisorder l Standardizedscreeningmeasure
l Informandconferwithrelevantprofessionals
l Informalcliniciandesignedmeasure
l Referforrelatedevaluations
l Recommendtreatment,monitoring,ornotreatment l Clientandfamilyinterview
Diagnosisofalanguagedisorder l Counselclientandfamily l Standardizednormreferencedtests
l Informandconferwithrelevantprofessionals l Parentreportinstruments
l Standardizednormreferencedorcriterion
l Recommendtypeandfrequencyoftreatment
referencedtests
l Identifystrengthsandweaknessesin
l Informalmeasuresrelatedtospecifictreatmentgoals
Planningformanagementoflanguagedisorder communicativefunctioning
orusedtodescribedomainsforwhichmeasuresare
l Consultwithprofessionalsservingclientneeds
unavailableorthatrequirearealisticsetting(e.g.,
(e.g.,educators,psychologists,physicians)
functionalperformanceintheclassroom)
l Inferdevelopmentaltrends l Standardizednormreferencedorcriterion
l Modifytreatmentplan referencedtests
Assessmentofchangeincommunicationovertime
l Documenttreatmentefficacy l Informalmeasuresrelatedtospecifictreatmentgoals
l Dismissfromtreatment l Singlesubjectexperimentaldesigns
l Clientandfamilyinterview
Identificationofneedforadditionalinformationina l Refertoarelatedprofessionalforadditional
l Standardizednormreferencedtests
relatedarea information
l Informalcliniciandevisedmeasure
skills,mayrepresentapoorfitbetweentheassessmenttoolsusedtomeasureprogressandtheareasinwhichMaryBethhasinfactadvanced,oritmayrepresent
someunsatisfactoryclinicalpracticeofherregularspeechlanguagepathologist.Ontheotherhand,thislackofprogressmayreflectachangeinMaryBeths
neurologicalstatusthatrequiresmedicalattention.Therefore,oneofthemostimmediatedecisionstobemadefromaspeechlanguageperspectiveiswhethertorefer
MaryBethtoaneurologist.
Figure1.1,adecisionmatrix,illustratesamethodforthinkingaboutthepossibleoutcomesassociatedwiththisparticulardecision.Thistypeofdecisionmatrixhas
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Fig.1.1.AdecisionmatrixforthedecisionofwhethertoreferMaryBethforneurologicevaluation.
beenusedtoassesstheimplicationsofalternativechoicesinavarietyoffields(Berk,1984Thorner&Remein,1962Turner&Nielsen,1984).Toconstructsucha
matrixasameansofconsideringrepercussionsforasinglecase,onepretendsthatonehasaccesstotheultimatetruthaboutwhatisbestforMaryBeth.Fromthat
perspective,areferraleithershouldorshouldnotbemadenodoubts.
Withsuchperfectknowledge,therefore,supposethatareferralshouldbemade.Inthatcase,theclinicianwillhavemadeacorrectjudgmentifheorshehasreferred
andanincorrectoneifheorshehasnot.Iftheclinicianerrsbynotreferring,MaryBethmaybecomeinvolvedintheexpenseandfrustrationofcontinuingspeech
languagetreatmentthatisdoomedtofailure.Furthershemaybedelayedinorpreventedfromreceivingattentionforanincipientneurologiccondition,which,inturn,
couldhaveserious,evenlifethreateningconsequences.Althoughthiserrormightbecorrectedovertime,itseffectsarelikelytoberelativelylonglastingandpotentially
costlyintermsoftimeandmoney.
Ontheotherhand,supposethatthetruthisthatareferralisnotneededandthereforeshouldnotbemade.Inthatcasetheclinicianwillhavemadeacorrect
judgmentifshehasnotreferredandanerrorifshehas.Plausibly,thistypeoferrormayresultinaneedlessexpenditureoftimeandmoneyandinundueconcernonthe
partofMaryBethsfamily.Abitmorepositively,however,theeffectsofthiserrorwouldprobablyberelativelyshortlived:Oncetheneurologicevaluationtookplace,
theconcernwouldprobablyend.
Adecisionmatrixmakesitclearthatdifferenterrorsinclinicaldecisionmakingareassociatedwithdifferenteffects.Errorsvaryintermsofthelikelihoodthatthey
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willbedetected,thetimecourseforthatdetection,andthenatureofcoststheywillexactfromtheclientandclinician.Thedecisionmatrix,therefore,isaparticularly
powerfultoolbecauseitallowsonetoexamineboththefrequencyandtypeoferrorsmade.Ireturntothistypeofmatrixfrequentlybecauseofitshelpfulnessin
thinkingabouttoolsusedtoreachclinicaldecisions.
Inthenextsectionofthischapter,Iintroducemethodsusedtounderstand(andthereforepotentiallytoimprove)clinicaldecisionmaking.Theirdescriptionisfollowed
bytheintroductionofamodelthatisintendedtoserveasaframeworkinwhichtothinkaboutthestepsinvolvedinformulatingandansweringclinicalquestions.
AModelofClinicalDecisionMaking
Theprocessesbywhichindividualsmakedecisionsaboutcomplexproblemssuchasthoseinvolvedinavarietyofclinicalsettingshavebeenthefocusofseveral
linesofresearch(Shanteau&Stewart,1992Tracey&Rounds,1999).Eachdiffersfromtheotherssomewhatinintent,butallhavesomethingtoofferanyone
interestedinclinicaldecisionmaking.
First,decisionmakinghasbeenofinteresttopsychologistswhowanttounderstandhowcomplicatedproblemsaresolvedandtowhatextentthosewhoare
acknowledgedexpertproblemsolversinagivenarea(e.g.,chess,medicine,accounting)differfromnaiveproblemsolvers(Barsalou,1992).Second.skilleddecision
makinghasbeenstudiedbyresearchersfromavarietyofdisciplineswhowishtodevelopcomputerprogramscalledexpertsystems,whichseektomimicexpert
performance(Shanteau&Stewart,1992).Suchresearchershavefocusedonthecreationofcomputerprogramsyieldingoptimalclinicaljudgments.Becausethey
focusonsuccessfuldecisionmaking,theseresearchershavebeenuninterestedinunderstandingexperterrorsindecisionmaking.Finally,therehasbeenamuchsmaller
groupofresearcherswhostudythenatureandprocessofdecisionmakinginspecificfieldsforthebenefitofthefielditself.Inspeechlanguagepathologyand
audiology,suchresearchhasincreaseddramaticallyoverthelastdecade(e.g.,McCauley&Baker,1994Records&Tomblin,1994Records&Weiss,1991).
Researchersinthisthirdcategorytendtobeinterestedinbotherrorsandsuccessfulperformance,oftenasameansofimprovingprofessionaltraining.
Youmaybeasking,Howdoesresearchondecisionmakingrelatetomeasurementinspeechlanguagepathology?andmorespecifically,Howcanithelpmebea
betterprofessional?Tobeginwith,adetailedunderstandingofexpertclinicaldecisionmakingmayhelpbeginningcliniciansreachtheranksofexpertmorequickly.
Forexample,suchanunderstandingmayidentifywhichsourcesofinformationandwhichmethodsexpertsuseaswellaswhichonestheyavoid.Anotherpotential
benefitofresearchinclinicaldecisionmakingisthatitmayidentifyproblemsthatbesetevenexperiencedclinicians,therebyhelpingdecisionmakersatalllevelsbe
vigilantinavoidingthem(e.g.,Faust,1986Tracey&Rounds,1999).Arelativelybriefdescriptionoftwosuchproblemsmayhelpillustratethepotentialvalueofthis
typeofresearch.
Inareviewofresearchonhumanjudgmentinclinicalpsychologyandrelatedfields,Faust(1986)describedcliniciansoverrelianceonconfirmatorystrategies.
Essentially,theuseofaconfirmatorystrategymeansthatafterformingahypothe
Page8
sisearlyinthecourseofdecisionmaking(e.g.,regardingadiagnosis,etiology,orsomeotherclinicalquestion),theclinicianproceedstosearchoutandemphasize
informationtendingtoconfirmthehypothesis.Atthesametime,sheorhemayfailtosearchoutdiscrepantevidence.Thetendencyforveryableclinicianstoadopt
suchastrategyhasbeendemonstratedrepeatedlyinstudiesinwhichcliniciansareaskedtomakedecisionsonhypotheticalclinicaldata(Chapman&Chapman,1967,
1969Dawes,Faust,&Meehl,1993).
Foranexampleofhowaconfirmatorystrategymightoperateinacaseofdecisionmakinginspeechlanguagepathology,IreturntothecaseofAlejandro.Suppose
thatAlejandrosclinicianinitiallydevelopsthehypothesisthatAlejandrorespondsmostconsistentlywhencommunicatinginEnglish.Theclinicianwouldbeusinga
confirmatorystrategyifsheorhefailedtoevaluateAlejandrosperformanceforSpanishandinformallysoughtteachersimpressionsofhowwellAlejandrowas
respondingtotheEnglishonlyapproachshehadrecommended,butdidsoinsuchawayastoinviteonlypositivereactions.
Asecondexampleofaprobleminclinicaldecisionmakinghasbeendescribedasthefailuretorealizetheextenttowhichsamplingerrorincreasesassamplesize
decreases.(Faust,1986,p.421).TverskyandKahneman(1993)describedthispracticeasevidenceofthebeliefinthelawofsmallnumbers,bywhichthey
meanthetendencytoassumethatevenaverysmallsampleislikelytoberepresentativeofthelargerpopulationfromwhichitisdrawn.Returningtooneofthe
hypotheticalcasespresentedearlier,imaginethissortofproblemasmenacingtheclinicianwhoistoevaluateMaryBeth,theyoungsterwithDownsyndrome.Suppose
thatthatclinicianweretohaveseenonlytwoorthreechildrenwithDownsyndromeduringherclinicalcareereachofwhomhadmadeexceptionallypoorprogress.
Thedangerwouldbethattheclinicianwouldconsiderthosefewchildrenshehadseenasrepresentativeofallchildrenwiththatdiagnosis,therebycausingherto
downplaythestatedconcernsaboutMaryBethslackofprogress.
Neitheroftheseproblemsinclinicaldecisionmakinghasbeenseenasevidenceofgrossincompetence.Althoughpoorcliniciansmaysuccumbmorefrequentlytothese
practices,thepracticesthemselvesshouldbeofconsiderableconcerntoscientificallyorientedclinicianspreciselybecausetheyseemtoberelatedtotendenciesin
humanproblemsolving,andtheymustactivelybeworkedagainstforthegoodofclientsandoftheprofession.
Onceawarethatbadhabitssuchasthosedescribedabovemaycreepintoclinicaldecisionmaking,thewarycliniciancanseekremedies.Amongtheremedies
recommendedforthetendencytouseaconfirmatorystrategyistheadoptionofadisconfirmatorystrategy,inwhichevidencebothforandagainstonespethypothesis
issoughtafterandvalued.Similarly,abeliefinthelawofsmallnumberscanbeunderminedbyremindersthatwhenonehasonlylimitedexperiencewithindividuals
withaparticulartypeofcommunicationdisorder,thecharacteristicsofpeoplefromthatsamplearequitelikelytobeunrepresentativeofthatpopulationasawhole.
Althoughtheprocessbywhichspeechlanguagepathologistsandaudiologistsreachclinicaldecisionsisfarfromwellunderstoodatthispoint(Kamhi,1994Yoder&
Kent,1988),themodelshowninFig.1.2isintendedtoserveasaworkingmodelthatcanbe
Page9
Fig.1.2.Amodelillustratingthewaysinwhichmeasurementsareusedtoreachclinicaldecisionsleadingtotheinitiationormodificationofclinicalactions.
elaboratedonasunderstandingincreases.Suchagraphicmodelcanhelpemphasizethevariednatureoftheprocessesinvolvedinreachingcomplexclinicaldecisions,
includingboththosethatareverydeliberateandreadilyavailableforinspectionaswellasthosethatarealmostautomaticandlessavailableforobservation.
Theprocessofclinicaldecisionmakingisinitiatedasthespeechlanguagepathologistformulatesoneormoreclinicalquestions.Althoughsuchquestionsmayoften
coincidewiththoseactuallyexpressedbytheclient,theymaynotalwaysdoso.Thusforexample,theparentsof3yearoldMaryBethmaynothaveexpressed
interestinhavingherhearingstatusevaluated.Ontheotherhand,herspeechlanguagepathologistwouldseethatasacriticallyimportantquestion,givenboththe
susceptibilitytomiddleearinfectionwithassociatedhearinglossamongchildrenwithDownsyn
Page10
dromeandthepivotalroleofhearinginspeechlanguageacquisition.Thisexamplepointsoutthatclinicalquestionsarisebothfromclientsexpressionsofneedand
fromtheexpertknowledgepossessedbytheclinician.
Theformulationofclinicalquestionsisofcentralimportancetothequalityofclinicaldecisionmakingbecauseitdrivesallthatfollows.First,theclinicalquestion
determineswhatrangeofinformationshouldbesought.Second,itguidestheclinicianintheselectionorcreationofappropriatemeasurementtools.Infact,itiswidely
heldthatanymeasurementtoolcanonlybeevaluatedinrelationtoitsadequacyinaddressingaspecificclinicalquestion(AmericanEducationalResearchAssociation
[AERA],AmericanPsychologicalAssociation[APA],&NationalCouncilonMeasurementinEducation[NCME],1985Messick,1988).Nomeasureisintrinsically
goodorvalid.Rather,thequalityofameasurevariesdependingonthespecificquestionitisusedtoaddress.Thus,forexample,agivenlanguagetestmaybean
excellenttoolforansweringaquestionabouttheadequacyof4yearoldMaryBethsexpressivelanguageskills,yetitmaybeaperfectlyawfultoolifusedtoexamine
suchskillsfor9yearoldbilingualAlejandro.
Optimally,specificmeasurementtoolswillbeselectedsoastoaddressthefullscopeofeachclinicalquestionbeingposedusingthebestmeasuresavailable(Vetter,
1988b).Forsomequestions,however,thewealthofcommerciallyavailablestandardizedtestsandpublishedprocedureswillfailtoyieldanyacceptablemeasure,or
evenanymeasureatall.Atsuchtimes,cliniciansmaydecidetodevelopaninformalmeasureoftheirown(Vetter,1988a),ortheymaysimplyhavetoadmitthatnotall
clinicalquestionsforallclientsareanswerable(Pedhazur&Schmelkin,1991).
Theadministrationorcollectionofselectedclinicalmeasuresiscertainlythemostobviousportionoftheclinicaldecisionmakingprocess.Itsimportancecanbe
emphasizedbyreferencetothedataprocessingadagegarbagein,garbageout.Putmoredecorously,theactofskillfuladministrationiscrucialtothequalityof
informationobtained.Haphazardcompliancewithstandardadministrationguidelinesmayrendertheinformationobtainedspuriousandmisleading,therebyundermining
alllatereffortsofthecliniciantouseittoarriveatareasonableclinicaldecision.
Followingdatacollection,theclinicianexaminesinformationobtainedacrossavarietyofsourcesandintegratesthatinformationtoaddressspecificclinicalquestions.
Forexample,inordertocommentonthereasonablenessofprogressmadebyMaryBethduringthepast2years,herspeechlanguagepathologistwillneedtoperform
aHerculeantaskintegratingacrosstimeandcontentareameasuresrelatedtospeech,language,hearing,andnonverbalcognition.
ComponentsoftheclinicaldecisionmakingprocessoutlinedinFig.1.1havereceiveddifferingamountsofattentionfromspeechlanguagepathologyandaudiology
professionals.Thus,forexample,considerableattentionhasbeenpaidtotheformulationofrelevantclinicalquestionsforspecificcategoriesofcommunication
disorders(e.g.,Creaghead,Newman&Secord,1989Guitar,1998Lahey,1988).Ontheotherhand,littlehasbeenwrittenabouthowclinicianscanusesuch
informationtoarriveateffectiveclinicaldecisions(Records&Tomblin,1994Turner&Nielsen,1984).Therefore,intheremainderofthistext,bothvenerable
conceptsandemerginghypotheseswillbesharedtohelpreadersimprovethequalityoftheirclinicaldecision
Page11
makingand,consequently,oftheirclinicalactionstowardchildrenwithdevelopmentallanguagedisorders.
Summary
1.Measurementofdevelopmentallanguagedisordersdrawsonmethodsusedinawidevarietyofdisciplines.
2.Thepurposesofthistextaretohelpreaderslearntoframeeffectiveclinicalquestionsthatwillguidethedecisionmakingprocess,torecognizethatallmeasurement
opportunitiespresentalternatives,andtorecognizetheconnectionbetweenthequalityofclinicalactionsandthequalityofmeasurementusedintheclinicaldecision
makingprocess.
3.Speechlanguagepathologistsobtainanduseinformationobtainedthroughmeasurementtoarriveatdiagnosesthataffectmedical,educational,social,andevenlegal
outcomes.Theyderivethisinformationcooperativelywithothers(e.g.,familiesandotherprofessionals)andshareitwithothersasameansofachievingthechilds
greatestgood.
4.Measurementisimportantbecauseithelpsdriveclinicaldecisionmaking,whichinturnaffectsclinicalactions.
5.Measurementisusedtoaddressclinicalquestionsrelatedtoscreening,diagnosis,planningfortreatment,determiningseverity,evaluatingtreatmentefficacy,and
evaluatingchangeincommunicationovertime.
6.Thecognitiveprocessesinvolvedinclinicaldecisionmakingarenotwellunderstoodbuthavebeguntobestudiedinresearchaddressingcomplexproblemsolving,
computerexpertsystems,andspecificissueswithinavarietyoffields(e.g.,medicine,specialeducation).
7.Examplesofproblematictendenciesthathavebeenidentifiedaspossiblebarrierstoeffectiveclinicaldecisionmakingincludetheuseofconfirmatorystrategiesand
thebeliefinthelawofsmallnumbers.
KeyConceptsandTerms
beliefinthelawofsmallnumbers:thetendencytoovervalueinformationobtainedfromarelativelysmallsampleofindividuals,forexample,thosefewindividuals
withanuncommondisorderwithwhomonehashaddirectcontact.
clinicaldecisionmaking:theprocessesbywhichcliniciansposeandanswerclinicalquestionsasabasisforclinicalactionssuchasdiagnosingacommunication
disorder,developingatreatmentplan,orreferringaclientformedicalevaluation.
confirmatorystrategy:thetendencytoseekandpayspecialattentiontoinformationthatisconsistentwithaclinicalhypothesiswhilefailingtoseek,orundervaluing,
informationthatisnotconsistentwiththehypothesis.
decisionmatrix:amethodusedtoconsidertheoutcomesassociatedwithcorrectandincorrectdecisions.
Page12
differentialdiagnosis:theidentificationofaspecificdisorderwhenseveraldiagnosesarepossiblebecauseofsharedsymptoms(selfreportedproblems)andsigns
(observedproblems).
measurement:methodsusedtodescribeandunderstandcharacteristicsofaperson.
StudyQuestionsandQuestionstoExpandYourThinking
1.Takingeachofthethreecasesdescribedearlierinthechapter,useTable1.1todeterminewhattypesofclinicaldecisionsandrelatedclinicalactionsarelikelytobe
requiredforeach.
2.ForeachofthosecasesusedinQuestion1,identifyabinaryclinicaldecisionandconsidertheimplicationsofthetwokindsoferrorsthatcanresult.
3.Onthebasisofyourcurrentknowledgeofchildrenwithlanguagedisorders,developahierarchyofoutcomesthatmightresultfromclinicalerrorsinthefollowing
cases:
l screeningofhearingina4montholdinfant
l collectionoftreatmentdatainEnglishforachildwhosefirstlanguageisVietnamese
l collectionoftrialtreatmentdataforpurposesofselectingtreatmentgoalsforachildexhibitingsignificantsemanticdelays
l evaluationofalanguageskillsinachildwhoexhibitsseveredelaysinspeechdevelopment.
4.Thinkaboutdecisionsbigandsmallthatyoumayhavemadeduringthelastweek.Trytoremembertheprocessbywhichyoureachedyourdecision.Didanyof
yourdecisionmakinginvolvetheuseofaconfirmatorystrategy?Describethespecificexampleandhowyourthinkingmighthavedifferedifyouhadavoidedsucha
strategy.
RecommendedReadings
Barsalou,L.W.(1992).Cognitivepsychology:Anoverviewforcognitivescientists.Hillsdale,NJ:LawrenceErlbaumAssociates.
McCauley,R.J.(1988).Measurementasadangerousactivity.Hearsay:JournaloftheOhioSpeechandHearingAssociation,Spring1988,69.
Tracey,T.J.,&Rounds,J.(1999).Inferenceandattributionerrorsintestinterpretation.InJ.W.Lichtenberg&R.K.Goodyear(Eds.),Scientistpractitioner
perspectivesontestinterpretation(pp.113131).Boston:Allyn&Bacon.
References
AmericanEducationalResearchAssociation(AERA),AmericanPsychologicalAssociation(APA),&NationalCouncilonMeasurementinEducation(NCME)
(1985).Standardsforeducationalandpsychologicaltesting.Washington,DC:APA.
Barsalou,L.W.(1992).Thinking.Cognitivepsychology:Anoverviewforcognitivescientists.Hillsdale,NJ:LawrenceErlbaumAssociates.
Page13
Berk,R.A.(1984).Screeninganddiagnosisofchildrenwithlearningdisabilities.Springfield,IL:C.C.Thomas.
Chapman,L.J.,&Chapman,J.P.(1967).Genesisofpopularbuterroneouspsychodiagnosticobservations.JournalofAbnormalPsychology,72,193204.
Chapman,L.J.,&Chapman,J.P.(1969).Illusorycorrelationasanobstacletotheuseofvalidpsychodiagnosticsigns.JournalofAbnormalPsychology,74,271
280.
Creaghead,N.A.,Newman,P.W.,&Secord,W.A.(1989).Assessmentandremediationofarticulatoryandphonologicaldisorders.Columbus:Merrill.
Dawes,R.M.,Faust,D.,&Meehl,P.E.(1993).Statisticalpredictionversusclinicalprediction:Improvingwhatworks.InG.Keren&C.Lewis(Eds.),Ahandbook
fordataanalysisinthebehavioralsciences:Methodologicalissues(pp.351367).Hillsdale,NJ:LawrenceErlbaumAssociates.
Faust,D.(1986).Researchonhumanjudgmentanditsapplicationtoclinicalpractice.ProfessionalPsychology,17,420430.
Guitar,B.(1998).Stuttering:Anintegratedapproachtothenatureandtreatment(3rded.).Baltimore,MD:Williams&Wilkins.
Kamhi,A.G.(1994).Towardatheoryofclinicalexpertiseinspeechlanguagepathology.Language,Speech,HearingServicesinSchools,25,115118.
Lahey,M.(1988).Languagedisordersandlanguagedevelopment.NewYork:Macmillan.
McCauley,R.J.(1988,Spring).Measurementasadangerousactivity.Hearsay:JournaloftheOhioSpeechandHearingAssociation,69.
McCauley,R.J.&Baker,N.E.(1994).Clinicaldecisionmakinginspecificlanguageimpairment:Actualcases.JournaloftheNationalStudentSpeechLanguage
HearingAssociation,21,5058.
Messick,S.(1989).Validity.InR.L.Linn(Ed.),Educationalmeasurement(pp.13104).NewYork:AmericanCouncilonEducationandMacmillanPublishing.
Pedhazur,R.J.,&Schmelkin,L.P.(1991).Measurement,design,andanalysis:Anintegratedapproach.Hillsdale,NJ:LawrenceErlbaumAssociates.
Records,N.L.,&Weiss,A.(1990).Clinicaljudgment:Anoverview.JournalofChildhoodCommunicationDisorders,13,153165.
Records,N.L.,&Tomblin,J.B.(1994).Clinicaldecisionmaking:Describingthedecisionrulesofpracticingspeechlanguagepathologists,JournalofSpeechand
HearingResearch,37,144156.
Rowland,R.C.(1988).Malpracticeinaudiologyandspeechlanguagepathology.Asha,4548.
Shanteau,J.,&Stewart,T.R.(1992).Whystudyexpertdecisionmaking?Somehistoricalperspectivesandcomments.OrganizationalBehaviorandHuman
DecisionProcesses,53,95106.
Thorner,R.M.&Remein,Q.R.(1962).Principlesandproceduresintheevaluationofscreeningfordisease.PublicHealthServiceMonographNo.67,408421.
Tracey,T.J.,&Rounds,J.(1999).Inferenceandattributionerrorsintestinterpretation.InJ.W.Lichtenberg&R.K.Goodyear(Eds.),Scientistpractitioner
perspectivesontestinterpretation(pp.113131).Boston:Allyn&Bacon.
Turner,R.G.&Nielsen,D.W.(1984).Applicationofclinicaldecisionanalysistoaudiologicaltests.EarandHearing,5,125133.
Tversky,A.&Kahneman,D.(1993).Beliefinthelawofsmallnumbers.InG.Keren&C.Lewis(Eds.),Ahandbookfordataanalysisinthebehavioralsciences:
Methodologicalissues(pp.341350).Hillsdale,NJ:LawrenceErlbaumAssociates.
Vetter,D.K.(1988a).Designinginformalassessmentprocedures.InD.E.Yoder&R.D.Kent(Eds.),Decisionmakinginspeechlanguagepathology(pp.192
193).Toronto:BCDeckerInc.
Vetter,D.K.(1988b).Evaluationoftestsandassessmentprocedures.InD.E.Yoder&R.D.Kent(Eds.),Decisionmakinginspeechlanguagepathology(pp.
190191).Toronto:BCDeckerInc.
Yoder,D.E.,&Kent,R.D.(Eds.)(1988).Decisionmakinginspeechlanguagepathology.Toronto:BCDeckerInc.
Page14
Page15
PART
I
BASICCONCEPTSINASSESSMENT
Page16
Page17
CHAPTER
2
MeasurementofChildrensCommunicationandRelatedSkills
TheoreticalBuildingBlocksofMeasurement
BasicStatisticalConcepts
CharacterizingthePerformanceofIndividuals
CaseExample
TheoreticalBuildingBlocksofMeasurement
WhatIsMeasuredbyMeasurements?
Measurementsareusuallyindirect,thatis,theyinvolvethedescriptionofacharacteristictakentobecloselyrelatedtobutdifferentfromthecharacteristicofinterest.
Asanillustrationofthisnotion,PedhazurandSchmelkin(1991)consideredtemperature.Conceptually,temperatureismostcloselyrelatedtotherateofmolecular
movementwithinamaterial,yetitisalmostalwaysmeasuredusingacolumnofmercury.Inthisway,themeasurementismadeindirectlyusingtheheightofthecolumn
ofmercuryastheindicator,orindirectfocusofmeasurement.Althoughitwouldbepossibletodeterminetherateofmolecularmovementmoredirectly,thisisnot
donebecauseoftheconsiderableexpenseandeffortinvolved.
Similarly,measurementsofbehaviororothercharacteristicsofpeoplearealmostalwaysindirect.Consider,forexample,acharacteristicthatmightbeofinteresttoa
Page18
speechlanguagepathologist,suchasachildsabilitytounderstandlanguage.Clearly,asinthecaseoftemperature,onecannoteasilymeasurethischaracteristicina
directfashion.Infact,theabilitytounderstandlanguagecannoteverbedirectlymeasuredbutinsteadmustbeinferredfromavarietyofindicators.Thisisbecausethat
abilityisatheoreticalconstruct,1aconceptusedinaspecificwaywithinaparticularsystemofrelatedconcepts,ortheory.Thus,thetheoreticalconstructreferred
tohereastheabilitytounderstandlanguagerepresentsshorthandforthecarefullyweighedobservationsonehasmadeaboutpeopleastheyrespondtothe
vocalizationsofothersaswellasfortheinformationonehasreadorbeentoldaboutthisconstructbyothers.Figure2.1attemptstocapturethecomplexrelationship
betweenwhatonewantstomeasure,thetheoreticalconstruct,andtheindicatorsusedtomeasureit.
LookingatFig.2.1,youcanseethattherearemanypossibleindicatorsforasingleconstruct.Thispremiseisimportanttocliniciansandresearcherswhoneedto
recognizethatanytestormeasuretheyuserepresentsachoicefromthesetofallpossibleindicators.
Aswillbecomeclearerinlatersectionsofthisbook,thewealthofindicatorsavailableforaconstructpresentsflexibilityforthoseinterestedinmeasuringtheconstruct,
butitalsopresentspotentialproblems.Forexample,adiverserangeofindicatorsforasingleconstruct(e.g.,intelligence)canleadtoconfusionwhencliniciansor
researchersusedifferentindicatorsinrelationtothesameconstructandreachdifferentconclusionsaboutboththeconstructandhowthecharacteristicbeingstudied
functionsintheworld.Asanexample,ifoneweretouseanintelligencetestthatheavilyemphasizesknowledgeofaparticularculture,thenuseofthatmeasurewith
childrenwhocomefromadifferentculturewouldleadtoverydifferentconclusionsregardinghowintelligentthechildrenare.
Alternatively,focusingonasingleindicatorandignoringthebroaderrangeofpossibleindicatorsforagivenconstructcanleadtoitsimpoverishment.Thistypeof
problemhasrecentlyreceivedattentionintheliteratureonlearningdisabilities,whereithasbeenassertedthatintelligenceissynonymouswithperformanceonone
particulartesttheWechslerIntelligenceScaleforChildrenRevised(Wechsler,1974).Criticscomplainthattheuseofthissinglemeasuremeansthatthe
knowledgegainedbysuchresearchmaybefarmorelimitedinitsappropriateapplicationthanhasbeenappreciated.Insummary,thechoiceofwhichindicatorand
howmanyindicatorsareusedinordertogaininformationaboutaparticularconstructbeitintelligence,receptivelanguage,ornarrativeproductionhaveimportant
implicationsforthequalityofinformationtobegained.
PedhazurandSchmelkin(1991)describedtwokindsofindicators:reflectiveandformativeindicators.Reflectiveindicatorsrepresenteffectsoftheconstruct,and
formativeindicatorsrepresentcausesofit.Anexampleofareflectiveindicatorofonesabilitytounderstandalanguagewouldbetheproportionofasetofsimple
commandsinthatlanguagethatonecancorrectlyfollow.Anexampleofaformativeindicatorofonesabilitytounderstandalanguagewouldbethenumberofyears
onehas
1Withintheliteratureonpsychologicaltesting,thereisatendencytorefertosuchconstructsaslatentvariables.
Page19
Fig.2.1.Therelationshipbetweenatheoreticalconstructsinglewordcomprehensionandseveralindicatorsthatcouldbeusedtomeasureit.
beenexposedtoit.Almostallindicatorsarereflectivehowever,formativeindicatorsaresometimesused.
Bythispoint,youmaybescratchingyourhead,wonderingwhetherthetermindicatorissynonymouswiththesomewhatmorefamiliartermvariable.Infact,those
termsarequitecloselyrelatedand,attimes,maybeusedsynonymously.Iintroducedthetermindicatorfirstbecausevariableissocloselyassociatedwithresearch
thatitsapplicationtoclinicalmeasuresmighthaveseemedconfusing.Consequently,Ibelievethataninitialdiscussionofindicatorsmayhelpreadersseehowsimilar
clinicalandresearchmeasuresaretooneanotherwhileavertingtheconfusion.Forthepurposesofthisbook,indicatorandvariablewillbeusedalmost
interchangeablytorefertoameasurablecharacteristicassociatedwithatheoreticalconstruct.However,variableisfrequentlyusedinamorerestrictedwaythan
indicator,torefertoapropertythattakesonspecificvalues(Kerlinger,1973).
Onemoretermthatcommonlyfunctionsasabuildingblockformeasurementindescriptionsofhumanbehaviorandabilitiesistheoperationaldefinition.Thisterm
wasoriginallyintroducedinphysicsbyBridgman(1927)tosuggestthatinagivenapplication(e.g.,aspecificresearchdesignoraparticularclinicalmeasure)a
constructcanbeconsideredidenticaltotheproceduresusedtomeasureit.Operationaldefinitionshavebeeninfluentialincommunicationdisordersbecausetheyhave
givenrisetotheclinicaluseofbehavioralobjectives,specificstatementsdefiningdesiredoutcomesoftreatmentforclientsintermsthatexplainexactlyhowonewill
knowwhetherthedesiredoutcomehasbeenachieved.Operationaldefinitionsareprobablymostusefulasameansofencouragingustothinkcarefullyaboutthe
specificindicatorsweusetogaininformationaboutagiventheoreticalconstruct.
Page20
TESTINGANDMEASUREMENTCLOSEUP:
ALFREDBINETANDTHEPOTENTIALEVILSOFREIFICATION
Inhis1981bookTheMismeasureofMan,StephenJayGould,anotedbiologistandpopularizerofscience,describedtheworkofAlfredBinet,theFrenchman
whodevelopedoneofthefirstwellknownintelligencetests.GouldnotedthatBinetbegantodevelopthetestin1904whenhewascommissionedbytheministerof
educationtodeviseapracticaltechniqueforidentifyingthosechildrenwhoselackofsuccessinnormalclassroomssuggestedtheneedforsomeformofspecial
education(p.149).Almostassoonasthetestcameintouse,Binetexpressedhopesthatitsresultsnotbetakenasironcladpredictionsofwhatachildcould
achieve,butthattheybeusedasabasisforprovidinghelpratherthanasajustificationforlimitingopportunities.Gouldwentontodescribetheregrettabledismantling
ofBinetsfondhope.
Gouldsbookdescribestheprocessofthereificationofintelligence,aprocessinwhichanabstract,complextheoreticalconstruct(suchasintelligence)comesto
havealifeofitsown,tobeseenasrealratherthantheabstractapproximationsthatitsoriginatorsmayhavehadinmind.Toillustratethisprocess,Goulddescribed
eventsintheUnitedStatesthatoccurredwithinamere20yearsofBinetsinitialtestdevelopment.Intelligencehadbeenreifiedtothepointthatitwasusedor
rathermisusedasabasisfordecisionshavingmajoreffectsonmilitaryservice,emigrationpolicies,penalsystems,andthetreatmentofindividualssuspectedof
mentaldefectiveness:
LevelsofMeasurement
Therearenumerouswaystocategorizemeasurements,butthenotionoflevels,orscales,ofmeasurementintroducedbyS.S.Stevens(1951)isoneofthemost
influentialandcontinuestoinspirebothdefendersandattackers.Stevensslevelsdescribethemathematicalpropertiesofdifferentkindsofindicators,orvariables.The
conceptoflevelsisusuallydefinedoperationally,witheachlevelofmeasurementdescribedintermsofthemethodsusedtoassignvaluestovariablesforexample,
whetherthevaluesareassignedusingcategories(normalvs.disordered)versusnumbers(percentagecorrect).
Typically,ahierarchicalsystemoffourorderedlevelsisdiscussed,inwhichthehigherlevelspreservegreateramountsofinformationaboutthecharacteristicbeing
measured.Table2.1summarizesthedefiningpropertiesofeachlevelofmeasurementandlistsexamplesofeachthatrelatetotheassessmentofchildhoodlanguage
disorders.Theselevelsnotonlyhaveimplicationsforourinterpretationofspecificmeasures,butalsowhatstatisticswillbeappropriatefortheirfurtherinvestigation.
Thenominallevelofmeasurementreferstomeasuresinwhichmutuallyexclusivecategoriesareused.Diagnosticlabelsandcategorysystemsfordescribingerrors
arefrequentlyusedexamplesofnominalmeasures.Althoughnumeralsmaysome
Page21
Table2.1
ThreeLevelsofMeasurement,TheirDefiningCharacteristics
andExamplesFromDevelopmentalLanguageDisorders
Levelof
Measurement Characteristics Examples
l Describingachildashavingwordfindingdifficulties
Nominal l Mutuallyexclusivecategories l Labelingachildsproblemasspecificlanguageimpairment
l Describingachildsuseandnonuseforeachof14grammaticalmorphemes
l Describingtheseverityofachildsexpressivelanguagedifficultiesassevere
l Characterizingachildsintelligibilityalongaratingscale,suchasintelligible
l Mutuallyexclusivecategories
withcarefullistening,wherenoefforthasbeenmadetoassurethatthescalehas
Ordinal l Categoriesreflectarankorderingofthecharacteristicbeing
equalintervals
measured
l Describingachildslanguageinaconversationalsampleasproductiveata
particularphase(Lahey,1988)
l Mutuallyexclusivecategories l Summarizingachildsstandardizedtestperformanceusingaraworstandard
l Categoriesreflectarankorderingofthecharacteristicbeing score
Interval measured l Describingachildsspontaneoususeofpersonalpronounsusingthenumberof
l Unitsofequalsizeareusedmakingthecomparisonof correctresponses
differencesinnumbersofunitsmeaningful l Ratingintelligibilityusinganequalintervalscale
timesbeusedaslabelsfornominalcategories(e.g.,serialnumbersornumbersonbaseballjerseys),nominalmeasurementsarenotquantitativeandsimplyinvolvethe
assignmentofanindividualorbehaviortoaparticularcategory.Measurementatthislevelisquitecrudeinthatallpeopleorbehaviorsassignedtoaspecificcategory
aretreatedasiftheyareidentical.
Ideally,categoriesusedinnominallevelmeasuresaremutuallyexclusive:Eachpersonorcharacteristictobemeasuredcanbeassignedtoonlyonecategory.
Diagnosticlabelsusedinchildhoodlanguagedisorderscanideallybethoughtofasnominalhowever,theyarenotalwaysmutuallyexclusive.Forexample,achildmay
havelanguageproblemsassociatedwithbothmentalretardationandhearingimpairment.Similarly,achildwithmentalretardationmayshowapatternofgreater
difficultieswithlinguisticthannonlinguisticcognitivefunctions,leadingonetowanttoentertainadesignationofthechildasbothlanguageimpairedandmentallyretarded
(Francis,Fletcher,Shaywitz,Shaywitz,&Rourke,1996).
Theordinallevelofmeasurementreferstomeasuresusingmutuallyexclusivecategoriesinwhichthecategoriesreflectanunderlyingrankingofthecharacteristic
Page22
tobemeasured.Putdifferently,atthislevel,categoriesbearanorderedrelationshiptooneanothersothatobjectsorpersonsplacedinonecategoryhavelessormore
ofthecharacteristicbeingmeasuredthanthoseassignedtoanothercategory.Despitethegreaterinformationprovidedatthislevelofmeasurementcomparedwiththe
nominallevel,itlackstheassumptionthatcategoriesdifferfromoneanotherbyequalamounts.Severityratingsareprobablythemostcommonlyusedordinalmeasures
inchildhoodlanguagedisorders.
Althoughordinalmeasuresreflectrelativeamountsofacharacteristic,theyarestillnotquantitativeinthesenseofreflectingprecisenumericalrelationshipsbetween
categories.Forexample,althoughaprofoundexpressivelanguageimpairmentmayberegardedasrepresentingmoreofanimpairmentthanasevereexpressive
languageimpairment,itisnotclearhowmuchmoreoftheimpairmentispresent.
Oneresultoftheabsenceofequaldistancesbetweencategories(alsocalledequalintervals)inanordinalmeasureisthatwhenrankingsarebasedonanindividual
judgment,theyarelikelytobequiteinconsistentacrossindividuals.Imaginethecaseofaclinicianwhoonlyserveschildrenwithdevastatinglyseverelanguage
impairments.Whenthatclinicianusesthelabelmildtodescribeachildsproblems,itmaymeansomethingverydifferentfromthelevelofimpairmentmeanttobe
conveyedbythesamelabelwhenitisusedbycliniciansservingalessinvolvedpopulation.Becauseofthis,ithasbeenrecommendedthatordinalmeasuresbeused
whentheratingsmadebyasingleindividualwillbecomparedwithoneanother,butnotwhenratingsofseveralpeoplewillbecompared(Allen&Yen,1979
Pedhazur&Schmelkin,1991).
Theintervallevelofmeasurementreferstomeasuresusingmutuallyexclusivecategories,orderedrankingsofcategories,andunitsofequalsize.Itisthehighest
levelofmeasurementusuallyencounteredinmeasurementsofhumanabilitiesandbehavior.Unlikemeasurementsatthefirsttwolevels,measurementsatthislevelcan
beconsideredquantitativebecausenumericaldifferencesbetweenscoresaremeaningful,aswasnotthecasefornumeralsusedatthenominalorordinallevels.Test
scoresareusuallyidentifiedasthemostfrequentexamplesofthislevelofmeasurementinchildhoodlanguagedisorders.
Theuseofequalsizeunitsinintervallevelmeasurementsallowsmoreprecisecomparisonsofmeasuredcharacteristicstotakeplace.Forexample,someonewho
receivesascoreof100onavocabularytestcanbesaidtohavereceived10morepointsthansomeonewhoreceivedascoreof90,andthesamecanbesaidforthe
personwhoscored40pointswhencomparedwithsomeonewhoscored30onthesametest.Whatcannotbesaid,however,isthatsomeonewhoreceivedascoreof
80knewtwiceasmuchassomeonewhoreceivedascoreof40thatcomparisonentailsaratio(80:40),andtheabilitytodescriberatiospreciselyisnotreacheduntil
thefinallevelofmeasurement.However,formostmeasurementpurposes,theintervallevelofmeasurementallowssufficientprecision.
Theratiolevelofmeasurementreferstomeasuresusingmutuallyexclusivecategories,orderedrankingsofcategories,equalsizeunits,andarealzero.Achievement
ofthislevelofmeasurementisconsideredrareinthebehavioralsciences,butoccurswhenameasuredemonstratesallofthetraitsassociatedwithintervalmeasures
along
Page23
withasensitivitytotheabsenceofthecharacteristicbeingmeasuredtherealzeromentionedabove.Thetermratioisusedtodescribesuchmeasuresbecauseratio
comparisonsoftwodifferentmeasurementsalongthisscaleholdtrueregardlessoftheunitofmeasurementthatisused.Itshouldalsobenotedthatwhenratiosare
formedfromothermeasures,theyachievethislevelofmeasurement.Forexample,theratioofapersonsheighttoweightfallsattheratiolevelofmeasurement.
Measuresinvolvingtime(suchasageorduration)areprobablythemostcommonoftherelativelyfewmeasuresinchildhoodlanguagedisordersthatreachtheratio
level.
Atthispoint,readersmaywonderwhyscoredataarenotdescribedasfallingattheratiolevelofmeasurementgiventhatascoreof0onatestorotherscoredclinical
measuresisanunpleasantbutrealpossibility.Forscoredata,however,thezeropointisconsideredanarbitraryzeroratherthanarealzerobecauseascoreof0does
notreflectarealabsenceofthecharacteristicbeingstudied(Pedhazur&Schmelkin,1991).Thus,forexample,ascoreofzeroona15itemtaskconcerning
phonologicalawarenessisnotconsideredindicativeofacompleteabsenceofphonologicalawarenessonthepartofthepersontakingthetest.Inordertodemonstrate
thatapersonhasnophonologicalawareness,thetestwouldneedtoincludeitemsaddressingallpossibledemonstrationsofphonologicalawarenessandwould
thereforebetoolongtoadminister(ordevise,forthatmatter).
Informationconcerninglevelsofmeasurementmaybeareviewtomanyreaderswhorememberitfrompaststatisticsorresearchmethodscourses.Levelsof
measurementareintroducedinthosecontextsbecauseeachlevelisassociatedwithspecificmathematicaltransformationsthatcanbeappliedtomeasurementsatthat
levelwithoutchangingtherelationshipbetweenthecharacteristictobemeasuredandthevalueorcategoryassignedtoit.Thosemathematicalproperties,inturn,
determinethetypesofstatisticsconsideredappropriatetothemeasure.Ingeneral,thelowerthelevelofmeasurement,thelessinformationcontainedinthemeasure
andthelessflexibilityonewillhaveinitsstatisticaltreatment.
Recallthatagivenconstructmaybeassociatedwithindicatorsatvariouslevelsofmeasurement.Consequently,thelevelofmeasurementofanindicatormaybeone
considerationwhenchoosingaparticularmeasure.Thus,forexample,imaginethatyouareinterestedincharacterizingachildsskillatstructuringanoralnarrative.At
thecrudestlevel,onemightchoosetolabelachildsperformanceintheproductionofsuchanarrativeasimpairedornotimpairedmeasuringitatanominallevel.For
greaterprecision,however,aspontaneousnarrativeproducedbythechildmightberatedusinga5pointscale,with1indicatingaverypoorlyorganizednarrative
and5anarrativewithadultlikestructure.Yetprobablythemostsatisfactorytypeofmeasurefordescribingthischildsdifficultiesisoneattheintervallevelof
measurement.AnexampleofsuchameasurefornarrativeproductionisonedevisedbyCulatta,Page,andEllis(1983),inwhichthechildreceivesascoreforthe
numberofpropositionscorrectlyrecalledinastoryretellingtask.Withsuchameasure(asopposedtomeasuresatthenominalorordinallevels),youcanobtain
greaterinsightintothenatureofthedifficultiesfacingthechildandcanmorereadilymakecomparisonstotheseverityofotherchildrenwithproblemsinnarrative
production.
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BasicStatisticalConcepts
Asabranchofappliedmathematics,thefieldofstatisticshastwogeneraluses:describinggroupsofmeasurementsmadetogaininformationaboutoneormore
variablesandtestinghypothesesabouttherelationshipsofvariablestooneanother.Formanystudentsinanelementarystatisticsclass,eachoftheseusesrepresentsa
vast,aweinspiring,andsometimesfearprovokinglandscape.Inthissectionofthechapter,onlythehighestpeaksandlowestvalleysoftheselandscapeswillbe
surveyed.Specifically,selectedstatisticalconceptsareintroducedintermsoftheirmeaningandthepracticalusestowhichtheyareappliedbythoseofusinterestedin
measuringchildrensbehaviorsandabilities.Althoughstatisticalcalculationsaredescribed,onlyrarelyarespecificformulasgivensothattheconnectionbetween
meaningandapplicationcanremainparticularlyclose.MoreelaborateandmathematicallyspecificdiscussionscanbefoundinsourcessuchasPedhazurandSchmelkin
(1991).
StatisticalConceptsUsedtoDescribeGroupsofMeasurements
Oneofthemostcommonusesofstatisticsistosummarizegroupsofmeasurements,typicallyreferredtoasdistributions.Distributionscanconsistofasetof
measurementsbasedonactualobservations(oftencalledasample)orasetofvalueshypothesizedforasetofpossibleobservations(oftencalledapopulation).An
exampleofadistributionbasedonasamplewouldbeallofthetestscoresobtainedbychildreninasinglepreschoolclassonascreeningtestoflanguage.Incontrast,
anexampleofadistributionbasedonapopulationwouldbeallofthescoresonthatsametestobtainedbyanychildwhohasevertakenit.Exceptwhenpopulation
distributionsarediscussedfromapurelymathematicalpointofview,theyarealmostalwaysinferredfromaspecificsampledistributionbecauseoftheimpracticalityor
evenimpossibilityofmeasuringthepopulation.
Twotypesofstatisticsusedtosummarizedistributionsofmeasurementsaremeasuresofcentraltendencyandvariability.Measuresofcentraltendencyaredesigned
toconveyatypicalorrepresentativevalue,whereasmeasuresofvariabilityareusedtoconveythedegreeofvariationfromthecentraltendency.
Measuresofcentraltendencyhavebeendescribedasindicatinghowscorestendtoclusterinaparticulardistribution(Williams,1979,p.30).Thethreemost
commonmeasuresofcentraltendencyare(inorderofdecreasinguse)themean,median,andmode.Themeanisthemostcommonmeasureofcentraltendency.Itis
usedtorefertothevalueinadistributionthatisthearithmeticaverage,thatis,theresultwhenthesumofallscoresinadistributionisdividedbythenumberofscoresin
thedistribution.Unlikethetwoothermeasuresofcentraltendency,themeanisappropriateonlyformeasurementsthatfallatintervalorratiolevels.Althoughitis
consideredtherichestmeasureofcentraltendency,themeanhasthenegativefeatureofbeingparticularlysensitivetooutliersextremescoresthatdiffergreatlyfrom
mostscoresinthedistribution.Becauseofthis,themeanwillsometimesnotbeusedevenifthelevelofmeasurementallowsitinstead,themedian,whichisthenext
mostsensitivemeasureofcentraltendencywillbeused.
Page25
Themedianisthescoreorcategorythatliesatthemidpointofadistribution.Itisthemiddlescoreinthecaseofungroupeddistributionsofintervalorratiodataand
themiddlecategoryinthecaseofordinaldata.Themedianisconsideredanappropriatemeasureofcentraltendencyforeitherordinalorintervalmeasuresandiseven
superiortothemeanintermsofitsrelativestabilityinthefaceofoutliers.Ontheotherhand,itisconsideredinappropriatefornominalmeasuresbecausethecategories
usedatthatlevelofmeasurementcannot,bydefinition,beorderedlogically.Becauseofthislackoforderinnominaldata,findingamiddlescoreorcategoryis
nonsensical.
Thethirdandfinalmeasureofcentraltendency,themode,hasrelativelyfewuses.Themodesimplyreferstothemostfrequentlyoccurringscore(forintervalorratio
data)orcategory(fornominaldata).Becauseofthewaythemodeisdefined,itispossiblefortheretobemorethanonemodeinagivendistribution,inwhichcasethe
distributionfromwhichitcomescanbereferredtoasbimodal,trimodal,andsoforth.Fornominalleveldata,themodeistheonlysuitablemeasureofcentraltendency.
Becausemeasurementswithinadistributionvary,ameasureofvariabilityisalsorequiredtocharacterizeiteffectively.Threemeasuresofvariability,twoofwhichare
verycloselyrelated,aremostfrequentlyusedindescriptionsofchildrensabilitiesandbehaviors.Aswasdoneinthedescriptionofmeasuresofcentraltendency,these
measureswillbedescribedinorderofdecreasinguse.
Althoughconsideredsomewhatdauntingbybeginningstatisticsstudentsbecauseofitsrelativelyinvolvedcalculations,themostfrequentlyusedmeasureofvariabilityis
thestandarddeviation.Thestandarddeviationwasdevelopedforintervalandratiomeasuresasanimprovementontheseeminglygoodideaofdescribingthe
average(ormean)difference(ordeviation)fromthemean.Theproblemwithanaveragedeviationwasthatbecauseofthewaythemeanisdefined,allofthe
deviationsabovethemeanarepositiveinsignandwouldthereforebalanceallofthenegativedeviationsfallingbelowthemean,leadingtoanaveragedeviationofzero
foralldistributionsregardlessofobviousdifferencesinvariabilityfromonedistributiontoanother.Inordertoavoidthisproblem,thestandarddeviationiscalculated
inamannerthatmakesalldeviationspositive.Nonetheless,theintentbehindthestandarddeviationistoconveythesizeofthetypicaldifferencefromthemeanscore.
AsIexpandoninanupcomingsectionofthischapter,thestandarddeviationhasspecialsignificancebecauseofitsrelationshiptothenormalcurve.Specifically,
standarddeviationunitsbecomecriticaltocomparisonsofonepersonsscoreagainstadistributionofscores,suchasoccurswhentestnormsareused.
Theconceptofvarianceiscloselyrelatedtothestandarddeviation.Infact,thestandarddeviationofadistributionisthesquarerootofitsvariance.Despitethisvery
closerelationshiptostandarddeviation,varianceislessfrequentlyusedbecause,unlikethestandarddeviation,itcannotbeexpressedinthesameunitsasthemeasure
itisbeingusedtocharacterize.Forexample,youcandescribetheageofagroupofchildreninmonthsbysayingthatthemeanageforthegroupis36months,andthe
standarddeviationis3months.Thisresultsinamuchclearerdescriptionthansayingthatthemeanageforthegroupis36months,andthevarianceis9.No,not9
monthssimply9.Becauseofthisunitlessness,varianceisrarelyusedwhenthe
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intentissimplytodescribethecharacteristicsofagroup.Itdoesplayaroleinsomestatisticaloperations,however,andsoisanimportantstatistictobeawareof.
Theleastcomplicatedmeasureofvariability,therange,isalsotheleastfrequentlyusedofthethreemeasures.Itrepresentsthedifferencebetweenthehighestand
lowestscoresinadistribution.Theutilityoftherangeliesinitseaseofcalculationanditsapplicabilitytodistributionsatanylevelofmeasurementotherthanthenominal
level.Forintervalorratiodata,itiscalculatedbysubtractingthelowestfromthehighestscoreandadding1.Thusforexample,ifthehighestandlowestscoresina
distributionoftestscoreswere85and25,respectively,therangewouldbe61.Attheordinallevel,therangeisusuallyreportedbyindicatingthelowesttohighest
valueused.Forexample,onemightreportthatlistenerratingsofachildsintelligibilityinconversationrangedfromusuallyunintelligibletointelligiblewithcareful
listening,orfrom2to4ifa5pointnumericscalewereused.Becausetherangeisbasedononlytwonumbers(ortwolevelsinthecaseofanordinalmeasure),its
weaknessisthelackofsensitivityandsusceptibilitytotheeffectsofoutliers.
Insummary,measuresofcentraltendencyandvariabilityareusefulfordescribinggroupsofmeasurementsrelatedtoasinglevariableandareselectedonthebasisof
thevariableslevelofmeasurement.
StatisticalConceptsUsedtoDescribeRelationshipsbetweenVariables
Anumberofstatisticalconceptsareavailabletodescriberelationshipsbetweenandamongtwoormoregroupsofmeasurementsandtotesthypothesesaboutthe
natureofthoserelationships.Becausetheintenthereistofocusonlyonthoseconceptsmostbasictounderstandingmeasurementapplicationsindevelopmental
languagedisorders,onlyoneofthoseconceptswillbediscussedinsomedetailthecorrelation.
Thecorrelationbetweentwovariablesdescribesthedegreeofrelationshipexistingbetweenthemaswellasinformationaboutthedirectionofthatrelationshipandits
strength.Correlationcoefficientstypicallyrangeindegreefrom0(indicatingnorelationship)topositiveornegative1(indicatingaperfectrelationshipinwhichknowing
onemeasureforanindividualwouldallowyoutopredictthatpersonsperformanceonthesecondmeasurewithperfectaccuracy).Thesignofthecorrelationrefersto
itsdirection:Apositivecorrelationindicatesthatasonemeasureincreases,thesecondmeasureincreasesaswell.Relationshipsassociatedwithapositivecorrelation
aresaidtobedirect.Avividexampleofadirectrelationshipwouldbetherelationshipsomeseebetweenmoneyandhappiness.Incontrast,anegativecorrelation
indicatesthatasonemeasureincreases,thesecondmeasuredecreases.Relationshipsassociatedwithanegativecorrelationaresaidtobeinverse.Avividexampleof
aninverserelationshipwouldbetherelationshipbetweenunpaidbillsandpeaceofmind.
Figure2.2containsexamplesofgraphicrepresentationsofcorrelationsthatdifferinmagnitudeanddirection.Noticethattwoofthecorrelationsaredescribedasbeing
associatedwithacorrelationcoefficientof0.Thesecondofthosedemonstratesacurvilinearrelationship,whichcannotbecapturedbythesimplemethodsdescribed
here.
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Fig.2.2.Illustrationsshowingthevarietyofrelationshipsthatcanexistbetweenvariablesandcanpotentiallybedescribedusingcorrelationcoefficients.Theseinclude
norelationship(i.e.,thevalueofonevariableisindependentofthevalueoftheother),acurvilinearrelationship(i.e.,inwhichthenatureoftherelationshipbetween
variableschangesinacurvilinearfashiondependingonthevalueofoneofthevariables),andlinearrelationshipsoflowerandgreatermagnitudes.
Asamoredetailed(andrelevant)exampleinvolvingcorrelation,letsconsidertwohypotheticalsetsoftestscoresobtainedforaclassofthirdgradersoneonreading
comprehensionandtheotheronphonologicalawareness(explicitknowledgeofthesoundstructureofwords).Ifthisgroupofchildrenwerelikemanyothers,thenone
wouldexpecttheirperformancesonthesetwomeasurestobepositivelycorrelated(e.g.,Badian,1993Bradley&Bryant,1983)thatis,onewouldexpectthat
childrenwhoreceivehigherscoresonthereadingcomprehensiontestwouldreceivehigherscoresonthephonologicalawarenesstest.However,becausemanyfactors
affecteachoftheabilitiestargetedbythemeasures,itwouldbeunlikelythatthemagnitudeofthecorrelation,whichreflectsthestrengthoftheassociation,wouldbe
verylarge.In
Page28
fact,alowcorrelationmightbeexpectedinthiscontext.Table2.2containslabelsthatarefrequentlyusedtodescribecorrelationsofvariousmagnitudes(Williams,
1979).
ThecorrelationcoefficientmostfrequentlyusedindescribinghumanbehavioristhePearsonproductmomentcorrelationcoefficient(r),thespecifictypeofcorrelation
thatwouldhavebeenappropriatefortheexamplegivenabove.Unfortunately,thatcorrelationcoefficientisonlyconsideredappropriateformeasurementsatthe
intervalorratiolevelofmeasurement.Formeasurementsattheordinallevel,Spearmansrankordercorrelationcoefficient()canbecalculated.Atthenominallevel,
thecontingencycoefficient(C)isusedtodescribetherelationshipbetweenthefrequenciesofpairsofnominalcategories.
Inadditiontothesecorrelationcoefficients,however,thereareseveralothercorrelationcoefficients(e.g.,phi,pointbiserial,biserial,terachoic)thatareusedduringthe
developmentofstandardizedtests.Thechoiceoftheselessfamiliarcorrelationcoefficientsisdictatedbythecharacteristicsofthemeasurementstobecorrelated,such
aswhethereitherorbothofthemeasurementsaredichotomous(e.g.,yesno,correctincorrect),multivalued(e.g.,numbercorrect),orcontinuous(e.g.,response
times).
Itiseasytobeintimidatedbyanunfamiliarcorrelationcoefficient.However,thisdangercanbecounteredwiththeknowledgethattheconceptofcorrelationremains
thesame,regardlessofhowexoticthenameofthespecificcoefficient.Thus,whetheroneisusingphiorPearsonsproductmomentcorrelation,acorrelation
coefficientalwaysisintendedtodescribetheextenttowhichtwomeasurestendtovarywithoneanother.Infact,evenwhenoneexaminestherelationshipsbetween
thedistributionsofmorethantwovariablesusingmultiplecorrelations,theinterpretationofcorrelationsremainsessentiallyunchanged.
Correlationcoefficientsareusuallyreportedalongwithastatementofstatisticalsignificance,whichdescribestheextenttowhichthecorrelationcoefficientislikely
todifferfromzerobychance,giventhesizeofthesampleonwhichitisbased.Ingeneral,statementsofstatisticalsignificancealwayscarrytheimplicationthatalthough
aparticularsampleofbehaviorwasobserved,itisbeingusedtodrawconclusionsforthelargerpopulation.Statementsofstatisticalsignificanceareusedtotest
hypothesesconjecturalstatementsaboutarelationbetweentwoormorevariables(Pedhazur&Schmelkin,1991).Inthiscase,thehypothesisisthattheobtained
correlationcoefficientdiffersfromzero.Statisticalsignificanceindicatesthattheobtainedvaluewasunlikelytohaveoccurredbychance.
Table2.2
DescriptiveLabelsAppliedtoCorrelationsofVaryingMagnitudes
Unfortunately,acorrelationsstatisticalsignificanceissometimesmistakenlytakenasthemostimportantindicationofitsimportance.However,averylowcorrelation
coefficientisunlikelytobeimportantevenifitisstatisticallysignificantbecauseitdoesnotexplainmuchofthevariabilityofthecorrelatedmeasures.Inaddition,the
largerthesamplesize,theeasieritisforacorrelationcoefficienttoattainstatisticalsignificance.Therefore,althoughastatisticallysignificantcorrelationcoefficientis
alwaysdesirable,themagnitudeaswellasthesignificanceofthecorrelationmustbeconsidered.
Anadditionalconcernsurroundingtheinterpretationofcorrelationcoefficients,suchasthePearsonproductmomentcorrelationcoefficient,isthatitsmagnitudedoes
notitselfreflecttheextenttowhichtwovariablesexplainoneanother.Instead,thatinformationisprovidedbyacloselyrelatedstatistic,thecoefficientofdetermination,
whichcanalsobereferredtoasvarianceaccountedfor,orr2,forthePearsonproductmomentcorrelation.Itiscalculatedbysquaringthecorrelationcoefficient
andmultiplyingittimes100.Asanexample,assumethatthecorrelationbetweentwosetsoftestscoreswas.60(amoderatecorrelationaccordingtoTable2.2).The
correspondingcoefficientofdeterminationwouldbe36%,meaningthat36%ofthevariationobservedinthetwosetsoftestscoreswasaccountedforbytheir
relationshipleavingasubstantial64%unexplained.Awarenessofthisconceptbecomesimportantinevaluatingcorrelationalevidenceprovidedbytestdevelopersto
supportthequalityoftheirtest.
Intheirbookonphonologicdisorders,BernthalandBankson(1998)madeageneralpointconcerningthelimitationsofstatisticalsignificanceasanindicationofthe
importancearesearchfinding.Althoughtheywerenottalkingspecificallyaboutcorrelationaldata,theywarnedcliniciansagainsttheassumptionthatanystatistically
significantfindingreportedintheresearchliteraturewasworthyofimpactonclinicalpractice.Theyusethetermclinicalsignificancetosuggestthatonlyrelatively
largeeffects(i.e.,thosethatwouldbeassociatedwitharelativelylargeproportionofvarianceaccountedfor)wouldlikelybeofimportanceintheclinicalenvironment.
Theyencouragedreaderstolookforevidenceofthesizeofrelationshipsintheformofvariationaccountedfor,whichisreportedasomegasquaredformany
analyses(Young,1993).Forthepurposesofthisbook,BernthalandBanksonscautionshouldbeconsideredasitappliestobothcorrelationcoefficientsandany
statisticalfindingthatmightbeusedindiscussionsofchildrenslanguageabilities.
Afinalcautionarystatementconcerningtheinterpretationofcorrelationsisthefundamentalideathattheexistenceofacorrelationbetweentwomeasuresdoesnot
constituteevidenceofacausalrelationshipbetweenthem.Thus,returningtotheexampleinitiallyusedtointroducetheconceptofcorrelation,rememberthatchildrens
scoresontwotests,oneofreadingcomprehensionandoneofphonologicalawareness,werefoundtobecorrelated.Althoughitwouldbeverytemptingtoconclude
thatchildrensphonologicalawarenesscausedtheircomprehensionperformance,thatwouldbeanincomplete,evenincorrectinterpretationofthecorrelation.
Theoreticallysuchaninterpretationwouldbequiteinvitingbecauseitwouldbeeasytoimaginethatagreaterfamiliaritywiththesoundstructureofawrittenlanguage
wouldmakeitsprocessingeasier,thusresultinginimprovedcomprehension.Infact,however,itisequallyplausiblethatchildrenscomprehensioncausedtheir
performanceonthephonologicaltasks.Thatis,theirlevelofcomprehensionmayhaveallowedthemtoprocessthe
Page30
soundinformationofthelanguagetoagreaterdegreebecausetheywerenotasoverwhelmedwiththeothermemoryandprocessingdemandsassociatedwith
understandingtext.Thus,theywouldperformbetteronthephonologicalawarenesstestbecauseoftheircomprehensionskills.Finally,itwouldalsobeplausibleto
imaginethatchildrensperformancesonbothtaskswereinfactcausedbysomethirdvariableorbymultiplevariables.Theoftrepeatedwarningnottoconfuse
correlationwithcausationisprobablyoneofthemostimportantlessonsinthisoranybookbecauseofitsimpactoncriticalthinkinginnonscientificaswellasscientific
realms.
Inadditiontosimplecorrelations,awiderangeofotherstatisticsareavailableforexamininghypothesesabouttherelationshipbetweenvariables.Frequently,
hypothesesrelatetotherelationshipofoneormoreclassificationvariables(e.g.,ageandgender)toanoutcomeorresponsevariable(e.g.,performanceonaparticular
test).Alternatively,statisticsareusedtodeterminewhetheroneormorevariableshaveacausaleffectonaresponsevariable.Whenthatisthecase,variables
hypothesizedtobecausesaretermedindependentvariablesandthosehypothesizedtobeeffectsaretermeddependentvariables.Selectionofspecificstatistical
techniquesfortestingahypothesisdependsquiteheavilyonthelevelofmeasurementoftheoutcomeordependentvariable.
Variablesmeasuredattheintervalorratiolevelofmeasurementaregenerallystudiedusingparametricstatistics(e.g.,ttests,analysesofvariance,orANOVAs)
whereasvariablesmeasuredatnominalorordinallevelsareexaminedusingnonparametricstatistics(e.g.,chisquareanalysesandCochransQ).Nonparametric
statisticsarealsousedwhenthedependentvariableseemstobedistributedinamannerthateitherdepartssignificantlyfromanormaldistributionorseemslikelyto
violateassumptionsunderlyingtheuseofnormaldistributions.Aconciseintroductiontothedecisionmakingbehindtheselectionofanappropriatestatisticaltechnique
canbefoundinChial(1988).LongerdiscussionscanbefoundinFreedman,Pisani&Purves(1998)orMcClave(1995)forparametricstatistics,andConover
(1998)orGibbons(1993)fornonparametricstatistics.
Statisticaltechniquesfortestinghypothesesarenotexploredfurtherherebecauseoftheirrelativelylimiteduseinassessingchildrenslanguagedisorders.Theyprimarily
comeintoplayinthedocumentationprovidedbytestdeveloperstosupportthevalueofstandardizedmeasures,andtheywillbediscussedfurtherinthatcontextinthe
nextchapter.
CharacterizingthePerformanceofIndividuals
Methodsforsummarizinganindividualsperformancevarydependingonthenatureofthemeasurementbeingmade.Numerousschemesforcategorizingmeasurements
ofhumanbehaviorhavebeenproposed.Thesecategorizationsoftenassumethatthemeasurementsofinterestareformaltestsbecausetestsarethemoststudiedform
ofmeasurementrelatedtohumanabilitiesandbehaviors.Onefrequentlydiscussedcategorizationseparatesachievementtestingfromabilitytestingtheformer
seekstomeasureactuallearning,andthelatterseekstomeasurelearningpotential.Withinachievementtesting,distinctionsaremadebetweenplacementtesting,which
takesplacepriortoinstructionformativeanddiagnostictesting,whichtakeplaceduring
Page31
instructionandsummativetesting,whichtakesplaceattheendofinstruction(Gronlund,1982).Formativetestingisdesignedtomeasurethelearnersprogressas
learningisunderway,whereasdiagnostictestingidentifiesthesourceofdifficultiesimpedingthelearnersprogress.Summativetestingisdesignedtoevaluatelearning
progressatsomeendingpoint,forexample,attheendofaschoolterm.
Othercategoriesappliedtotestshaveincludedpaperandpenciltests,themoststudiedmediumfortestexecutionperformancetests,whichtypicallyinvolvethe
testtakersmanipulationofobjectsorperformanceofsomeactivitythatusuallydoesnotinvolvetheuseofpaperandpencilandcomputerizedtests,whichinvolve
theuseofcomputerdisplaysorbothcomputerdisplayandkeyboardedresponses.Althoughperformancetestspredominateasamethodoftestingindevelopmental
languagedisorders,paperandpenciltestsaretypicallyusedincaseswhenwrittenlanguageskillsareassessed.Computerizedtestingisagrowingtopicofinterest
(e.g.,Wiig,Jones,&Wiig,1996)becauseofthepossibilitiesitpresentsforprovidingmoreinteresting,evenanimatedstimuliandforgreatertailoringoftestitemstoa
clientsneedsbychoosinglateritemsbasedonearlierperformance(Bunderson,Inouye,&Olsen,1989).Eachofthesetypesoftestsaltersaspectsofthetest
administrationandscoringprocessandthusindirectlyaffectstheinterpretationofindividualscores.
Althoughtestsandothermeasurescanbecategorizedalongmanydifferentdimensions,thecategorizationofmeasuresasnormreferencedversuscriterionreferenced
hasthegreatestimpactonhowindividualperformancesareinterpreted.Infact,attimes,thesetwocategoriesarereferredtoasmodesofscoreinterpretationrather
thantypesoftests(e.g.,APA,AERA,&NCME,1985).
NormReferencedversusCriterionReferencedMeasures
Overall,normreferencedmeasuresarethoseforwhichanindividualsperformanceisinterpretedinrelationtotheperformanceofothers,andcriterion
referencedmeasuresarethoseforwhichanindividualsperformanceisinterpretedinrelationtoanestablishedbehavioralcriterion.Table2.3listssomenorm
referencedandcriterionreferencedmeasureswithwhichreadersmayhavehadpersonalexperienceaswellassomethatarecommonlyusedindevelopmental
languagedisorders.Althoughnoteveryauthorwouldagreethatsomeofthemoreinformalofthesemeasuresshouldbecategorizedasnormorcriterionreferenced,
eachofthemeasuresfitswithinthedefinitionsappearingatthebeginningofthisparagraph.
ThedependenceofthiscategorizationonthemethodusedtointerpretanindividualsscorecanbeillustratedusingthebriefexampleinTable2.4,whichIcallthe
AmazingUniversityofVermontTest.ImaginefirstthatthiswouldbetestistobegiventodeterminewhichincomingstudentstotheUniversitywillreceiveascholarship
beinggrantedbytheUniversitysAlumniAssociation.Ifthatwerethetestspurpose,appropriatescoreinterpretationwouldinvolvecomparingalloftheincomingfirst
yearstudentstoseewhichoneshadthemostknowledgeandthuswouldreceivethescholarship.Thatmethodofscoreinterpretation,therefore,woulddependnotonly
onknowledgeofasingletesttakersscore,butalsoonknowledgeoftheperformanceoftheentiregroupagainstwhichtheindividualsperformancewastobe
compared.
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Table2.3
ExamplesofCriterionandNormReferencedMeasuresAssociatedWithReaders
PersonalExperiencesandClinicalPracticeinDevelopmentalLanguageDisorders
Normreferenced Criterionreferenced
l IQtests
l Driverstest
l GREs l Mostarticulationorphonologytests
l IQtests l Eyeexamination
l SATs l Treatmentprobesinwhichaset
l Mostlanguagetests l Classroomexamination(without
l Classroomtests(withgradingonthe criterion(e.g.,80%)isused
gradingonthecurve)
curve)
Note.GRE=GraduateRecordExaminationSAT=ScholasticAptitudeTest.
Table2.4
TheAmazingUniversityofVermontTest
(a)Burlington,Vermont(b)Montpelier,Vermont
1.TheUniversityofVermontislocatedin (c)Manchester,NewHampshire(d)St.Albans,Vermont
(e)EnosburgFalls,Vermont
(a)UofV(b)VU(c)UVM(d)MUV
2.TheofficialacronymfortheUniversityis
(e)noneoftheabove
(a)5001500(b)15003000(c)30004500
3.ThenumberofstudentsattendingtheUniversityis
(d)45006000(e)>10,000
(a)greyandwhite(b)greenandwhite
4.Theschoolcolorsare
(c)greyandgreen(d)greenandgold(e)greyandgold
(a)snowyowl(b)raccoon(c)barnowl(d)catamount
5.ThemascotoftheUniversityis
(e)Jerseycow
(a)cowtipping(b)icehockey(c)football
6.ThemostpopularspectatorsportattheUniversityis
(d)downhillskiing(e)snowboarding
(a)EthanAllen(b)IraAllen(c)WoodyAllen
7.ThemostfamousphilosophergraduatingfromUVMwas
(d)WoodyJackson(e)JohnDewey
(a)Scholarshipandhardwork(b)Staywarm
8.TranslatedfromtheLatin,theschoolmottomeans (c)LivefreeandstayoutofNewHampshire
(d)Suspectflatlanders(e)Independenceanddignity
Suchacomparisongroupiscalledanormativegroup,hence,thedesignationnormreferencedtorefertothemethodofscoreinterpretationandsometimestorefer
tothespecifictypeofmeasurebeingused.
Norms,then,refertothespecificinformationaboutthedistributionofscoresassociatedwiththenormativegroup.Twotypesofnormsmeritspecialattention:national
normsandlocalnorms.Nationalnormsaredataconcerningagroupthathasbeenrecruitedsoastoberepresentativeofanationalcrosssectionofindividualswho
mightbetested.Normsfortestsinvolvingchildrenaretypicallyorganizedsothatinformation
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basedonsubgroupsofchildrenarereportedbyage(usuallyin26monthintervals),bygrade,orboth.Itisoftenrecommendedthatwhennormsarecollected,the
normativegroupsbematchedagainstnationaldata(usuallycensusdata)forsocioeconomicstatus,race,ethnicity,education,andgeographicregion(Salvia&
Ysseldyke,1995).Nationalnormsarecollectedalmostsolelyforstandardizedmeasuresthatwillbeusedwithverylargenumbersofindividualseachyear.For
example,intelligencetests,educationaltests,andmanylanguageteststypicallyprovidenationalnorms.
Localnormsarepreparedwhennationalnormsforameasureareunavailableorinappropriatetoagroupoftesttakers.Theyrepresentnormative,datacollectedona
groupoftesttakerslikethoseonwhomthemeasurewillbeused.Localnormsareespeciallyusefulwhennationalnormsarelikelytobeinappropriateforagroupof
testtakerswhoselanguageisunlikethatinwhichthetestiswritten.Mostfrequently,thiswouldinvolveindividualswhospeakoneofmanyregionalorsocialdialects
thataresignificantlydifferentfromtheidealizedstandardAmericanEnglishdialect,forexample,speakersofBlackAmericanEnglishorSpanishinfluencedEnglish.
Alternatively,aclinicianmaywanttocollectlocalnormsforspecificclientpopulationsforwhomnormativedataarelacking(e.g.,individualswithhearingimpairment,
mentalretardation,orcerebralpalsy).
RatherthanusingtheAmazingUniversityofVermontTesttocompareperformancesofanumberoftesttakers,youmightusetheAmazingUniversityofVermontTest
todeterminewhetheragroupofincomingstudentshasadequatelylearnedtheinformationincludedintheirorientationmaterials.Inthatcase,theoutcomeofthetest
couldleadtoastudentsbecomingexemptfromanadditionalorientationsessionorbeingrequiredtocompleteit.
Forthattestingpurpose,scoreswouldbeinterpretedinrelationtoabehavioralcriterion,forexample,6of10correct.Wheninterpretedinthatway,thetestcouldbe
describedasacriterionreferencedmeasure.Thelevelofperformancewouldthenbeconsideredacutoff,or,lessfrequently,acuttingscore.Oftenthetermmaster
isusedtorefertoatesttakerwhosescoreexceedsthecutoffscore,andnonmasterisusedtorefertoatesttakerwhosescorefallsbelowthecutoff.Brieflythen,in
contrasttoanormreferencedinterpretation,scoreinterpretationforacriterionreferencedmeasurehingesonknowledgeofthepersonsrawscoreandthecutoff
score.Informationaboutareferenceornormativegroupisnotnecessary.Itisoftenuseful,however,fordevelopersofcriterionreferencedmeasurestostudygroup
performancesasameansofdeterminingareasonablecutoffscoreonethatisempiricallyderivedratherthanbasedonanarbitrarycutoff,forexampleat80%
correct.
Inadditiontodifferencesinthemechanicsofscoreinterpretation,normreferencedversuscriterionreferencedmeasurestendtodifferinthescopeofknowledgebeing
assessedandthespecificmethodusedtochooseitems.Specifically,normreferencedmeasurestendtoaddressalargecontentareawhichissampledbroadly
whereascriterionreferencedmeasurestendtoaddressaquitenarrowlydefinedconceptthatissampledinasexhaustiveamanneraspossible.Fornormreferenced
measures,itemsareselectedsothatthegreatestamountofvariabilityintestscoresisachievedamongtesttakerswhereasforcriterionreferencedmeasures,itemsare
selectedprimarilybecauseofhowwelltheyaddressthetargetedconstruct.Figure2.3showsthestepsinvolvedinthedevelopmentofstandardizednormreferenced
andcriterionreferencedinstruments.
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Atthebeginningofthissection,onlyasinglemeasure,theAmazingUniversityofVermontTest,wasusedtointroducetheconceptsofcriterionandnormreferencing.
Thiswasdoneinordertoemphasizethatmethodofinterpretationisthemostcrucialfeaturedistinguishingnormfromcriterionreferencedmeasures.Practically,
however,becauseofdifferencesinhowitemsareselectedforeachtypeofmeasure,itisverydifficulttodevelopasinglemeasurethatcanequallysupportthesetwo
differentapproachestoscoreinterpretation.
TypesofScores
NormReferencedMeasures
Fornormreferencedmeasures,avarietyoftestscoresisuseful.Becauseofthecentralityofthecomparisonbetweenthetesttakersandthenormativegroups
performances,however,therawscoreisoflittlevalue
Fig.2.3.Stepsinvolvedinthedevelopmentofnormreferencedandcriterionreferencedstandardizedmeasures.
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exceptasthestartingpointforotherscores.Theseotherscoresaretermedderivedscoresbecauseoftheirdependentrelationshiptotherawscore.Threetypesof
derivedscoresdeserveattention:developmentalscores,percentileranks,andstandardscores.Thesearelistedinincreasingorderofboththeirvalueasameansof
representingatesttakersperformanceandtheircomplexityofcalculation.
DevelopmentalscoresaretheleastvaluablederivedscoresbutarestillubiquitousinclinicalandresearchcontextsaparadoxthatIwilladdressshortly.Thetwo
mostcommonlyuseddevelopmentalscoresareageequivalentscoresandgradeequivalentscores.Atesttakersageequivalentscoreisderivedbyidentifying
theagegroupthathasameanscoreclosesttothescorereceivedbytheindividualtesttaker.Forexampleifatesttakersrawscoreof85correspondingthemeanraw
scoreofagroupof3yearolds,theageequivalentscoreassignedtothetesttakerwouldbe3years.Ifthereisnoagegroupthatexactlymatchesthescoreofatest
taker,thenanestimationismadeofhowmanymonthsshouldbeaddedtotheagegroupwhosemeanfallsjustbelowthatofthetesttaker,resultingingradeequivalent
scores,suchas2years,6monthsor5years,11months.Typically,testusersdonothavetoexaminethegroupdatadirectly,butaregiventableslistingrawscoresand
theagescorestowhichtheycorrespond.
Gradeequivalentscoresaresimilarinmanyrespectstoageequivalentscoresbutare,asonewouldguessfromtheirname,derivedfromdataconcerningthemean
performanceofgroupsoftesttakersindifferentgrades.Whenestimationisrequired,gradeequivalentscoresarereportedintenthsofagrade.Thus,fora12yearold
whoachievesascorejustslightlyabovethatofagroupof4thgraders,agradeequivalentof4.1or4.2mightbeassigned.
Inpsychometriccircles,almostneverisakindwordspokenaboutscoresofthistype.Long,derogatorylistsoftheproblemswithdevelopmentalscoresabound(e.g.,
McCauley&Swisher,1984Salvia&Ysseldyke,1995),butthelistsinvariablycenteraroundconcernsthatsuchscoresareeasilymisunderstoodandlikelytobe
unreliable.Table2.5providesanelaborateversionoftheselistsaswellasapointedcommentaryondevelopmentalscores.
Theappealofdevelopmentalscoresistwofold.First,theapparentuniformityofmeaningofsuchscoresacrossdifferenttestsmakesitseemthattheyallowfora
comparisonofskillsindifferentareasandpermitasensitivequantificationofdegreeofimpairment.Thus,whena9yearoldchildissaidtohaveskillsfallingatthe7
yearlevelinmathandthe8yearlevelinreceptivelanguage,itcanbemisinterpretedasindicatingsignificantproblemsinbothareas,withamoresevereimpairmentin
mathematics.Althoughmanyindividualsarequiteawareofthelowesteeminwhichdevelopmentalscoresareheld,theynonethelessfallintomisinterpretationslikethis.
Giventhatageequivalentscoresonlycrudelycomparetwoscoresastheirmeansofnormreferencing,neitherindividualdevelopmentalscoresnorcomparisons
betweenthemnecessarilyconveydegreesofimpairment.Dependingonthetestsused,forexample,itmaybethatagreatmanyverynormallydevelopingchildren
wouldexhibitthesameimpairedscores.
Thesecondappealofdevelopmentalscoresliesoutsidetheinterestsofindividualtestusers.Numerousstateandinsuranceregulationsdemandthatdevelopmental
scoresbeusedtodescribetestperformances,presumablyonthebasisofthemisconceptionscitedearlierthatmeaningfulcomparisonsbetweenskillareascanbe
based
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Table2.5
FiveDrawbackstoDevelopmentalScores,SuchasAgeEquivalent
andGradeEquivalentScores(Anastasi,1982Salvia&Ysseldyke,1995)
Developmentalscoresleadtofrequentmisunderstandingsconcerningthemeaningofscoresfallingbelowachildsageorgrade.Forexample,aparentmay
interpretanageequivalentof5years,10monthsasevidenceofadelayina6yearold.Infact,bydefinition,halfofthosechildreninagivenagegroup(orgrade
1.
level)wouldreceiveageequivalentscoresbelowthechildsage.Thisproblemarisesbecausedevelopmentalscorescontainnoinformationaboutnormalgroup
variability.
Thereisatendencytointerpretdevelopmentalscoresasindicatingthatperformancewassimilartothatofanindividualofcorrespondingageforexample,thata
2. scoreof3years,6monthswouldbeassociatedwithperformancethatwasqualitativelylikethatofa3yearold.Infact,however,itisunlikelythatthenature
andconsistencyoferrorswouldbesimilarfortwoindividualswithsimilardevelopmentalscoresbutdifferingagesorgradelevels.
3. Developmentalscorespromotecomparisonsofchildrenwithotherchildrenofdifferentagesorgradesratherthanwiththeirsameagepeers.
Developmentalscorestendtobeordinalintheirlevelofmeasurement.Therefore,theylackflexibilityinhowtheymaybetreatedmathematicallyandareproneto
4. beingmisunderstood.Forexample,adelayof1yearinafifthgraderwhoreceivesagradeequivalentscoreof4isnotnecessarilycomparabletoadelayof1
yearinaninthgraderwhoreceivesagradeequivalentscoreof8.
5. Developmentalscoresarelessreliablethanothertypesofscores.
onthem.AsIdiscussinthenextsectionofthischapter,suchregulationoftestusersprovidesavividexampleofthenumerouscasesinwhichassessmentmustrespond
toavarietyofforcesoutsideofthedirectclinicalinteractionbetweenclinicianandclient.Typically,testusersfacedwiththedilemmaofhavingtoreportdevelopmental
scoresareadvisedbypsychometricianstoreportthemalongwithmoreusefulderivedscoresinamannerthatminimizesthelikelihoodofmisunderstanding.
Percentileranksareactuallyonevarietyofaclassofderivedscoresthatincludesquartilesanddeciles.Percentileranksrepresentthepercentageofpeoplereceiving
scoresatorbelowagivenrawscore.Thus,apercentilerankof98,or98thpercentile,indicatesthatatesttakerreceivedascorebetterorequaltothoseof98%of
personstakingthetest(usuallythenormativesample).Thistypeofscorehasthedistinctadvantageofbeingreadilyunderstoodbyawiderangeofpersons,including
parentsandsomeolderchildren.
Percentilerankshavetwodisadvantages.Thefirstisthattheyaresometimesmisunderstoodasmeaningpercentageofcorrectresponsesonthetest.Readerscanavoid
thisfalsestepiftheyrememberthatonaverydifficulttest,onecouldperformbetterthanalmostanyone(andthereforehaveahighpercentilerank),butinfacthave
obtainedalowpercentagecorrect.Theseconddisadvantageofpercentileranksisthat,likedevelopmentalscores,theyrepresentanordinalmeasureandthuscannot
becombinedoraveraged.
Standardscoresrepresentthepinnacleofscoringapproachesusedinnormreferencedtesting.Theypreserveinformationaboutthecomparisonbetweenanindividual
andappropriateagegroupandinformationaboutthevariabilityofthenormativegroup.
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Inaddition,theyareattheintervallevelofmeasurementandthuscanbecombinedandaveragedinwaysnotpossiblewiththeothertypesofscoresdiscussedearlier.
Standardscoresarestandardbecausetheoriginaldistributionofrawscoresonwhichtheyarebasedhasbeentransformedtoproduceastandarddistributionhaving
aspecificmeanandstandarddeviation.Becausestandardscoresarenormallydistributed,theycanbeinterpretedintermsofknownpropertiesofthenormal
distribution,especiallyexpectationsconcerninghowexpectedorunexpectedaparticularscoreis.Thismakesstandardscoresafavoredmethodofcommunicatingtest
resultsamongprofessionals.Figure2.4illustratestherelationshipbetweenthenormalcurveandseveralofthemostfrequentlyusedscores:thezscore,deviationIQ
score,andTscores.
Themostbasicstandardscoreisthezscore,whichhasameanof0andastandarddeviationof1.Itiscalculatedbytakingthedifferenceofaparticularrawscore
fromthemeanforthedistributionanddividingtheresultbythestandarddeviationofthedistribution.Eachscoreisrepresentedbythenumberofstandarddeviationsit
fallsfromthemean,withpositivevaluesrepresentingscoresthatwereabovethemeanandnegativevalues,representingthosebelowthemean.Becauseofthe
relationshipbetweenthistypeofscoreandthenormalcurve,itispossibletoknowthatazscore
Fig.2.4.Therelationshipbetweenthenormalcurveandseveralofthemostfrequentlyusedstandardscores,includingthezscore,deviationIQscore,andTscores.
FromAssessmentofchildren(p.17),byJ.M.Sattler,1988,SanDiego,CA:Author.Copyright1988byJ.M.Sattler.Reprintedwithpermission.
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of2falls2standarddeviationsbelowthemeanandthatfewerthan3%ofthenormativepopulationhadascorethatloworlower.
OtherwidelyusedstandardscoresindevelopmentallanguagedisordersarethedeviationIQandtheTscore.Thesescoressharethevirtueofzscoresintheirknown
relationshipstothenormalcurve:ThedeviationIQhasameanof100andastandarddeviationof15.Asanadditionalbenefit,suchscoresaresomewhatlessopento
theconfusionassociatedwithnegativenumbersusedinzscores.However,theirinterpretationremainsquitechallengingforpeoplewhoareunfamiliarwiththeuseof
thenormalcurveinscoreinterpretation.Still,becauseoftheirstrengths,standardscoressuchasthesearefrequentlyusedamongprofessionals,withpercentiles
favoredforusewithotheraudiences.
CriterionReferencedMeasures
Forcriterionreferencedmeasures,rawscoresarethemajortypeofscorebecausebydefinitionsuchmeasuresinvolvethecomparisonofarawscoreagainstagiven
criterionorcuttingscore.Asmentionedpreviously,itispossibleforthecutoffscoretobebasedonempiricalstudyorforittobearbitrarilyestablishedonthebasisof
hypothesesaboutthelevelofperformance,orperformancestandard,requiredforsatisfactoryadvancementtolaterlevelsofskillacquisition(McCauley,1996).
CaseExample
Case2.1illustratesmostoftheconceptsdiscussedinthischapterastheyrelatetoAustin,a5yearoldboywithspecificlanguageimpairment.Thishypotheticalreport
isannotatedtohighlightinstanceswhereameasurementhasbeenmadebytheclinician.Specifically,bothformalandinformalmeasuresareboldedinthiscase.
Case2.1
SpeechLanguageHearingCenter
353LuseStreet
Burlington,VT054050010
Clientsname:AustinG.
Address:(childshomewithmotherandstepfather) DateofEvaluation:2/12/97
284WillowCreekRoad Parentsnames:LeslieG.(mother)
Burlington,VT05401 WarrenG.(stepfather)
GeorgeC.(father)
33ElmStreet
DateofBirth:1/8/92 Savannah,GA31411
EducationStatus:Kindergarten h:(912)9999393
School:WoodwardElementarySchool ReferralSource:Dr.A.B.Park
2StationStreet Studentclinician:E.Miller,B.A.
Burlington,VT05401 Supervisor:R.J.Turner,M.S.,CCCSLP
Dateofreport:2/14/97
Page39
BACKGROUNDINFORMATION
Austin,a5year,1montholdboy,wasseentodayforaspeechandlanguageevaluationfollowingreferralbyhisprimarycarephysician.Dr.A.B.Park.Background
informationwasobtainedusingacasehistoryform,anindepthparentinterviewconductedwithMr.andMrs.G.,whoaccompaniedAustintoday,andaphone
conversationwithMr.C.,Austinsbiologicalfather.
ThereasonsgivenbyMr.andMrs.GfortodaysevaluationweregrowingconcernsregardingAustinsarticulation,overallintelligibility,andexpressivelanguage
skills.Mr.andMrs.GreportthatstrangersandevenotherchildreninAustinsclassfindhimdifficulttounderstandandfrequentlyaskhimtorepeatwhathehassaid.
Heisalsobecomingincreasinglyfrustratedwithfamilymemberswhentheyfailtounderstandhim,resultinginincreasinglyfrequentandescalatingargumentswithhis
oldersister.Elizabeth(age10).Incontrast,theyreportthatheunderstandseverythingthatissaidtohimandisrecognizedasaverybrightchildevenbyadultswho
failtounderstandhim.
AustinandhissisterElizabethlivewithMr.andMrs.Gandseetheirbiologicalfather,Mr.C,onlyatholidaysandfor6weeksinthesummer.Theparentsdivorced
whenAustinwas1yearold,andhecallshisstepfatheraswellashisbiologicalfatherDaddy.AustincurrentlyattendsakindergartenclassintheWoodward
ElementarySchoolBurlington,wherehehasthreeorfourespeciallyclosefriends.AccordingtohisteacherMrs.Smithsreportstohisparents,Austinisahappy
childWhoispopularatleastinpartbecauseofhisenthusiasticmannerandskillatplaygroundathletics.Becauseheissmallforhisage(inthe5thpercentileforheight
andweight)andbecauseofhisimmaturesoundingspeech,heissometimesteasedbychildrenfromolderclassesaboutbeingababy,butisreadilydefendedbyhis
classmatesandappearsunaffectedbysuchtaunts,accordingtoMrs.Smith.ShereferredAustinforaspeechlanguageevaluationbytheschoolspeechlanguage
pathologistinJanuarybecauseofconcernsabouthislanguageproductionandarticulation,butotherwiseshestatesthatheisperformingwellinthekindergarten
classroom.Becausecircumstancespreventedthatevaluationfromtakingplace,Mr.andMrs.GhaddecidedtoseekanevaluationattheLuseCenter.
Austinsbirthandearlyhealthanddevelopmentalhistoryareunremarkableexceptfordelaysintheonsetofspeech,withonlyabout10wordsbyage2andnoword
combinationsuntilage3.Althoughhehadshownadramaticincreaseinthelengthofhisutterancesoverthepast2years,hisparentsreportedthathestillspeaksin
incomplete.sentencesandproducesmanywordsincorrectly.Bothbiologicalparentsreportedasignificanthistoryoffamilymemberswithspeechandlanguage
problems,includingMr.C.,whoreceivedspeechtherapyuntil5thgradeforwhatappearedtohavebeenlanguagerelatedconcerns,twoofAustinspaternaluncles,
onematernalauntintheprecedinggeneration,andtwomaternalcousins.
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LISTOFASSESSMENTTOOLS
Theassessmentproceduresthatwereconductedduringthisevaluationarelistedandreportedintheparagraphsthatfollow.
Hearingscreeningtest
TestofLanguageDevelopment2Primary(Newcomer&Hammill,1991).
ExpressiveOneWordPictureVocabularyTest(Gardner,1990)
PeabodyPictureVocabularyTest3(Dunn&Dunn,1997)
BanksonandBanksonTestofPhonology(Bankson&Bernthal,1990)
OralStructuralMechanismExaminationRevised(St.Louis&Ruscello,1987).
Inaddition,informalprocedureswereusedtoscreenpragmatics,voice,andfluency.Overallresultsofthesetestsandproceduresaredescribedinthefollowing
sections,withmoredetailedinformationaboutsubtestperformanceandspecificerrorsavailableonsummarytestforms(seefile).
Hearing
Austinshearingwasscreenedusingpuretonesthatwerepresentedunderheadphonesat20dBbilaterallyat500,100,2000,and4000Hz.Hepassedthescreening
inbothears.
ReceptiveLanguage
AustinsabilitytounderstandwhatissaidtohimwasassessedusingreceptiveportionoftheTestofLanguageDevelopment2Primary(TOLDP:2)andthe
PeabodyPictureVocabularyTest3(PPVT2).OnthereceptivelanguagesubtestsoftheTOLDP:2,Austinreceivedalisteningquotientof96,which
approximatesapercentilerankof50.OnthePPVT2,hisperformancewasevenbetter.Therawscoreheobtainedwas78,whichcorrespondstoapercentilerank
of75andastandardscoreof110.
ExpressiveLanguage
AustinsabilitytoexpresshimselfwasassessedusingtheTOLDP:2expressiveportionsandtheExpressiveOneWordPictureVocabularyTestRevised,
aswellasinformalmeasuresobtainedfromatranscriptionofaconversationalsampletakenasAustinplayedwithhismother.Austinsformaltestscoreswere
considerablyloweronthesemeasures,inpartbecauseofthedifficultiesassociatedwithhisspeechintelligibility.OnEOWPVTR,Austinreceivedarawscore
Page41
of20,whichcorrespondstothe5thpercentileandastandardscoreof76.Ofhis10errorsonthattest,approximately4wereunambiguouswithrespecttothe
possibleimpactofhisspeechproductiondifficultiesforexample,theyinvolvedtheuseofamoregeneralorassociatedwordthanthetarget,ortheyconsistedof
instanceswhenAustinsaidthathedidnotknowthename.OntheTOLDP:2expressivesubtests,Austinreceivedanoverallspeakingquotientof61,whichfalls
belowthefirstpercentile.Anexaminationofhisutterancesduringaconversationwithhismotherrevealedfrequentomissionofgrammaticalmorphemes,an
absenceofcomplexsentences,andatendencytooverusethewordthingytorefertonumerouselementsofaLegoconstructionthattheybuiltcooperatively.
PhonologyandOralMotorPerformance
TheOralSpeechMechanismExaminationRevised(OSMER)wasusedtoexaminetheadequacyofAustinsoralstructuresforspeechproduction.His
performanceonthatmeasurewaswellwithinthenormalrange,withnosignsofincoordinationorweaknessandnoobservableabnormalitiesofthestructuresusedin
speech.Errorsnotedintheproductionofrepeatedsyllablesmirroredthoseinhisconversationalspeech.
OntheBanksonBernthalTestofPhonology,Austinreceivedawordinventoryscore,whichreflectsthenumberofwordsproducedcorrectly,of39,which
correspondstoaStandardScoreof71andapercentilerankof3.Errorsoccurredprimarilyonmedialorfinalconsonants.Patternsoferrorsthatoccurredmost
frequentlywerefinalconsonantdeletion(omissionofthefinalconsonantintheworde.g.,batbecomesba),clustersimplification(replacementorlessofoneor
moreelementsofaconsonantclustere.g.,clownbecomesclo),andfronting(replacementofavelarconsonantbyamoreforwardconsonante.g.,gun
becomesdun).Effortstoelicitcorrectproductionoftwoconsonantsthathadnotbeenproducedcorrectlyuptothatpoint(viz.,k,g)wereundertakenusinga
phoneticplacementinstructionsandtouchcuesresultedinvelarfricativeapproximations.Othersoundsconsistentlyinerrorwere[s,z,r]and[l].
Whenthelanguagesamplediscussedintheprevioussectionwasexaminedwithregardtospeecherrorsandintelligibility,very,similarerrorpatternswereobserved
andthepercentageofunderstandablewordsoutofallwordsspokenwasdeterminedtobe70%.
ScreeningforOtherLanguageandSpeechProblems
TheconversationalsamplebetweenAustinandhismotherwasalsoexaminedtoscreenforproblemsinpragmatics,voice,andfluency.Austinsuseoflanguage
andhisabilitytodescribetheplotofamoviehehadrecentlyseenwith
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outhismotherappearedappropriateforhisage.Hisvoicequalityandpitchwerenormal.Fluencyalsoappearednormal,althoughfrequentrepetitionsandrewordings
ofsentencesoccurredinresponsetohismothersverbalandnonverblindicationsofhavingdifficultyinunderstandingsomeofhisutterances.AlthoughAustins
awarenessofhiscommunicationdifficultiesisquitesophisticatedinachildofhisage,hisfacialexpressionandmovementsattimessuggestedsignificantfrustration.
Summary
Austinappearstobeabrightandsensitive5yearoldwithnosignificantmedicalhistory,butafamilyhistoryofcommunicationdifficulties.Todaysevaluationreveals
normalhearingandlanguagecomprehension,aswellasgoodconversationalskillsandnormalvoiceandfluency.Austinsdifficultiesinbeingunderstoodaremoderate
tosevereatthistimeandappeartoreflecthisdifficultiesinusingsoundsasexpectedforhisageandinselectingandcombiningwordstocreategrammatically
acceptablesentences.Hisstrongskillsinotherareas,supportbyfamilyandschoolpersonnel,andclearmotivationtoimprovehiscommunicationeffortssuggesta
verypositiveprognosisforchange.
Recommendations
Austinislikelytobenefitfromspeechlanguageinterventionconductedinindividualandgroupsettingathisschool,includinginclassworkconductedbyhisteacherin
consultationwiththeschoolspeechlanguagepathologist.Areastobetargetedincludephonology,expressivevocabulary,andsyntax.Specificgoalsshouldaddress
(a)thephonologicalprocessesoffinalconsonantdeletionandfronting,(b)expressivevocabularyrelatedtoschoolactivities,(c)theuseofgrammaticalmorphemes
thatarenotcurrentlyusedbutshouldbepronounceablegivenhiscurrentphonologicalsystem,and(d)thedevelopmentofstrategiesfordealinginamorerelaxedway
withlistenersdifficultiesinunderstandingAustinsspeech.
ItwasapleasuretomeetAustinandhisfamilytodayandtohavetalkedpreviouslytoothersinvolvedinhiseducationandupbringing.Weurgeyoutocallwithany
questionsyoumighthaveaboutthisreportorAustinsongoingdevelopment.
Sincerely,
E.Miller,B.A.R.J.Turner,M.S.,CCCSLP
StudentclinicianSupervisor
Page43
Summary
1.Measurementisusuallyindirect,meaningthatitinvolvesthemeasurementofcharacteristics,sometimescalledindicators,thatarecloselyrelatedtobutdifferentfrom
thecharacteristicbeingdescribedbytheprocessofmeasurement.
2.Theuseoftheoreticalconstructs,whichareexaminedusingvariousindicators,underliesclinicalaswellasresearchmeasurement.
3.Fourlevelsofmeasurement,firstproposedbyS.S.Stevens(1951),arenominal,ordinal,interval,andratio.Theselevelscorrespondtodifferentmethodsof
assigningmeasurementstocharacteristics,whichhaveimplicationsforthemeasurementsappropriateinterpretationandstatisticalstudy.
4.Measuresatthenominallevel,suchasdiagnosticlabelsorlabelsoferrortype,involvetheassignmentofmeasuredindividualperformancesorbehaviorstomutually
exclusivecategories.Measurementsattheordinallevels,suchasseveritylabels,alsousemutuallyexclusivecategories,butonesthatcanbeorderedasdemonstrating
moreorlessofthemeasuredcharacteristic.
5.Measuresattheintervallevel,suchastestscoresreportedinraworstandardscores,involvetheassignmentofnumberedvaluestocharacteristics.Thisisthehighest
levelofmeasurementusuallyattainedinthebehavioralsciences.
6.Oftenatheoreticalconstructcanbemeasuredusingindicatorsfallingatvariouslevelsofmeasurement.
7.Statisticsareusefulforgainingandsummarizinginformationaboutgroupsofmeasurements,calleddistributions,aswellasfortestinghypothesesaboutthe
relationshipsbetweendistributionsorbetweenanindividualscoreandadistribution.
8.Twotypesofstatisticsusedinsummarizingdistributionsofmeasurementsaremeasuresofcentraltendency(e.g.,mean,median,mode)andmeasuresofvariability
(e.g.,standarddeviation,variance,range).Centraltendencyreferstothemosttypicalvaluesinadistribution,whereasvariabilityreferstothetendencyofvaluesinthe
distributiontodifferfromoneanother.
9.Inthemeasurementliterature,correlationcoefficientsaretheonesmostusedtodescribetherelationshipbetweengroupsofmeasures,withthePearsonproduct
momentcorrelationcoefficientachievingthegreatestuse.Correlationreferstothetendencyforvaluesofonedistributiontobesystematicallyrelatedtovaluesof
anotherdistribution.
10.Causalinferencescannotbemadedirectlyfromobservationsofcorrelations:IfvariablesAandBarerelated,itmaybecauseAcausedB,BcausedA,orthatboth
arecausedbyathirdvariableorsetofvariables.
11.Normreferencedmeasuresareinterpretedthroughthecomparisonofapersonsperformancetothoseofarelevantnormativegroupusuallyusingaderived
scorethatincorporatesinformationrelevanttothecomparison.Criterionreferencedmeasuresareinterpretedthroughthecomparisonofapersonsperformancetoa
performancestandardusuallyusingarawscore.
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12.Derivedscoresconsistofdevelopmentalscores(ageandgradeequivalentscores),percentileranks,andstandardscores(e.g.,zscores,Tscores,deviationIQ
scores).Percentileranksareprobablythemostwidelyusedamonglaypersons,whereasstandardscoresarepreferredbymostprofessionals.Althoughwidelyused,
developmentalscoresaretheleastrespectedtypeofscoreamongprofessionalsbecausetheyencouragemisunderstandingandarelessreliablethanotherderived
scores.
KeyConceptsandTerms
abilitytesting:asystematicprocedureforexploringlearningpotential.
achievementtesting:asystematicprocedureforexaminingpastlearning.
ageequivalentscore:aderivedscorecorrespondingtotheagegroupwiththemeanscorethatisclosesttotherawscorereceivedbytheindividualtesttaker.
behavioralobjectives:adescriptionoftreatmentgoalsintermsofclientbehaviors.
clinicalsignificance:thelikelyvalueofaparticularresearchfindingonthebasisofthereliabilityofthefinding(i.e.,itsstatisticalsignificance)anditsmagnitude.
computerizedtests:teststhatinvolvetheuseofcomputerdisplay,keyboardedresponses,orboth.
correlation:thedegreeofrelationshipexistingbetweentwoormorevariables.
criterionreferencedmeasure:ameasureinwhichscoresareinterpretedinrelationtoaparticularbehavioralcriterioncontrastswithnormreferencedmeasure.
developmentalscores:atypeofderivedscoreinwhichdevelopmentistakenintoaccount,forexample,ageequivalentandgradeequivalentscores.
distribution:agroupofscores,eithertheoreticalorobserved.
formativeindicators:indicatorsthatareassociatedwithacauseofaconstructthatisofinterest.
gradeequivalentscores:aderivedscorecorrespondingtothegradespecifiedgroupwiththemeanscorethatisclosesttotherawscorereceivedbytheindividual
testtaker.
indicator:anindirectobjectofmeasurementsomethingonemeasuresinplaceofthecharacteristiconeisreallyinterestedinbecauseitisbothrelatedtotheactual
focusofinterestandismoreaccessibletomeasurement.
intervallevelofmeasurement:alevelofmeasurementusingmutuallyexclusivecategoriesinwhichscoresreflectarankorderingofthecharacteristicbeingmeasured
andthedifferencebetweenadjacentscoresisequalinsizeforexample,scoresonabehavioralprobe.
localnorms:summariesoftheperformanceofarelevantgroupofindividualsthatareobtained,oftenwhennationalnormsareunavailable,forpurposesofmakinga
specificcomparisonbetweenanindividualtesttakersperformanceandthoseofthatgroup.
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mean:adistributionsarithmeticaverage.
median:themiddlescoreofadistribution.
mode:themostfrequentlyoccurringscore(s)ofadistribution.
nationalnorms:summariesofthetestperformancesofalargegroupofindividualsagainstwhichapersonsperformancecanbecomparedusuallyconsistingof
individualswithknowndemographiccharacteristics.
nominallevelofmeasurement:alevelofmeasurementinwhichcharacteristicsofanindividualareassignedtomutuallyexclusivecategories(e.g.,boysandgirls).
nonparametricstatistics:statisticsthatdonotrequireassumptionsaboutthenatureoftheunderlyingdistributionfromwhichobservationsaredrawn.
normaldistribution:atheoreticaldistributionofscoresorsetofscoreswithknownmathematicalproperties.
normativegroup:agroupwhoseperformanceisusedinthecomparisonandinterpretationofanindividualsscoreinnormreferencedscoreinterpretation.
normreferencedmeasure:ameasureinwhichscoresareinterpretedinrelationtotheperformanceofanormativegroupcontrastswithcriterionreferenced.
norms:dataconcerningthedistributionofscoresachievedbyanormativegroup.
operationaldefinition:definingavariablethroughtheoperationsusedtomeasureit.
ordinallevelofmeasurement:alevelofmeasurementusingmutuallyexclusivecategoriesthatreflectarankorderingofthecharacteristicbeingmeasured.
paperandpenciltests:conventionaltestinginwhichprintedtestmaterialsarecompletedindependentlybyliteratetesttakers.
parametricstatistics:statisticsthatrequirecertainassumptionsaboutthenatureoftheunderlyingdistributionfromwhichobservationsaredrawn.
percentileranks(percentiles):derivedscoresrepresentingthepercentageofindividualsperformingatorbelowagivenrawscore.
performancestandard:acriterionagainstwhichanindividualsperformancecanbecomparedincriterionreferencedscoreinterpretation.
performancetests:teststoassessskillsinvolvingthemanipulationofobjectsorthatotherwisearedifficultorimpossibletoassessusingpaperandpenciltests.
range:onemethodofdescribingthevariabilityofadistributionthedifferencebetweenthehighestandlowestscoresinthedistribution.
ratiolevelofmeasurement:alevelofmeasurementusingmutuallyexclusivecategories(scores)inwhichthescoresreflectarankorderingofthecharacteristicbeing
measured,thedifferencebetweenadjacentscoresisequalinsize,andthereisarealzeroalongthescaleforexample,thetimeelapsingbetweenpresentationofa
pictureandnameproduction.
reflectiveindicators:indicatorsthatareassociatedwiththeeffectsofaconstructthatisofinterest.
Page46
standarddeviation:amethodofdescribingthevariabilityofadistributionofscoresthesquarerootofthevariance.
standardscores:derivedscoresinwhichatransformationhasbeenusedtoassureapredeterminedmeanandstandarddeviation,forexample,ameanof100and
standarddeviationof15.
statisticalsignificance:statisticalevidencethatanobtainedvaluewasunlikelytohaveoccurredbychance.
theoreticalconstruct:aconceptusedinaspecificwaywithinaparticularsystemofrelatedconcepts.
theory:asystemofrelatedconcepts,usuallyusedtoexplainavarietyofrelateddataconcerningaphenomenonofinterest.
variables:measurablecharacteristicsthatdifferunderdifferentcircumstances.
variance:amethodofdescribingthevariabilityofadistributionitconsistsofthemeanofthesquareddistancesofscoresfromthedistributionmean
StudyQuestionsandQuestionstoExpandYourThinking
1.Imaginethatyouareinterestedinmeasuringtheabilityofachildtounderstandthenamesofcolorsusuallyknownbychildrenofhisorherage.Thinkoffourdifferent
indicatorsfortheconstructofcolornamecomprehensiontwothatarereflectiveandtwothatareformative.
2.Proposeanindicatorofspellingproficiencyfallingateachofthefirstthreelevelsofmeasurement:nominal,ordinal,andinterval.
3.SupposethatameasurementtooloffersyoutwodifferentnormativegroupsagainstwhichtocomparetheperformanceofachildwhospeaksKoreanasafirst
languageandEnglishasasecondonegroupconsistingofchildrenofsimilarageswithsimilarlanguagehistoriestothechildtobetestedandoneofchildrenofsimilar
ageswithEnglishastheironlylanguage.Whatwouldeachcomparisontellyouaboutthechild?
4.Foreachofthefollowingmeasurementpurposes,explainwhichtypeofscoreinterpretationwouldbemostsuitablenormorcriterionreferencing:
a. identifyingthepoorestperformanceonaclassroomtest
b. competencytestingforgraduationfromhighschool
c. testingforlicensureinaprofession,suchasspeechlanguagepathology
d. nationaltestingforscholasticaptitude(e.g.,SATsorGREs)
e. determiningsuccessoftreatmentaimedatimprovingastudentscorrectuseofselectedverbforms
5.Findanewspaperarticleinwhichabehavioralmeasureisdescribed.Whatconstructappearstobemeasured?Atwhatlevelisthatmeasurementconducted?What
measuresofcentraltendencyandvariabilitywouldbeappropriateforthismeasure?
Page47
6.Findanewspaperarticleinwhichtherelationshipbetweentwovariablesisdescribed.Isacausalrelationshipbetweenthesevariablesimplied?Doesthat
interpretationseemwarrantedorcanyouimagineadifferentcausalrelationshipbetweenthevariables?Describeit.
7.Onthebasisofyourpersonalobservation,describetwovariablesyoubelievehaveapositivecorrelationwithoneanother,thentwothathaveanegativecorrelation.
8.A3yearoldchildreceivesatestscoreonanormreferencedtestthatfallsatthe35thpercentileandyieldsanageequivalentscoreof2years,8months.Explain
themeaningofthosescoresasifyouweretalkingtoaveryworriedparent.
9.Theparentofahighachieving10yearoldgirltellsyouthatherdaughterhasbeentestedbyaneighborwhoisstudyingpsychologyandachievedastandardscore
of100onanintelligencetest.Shewondersifthatdoesntmeanthatherchildsperfectscoresuggeststhatsheisageniuswhoshouldskipseveralgrades.Whatwould
youtellheraboutherchildsperformance?(Thisistricky.Considerboththefactthatyoudidntobtainthisinformationdirectlyaswellasthemeaningofstandard
scores.)
10.Pretendthatyouhavedevisedatesttodeterminestudentsmasteryofthecontentcoveredinthischapter.Howmightyoudetermineanappropriatecuttingscore?
(No,theanswertothisisnotinthebookuptothispoint.Thinkcreatively).
RecommendedReadings
Gould,S.J.(1981).Themismeasureofman.NewYork:Norton.
Sattler,J.M.(1988).Assessmentofchildren(3rded.).SanDiego:Author.
References
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AmericanPsychologicalAssociation,AmericanEducationalResearchAssociation,&NationalCouncilonMeasurementinEducation.(1985).Standardsfor
educationalandpsychologicaltesting.Washington,DC:AmericanPsychologicalAssociation.
Anatasi,A.(1982).Psychologicaltesting(5thed.).NewYork:Macmillan.
Badian,N.(1993).Phonemicawareness,namingandvisualsymbolprocessingandreading.ReadingandWriting,5,87100.
Bankson,N.W.,&Bernthal,J.E.(1990).BanksonBernthalTestofPhonology.Chicago:Riverside.
Bernthal,J.E.,&Bankson,N.W.(1998).Articulationandphonologicaldisorders(4thed.).EnglewoodCliffs,NJ:PrenticeHall.
Bradley,L.,&Bryant,P.(1983).Categorizingsoundsandlearningtoread:Acausalconnection.Nature,301,419421.
Bridgman,P.W.(1927).Thelogicofmodernphysics.NewYork:Macmillan.
Bunderson,C.V.,Inouye,D.K.&Olsen,J.B.(1989).Thefourgenerationsofcomputerizededucationalmeasurement.InR.L.Linn(Ed.),Educational
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Chial,M.R.(1988).Utilityinferentialstatistics.InD.Yoder&R.D.Kent(Eds.),Decisionmakinginspeechlanguagepathology(pp.198201).Toronto:B.C.
Decker.
Conover,W.M.(1998).Practicalnonparametricstatistics(3rded.).NewYork:Wiley.
Page48
Culatta,B.,Page.,J.L.,&Ellis,J.(1983).Storyretellingasacommunicativeperformancescreeningtool.Language,Speech,andHearingServicesinSchools,14,
6674.
Francis,D.J.,Fletcher,J.M.,Shaywitz,B.A.,Shaywitz,S.E.,&Rourke,B.P.(1996).Defininglearningandlanguagedisabilities:Conceptualandpsychometric
issueswiththeuseofIQtests.Language,Speech,andHearingServicesinSchools,27,132143.
Freedman,D.,Pisani,R.,&Purves,R.(1998).Statistics(3rded).NewYork:Norton.
Gardner,M.F.(1990).ExpressiveOneWordPictureVocabularyTestRevised.Novato,CA:AcademicTherapy.
Gibbons,J.D.(1993).Nonparametricstatistics:Anintroduction.NewburyPark,CA:Sage.
Gould,S.J.(1981).Themismeasureofman.NewYork:Norton.
Gronlund,N.(1982).Constructingachievementtests(3rded.).EnglewoodCliffs,NJ:PrenticeHall.
Kerlinger,F.N.(1973).Foundationsofbehavioralresearch.(2nded.)NewYork:Holt,Rinehart&Winston.
Lahey,M.(1988).Languagedisordersandlanguagedevelopment.NewYork:Macmillan.
McCauley,R.J.(1996).Familiarstrangers:Criterionreferencedmeasuresincommunicationdisorders.Language,Speech,andHearingServicesinSchools,27,
122131.
McCauley,R.J.,&Swisher,L.(1984).Useandmisuseofnormreferencedtestsinclinicalassessment:Ahypotheticalcase.JournalofSpeechandHearing
Disorders,49,338348.
McClave,J.T.(1995).Afirstcourseinstatistics(5thed.).EnglewoodCliffs,NJ:PrenticeHall.
Newcomer,P.L.,&Hammill,D.D.(1991).TestofLangugeDeveloment2Primary.Austin,TX:ProEd.
Pedhazur,R.J.,&Schmelkin,L.P.(1991).Measurement,design,andanalysis:Anintegratedapproach.Hillsdale,NJ:LawrenceErlbaumAssociates.
Salvia,J.,&Ysseldyke,J.E.(1995).Assessment(6thed.).Boston:HoughtonMifflin.
Sattler,J.M.(1988).Assessmentofchildren(3rded.).SanDiego,CA:Author.
St.Louis,K.O.&Ruscello,D.(1987).OralSpeechMechanismScreeningExaminationRevised.Baltimore:UniversityParkPress.
Stevens,S.S.(1951).Mathematics,measurement,andpsychophysics.InS.S.Stevens(Ed.),Handbookofexperimentalpsychology(pp.149).NewYork:
Wiley.
Wechsler,D.(1974).ManualfortheWechslerIntelligenceScaleforChildrenRevised.SanAntonio:ThePsychologicalCorporation.
Wiig,E.S.,Jones,S.S.,&Wiig,E.D.(1996).Computerbasedassessmentofwordknowledgeinteenswithlearningdisabilities.Language,Speech,andHearing
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Young,M.A.(1993).Supplementingtestsofstatisticalsignificance:Variationaccountedfor.JournalofSpeechandHearingResearch,36,644656.
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CHAPTER
3
ValidityandReliability
HistoricalBackground
Validity
Reliability
HistoricalBackground
ThehistoricrootsofbehavioralmeasurementcanbetracedtotestsusedinthethirdcenturyB.C.bytheChinesemilitaryforthepurposeofidentifyingofficersworthy
ofpromotion(Nitko,1983).Despitesuchearlybeginnings,however,widespreadinterestinmeasurementforpurposessuchashelpingchildrenhasfarmorerecent
origins,beginningatthecloseofthe19thcentury.Notsurprisingly,therefore,therearemanythreadsofthoughtleadingtothediversityofinstrumentsandprocedures
nowbeingusedtodescribeandmakedecisionsaboutpeople.
Duringthe20thcentury,perspectivesonhowtodevelopandusemeasuressuchasthoseusedtohelpchildrenwithdevelopmentallanguagedisordershavecomefrom
education,psychology,andmostrecentlyspeechlanguagepathology.Overthisrelativelybriefperiodoftime,professionalandacademicorganizationsinthese
fieldshavetakenontheresponsibilityofdevelopingstandardsoftestdevelopmentanduse.Theseeffortshaveprimarilyfocusedontests,wheretestisdefinedasa
behavioralmeasureinwhichastructuredsampleofbehaviorisobtainedunderconditionsinwhichthetestedindividualisexpected(oratleasthasbeeninstructed)to
dohisor
Page50
herbest1(APA,AERA,&NCME,1985).Despiteafocusontestsinthisnarrowsense,suchstandardshavealwaysbeenmeanttoapplytoallbehavioral
measuresalthoughtheyapplytoagreaterorlesserextentdependingonthespecificcharacteristicsofthemeasure.
MostnotableamongeffortstoprovideguidancetotestdevelopersandusershavebeenthoseoftheAPA,AERA,andNCME.In1966,aftertwoearliersetsof
testingstandards(APA,1954NationalEducationAssociation,1955),thethreeorganizationsworkedtogethertocreateasingledocument,Standardsfor
EducationalandPsychologicalTestsandManuals,whichhasgonethroughtworevisions.ThemostrecentrevisionwasrenamedStandardsforEducationaland
PsychologicalTesting(AERA,APA,&NCME,1985).
Thefrequentrevisionofthesestandardsreflectsthebriskpaceofresearchandongoingdiscussionaboutbehavioralmeasurement.Oneparticularlyimportanttransition
occurringwithinthepasttwodecadesisreflectedinthechangeoftitlefromStandardsforTeststoStandardsforTesting.Thischangeemphasizesthecentrality
ofthetestuserinmeasurementquality.Earliereditionsfocusedonwaysinwhichtestdeveloperscoulddemonstratethequalityoftheirinstruments.Farlessattention
waspaidtoissuesrelatedtoactualtestadministrationandinterpretation.Infact,whereas75%ofthe1974versionrelatedtoteststandards,only25%ofitrelatedto
standardsoftestuse.Inthemostrecentversion,therehasbeenalmostareversalinthosepercentages:about60%relatestotestuseversus40%toteststandards.
Thisshiftisconsistentwiththemostinfluentialworkconductedinthelastdecadeinwhichtestusersareaskedtoconsidernotsimplythetechnicaladequacyof
methodsusedtoderivespecifictestscores,butalsotheimpacttheirdecisionswillhave(Messick,1989).Notsurprisingly,thetermethicshascroppedupfrequentlyin
thecourseofthesediscussions.Itwillsurfacefrequentlyinthistextaswell.
Beginningwiththischapter,IhopethatreaderswilladoptaperspectivesimilartothatsetbytheAPA,AERA,andNCME(1985).Specifically,Ihopethatyouwill
considermeasurementqualityindevelopmentallanguagedisordersasaarenainwhichmanyelementscomeintoplay,butinwhichyouaretheliontamer,theperson
whoremainsexpertlyinchargeofapotentiallydangeroussituation.Inthischapterandtheonethatfollowsit,Ifocusonhowbesttoselectappropriatemeasuresonce
youhaveafairlyspecificapplicationinmind.ChaptersinPartIIfocusonthosespecificapplicationscommonlyfacedbyclinicianswhoworkwithchildrenwhohave
developmentallanguagedisorders.Thosechapterswillfigureprominentlyinhelpingyoulearntotailoryourmeasurementstothespecificpurposesyouhaveinminda
keylessonforthoseinterestedinprovidingtheirclientswiththebestpossiblecare.
Theremainderofthischapterisintendedtointroduceyoutovalidityandreliability,twoconceptsthatinvariablydominatediscussionsofmeasurementquality.Validity
isbyfarthemostcentralofthetwoterms.Itevenmightbesaidthatanydiscussionofmeasurementqualityisautomaticallyadiscussionofvalidity.Reliabilityisof
1Thisassumptionisprobablynotwellfoundedformanychildrenwithlanguagedisorders,whomaybeunabletounderstandwhatitmeanstodoonesbestorwho
maybeunwillingtodoit.Ireturntothisissueatnumerouspointsthroughoutthisbook.
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lesserimportancebutisstillvital.Itssecondaryplacederivesfromitsroleasprerequisitefor,butnotsoledeterminantof,validity.
Validity
Validitycanbedefinedastheextenttowhichameasuremeasureswhatitisbeingusedtomeasure.So,youmightask,whatsallofthefussabout?Despiteits
seemingsimplicity,however,theconceptofvalidityhasanumberofsubtlenuancesthatcanbedifficulttograspforeventhemostseasonedusersofbehavioral
measures.Severalmisconceptionsareevidentwhenatestuserordevelopersayssweepinglythatagiventestisavalidtest.First,thiskindofstatementabouta
measuresuggeststhatitsomehowpossessesvalidity,independentofitsuseforaparticularpurpose.Second,itsuggeststhatvalidityisanallornothingproposition.
Bothofthosesuggestionsareuntrue,however.Whatcansafelybesaidaboutagivenmeasureisthatitseemstohaveacertainlevelofvaliditytoansweraspecific
questionregardingaspecificindividual.However,evenreachingthatlessthandefinitivesoundingconclusionrequiresconsiderableworkonthepartoftheclinician.
Toexplorethegeneralconceptofvalidityalittlemorefully,consideraspecific,widelyusedmeasurethePeabodyPictureVocabularyTestIII(Dunn&Dunn,
1997).Thatmeasurewasdevelopedforthepurposeofexaminingreceptivevocabularyinawidevarietyofindividualsusingataskinwhichasinglewordisspokenby
thetestgiverandthetesttakerpointstoonepicture(fromasetoffour)towhichthewordcorresponds.Despitetheexceptionallydetaileddevelopmentundergoneby
thePPVTIII,itisnonethelessquiteeasytoimaginesituationsinwhichitsusecouldleadtohighlyinvalidconclusionsand,thus,forwhichitsvaliditycouldbe
questioned.Forexample,usingthePPVTIIItoreachconclusionsaboutatesttakersartistictalentoraboutthevocabularyofsomeonewhodoesnotspeakEnglish
representgrossexamplesofhowmisapplicationunderminesvalidity.
OnecanalsoimagineorsimplyobservelessobviousyetsimilarlyproblematicapplicationsofthePPVTIII.Forexample,thePPVTIIImightbeusedtodraw
conclusionsaboutoverallreceptivelanguage,ratherthanreceptivevocabularyonly.Itmightalsobeusedtoexaminethereceptivevocabularyskillsofanindividualor
grouplackingmuchpreviousexposuretomanyvocabularyitemspicturedintheexam.Ineachofthesecases,thevalidityofthetestsusewouldbeadverselyaffected,
althoughprobablynottothedegreeofthefirst,extremeexamples.Thus,theselatterexamplesillustratethecontinuousnatureofvaliditybyshowingthatameasurecan
belessvalidthanifitwereusedappropriately,butmorevalidthanifwildlymisused.Theselasttwoexamplesarealsopoignantbecausetheyarentjusthypothetical
examples,butactualonesthatreadilyoccurifaclinicianiscarelessornaiveabouttheconceptofvalidity.
Asanotherwayofthinkingabouttheseproblemsinvalidity,considertwoquestions:(a)Issomethingotherthantheintendedconstructactuallybeingmeasuredbythe
indicator(thetest)?and(b)Doestheindicatorreflectitstargetconstructinsuchalimitedwaythatmuchofthemeaningoftheconstructislost?Affirmativeanswersto
eitherorbothofthosequestionschipawayatthevalueoftheindicatorasameans
Page52
ofmeasuringtheintendedconstructand,bydefinition,chipawayatthemeasuresvalidity.Thus,whenthePPVTIIIisusedasameasureofreceptivelanguageasa
whole,theconstructofreceptivelanguageisgreatlyimpoverished,henceonecanconcludethatreducedvalidityisastrongrisk.Ontheotherhand,itmaybeusedto
measurevocabularyskillsinindividualswhohavenothadmuchexposuretothevocabulary.Thenitmaybecomeameasureofexposuretothevocabularyrather
learningofthevocabulary,thusreducingthemeasuresvaliditybecausethetestwouldnotbemeasuringwhatitwassupposedtomeasure.
Giventhecontinuousnatureofvalidityandtheconsiderablespecificitywithwhichitmustbedemonstrated,howdoesoneascertainthatameasureisvalidenoughto
warrantuseforaparticularpurpose?InthenextsectionIoutlinemethodsthatareusedbytestdevelopersandotherresearcherstoprovidesupportofageneral
naturethatis,suggestingbroadparametersassociatedwithitsusefulapplication.Methodsusedbytestuserstoevaluatethatsupportintermsofaspecificapplication
aredescribedinthenextchapter.
WaysofExaminingValidity
Themethodsusedtodemonstratethatameasureislikelytoprovevalidforageneralpurpose(suchasidentifyingaproblemareaormonitoringlearning)havegrownin
numberandsophisticationovertheyears.Althoughthemethodsarehighlyinterrelated,theyarenonethelesscharacterizedasfallingintothreecategories:construct
validation,contentvalidation,andcriterionrelatedvalidation.Thesethreecategoriesareorderedbeginningwiththemostimportant.
ConstructValidation
Constructvalidationreferstotheaccumulationofevidenceshowingthatameasurerelatesinpredictedwaystotheconstructitisbeingusedtomeasurethatis,to
showthatitisaneffectiveindicatorofthatconstruct.Awidevarietyofevidencefallsintothiscategory,includingevidencethatisdescribedascontentorcriterion
relatedinthesectionsthatfollow.Ifthatseemsconfusingtoyouatfirst,youarenotalonethetheoreticalcentralityofconstructvalidityhasonlyrecentlybeen
recognized.Untilthattime,validitywasusuallyconveyedascomposedofthreepartsratherthanasaunity.
Figure3.1portraystherelationshipbetweenthethreetypesofvalidityevidence.Italsoconveysthetwomeaningsofconstructvalidity(a)asacovertermforall
typesofvalidityevidenceand(b)asatermusedtorefertoseveralmethodsofvalidationthatarenotseenasfittingundereithercontentorcriterionrelatedvalidation
techniques.
Theunderlyingsimilarityofmethodsuniquelydefinedasdemonstratingconstructvaliditycanperhapsbestbeseenthroughadiscussionoftheearlieststagesin
measurementdevelopment.Whenapproachingthedevelopmentofabehavioralmeasure,thedeveloperconsidershowtheconstructtobemeasured(suchasreceptive
vocabulary)isrelatedtootherbehavioralconstructsandeventsintheworld(suchasage,gender,otherabilities).Alsoconsideredatthisstagearepossibleindicators
(suchaspointingatnamedpicturesoractingoutnamedactions)thatmightreasonablybeused
Page53
Fig.3.1.Agraphicanalogyillustratingthedifferentkindsofevidenceofvalidity.
toobtaininformationabouttheconstructandtherebyserveasthebasisforthemeasure.
Forexample,inthecaseofreceptivevocabularyasapossibleconstruct,thetestdeveloperbeginswithascientificknowledgebasethatsupportsexpectationsabout
howreceptivevocabularyisaffectedbyphenomenasuchageandgender.Thatknowledgebasealsogeneratesexpectationsabouthowtheconstructisrelatedtoother
behavioralconstructssuchasexpressivelanguagedevelopmentandhearingability.Fromthisknowledgebase,thedeveloperformulatespredictionsabouthowavalid
indicator,ormeasure,willbeaffectedbysuchphenomenaandhowsuchavalidindicatorwillberelatedtootherconstructs.Evidencesuggestingthatthemeasureacts
aspredictedsupportsclaimsofconstructvalidity.Fourspecificmethodsofconstructvalidationarediscussedinupcomingparagraphsdevelopmentalstudies,
contrastinggroupstudies,factoranalyticstudies,andconvergentdiscriminantvalidationstudies.
Formanymeasuresusedwithchildren,twokindsofstudiesarefrequentlyusedtoprovideevidenceofconstructvaliditydevelopmentalstudies(sometimescalledage
differentiationstudies)andstudiesinwhichgroupswhoarebelievedtodifferinrelationtotheconstructarecontrastedwithoneanother(sometimescalledgroup
differentiationstudies).Table3.1providesanexampleofthedescriptionprovidedforeachofthesetypesofstudy.Thespecificexamplesusedherearenotconsidered
tobethemostthoroughnorthemostsophisticatedpossibleexamples.Insteadtheyaremeanttohelpyouanticipatethewaysuchstudiesaredescribedintestmanuals.
Thedevelopmentalmethodofconstructvalidationisbasedonthegeneralexpectationthatlanguageandmanyrelatedskillsofinterestincreasewithage.The
Page54
Table3.1
ExamplesofTestManualDescriptionsofTwoTypesofConstructValidationStudies
Typeofstudy Description
CorrelationalmethodswereusedtodetermineifperformanceontheTWF[TestofWordFinding]changeswithage.UsingthePearson
productmomentcorrelationprocedure,TWFaccuracyscores(scalescoresgeneratedfromtheRaschanalyses)werecorrelatedwiththe
chronologicalageofthe1,200normalsubjectsinthestandardizationsample.Allcoefficientswerestatisticallysignificantandofasufficient
magnitudetosupporttheconstructvalidityoftheTWFasameasureofexpressivelanguageforbothboysandgirlsandofchildrenof
Developmentalstudies
differentethnicandracialbackground.
Comparisonofaccuracyscoresateachgradelevelalsoreflecteddevelopmentaltrendsastheaccuracyscoresofthenormalsubjectsinthe
standardizationsampleincreasedacrossgrades.Thesefindings,whichsupportgradedifferentiationbytheTWFforallbutonegrade,are
afurtherindicationofdevelopmentaltrendsintestperformancesontheTWF.(German,1986,p.5)
InordertotestthecapacityoftheTELD[TestofEarlyLanguageDevelopment]todistinguishbetweengroupsknowntodifferin
communicationability,weadministeredtheTELDtoseventeenchildrenwhowerediagnosedascommunicationdisorderedcases.No
childrenwithapparenthearinglosseswereincludedinthegroup.Eightypercentofthechildrenwerewhitemalestheyrangedinagefrom
threetosixandahalf.Insocioeconomicstatus,sixtyfourpercentweremiddleclassorabove.AllofthechildrenattendedschoolinDallas,
Contrastinggroup
Texas.
studies
ThemeanLanguageQuotient(LQ)derivedfromtheTELDforthisgroupwas76.SincetheTELDisbuilttoconformtoadistributionthat
hasameanof100andastandarddeviationof15,itisapparentthattheobserved76LQrepresentsaconsiderabledeparturefrom
expectancy.Itisadiscrepancythatapproachestwostandarddeviationsfromnormal.Thesefindingsweretakenasevidencesupportingthe
TELDsconstructvalidity.(Hresko,Reid,&Hammill,1981,p.15)
hypothesistestedinthistypeofvalidationstudyisthatperformanceonthemeasurebeingstudiedwillimprovewithage.Asyouprobablyrecallfrompreviouscourse
work,developmentalstudiesofthiskindcantakeacoupleofdifferentformsone(calledalongitudinalstudy)comparestheperformancesofasinglegroupof
childrenacrosstime,andasecond(calledacrosssectionaldesign)comparestheperformancesofseveralgroupsofchildren,eachgroupfallingatadifferentage.
Crosssectionalstudiesareparticularlypopularamongtestdevelopers,undoubtedlybecausethedataneededtotestthehypothesisarethesameasthoseneededto
providenorms.
Asecondmajortypeofconstructvalidationstudy,whichcanbecalledthecontrastinggroupsmethodofconstructvalidation,teststhehypothesisthattwoor
moregroupsofchildrenwilldiffersignificantlyintheirperformanceonthetargetedmeasure.Again,considerreceptivevocabularyastheexample.Obviously
developingatestofreceptivevocabularyforusewithchildrenonlymakessenseifyoubelievethattherearesomechildrenwhoseperformancefallssofarbelowthatof
peersasto
Page55
havesignificantnegativeconsequences.Forthistypeofmeasure,onemightevaluateconstructvaliditybyfindinggroupsofchildrenwhoarethoughttodifferintheir
receptivevocabularyknowledge(e.g.,childrenwithadevelopmentallanguagedisordervs.childrenwithoutsuchadisorder).Inthistypeofstudy,ifthemeasureisa
validreflectionoftheconstruct,childrenwhohavebeenidentifiedasdifferinginrelationtotheconstructshouldalsodifferintheirperformanceonthemeasure.See
Table3.1foranexampleofavalidationstudyofthistype.
Athirdcategoryofconstructvaliditystudyisidentifiedthroughtheuseofaspecificstatisticaltechniquefactoranalysis.Factoranalysisislessfrequentlyusedin
speechlanguagepathologythanitisinsomeotherdisciplines.Forexample,ithasbeenusedmostextensivelytostudyintelligencetests.Besidesitsvalueasameansof
studyinganalreadydevelopedmeasure,factoranalysisisfrequentlyusedinearlystagesoftestdevelopmentasanaidinselectingitemsfromapoolofpossibleitems.
Thetermfactoranalysisdescribesanumberoftechniquesusedtoexaminetheinterrelationshipsofasetofvariablesandtoexplainthoseinterrelationshipsthrougha
smallernumberoffactors(Allen&Yen,1979).Factoranalysisassistsresearchersintheverydifficultprocessofmakingsenseofalargenumberofcorrelations,the
mostbasicmethodfordescribinginterrelationships(asdescribedinchap.2).
Infactoranalyticstudies,theoriginalsetofvariablestobestudiedtypicallyconsistsofagroupsperformanceonthetargetmeasureaswellasasetofother
measuressomeofwhichtapasimilarconstructasthetargetmeasure.Althoughtheconceptofthefactordoesnotexactlyrelatetoaspecificunderlyingconstruct,all
measuresrelatedtoasingleconstructareexpectedtobeassociatedwithasinglefactor.Therefore,constructvaliditywouldbedemonstratedinthistypeofstudywhen
thetargetmeasureshares,orloadson,thesamefactorasmeasuresforwhichvaliditywithrespecttoaparticularconstructhasalreadybeendemonstrated(Pedhazur
&Schmelkin,1991).
Aparticularlysophisticatedmethodproposedforstudyingconstructvalidityexistsinprinciple,isappliedtomeasuresdevelopedforavarietyofbehavioralconstructs,
butisrarelyappliedinspeechandlanguagemeasures.Thatisthemethodknownasconvergentanddiscriminantvalidation(Campbell&Fiske,1959),whichis
associatedwithatypeofexperimentaldesigntheycalledamultitraitmultimethodmatrix.Becauseoftherelativerarityofthisapproachformeasuresusedwithchildren
whohavelanguagedisorders,Idonotdiscussitindetail.However,becausethismethodissometimesusedformeasuresyouwillbeinterestedin,itisimportantto
knowthatconvergentvalidiationreferstodemonstrationsthatameasurecorrelatessignificantlyandhighlywithmeasuresaimedatthesameconstruct,butusing
differentmethodsdiscriminantvalidationreferstodemonstrationsthatitdoesnotcorrelatesignificantlyandhighlywithmeasurestargetingdifferentconstructs
(Pedhazur&Schmelkin,1991).
AnexamplefromAnastasi(1988)mayhelpmaketheideasbehindconvergentanddiscriminantvalidationclearer:
Correlationofaquantitativereasoningtestwithsubsequentgradesinamathcoursewouldbeanexampleofconvergentvalidation.Forthesametest,discriminant
validitywouldbeevidencedbyalowandinsignificantcorrelationwithscoresonareadingcomprehensiontest,sincereadingabilityisanirrelevantvariableinatest
designedtomeasurequantitativereasoning.(p.156)
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Inshort,validityissupportedinthisapproachthroughevidencethatthemeasureunderstudyismeasuringwhatitissupposedtomeasureinamanneruncontaminated
byitsrelationshiptosomethingelsethatitwasnotsupposedtomeasure.
Inthecontextoftheirdiscussionofconvergentanddiscriminantvalidation,PedhazurandSchmelkin(1991)discussedapairoffallaciesthatthreatenresearchers
understandingoftheevidencetheyobtainusingthismeasure,butequallyapplytothoughtsabouttestselection.Cleverly,theyhavebeentermedthejingleandjangle
fallacies.Jinglefallaciesarisewhenoneassumesthatmeasureswithsimilarnamesmusttapsimilarconstructswhereasjanglefallaciesarisewhenoneassumesthat
measureswithdissimilarnamesmusttapdissimilarconstructs.Obviously,closeexaminationofactualcontentcanhelpwardoffthedeludingeffectsofsuchthinking.
AlthoughIonlydiscussedfourmethodsofconstructvalidation,manymoremethodsareactuallyused,includingthosethathaveconventionallybeenidentifiedin
associationwithcontentandcriterionrelatedvalidation.Methodsfittingundercontentandcriterionrelatedvalidationtechniquesarediscussednext.Theseare
typicallyviewedasmoreeasilyunderstoodthanconstructvalidation.
ContentValidation
Contentvalidationinvolvesthedemonstrationthatameasurescontentisconsistentwiththeconstructorconstructsitisbeingusedtomeasure.Aswithconstruct
validity,thedeveloperaddressesconcernsaboutcontentvalidityfromtheearlieststagesofthemeasuresdevelopment.Suchconcernsnecessitatetheuseofaplanto
guidetheconstructionofthecomponentsofthemeasure(testitems,inthecaseofstandardizedtests).Theplanensuresthatthecomponentsofthemeasurewill
providesufficientcoverageofvariousaspectsofaconstruct(oftencalledcontentcoverage)whileavoidingextraneouscontentunrelatedtotheconstruct(thusassuring
contentrelevance).Later,contentvalidityisevaluateddirectly,usuallythroughtheuseofapanelofexpertswhoevaluatetheoriginalplanandtheextenttowhichit
waseffectivelyexecuted.Table3.2liststhebasicstepsinvolvedinthedevelopmentofstandardizedmeasures.
Despiteunderlyingsimilarities,thespecificwaysinwhichconcernsregardingcontentvalidityaffectthedevelopmentprocessdifferfornormreferencedandcriterion
referencedmeasures.Beforeattemptingacomparisonofthesedifferences,recall
Table3.2
StepsInvolvedintheDevelopmentofaStandardizedMeasure
(Allen&Yen,1979Berk,1984)
Step TestDevelopmentActivity
1 Planthetest
2 Writepossibleitems
3 Conductanitemtryout
4 Conductanitemanalysis
5 Developinterpretivebase(normsorperformancestandards)
6 Collectadditionalvalidityandreliabilitydata
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thesetwoideasfromchapter2:(a)contenttendstobebroadlysampledfornormreferencedmeasuresandextensively,almostexhaustively,sampledforcriterion
referencedmeasuresand(b)apersonsperformanceisinterpretedinrelationtotheperformanceofanormativegroupfornormreferencedmeasuresandtoaspecific
performancelevelforcriterionreferencedmeasures.Inthefollowingsections,Idescribetheeffectofthesedifferencesoncontentvalidationwithinthecontextofan
explanationofproceduresusedinthedevelopmentofnormreferencedaswellascriterionreferencedmeasures.
TheDevelopmentofNormReferencedMeasuresandContentValidity.Fornormreferencedtests,thedevelopmentoftheplaninvolvesdecisionsaboutthe
numberandcomplexityofconstructstobeexaminedaswellasthenumbersandkindsofitemstobeused.Sometestsattempttotakeononlyoneconstruct(e.g.,the
PPVTIIIDunn&Dunn,1997),whereasothersaddressmanyorcomplexconstructsandconsequentlyarecomposedofnumeroussubtests(e.g.,theTestof
LanguageDevelopmentIntermediate3[Hammill&Newcomer,1997]),inwhichthecomplexconstructoflanguageisviewedascomposedofnumeroussimpler
constructsinvolvingvariousaspectsofreceptiveandexpressivelanguage).
Next,asmanyas1.5to3timesasmanyitemsarewrittenasareexpectedtobeusedinthefinalversionofthetest(Allen&Yen,1979).Itemsarewrittenwiththe
goalofsamplingevenlyacrosstherangeofallpossibleitemsandprovidingalargeenoughpoolofitemsthattheireffectivenesscanbestudiedinthenextstepsofthe
testsdevelopment:itemtryoutanditemanalysis.
Anitemtryoutisconductedusingalargesampleofindividualschosentobeassimilaraspossibletothoseforwhomthetestwillultimatelybeused.Afterthetestis
giventothesample,theperformanceofeachitemisstudiedusingitemanalysis.Thisanalysistendstorelymostheavilyoninformationabouttheitemsdifficultyand
discriminationbutcaninvolveavarietyoftechniques(includingfactoranalysis)intendedtohelpthetestdeveloperarriveatasubsetofthemostvaliditemsbythrowing
outormodifyingunsatisfactoryitems.
Itemdifficulty(p)isthenumberofpersonsansweringtheitemcorrectlydividedbythenumberofpersonswhotooktheitem.Itcanbeusedtogaugewhetheranitem
isappropriatetotherangeofabilitiescharacteristicofthetargetpopulation.Obviously,ifatestispassedbyeveryone(p=1.0)orisfailedbyeveryone(p=.0),itwill
nothelpyourankindividualsrelativetooneanotherthegoalofanormreferencedmeasure.Infact,itisgenerallyheldthatanitemhasthemaximumabilityto
discriminateamongtesttakerswhenithasapvalueof.50.Normreferencedtestdevelopersareoftenencouragedtostriveforitemswithdifficultiesfalling
between.30and.70asanacceptablerangearound.50(Allen&Yen,1979Carver,1974).Itemsthatfalloutsideofthisrangearediscardedorrewritten(becausea
difficultitemmayonlybedifficultbecauseitswordingisconfusing).
Itemdiscriminationcanbemeasuredinseveraldifferentways,withitemdiscriminationindexesanditemtotaltestscorepointbiserialcorrelationsasthemostpopular
methods.Itemdiscriminationreflectstheextenttowhichpeopletendtoperformsimilarlyontheitemastheydoonthetestasawhole(Allen&Yen,1979).Itisgen
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erallythoughtthatbetteritemswillbethoseforwhichthereisatendencyformorepositiveperformancesontheitemtobeassociatedwithmorepositiveperformance
onthetestaswhole.Again,itemsthatfailtoperforminadesirablefashionarecandidatesforrewritingorexclusion.
Onceitemsarerewrittenandasubsequentitemanalysisdemonstratesasatisfactoryreportonthefinalbodyofitems,thelaststepofthetestconstructionprocess
involvesthecollectionofinitialinformationabouttheinstrumentsoverallvalidityandreliabilityandthepreparationofdocumentationconcerningtheinstrument.Content
validitycomesinatthispointintwoways.First,byreportingonthespecificmethodsusedinthestepsIdescribed,thetestauthorisprovidingapotentialtestuserwith
someevidencethattheinitialintendedcontentofthetesthasbeenwelltranslatedintothefinalmeasure.Second,onetypeofdatacollectedduringthefinalstepoftest
constructionconsistsofexpertevaluationofthedevelopmentprocessandofthefinalfitbetweenintendedandactualcontentofthetest.Table3.3providestwo
examples,showinghowdifferenttestmanualsdescribethisinformation.
TheDevelopmentofCriterionReferencedMeasuresandContentValidity.Criterionreferencedmeasuresareconstructedusingstepssimilartothose
previouslydescribed.However,numerousdifferencesinmethodsandrationalesdistinguishthedevelopmentofsuchmeasuresfromthedevelopmentofnorm
referencedmeasures.
Tobeginwith,theinitialplanusedforacriterionreferencedmeasuretendstobemoreelaborateanddetailedthanthatusedinnormreferencedmeasureconstruction
(Glaser,1963Glaser&Klaus,1962).Also,behavioralobjectives,oftenhierarchicallyarranged,maybeusedaspartoftheplan,particularlywhenthemeasureis
beingdevelopedtoexamineprogressintheacquisitionofaparticularbodyofinformationoraparticularskill(Allen&Yen,1979).Nitko(1983)offeredadetailed
accountingofthesometimesveryintricateplansusedforcriterionreferencedmeasures.
TheTestingandMeasurementCloseUpinthischapterprovidesaverypersonalexamplefromthelifeofoneoftheauthorsquotedmostfrequentlyonthetopicof
validity,AnneAnastasi,whichremindsusofthedifferenceinnormreferencedandcriterionreferencedtests.
Oncetheplanhasbeenfinalized,itemsarewrittensothattheyaddressallaspectsoftheintendedcontent.Althoughexhaustiveistoostrongaword(anexhaustive
testofanyconstructworthknowingaboutwouldundoubtedlyrequireseverallifetimes),theextensivenessofitemcoverageisdefinitelyinthedirectionofexhaustive
whencomparedwiththatofnormreferencedmeasures.
Itemtryoutsandanalysesofferanotherpointatwhichmajordifferencesseparatenormreferencedfromcriterionreferencedinstruments.Fornormreferenced
measures,itemsareselectedfortheirabilitytodiscriminateacrossarangeofabilitiesforcriterionreferencedmeasures,however,itemsareselectedfortheirabilityto
discriminatebetweenperformancelevels.Mostcommonly,dichotomousperformancelevelsareused,suchthatitemsareselectedfortheirabilitytodiscriminate
betweenperformanceshowingmasteryofaparticularcontentversusthatshowingnonmastery.Forthatpurpose,anidealitemsdifficultywouldapproximatezerofor
nonmastersand1formasters.Onemethodusedtotentativelyidentifymastersandnonmasters
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Table3.3
ExamplesofTwoTypesofCriterionRelatedValidityStudies
l TestofPhonologicalAwareness(TOPA):WhentheTOPA(TestofPhonologicalAwareness)wasgiventoasampleof100
childrenattheendofkindergarten,itwasfoundtobesignificantlycorrelatedwithtwoother,relativelydifferentmeasuresof
phonologicalawareness.TheTOPAKindergartenscoreswerecorrelatedwithscoresfromameasurecalledsoundisolation(a15
itemtestrequiringpronunciationofthefirstphonemeinwords)at.66andwithasegmentationtask(requiringchildrentoproduceall
thephonemesinathreetofivephonemeword)at.47.Bothoftheseothermeasuresassessedanalyticalphonologicalawareness,
althoughtheyrequiredamoreexplicitlevelofawarenessthandidtheTOPA.(Torgesen&Bryant,1994,p.24)
Concurrentvalidity l PreschoolLanguageScale3(PLS3):AstudyoftherelationshipbetweenPLS3andCELFR[ClinicalEvaluationof
LanguageFunctionRevised(Semel,Wiig,&Secord,1987)]wasconductedwith58children.Thesampleconsistedof25males
and33femalesranginginagefrom5yearsto6years,11months(mean=6years,0months).Thetwotestswereadministeredin
counterbalancedorder.Thebetweentestintervalrangedfromtwodaystotwoweeks,withanaverageof4.5days.Bothtestswere
administeredbythesameexaminer.Reportedcorrelationswereasfollows:PLS3AuditoryComprehensionwithCELFR
ReceptiveComposite(r=.69)PLS3ExpressiveCommunicationwithCELFRExpressiveComposite(r=.75)PLS3Total
LanguagescorewithCELFRtotalScore(r=.82).(Zimmerman,Steiner,&Pond,1992,p.95)
l TestofPhonologicalAwareness(TOPA):WhentheTOPAKindergartenwasgivento90kindergartenchildrensampledfrom
twoelementaryschoolsservingprimarilylowsocioeconomicstatusandracialminoritychildren,itscorrelationwithameasureof
alphabeticreadingskill(theWordAnalysissubtestfromtheWoodcockReadingMasteryTest)attheendoffirstgradewas.62.
Thus,between30%to40%ofthevarianceinwordlevelreadingskillsinfirstgradewasaccountedforbytheTOPAadministered
inkindergarten.(Torgesen&Bryant,1994,p.24)
Predictivevalidity
l ReceptiveExpressiveEmergentLanguageScale(REEL2):Inthefirststudyinvestigatingpredictivevalidity,researchersatthe
UniversityofFloridasEmergentLanguagelaboratoryconductedalongitudinalstudyof50normalinfantsfromlinguistically
enrichedenvironments.Afterrepeatedmonthlytestingovera2to3yearperiod,allinfantswerefoundtoachievemeanaverage
scoresforReceptiveLanguageAge(RLA)andExpressiveLanguageAge(ELA),andCombinedLanguageAge(CLA)atorabout
theirchronologicalages.(Bzoch&League,1992,p.10)
hasbeentoexamineperformancesofanitemtryoutsamplebeforeandafterinstructiondesignedtoproducemastery(Allen&Yen,1979).Inthatcontext,betteritems
arethoseinwhichpvaluesshowthegreatestupwardchange.
Aswasthecasewithnormreferencedmeasures,thelaststepofthetestconstructionforacriterionreferencedmeasureinvolvesthecollectionofinitialinformation
abouttheinstrumentsoverallvalidityandreliabilityandthepreparationofdocu
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mentationconcerningtheinstrument.Here,theeffectsoncontentvalidityareachievedusingmeanssimilartothoseusedfornormreferencedmeasures.Inadditionto
providingdescriptiveevidenceoftheproceduresusedtodevelopthetestscontent,testauthorslooktotheresultsofexpertevaluationsofconstructionmethodsand
finaltestcontentasafurthersourceofcontentvalidation.
TESTINGANDMEASUREMENTCLOSEUP
AnneAnastasihasbeencalledoneofpsychologysleadingwomen.Shewasoneofonlyfivewomen(ofatotalof96psychologists)tobeconsideredduringthe
firsteightdecadesofthiscenturyinaprominentseriesofbooksrecordingthehistoryofpsychologythroughautobiography(Stevens&Gardner,1982).Although
Anastasihasmadecontributionsinavarietyofareasinpsychology,thereasonthatsheisincludedhereisbecauseofherauthorshipofaclassictextonpsychological
testing(Anastasi,1954).Thattexthasgonethroughseveneditions,withthelatesteditionpublishedin1997.Ithasundoubtedlyservedasthesourceofmore
informationontestingforpsychologistsandothersthanperhapsanyotherwork,andinitslatestedition,Anastasi(1997)againprovidedoneoftheclearestsources
foressentialinformationonvalidityandreliability.
Intheearly1980s,attheUniversityofArizona,IhadthepleasureofhearingAnneAnastasipresentalecture,whenshewasinher70s.Herblackpatentleather
pocketbookwasproppedupinfrontofheronthepodiumasshespoke,itsstiffhandlealmostobscuringtheaudiencesviewofherwhitehair,thickhornrimmed
glasses,andthebrighteyesthatlaybehindthem.Idonotactuallyremembermuchaboutthedetailsofherpresentation,exceptthatherspeechwasasclearasher
writingandwaspresentedwithoutasinglenote.Shewasasimpressiveinpersonasshehadbeenonthepage.
Thefollowingpassagefromherautobiographybreatheslifeintotwoverydifferentideasfromthischapter.First,itshowsthepossiblytraumatizingeffectthatthe
processofassessmentcanhaveevenonachildwhosebiggestproblemappearstohavebeenherexceptionalintelligence.Seconditrevisitsthedistinctionbetween
normreferencedandcriterionreferenced(orasshecallsithere,contentreferenced)scoreinterpretation.
Throughoutmyschooling,Iretainedadeeprootednotionthatanygradeshortof100percentwasunsatisfactory.AtonetimeIactuallybelievedthatasingleerror
meantafailingscore.Irecallaspellingtestin4B,inwhichwewrotetenwordsfromdictation.Iwasunabletohearoneofthewordsproperly,becausethesubway
hadjustroaredpastthewindow(itwaselevatedinthatarea).Thewordwasfriend,butIhearditasbrand.Asaresult,theitemwasmarkedwrongandmy
gradewasonly90%.ThateveningwhenItoldmymotheraboutit,sheconsoledmeandadvisedmetoraisemyhandatthetimeandtelltheteacher,ifanythinglike
thatshouldhappenagain.Butshedidnotdisabusemeofthenotionthatanythingshortofaperfectscorewasafailure.Ieventual
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lydiscoveredformyselfthatonecouldpassdespiteafewerrorsbutIalwaysfeltpersonallyuncomfortablewiththeidea.Thereseemedtobesomelogicalfallacyin
callingaperformancesatisfactorywhenitcontainederrors.Iwasapparentlyfollowingacontentreferencedratherthananormreferencedapproachtoperformance
evaluation.(Anastasi,1980,p.78).
FaceValidity.Onefurthertopicregardingcontentvaliditythatdemandsattentionisnotreallyamatteroftruevalidityatall,despiteitsbeingtermedfacevalidity.
Facevalidityisthesuperficialappearanceofvaliditytoacasualobserver.Facevalidityisconsideredapotentiallydangerousnotionifatestusermistakenlyassumes
thatacursoryevaluationofameasureforitsfacevalidityconstitutessufficientevidencetowarrantitsadoption.Nonetheless,facevaliditycanplayaroleinatests
actualvalidityforexample,poorfacevaliditymaycauseatesttakertodiscounttheimportanceofameasureandtherebyundermineitsabilitytofunctionasintended.
Insummary,thekindofevidenceprovidedfornormreferencedversuscriterionreferencedmeasuresdiffers.However,contentvalidationforbothtypesofmeasuresis
achievedthroughtheauthorscarefulplanning,execution,andreportingofthemeasuresdevelopmentandthroughthepositiveevaluationofthisprocessbyexpertsin
thecontentbeingaddressed.
CriterionRelatedValidation
Criterionrelatedvalidationreferstotheaccumulationofevidencethatthemeasurebeingvalidatedisrelatedtoanothermeasureacriterionwherethecriterionis
assumedtohavebeenshowntobeavalidindicatorofthetargetedconstruct.Puttingthisinprimitiveterms,criterionrelatedvalidationinvolveslookingtoseeifyour
duckactslikeaduck.Thisexplanationderivesfromfamousstreetwiselogicinwhichanythingthatlookslikeaduck,walkslikeaduck,andquackslikeaduckis
determinedtobeaduck.Thus,asyousetouttovalidateyourmeasure(Duck1),yousearcharoundforaduck(Duck2,a.k.a.CriterionDuck)thateveryone
acknowledgesisindeedatrueduck(i.e.,avalidindicatoroftheunderlyingconstruct).Thenyouputyourducksthroughtheirpacestoseetowhatextenttheyact
similarly.Thegreatertheirsimilarities,thebettertheevidencethattheyshareacommonduckness.Andthen,voil:Youhaveevidenceofcriterionrelatedvalidity!
IncaseIlostyouthere,thewaythatcriterionrelatedvalidationworksforabehavioralmeasureisthatoneobtainsevidencebyfindingastrong,usuallypositive
correlationbetweenthetargetmeasureandacriterion.Thechoiceofthecriterioniscrucialbecauseoftheassumptionthatthecriterionhashighvalidityitself.Itcan
alsobeproblematicbecauseformanyconstructsitmaybedifficulttofindacriterionthatcanclaimsuchanexaltedstatus.
Twotypesofcriterionrelatedvaliditystudiesaretypicallydescribed:concurrentandpredictive.Predictivevalidityismostrelevantwhenthemeasureunderstudywill
beusedtopredictfutureperformanceinsomearea.Forexample,thePredictive
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ScreeningTestofArticulation(PSTAVanRiper&Erickson,1969)wasintendedtopredictwhetherachildtestedatthebeginningoffirstgradewouldstillbe
consideredimpairedinphonologicperformance2yearslater.Consequently,thistypeofevidencewasimportantindemonstratingthatthetestwouldmeasurewhatit
wassupposedtomeasure.Inthatparticularcase,thetestdevelopersusedasthecriterionmeasuretheresearchersjudgmentsofnormalarticulationversuscontinued
articulatoryerrorsbasedonasimplephoneticinventoryandonsamplesofspontaneousconnectedspeechobtained2yearsafterinitialtestingwiththePSTA.
Astudyofconcurrentvalidityisperformedwhenthecriterionandtargetmeasuresarestudiedsimultaneouslyinagroupofindividualslikethoseforwhomthetestwill
generallybeused.Itisbyfarthemorecommontypeofcriterionrelatedvaliditystudy.SeeTable3.3foranexampleofthistypeofvaliditystudy.
Forbothpredictiveandconcurrentstudiesofcriterionrelatedvalidity,theresultingcorrelationcoefficientisoftentermedavaliditycoefficient,ormorespecifically,asa
predictiveorconcurrentvaliditycoefficient,respectively.Interpretationofsuchcoefficientsisessentiallythesameasthatdescribedforcorrelationsinchapter2.
However,onefactorintheinterpretationofvaliditycoefficientsthatwasnotaddressedpreviouslyconcernshowhighacorrelationhastobeforonetoconsiderit
crediblesupportofameasuresvaliduseforaparticularpurpose.TheStandardsforEducationalandPsychologicalTesting(APA,AERA,&NCME,1985)
doesnotprovidedirectguidanceonthisquestion.However,severalexpertsrecommendthatwhenameasureisgoingtobeusedtomakedecisionsaboutanindividual
(ratherthanasawaytosummarizeagroupsperformance),astandardof.90shouldbeused.Asanadditionalproviso,thecorrelationcoefficientshouldalsobefound
tobestatisticallysignificant(Anastasi,1988).
FactorsAffectingValidity
Anythingthatcausesameasuretobesensitivetofactorsotherthanthetargetedconstructwilldiminishthemeasuresvalidity.Forexample,abathroomscalethat
becomessensitivetoroomtemperatureorhumidityislikelytobelessvalidasanindicatorofhowmuchdamageonehasdoneafteraseriesofholidaymeals.Inthis
sectionofchapter,Iconsiderfactorsaffectingthevalidityofbehavioralmeasuressuchasthoseusedwithchildrenfirstconsideringtwofactorsoverwhichthe
clinicianhasconsiderabledirectcontrol,thentwofactorsoverwhichtheclinicianscontrolisfarlessdirect.
SelectionofanAppropriateMeasure
Asmentionedatthebeginningofthischapter,probablythebiggestfactoraffectingthevalidityofdecisionsmadeusingaparticularmeasureisthesuitabilityofthematch
betweenthespecifictestingpurposeandthedemonstratedqualitiesofthemeasuretobeused.Themajorityofinformationdescribedthusfarrelatestoactivities
performedbythedeveloperofastandardizedmeasure.Stilltobediscussedishowtestusersmakeuseofthatinformationtodotheirratherlargepartinassuringthe
validityoftheirowntestuse.Forthemoment,itissufficientthatyoubeawarethatyourroleiscriticalinassuringtestingvalidityandthatitbeginswithathorough
evaluationofinformationprovidedbythe
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testdeveloper,testreviewers,andtheclinicalliteratureinlightofyourclientsneeds.Specificstepsleadingtosuchanevaluationaredescribedinthenextchapter.
AdministrationoftheMeasure
Aftersuccessfulselectionofameasure,theclinicianplaysacriticalroleinassuringvaliditythroughitsskilledandaccurateadministration.Unlessameasureis
administeredinamannerconsistentwiththemethodsusedindevelopingthemeasuresnormsandtestingitsreliabilityandvalidity,anycomparisonoftheresulting
performanceagainsteithernormsorperformancestandardsbecomesdistorted,evennonsensical.Thusforexample,thedirectionssupplied,withatestmayindicate
thatorallypresenteditemsaretobereadaloudonlyonce.Inthatcase,thedifficultyofthattestwillprobablybelessenedifthetestuserdecidesthatitsonlyfairto
thechildtogiveasecondchancetoheartheinformationincludedintheitem.Inreality,however,itisdecidedlyunfairtothechildifthetestisbeingusedtoprovide
informationabouthowthatchildsperformancecompareswithastandardthatwasdeterminedunderdifferentconditions.
Skilledadministrationofstandardizedmeasures,however,goeswellbeyondthepreservationofidealizedconditions.Italsofacilitatesacrucialbutsometimes
overlookedfunctionofatestingsituationthatis,theestablishmentofatrusting,potentiallyhelpfulrelationshipbetweentheclinicianandthechildbeingtested.Iftest
administrationgoeswell,thechildcomesawayfromtheexperiencewithasensethatthetestgiverlikesthechildandisarewardingpersonwithwhomtointeract.Ifit
doesnot,notonlywillthetestdatabecompromised,butthechildmaydevelopexpectationsofthetestgiverthatwillbedifficulttoovercome.Indeed,some
researchers(Maynard&Marlaire,1999Stillman,Snow,&Warren,1999)whoexaminethetestingprocessindetailnotethatfartoolittleattentionispaidtothe
collaborativenatureoftesting,inwhichtheexaminerisnotapassiveconduitofitemsbutanintegralparticipantinthetestingoutcome.Table3.4listssomesuggestions
gleanedfromseveralyearsofclinicalexperience(myownandothers)concerninghowtofacilitatetesting.
ClientFactors
Clientfactorsaresuchakeyfeaturetovalidtestingofchildrenthatitseemsworthdiscussingthemunderaseparateheading.Ofparticularinterestaremotivationand
whatSalviaandYsseldyke(1995)calledenablingbehaviorsandknowledge.
Motivationaffectstheperformanceofadultsandchildreninoftendramaticways.Althoughthetopicofmotivationhasbeentheimpetusforextensiveresearchin
severaldisciplines,youcanquicklyappreciatethedevastatingimpactoflowmotivationbylookingbackoveryourownexperiencesandrememberinganoccasion
whenaclassroomquizortestfellatatimewhenyouwerepreoccupiedbyotherthingshappeninginyourlife,orperhapsatimewhenyoupsychedyourselfout,
therebyseeminglynecessitatingthefulfillmentofaprophecyoffailure.Forme,theexperiencethatcomestomindisamidtermexaminationItookincollege.Ihad
foundanunconsciousbutstillbreathingmockingbirdonmywaytotheexam.Consequently,duringtheexamination,Ispentmuchmoreofmytimewonderingwhether
thebirdwouldstill
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Table3.4
TestingRecommendations
ThingstoConsiderWhenTestingChildren
Rememberthatchildrenrarelyhavemuchsophisticationintesttakingskills.Theyexpectyourrelationshipwiththemtobebasedonthesamerulesthatapplyto
1.
interactionsinothersituations.Thereforeitisyourresponsibilitytohonortheirexpectationsandfindwaystoachieveyourgoalswithinthatcontext.
Childrenseffortstoachievetheirbestforyouwillbebuiltontheexpectationthatyouandtheyareouttopleaseeachotherintheinteraction.Youwanttobe
2.
acceptedbythechildasarewarding,appreciativeadultwhoisgenerallyfuntobewith.
Forolderchildren,youneedtostriveforabalanceinwhichyouareincontrolasmuchasyouneedtobetohaveyourquestionsansweredandthechildisin
controlasmuchaspossibleotherwise.Forexample,itisimportantthatyoumaintaincontroloveryourtestmaterials,arerelativelyfirmwhenyoumakearequest
3.
thatisanecessarypartofthetestingprocess,andonlyofferchoiceswheretheyaretrulyavailable(e.g.,avoidaskingquestionssuchasthefollowingiftheyare
nottrueoffers:Doyouwanttolookatsomepictureswithmenow?).
Helpchildrencooperatebyinformingthemaboutthecontent,order,andtimeframesassociatedwithvariousassessmenttasks.Towardthisend,considerdoing
thefollowing:(a)Wheneverpossible,allowthechildtomakechoicesinorderingactivities,and(b)deviseamethodtoletchildrenknowhowmuchmoreis
4.
requiredofthem.Forolderchildren,youcanusealistwhereeachcompleteditemischeckedofforrewardedwithasticker.Foryoungerorlesssophisticated
children,youcanusetokensequalingthenumberofactivities,whichareremovedfromsightormovedtoadifferentlocationaseachactivityisfinished.
bealivewhenIfinisheditandwhereIcouldgethelpforitifitwerestillalive,thanIspentactivelyfocusedontheoutcomeoftheexamination.Withpredictableresults.
(Sadly,thebirdfarednobetterthanmyexamgrade.)
Motivationisparticularlycriticalformeasuresthatareintendedtoelicitonesbesteffort.Onevarietyofsuchmeasuresarethoseinwhichclientsareassumedtobe
doingtheirbestunderconditionsstressingaccuracy,speedofexecution,orboth.Thesearesometimescalledmaximalperformancemeasures.Commonexamplesof
maximalperformancemeasuresinchildhoodlanguagedisordersincludemeasurementoflanguagefunctionsinwhichresponsesaretimedaswellasavarietyofspeech
productionmeasures,includingdiadochokineticrate.Inadiscussionofsuchmeasuresusedtostudyspeechproduction,Kent,KentandRosenbek(1987)cautioned
thatextremecareshouldbetakenbeforeconcludingthatatesttakerisfullyawareandmotivatedandthereforelikelytoproduceaperformancethatcanreasonablybe
comparedwithnormsorbehavioralstandards.TheneedforcautionisparticularlygreatforyoungerchildrenandforchildrenwitheitherDownsyndromeorautism,but
itshouldalwaysbeaconcernforanychild.Whereasthelevelofconcernshouldbegreatestformaximalperformancetesting,anytestingofachildwillbesubjectto
reducedvalidityifthechildisuninterestedoroverlyanxious.
EnablingbehaviorsandknowledgearedefinedbySalviaandYsseldyke(1995)asskillsandfactsthatapersonmustrelyontodemonstrateatargetbehavioror
knowledge.Ifanassumedenablingbehaviorisabsentordiminished,performanceonthe
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measuremaynolongerbeassociatedwiththebehaviorunderstudyhenceitsvalidityisthreateneddramatically.Enablingbehaviorsthatarefrequentlyassumedin
childrenslanguagetestsincludeadequatevision,hearing,motorskill,andunderstandingofthedialectinwhichthetestisconstructed.Infact,althoughIdiscussedit
earlierasaseparatecategory,positivemotivationtoparticipateinassessmentisafrequentlyassumedenablingbehavior.
Reliability
Reliability,orconsistencyinmeasurement,isinvariablylistedasamajorfactoraffectingvaliditybecauseitisanecessaryconditionforvalidity,meaningthatameasure
canonlybevalidifitisalsoreliable.Reliabilitydoesnotassurevalidity,however.Figure3.2illustratesthisrelationshipbetweenreliabilityandvalidityusingarcheryas
ananalogy.Targetnumber1demonstratesthehandiworkofanarcherwhoseaimisbothreliableandvalidnumber2,anarcherwhoseaimisreliable,butnotvalid
andnumber3,anarcherwhoseaimisneitherreliablenorvalid.Inbehavioralmeasurement,theuseofmeasureswithdegreesofreliabilityandvaliditysimilartothat
shownintargets2and3willhavesimilarlynegativeoutcomes,althoughunfortunatelytheoutcomesmaynotbeasobviousand,therefore,willbehardertodetect
and,possibly,torectify.
Fig.3.2.Agraphicanalogyillustratingtherelationshipbetweenreliabilityandvalidity.
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Onepoint(nopunintended)madebyFig.3.2isthatreliabilitylimitshowvalidameasurecanbeanylossofreliabilityrepresentsalossofvalidity.Thus,information
aboutreliabilitycanprovideveryimportantinsightintothequalityofameasure.Toillustratethisprobleminamorelivelyway,imaginetheproblemsassociatedwithan
elasticandthereforeunreliableruler.Overrepeatedmeasurementsofasinglepieceofwoodwithsucharuler,itsuseroneachattemptmighttrydesperately,even
comically,toapplyexactlythesameoutwardpressurestotheruleralmostcertainlyinvain,withmeasurementsof5inchesonetime,6inchesthenext,andsoon.
Withsuchimmediatefeedback,theuserofthemeasurewouldsurelyrecognizethehopelesslackofvalidityinthesemeasurementsandwouldundoubtedlygolooking
forabetterruler.Unfortunately,whenhumanbehaviorisbeingmeasured,evenmeasureswithreliabilityequivalenttothatofanelasticrulerwouldnotbesoeasily
recognized.Thus,becauseoftheimportanceofreliability,thenextsectionofthischapterisdevotedtoamoredetailedexplanationofreliabilitywhatitisandhowitis
studied.
Reliability
Reliabilitycanbedefinedastheconsistencyofameasureacrossvariousconditionssuchasconditionsassociatedwithchangesintime,intheindividualadministering
orscoringthemeasure,andevenchangesinthespecificitemsitcontains.Ifameasureisshowntobeconsistentinitsresultsacrosstheseconditions,thenitsusercan
makeinferencesfromperformanceunderobservedconditionstobehaviorsandskillsshowninother,unobservedconditions.Inshort,acceptablereliabilityallowsfor
generalizationoffindingsobtainedintheassessmentsituationtoabroaderarrayofreallifesituationsthoseinwhichtestusersarereallymoreinterested.
Whenthereliabilityofameasureisexaminedduringthecourseofitsconstruction,thatinformationisfrequentlyrepresentedusinganothertypeofcorrelationcoefficient
calledareliabilitycoefficient.Alternatively,moresophisticatedstatisticalmethodshavebeendevelopedtoexaminethereliabilityofmeasuresonthebasisofan
influentialperspectivecalledGeneralizabilitytheory(Cronbach,Gleser,Nanda,&Rajaratnam,1972),whichattemptstoexamineseveralsourcesofinconsistency
simultaneously.Thesemethods,however,arerelativelyrecentandonlyinfrequentlyappliedinspeechandlanguagemeasures(Cordes,1994).
Anotherwayforthinkingaboutreliabilityisintermsofhowitaffectsanindividualscore.Themostpopularframeworkguidingthisperspectiveonreliabilityis
sometimesdescribedastheclassicalpsychometrictheoryortheclassicaltruescoretheory.Althoughrecentdevelopments,includingGeneralizabilitytheory,have
eclipsedclassicaltheoryasthecuttingedgeofpsychometrics(Fredericksen,Mislevy,&Bejar,1993),classicaltheorynonethelesspervadesmuchofthepractical
methodsusedbytestdevelopersandhencetestusers.Further,itscontinuingutilityispraisedevenbythoseactivelyworkingalongotherlines(e.g.,Mislevy,1993).
Themostimportantassumptionassociatedwithclassicaltruescoretheory(Allen&Yen,1979)isthatanobservedscore(ascoresomeoneactuallyobtains)isthe
sumofthetesttakerstruescoreplussomenonsystematicerror.Thus,thetruescoreisan
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idealization.Ithasalternativelybeendescribedasthescoreyouwouldfindifyouhadaccesstoacrystalballorasthemeanscoreatesttakerwouldachieveiftested
infinitely.Noticethaterrorandreliabilityarecorrelatedinthisperspective.Specificallytheyareinverselyrelated:Thelargerthereliability,thesmallertheerror.
Besidesitshistoricalvalue,thisperspectiveonreliabilityisusefulbecauseitforeshadowsourabilitytoapplyreliabilityinformationobtainedonagrouptopossibleerror
intheobservedscoreofanindividualtesttaker,suchasourclient.Whenthereliabilityofameasureisexpressedinrelationtoindividualscores,thatinformationis
representedusingameasureknownasthestandarderrorofmeasurement(SEM).Itsmentionhereismeanttowhetyourappetiteforfurtherinformation,whichis
providedlaterundertheheadingInternalConsistency.
WaysofExaminingReliability
Threetypesofreliabilityareofmostfrequentinteresttestretestreliability,internalconsistencyreliability,andinterexaminerreliability.Afourthtypeofreliability,
alternateformsreliability,isrelativelyinfrequentlyused.Themethodsusedtodemonstratesuchreliabilitywithaparticulargroupoftesttakersdependtosomeextent
onwhetheritwillbeinterpretedusingacriterionreferencedornormreferencedapproach.Whereasthereiswidespreadagreementconcerningthemethodstobeused
tostudythereliabilityofnormreferencedmeasures,debatecontinuesconcerningthebestmethodstobeusedwithcriterionreferencedmeasuresandwhethermethods
traditionallydevelopedfornormreferencedmeasurescanalsobeusedwithcriterionreferencedmeasures(Gronlund,1993Nitko,1983).Idiscussreliabilityprimarily
fromthetraditional,ornormreferenced,perspective,butnotethosepointsatwhichmethodsrecommendedforcriterionreferencedmeasuresdepartfromthat
perspective.
TestRetestReliability
Testretestreliabilityisstudiedinordertoaddressconcernsaboutameasuresconsistencyovertime.Itisparticularlyimportantwherethecharacteristicbeing
measuredisthoughttoremainrelativelyconstantforatleastshorterperiodsoftime(suchas2weekstoamonth).Sometimesadistinctionismadebetween
examinationsofreliabilityoverperiodsoftimeunder2monthsandthoseofreliabilityoverlongerperiodsoftime,whichisthentermedstability(e.g.,Watson,1983).
However,morecommonisatendencyforthetermstestretestreliabilityandstabilitytobeusedinterchangeably.
Fornormreferencedmeasuresusedwithchildrenwithlanguageimpairments,testretestreliabilityistypicallystudiedbytestingagroupofchildrensimilartothosefor
whomthemeasureisintendedontwooccasions,usuallynomorethanamonthapart.Acorrelationcoefficient,calledatestretestreliabilitycoefficient,iscalculated
todescribetherelationshipbetweenthetwosetsofscoresandisinterpretedinamanneridenticaltothatusedforpreviouscorrelationcoefficients,withincreasing
correlationsizeshowingagreaterdegreeofrelatednessbetweenthetwosetsofscores.
Formeasuresusedwithchildren,thetestretestintervalisparticularlycrucialbecauserapiddevelopmentalchangesarelikelytoaffectwhatevercharacteristicisbeing
meas
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uredifthetestretestintervalistoolarge.Thusitisimperativethattestdevelopersreportthesizeofthatintervaloverwhichtestretestreliabilityiscalculated.Only
rarelywillameasurebeexaminedfortestretestreliabilityoveranintervallongerthanamonth.
Onelimitationoftestretestreliabilitycoefficientsistheirsusceptibilitytocarryovereffectswherethefirsttestingaffectsthesecond.Dependingonthenatureofthe
carryover,theapparentreliabilityofameasureforuseinaonetimetestingsituation(themosttypicalapplication)mightbeeitherinflatedordeflated(Allen&Yen,
1979).Forexample,practiceeffectsmightmakethetesteasieronthesecondtesting,causinganswerstochangefromthefirsttosecondtestingthatwouldresultina
reliabilitycoefficientthatissmallerthanitwouldbeifcarryoverhadnotoccurred.Ontheotherhand,testtakersmayremembertheiranswersfromthefirsttestingand
simplyrepeatthemonthesecond,resultinginareliabilitycoefficientthatislargerthanitwouldbeifcarryoverhadnotoccurred.Becauseofthis,testdeveloperswill
sometimesadoptmethodsotherthanthestraightforwardtestretestmethod,choosingtousealternateformsretestingmethodstosupplementorsometimeseven
replacetestretestdata.
Manymeasuresofconsiderableutilitytospeechlanguagepathologistsworkingwithchildrenwhohavelanguageimpairmentsarenotstandardizedtestsforwhich
reliabilitydataareprovided.Instead,theyareinformalmeasuresdevisedforalimitedpurpose.Forinformalmeasuresitismorecommontodiscusstheconceptof
consistencyundertheheadingofagreement.Thus,forexample,itispossibletocalculatetestretestagreementforaninformalmeasureusedbyasingleclinician.
Figure3.3providesanexampleofaninformalprobemeasureforwhichanagreementmeasureiscalculated.Althoughthisexampleusestwojudges,analogous
methodscanbeusedtoexamineconsistencyforasinglejudgeovertime.Inthisexample,theimportanceofagreementmeasuresingivingyouasenseofthe
consistencyofmeasurementishighlightedwhenyounoticethatthetwojudgesarrivedatexactlythesamepercentagecorrectcalculationfortheclient.However,they
didsowhileagreeingaboutwhichwordswerecorrectlyproducedatapercentagealmostequaltothatpredictediftheirjudgementswereduetochance(50%)!A
particularlypopularalternativetothesimpleprocedureIdescribedistheKappacoefficient(Fleiss,1981Hsu&Hsu,1996),whichaddressesthisproblemofchance
agreement.McReynoldsandKearns(1983)areanespeciallyhelpfulresourceforthoseinterestedinamorethoroughdescriptionofagreementmeasures.Yetanother
resourceforthoseinterestedinadetaileddiscussionofthemeaningandrelativemeritofsuchmeasurescanbefoundinCordes(1994).
InternalConsistency
Internalconsistencyisstudiedinordertoaddressconcernsaboutameasuresconsistencyofcontent.Itisprimarilyofinterestincaseswhereatestorsubtesthas
itemsthatareassumedtofunctionsimilarly.Obtaininginformationaboutinternalconsistencyfornormreferencedmeasurespresentsfewpracticaldifficulties:Thesame
informationusedtoprovidenormsisusedtostudyinternalconsistency.Thus,informationaboutinternalconsistencyisoftenprovided,eveniflittleelseis.
Themostbasicmethodforexamininginternalconsistencyinvolvesthecalculationofasplithalfreliabilitycoefficient,whereperformancesofagroupoftesttakerslike
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Fig.3.3.Anexampleshowinghowtocalculateapointtopointmeasureofagreement.
thoseforwhomthemeasureisdesignedarecomparedfortwohalvesofthemeasure.Althoughthemeasuremaybesplitinhalfusingavarietyofstrategies,mostoften
evenitemsarecomparedwithodditemsthroughthecalculationofacorrelationcoefficient.Highercorrelationsaretakenasevidenceofinternalconsistency.
Amajorproblemwiththesplithalfmethodisthatbecauseyoucompareonlyonehalfofthetestitemswiththeotherhalf,theamountofdatausedinthecorrelation
coefficientishalfwhatitshouldbe.Thishastheeffectofmakingthecorrelationcoefficientsmallerthanitwouldotherwisebe.Alternativemethodshavebeen
developedtocopewiththislimitation.
ThetwomostimportantalternativemeasuresofinternalconsistencyencounteredintestsforchildrenaretheKuderRichardsonformula(KR20)andCoefficientalpha
().KR20(which,incaseyourecuriousaboutthename,wasthetwentiethformulausedbyKuder&Richardsoninafamous1937articleKuder&Richardson,
1937)isusedonlyfordichotomouslyscoreditems(e.g.,thosescoredas1=rightand2=wrongonly).Itcannotbeusedforitemsthatarenotscoreddichotomously
(e.g.,thoseusingaratingsystemfrom1to4).Thislimitationledtothedevelopmentof.CoefficientalphaisamoregeneralformulathanKR20andcanhandleboth
dichotomouslyandnondichotomouslyscoredmeasures.KR20andarethoughttobemoresensitivethansplithalfmethodstohomogeneityofitemcontent,meaning
theextenttowhichitemsareaimedatthesamespecificconstruct.Thustheyaresometimesdescribedasmeasuresoftesthomogeneity.
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NearthebeginningofthissectiononreliabilityIintroducedtheideathatreliabilitycanbeconsideredintermsofitsimpactonagivenscoreusingastatisticcalledthe
SEM.TheSEMisdiscussedingreaterdetailatthispointbecauseitisusuallybasedonameasureofinternalconsistency(possiblybecauseoftheeasyavailabilityof
thistypeofreliabilitydata,ratherthanfortheoreticalreasons).TheformulafortheSEMisrelativelyeasytounderstandanduse.Itiscalculatedbymultiplyingthe
standarddeviationofthetestbythesquarerootof1minusthereliabilitycoefficient.Itrepresentsthedegreeoferroraffectinganindividualscore.
Recallthatasreliabilityincreases,thesizeoftheSEMdecreases:Themorereliableameasure,thesmallertheerroraffectingindividualscoresandthemoreprecisethe
measurement.Thus,onecanusetheSEMdirectlyasameansofdeterminingwhichoftwocompetingmeasuresismoreprecise.Forexample,fora4yearoldchild
youmaywanttocomparetheSEMfortwotestsdesignedtoaddressreceptivevocabularyskillsusingverysimilartasks.Althoughthereareadditionalgroundson
whichyoumaywanttocomparethetwotests,precisionwouldbeoneimportantfeaturetoconsiderinmakingachoicebetweenthem.Searchingintheirtestmanuals,
youfindthattheSEMforthefirsttestis7(forwhichthemeanstandardscoreis100,SD=15)andforthesecondtestis4(forwhichthemeanandstandardscoreis
100,SD=15).Thus,thesecondisthemorepreciseofthetwomeasures.(Althoughitispossibletomakeessentiallythesamecomparisonusingthereliability
coefficientsforthesemeasures,phrasingthatcomparisonintermsoftheSEMallowsyoutoseemuchmorevividlytheimpactonanindividualscore.)
TheSEMcanalsobeused,alongwithinformationaboutthenormalcurve,toobtainaconfidenceintervalaroundanobtainedscoreaconceptIdiscussmorefullyin
chapter9aspartofalargerdiscussionoftestscoresandidentificationdecisions.
InterexaminerReliability
Interexaminerreliabilityisstudiedinordertoaddressconcernsaboutameasuresconsistencyacrossexaminers.Essentially,thisformofreliabilitystudyaddressesthe
question,Aredifferentexaminerslikelytoaffectperformanceonthemeasure?Dependingonthespecificfocus,itcanbecalledbyavarietyofnames:interscorer
reliability,interobserverreliability,interjudgereliability,amongothers.Thenatureofthestudydependsonwhichaspectsofthesequenceofactivitiesinvolvedin
administering,scoring,andinterpretingthemeasureareexpectedtobemostvulnerabletoinconsistency.Forexample,ifameasureinvolvesasophisticatedperceptual
judgmentonthepartoftheexaminer(suchastheapplicationofa5pointratingscale),thataspectofthetestsusewouldbetheprimaryfocusofareliabilitystudy.
Alternatively,ifthecalculationofameasurestotalscoredependedonthecalculationandcorrectrecordingofnumeroussums,thenthataspectofthetestsusewould
beamoreimportantfocusofstudy.
Wherepossibleduringreliabilitystudies,twotestersareaskedtoperformthesamefunction(e.g.,scoring),eitherfromtape(audioorvideo)orlive,forasinglegroup
oftesttakers.Thentheresultingscoresareexaminedusingareliabilitycoefficient.Whentheactualadministrationofitemsseemstoprovideasourceoferror,thesame
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groupoftesttakersmaybetestedbytwotesters.Theresultswillbelessclearcutinthatcase,however,becausedifferencesinthetwotestingtimescouldbedueto
differenceseitherintestersorintestingtimes(testretestreliability).
Forinformalmeasures,consistencyacrossusersofthemeasureismorecommonlydiscussedintermsofagreement.Forexample,itispossibletocalculateagreement
fortwoexaminersusingabehavioralprobetoexamineperformancewithinaspecifictreatmenttask.ThemethodsareidenticaltothosedescribedinFig.3.3.
AlternateFormsReliability
Alternateformsreliabilityisstudiedtoaddressconcernsaboutconsistencyacrossvaryingformsofthetest.Multipleversionsofatest,termedalternateorparallel
forms,tendtobecreatedwhenatestwillprobablybeusedonmorethanoneoccasionwithanindividual,thusmakingrepeattestingsubjecttopossiblecarryover
effects.Alternateformsarecreatedbyselectingitemsforeachformfromacommonpoolofpossibleitems.Alternateformsreliabilityisstudiedbyadministeringone
version,thenanother(balancedsothathalfofthetesttakerswilltakeoneversionfirstandtheotherhalfwilltaketheotherversionfirst),andthencalculatinga
correlationcoefficientfortheresultingtwosetsofscores.Oftentheintervalbetweentestingsisveryshort,andthecorrelationcoefficientisthoughttoreflectonly
differencesintheformused.Iftheintervalislonger,however,theresultingcorrelationcoefficientcanbeexpectedtoreflectnotonlydifferencesincontentbetweenthe
twoforms,butalsochangesduetotime.Therefore,informationabouttheintervalbetweentestingsshouldbereportedaspartofthetestdevelopersdescriptionofthe
study.
Alternate,orparallel,formsarerarelyprovidedfortestsusedwithchildrenwhohavedevelopmentallanguageproblems.Theyaretypicallyreservedforteststhatare
usedwithgreaterfrequency,suchassomeeducationalandintelligencetests.Nonetheless,thereareasmallnumberoftests(e.g.,thePPVTIII,Dunn&Dunn,1997)
thatdoprovidethisinformation,whichiswhyitisconsideredhere.
FactorsAffectingReliability
Anyfactorthatincreasesthelikelihoodthatnonsystematicerrorwillenterintothetestingsituationwill,bydefinition,decreaseameasuresmeasuredreliability.
Consequently,anylackofsimilaritybetweentestingconditionsduringastudyoftestretestreliabilityorinterexaminerreliability,forexample,arelikelytoresultinlower
reliabilitycoefficients.Inaddition,thereareacoupleoffactorsthatmaynotbesoobviousthatwilldistortthemagnitudeofreliabilitycoefficients.Thesearediscussed
furtherinavarietyofsources,includingNitko(1983)andGronlund(1993).
First,thelengthofthemeasureusedwillaffectthesizeofthereliabilitycoefficient.Ingeneral,thelongerameasure,thegreateritsreliability.Thisfactorpresentsa
significantchallengetothosewishingtodeveloptestsfortesttakerswithshorterattentionspans(e.g.,children!).
Second,thespecificgrouponwhichreliabilityisstudiedmayaffectthesizeoftheobtainedreliabilitycoefficient.Onereasonforthisisaphenomenonknownasrestric
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tionofrange.Whatthatmeansisthatwhenthereislittlevariabilityinperformanceinadistributionofscores(therestrictedrange),thesizeofthecorrelationcoefficient
willbesmallerthanifthesamepatternofvariationwereextendedoveralargerrangeofscores.
Anotherreasonforthepossibilityofspecificgroupsaffectingthesizeofreliabilitycoefficientsisthatcharacteristicsofonegroupmaymakeitsusceptibletoerrorthat
doesnotaffectadifferentgroup.TaketheperformanceonanIQtestofonegroupwithandonegroupwithoutanidentifiedlearningdisability.Theabilityofthosetwo
groupstoperformconsistentlyunderthesameconditionsmaynotbethesame,leadingtodifferingresultsifreliabilitycoefficientsweretobecalculatedforeachgroup.
Thedangerwouldbe,however,thatratherthanlookingforevidenceforeachgroupseparately,onewouldconsiderevidenceaboutthegroupwithoutanidentified
learningdisabilityassufficientforbothgroups.Here,ashasbeenstressedbefore,theadequacyofevidenceconcerningreliability(andvalidity)needstobeconsidered
inlightofthespecificcircumstances(whoisbeingmeasuredandforwhatpurpose)motivatingtheclinicianssearchforanappropriatemeasure.Inthenextchapter,
proceduresarepresentedthataredesignedtohelpyoulearnhowtoevaluateindividualmeasureswithinaclientorientedframework.
Summary
1.Althoughbehavioralmeasurementhasrelativelyancientroots,clinicalandeducationaltestingbeganonlyattheendofthe19thcentury.
2.ThemostinfluentialstandardsdevelopedforeducationalandpsychologicaltestinghavebeenthoseofAPA,AERA,andNCME(1985).Thesestandardsapplyto
allbehavioralmeasures,butapplymoststrictlytostandardizedtests.
3.Thetestuserisresponsibleforassuringthataspecificmeasureislikelytoprovidetheinformationbeingsought(i.e.,thatthemeasureisavalidmeasureforthe
purposetowhichitwillbeput).
4.Becauseallevidenceofvaliditydependsondemonstrationsthatthemeasurecapturesthetheoreticalconstructitwasintendedtoassess,constructvaliditycanbe
seenastheoverarchingframeworkofvalidation.Asaresultofhistoricalfactors,however,threetypesofevidencearetypicallydiscussed:constructvalidity,content
validity,andcriterionrelatedvalidity.
5.Fourspecificmethodsofconstructvalidationincludethedevelopmentalmethod,thecontrastinggroupsmethod,factoranalyticstudies,andstudiesofconvergent
anddiscriminantvalidity.
6.Contentvalidationactivitiesoccuraspartofthedevelopmentprocess(e.g.,documentationofthetestplan,itemanalyses)and,followingdevelopment,aspartof
validationactivities.
7.Standardizedmeasuresdesignedforcriterionreferencedinterpretationandfornormreferencedinterpretationaredevelopedusingsimilarsteps,butdifferinthe
methodsusedtomakedecisionsateachstep.
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8.Facevalidity,orpublicrelationsvalidityasitissometimescalled,involvesameasuresappearanceofvalidityratherthanthedegreeofvalidityitwillbeshownto
haveoncloser,systematicscrutiny.
9.Criterionrelatedvalidityinvolvesthecollectionofevidencesuggestingthatthetargetmeasureperformsinamannersimilartothatofanalreadyvalidatedcriterion
measure.Concurrentvalidityreferstocriterionreferencedvalidationstudiesinwhichthecriterionandthetargetmeasureareadministeredtotheparticipantatthesame
pointintime,whereaspredictivevalidityreferstostudiesinwhichthetargetmeasureisobtainedfirstandthecriterionatalatertime.
10.Validityisaffectedbyappropriatemeasureselection,testadministrationconditions,reliability,andclientfactorssuchasmotivationandenablingbehaviors.
11.Reliability(consistencyofmeasurement)placesanupperlimitonpossiblevalidity,butevenperfectreliabilitydoesnotensurevalidity.Reliabilityisthereforesaidto
beanecessary,butnotsufficientconditionforvalidity.
12.Studiesofreliabilityusuallytargetconsistencyacrosstestingoccasions(testretestreliability),acrosssubsetsoftestitems(internalconsistencyreliability),and
acrosstesters(interexaminerreliability).Forspeechlanguagepathologyandaudiologymeasures,consistencyacrosstestversions(alternateformreliability)ismuch
lessfrequentlyexamined.
13.Whenreliabilityinformationisreportedforaparticularmeasure,reliabilitycorrelationcoefficientsareusedmostfrequently.Whensuchinformationisreportedin
relationtoaspecificscoreobtainedbyanindividual,SEMisused.
14.Wheninformationaboutconsistencyissoughtforinformalmeasures,agreementmeasuresareusuallycalculated.Themostcommonmeasuresofagreementare
interexaminerandinterexamineragreement.
15.Classicaltruetestscoretheoryholdsthatthescoreactuallyreceivedbyanindividual(theobtainedscore)iscomposedoferrorandthetheoreticalscorethe
individualshouldreceive(thetruescore).
16.SEMcanbeusedtoconstructaconfidenceintervalwithinwhichonecandetermineahighprobabilityoffindingtheindividualstruescore.
17.Reliabilityisaffectedbytestlength(withfeweritemsresultinginlowerreliability)andbytherangeofabilitiesrepresentedinthereliabilitysubjects(withasmaller
rangeofabilitiesresultinginlowerreliability).
KeyConceptsandTerms
constructvalidation:theaccumulationofevidenceshowingthatameasurerelatesinpredictedwaystotheconstructitisbeingusedtomeasure.
contentvalidation:theaccumulationofevidencesuggestingthatthecontentincludedinameasureisrelevantandrepresentativeoftherangeofbehaviorsfittingwithin
theconstructbeingmeasured.
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contrastinggroupsmethodofconstructvalidation:theaccumulationofevidencesuggestingthatgroupsknowntodifferintheextenttowhichthetestedconstruct
appliestothemalsodifferintheirperformanceonthetargetmeasure.
convergentanddiscriminantvalidation:theaccumulationofevidencesuggestingthatameasurecorrelatessignificantlyandhighlywithmeasuresaimedatthesame
construct(convergentvalidation)aswellasevidencethatthemeasuredoesnotcorrelatesignificantlyandhighlywithmeasurestargetingdifferentconstructs
(discriminantvalidation).
criterionrelatedvalidation:theaccumulationofevidencesuggestingthatthemeasureperformsinamannersimilartoanothermeasure(thecriterion)thatisbelieved
tobeavalidindicatoroftheconstructunderstudy,eitherwherebothcriterionandmeasureareadministeredatonepointintime(concurrentvalidation)orwiththe
criterionmeasuredatalaterpointintimethanthetargetmeasure(predictivevalidation).
developmentalmethodofconstructvalidation:theaccumulationofevidencesuggestingthatperformanceonameasurechangeswithage(usuallyimproves),when
themeasureismeanttotargetaconstructthatisthoughttochangewithage.
enablingbehaviorsandknowledge:behaviorsnotrelatedtotheconstructunderstudythatarenonethelessrequiredforsuccessfultestperformance(e.g.,visionfor
tasksusingvisualstimuli,previousexposuretovocabularybeingused).
facevalidity:theappearanceofvalidityofameasure,whichisnotnecessarilyreflectiveofitsactualvalidity.
factoranalysis:anumberofstatisticalproceduresusedduringtestdevelopmentandconstructvalidationtodescribeandconfirmtherelationshipsofanumberof
variables.
informalmeasure:ameasuredevelopedforalimitedmeasurementpurposeforwhichastandardizedmeasurewasinappropriateorunavailableforexample,probes
designedbyspeechlanguagepathologiststoassesslearningwithinatreatmentsessionareusuallyinformalmeasures.
interexamineragreement:theextenttowhichresultsofameasureagreewhenitisadministered,scored,orinterpretedbytwoormoreexaminers.
interexaminerreliability:theconsistencyofameasureacrosstwoormoreexaminers,alsotermedinterjudgereliability,interobserverreliability,andintertester
reliability.
internalconsistency:theconsistencyofameasureacrosssubdivisionsofitscontent,usuallymeasuredusingsplithalfreliability,KR20,orcoefficient.
itemanalysis:avarietyofproceduresappliedtothepoolofitemsbeingconsideredforinclusioninameasurethatexamineitspossiblecontributionstotheoverall
measure.
observedscore:thescoreactuallyachievedbyagiventesttakerusuallycontrastedwithtruescoreinclassicaltruescoretheory.
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reliability:consistencyofameasureacrosschangesintime(testretest),intheindividualadministeringorscoringit(interexaminer),andinthespecificitemsitcontains
(internalconsistency).
standarderrorofmeasurement(SEM):ameasureofreliabilitythatisexpressedintermsoftheoriginalunitsofmeasurement(e.g.,numberofitems).
testretestreliability:theconsistencyofameasurethatisadministeredattwopointsintime.
test:abehavioralmeasureinwhichastructuredsampleofbehaviorisobtainedunderconditionsinwhichthetestedindividualisassumedtoperformathisorher
best(APA,AERA,&NCME,1985).
truescore:atheoreticalvaluethathypotheticallywouldbeobtainedbyatesttakerifthemeasurebeingusedwereperfectlyreliable,thatis,wereunaffectedbyerror
validity:theextenttowhichameasureactuallymeasureswhatitclaimstomeasure.
StudyQuestionsandQuestionstoExpandYourThinking
1.Definevalidity.
2.Chooseaspecifictestdealingwithchildlanguage.Comparesourcesofinformationaboutitscontent:(a)contentimpliedbythetitle,(b)itsapparentcontentonthe
basisoftheauthorsoverviewstatementsconcerningtheintendedpurposeofthetestanditsintendedcontent,and(c)individualitems.Howmightanaivetestuserbe
misledifheorsheonlyconsidersthetitle?
3.Describethethreemajorkindsofvalidityevidenceandtheirrelationshipswithoneanother.
4.Translatethefollowingsentenceintoaformthatsomeoneunfamiliarwithtestingwouldbeabletounderstand:Reliabilityisanecessarybutnotsufficientconditionfor
validity.
5.Listthestepsrequiredinthedevelopmentofastandardizedmeasure.Compareandcontrastthesestepsastheyapplytocriterionversusnormreferenced
measures.
6.Imaginethatyouvesetupataskwith20itemsthatyoubelievemaybedifficultforyoutorateconsistentlyascorrectorincorrect.Whatprocedurewouldyouuse
toobtainameasureofyourconsistencyinratingtheseitems.
7.Listthreefactorsknowntoaffectvalidity.
8.Listthreefactorsknowtoaffectreliability.
9.Explainhowtheamountofvariabilityintestscoresaffectsthemagnitudeofcorrelationcoefficients.Whatimplicationsdoesthiseffecthavefortestdevelopers?
10.Whatismeantbytheconvergentdiscriminantapproachtoconstructvalidity?
11.Howdoesreliabilityrelatetoclassicaltruescoretheory?
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12.Whyisinternalconsistencyassociatedwiththreemeasures:splithalfreliability,KR20,andcoefficient?
13.Listfiveenablingbehaviorsrequiredfortheperformanceofapicturevocabularytestinwhichthetesttakerisrequiredtolistentothenameofanactionandpick
outapicture(fromagroupof4)thatcorrespondstotheaction.
14.Reflectonsituationsinwhichateacher,coach,orparenthashelpedyoudosomethingthatyoufoundparticularlydifficult.Whatdidtheydothathelpedyoufeel
motivatedtotrythatdifficultsomething?Howmightyouapplythesameapproachtothetestingofareluctantchild?
RecommendedReadings
AmericanEducationalResearchAssociation,AmericanPsychologicalAssociation,andNationalCouncilonMeasurementinEducation.(1985).Standardsfor
educationalandpsychologicaltesting.Washington,DC:AmericanPsychologicalAssociation.
Gronlund,N.E.(1993).Howtomakeachievementtestsandassessments.(5thed.).Boston:Allyn&Bacon.
Lyman,H.B.(1963).Testscoresandwhattheymean.EnglewoodCliffs,NJ:PrenticeHall.
McReynolds,L.,&Kearns,K.(1983).Singlesubjectexperimentaldesignsincommunicativedisorders.Baltimore:UniversityParkPress.
Messick,S.(1989).Validity.InR.L.Linn(Ed.),Educationalmeasurement(3rded.,pp.13103).NewYork:AmericanCouncilonEducationandMacmillan.
Sattler,J.(1988).Assessmentofchildren(3rded.).SanDiego,CA:Author.
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Mislevy,R.J.(1993).Foundationsofanewtesttheory.InN.Fredericksen,R.J.Mislevy,&I.I.Bejar(Eds.),Testtheoryforanewgenerationoftests(pp.19
40).Hillsdale,NJ:LawrenceErlbaumAssociates.
NationalEducationAssociation.(1955).Technicalrecommendationsforachievementtests.Washington,DC:Author.
Nitko,A.J.(1983).Educationaltestsandmeasurement:Anintroduction.NewYork:HarcourtBraceJovanovich.
Pedhazur,R.J.,&Schmelkin,L.P.(1991).Measurement,design,andanalysis:Anintegratedapproach.Hillsdale,NJ:LawrenceErlbaumAssociates.
Salvia,J.,&Ysseldyke,J.E.(1995).Assessment(6thed.).Boston:HoughtonMifflin.
Semel,E.,Wiig,E.H.,&Secord,W.(1987).ClinicalEvaluationofLanguageFundamentalsRevised.SanAntonio:ThePsychologicalCorporation.
Stillman,R.,Snow,R.,&Warren,K.(1999).Iusedtobegoodwithkids.EncountersbetweenspeechlanguagepathologystudentsandchildrenwithPervasive
DevelopmentalDisorders(PDD).InD.Kovarsky,J.Duchan,&M.Maxwell(Eds.),Constructing(in)competence(pp.2948).Mahwah,NJ:LawrenceErlbaum
Associates.
Stevens,G.,&Gardner,S.(1982).Thewomenofpsychology.Cambridge,MA:Schenkman.
Torgesen,J.K.,&Bryant,B.R.(1994).TestofPhonologicalAwareness(TOPA).Austin,TX:ProEd.
VanRiper,C.,&Erickson,R.(1969).Apredictivescreeningtestofarticulation.JournalofSpeechandHearingDisorders,34,214219.
Zimmerman,I.L.,Steiner,V.G.,&Pond,R.E.(1992).PreschoolLanguageScale3.SanAntonio,TX:PsychologicalCorporation.
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CHAPTER
4
EvaluatingMeasuresofChildrensCommunicationandRelatedSkills
ContextualConsiderationsinAssessment:TheBiggerPictureinwhichAssessmentsTakePlace
EvaluatingIndividualMeasures
Inthelastchapter,youwereintroducedtothemostimportanttestrelatedconsiderationsforevaluatingindividualmeasures:validityandreliability.Inthischapter,you
willlearnaboutfactorstoconsiderinevaluatingmeasuresandabouthowtoperformsuchanevaluationaprocessthatmakesthemostsensewhenthefocusisshifted
awayfromthetestitselfandtowardthereasonforitsuse:thechildinquestionandthelargerworldinwhichheorshemoves.
Speechlanguagepathologistsusemeasurementinformationtoachievegoalsaffectingchildrenshealth,development,familylife,education,andsocialwellbeing.They
obtainthisinformationcooperatively(workingprimarilywithfamiliesandotherprofessionals)andshareitwithothersasameansofachievingthechildsgreatestgood.
Thiscooperativepursuitonbehalfofthechildisnotsimplyapracticalmatter,althoughitcertainlyaffectsthelogisticsofmeasurementinverypracticalways.Rather,a
richunderstandingofthewayinwhichchildrensinteractionswiththeworldaremediatedbytheirfamilyandcultureiscriticaltoframingquestionsthatwillresultin
validresponsestothechildsneeds.Alsoneeded,however,isanappreciationthattheclinicianbringshisorherownhistory,culture,andworkplaceconstraintstothe
questionaskingsituation
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allofwhichwillalsobearonwhichquestionsareaskedandhowtheyareanswered.Inthefirsthalfofthischapter,Idiscussthelargercontextofmeasurement,
focusingfirstonfactorsaffectingthechildandthenonfactors,thatmoredirectlyimpingeontheclinician.Figure4.1illustratesavisualmodelforthinkingaboutthis
largercontext.
ContextualConsiderationsinAssessment:TheBiggerPictureinWhichAssessmentsTakePlace
In1974,UrieBronfenbrennerwasresponsibleforanevaluationofthedevelopmentalresearchofthaterawhichcanstillchilltheheartofresearchersandclinicianswho
studychildreninhighlystructuredcontexts.Specifically,hedescribedthatresearchasthestudyofthestrangebehaviorofchildreninstrangesituationsforthebriefest
possibleperiodoftime(Bronfenbrenner,1974).Thisquotationbringsintosharpfocusadeepconcernthatresearcherswerefailingtocapturetheessentialfactors
affectingthechildbyfailingtostudythemandtheirmostinfluentialcompanions(usuallyparents)inthenaturalsituationsinwhichdevelopmentoccurs.Shiftingspecies
forasecond,onecouldsaythatessentiallyBronfenbrennerpointedoutthatdrawingconclusionsaboutchildreninreallifefromexistingresearchparadigmswasakinto
concludingthatoneknewaboutlionsinthewildbyobservinglionsmovingaroundtheartificialrocks,caves,andpondsoftheirenclosureinazoo.Anyonewhohas
seenawildeyed,noncompliant,andvirtuallynonverbalchildleaveaclinicroomtobeginafastpaced,detailedlitanyofhisordealscanunderstandBronfenbrenners
pointaswellastherelevanceofthelionanalogy.
AvastresearchliteraturewasspawnedbyBronfenbrennerscriticismandbytheprogramofresearchheandothersundertooktounderstanddevelopmentthrough
observationsofchildrenandtheircaretakersinreallifesettings.Theresultingliteratureisassociatedwithanevolvingtheoryofdevelopment(Bronfenbrenner,1986
Bronfenbrenner&Morris,1998)thatcanprovideuswithavaluablestartingpointforthinkingaboutthelargercontextofassessment.
Arecentarticulationofthismodel(Bronfenbrenner&Morris,1998)wasdescribedbyitsauthorsasabioecologicalmodelofdevelopmentbecauseitemphasizes
boththechildscharacteristicsandthecontextinwhichdevelopmentoccursascontributorstotheprocessofdevelopment.Amongthemostobviousmodifications
representedinthisversionofthemodelaretheplacingofgreateremphasisbothonbiologicalfactorsaffectingthechildandthosearoundhimorherandonthechilds
roleinaffectinghisorherenvironmentaswellasbeingaffectedbyit.Theenduringcentralcomponentofthemodel,however,andthecomponentthatwasmost
neededandchampionedinspeechlanguagepathology,isitscelebrationoftheimportanceofthechildsenvironmenttodevelopmentalprocesses,especiallythesocial
environment(Crais,1995Muma,1998).InthefollowingpagesIbrieflydiscusshowcurrentthoughtsonthecontextsoffamily,language,culture,andsocietyasa
wholecontinuetoshapeandreshapeviewsofvalidlanguageevaluationandhowaspectsoftheclinicianscontextalsoaffecttheevaluationofchildrenslanguage.
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Fig.4.1.Amodeloffactorsaffectingthechildandtheclinicianintheassessmentprocess.FromAssessingandscreeningpreschoolers:Psychologicaland
educationaldimensions(p.6),byVasquezNuttall,Romero,andKalesnik,Boston:Allyn&Bacon.Copyright1999byAllyn&Bacon.Adaptedbypermission.
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FamilialContexts
Whyshouldfamiliesbeseenasthecentralforumforlanguagedevelopmentand,thus,languageassessment?Fromthetimethechildisborn,thefamilyconstitutesthe
mostbasicandenduringofcontextsinwhichchildrenspendtheirtimeandtheirenergies.Further,thefoundationofcommunicationandlanguageisestablishedwiththe
giveandtakeofearlyfeedingandproceedsonwardtoallattainedlevelsoflinguisticachievement.
Althoughthesetruthshaveprobablyalwaysbeenrecognizedbyprofessionalsatsomelevel,theyhavetendedtobeoverlookedinmeasurementpracticesuntilthe
diffusionoftheoriessuchasthatproposedbyBronfenbrennerledtopoliticalaction.Specifically,theEducationoftheHandicappedActAmendmentsof1986required
IndividualEducationalPlans(IEPs)forchildrenages3to5andIndividualizedFamilyServicePlans(IFSPs)forchildrenyoungerthan3.Throughtheserequirements,
thelawembodiedtheperspectivethatbecauseoftheintertwinedandinterdependentnatureofchildandfamilyneeds,effectiveevaluationandinterventionforchildren
requiresinclusionofthefamilyascollaboratorsthatis,asactiveagentsinthelifeandaffairsofthechildratherthanaspassiverecipientsofprofessionalactivities.
Particularlyforchildrenbelowtheageofthree,thisperspectivewasseenascrucial,hencetherequirementoftheIFSPforthatagegroup.
WithintheIFSPprovisions,assessmentsincludeinformationaboutfamilystrengths,needs,andvariablesrelatedtoprogramservices,aswellasaboutthechilds
currentleveloffunctioning(Radziewicz,1995).Radziewicznotedthateffectivefamilyassessmentisconductedinamannerthatispositiveforthefamily,respectfulof
thefamilysvalues,inclusiveofkeyfamilymembers,nonintrusive,andaimedattargetingfamilyneedsandresources(Radziewicz,1995).Newtypesoftoolshavebeen
developedtoaddressclinicalquestionsconcerningthenatureofthefamilyandofparentchildinteractions.Radziewicz(1995)andCrais(1992,1995)provided
excellentdiscussionsofthese.
Inadditiontoservingasafocusofattentionofprofessionals,however,parentsandfamilieshavebecomemoreactivelyinvolvedinavarietyofclinicalactivities,
includingscreening,providingdescriptionsandotherdata,validatingevaluationfindings,andevenadministeringsometests.Althoughtheseactivitiesaredescribedin
laterchapters,theyarementionedheretohelpyoubecomeawarethatyourconsiderationofaninstrumentsvaliditywilloftenincludethinkingaboutthesuitabilityofits
usewithandbyparents.Notsurprisingly,thisneedisgreatestforyoungerchildrenandinfantsandforchildrenwhoaremoreaffectedbytheirdifficulties.
CulturalLinguisticContextsforAssessment
Justasthechildisembeddedwithinhisorherfamily,sotooisthefamilyembeddedwithinaspecificcultureandlinguisticcontext.Thus,effectiveinteractionwith
familiesdependsnotsimplyontheclinicianschoosingtoincludethemintheprocess,butalsoonherorhisknowledgeofeachfamilysculturalandlinguistic
expectations.Thevarietyofculturalandlinguisticdifferencesaffectingacliniciansinteractionwith
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parentsisquiteawesome.Amongjustafewofthedifferencesdiscussedinagrowingliterature(Damico,Smith,&Augustine,1996DonahueKilburg,1992van
Kleeck,1994)arethefollowing:
1. differencesinchildrearingpractices(e.g.,theappropriatenessofaskingchildrentoengageinquestionaskingortoreciteinformationalreadyknownby
listeners)
2. differencesinpatternsofdecisionmakingwithinfamilies(e.g.,whichfiguresareseenasprimarydecisionmakers)
3. differencesinfamilychoicesconcerninglanguageanddialectuse(e.g.,whetherchildrenareexpectedtousethelanguageofthehome)
4. anddifferencesinhowdifficultiesincommunicationareviewed(e.g.,howtheyareviewedasaffectingthefamilyandchild).
Differencessuchasthesecanaffectthenatureandextentofcommunicationsoccurringbetweencliniciansandparents,howtheyareincludedintheirchildscare,the
natureofintervention,andmostimportantlyforthepurposesofthisbookhowlanguageevaluationsareplanned,executed,andactedon.Also,becauseevaluations
arepromptedbyheightenedparentalconcernorcanacttopromoteparentsfocusontheirchild,evaluationsthatsuccessfullyinvolveparentscanalsoenlistparents
continuingengagementinwaysthatarecriticaltothechildssuccess.Table4.1summarizesreportedtrendsintheattitudesofAsianAmericans,AfricanAmericans,
andHispanicAmericanstowardchildren,family,andchildrearing.Ofcourse,thesetrendsrepresentprejudices,thatis,prejudgments,ofatype:Thereissimplyno
substituteforfindingouthowaspecificfamilyfunctionsandwhatitsattitudesare,regardlessofitsculture.
Thateachchildisalsoamaturinguserofambientlanguage(s)anddialect(s)willaffectassessmentdramatically.Mostobviously,cliniciansareawareofthiswhenthey
areaskedtoassessthecommunicationskillsofachildwhosefirstlanguageisnotthesameastheirown,andtheymustdecidewhetherandhowtheycanbeinvolved
withthechild.Cliniciansarealsoawareofthiswhentheyservechildrenwhodifferinsocialorregionaldialectfromthemselves.Inbothcases,theclinicianmustoften
determinewhetherthedifferencesfromthemainstream,dominant,orschoollanguageareduetolanguagedisorderortodifficultiesspecifictosecondlanguageor
dialectacquisition(e.g.,inadequateexposure,transferenceeffectsfromthefirstlanguageordialect,motivationaldifferencesbetweenfirstandsecondlanguage
acquisitionDamicoetal.,1996).
Issuesrelatedtothepresenceofculturallyandlinguisticallydiverseclientswasonceseenasamatterofsporadicsignificance.Onceitwasconsideredmoreimportant
inbiggercitieswithlargerimmigrantpopulationsandingeographicregionswithgreatercultural,ethnic,anddialectaldiversity.Now,howeverithasbeenestimatedthat
oneineverythreeAmericansisAfricanAmerican,Hispanic,AsianAmerican,orAmericanIndian(AmericanSpeechLanguageHearingAssociation[ASHA],1999).
Althoughnationallyandglobally,diversityinlanguageandcultureistheruleratherthantheexception,thatfactisnotrepresentedinthedemographicsoftheprofessions
of
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Table4.1
TrendsinAttitudesTowardChildren,Family,andChildRearing
AsianAmericans
l Strictgenderandageroles
l Fatherthefamilyleader,headoffamily
l Motherthenurturer,caregiver
l Oldermalessuperiortoyoungermales
l Femalessubmissivetomales
l Close,extendedfamilies
l Multigenerationalfamilies
l Olderchildrenstrictlycontrolled,restricted,protected
l Physicalpunishmentused
l Parentsactivelypromotelearningactivitiesathomemaynotparticipateinschoolfunctions
l Childrenaretreasured
l Infant/toddlerneedsmetimmediatelyoranticipated
l Closephysicalcontactbetweenmotherandchild
l Touchratherthanvocal/verbalisprimaryvehicleofearlymotherinfantinteraction
l Harmonyofsocietymoreimportantthanindividual
l Infantseenasindependentandneedingtodevelopdependenceonfamilyandsociety
AfricanAmericans
l Mothersandgrandmothersmaybegreatestinfluences
l Strongextendedfamilytiesareencouraged
l Independenceandassertivenessencouraged
l Infantsmaybefocusoffamilyattention
l Affectionatetreatmentofbabies,butfearofspoiling
l Strongbeliefindiscipline,oftenphysical
l Caregivingofoldertoddlermaybedonebyanolderchild
HispanicAmericans
l Strongidentificationwithextendedfamily
l Familiestendtobepatriarchalwithmalesmakingmostdecisions
l Infantstendtobeindulgedtoddlersareexpectedtolearnacceptablebehavior
l Emphasisplacedoncooperativenessandharmonyinfamilyandsociety
l Independenceandabilitytodefendselfencouraged
l Oldersiblingsoftenparticipateinchildcare
Note.FromFamilyCenteredEarlyInterventionforCommunicationDisorders:PreventionandTreatment(p.21),byG.DonahueKilburg,1992,
Gaithersburg,MD:Aspen.Copyright1992byAspen.Reprintedwithpermission.
speechlanguagepathologyandaudiology.Thus,cliniciansareincreasinglyfacedwiththespecialchallengeofenlargingtheirunderstandingofotherculturesand
linguisticcommunitiesandtheskillsrequiredtoimplementthatunderstandingintheirwork.
Theprocessofrespectingdiversityinchildrenandintheirfamiliespervadesallphasesofclinicalinteraction.Becauseitiscriticaltovalidscreening,identification,
description,andassessmentsofchange,diversityarisesasacontinuingpointofdiscussionthroughouttheremainderofthistext.Ihighlightitherebecauseofits
particularrelevancetothetestreviewprocessdiscussedlaterinthischapter.
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SocietalandLegalContexts
Justasthechildwhoselanguagedevelopmentisindoubtexistsasamemberofalargercommunity,sotooisthespeechlanguagepathologistwhoservesthechild.He
orsheisalsoaparticipantinthelargersocialcontextsofagivenprofessionandworkplacewithinaparticulartimeandplaceagivenerawithinagivenschooldistrict
orinstitution,state,andcountry.Eachofthesecontextualfactorscanaffectdecisionsaboutassessment.Arecentdiscussionoftherolesandresponsibilitiesofschool
speechlanguagepathologists,containedwithinanextensiveASHAdocumentavailableontheirwebsite,emphasizedthisfact(ASHA,1999).Table4.2includesjusta
smallnumberofthemanyfactorsASHAdescribedasaffectingclinicalpracticewithchildren.Inthisbriefsection,twoparticularlycompellingsourcesofeffectson
measurementpracticeareaddressed:nationallegislationandchangingglobalperspectivesondisablement.
NationalLegislation
Asmentionedbrieflyintermsofregulationsregardingfamilyinvolvement,legalinfluencesonhowchildrenareevaluatedforlanguageproblemsrepresentsomeofthe
mostpowerfulinfluencesinclinicalpractice.Inparticular,federallegislationestablishingthewaysinwhichpublicschoolsaddresstheneedsofchildrenhashad
profoundeffectsonhowchildrensproblemsarescreened,identifiedandaddressed(ASHA,1999Demers&Fiorello,1999).Thus,asdescribedearlier,itwas
throughEducationoftheHandicappedActAmendmentsof1986thatideasabouttheneedforgreaterattentiontofamiliesbecameapotentfactorinshapingactual
practice.Inthissection,Ipointouttheevenbroadereffectsthathaveresultedfromanumberofotherlegislativeinitiatives,payingparticularattentiontothe
IndividualswithDisabilitiesEducationAct(IDEA),whichwaspassedin1990.
TheIDEAbuiltonandmodifiedearlierlegislation,includingtwolandmarkfederallaws:theEducationforAllHandicappedChildrenActof1975(P.L.94142),which
establishedmanynowstandardfeaturesofeducationalattentiontochildrenwithspecialneedsandEducationoftheHandicappedActAmendments(1986),which
mandatedservicesforthosechildrenfrombirthtoage21,inadditiontoitsroleinpressingforgreaterinclusionoffamiliesineducationalevaluations.Since1990,the
IDEAhasbeenamended(IDEAAmendmentsof1997)andhashadregulationsdevelopedforitsimplementation.
Table4.2
ABriefListofSomeoftheContextualFactorsAffectingSpeechLanguagePathologyPracticeAmongSchoolBasedClinicians(ASHA,1999)
l Specificfederallegislativeactions(e.g.,theIndividualswithDisabilitiesEducationActof1990)
l Stateregulationsandguidelines
l Localpoliciesandprocedures
l Staffingneeds
l Caseloadcompositionandseverity
l Cutbacksineducationbudgets
l Personnelshortages
l Expandingroles
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TheIDEAandthe1997amendmentstoitmaintainednumerouselementsoftheearlierlegislation.Amongthemostimportantofthesemaintainedfeaturesisamandate
fornondiscriminatoryassessment.Insuchassessments,itisrequiredthatmeasuresbeadministeredinthechildsnativelanguagebytrainedpersonnelfollowingthe
proceduresoutlinedinthetestmanual.Inaddition,thesemorerecentlawsdictatethatvalidityinformationforatestbespecifictothepurposeforwhichthetestisused.
Further,thislegislationrequiresthatevaluationsofchildrenbecomprehensive,multifactored,andconductedbyaninterdisciplinaryteam.Althougheachofthese
componentswasviewedasthebestpracticeatthetimeoflegislation,legislationandthepotentialforlitigationwherelegislationisnotfollowedgiverisetotheactual
implementationofprofessionalandacademicrecommendations.However,itsimportanttorecognizethatlegislationisnotalwaysinaccordwithbestpractices,asI
discussinlatersections.
NewprovisionsoftheIDEA,itsamendments,andthemorerecentdevelopmentofregulationsimplementingitincludesomechangesinnomenclature,suchas
abandonmentofthetermhandicappedforthetermdisabledasthedesignationgiventochildrencoveredbythelaw.Inaddition,theselegalactionshaveadded
severalnewseparatedisabilitycategories,withautismbeingthemostrelevanttodiscussionsoflanguagedisorders.Othernewelementsconsistofdemandsfor
increasedaccountabilitywithresultingincreasesindocumentationrequirementsandinsistencethatchildrensIEPscontaininformationconnectingthechildsdisabilityto
itsimpactonthegeneraleducationcurriculum(ASHA,1999Demers&Fiorello,1999).
Becauseofthelegislationdescribedabove,speechlanguagepathologistswhoworkwithchildreninschoolsareinvolvedinabroaderrangeofresponsibilitiesand
potentialroles(ASHA,1999).Thechildrentheyevaluatearemorediverseinage,language,andculture,andthecollaborativenatureoftheirworkhasincreased
dramatically.Also,cliniciansaremademoreaccountableforthevalidityoftheinstrumentstheyuseandthemethodstheyfollowinevaluatingclients.
Toagreatextent,theeffectsofnationallegislationaresupportiveofgoodmeasurementpractices.Atthesametime,however,legislationintroducescomplexityfor
clinicians,whofaceincreasingresponsibilities,increasingdemandsfordocumentation,andthepushtoreviseordevelopstrategiestodealwiththespecificwaysin
whichindividualstatesandschooldistrictsimplementfederallaw.SomeofthecomplicationstoclinicalpracticeintroducedbystateDepartmentsofEducationare
discussedastheyrelatetospecificmeasurementquestionsinlaterchapters.
WorldHealthOrganizationDefinitions
Ataninternationallevel,changesbroughtaboutbytheWorldHealthOrganization(WHO)oftheUnitedNationshaveaffectedassessmentpractices(WHO,1980).
Aspartofitschargetodevelopaglobalcommonlanguageinthefieldofhealth,WHOproposedguidelinesreflectingchangingviewsabouthealthanddepartures
fromhealththatwouldaffectawidearrayofsectors,includinghealthcare,research,planningandpolicyformation,andeducation.Specifically,in1980,WHO
developedtheInternationalClassificationofImpairments,Disabilities,andHandicaps(ICIDH),inwhichvarioustypesofoutcomesassociatedwithhealth
conditionswereconsidered.
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The1980ICIDHclassificationrecognizedfourlevelsofeffects.Theselevelsaresummarizedherewithexamplestakenfromapplicationstolanguagedisorders.First,
thereisdiseaseordisorder,thephysicalpresenceofahealthcondition,forwhichalanguagedisordercanserveastheexample.Next,thereisimpairment,an
alterationofstructureorfunctioncausingtheindividualwiththeconditiontobecomeawareofit.Forchildrenwithlanguagedisorders,anexampleofapossible
impairmentwouldbeinappropriateuseofgrammaticalmorphemes.Thethirdlevelofeffectsisdescribedasdisability,analterationinfunctionalability.Forchildren
withlanguagedisorders,thedisabilityassociatedwiththeirdifficultiescouldbeadecreasedabilitytocommunicate.ThelastlevelrecognizedintheICIDHisthatof
handicap,whichisasocialoutcome.Thus,negativeattitudesonthepartofplaymatesorteacherstowardaffectedchildrenconstitutesapossiblehandicapassociated
withlanguagedisorder.
Althoughchangesinthesetermsandthereasonsforthosechangesarediscussedinamoment,Ifirstdiscusstwoimportantimplicationsofthisnewclassificationsystem
thathaveprovenmostsignificant.First,althoughthereisatendencyforthesefourtypesofeffectstoberelatedtooneanother(e.g.,formoreseveredisorderstobe
associatedwithgreaterhandicaps),thisisnotalwaysthecase.Forexample,itispossibleforahandicaptoexistapartfromthepresenceofadiseaseordisorder,as
mightbethecaseifsocietalprejudiceagainstanindividualoccurredintheabsenceofactualimpairment.Aspecificexamplemightbeifachildweretobeexcludedby
agroupofpeersbecauseofacleftlip,anobservablebutfunctionallyinsignificantdifference.
Similarly,itispossibleforamoresevereimpairmenttobeassociatedwithonlyamilddisabilityandminimalhandicapbecauseofsuccessfulcompensatorystrategieson
thepartoftheindividual,effectiveinterventionsonthepartofprofessionals,orboth.Imagineachildwithamoderatehearinglossacquiredafterinitialstagesof
languageacquisitionarecompletewhoexperienceshighoverallintelligence,strongmotivation,asupportivehomeenvironment,andeffectiveauditorymanagement.
Suchachildcouldbeexpectedtoexperiencelessereffectsoncommunicationeffectivenessandonsocialrolesthanwouldbeexpectedonthebasisoftheseverityof
hearinglossalone.Thisclassificationcausesonetoconsidertheroleofnotonlythechild,butalsoofhisorhersurroundingsindeterminingthenatureofnegativeeffects
experiencedbecauseofadisorder.
Asecondmajorimplicationofthe1980classificationisthateachofthefourlevelsofeffectsisunderstoodtobeassociatedwithdifferentmeasurementgoalsforboth
researchandclinicalpurposes.Forexample,measurementfocusedatthelevelofhandicaprequiresinformationabouthowachildssocialandeducationalrolesare
affectedbyhisorhercondition.Thiscontrastswithmeasuresfocusedatthelevelofimpairment,whichrequireinformationaboutthechildsuseofparticularlanguage
structures.Thegreaterattentionpaidtothelargerramificationsofhealthconditionscoincideswithanurgentpushinbothclinicalandeducationalsettingsformeasuring
andevaluatingtheeffectivenessofinterventionsintermsthesehigherordereffects.
Despitethewidespreadinfluenceofthe1980classificationsystem,dissatisfactionexistedwithitsterminologyandwiththewaysinwhichthesocialcontributionstothe
effectsofhealthconditionswashandled.Amongspecificcriticismswasthatterminologywassometimesconfusingandincludedtheuseofpotentiallyoffensiveterms
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suchashandicap(Frattali,1998).Themodelunderlyingtheclassificationwasalsocriticizedforfailingtorepresenttheinfluenceofcontextualfactors.
Becauseofconcernsaboutthe1980classificationsystem,adraftrevisionwasputforwardin1997forcommentandfieldtesting,withanexpectedfinalapprovaldate
forafinalversionin2000(WHO,1998).TheproposedclassificationsystemiscalledtheICIDH2:InternationalClassificationofImpairments,Activities,and
Participation(WHO,1998),reflectingsignificantchangestothetheoreticalorientationfromtheearlierclassificationofImpairments,Disabilities,andHandicaps.
Thedetailsofthefinalrevisionremainindefiniteatthemoment.Nonetheless,thecurrentdraftwarrantsdiscussionbecauseofitsvalueasanindicatorofemerging
trendsandbecauseitfitssnuglywiththeviewofchildrenadvanceduptothispointinthechapterthatis,asdeeplyaffectingandaffectedbytheirenvironment.
Asitsmostimportantchange,the1997classificationisdesignedtoembraceamodelinwhichhumanfunctioninganddisablementresultfromaninteractionofthe
individualsconditionandhisorhersocialandphysicalenvironment.Inthissystem,therefore,thefollowingdefinitionsareusedtodescribelevelsoffunctioning(or
wheredecreasedfunctioningisnoted,disablement)inthecontextofahealthcondition:
1.Impairmentisalossorabnormalityofbodystructureorphysiologicalorpsychologicalfunction,e.g.,lossofalimb,lossofvision(WHO,1998,p.8).Notice
thatthislevelcorrespondstothecurrentICIDHlevelofimpairmentandthusmightrefertoachildsabnormalordelayedlanguagecharacteristics.
2.AnActivityisthenatureandextentoffunctioningattheleveloftheperson.Activitiesmaybelimitedinnature,duration,andquality,e.g.,takingcareofoneself,
maintainingajob(WHO,1998,p.8).NoticethatthislevelreplacesthecurrentICIDHlevelofdisabilityandthusmightrefertoachildsreducedabilityto
communicate.
3.ParticipationisthenatureandextentofapersonsinvolvementinlifesituationsinrelationtoImpairment,Activities,HealthConditionsandContextualfactors.
Participationmayberestrictedinnature,durationandquality,e.g.,participationincommunityactivities,obtainingadrivinglicense(WHO,1998,p.8).This
finallevelcorrespondstotheolderlevelofhandicapandthusmightrefertonegativesocialoutcomesofachildslanguageproblems.
Onthebasisofthesenewformulations,onecanseecontinuitiesbetweentheproposedandexistingsystemsyetalsonoticeasignificantchangeinorientationthatis
bothmorepositiveintoneandmorerecognizingofcontextualinfluences.Inthenewclassificationsystem,apersonsenvironmental(socialandphysical)andpersonal
contextsaresaidtoinfluencehowdisablementateachoftheselevelsisexperienced.Inparticular,twotypesofcontextualfactorsaredeemedmostimportant:(a)
environmentalandphysicalfactors(suchassocialattitudes,physicalbarriersposedbyspecificsettings,climate,andpublicpolicy)and(b)personalfactors(e.g.,
education,copingstyle,gender,age,andotherhealthconditionsWHO,1998,p.8).
Fromthisoverview,itisevidentthatthethrustoftheICIDH2willbesupportformanyoftheprincipleschampionedbyBronfenbrenner,byrecentfederallegislation,
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andbyadvocatesforanintegratedviewofvalidityinwhichtheeffectsofadecisionmadeusingameasuremustbeconsideredwhenoneevaluatesameasuresvalidity.
Overall,aunifyingprincipleisthatdecisionmakingonbehalfofchildrenrequiresattentionnotsimplytopropertiesofthechildbuttothecontextinwhichthedecisionis
beingmadeandactedon.
Inthelasthalfofthischapter,practicalstepsinvolvedintheprocessofevaluatingmeasuresforpossibleuseindecisionmakingaredescribed.AlthoughIhave
renderedthelargercontextinwhichthisprocessmusttakeplaceinonlythegrossestdetail,Ihopethatyoucansensethesheerintricacyofthetaskathand.Onthe
onehand,confrontingtheverysignificantintellectualchallengeentailedintheselection,use,andinterpretationofappropriatemeasuresmakesmenearlyturntailand
run.Ontheotherhand,however,therewardsofsuccessfulclinicaldecisionmakingandactionwouldbelesssweetiftheywereeasilywon.
EvaluatingIndividualMeasures
Evaluatingindividualmeasuresislikesolvingamystery,wherethemysteryishowtoviewameasureforusewithaparticularclientorgroupofclients.Afterageneral
planisdevelopedintheearlystagesofthereviewprocess,cluesarecollectedandweighed.Mostcluescomefromthecliniciansknowledgeofindividualclientsand
theirneedsandfromthemanualfortheparticularmeasure.Additionalsourcesofinformation,suchastestreviewsandpertinentresearcharticles,canalsohelpinthe
process.Thischapterisarrangedsothat,followingabriefoverviewoftwomodesofreviewing,youareintroducedtothetestmanualandthentoothersourcesof
informationtohelpyoureachafinaldecisiontocrackthecase,ifwefollowthedetectiveanalogy.
ClientversusPopulationOrientedReviewsofMeasures
Ihavesaidthatthevalidityofameasuredependsonitsabilitytoansweraparticularclinicalquestionforaparticularchild.Consequently,theappropriatenessofa
measureisdeterminedwithintherealmoftheparticularsideally,withinafirmappreciationoffactorsimportanttoanindividualchild,suchascoexistinghandicapping
conditions,languagebackground,gender,andageasonereviewsthetestmanualandothersourcesofinformationforthemeasure.Suchareviewmightbesaidto
beaclientorientedreviewofthemeasure.
Clientorientedreviewofmeasuresisanidealthatisoftenunattainable.Giventhepaceofmostclinicalenvironments,cliniciansarerarelyabletorevieweachpotential
measurethoroughlyandcompareitwithcompetingmeasuresimmediatelypriortoeachmeasurementtheymake.Infact,cliniciansmorecommonlyusewhatIwould
callapopulationorientedevaluation.
Inapopulationorientedreviewofameasure,theclinicianreviewsthemeasuresdocumentationinreferencetoaparticulargrouporgroupsusuallythosesubgroups
ofchildrentheyservemostfrequently.Forexample,aspeechlanguagepathologistinaruralVermontschoolwouldpayspecialattentiontoatestslikelyvaluefora
subgroupofchil
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drenwithfewsignificantproblemsinotherareasofdevelopment,whocomefromhomesinwhichEnglishistheonlylanguagespoken,andsocioeconomicstatusis
middletolow.Incontrast,averydifferentpopulationorientedassessmentmightbeconductedbyaspeechlanguagepathologistinaBostonschooldistrictwitha
caseloadconsistingsolelyofchildrenfromFrenchspeakingHaitianfamilieslivinginpoverty.Althoughevaluatingameasureforthesetwopopulationswouldinvolve
manyofthesamequestions,eachwouldrequiredifferentanswersreflectingsensitivitytotherelevantpopulation.
Populationorientedreviewsaremostfrequentlyconductedwhenanewmeasureisconsideredforpurchase,whenameasureisexaminedatapublishersdisplayata
convention,orwhenaspeechlanguagepathologistentersanewpositionandinventoriesavailablemeasures.Incontrast,clientorientedreviewsofmeasuresoften
arisewhenanuncommonclinicalquestionemergesorwhenachildsparticularpatternofproblems(e.g.,mentalretardationandaseverehearingloss)makethechilds
needsinatestingsituationtoounlikethoseforwhichtheclinicianhasconductedapopulationorientedevaluation.
HowtoUseTestManuals
Regardlessofthetypeofreviewyouundertake,theoutcomeofyourevaluationwillneversimplybeabuydontbuyorusedontusedecision.Athoroughreview
providespotentialuserswithanappreciationofthemeasureslimitationsforanswerstospecificclinicalquestions.
Thetestmanualisthedefinitivesourceofinformationonastandardizedmeasure.Infact,manyoftherecommendationsmadeintheStandardsforPsychologicaland
EducationalTesting(APA,AERA,&NCME,1985)relatedirectlytomaterialthatshouldbeprovidedintestmanuals.Despitetheirimportance,however,test
manualsrangewidelyintheirsophisticationandvalue.Attheirbest,testmanualsprovidenotonlythebasicinformationrequiredtoevaluatethemeasures
appropriatenessforgivenuseswithspecificpopulations,butalsoinsightfultutorialinformationthatcanreinforceandextendonesunderstandingoftestconstruction
anduse.Attheirworst,testmanualsappeartobelittlemorethansalesbrochuresdesignedtoobscureatestsweaknessesandimplythatitcanbeusedforallclients
andtestingpurposes.Evenmeasuresthatarevaluableadditionstoacliniciansarsenalmayimplypossibleusesthatreallyarenotsupportable.Consequently,a
cliniciansdetectivetalentsarecalledontoferretoutthetruth!
ThereviewingguidereproducedinFig.4.2isaworksheetforevaluatingbehavioralmeasures.Itisblanksothatyoucanreadilyduplicateanduseit.Anannotated
versionoftheguide,whichappearsasFig.4.3,summarizesthemostimportantkindsofinformationorcluesyouwillbelookingforasyouconductameasure
review.Theannotatedguideisdesignedtofunctionlikethereadyreferencecardsavailableformanysoftwareapplications.
Thereviewingguideandannotatedguideareincludedtomakereviewingamoreefficientprocess,buttheirinclusionisnotwithouthazards.Thedangerofsuch
worksheetsandsummariesisthatsomeindividualsmayconsiderthemalloneneedstoknowinordertoconductacrediblereview.Thisisabigmistake!Theseguides
areafirststepthatshouldalwaysbeaccompaniedbyawillingnesseveneagernessto
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Fig.4.2.Annotatedreviewform.
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(continued)
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Fig.4.3.Reviewform.
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lookbackattrustedresourcesonmeasurement,especiallytheStandardsforEducationalandPsychologicalTesting(APA,AERA,&NCME,1985).Afterall,
evenSherlockHolmesdependedonhislearnedfriendDr.Watson!
Numerousauthorswritingaboutpsychometricissuesproposereviewproceduresthatareverysimilartothosedescribedhere(e.g.,Anastasi,1988,1997Hammer,
1992Hutchinson,1996Salvia&Ysseldyke,1998Vetter,1988b).Appendix5inSalviaandYsseldyke(1998,pp.763766),HowtoReviewaTest,isa
particularlyinformativeandamusingdescriptionofthereviewprocess.
IntheremainderofthissectionIleadyouthroughtheannotatedguide,explainingwhyitisimportanttolookforcertainkindsofinformation.Thesesectionsareless
sketchyversionsofthebriefsummariesgiveninFig.4.3.Someoftheircontentshouldsoundquitefamiliarbecauseitisbasedontheconceptsdiscussedatlengthin
chapter3.Thissectionendswithareviewguidecompletedaspartofahypotheticalclientorientedreview(Fig.4.4).
1.ReviewerThisinformationwillprobablybeunnecessaryforreviewerswhofunctionaloneintheirtestselectionandevaluation.Ontheotherhand,itcanbehelpful
incaseswheremultipletestuserssharereviewingresponsibilities,atleastforpreliminary,populationorientedreviews.Useofastandardguidefacilitatessuchsharing
byreducingdifferencesbetweenreviewersandofferinglaterreviewersapossiblestartingpointforclientorientedreviews.
2.IdentifyingInformationBesidesinformationthatcanhelpyoulocateorreplaceaninstrument,thissectionprovidespreliminarycluestothescopeandnatureof
themeasure.Testnamesvarygreatlyinjusthowmuchtheydiscloseaboutthenatureofthetest(e.g.,whetheritiscomprehensiveoraimedatonlyonemodalityorone
domainoflanguage),sotheyshouldbeapproachedwithcaution.Testingtime,whichusersmaywanttobreakdownintermsofprojectedadministrationandscoring
times,isofpracticalimportancewhenschedulingtesting.
Informationaboutbasiccharacteristicsofthemeasuresuchaswhetheritisstandardizedversusinformal,criterionreferencedversusnormreferenced,isusedto
determinethemeasuressuitabilityforcertainclinicalquestionsandguidesexpectationsforothersectionsofthereviewguide.AlthoughallmajorsectionsoftheGuide
arerelevanttoallmeasures,thekindsandamountsofinformationprovidedvarydependingonthemeasurestype.Manualsforstandardized,normreferenced
measuresprobablyprovidethegreatestamountsofinformation.Ontheotherhand,moreinformal,criterionreferencedmeasures,whichhaveoftenbeencreatedbyan
individualclinicianforaspecificpurpose,havefarlessinformationavailable.(AlthoughseeVetter,1988a,forrecommendationsaboutthekindofinformationthat
shouldbekeptforanyprocedurethatmightprofitablybeusedonrepeatedoccasions).
3.TestingPurposeHere,yousummarizeyourknowledgeoftheintendedclientorpopulation.Relevantinformationincludestheclientsage,otherproblems(e.g.,
visual,motor,orcognitiveimpairments),andimportantlanguagecharacteristics(e.g.,bilingualhome,regionalorsocialdialectuse).
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Fig.4.4.Sampleofacompletedreviewform.
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Themainclinicalquestionsleadingtothesearchforanappropriatemeasureshouldalsorecordedhere:Isthemeasuregoingtobeusedforscreening,identifyinga
problemordifference,treatmentplanning,orassessingchange?Also,whatlanguagemodalitiesandskillareasareofinterest?Asmentionedinchapter1,eachofthese
clinicalquestionsrequiresdifferentmeasurementsolutions.Therefore,thereviewershouldconductallreviewswiththeassessmentpurposevividlyinmind.Chapters9
12addressinconsiderabledetailthedemandsassociatedwithdifferentclinicalquestions.
4.TestContentThissectionreturnsthereviewersattentiontothetestmanual.Gainingaclearunderstandingofatestscontentusuallyrequiresthatyouexamineat
leasttheearlysectionsofthetestmanualandthetestformitself.Homogeneousmeasures,inwhichallitemsareaimedatasinglemodalityandlanguagedomain,are
relativelyeasytospecifyintermsoftheircontent.Forexample,theExpressiveOneWordPictureVocabularyTestRevised(Gardner,1990)fitsintothiscategoryits
contentcanbespecifiedasexpressivevocabularyorexpressivesemantics.Usually,however,measuresaddressmorethanonecontentarea,whichareindicated
throughtheuseofsubtestsorsubscores.Forthissectionofthereviewguide,aswellasforthesectionsthatfollowit,recordingpagenumbersalongwithyourfindings
isanexcellentwaytoencouragecheckingagainstthemanualduringlateruseofthecompletedguide.
Asyourecordinformationabouttestcontent,youwanttoseehowwellthecontentareascoveredbythemeasurematchthoseofinterestforyourclient.Eventhe
natureofitems(e.g.,forcedchoicevs.openendedresponses)willbeimportantinhelpingyoudeterminewhetherthebehaviorsorabilitiesofinterestwillbethelargest
contributortoyourclientsperformance.Recallthatonethreattovalidityintroducedinchapter3wasthatofenablingbehaviors,behaviorsthatenableatesttakerto
takethetestvalidly.Forexample,supposethatyouwereinterestedinassessingthereceptivelanguageskillsofachildwithcerebralpalsywhofatiguedeasilyifasked
toshoworactoutresponses.Themotoricdemandsofmeasuresbecomeenablingbehaviorsthatwillnegativelyinfluencethechildsperformanceeventhoughtheyare
independentofthetargetedconstructofreceptivelanguage.
Inadditiontoprovidingatangibleremindernottooverlookpossiblyproblematicenablingbehaviors,thissectionofthereviewformshouldalsostimulatecluegathering
aroundwhatisactuallybeingtested(Hammer,1992Sabers,1996).Recallthatasthetestdevelopermovesfromanidealformulationofthemeasuresunderlying
constructtothedownanddirtytaskofwritingsetsofitems,certainbehaviorsorskillsnecessarilytagalongtoyieldafleshedoutconstructthatmayormaynotmatch
yourown(oreventheauthors)intendedformulations.
Asanexampleofhowconstructscanbemodifiedasatesttakesshape,imagineatestdeveloperwhodecidestodeviseameasuretoassessuseofcomplexsentences
usingmethodsthatplaceaheavydemandonworkingmemorycapabilities.Forexample,thetestdevelopercouldprovidethetesttakerwithasetofsevenwords,
includingthewordbecausethataretobeusedtocreateasinglesentence.Althoughthefinalforminwhichtheconstructisrealizedmaybeacceptabletosometest
users,itmay
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notbetoothers,dependingontheirunderstandingofthetargetedconstruct.Itisprimarilythroughcarefulattentiontothisstepinthereviewprocessthatyouwill
becomeawareofcorrespondencesordisjunctionsbetweenthetestdevelopersandyourviewofwhatisbeingtested.Armedwiththisknowledge,youcanmake
aninformeddecisionastowhethertheconstructbeingmeasurediscloseenoughtoyourreasonfortestingforyoutoconsiderusingit.
5.StandardizationSample/NormsAtfirstglance,thissectionmayseemtobeprimarilyofinterestwhenyouarelookingforanormreferencedinstrument,thatis,
oneinwhichscoresareinterpretedprimarilyonthebasisofhowthetesttakersperformancecomparesinaquantitativewaywiththatofapeergroup.Infact,
however,thenatureofthestandardizationsamplehasimportantimplicationsforallmeasures.Itcandeterminetheextenttowhichsummarystatistics(inthecaseof
normreferencedmeasures)orsummarydescriptionsofbehaviors(inthecaseofcriterionreferencedmeasures)arelikelytoreflectcharacteristicsofmostchildren
ratherthanthoseofasmall,potentiallynonrepresentativegroup(e.g.,childrenofaffluent,highlyeducatedparents).Nonetheless,therearesomedifferencesinhowthe
informationprovidedinthissectionwillbeweighedonthebasisofthenatureoftheinstrument.
Whenanormreferencedmeasureisbeingevaluated,youlookforacleardescriptionofthenormativesamplethatwasused:howmanychildrenwerestudied,whether
andwhyanychildrenwereexcluded,andhowrepresentativethesampleiscomparedwiththepopulationyourclient(orsubgroupofclients)fitsinto.Ideally,atleast
50childrenwhoarewithinarelativelysmallrangeinagefromthatofyourclient(usuallynomorethan6monthsolderoryounger)willhavebeentested.Also,you
wantthesechildrentobesimilarinrace,languagebackground,andsocioeconomicstatustothechildorchildrenyouhaveinmind.
Whentherearesignificantdifferencesbetweenthenormativesampleandyourclient(s),youneedtodrawonyourknowledgeoftheappropriateresearchbaseaswell
asyourownknowledgeofculturaldifferencestodeterminetowhatextentthevalidityofthismeasureislikelytobeundermined.Ifameasuresvalidityisseriously
underminedandalternativemeasuresareunavailable,avarietyofapproaches,includingdynamicassessmentandthedevelopmentofaninformalmeasure,represent
possiblestrategies(seechap.10forfurtherdiscussionofthisissue.)
Foranormreferencedinstrument,youalsowanttoexaminethetypesofscoresthetestusestodescribethetesttakersperformance.Intermsofdesirability,standard
scoresrankfirst,percentilescoresarenext,anddevelopmentalscores(suchasageequivalentorgradeequivalentscores)earnasorrylastplace.Inthissectionofthe
reviewform,youmayalsowanttorecordtheavailabilityoftablesthatrecordthestandarderrorofmeasurement(whichwillbediscussedatgreaterlengthbelowunder
reliability).Recordingthatinformationhereisagoodideabecauseitindicatestheamountoferrorassociatedwithatesttakersstandardscore.
Whenacriterionreferencedmeasureisevaluated,thecompositionofgroupsusedtodeterminecutoffscoreswillbethefocusofyourscrutinyatthispointinthe
reviewform.Iamnotawareofrecommendationsconcerningsamplesizeandcompositionthatareasspecificasthosegivenabovefornormreferencedmeasures.
However,you
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wanttobesurethatthegroupforwhomthecutoffscoresareprovidedaresimilartoyourclientorclientsandthatthegroupislargeenoughsothatthecutoffislikely
tobestable(McCauley,1996).
6.ReliabilityInthissection,youwillsummarizerelevantinformationaboutthetestsreliability,whichisalmostalwayscontainedinaseparate,clearlymarkedsection
ofthetestmanual.Theoperativewordhereisrelevant.Themanualmayreport6,10,even20studiesinwhichthereliabilityofthemeasurewasexamined.
Nonetheless,therelevantonesarethose(a)usingparticipantswhoareassimilaraspossibletoyourclient(s)and(b)focusingonthetypeofreliabilitythatiseithermost
atriskbecauseofthenatureoftheinstrumentormostimportanttoyourclinicalquestion.Recallthatchapter3discussesthedifferentkindsofreliabilitydatathatare
typicallyofinterest.
Onceyouhavedecidedwhatformsofreliabilityareofgreatestimportance,howdoyouknowwhethertheevidenceisadequate?Fornormreferencedtests,the
evidencewillalmostalwaystaketheformofreliabilitycoefficients.Traditionally,ithasbeensuggestedthatonedemandcorrelationcoefficientsthatarestatistically
significantandatleast.80inmagnitudeforscreeningpurposesandatleast.90whenmakingmoreimportantdecisionsaboutindividuals(Salvia&Ysseldyke,1998).
However,amorecircumspectrecommendationmightbethatyouwantthebestreliabilityavailableonthemarket.BythisImeanthatwhentheidealof.90isnot
available,andadecisionmustbemade,youwillwantthebestthatyoucanfindaswellasmultiple,independentsourcesofinformation.
Forcriterionreferencedmeasures,evidenceforreliabilitycantakeagreatmanyformsfromcorrelationcoefficientstoagreementindices(Feldt&Brennan,1989).
Suchevidenceforcriterionreferencedmeasuresusuallyaddressesthequestionofhowconsistentlythecutoffcanbeusedtoreachaparticulardecision.Asyouwould
dofornormreferencedmeasures,focusontheresultsofthosestudiesthatinvolveresearchquestionsmostlikeyourclinicalquestionandparticipantsmostlikeyour
client(s).Informationabouttherelationshipbetweentypesofreliabilityandclinicalquestionsisdiscussedinchapters9to11.
7.ValidityAlthoughtheentirereviewformisaimedatyourcrackingthecaseofameasuresvalidityforaparticularuse,inthissectionofthereviewform,youwill
summarizethemostimportantoftheinformationprovidedbythetestdeveloperforthepurposeofevaluatingvalidity.Althoughmostoftheinformationofinterestwill
probablybefoundinclearlylabeledsectionsofthemanual,informationrelevanttoconsiderationsofcontentandconstructvalidityisalsofrequentlyfoundinsections
dealingwiththemeasuresinitialdevelopmentandsubsequentrevisions(ifany).Recallthatsomeofthespecificmethodsusedtoprovideevidenceofvalidity(e.g.,
developmentalstudies,contrastinggroupstudies)arediscussedatsomelengthinthepreviouschapter.
Thestatisticalmethodsthatareusedtodocumentvalidityvaryfromcorrelationcoefficientstoanalysesofvariancetofactoranalysis.Consequently,adiscussionof
whatconstitutesacceptabledatamustremainfairlygeneralhere.Overall,onelooks
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toseethatthemeasureisshowntofunctionasitispredictedtofunctionifvalid.Aswithreliabilityevidence,thenatureoftheparticipantsinthestudywillaffectthe
extenttowhichitisrelevantforyourclientandpurposes.Asyoucompletethissectionofthereviewform,everyskepticalboneinyourbodyshouldberecruitedfor
service.Claimingvaliditydoesntmakeameasurevalid,althoughattimestestdevelopersseemtoforgetthis.
8.OverallImpressionsofValidityforTestingPurposeandPopulationAtthispointinthereviewguide,youputthecluestogethertosumupthecase.Your
studyoftheprosandconsshouldbesummarized,withholesintheevidencenotedanddiscussedintermsoftheirimplicationsforinterpretingresults.Thisiswhereyou
determinewhetheryoubelievetheinstrumentcanbesafelyusedand,ifused,whatcautionsshouldbekeptinmindwhenitisadministeredandinterpreted.Clearly,this
isthemostdemandingpointinthereviewprocessakintoafinalexamortheconcludingparagraphofalargepaper.Althoughpracticeisperhapsthebestwayof
honingtherequisiteanalyticskills,examinationofotherreviewsoftheinstrument(whentheyreavailable)canhelpyoumakesureyouhavenotoverlookedanymajor
cluesandcanalsohelpyouseehowothershaveapproachedthetask.Evenexaminingreviewsonothermeasurescanprovehelpfulforgettingasenseofhow
seasoneddetectivessumuptheircases.(e.g.,SeereviewsinConoley&Impara,1995,oftheReceptiveExpressiveEmergentLanguageTest2[Bzoch&
League,1994],writtenbyBachman[1995]andBliss[1995]andoftheTestofEarlyReadingAbilityDeaforHardofHearing[Reid,Hresko,Hammill,&
Wiltshire,1991],writtenbyRothlisberg[1995]andToubanos[1995]).
Becauseexamplescanprovesohelpfulindevelopingonesunderstandingofanewprocess,IincludedFig.4.3,whichillustrateshowIwouldcompletethereviewing
guidefortheExpressiveVocabularyTest(Williams,1997)asIconsideritsvalidityforusewithahypotheticalchild,Melissa.Melissaisa9year,2montholdgirl
whohaspreviouslybeenreceivingtreatmentforaspecificlanguageimpairment.Sheisbeingtestedaspartofaperiodicreevaluation,whichwillbeusedbyan
educationalteamtodeterminewhethershewillcontinuetoreceiveservicesinherschool.Melissasunilateralhearinglossandproblemswithattentionwillrequire
specialattentionduringthereviewoftheExpressiveVocabularyTest(Williams,1997)forpossibleuse.
HowtoAccessOtherSourcesofInformation
Inadditiontotestmanuals,independenttestreviewsareavailabletohelpinthetestreviewprocessinthreedifferentforms:reviewsappearinginstandardreference
volumesonbehavioralmeasures,journalarticlesreviewingoneormoretestsinaparticulararea,andcomputerdatabasesoftestreviews.
Standardreferencesandjournalarticlesthatincludereviewsoftestsusedfrequentlyintheassessmentofchildrenwithdevelopmentallanguagedisordersorthat
providespecificinformationrelevanttoanunderstandingofindividualtestsarelistedinTable4.3.
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Table4.3
BooksandJournalArticlesProvidingInformationAboutSpecificTestsUsedWithChildren
Books
AmericanSpeechLanguageHearingAssociation.(1995).Directoryofspeechlanguagepathologyassessmentinstruments.Rockville,MD:Author.
Compton,C.(1996).Aguideto100testsforspecialeducation.UpperSaddleRiver,NJ:GlobeFearonEducational.
Impara,J.C.,&Plake,B.S.(Eds.).(1998).Thirteenthmentalmeasurementsyearbook.Lincoln,NE:BurosInstituteofMentalMeasurements.
Keyser,D.J.,&Sweetland,R.C.(1994).(Eds.).Testcritiques(Vol.X).Austin,TX:ProEd.
Murphy,L.L.,Conoley,J.C.,&Impara,J.C.(Eds.).(1994).TestsinprintIV:Anindextotests,testreviews,andtheliteratureonspecifictests.Lincoln,
NE:BurosInstituteofMentalMeasurements.
JournalArticles
Huang,R.,Hopkins,J.,&Nippold,M.A.(1997).Satisfactionwithstandardizedlanguagetesting:Asurveyofspeechlanguagepathologists.Language,Speech,
andHearingServicesinSchools,28,1223.
McCauley,R.J.,&Swisher,L.(1984).Psychometricreviewoflanguageandarticulationtestsforpreschoolchildren.JournalofSpeechandHearingDisorders,
49,342.
Merrell,A.W.,&Plante,E.(1997).Normreferencedtestinterpretationinthediagnosticprocess.Language,Speech,HearingServicesinSchools,28,5058.
Plante,E.,&Vance,R.(1994).Selectionofpreschoollanguagetests:Adatabasedapproach.AmericanJournalofSpeechLanguagePathology,4,7076.
Plante,E.,&Vance,R.(1995).Diagnosticaccuracyoftwotestsofpreschoollanguage.AmericanJournalofSpeechLanguagePathology,4,7076.
Stephens,M.I.,&Montgomery,A.A.(1985).Acriticalreviewofrecentrelevantstandardizedtests.TopicsinLanguageDisorders,5(3),2145.
Sturner,R.A.,Layton,T.L.,Evans,A.W.,Heller,J.H.,Funk,S.G.,&Machon,M.W.(1994).Preschoolspeechandlanguagescreening:Areviewofcurrently
availabletests.AmericanJournalofSpeechLanguagePathology,3,2536.
EachnewvolumeintheMentalmeasurementsyearbookseriescontainsreviewsofcommerciallyavailabletestsandteststhathavejustbeenpublishedorwere
revisedsincetheirreviewinaprecedingvolume.Entriesarealphabeticallyorganizedbythenameofthetest,withtworeviewspreparedindependentlybyindividuals
withexpertiseintesting,inthecontentareatested,orboth.Anewvolumeofthisseriesappearsabouteverythreeyears.Inaddition,reviewspublishedsince1989are
availableontheInternettoallowforonlinesearchesthatcanhelpconsumersfindreviewsaswellasspecifickindsofmeasuresbecauseofsearchingcapabilities.
SeveralrecentjournalarticlesreviewingtestsinaparticularcontentareaorforaparticulargroupofchildrenwithlanguageimpairmentsarealsolistedinTable4.3.
Computerdatabasesrepresentamorerecentpossiblesourceofinformationonstandardizedmeasures.ReviewsfromtheMentalmeasurementsyearbookseriesare
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availableonlinethroughcolleges,universities,andpubliclibraries.Reviewsincludedinthisonlinedatabaseareidenticalincontenttothoseincludedinthebound
volumesoftheMentalmeasurementsyearbook.Further,thesereviewsaremoretimelythanthoseappearingintheprintedvolumesbecausereviewsthatwill
eventuallybeincorporatedinalaterboundvolumeareaddedeverymonth.
TheHealthandPsychosocialInstruments(HaPI)databaseisalsoavailableatmanylibrariesandcanbesearchedonline.Itallowsonetosearchforinformationabout
aspecifictest,tofindthepublishinginformationaboutatestthroughitsname,acronym,orauthorship,andtosearchforinstrumentsfocusingbycontentoragegroup.
TheHaPIpublishesabstractsanddoesnotcontaincompletereviewsofinstruments.However,itdoesindicatewhetherinformationisreportedforsevencritical
characteristics:internalconsistencyreliability,testretestreliability,parallelformsreliability,interraterreliability,contentvalidity,constructvalidity,andcriterionrelated
validity.
Summary
1.Effectiveevaluationofmeasuresofchildrenscommunicationandrelatedskillsmustbeconductedwithappreciationforthecontextualvariablesaffectingboth
childrenandclinicians.
2.ThebioecologicaltheoryofBronfenbrennerandhiscolleaguesemphasizestheinterplayofthechildscharacteristicswiththoseofhisorherenvironment,beginning
withthefamilyandextendingtothebroaderphysical,social,andhistoricalenvironmentaswell.Therelevanceofthistheorytotheevaluationofmeasuresand
measurementstrategiesforchildrenliesintheconnectionbetweenvalidityandattentiontothesecontextualvariables.
3.Amongthecontextualvariablesaffectingcliniciansastheyinteractwithchildrenandevaluatetheirlanguagearenotonlypersonalvariables(e.g.,theirownlanguage
andculture),butalsolegalvariablesandothervariablesaffectingtheirprofessionalpractice.
4.Evaluationofindividualmeasuresrequiresthepotentialtestusertogathercluessuggestingthestrengthsandweaknessesofthemeasureforansweringaparticular
clinicalquestionforaparticularclient.Clientorientedreviewsareconductedtorefineinformationobtainedfromapopulationorientedrevieworinresponsetothe
exceptionalneedsofaparticularclient.
5.Testmanualsorothermaterialsprovidedbythedeveloperofameasureserveastheprimarysourceofinformationtobeconsideredinevaluatingitsusefulnessfora
givenclient.
6.Thetestreviewerneedstoapproachthereviewprocessarmedwithaskepticalattitudetowardunprovenclaimsandanarsenalofinformationregardingacceptable
psychometricstandards.
7.TheStandardsforeducationalandpsychologicaltesting(AERA,APA,&NCME,1985)isthemostwidelyacceptedsourceforsuchinformationonstandards.
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8.Additionalinformationforuseinthereviewingprocessisavailableintheformofreviewspublishedinstandardreferencebooks,relevantjournalarticles,and
computerdatabases.
9.Inspiteofexistingidealsforevidenceofreliabilityandvalidity,theclinicianmaynonethelessdecidetouseaparticularmeasureevenwhenitdoesnotreachanideal,
whenitisthebestavailableforaparticularclient,andaclinicaldecisionmustbemade.
KeyConceptsandTerms
clientorientedmeasurereview:evaluationofameasuresappropriatenessforuseinansweringaspecificclinicalquestionforasingleclient.
IndividualswithDisabilitiesEducationAct(IDEA):federallegislationaddressingtheeducationneedsofindividualswithdisabilities,includingchildrenwith
communicationdisorders.
InternationalClassificationofImpairments,Disabilities,andHandicaps(ICIDH):aclassificationdesignedbytheWHOforglobalusebyhealthprofessionals,
educators,legislators,andothergroupsconcernedwithhealthrelatedissuestoserveasacommonlanguage.
Mentalmeasurementyearbooks:awellregardedsourceoftestreviews.
nondiscriminatoryassessment:theuseofmeasuresandproceduresforadministeringandinterpretingdatathatwillnotconfoundachildslanguageordialect
backgroundwiththetargetoftesting.
populationorientedmeasurereview:apreliminaryevaluationofameasureslikelyappropriatenessforuseinansweringoneormoreclinicalquestionsfora
populationofclientswhoshareimportantsimilarcharacteristics.Populationorientedreviewsofmeasuresareoftenconductedforsubgroupsofclientswhoare
frequentlyseenbyagivenclinician.
StudyQuestionsandQuestionstoExpandYourThinking
1.Consideryourownsocialecology.Thinkaboutaspecifickindofdecisionyouhavemadeorwillmake(e.g.,concerningschooloremployment).Whatinstitutions
andpeopleaffectyourdecision?
2.Talktotheparentofayoungchildaboutthecontextsinwhichthatchildfunctionsdaycare,timespentwithextendedfamily,andsoforth.Determinehowmany
hoursthechildspendsineachsettingandwhothemaininteractionpartnersforthechildare.Howmightthesesettingsinfluencethecommunicationexperiencesofthis
child?
3.Listfivedomainsoflanguage.
4.Doestimetakentoconductatesthaveanyobviouspotentialrelationshiptothevalidityoftesting?Ifso,whenorforwhatgroupsofchildren?
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5.Discusstheimportanceofconductingaclientorientedreviewratherthansimplyapopulationorientedreviewofameasureyouwillusewithaspecificclient.
6.GotothelibraryandexamineseveralvolumesoftheMentalmeasurementsyearbookseries.Describetheprocessbywhichtestsareselectedtobereviewed,and
examinetworeviewsforasinglespeechlanguagemeasure.
7.Chooseatestthatyouhaveheardreferredtoinacourseyouhavetaken.SeeifyoucanfindareviewforitintheMentalmeasurementsyearbookseriesor
elsewhere.Also,considertheextenttowhichtheinteractionimplicitinthetestingproceduresmatchesthekindsofexperiencesachildmighthaveonaneverydaybasis.
8.Completeareviewformforanormreferencedspeechlanguagetest.
9.Completeareviewformforacriterionreferencedspeechlanguagemeasure.
RecommendedReadings
Hutchinson,T.A.(1996).Whattolookforinthetechnicalmanual:Twentyquestionsforusers.Language,Speech,HearingServicesinSchools,27,109121.
Sabers,D.L.(1996).Bytheirtestswewillknowthem.Language,Speech,HearingServicesinSchools,27,102108.
Salvia,J.,&Ysseldyke,J.(1998).Appendix5.InJ.Salvia&J.Ysseldyke(Eds.),Assessment(5thed.,pp.763766).Boston:HoughtonMifflin.
References
AmericanPsychologicalAssociation,AmericanEducationalResearchAssociation,NationalCouncilonMeasurementinEducation.(1985).Standardsfor
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AmericanSpeechLanguageHearingAssociation.(1999).Guidelinesforrolesandresponsibilitiesoftheschoolbasedspeechlanguagepathologist[Online].
Available:http:/www.asha.org/professionals/library/slpschool_i.htm#purpose.
Anastasi,A.(1988).Psychologicaltesting(6thed.).NewYork:Macmillan.
Anastasi,A.(1997).Psychologicaltesting(7thed.).UpperSaddleRiver,NJ:PrenticeHall.
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measurementsyearbook.(pp.843845).Lincoln,NE:BurosInstituteofMentalMeasurements.
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measurementsyearbook(p.846).Lincoln,NE:BurosInstituteofMentalMeasurements.
Bronfenbrenner,U.(1974).Developmentalresearch,publicpolicy,andtheecologyofchildhood.ChildDevelopment,45,15.
Bronfenbrenner,U.(1986).Recentadvancesinresearchontheecologyofhumandevelopment.InR.K.Silbereisen,E.Eyferth,&G.Rudinger(Eds.),Development
asactionincontext:Problembehaviorandnormalyouthdevelopment(pp.286309).NewYork:SpringerVerlag.
Bronfenbrenner,U.,&Morris,P.(1998).Theecologyofdevelopmentalprocesses.InW.Damon&R.M.Lerner(Eds.),Handbookofchildpsychology:
Theoreticalmodelsofhumandevelopment(5thed.,Vol.1,pp.9931028).NewYork:Wiley.
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PART
II
ANOVERVIEWOFCHILDHOODLANGUAGEDISORDERS
PartIIintroducesthefourmostfrequentlyoccurringcategoriesofchildhoodlanguagedisorders:specificlanguageimpairment(chap.5)andlanguageproblems
associatedwithmentalretardation(chap.6),autismspectrumdisorders(chap.7),andhearingimpairment(chap.8).Eachchapterisdesignedtoprovideanoverview
ofthenatureandspecialtestingproblemsassociatedwithonecategory.
Withineachchapter,disordercategoriesaredefined,wherepossible,accordingtocriteriaoutlinestheDiagnosticandstatisticalmanualofmentaldisorders(4th
ed.DSMIV)oftheAmericanPsychiatricAssociation(1994)andinsomechaptersaccordingtootherinfluentialdefinitions.Eachdisordercategoryisthenfurther
introducedintermsofitssuspectedcauses,thespecialchallengestolanguageassessmentaffordedbychildrenwiththespecificproblem,theirexpectedpatternsof
languageperformance,andaccompanyingproblemsthatmayfurthercomplicatethesechildrenslivesandcommunicationfunctioning.Eachchapteralsocontainsa
shortpassagewrittenfromtheperspectiveofsomeonediagnosedwiththeconditionaddressedinthechapter.
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CHAPTER
5
ChildrenwithSpecificLanguageImpairment
DefiningtheProblem
SuspectedCauses
SpecialChallengesinAssessment
ExpectedPatternsofLanguagePerformance
RelatedProblems
DefiningtheProblem
Sandyisacompact6yearoldwhowaslateintalkingandconsideredunintelligiblebyallbutafewfamilymembersuntilaboutage5.Sheisstilloften
mistakenforayoungerchildbecauseofhersize,limitedvocabulary,andfrequenterrorsingrammar.Havingrecentlytransferredtoanewschool,Sandyis
havingtroubleadjustingandhasbecomeveryquietexceptforoccasionalinteractionswithfriendsfromherpreviousschool.
Joshua,a9yearoldwithahistoryofdelayedspeechandlanguage,continuestouseshort,simplesentencesthatareoftenineffectiveingettinghismessage
across.Despitesignificantgainsinhisoralcommunication,hehasmadelittleprogressinearlyreadingskills.Thus,despitetwoyearsofinstructionand
specialsupportinbothoralandwrittenlanguage,henameslettersofthealphabetinconsistentlyandhasa
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sightvocabularylimitedtoabout30words.Joshuaalsoappearstohavedifficultyunderstandingmanyoftheinstructionsgivenintheclassroom.
Wilsonisa4yearoldwhirlwindwhoaugmentshislimitedspeechproductionswithanimatedgesturesand,sometimes,trulygifteddoodles.Becauseofhis
activitylevelandawkward,sometimesoverwhelmingstyleofinteracting,heisavoidedbyhispeersandhasformedfierceattachmentstothepreschool
teacherandhisspeechlanguagepathologist.Wilsonsparentsandeducatorsarebeginningtoquestionwhetherhisactivitylevelfallswithinthenormal
rangeandwillbediscussingthepossibilityofhavinghimevaluatedforattentiondeficitdisorderwithhyperactivityattheirnextmeeting.Wilsonsabilityto
understandthecommunicationsofothershasneverbeenquestioned.
AlthoughSandy,Joshua,andWilsonarevariedintheirpatternsofcommunicationdifficulties,eachcanbedescribedasdemonstratingspecificlanguageimpairment
(SLI),adisorderestimatedtoaffectbetween1.5and7%ofchildren(Leonard,1998).Arecentlyproposedfigureof7%for5yearoldsmaybethebestcurrent
estimateofprevalence:Theresearchonwhichitwasbasedwasrigorousandincludedtheuseofacarefullyselectedsampleof7,218children(Tomblinetal.,1997).
Althoughestimatesdifferconsiderablyfromstudytostudy,ithasgenerallybeenfoundthatboysareaffectedmoreoftenthangirls,withsomestudiessuggestingthat
boysareattwicetheriskofgirls(Tomblin,1996b).
SLIcanbedefinedasdelayedacquisitionoflanguageskills,occurringinconjunctionwithnormalfunctioninginintellectual,socialemotional,andauditory
domains(Watkins,1994,p.1).Thus,SLIisfrequentlydescribedasadisorderofexclusion.Assuch,itcanseemlikeadefinitionofleftovers,encompassingthose
instanceswherelanguageimpairmentexistsbutcannotreadilybeattributedtofactorsthatclearlylimitachildsaccesstoinformationaboutlanguageortotheabilities
requiredtoundertakethecreativetaskoflanguageacquisition.Ontheotherhand,specificlanguageimpairmentcanberegardedasapureformofdevelopmental
languagedisorder,oneinwhichlanguagealoneisaffected(Bishop,1992b).
Hopesofdefiningthenatureofspecificlanguageimpairmenthaveinstigatedawealthofresearchinchildlanguagedisordersoverthepast50years.Initiallytermed
congenitalaphasiaordevelopmentaldysphasia,SLIseemedtooffertheopportunitytolookatapure,orspecific,varietyofcommunicationdisorder(Rapin,
1996Rapin&Allen,1983).Historically,eachofthecategoriesofdevelopmentallanguagedisordersexaminedinotherchaptersinthissectionofferedostensibly
obviousexplanationsfortheirexistence.Incontrast,childrenwithSLIofferednoapparentexplanationsyetpromisedanopportunitytolookattheuniqueeffectsof
impairedlanguageondevelopment.Orsoitfirstappeared.IntheRelatedProblemssectionofthischapter,youwillreadaboutthesubtledifferencesincognitionand
otherattributesthathavebeenidentifiedinchildrenwithSLIandthatthusthreatennarrowconceptionsofspecificimpairment.
TheDSMIV(AmericanPsychiatricAssociation,1994)doesnotusethetermspecificlanguageimpairment,butincludestwodisordersthattogethercovermuchof
thesameterrain:ExpressiveLanguageDisorderandMixedExpressiveReceptiveLanguageDisorder.Table5.1liststhediagnosticcriteriaforthesetwo
communication
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Table5.1
SummaryofCriteriaforTwoDisordersCorrespondingtoSpecificLanguageImpairmentFromtheDiagnosticandStatisticalManual(4thed.)oftheAmerican
PsychiatricAssociation(1994)
ExpressiveLanguageDisorder(AmericanPsychiatricAssociation,1994,p.58)
Thescoresobtainedfromstandardized,individuallyadministeredmeasuresofexpressivelanguagedevelopmentaresubstantiallybelowthoseobtainedfrom
standardizedmeasuresofbothnonverbalintellectualcapacityandreceptivelanguagedevelopment.Thedisturbancemaybemanifestclinicallybysymptomsthat
A.
includehavingamarkedlylimitedvocabulary,makingerrorsintense,orhavingdifficultyrecallingwordsorproducingsentenceswithdevelopmentally
appropriatelengthorcomplexity.
B. Thedifficultieswithexpressivelanguageinterferewithacademicoroccupationalachievementorwithsocialcommunication.
C. CriteriaarenotmetforMixedReceptiveExpressiveLanguageDisorderorPervasiveDevelopmentalDisorder.
IfMentalRetardation,aspeechmotororsensorydeficit,orenvironmentaldeprivationispresent,thelanguagedifficultiesareinexcessofthoseusually
D.
associatedwiththeseproblems.
MixedReceptiveExpressiveLanguageDisorder(AmericanPsychiatricAssociation,1994,pp.6061).
Thescoresobtainedfromabatteryofstandardizedindividuallyadministeredmeasuresofbothreceptiveandexpressivelanguagedevelopmentaresubstantially
A. belowthoseobtainedfromstandardizedmeasuresofnonverbalintellectualcapacity.SymptomsincludethoseforExpressiveLanguageDisorderaswellas
difficultyunderstandingwords,sentences,orspecifictypesofwords,suchasspatialterms.
B. Thedifficultieswithreceptiveandexpressivelanguagesignificantlyinterferewithacademicoroccupationalachievementorwithsocialcommunication.
C. CriteriaarenotmetforPervasiveDevelopmentalDisorder.
IfMentalRetardation,aspeechmotororsensorydeficit,orenvironmentaldeprivationispresent,thelanguagedifficultiesareinexcessofthoseusually
D.
associatedwiththeseproblems.
disorders.ThedivisionofSLIintothesetwocategoriesreflectsarecurringimpulseamongresearchersandclinicianstoidentifysubgroupswithinthelarger
populationinthiscaseandmostoftenaccordingtowhetherreceptivelanguageissignificantlyaffected.
TheDSMIVcriteriaincludeavariationontheexclusionaryelementsoftheSLIdefinitiondescribeduptothispoint.Specifically,inCriterionDforbothdisorders,the
clinicianisdirectedtolookforlanguageimpairmentswhoseseverityisunexplainedbytheobviousthreatstolanguagedevelopmentincludedinotherexclusionary
definitions(e.g.,thepresenceofhearingimpairmentormentalretardation).TheDSMIVdefinitionsallowbothfortheidentificationofalanguageimpairmentwhenno
obviousthreatsexistsaswellasforcaseswherethepresenceofthesethreatsdoesnotseemsufficienttoaccountforthedegreeofproblempresented.
MostresearchersoverthepastthreedecadeshaveuseddefinitionslargelylikethosediscussedandhaveparticularlyreliedontheoperationalizationofSLIproposed
byStarkandTallal(1981,1988).Thedetailsofsuchdefinitions,however,haveprovenquitecontroversial(Camarata&Swisher,1990Johnston,1992,1993
Kamhi,
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1993Plante,1998).Movingfromthelaboratorytoclinicalpracticeinschools,thecontroversyisintensifiedbecausestatepoliciesarevigorousparticipantsinthe
decisionmakingprocess.Inparticular,theuseofdifferenceordiscrepancyscoresisoftenmandatedbuthasfacedincreasingcriticism(e.g.,Aram,Morris,&Hall,
1993Fey,Long,&Cleave,1994Kamhi,1998).AlthoughmethodsusedinidentificationofSLIarediscussedatsomelengthintheSpecialChallengesin
Assessmentsectionofthischapter,theyarementionedherebecausetheyaffectunderstandingofthenatureoftheproblemandthereforeaffectresearchintendedto
obtaininformationaboutsuspectedcauses,patternsoflanguageperformance,andrelatedproblems.
ItseemsimportanttorecognizethatSLIisatermthatisoftenabsentfromthedaytodayfunctioningofspeechlanguagepathologistsinmanyclinicalandeducation
settings.Instead,theyfrequentlyusethetermslanguagedelaysorlanguageimpairments,therebyremainingsilentonthespecificityofagivenchildsproblems
(Kamhi,1998).Nonetheless,thefoundationofresearchonthispopulationandclinicalwritingsprovidesanimportantcontextforscientificallyorientedclinicalpractice.
Inthesamewaythatfieldgeologistsneedtoknowaboutbasicchemistrydespitefewencountersinthewildwithpureironorotherelements,speechlanguage
pathologistscanlearnfromattemptstoidentifyandunderstandSLIsandtorecognizethemwhentheyencounterthemintheirpractice.Theverylengthofthischapter
comparedwiththeothersaddressinginformationaboutsubgroupsofchildrenwithlanguagedisorderstestifiestothefertilityoftheresultingexplorations.
SuspectedCauses
Thequestionofwhatcausesisolatedlanguageimpairmenthasbeenapproachedfromseveralperspectivesfromgenetictolinguistic,physiologicaltosocial.Itremains
aquestionor,moreaccurately,aseriesofrelatedquestionsthattantalizesresearchers,clinicians,andparentsalike.Itisbestviewedasasetofrelatedquestions
becauseonecanconceiveofcausesonseveraldifferentlevels(e.g.,physicalaswellassocial).Inaddition,itcanbeviewedthatwaybecauseeffectsarefrequentlythe
resultofaconvergenceofcausesratherthanasinglecause.Thustwoormorefactorsmayneedtocomeintoplaybeforeimpairedlanguageoccurs.Understanding
causationisfurthercloudedbythefactthatresearchersarefrequentlyonlyinthepositionofidentifyingriskfactorsthatis,factorsthattendtocooccurwiththe
presenceofSLI,butthatcanonlybethoughtofaspotentialcausesuntilthenatureoftheassociationcanbeworkedoutthroughfurtherresearch.
Inthissection,areviewofsuspectedcausesencompassesnotonlydifferencesinbrainstructureandfunction,genetics,andselectedenvironmentalfactors,butalso
moreabstractlinguisticandcognitivediscussionsoftheoriginsofspecificlanguagedisorderinchildren.Althoughthereisconsiderableturmoilinthecommunityofchild
languageresearchersconcerningthemoreabstractaccountsprovidedinlinguisticandcognitiveexplanations,theirroleinassessmentandplanningfortreatmenthasthe
potentialforbeingmoreimmediateandinfluentialthanthatofaccountsrelatedtogeneticsandphysiology.
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Genetics
GeneticoriginsforSLIhaveprobablybeensuspectedforsomeyearsbyanyonewhohasencounteredfamiliesinwhichlanguageproblemsseemmorecommonplace
thanonemightexpectgiventherelativeexceptionalityoflanguageimpairment.Nonetheless,seriousstudyofgeneticcontributionstoSLIhavebeenundertakenonlyin
thelastcoupleofdecades(Leonard,1998Pembrey,1992Rice,1996).Largely,theincreaseinsuchstudieshasoccurredbecauseofadvancesinthestudyof
behavioralgenetics(Rice,1996).Inaddition,however,thedelayedinterestinthegeneticsoflanguageimpairmenthasresultedfromtheneedforagreementona
phenotype,thatis,thebehaviororsetofbehaviorsthatconstitutecriticalcharacteristicsofthedisorder(Gilger,1995Rice,1996).
Severaldifferenttypesofgeneticstudiesareregularlyusedtolinkspecificdiseasesorbehavioraldifferenceswithgeneticunderpinnings(Brzustowiz,1996).Among
thosethathavebeenusedtothegreatestextentsofarinstudyingSLIarefamilystudies,twinstudies,andpedigreestudies.Infamilystudies,thefamilymembersofa
proband(i.e.,anaffectedpersonwhoisthefocusofstudy)areexaminedtodeterminewhethertheyshowevidenceofthecharacteristicordisorderunderstudyat
ratesthatarehigherthanwouldbeexpectedinthegeneralpopulation.Iftheydo,thecharacteristicordisorderisconsideredfamilialastateofaffairsthatcouldbe
duetogeneticoriginsortocommonexposuretootherinfluences.Thus,forexample,afondnessforchocolatemightbefoundtobefamilial,but,withoutfurtherstudy,
couldjustaseasilybeduetolongexposuretoakitchenfullofchocolatedelicaciesastoageneticbasis.
Intwinstudies,comparisonsofthefrequencyofacharacteristicordisorderaremadebetweenidenticalandfraternaltwins.Becauseidenticaltwinssharethesame
geneticmakeup,theyshouldshowhigherconcordanceforthecharacteristicifithasageneticbasisthatis,thereshouldbeastrongtendencyforbothidenticaltwins
toeitherhaveornothavethecharacteristic.Incontrast,iftheirratesofconcordancearerelativelyhigh,butsimilartothoseofthefraternaltwins(whoarenomore
geneticallyrelatedthananypairofsiblingsandthusonaverageshare50%oftheirgeneticmakeup),thecharacteristicmightstillbeconsideredfamilial.However,in
thatcase,itwouldbemorelikelytheresultofenvironmentalratherthangeneticinfluences.(SeeTomblin,1996b,foradiscussionofsomeofthecomplexitiesofthis
typeofdesign.)
Inpedigreestudies,asmanymembersas,possibleofasingleprobandslarge,multigenerationalfamilyareexaminedinordertogetinsightintopatternsofinheritance
associatedwiththetargetedcharacteristicordisorder.Closelyrelatedtopedigreestudiesaresegregationstudiesinwhichmultiplefamilieswithaffectedmembersare
examinedtocompareobservedpatternsofinheritancewithpatternsthathavebeenobservedforothergeneticallytransmitteddiseases.
DespitethedifficultiesassociatedwithdefiningadisorderascomplexasSLI(Brzustowicz,1996),considerableprogresshasbeenmadeoverthepast15yearsin
understandinggeneticcontributionstothedisorder.Familialstudies(e.g.,Neils&Aram,1986Tallal,Ross,&Curtiss,1989Tomblin,1989)haveconsistently
demonstratedhigherriskamongfamiliesselectedbecauseofanindividualmemberwithSLIthanfamiliesselectedbecauseofanunaffectedmemberwhoisservingasa
control
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participant.Complicatingthesefindings,however,havebeenobservationsthatmanychildrenwithSLIcomefromfamilieswheretheyaretheonlyaffectedmember
(Tomblin&Buckwalter,1994).Further,familyhistoriesofSLImaybemorecommonamongchildrenwithexpressiveproblemsonlythanamongthosewithboth
receptiveandexpressiveproblems(Lahey&Edwards,1995).
Whereassomefamilialstudies(e.g.,Neils&Aram,1986Tallaletal.,1989Tomblin,1989)haveusedquestionnairestoexaminethelanguageskillsofotheroften
olderfamilymembers,othershaveuseddirectassessmentoflanguageskills(e.g.,Plante,Shenkman,&Clark,1996Tomblin&Buckwalter,1994).Thelatterstudies
areconsideredmoredesirable(Leonard,1998)becausetheyrelyneitheronparticipantsmemoriesofchildhooddifficultiesnoronpotentiallyincompleteand
inaccurateschoolorclinicalrecords.Further,theyseemtobemoresensitivetomanifestationsofSLIinadults,therebycapturingagreaternumberofaffected
individualsforexaminationofinheritancepatterns(Planteetal.,1996).Mostimportantly,however,bothtypesofstudiescandemonstratefamilialpatternsofSLI,
whicharethefirststeptowardprovingitsgeneticunderpinningsforinleastsomeaffectedindividuals.
Twinstudies(e.g.,Bishop,1992aTomblin,1996b)havedemonstratedhigherconcordanceforSLIamongidenticalthanfraternaltwins,thusprovidingevidenceof
somedegreeofgeneticinfluence.However,evenamongidenticaltwins,concordanceisnotperfect,despitetheiridenticalgeneticmakeup.Consequentlyithasbeen
suggestedthateithertheaffectedgeneassociatedwithSLIdoesnotalwaysproducethesameoutcome(duetoincompletepenetrance)oritdoesnotoperatealoneto
produceSLI(Tomblin&Buckwalter,1994Leonard,1998).Intheformercase,incompletepenetrancereferstocasesinwhichageneassociatedwithadisorder
failstoactinanallornothingfashion,withsomepeoplewhocarryageneshowingnoilleffects(Gilger,1995).ThelatterprospectmeansthatSLImaybecausedby
morethanonegeneorthatageneorgroupofgenesmustoperateincombinationwithenvironmentalfactors.
CurrentresearchonthegeneticsofSLIisweighingthesealternativescenarios.Amongthekindsofstudiesneededarepedigreeandsegregationstudiesinwhich
groupsoffamiliesorasinglefamilyisstudiedacrossgenerations.Onefamily,referredtoastheKEfamily,hasbeenunderstudyforsometime(e.g.,Crago&Gopnik,
1994Gopnik&Crago,1991VarghaKadeem,Watkins,Alcock,Fletcher,&Passingham,1995).Thisfamilycontinuestobeexaminedtodeterminewhethera
hypothesizedautosomaldominanttransmissionmodeisatwork.Briefly,autosomaldominanttransmissionmeansthatthedisorderistransmittedthroughapairof
autosomalchromosomes(i.e.,oneofthe22chromosomepairsthatarenotsexlinked)andwilloccurevenifonlyoneofthetwochromosomesinapairisaffected.
TheKEfamilyhasmanyaffectedmembers,aswouldbeexpectedgivenanautosomaldominantmodeoftransmission,asopposedtomodesinvolvingthesex
chromosomes(asinglepair)orarecessivemodeoftransmissioninwhichbothmembersofapairwouldbeaffectedtoresultinthedisorder.Infact,mostmembersof
theKEfamilydemonstratebothseverelyimpairedspeechandlanguage,andseveralshowcognitiveimpairmentorpsychiatricdisordersaswell.Thus,additionalwork
isneededtoexamineotherfamilieswhomightbemorerepresentativeofgreaternumbersofchildrenwithSLI.
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Continuingpursuitofinformationaboutgeneticbasesisthoughttobeusefulbecauseitmaybepossibletodeterminewhataspectsoflanguageimpairmentaremore
biologicallydeterminedand,therefore,perhapslessamenabletotreatment.Oncethosedeterminationsaremade,clinicianscouldfocusonthefosteringof
compensatorystrategiesorontheameliorationofremainingaspectsofthelanguageimpairmentthatmaybemoremodifiablethroughtreatment(Rice,1996).
DifferencesinBrainStructureandFunction
TheprospectofdifferencesinbrainstructureandfunctionbetweenchildrenwithSLIandthosewithouthasbeckonedasapotentialexplanationsinceresearchersfirst
beganruminatingaboutthisdisorder.Thisisillustratedbytheuseofthetermchildhoodaphasiainthe1930sandseveraldecadesthereafter.Amongthepossibilities
thathavebeenexaminedarethoseofearlydamagetobothcerebralhemispheres,ofdamagetothelefthemisphereonly(Aram&Eisele,1994Bishop,1992a),as
wellasthepossibilitythatdifferencesarenottheresultofdamageperse,butratheraretheexpressionofnaturalgeneticvariation(Leonard,1998).
Currently,casesoffrankneurologicdamageforexamplethosefollowingastrokeorheadinjuryareexcludedfromdefinitionsofSLI.Somewhatmoredifficultto
classifyaretheproblemsofchildrenwithLandauKleffnersyndrome,alsocalledacquiredepilepticaphasia.Thesechildrenfailtoshowsignsoffocaldamageexcept
forelectroencephalographicabnormalities,yettheyexperienceaprofoundlossoflanguageskills(Bishop,1993).Althoughincludedinearlyformulationsofchildhood
aphasia,thissyndromehasrecentlybeenfoundtofitwithincasesthataretypicallyexcludedfromSLI.
DespitetheexclusionofknownbraindamagefromstrictdefinitionsofSLI,arelativelylargenumberofstudiesusingtechniquessuchasmagneticresonanceimaging
(MRI)and,lessfrequently,autopsyexaminationhavebeenundertakentodeterminewhethersubtledifferencesinbrainstructureandfunctioncanaccountforthe
difficultiesfacingchildrenwithSLI.Oftenthesedifferenceshavebeenstructuralanomaliesthatseemtodepartfromthoseconsideredoptimalforalefthemisphere
dominanceforspeechleadingtoeitherrighthemispheredominanceoralackofdominancebyeitherhemisphere(Gauger,Lombardino,&Leonard,1997).
Increasingly,itisthoughtthatsuchdifferencesmayreflectvariationsinstructurethatmakelanguagedevelopmentlessefficient(e.g.,Leonard,1998).
Twoareasofthecerebralhemispheresinwhichsuchvariationshavebeenidentifiedaretheplanatemporaleandtheperisylvianareas,illustratedinFig.5.1.Thesetwo
areasoverlap,withthesmallerplanumtemporalelyingwithinthelargerperisylvianregionofeachhemispherebothoftheareasliewithinanareathathasconsistently
beenshowntobeassociatedwithlanguagefunction.
ExaminationsoftheplanatemporaleinindividualswithSLIweresparkedbya1985autopsystudy(Galaburda,Sherman,Rosen,Aboitiz,&Geschwind)ofadultswho
hadhadwrittenlanguagedeficits.Detailedexaminationoftheseindividualsbrainsafterdeathshowedanatypicalsymmetrybetweentheplanumtemporaleontheleft
andtheoneontheright.Thispatterncontrastedwiththemoretypicalasymmet
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Fig.5.1.Theleftcerebralhemispherewiththeplanumtemporalehighlighted.FromNeuralbasesofspeech,hearing,andlanguage(Figure92),byD.P.Kuehn,
M.L.Lemme,&J.M.Baumgartner,1989,SanAntonio,TX:ProEd.Copyright1989byProEd.Adaptedwithpermission.
ricarrangementinwhichtheplanumtemporaleontheleftisbiggerthanthatontheright,withthelargersizethoughttoreflectgreaterinvolvementinlanguage
processing.Theatypicalsymmetryresultsfromatypicallysizedleftplanumtemporaleandalargerthanusualrightplanumtemporale.Intheonlyautopsystudy
conductedtodateforasinglechildwithSLI,thissameatypicalsymmetrywasobserved(Cohen,Campbell,&Yaghmai,1989).
Similarasymmetries,withleftlargerthanrighthemisphereperisylvianareas,havealsobeenidentifiedinautopsystudiesperformedonindividualswhodidnothave
SLIduringtheirlifetimes(e.g.,Geschwind&Levitsky,1968Teszner,Tzavares,Gruner,&Hecaen,1972).Theperisylvianareas,ratherthanthesmallerplana
temporale,becamethefocusofaseriesofstudiesconductedbyPlanteandhercolleagues(Plante,1991Plante,Swisher,&Vance,1989Plante,Swisher,Vance,&
Rapcsak,1991).Inthosestudies,Planteandhercolleaguescomparedtherelativesizeoftheseareasbetweenhemispheresandbetweenfamilymemberswhowere
affectedorunaffectedbySLI.TheresearchersfocusedontheperisylvianareasratherthantheplanatemporalebecauseoflimitationsintheuseofMRI(Plante,
1996)atechniquethatwasnonethelesshighlydesirablebecauseitcouldbeusedevenonveryyoung,liveparticipants.
TheresearchersfoundthatchildrenwithSLIandtheirfamiliesdemonstratedperisylvianareasthatwerelargerontherightthanthosetypicallyseeninstudiesof
individualswithoutSLIoraknownfamilyhistoryofSLI(Plante,1991Planteetal.,1989,1991).Theselargerrightperisylvianareassometimesassociatedwith
symmetryacrosshemispheresandsometimeswithasymmetriesfavoringtherighthemisphere.Nonetheless,becausesomeindividualswithatypicalconfigurationsdid
notshowlanguageimpairment,andotherswithnormalconfigurationsdidshowsuchimpairment,thisstructuraldifferencecannotbeseenasasinglecauseoflanguage
impairment.Ina1996reviewofthisliterature,PlantenotedthattheabsenceofabnormalfindingsforsomeindividualsmaysimplybeduetotheinsensitivityofMRI
techniquestosubtledifferencesinbrainstructure.Nonetheless,herargumentdoesnotreallyexplaintheinstancesinwhichidentifiedatypicalstructuresareassociated
withnormallanguageperform
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ance.Furthermore,Plante,aswellasotherresearchersinthefield(Leonard,1998Rice,1996Watkins,1994),believethatanumberoffactorsprobablyneedtobe
inplaceforstructuralbraindifferencestoculminateinlanguageimpairment.
MorerecentstudieshavelookednotonlyattheperisylvianareasbutalsoatotherbrainstructuresfordifferencesthatmayhelpresearchersbetterunderstandSLI
(e.g.,Clark&Plante,1998Gaugeretal.,1997Jackson&Plante,1996).Whereasmanyofthesehavebeenregionsinorclosetotheperisylvianregion(e.g.,Clark
&Plante,1998Jackson&Plante,1996),othershavelookedatmuchlargerareasofthecerebrum(Jernigan,Hesselink,Sowell&Tallal,1991),attheextensivetract
ofnervefibersconnectingthetwocerebralhemispheres(Cowell,Jernigan,Denenberg&Tallal,1994,citedinLeonard,1998),andatareasincludingtheventricles
(Trauner,Wulfeck,Tallal,&Hesselink,1995).Allofthesestudiesfoundatleastsomedifferences(Cowelletal.,1994).
Inarecentreviewofthesestudiesandothersusingbehavioralandneurophysiologicaldata,Leonard(1998)summarizedtheevidenceasindicatingthehighpercentage
ofatypicalneurobehavioralfindingsforchildrenwithspecificlanguageimpairmentimplicatesaconstitutionalbasisthatmaycontributetothepresenceoflanguage
impairment.Theoriginsofthesesuspecteddifferencesinbrainstructureleadtootherkindsofquestionsaboutcauses,suchasenvironmentalfactors.
EnvironmentalVariables
Environmentalvariablescanencompassphysical,social,emotional,orotheraspectsofthedevelopingchildssurroundingsfromconceptiononward.Twotypesof
environmentalvariables,however,havereceivedthegreatestamountofattentionforSLI(a)variablesconstitutingthesocialandlinguisticenvironmentinwhich
childrenwithSLIareacquiringtheirlanguage(Leonard,1998)and(b)demographicvariables,suchasparentaleducation,birthorder,andfamilysocioeconomicstatus
(SES),thataffectthatenvironmentinlessdirectways(Tomblin,1996b).
AparticularlyengagingandclearaccountoftheliteratureexaminingconversationalenvironmentofchildrenwithSLIcanbefoundinLeonard(1998,chap.8).Inthe
literatureexaminingthistypeofenvironmentalinfluence(e.g.,Bondurant,Romeo&Kretschmer,1983Cunningham,Siegel,vanderSpuy,Clark,&Bow,1985),most
studieshavefocusedonthenatureandlinguisticcontentofconversationsoccurringbetweenchildrenwithSLIandtheirparents.Usually,comparisonsaremadeto
conversationsbetweenparentsandtheirnormallydevelopingchildren(agematchedorlanguagematched,dependingonthestudy).Inaddition,inordertoclarify
chickenortheeggspeculationaboutthedirectionofcausation(i.e.,Aredifferencesinconversationcausingchildrensproblemsorresultingfromthem?),studies
havealsoexaminedconversationsbetweenchildrenwithSLIandunrelatedadults(Newhoff,1977)andevenwithotherchildren(e.g.,Hadley&Rice,1991).
Despitetheimpedimentsofferedbyabundantmethodologicalvariationsandchallengingpatternsofempiricaldisagreements,Leonard(1998)venturedafew
generalizationsaboutthislineofinvestigation.First,mostoftheevidenceinwhichchildrenwithSLIarecomparedwithcontrolchildrenwhoaresimilarinagesuggests
thattheir
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conversationpartners(parents,otheradults,andpeersalike)makeallowancesfortheirdiminishedlanguageskillsandarethusreactingto,ratherthancausing,the
childrensproblems.Forexample,Cunninghametal.(1985)foundthatmothersofchildrenwithSLIinteractedsimilarlytomothersofcontrolchildrenofthesimilar
agesinconditionsoffreeplay,butaskedfewerquestionsduringastructuredtask.Inaddition,forthosechildrenwithSLIwhosecomprehensionandproductionwere
bothaffected,mothersreducedtheirlengthofutterance,somethingthatwasnotdonebymotherswhosechildrenwereeithernormallydevelopingorhadSLIinwhich
onlyexpressivelanguagewasaffected.
Second,Leonard(1998)contendedthatinstudieswherechildrenwithSLIarecomparedwithyoungerchildrenwhoaresimilarinlanguagecharacteristics,findingsare
lessconsistentinshowingdifferences.Nonetheless,themostreliabledifferenceinhoweachgroupisspokentobytheirparentsinvolvesthefrequencywithwhich
recastsareused.Arecastisarestatementofachildsproductionusinggrammaticallycorrectstructures,oftenincorporatingmorphosyntacticformsthathadbeen
omittedorproducedinerrorbythechild(Leonard,1998).Recentresearchhassuggestedthatthisconversationalstrategyisusedfrequentlybyparentsofnormally
developingchildrenatearlierstages,butisthenfadedovertime.Ithasalsobeenshowntobeausefultherapeuticstrategy(Nelson,Camarata,Welsh,Butkovsky,&
Camarata,1996).Interestingly,LeonardnotedthatratherthanincreasingtheiruseofthiskindofstatementwithchildrenwithSLIasmightbeexpectedin
compensation,parentsofchildrenwithSLIuseitlessfrequentlythanthoseofchildrenwithoutSLI.Despitethepossiblevalueofadditionalresearchinclarifyingwhy
thisdifferenceisseen,allinall,thislineofresearchhasnotprovenasproductivetotheunderstandingofthegenesisofSLIaswasoncehoped(Leonard,1998).
Turningtopossiblecluesintheformofdemographicvariables,Tomblin(1996b)searchedforriskfactorsindemographicdataobtainedfromthepreliminaryresults
(consistingof32childrenwithSLIand114controls)ofalargerepidemiologicalstudy(plannedtoinclude200childrenwithSLIand800controls).Specifically,he
lookedforassociationsbetweendemographicandbiologicaldataandthepresenceofSLI.Amongthevariablesheexaminedrelativetothehomeenvironmentwere
parenteducation,familyincome,andbirthorderofthechildinthefamily.AlthoughthereweretrendsinthedirectionofchildrenwithSLIbeinglaterbornandhaving
parentswithfeweryearsofeducationthanunaffectedchildren,neitherofthesetrendswassignificant.Tomblinspeculatedthatthetwotrendsmayhavebeenduetothe
extentthatlowerincomesareassociatedwithlargerfamilies.
AlsoavailabletoTomblin(1996b)weredataconcerningexposuretobiologicalriskfactorsincludingmaternalinfectionorillness,medication,useofalcohol,anduseof
tobaccoduringpregnancy,aswellastheevidenceofpotentialtraumaatbirthandtheparticipantsbirthweights.Inthesepreliminarydataatleast,Tomblinfoundno
differencesbetweenthegroupsrelativetomaternalinfectionandillnessduringpregnancy,andactuallyfoundlower,butnonsignificantratesofexposuretoalcoholand
medication.Birthhistoriesandbirthweightsalsodidnotdiffersignificantly.OnlymaternalsmokingshowedatrendtowardshigherlevelsamongthechildrenwithSLI.
Althoughattributingthelackofsignificantfindingstotherelativelysmallsamplesizesused,
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Tomblinalsosuggestedthatthelargernumbersassociatedwiththecompletedstudywouldbeunlikelytorevealeffectsizesofanymajorsignificance,whereeffect
sizesrelatetothemagnitudeofthedifferencebetweengroups.
Clearly,findingsacrossseverallinesofresearchsuggesttheneedforthecontinuationandcoordinationofeffortstounderstandthecomplexityofvariablesthatput
childrenatriskforSLI.Althoughneurologicandgeneticresearchfindingshavebeenparticularlyexcitingoverthepasttwodecades,thesevariablesarenotsufficientby
themselvestoexplainSLI.Biologicalandenvironmentalfactorsrepresentimportantfrontiersforamorecompleteunderstandingoflanguageimpairment(Snow,1996).
Atadifferentlevelofexplanation,linguisticandcognitiveaccountsattempttoprovidemoreimmediateexplanationsforthespecificpatternsoflanguagebehaviorsseen
inSLIandtheirvariabilityacrosschildrenandovervaryingages.
LinguisticandCognitiveAccounts
AlargenumberoflinguisticaccountsofSLIaswellascognitiveaccountshavebeenadvancedoverthepastseveraldecades.Atpresent,morethanadozen
warrantseriousconsideration(Leonard,1998).Asagroup,theseaccountsdeservesomeattentionherebecauseoftheirpotentialimpactonassessmentandtreatment
ofchildrenforwhomSLIissuspectedorconfirmed.
Asdiscussedinpreviouschapters,thevalidityoftheassessmenttoolchieflyturnsontheextenttowhichitcapturestheconstructbeingmeasured.Consequently,
differentmodelsofSLIimplytheneedfordifferentmeasures.Inpractice,however,thelinkbetweentheoreticalunderstandingsofacomplexbehaviorandreadily
availableassessmentproceduresisusuallyfarfromdirect.Thisisparticularlytruewhentherearealargenumberofcompetingaccountsbutnoclearfrontrunnersthe
currentcaseforSLI.Inaddition,thetermaccounts,usedhereandusedbyLeonard,specificallyimpliesacknowledgementthattheseformulationsfailtotietogether
thebreadthofdatathataretypicallyassociatedwithuseofthetermtheories.Despitetheselimitations,somefamiliaritywiththesecompetingaccountscanhelpreaders
anticipatefuturetrendsinboththeoreticaleffortsandinrecommendedassessmentpractice.
Leonard(1998)reviewedawidefieldoflinguisticandcognitiveexplanationsofSLI,dividingthemintothreecategories.Specifically,heconsideredsixexplanationsof
SLIfocusingondeficitsinlinguisticknowledge:threeonlimitationsingeneralprocessingcapacityandthreeonspecificprocessingdeficits.Becauseofspacelimitations,
eachofthesetwelveaccountscannotbediscussedindetailhere.Instead,asmallsubsetwillbeusedtointroducereaderstothiscomplexdebateandillustratethe
challengesawaitingresearchersandclinicianswhoseektotranslatetheseaccountsintoassessmentpractice.
LanguageKnowledgeDeficitAccounts
Leonard(1998)arguedthatChomskys(1986)principlesandparametersframeworktolanguageacquisitioncanbeseenasafoundationforthemajoraccountsin
whichdeficitsinlinguisticknowledgearepostulatedascentraltoSLI.Stemming
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fromtransformationalgrammarofthe1960sand1970s,principlesrepresentuniversalsofnaturallanguages,andparametersthedimensionsalongwhichindividual
languagesdiffer.Childrenarepresumedtoworkwithintheconstraintsassociatedwithuniversalprinciplestoacquirethespecificknowledgeoftheparametersettings
associatedwiththeirambientlanguage.Chiefamongthedifficultiesfacingchildreninthisprocessistheapparentneedtounderstandmorethanjustthesurfacerelations
existingbetweenwordsinsentencesastheyareheard.Rather,theymustalsounderstandtheunderlying,orinferred,relationshipsbetweenlexicalcategories(e.g.,
noun,verb,adjective)andfunctionalcategoriesthatexplainrelationshipsbetweenwordswithinsentences(e.g.,complementizer,inflection,determiner).
DifferencesintheaccountsthatLeonard(1998)placedwithinthiscategorylieprimarilyinwhichareaoflinguisticknowledgeisabsentor,moreoften,incompletein
childrenwithSLI.Leonardhimselfandseveralcolleaguesareassociatedwithaccountsinwhichknowledgeoffunctionalcategoriesoverallisdeemedincomplete
(Leob&Leonard,1991Leonard,1995).Alternatively,Rice,Wexler,andCleave(1995)areassociatedwiththeextendedoptionalinfinitiveaccount,inwhich
childrenwithSLIarethoughttoremaintoolonginadevelopmentalphaseinwhichtenseistreatedasoptional.OtheraccountsseechildrenwithSLIasunableto
developimplicitgrammaticalrules(Gopnik,1990),asdevelopingrulesthataretoonarrowintheirapplication(e.g.,Ingram&Carr,1994),oraslackingtheabilityto
understanddifferentagreementordependentrelationshipsexistingbetweenfunctionalcategories(e.g.,Clahsen,1989vanderLely,1996).
Amongthesignificantchallengesfacingtheseaccountsistheirneedtoprovidemorecompleteexplanationsofthevariabilityindevelopmentalpatternsshownby
childrenwithSLIandofcrosslinguisticdifferencesintheerrorpatternsanddevelopmentofchildrenwithSLI.Inaddition,despiteemergingeffortstotielinguistic
accountstogenetic,biological,andenvironmentalaccounts(e.g.,Gopnik&Crago,1991),furtherstepsinthatdirectionareneeded.
AccountsPositingGeneralProcessingDeficits
GeneralprocessingdeficitaccountsofSLIplacegeneraldeficitsincognitiveprocessingatthecoreofSLI,withthemostambitiousofthemholdingthesedeficits
responsibleforboththelinguisticandnonlinguisticdifferencesseeninchildrenwithSLI(Leonard,1998).Ratherthanassumethatspecificcognitivemechanismsare
affectedasisdoneinthethirdandfinalcategoryofaccountstheseaccountspostulateamorewidespreaddeficiencyofferingasimpler,moreelegantexplanationof
thepatternsofdeficitsseeninchildrenwithSLI.Typically,suchaccountstendtodescribecentralcognitivedeficitsintermsofreductionsinprocessingcapacityor
speed.
Suchaccountsareparticularlycompellingforexplanationsofdifficultiesinwordrecallandretrievalandcomprehensionaswellasnonlinguisticcognitivedeficits,but
mustalsoexplainthespecialdifficultiesassociatedwithmorphosyntaxinmostEnglishspeakingchildrenwithSLI.AmongthenumerousresearcherscitedbyLeonard
(1998)asworkingonaccountsofthistypeareEllisWeismer(1985),Bishop(1994),EdwardsandLahey(1996Lahey&Edwards,1996)aswellasLeonard
himself.
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Leonardssurfacehypothesis(e.g.,Leonard,1989Leonard,Eyer,Bedor,&Grela,1997)representsoneofthemostthoroughlyprobedofthegeneralprocessing
deficitaccountsand,consequently,serveshereasanimportantexemplarofsuchaccounts.Thesurfacehypothesissuggeststhatdifferencesinthepatternofdeficits
observedcrosslinguisticallyinchildrenwithSLImaybeduetodifferencesinlanguagestructureacrosslanguages.Suchdifferencesarethoughttoleadtodifferencesin
processingdemandsratherthantotheimpairedgralnmaticalsystemspositedbylinguisticaccounts.Thisaccountemphasizestheimportanceofsurfacefeaturesof
languages,suchasthephysicalpropertiesofEnglishgraummaticalmorphology,thatmayrepresentspecialchallengestochildren,particularlytothosewithreduced
processingcapabilities.
Accordingtothesurfacehypothesis,childrenwithSLIwilltakelongertoacquirethemoredifficultaspectsoftheirlanguageandmayfocustheirprocessingeffortsin
someareasattheexpenseofothers(e.g.,onwordorderattheexpenseofmorphology).Amongthosefeaturesofalanguagethatareconsideredparticularly
vulnerablearethosethatarerelativelybrief,uncommoninlanguagesoftheworld,orlessregularwithinthelanguage(e.g.,numerousgrammaticalmorphemesin
English).Leonard(1998)providesathoroughdescriptionofthesuccessesandfailuresofthisaccountinexplaininganeverexpandingbodyofempiricaldatafrom
severallanguagegroups.Furtherheshowsitsbasiccompatibilitywiththesurfacehypothesisandotherprocessinglimitationaccountsthatemphasizereducedspeedof
processing.
Aswiththegrammaticalknowledgeaccounts,accountsthatpositgeneralprocessingdeficitshaveawiderangeofcrosslinguisticdatatoaddress,includingpatternsof
errorsandofacquisitionpatternsinchildrenwithSLI.Further,theappealofsuchaccountsintermsofsimplicityisenhancediftheycanalsoaddresssimilardatafor
childrenwithoutimpairedlanguage.AddtothatthedesirabilityofaddressingemergingdataonthegeneticandbiologicfactorsassociatedwithSLIanditbecomesonly
asmallwonderthatconsensusleadingtoaunifiedtheoryofSLIeludestheresearchcommunityatthistime.ThelastofthethreetypesofaccountsLeonarddescribes
withinthiscommunitywrestleswiththissamelistofempiricalchallengesbutproposescognitivelimitationsthataremorespecificinnature.
SpecificProcessingDeficitAccountsofSLI
AccordingtoLeonard(1998),threeaccountshavefocusedonspecificdeficitsasresponsibleforfarreachingconsequencesforlanguagefunction.Respectively,these
accountshypothesizedeficitsinphonologicalmemory(EllisWeismer,Evans,&Hesketh,1999Gathercole&Baddeley,1990),intemporalprocessing(Tallal,1976,
Tallal&Piercy,1973Tallal,Stark,Kallman,&Mellits,1981),andinthemechanismsusedforgrammaticalanalysis(Locke,1994).Theseaccountsarelesswell
developedthanthelinguisticandgeneralcognitivedeficitaccountsintermsofthebreadthofdatatheyencompass.
Oftheseaccounts,theaccountsassociatedwithtemporalprocessing(viz.,Stark&Tallal,1988Tallaletal.,1996)havehadthegreatestrecentimpact,including
considerableattentioninthepopularpress(e.g.,inaUSATodayarticle[Levy,1996]).
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ThisattentionhaslargelybeentheresultofthepopularizationofaspecifictrainingprogramcalledFastForWord(ScientificLearningCorporation,1998).
AfteralonghistoryofworkonSLI,TallaljoinedwithMichaelMerzenichandotherstoconductaseriesofremarkabletreatmentstudies(Merzenichetal.,1996Tallal
etal.,1996).InthosestudiesuseofFastForWord,acomputertrainingprogramdesignedtoaddresshypothesizedprocessingdifficulties,resultedinsignificantgainsin
languageperformanceandauditoryprocessing.DevelopmentofthatprogramwasbasedonevidencethatchildrenwithSLIhavedifficultyprocessingbriefstimulior
stimulithatfollowoneanotherinrapidsuccessiondifficultiesthatmightsignificantlyaffectachildsabilitytoprocessspeech.Further,theprogramisbasedonthe
hypothesisthatthedeficitcanbeamelioratedbyexposingchildrenwithSLItostimulithatareinitiallyrecognizablebutacousticallyalteredthroughthelengtheningof
formanttransitions.Duringtreatment,childrenparticipateinalargenumberofvideogameliketrialsinwhichtheyarerequiredtomakejudgementsaboutthealtered
stimuli.Acrosstrials,thestimuluscharacteristicsarealteredinthedirectionofnaturalspeech.
Readersareencouragedtotakenoteofthedebatesurroundingthisaccountandthecommercializationithasfostered(e.g.,Gillam,1999Veale,1999).Ironically,the
authorsoftheotheraccountsdiscussedinthissectionofthechapterhaveappearedtotakegreaterpainstotietogetherahugenumberofempiricalcluesaboutthe
natureofSLI.However,itisraretofindthepublicsoawareofanaccountoratleastthetreatmentprogramassociatedwithitandtoclamorforitsusewith
childrenpresentingwithawiderangeofcommunicationrelateddisorders(includingreadingdisabilitiesandautism).Thesepublicresponsesalonemakeitafascinating
areaofadditionalinvestigationforcliniciansandresearchersinterestedinchildrenslanguagedisorders.Independentvalidationofthistreatmentanditstheoretical
underpinningshasyettobeprovided(Gillam,1999).
WhatsAheadforAccountsofSLI?
Inthissection,Ihavetriedmybesttopointoutthemostimportantlandmarksofthisvastandchangingterrain(helpedconsiderablybytheworkofLeonard,1998,and
theurgingsofBernardGrelatoaddressthesecomplexissues).However,IamcertainthatIhavemissedsomeimportantvantagepointsandcriticalroadways.
Nonetheless,Ihopethatthisbriefoverviewprovidesyouwiththesenseofthecomplexitiesfacingtheseresearchers.
Theresearchersworkingonthistopichaveimmenseamountsofdatatoaddressiftheyaretosettleonatrulycomprehensivetheory,ratherthanfragmentedaccounts
ofisolatedaspectsofSLI.NotonlymusttheydealwithinformationabouthowchildrenofSLIperformonarangeoflanguageandnonlanguagetasks,theymustdoso
forthewiderangeofspokenlanguagesandacrossthelifespan.Furthertheymusttiethesetogetherwiththeburgeoningfindingsaboutthegenetics,brainstructures,
andsocialcontextsofchildrenwithSLI.
OtherchallengesfacingresearchersinterestedinSLIhavebeensummarizedbyTagerFlusberg&Cooper(1999),whoreviewedthefindingsofarecentNational
InstitutesofHealthworkshopfocusedonstepsneededtoproducecleardefinitionsofSLI
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forgeneticstudy.Despitethenarrowfocusofthatconference,therecommendationsthatcameoutofitappeargermanetothoughtsabouttherelationoftheoryto
assessmentpractices.AmongtherecommendationssummarizedbyTagerFlusbergandCooperarethatresearchersabandonexclusionarydefinitionsofSLI,broaden
thelanguagedomainsandinformationprocessingskillstheyassess,anddevelopastandardapproachtodefiningSLI,notonlyinpreschoolersbutalsoinolderschool
agechildren,adolescents,andadults.Thesesamerecommendationsareclinicallyrelevantinsofarascombiningclinicalandresearcheffortsmayresultinthegreatest
gainsinbotharenas.
SpecialChallengesinAssessment
InadditiontothetheoreticalchallengestotheassessmentofchildrenwithSLI,thesechildrenalsocomewitharangeofpersonalreactionstotestingthatareatleast
partiallydeterminedbytheamountofsuccesstheyexpect.Anyofuswhohasdifficultyincertainareas,suchassinging,drawing,orplayingsportsknowshow
uncomfortablewefeelwhenourperformanceinthoseareasisevaluated.Consequently,Iurgeyoutoreferbacktochapter3forsomeofthegeneralguidelines
addressedinthatchapter,whichwillserveasausefulexerciseinpreparingforworkingwithchildrenwithSLI.
Beyondthepersonaldynamicsthatshouldalwaysbeaspecialconsiderationinassessment,childrenwithSLIpresentseveralproblemsrelatedtohowtheyare
identifiedasneedinghelp.Plante(1998)pointedoutatleastthreeproblemswithhowsuchchildrenhavebeenidentifiedbyresearchers.SomeofPlantesconcerns
abouttheliteraturealsofaceclinicians.Eventhosethatdonot,deserveattentionbyknowledgeableconsumersofthisresearchliterature.
First,Plante(1998)argued,researchershavetendedtousecriteriafornonverbalIQ(oftennonverbalIQof85orgreater)thatexcludenotonlychildrenwithmental
retardationbutlargenumbersofotherswhoselowerintelligencemakesthemnolessrelevanttoourunderstandingofSLI.Second,Plantenotedthatintheidentification
process,researchershavetendedtousetestsandcutoffscoresonthoseteststhathavenotbeenshowntosuccessfullyidentifychildrenwiththedisorder.Specifically,
shequestionedtwoparticularaspectsofthevalidityofthosetestsandcutoffs:theirsensitivity(theextenttowhichindividualswithdisordersareactuallyidentifiedas
havingthedisorder)andspecificity(theextenttowhichindividualswithoutdisordersaresuccessfullyidentifiedassuch).(Seechap.9formorecompleteexplanations
oftheseconcepts).
Third,Plante(1998)questionedtheuseofdiscrepancyordifferencescoresinthepracticeoftenreferredtoascognitivereferencing.Cognitivereferencingoccurs
whentheidentificationofSLIhingesonthedemonstrationofaspecificdifferencebetweenexpectedlanguagefunction(basedonnonverbalIQ)andlanguage
performance.Planteattackedthispracticeontwogrounds:(a)becauseofatendencyforsuchcomparisonstobebasedonageequivalentscores,whicharethe
targetsofalonghistoryofcriticismfrompsychometricperspectives(e.g.,seechap.2)and(b)becausethereisnogoodevidencetosupporttheuseofnonverbalIQ
asanindicatoroflanguagepotential.Asjustoneexampleofthislackofevidence,KrassowskiandPlante(1997)reportedalackofstabilityintheperformanceIQ
scoresof75childrenwithSLIovera3yeartimeframethatwouldbeinconsistentwiththeiruseasaconstant
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measureoflanguagepotential.Planteandhercolleaguesarejoinedbylargenumbersofthecommunityoflanguageresearchersinfindingseriousmanywouldsay
fatalflawswithcognitivereferencing(e.g.,Arametal.,1993Feyetal.,1994Kamhi,1998Lahey,1988).Alongwiththeinstabilityofcategorizationsobtained
throughcognitivereferencing,othershavenotedthatsimilaramountsofimprovementinspecifictreatmentsaremadebychildrenwhowouldfallonbothsidesof
conventionalcognitivecriteria(e.g.,Feyetal.,1994).
Evenreaderswhohavesimplyskimmedearlierchaptersontheirwaytothisonewillrecognizecertaincommondilemmasfacingcliniciansaswellasresearchers
regardingcognitivereferencing.Thus,forexample,bothgroupsneedtobeascarefulaspossibletoselectmeasuresthathavebeenstudiedverycarefullyforthe
purposetowhichtheyarebeingused.Thatis,evidenceofcriterionrelatedvalidityforhowandwithwhommeasuresareusedissomethinginwhichbothcliniciansand
researchershaveaprodigiousstake.Inaddition,bothgroupsshouldavoidtherelativelyunreliableandmisleadingnatureofageequivalentscoresinsofarastheyare
abletodoso.Thewiggleroomleftbythatlastclausestemsfromthefactthatcliniciansmayfindthemselvescompelledtouseageequivalentscoresbythesettingsin
whichtheywork,particularlyforyoungerchildren.Withregardtocognitivereferencing,Casby(1992)notedthatin31states,eligibilityforservicesbasedonSLI
demanditsuseinsomeform.Insuchsituations,anethicalandsensiblerecommendationwouldbetoprovidetherequireddocumentation(i.e.,togoaheadandreport
thecognitivereferencedinformation,ageequivalentscores,orboth),butaccompanyitwithappropriatewarningsaboutthelimitationsofeachandrecommendations
fromamorescientificallysupportableperspective.
InadiscussionofproblemsofdifferentialdiagnosisinSLI,Leonard(1998)calledattentiontoafurtherdifficultyassociatedwiththeassessmentofchildrenconsidered
atriskforthedisorder.Specifically,hecalledattentiontothedifficultyindistinguishinglatetalkers,whowillultimatelyprovetobesimplylateindevelopinglanguage,
fromthosechildrenwhoselatetalkingforetellspersistingproblemsinlanguageacquisition.MostchildrenwithSLIhaveahistoryoflatetalking(whichisusuallydefined
intermsoflateuseofwords).However,onlyonequartertoonehalfoflatetalkerswillgoontobediagnosedwithalanguagedisorder.Developingaccurate
predictionsofwhichchildrenareshowingearlysignsofSLIhasspurredtheeffortsofanumberofresearcherswhohopethatearlyidentificationwillleadtoeffective
andefficientearlyintervention(e.g.,Paul,1996Rescorla,1991).
Unfortunately,thedramaticvariabilityinchildrensnormallanguagedevelopmentisprovingaconsiderableobstacle.Thus,reliablesignsyieldingreasonablyaccurate
predictionshaveevadedresearchers,leadingLeonard(1998)torecommendwithholdingdiagnosesuntilatleastage3andPaul(1996)toadviseawatchandsee
policy.AdifferinginterpretationofthedataonwhichPaulsrecommendationsarebasedthatincludesapleaformoreaggressiveinterventioncanbefoundinvan
Kleeck,Gillam,andDavis(1997).
Alsourgingmoreaggressiveresponsestolatetalkingchildren,Olswang,Rodriguez,andTimler(1998)representasomewhatmoreoptimisticreadingoftheresearch
evidence.Specificallytheyoutlinedspeechandlanguagedifferencesandotherriskfactorsthattheyproposeshouldpromptdecisionstointervene.Table5.2
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Table5.2
PredictorsandRiskFactorsUsefulinHelpingCliniciansDecideWhethertoEnrollToddlersWhoAreLateTalkersforIntervention
Predictors
Languageproduction
l Smallvocabularyforage
l Fewverbs
Play
l Preponderanceofgeneralallpurposeverbs OtitismediaProlongedperiodsofuntreatedotitis
l Primarilymanipulatingandgrouping
(e.g.,want,go,get,do,put,look,make,got) media
l Littlecombinatorialand/orsymbolicplay
l Moretransitiveverbs(e.g.,Johnhittheball)
l Fewintransitiveandditransitiveverbforms(e.g.,
hesleep,doggierun)
Languagecomprehension
l Presenceof6monthcomprehensiongap GesturesFewcommunicativegestures,symbolic HeritabilityFamilymemberwithpersistentlanguage
l Largecomprehensionproductiongapwith gesturalsequences,orsupplementarygestures andlearningproblems
comprehensiondeficit
Phonology
l Fewprelinguisticvocalizations
Socialskills
l Limitednumberofconsonants Parentneeds
l Behaviorproblems
l Limitedvarietyinbabblingstructure l Parentcharacteristics:LowSESdirectivemorethan
l Fewconversationalinitiations
l Lessthan50%consonantscorrect(substitutionof responseinteractionstyle
l Interactionswithadultsmorethanpeers
glottalconsonantsandbacksoundsforfront) l Extremeparentconcern
l Difficultygainingaccesstoactivities
l Restrictedsyllablestructure
l Vowelerrors
Imitation
l Fewspontaneousimitations
l Relianceondirectmodelandpromptingin
imitationstasksofemerginglanguageforms
Note.FromRecommendingInterventionforToddlersWithSpecificLanguageLearningDifficulties:WeMayNotHaveAlltheAnswers,butWeKnowaLot,by
L.Olswang,B.Rodriguez,&G.Timler,1998.AmericanJournalofSpeechLanguagePalhology,7,p.29.Copyright1998byAmericanSpeechLanguage
HearingAssociation.AmericanSpeechLanguageHearingAssociation.Reprintedwithpermission.
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summarizestheirlist.Theyrecommendedthatlargernumbersofriskfactorsbeviewedascauseforgreaterconcern.
ExpectedPatternsofLanguagePerformance
ThelanguageperformanceofchildrenwithSLIhasundergonegreaterscrutinythanthatofanyothergroupofchildrenwithlanguagedifficulties.Thediversityanddepth
ofthisresearchoverseveraldecadesleadstosomeclearexpectationsofareasinwhichdifficultiescanbeexpectedbutalsotoubquitousexpectationsthateachchild
willbedifferent.
Therefore,beforeIdelveintoexpectedpatternsofdifficulties,Ishouldmentionagainthatgeneralexpectationsleadtohypothesesaboutwhatmightbeexpectedina
givenchildnotinfalliblecertainties.GeneralizationsalsofailtorendereitherthevariationsfoundinstudiesidentifyingdistinctsubtypesofSLI(e.g.,Aram&Nation,
1975Rapin&Allen,1988Wilson&Risucci,1986)orinstudiesrevealingchangesinpatternsofimpairmentthatoccurwithage(e.g.,Aram,Ekelman,&Nation,
1984Stothard,Snowling,Bishop,Chipchase,&Kaplan,1998Tomblin,Freese,&Records,1992).Further,thesegeneralizationshavebeenidentifiedforchildren
acquiringEnglishapotentiallyseriouslimitationforcliniciansworkingwithchildrenacquiringotherlessstudiedlanguages(Leonard,1998).Thus,theexpected
patternsdiscussedherearedescribedonlybrieflyandaremeanttopromptconsiderationoflikelyareasofdifficulty,nottobecometheonlyonesgivenattention.
AmongthemorerobustfindingsfromstudiesexamininglanguageskillsinEnglishspeakingchildrenwithSLIhavebeenthefindingsthat(a)expressiveandreceptive
languageareoftendifferentiallyimpaired,and(b)degreeofinvolvementcanvaryfromquitemildtoquitesevere.Also,expressivelanguagetendstobemorefrequently
andseverelyaffectedanobservationthatisborneoutinmuchoftheliteratureandisalsoreflectedintheDSMIV(AmericanPsychiatricAssociation,1994)
definitionsharedatthebeginningofthechapter.Recentresearch,however,suggeststhatthisdisparitymaynotbeaslargeashassometimesbeenthought.Amongthe
childrenwhowerefoundtohaveimpairedlanguageinareportdealingwithalargeepidemiologicalstudy,Tomblin(1996a)identified35%ofchildrenwithexpressive
problems,28%withreceptiveproblems,and35%withbothexpressiveandreceptiveproblems(givenacutoffof1.25standarddeviationsbelowthemean).
InTable5.3,specificareasofdifficultyrelativetonormallydevelopingpeersaresummarizedonthebasisofanextensivereviewofliteratureappearinginLeonard
(1998cf.Menyuk,1993Watkins,1994).InTable5.3,thedensityofcommentsfallingunderlanguageproductionreflectsnotonlythetendencyforthismodalityto
beaffectedbymoreobviousandoftenmoreseveredeficitsthancomprehension,butalsobyatendencyforittohavereceivedmuchgreaterresearchattention.A
relatedtable,Table5.4,listsspecificgrammaticalmorphemesthathavebeenidentifiedasparticularlyproblematic.
AsyouexamineTable5.3,noticethatmanyalthoughnotallofthedifferencesshownbychildrenwithSLIresemblepatternsseeninyoungerchildrenandare
thereforecharacterizedasdelays.Thisobservationmayhaveimplicationsrelatedtothenatureofthisdisorder.Inaddition,itsupportsthereasonablenessof
approaching
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Table5.3
PatternsofOralLanguageImpairmentbyModalityandDomainReportedinChildrenWithSpecificLanguageImpairment(SLI)(Leonard,1998)
Semantics
l Delaysinacquiringfirstwordsandwordcombinations
Delaysinverbacquisition,withoveruseofsomecommon
Lexicalabilitiesandearlyword l l Deficientinlearningtounderstandnewwords,particularly
verbs(e.g.,do,go,get,put,want)
combinations thoseinvolvingactions
l Wordfindingdifficulties,aespeciallynotedinschoolage
children
l Increasedtendencytoomitobligatoryarguments(e.g.,
omissionofobjectfortransitiveverb)oreventheverbitself
l Increasedtendencytoomitoptionalbutsemanticallyimportant l Increaseddifficultyinacquiringargumentstructureinformation
Argumentstructure
information(e.g.,adverbialsprovidinginformationregardingtime, fromsyntacticinformationfornewverbs
location,ormannerofaction)anduseofaninfinitivalcomplement
(e.g.,Hewantstodothis)
l Grammaticalmorphologyconstitutesarelativeandsometimes
enduringweaknessinchildrenwithSLI(seeTable5.4foralistof l Limitedresearchsuggestspoorercomprehensionof
grammaticalmorphemesthathavereceivedparticularattention) grammaticalmorphemes,especiallyforthoseofshorterduration,
Grammaticalmorphologyb
l Grammaticalmorphologyrelatedtoverbsisespeciallyaffected andpooreridentificationoferrorsinvolvinggrammatical
l Errorsmostoftenconsistofomissionsratherthan morphemes
inappropriateuse,butarelikelytobeinconsistentineithercase
l Althoughoccasionallyoccurringalone,phonologicaldeficits
arealmostalwaysaccompaniedbyotherlanguagedeficits,and
viceversa
l Delaysaremostfrequentlyseenwithmosterrorsresembling
Phonology thoseofyoungernormallydevelopingchildren.
l Unusualerrorsinproductioncoccurrarely,butprobablymore
oftenthaninnormallydevelopingchildren
l GreatervariabilityinproductionthanchildrenwithoutSLIat
similarstagesofphonologicaldevelopment
(Continued)
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Table5.3(Continued)
l Someevidenceofpragmaticdifficulties
l Althoughthesedifficultieslargelyseemduetocommunication
l Limitedresearchsuggeststhatunderstandingofthespeech
problemsposedbyotherlanguagedeficits,independent
actsofothersmaybeaffected
Pragmatics pragmaticdeficitsmayoccuraswell
l Comprehensionoffigurativelanguage(e.g.,metaphors,
l Participationincommunicationisnegativelyaffectedwhen
idioms)canbeaffected
communicationinvolvesadultsormultiplecommunication
partners
l Cohesionofnarrativescanbeaffected,andsometimes l Comprehensionofnarrativescanbeaffectedwheninferences
Narratives
expectedstorycomponentsareabsent needtobedrawnfromtheliteralnarrativecontent
aEvidencedbyunusuallylongpausesinspeech,frequentcircumlocution,orfrequentuseofnonspecificwordssuchasitandstuff.
bGrammaticalmorphologycanbedefinedastheclosedclassmorphemesoflanguage,boththemorphemesseenininflectionalmorphology(e.g.,plays,played)
andderivationalmorphology(e.g.,fool,foolish),andfunctionwordssuchasarticlesandauxiliaryverbs(Leonard,1998,p.55).
cAmongtheunusualerrorsreportedforthispopulationarelaterdevelopingsoundsbeingusedinplaceofearlierdevelopingsounds,asoundsegmentaddition,and
useofsoundsnotheardinthechildsambientlanguage.
treatmentgoalsfromadevelopmentalperspective(Leonard,1998).Also,noticetheexpanseofunmappedcountryrevealedhere.Despiteseveraldecadesofwork,
muchremainsunknownabouttheabilitiesofchildrenwithSLIandhowtheyarerelatedtooneanother.Consequently,thepotentialforvaluableoutcomesfrom
experimentalexplorationisimmense!
Finally,onaverydifferentnote,readersofthistablemayfindthattheirknowledgeofsometerminologyrelatedtolinguisticdescriptionsofthesechildrensdifficultiesis
outdatedorincomplete.TheyarereferredtoHurford(1994)asareferenceguidetothemorebasicgrammaticalterms.
RelatedProblems
Whencomparedwithchildrendescribedinothersectionsofthisbook,childrenwithSLIhavefarfewerrelatedproblems.Despitethemorerestrictednatureoftheir
difficulties,however,childrenwithSLIareatincreasedriskforanumberofsignificant,ongoingproblemsinadditiontoalengtheninglistofsubtleperceptualand
cognitivedeficienciesthatweredescribedbrieflyearlier.Amongtheseareincreasedriskforemotional,behavioral,andsocialdifficulties.Inaddition,thereisincreased
riskforongoingacademicdifficultiesoftenassociatedwithdiagnosesoflearningdisabilities(Wallach&Butler,1994).
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Table5.4
ExamplesofGrammaticalMorphemes,anAreaofSpecialDifficultyforChildrenWithSpecificLanguageImpairment(SLI)
Inflectionalmorphemes
Pasttense,regulared:slept,walked,irregular:flew,hid
Thirdpersonsingulars:sits,runs
Progressiveing:isrunning,isseeing
Plurals:coats,flowers
Possessives(alsocalledgenitives):Sams,dogs
Othergrammaticalmorphemes
Copulabe:heisaboytheyarehappy
Auxiliarybe:sheishunting,hewascooking
Auxiliarydo:IdonthateyouDoyourememberthatman?
Articles:themanacat
Pronouns:anything,herself,I,he,they,them,her
Emotional,Behavioral,andSocialDifficulties
Thepossibilitythatchildrenwithspecificlanguagedisordersmaybeatriskfordifficultiesinpersonaladjustmenthasbeenexaminedatseverallevelsofseverity.These
levelsofseverityhaverangedfromstudiesexaminingtheprevalenceofidentifiablepsychiatricdiagnoses(e.g.,Baker&Cantwell,1987a,bBeitchman,Nair,Clegg,&
Patell,1986Beitchman,Brownlie,etal.,1996Beitchman,Wilson,etal.,1996)tostudiesexaminingspecificaspectsofpeerrelationshipsorsocialmaturation(e.g.,
Craig,1993Farmer,1997Fujiki&Brinton,1994Gertner,Rice,&Hadley,1994Records,Tomblin,&Freese,1992Rutter,Mawhood,&Howlin,1992).
Studieslookingatthisissuedifferinalargenumberofmethodologicalvariables(e.g.,agesstudied,methodsusedtodefinelanguageimpairmentandotherproblem
areas).Nonetheless,aserviceableoverviewoftheirfindingsisthatchildrenwithSLIareatincreasedriskfordifficultiesinvolvingtheiremotional,behavioral,andsocial
status.Further,thisgeneralizationholdsforbothchildrenandolderindividualswithahistoryofSLIevenwhentheyappeartohaveoutgrownpersistinglanguage
impairment(throughtreatmentormaturationalprocessesalonee.g.,Rutter,Mawhood,&Howlin,1992).Thereisevidencethatchildrenwithreceptiveproblemsor
thosewithbothexpressiveandreceptivelanguageproblemsareatgreaterriskthanthosewithexpressiveproblemsalone(e.g.,Beitchman,Wilson,etal.,1996
Stevenson,1996).Thecausalmechanismsinvolvedinthecooccurrenceofcommunicationproblemsanddifficultiesinemotional,behavioral,andsocialrealmsare
difficulttodiscernandarefarfrombeingunderstood(Stevenson,1996).Still,theimplicationsofthecooccurrencealonearenonethelessimportantforthosewhohelp
childrenwithSLI.
AmongthespecificproblemsassociatedwithSLIthatcanbecategorizedaspsychiatricproblemsareattentiondeficitdisorder(ADD),conductdisorder,andanxiety
disorders(Baker&Cantwell,1987b).Ofthesethreedisorders,perhapsthemostfamiliartomanypeopleisattentiondeficithyperactivitydisorder(ADHD).
With
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anestimatedprevalenceof4to6%ofallelementaryschoolagedchildren,ithasbeendescribedasthemostcommonsignificantbehavioralsyndromein
children(Wender,1995,p.185).RecallthatinthedescriptionofWilsonatthebeginningofthechapter,itwassuspectedasacontributortosomeofhisdifficultiesin
fittingintotheclassroomandinteractingwithpeers.
ADHDistypicallydiagnosedinchildrenwhoshowpatternsofinattention,overactivityimpulsivity,orboth,thatseeminappropriateforageanddetrimentalto
functioning(AmericanPsychiatricAssociation,1994).Althoughsymptomsofthedisordermaybemorecommoninsomesituationsthanothers,theyoccuracross
settings.ExcellentpracticalrecommendationsfordealingwiththesymptomsofthisdisorderintheclassroomareavailableinDowdy,Patton,Smith,andPolloway
(1998,AppendixA).
Conductdisorderisdiagnosedinchildrenwhodemonstratearepeatedandconsistentpatternofbehaviorthatisinappropriateforageandviolatessocialorevenlegal
norms(AmericanPsychiatricAssociation,1994Goldman,1995).Behaviorsthatareassociatedwiththisdiagnosiscanincludeaggressiontopeopleandanimals,
destructionofproperty,deceitfulness,theft,truancy,andrunningaway.
Anxietydisorderisdiagnosedinchildrenwhoworryexcessively,usuallyabouttheirperformance,withresultingnegativeeffectsontheirfunctioning(American
PsychiatricAssociation,1994).Althoughtheareaofconcernmayshiftfromtimetotime,theintensity,duration,andfrequencyoftheanxietyandworryareseenasout
ofproportionwiththeiractuallikelihoodorimpact.Childrenwiththisdisordermaybeoverlyconcernedaboutapprovalandrequireexcessivereassuranceaboutthe
adequacyoftheirperformanceorotherfocusofconcern.
Althoughthediagnosesofattentiondeficitdisorder,conductdisorderandanxietydisordersarerelativelyrareamongchildrenwithlanguageimpairment,anotherview
oftheassociationbetweenpsychiatricdiagnosesandlanguageskillshasbeentakenbyresearcherswhoexaminethelanguageskillsofgroupsofchildrenseenas
psychiatricoutpatients.Inonerelativelyrecentstudy,researchersfoundthatonethirdofthe399suchchildrenwhoselanguagewasscreenedwereidentifiedashaving
anunsuspectedlanguageimpairment(Cohen,Davine,Horodezky,Lipsett,&Isaacson,1993).Thus,awarenessofthispossibleassociationcanhelpspeechlanguage
pathologistscontributetothedevelopmentofchildrenwhoseemotionalandbehavioralissueshavepreviouslyovershadowedveryreallanguagedifficulties,aswellas
thosechildrenforwhomalanguagediagnosishasalreadybeenmade.
AcademicDifficulties
Theconnectionbetweenlanguagedifficultiesandacademicdifficultiesisapowerfulone.Intheearlygrades,academicskillsbuildonlanguageskillsusedineveryday
experience.Later,academicdemands,especiallyforwrittenlanguageacquisitionbutalsofortheunderstandinganduseoffigurativelanguage,narrativeconstruction
andtheuseoflanguageinreasoning(Nippold,1998),helpfueladditionalgainsinlanguagedevelopment.Atleastthatisthewaythingsarethoughttoworkfor
normallydevelopingchildren.
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Increasingly,itappearsthattheorallanguagedifficultiesofchildrenwithSLImaycontributetoandbeexacerbatedbytheunsuccessfullanguageexperiencesthey
encounterinschool.BashirandStrominger(1996)describedtheinterweavingoforalandwrittenlanguageproblemsasfollows:
Itisreasonabletoarguethatthecontinuedacademicvulnerabilityinchildrenwithlanguagedisordersinthemiddlegradesreflectsboththepersistenceoflanguage
problemsandrestrictionsonlaterlanguagedevelopmentresultingfromreducedreadingaswellasrestrictedexposuretodifferenttextsandtextbasedinformation.(p.
134)
Thus,notonlymaylanguageimpairmentsleadtoacademicdifficulties,butdifficultieswiththelanguageoftheacademicsettingmaycontributetochildrenfallingfurther
behindtheirpeersinlanguagedevelopment.
ArecentstudybyStothardetal.isquiterepresentativeoftheliteratureonlaterlanguageandacademicoutcomes(e.g,Hall&Tomblin,1978Tomblinetal.,1992
Weiner,1974)andcorroboratessomeofitsmorerobustfindings.Thestudyreportsondatafromthesamechildrenseenatages4,5,and15years.Experimental
measuresincludedmeasuresoforallanguage(receptivevocabulary,expressivevocabulary,generalcomprehension,grammaticalunderstanding,naming),shortterm
memoryandphonologicalskills(sentencerepetition,nonwordrepetition,andspoonerisms),andwrittenlanguage(consistingofonetestthatassessessingleword
reading,singlewordspelling,andreadingcomprehension).Inaddition,informationaboutchildrensspecialeducationstatuswasexamined.
ResultsindicatedthatchildrenwhowereseenashavingpersistingSLIatage5demonstratedlongstandingimpairment,withperformancesatage15fallingbelow
agematchedpeersonallorallanguagemeasures.Inparticular,47%ofthesechildrenobtainedverbalcompositescoresmorethan1standarddeviationbelowthe
mean,and20%obtainedscoresmorethan2standarddeviationsbelowthemean.Inaddition,theyshowedpersistingproblemsinreadingandspellingthathadresulted
inahighpercentagereceivingspecialeducationassistanceofsomekind.
Evenchildrenwhoseemedtohaverecoveredatage5,performedsignificantlylesswellthanagematchedpeersatage15onteststappingshorttermmemoryand
phonologicalskills.Further,almostathirdofthesechildren,31%(8outof26),demonstratedperformancesconsistentwiththepersistingSLIcategory,thatis,they
couldagainbeconsideredlanguageimpaired.Thisisconsistentwithapatterntermedillusoryrecovery,whichreferstotheapparentreemergenceofproblemsasthe
complexityofdemandsplacedonchildrenincreaseswithgradelevel(Scarborough&Dobrich,1990).
ThefewstudiesexploringthelanguageskillsandacademicaccomplishmentsofadultswithahistoryofSLI(Gopnik&Crago,1991Hall&Tomblin,1978Planteet
al.,1996Tomblinetal.,1992)confirmthatmanychildrenwithSLIwillcontinuetobeplaguedbysignificantdifferencesinlanguageperformancethatimpactother
areasoffunctioning,includingschooladvancement.
ThePersonalPerspectiveforthischapterillustratesthepossibilityoflongtermacademiceffectsofSLI.
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PERSONALPERSPECTIVE
ThisperspectivewasprovidedbyMichele,whotoldherstorytoCynthiaRoby,theauthorofWhenlearningistough:Kidstalkabouttheirlearningdisabilities
(1994).AlthoughMicheleprimarilydiscussedherlearningdisabilityanditsimpactonherschoolexperiences,itseemslikelythatshehadlanguageproblemsasa
learningproblem.
Myapartmentisaboveavideostoreinthecity.Icangorightdownstairsandrentamovie.Idonthaveanybrothersorsisters.MymotherisKorean.Sheworksat
acafeteria.MydadworksattheairporthesChinese.WeeatlotsofKoreanandChinesefood.Ilikericeandnoodles.Ilovepizza,too.
IthinkmyparentsfoundoutIhadalearningproblemwhenIwastwo.Ihadaproblemwhenpeoplewouldreadtome.IwouldjustdrawonthebooksbecauseI
couldntunderstandthestories.Itwashardformetounderstandthewords.
Ihatedmyoldschool,Ifeltalittlebitmadabouthavingalearningproblem.Icouldntreadthewordsandtheotherkidscould.IhadtobesenttoaquietroomsoI
couldread.Somebodywouldhelpmethere.ItmademefeelhappywhenIfinallygotextrahelp.Itdidntmakemefeelbadtogotothespecialclassroom.
Thenafewyearsago,myparentsdecidedtosendmetoaspecialschoolforkidswithlearningdisabilities.Ilikeitthere,andtheteachershelpme.Theytreatme
nicelyandhelpmewithmyreading.Evenso,recessisstillthemostfun.Irunaroundtheplaygroundwiththegirls.
Myparentshelpmewithschoolwork.Mydadusedtoshowmeflashcards.Hestillhelpsmewithmymath,myreading,andmyspelling.Hemadealistofallthe
mathfactsIhavetolearnitstapednexttomybed.Myparentsaregoodtome.TheydontgetangryatmebecauseIhavelearningproblems.
Ithinkmycousinmayhavelearningproblems,too.Heisjustlittle.Hegoestoschool,andwhentheteacherreadsabookhewontlisten.Heislikemeatthatage.
Imgoodatart.Iliketodoselfportraitsandpaintanddoprojects.Iwouldratherpaintalldayinsteadofdoingmathorreading.Ilikeclassicalmusic.AndlastyearI
learnedtoplayCanCanonthekeyboard.Ipracticedeveryday.SometimesIwouldmessupalittle.ThenIwoulddoitoveragain,andIwoulddoitright.
Ithinkhighschoolwillbehard,veryhard.Iamgoingtostudybiologyincollegeitsallabouthumanbeingsandthebodyparts.IllbeateacherwhenIgrowup.I
willtellkidsnottofightorpinch.Iwanttoteachlittlekids.Theyrecute!
Michelestip:Iwouldtellotherkidswithlearningproblemstogetbooksandkeeptryingtoreadthem.
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Althoughitistheexceptionalchildwithwrittenlanguagedifficultieswhoiswithoutahistoryofspokenlanguagedifficulties(Stark&Tallal,1988),notallchildrenwith
SLIgoontobeidentifiedwithdifficultiesinwrittenlanguage.Factorsthatappeartopredictlaterproblemsinliteracyincludedifficultieswithreceptivelanguage,
phonologicalawareness,andrapidnaming(Leonard,1998).Phonologicalawarenessisexplicitknowledgeaboutthesoundstructureofthelanguageforinstance,
thatwordsaremadeupofsyllablesandsyllablesofindividualsounds(Ball,1993).Othercomplicationstobedealtwithinunderstandingtherelationshipbetween
languageimpairmentandlateracademicdifficultiesareatendencyforlowerintelligenceandlowerSEStoencroachaspotentialconfoundingvariables(Schachter,
1996).
Summary
1.Specificlanguageimpairment(SLI)isaresearchconstructdesignedtohelpidentifyapurelanguagedisorderandisusuallydefinedintermsofexclusionaryaswell
asinclusionarycharacteristics,althoughsuchdefinitionsareincreasinglycontroversial.
2.AmongfactorsthataresuspectedinthecausationofSLIaregenetics,differencesinbrainstructureandfunction,andotherbiologicalfactors.Environmentalfactors,
especiallyaspectsofthechildssocialenvironment,havebeenexamined,butappearlessimportantatthistime.
3.Inaddition,linguisticandcognitiveaccountsofcausationinSLIhavereceivedextensiveattentionfromresearchers.AccordingtoLeonard(1998),thethreemajor
categoriesintowhichtheseaccountsfitarethosefocusedonlinguisticknowledgedeficits,generalprocessingdeficits,andspecificprocessingdeficits.
4.AlthoughtheoreticalunderstandingofSLIcanultimatelybeexpectedtoengendermajorshiftsinassessment]methods,littletranslationfromexperimentalassessment
toolstothoseavailabletopracticingclinicianshasyetoccurred.Moreimmediateimpactmayderivefromcallsforresearchers(andclinicians)toassesslanguageand
otherperformancedomainsmorebroadlyandtoseekconsensusondiagnosticmethods.
5.SpecialchallengestoassessmentincludeproblemswiththefrequentexclusionofchildrenwithmentalretardationfromdefinitionsofSLI,theuseofcognitive
referencinginresearch,bureaucraticallydictatedprotocols,andtheoveruseofmeasuresinidentificationwithoutsufficientstudyoftheirvalidityforthatpurpose.
6.Asanadditionalchallenge,theproblemofdifferentiatingyounglatetalkersfromchildrenwhowillhaveapersistentimpairmentinlanguageposesspecialdifficulties.
7.Patternsoflanguageimpairmentcanrangefrommildtoquitesevereandcanaffectbothreceptiveandexpressivelanguage.Domainsoflanguagethatareparticularly
problematicforyoungchildrenlearningEnglishappeartoincludemorphology,syntax,andphonology.
8.Relatedproblemsforthesechildrenincludesomewhatincreasedriskforemotional,behavioral,andsocialdifficulties,aswellasgreaterriskforpersistentacademic
difficulties.
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KeyConceptsandTerms
anxietydisorder:anemotionaldisorderinchildreninwhichtheirexcessiveanxietyandworrying,usuallyaboutperformance,adverselyaffectstheirperformancein
schoolandathome.
attentiondeficitdisorder(withorwithouthyperactivity):apsychologicaldisorderinwhichindividualsdemonstrateexcessiveinattentionanddistractibility,
implusivityandhyperactivity,orbothwhencomparedwithotherindividualsthesameage.
cognitivereferencing:theuseofameasureofintelligence(usuallynonverbalIQ)asareferenceagainstwhichtodefineimpairedlanguageitisbasedonthe
assumptionthatnonverbalcognitionrepresentsanupperboundforlanguagefunction.
concordance:agreementinthepresenceorabsenceofadisorderbetweentwoindividualsinanaturalpair(e.g.,apairofidenticalorfraternaltwins).
conductdisorder:apsychologicaldisorderinwhichthereisapersistentpatternofviolatingsocialrights,othersrights,orsocietalnormsthroughbehaviorssuchas
aggressiontowardpeopleoranimals,destructionofproperty,theft,ordeceitfulness.
effectsize:Ameasurereflectingthemagnitudeofdifferencebetweengroupsinanexperimentalstudy.Whereasstatisticalsignificanceaddressesthereliabilityofa
researchfinding,effectsizeprovidesimportantinformationforjudgingtheimportanceofastatisticallysignificanteffect.
FastForWord:AcomputerizedtreatmentdevelopedbyPaulaTallal,MichaelMerzenich,andtheircolleagues,basedonthepremisethatSLIiscausedbydifficulties
intemporalprocessing.
generalallpurposeverbs:Verbs,suchasdoandget,thatoccurwithrelativelyhighfrequencyinthespeechofnormallydevelopingchildren,butthatalsotendtobe
overusedinthespeechofchildrenwhoarelatetalkers.
generalprocessingdeficitaccountsofSLI:explanationsofSLIinwhichprocessingdeficitsarepresumedtoaccountforbothverbalandnonverbaldifficulties
documentedinchildrenwithSLI.Thesurfacehypothesisisonesuchaccount.
incompletepenetrance:thefailureofagenetohavethesameeffectonallindividualswhocarryit,forexample,whenagenethatisusuallyassociatedwithaspecific
diseasedoesnotproducethatdiseaseinsomeindividualswhocarryit.
latetalkers:ChildrenwhoshowdelaysinlanguageproductionthatmayrepresentearlysignsofSLIorsimplyadelayinlanguagedevelopmentthatisovercomeas
thechildmatures.
linguisticaccountsofSLI:AccountsinwhichdeficitsinlinguisticknowledgeareconsideredthecoredeficitsinchildrenwithSLI.Rice,WexlerandCleaves
extendedoptionalinfinitiveisanexampleofthistypeofaccount.
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magneticresonanceimaging(MRI):arelativelynoninvasiveradiographictechniqueusedtostudybrainstructureinlivingindividuals.
phenotype:thebehavioraloutcomeforwhichageneticexplanationissought(Rice,1996).
phonologicalawareness:explicitknowledgeaboutthesoundstructureofthelanguage,forexample,knowingthatwordsaremadeofsyllables,andsyllablesof
individualsounds.
proband:theaffectedindividualinageneticstudy,whoseidentifieddisorderordifficultyleadstoresearchersincludingthemandmembersoftheirfamilyingenetic
research.
recast:arestatementofachildsproductionusinggrammaticallycorrectstructures,oftenincorporatingmorphosyntacticformsthathadbeenomittedorproducedin
errorbythechild.
riskfactors:factorsthatareassociatedwithincreasedlikelihoodthatadisorderwilloccurthesefactorsmayormaynotrepresentcauses.
specificlanguageimpairment(SLI):delayedacquisitionoflanguageskills,usuallydefinedasoccurringintheabsenceofimpairmentsinotherareasoffunctioning,
suchasnonverbalcognitionandhearing.
specificprocessingdeficitaccountsofSLI:explanationsofSLIinwhichspecificprocessingdeficits(e.g.,inauditoryprocessingorphonologicworkingmemory)
arethoughttoaccountforthelanguageandotherdifficultiesassociatedwithSLI.Tallalsaccountbasedontemporalprocessingdeficitsisoneexample.
StudyQuestionsandQuestionstoExpandYourThinking
1.HowmightknowledgethatSLIissometimescausedbydifferencesinbrainstructureaffectdiagnosis?Howmightitaffecttreatment?
2.Rememberingthatcooccurrencedoesnotmeancausation,considerthesignificanceofaphysicalmarker,suchasaspecificneurologicalanomaly,forSLI.What
othermechanismsmightexplainitspresencebesidesitshavingaroleincausingtheappearanceoflanguagelearningdifficulties?
3.IfyouweretheparentofachildwithSLI,whatmightyouwanttoknowaboutthegeneticsofthiscondition?Howmightyou,asaclinician,explainthisinformation,
andwherecouldyousuggestthatbothyouandtheparentobtainadditionalinformation?
4.DescribethreepossiblecooccurringproblemsthatmayaffectthecommunicationandtesttakingbehaviorsofachildwithSLI.
5.Onthebasisofyourreading,whatdomainsoflanguageandcommunicationhavebeenconsideredimportantbyresearchers?Canyoufindstandardizedteststhat
correspondtotheseareas?
Page140
6.Whatresearchquestionsdoyouthinkaremostimportantforfurtheringourunderstandingofthiscondition?
RecommendedReadings
Gilger,J.W.(1995).Behavioralgenetics:Conceptsforresearchandpracticeinlanguagedevelopmentanddisorders.JournalofSpeechandHearingResearch,38,
11261142.
Gillam,R.(1999).ComputerassistedlanguageinterventionusingFastForward:Theoreticalandempiricalconsiderationsforclinicaldecisionmaking.Language,
Speech,andHearingServicesinSchools,30,363370.
Hurford,J.R.(1994).Grammar:Astudentsguide.Cambridge,England:CambridgeUniversityPress.
Leonard,L.(1998).Childrenwithspecificlanguageimpairment.Cambridge,MA:MITPress.
References
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Aram,D.M.,&Nation.J.(1975).Patternsoflanguagebehaviorinchildrenwithdevelopmentallanguagedisorders.JournalofSpeechandHearingResearch,18,
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CHAPTER
6
ChildrenwithMentalRetardation
DefiningtheProblem
SuspectedCauses
SpecialChallengesinAssessment
ExpectedPatternofStrengthsandWeaknesses
RelatedProblems
Tracy,a10yearoldwithDownsyndrome,attendsaregularclassroom,wherehervoiceoftenringsoutassheexpressesexuberantenthusiasmforallthe
funthingsthathappen.Tracyspeaksinshortsentencesthatarefrequentlydifficulttounderstand.Althoughshesometimesshowsconsiderablefrustration
withothersnotunderstandingher,mostofthetimeTracyappearsoblivioustotheirlackofunderstanding.Aspeechlanguagepathologistworkswithher
ongoalsrelatedtosyntaxandintelligibility,usuallywithintheclassroom.
Seth,a4yearoldwithcerebralpalsyandepilepsyaswellasmentalretardation,attendsaspecialpreschoolclassroomirregularlybecauseofhisfrequent
illnesses.Intheclassroom,hespendsmuchofhistimeinawheelchairoradaptiveseat,whichwasdesignedtoprovidehimwiththeposturalsupportneeded
forhimtocontrolhisheadmovements.Inadditiontoworkingwithhimintheclassroom,aspeechlanguagepathologistvisitshishomeonceaweekto
workwithSethandhismother.Sethvocalizesinfrequentlyandoftenseemsunawareofothersinhisenvironment.Goalsforhim
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includeestablishingnonverbalturntakingskillsandincreasingthefrequencyofhisvocalizations.
Jakeisa12yearoldboywithmildmentalretardationassociatedwithFetalalcoholsyndrome.Althoughhiscomprehensionskillstestwithinthenormal
range,andheisgenerallyunderstandableinhislanguageproduction,Jakehasconsiderabledifficultyinfollowingdirectionsinschool.Hehasbeen
diagnosedwithADDandrequiresfrequentredirectingtostayinvolvedinclassroomactivities.Althoughheiseagertoestablishfriendshipswithhis
classmates,hisabilitytousesocialcuestoguidehiscommunicationsappearsinconsistent.InterventionforJakeincludesindividual,attentionwithinthe
classroomandparticipationinasocialskillsgroupwiththespeechlanguagepathologistonetimeperweek.
DefiningtheProblem
Tracy,Seth,andJakearerepresentativeoftheapproximately3%ofschoolagechildrenintheUnitedStateswhoexhibitproblemsassociatedwithmentalretardation
(Roeleveld,Zielhuis,&Gabreels,1997),wherementalretardationcanbedefinedasreducedintelligenceaccompaniedbyreducedadaptivefunctioning,thatis,
reducedabilitytofunctionineverydaysituationsinamannerconsideredculturallyanddevelopmentallyappropriate.Becausecommunicationisaparticularlyimportant
adaptivefunctionaffectedbymentalretardation,speechlanguagepathologistsoftenworkwithaffectedchildrenandtheirfamilies.
About85%ofchildrenwithmentalretardationexperiencemildproblems(Lubetsky,1990)andmaynotbeidentifiedasmentallyretardeduntiltheyreachschoolage.
Childrenwithmoresignificantdegreesofimpairmentareoftenidentifiedatanearlierpointbecausetheirdelaysinachievingdevelopmentalmilestonesaremore
pronouncedandbecausetheyoftenhaveadditionalmedicaldifficulties,suchascerebralpalsyorepilepsy(Durkin&Stein,1996).Althoughmentalretardationis
usuallypresentfrombirth,itcanalsobediagnosedforconditionsthatcanoccurupto18yearsofage,includingexposuretoenvironmentaltoxinssuchasleadoverthe
firstfewyearsoflife.
Despitethebriefdefinitionofferedearlier,formulatingamorecomplete,usabledefinitionofmentalretardationthatisequallyacceptabletofamilies,advocates,
scientists,clinicians,andpoliticianshasprovedcontroversialanddifficultsomewouldsayimpossibleparticularlywheremilderformsofretardationareconcerned
(Baumeister,1997Roeleveldetal.,1997).Table6.1providestwoofthemostinfluentialdefinitionscurrentlybeingusedthoseproposedbytheAmerican
AssociationforMentalRetardation(AAMR)andtheAmericanPsychiatricAssociation.
TheAAMRandAmericanPsychiatricAssociationdefinitionsbothspecifyimpairmentinadaptiveskillsasacriticalelementintheidentificationprocess.Traditionally,
IQscorealone,withlessattentiontoadaptiveskills,wascentraltotheidentificationprocess.Thesetwonewerdefinitionsaddressessentiallythesameadaptiveskills
(viz.,communication,selfcare,homeliving,socialskills,communityuse,selfdirection,healthandsafety,functionalacademics,leisure,andwork).Despitethis
uniformity,however,thesedefinitionsarestillquitecontroversialbecauseofsignificantconcerns
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Table6.1
TwoInfluentialDefinitionsofMentalRetardation
AmericanAssociationonMentalRetardation(Luckasson,1992)
Mentalretardationreferstosubstantiallimitationsinpresentfunctioning.Itischaracterizedbysignificantlysubaverageintellectualfunctioning,existingconcurrently
withrelatedlimitationsintwoormoreofthefollowingapplicableadaptiveskillareas:communication,selfcare,homeliving,socialskills,communityuse,self
direction,healthandsafety,functionalacademics,leisure,andwork.Mentalretardationmanifestsbeforeage18.
AmericanPsychiatricAssociation(1994)
Diagnosticcriteria:
Significantlysubaverageintellectualfunctioning:anIQofapproximately70orbelowonanindividuallyadministeredIQtest(forinfants,aclinicaljudgmentof
A.
significantlysubaverageintellectualfunctioning)
Concurrentdeficitsorimpairmentsinpresentadaptivefunctioning(i.e.,thepersonseffectivenessinmeetingthestandardsexpectedforhisorheragebyhisor
B. herculturalgroup)inatleasttwoofthefollowingareas:communication,selfcare,homeliving,socialandinterpersonalskills,useofcommunityresources,self
direction,functionalacademicskllswork,leisure,health,andsafety
C. Theonsetisbeforeage18years.
aboutthelackofvalidmeasuresformanyadaptiveskillareas(e.g.,Jacobson&Mulick,1996Macmillan&Reschly,1997)andbecauseofdebatesaboutthenumber
ofdimensionsneededtocaptureadaptivefunctioning(Simeonsson&Short,1996).
AlthoughnotevidentinTable6.1,thecompleteAAMRandAmericanPsychiatricAssociationdefinitionsdiffersharplyintheirhandlingofseverity.Whereasthe
AmericanPsychiatricAssociationdefinitionmaintainsatraditionaltreatmentofseverityusingasystemwithfivelevels(seeTable6.2),theAAMRsystem(Luckasson,
1992)replacesthosewiththedescriptionoflevelsofsupportneededbytheindividual(intermittent,limited,extensive,andpervasive)forintellectualabilityandforeach
adaptiveskillseparately.Becausetreatmentrecommendationsareoftenformulatedonthebasisofseverity(Durkin&Stein,1996),thischangeintheAAMRdefinition
representsamajordeparturefromlongstandingpractice.
Table6.2
DegreesofSeverityofMentalRetardationUsed
bytheAmericanPsychiatricAssociation(DSMIV,1994)
Degree IQLevel
Mildmentalretardation 5055toapproximately70
Moderateretardation 3540to4055
Severementalretardation 2025to3540
Profoundmentalretardation Below20or25
Usedwhenthereisastrongpresumptionofmentalretardationbuttheindividual
Mentalretardation,severityunspecified
cannotbetestedusingstandardizedinstruments
Page149
Radicalchangesindefinitionssuchasthosejustdescribedcanaffectthewaysinwhichgovernmentalandotheragenciesdeterminewhichchildrenareeligiblefor
assistance.Theyalsoaffectresearcherswhomustidentifythegroupofindividualstowhomtheirresearchcanbegeneralizedandcliniciansastheyworkwithinthe
bureaucracytohelpaffectedchildrenandtheirfamilies(Macmillan&Reschly,1997).Therefore,althoughwranglesoverdefinitionscanseemirrelevanttoabasic
understandingoflanguageimpairmentanditsassessmentinchildrenwithmentalretardation,theyarepowerfulindetermininghowsuchchildrencanbehelped.For
example,dependingonwhichofthetwodefinitionsdescribedinthissectionisusedandexactlyhowitisimplemented,Jake,thethirdchilddescribedatthebeginning
ofthechapter,mightnotbeidentifiedasachildrequiringspecialattentionintheschoolsetting.
SuspectedCauses
Untilthepastdecade,onlyabout25%ofcasesofmentalretardationwereassociatedwithknownorganiccauses(e.g.,Downsyndrome,perinataltraumaGrossman,
1983).Recentadvances,however,bringthatfigureuptoabout50%(AmericanPsychiatricAssociation,1994Baumeister,1997),withawiderangeoforganic
causesnowidentified.Suchcausesareoftenassociatedwithmoreseverecasesofmentalretardation(Rosenberg&Abbeduto,1993).
OrganicCauses
Classificationofthemanypre,peri,andpostnatalorganiccausesofmentalretardationrevealshumanvulnerabilitytoamyriadoffactorsthatcanalterlaterneurologic
developmentandfunction.Table6.3presentsalengthybutfarfromcompletelistofpredisposingfactors.Knowledgeofcausationcanhelpineffortstoprevent
retardationinsomeindividuals,tocounselfamiliesregardingitslikelihoodofrecurringinlaterchildren,andtodeveloptreatmentsthatcanpreventoramelioratelong
termnegativeconsequences.
ThreeimportantknowncausesofmentalretardationareDownsyndrome,fragileXsyndrome,andfetalalcoholsyndrome.Eachoftheseconditionsisdescribedasa
syndromebecauseitisassociatedwithacommonsetofphysicaltraitsormalformationssharingasimilarprognosis(Batshaw&Perret,1981).Twoofthese
syndromeshavegeneticcausesthethird,fetalalcoholsyndrome,hasapreventablecausenamely,intrauterineexposuretoalcohol,apowerfultoxintothedeveloping
brain.Considerationofthesesyndromesdemonstratestheintimateconnectionsbetweenthecauseofmentalretardationandthenatureofcommunicationandother
difficultiesconfrontingaffectedchildren(Cromer,1981Hodapp&Dykens,1994Hodapp,Leckman,Dykens,Sparrow,Zelinsky,&Ort,1992cf.Hodapp&
Zigler,1990).
DownsyndromeandfragileXsyndromearethemostcommongeneticbirthdefectsassociatedwithmentalretardation.Beginningtounderstandthesetwoconditions,
therefore,dependsonatleastabarebonesgraspofhumangenetics,whichwillbeofferedhere.MorelengthytreatmentscanbefoundinresourcessuchasM.M.
Cohen(1997).
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Table6.3
CategoriesofOrganicPredisposingFactorsAssociatedWithMentalRetardation
(AmericanPsychiatricAssociation,1994,p.43)
Percentageofcasesofmental
retardationassociatedwith
Category thisfactor Specificconditions
5 l Inbornerrorsofmetabolism(e.g.,TaySachsdisease)
l Singlegeneabnormalities(e.g.,tuberoussclerosis)
Heredity
l Chromosomalaberrations(e.g.,fragileXsyndrome,asmallnumberofcasesofDown
syndrome)
Earlyalterations 30
ofembryonic l Chromosomalchanges(mostcasesofDownsyndromethoseduetotrisomy21)
development l Prenataldamageduetotoxins(e.g.,maternalalchoholconsumption,infections)
Pregnancyand
perinatal l Fetalmalnutrition,prematurity,hypoxia(oxygendeficiency),viralandotherinfections,and
problems 10 trauma
Generalmedical
conditions
acquiredin
infancyor
childhood 5 l Infections,traumas,andpoisoning(e.g.,duetolead)
Probablythemostbasicfactsingeneticsincludetheinformationthatallcellsinthehumanbodyexceptforthereproductivecells(sperminmenandovainwomen)
contain23pairsofchromosomes.These23chromosomepairsconsistof22pairsofnumberedautosomesand1pairofsexchromosomes,whichareidentifiedas
XXforwomenandXYformen.Thesechromosomes,whichholdmanyindividualgenes,actastheblueprintsforcellfunctionandthusdetermineanindividuals
physicalmakeup.
Unlikeotherhumancells,ovaandspermcellshavehalftheusualnumberofchromosomes23nonpairedchromosomesandonesexchromosome.Duringthe
reproductiveprocess,thisfeatureofreproductivecellsallowseachparenttocontributeonehalfofeachoffspringsgeneticmaterialasthegeneticmaterialsofboth
reproductivecellsarecombinedduringfertilization.Becausechromosomescontainnumerousgenes,defectstoeitherthelargerchromosomesortoindividualgenescan
resultinimpairedcellularfunctionduringembryonicdevelopmentandlaterlife.
Downsyndromeisanexampleofanautosomalgeneticdisorderinwhichextrageneticmaterialisfoundatchromosomepair21.Thisconditionarisesaboutoncein
every800livebirths,makingitthemostcommongeneticdisorderassociatedwithmentalretardation.About95%ofthetime,Downsyndromeoccursbecausean
entire
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Fig.6.1.GraphicrepresentationofthegenetictestusedtoidentifythepresenceofTrisomy21.FromBabiesWithDownSyndrome:ANewParentsGuide(p.8),
byK.StrayGunderson(Ed.),1986,Kensington,MD:WoodbineHouse.Copyright1986byWoodbineHouse.Reproducedwithpermission.
extrachromosomeispresent,resultingintheindividualspossessingthreechromosomesofchromosome21knownastrisomy21,insteadofthenormalpairingof
chromosomes(Bellenir,1996).Figure6.1illustratesthecompletesetofchromosomesassociatedwithagirlwhohasDownsyndrome.
Lessfrequently,Downsyndromeisassociatedwithonlyaportionofanextrachromosomeoccurringatchromosome21orwiththeoccurrenceofanentireextra
chromosome21,butonlyinsomecellswithinthebody(termedmosaicDownsyndrome).Usuallythechromosomaldefectoccursduringthedevelopmentofan
individualovum,butitcanoccurbecauseofaspermdefectoradefectoccurringaftertheunitingofthespermandovuminfertilization.Becauseofthistimingofthe
changeinthegeneticmaterial,Downsyndromeisdescribedasageneticdisorder,butnotaninheritedone,inwhichbothparentandchildareaffected.
Downsyndromeisassociatedwithacharacteristicphysicalappearance,involvingslantedeyes,smallskinfoldsontheinnercorneroftheeyes(epicanthalfolds),
slightlyprotrudinglips,smallears,anoverlylargetongue(macroglossia),andshorthands,feet,andtrunk(Bellenir,1996).Figure6.2showstwoyoungchildrenwith
thissyndrome.
OthermoreseriousphysicalanomaliesfoundamongchildrenwithDownsyndromeaffectthecervicalspine,bowel,thyroid,eyes,andheart(Cooley&Graham,
1991).ChildrenwithDownsyndromearemoresusceptibletoinfection,includingotitismedia
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Fig.6.2.TwochildrenwithDownsyndrome.
(Cooley&Graham,1991),andare20timesmorelikelythanotherchildrentodevelopanddiefromleukemia.Becauseoftheseabnormalities,asagrouptheirlife
expectancyissomewhatshortened,despiterecentadvancesinthecorrectionofcongenitalheartdefects,improvedcontrolofinfections,andavoidanceof
institutionalization.Roughly80%ofthesechildrenwilllivetotheageof30andbeyond(Cooley&Graham,1991).AdultswithDownsyndromehavealsobeenshown
tobeatincreasedriskfortheonsetofAlzheimerslikedementia,ordeclineinintellectualfunction(Connor&FergusonSmith,1997Zigman,Schupf,Zigman,&
Silverman,1993)
FragileXsyndromeiscurrentlythoughttobethesinglemostcommoninheritedcauseofmentalretardation(Baumeister&WoodleyZanthos,1996).Althoughit
occurslessfrequentlythanDownsyndromethemostfrequentgeneticcauseofmentalretardationfragileXismorefrequentlyinheritedthanDownsyndrome
becauseDownsyndromeisalmostneverpassedfromonegenerationtothenext.
FragileXoccursaboutonceinevery1250to2500menandabouthalfthatofteninwomen(Bellenir,1996).AlthoughfragileXcanoccurineithergender,itismore
oftenassociatedwithmentalretardationinaffectedmen.Whenmentalretardationoccurs,itcanrangefrommildtoprofoundlevels,withgenerallymilderimpairmentsin
affectedwomen(Dykens,Hodapp,&Leckman,1994).Becauseitspatternsofinheritancearemorecomplexthanthoseseeninotherpreviouslyidentifiedgenetic
disorders,fragileXwasonlyidentifiedinthe1970s(Lehrke,1972).
FragileXsyndromeinvolvesthesinglegeneFMR1,presentontheXchromosome,whichcanbedefectiveorabsent.Apartiallydefectivegeneisreferredtoasapre
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mutationandmaybeassociatedwithverymildorevennoobviousproblemsintheaffectedperson.Whenthedefectisgreater,orthegeneFMR1isabsent,more
seriousproblems,includingseveretoprofoundmentalretardation,arethelikelyoutcome.
FragileXsyndromeisinheritedthroughanXlinkedmodeoftransmission(similartohemophilia)inwhichsomeindividualsarecarriers(usuallywomen)andothers
areaffectedindividuals(usuallymen).FathershaveonlyoneXandoneYchromosome.Consequently,theycanonlytransmitadefectiveXchromosometoa
daughter,whowillhavereceivedasecondXfromhermother(whohastwoXandnoYchromosomes).BecauseonlyoneofthetwoXchromosomesinagirlislikely
tobeactive,itispossiblefordaughterstoappearunaffected,buttobecarriersofthedefectivechromosome.Theycanalsobeaffected,however,iftheypossesstwo
defectiveXchromosomesorifthedefectiveXchromosomeforsomereasonistheactiveone.Aboutonethirdofthosegirlswiththedefectivegenewillbeofnormal
intelligence,onethirdwillhaveborderlineintelligence,andonethirdwillhavegreaterdegreesofmentalretardation(AmericanCollegeofMedicalGenetics,1997).
About50%ofthemaleoffspringofcarrierwomenwilldemonstratefragileXsyndrome(Dykensetal.,1994),andmostofthesechildrenwillhavementalretardation.
BoyswithfragileXandmentalretardationoftensharethefollowingphysicaltraits:along,narrowfacelong,thick,prominentearsandoverlylargetesticles(Dykenset
al.,1994).Figure6.3showstwoyoungsterswiththiscondition.Beyondthephysicaltraitsnotedthroughoutlife,childrenareatriskforobesityduringadolescence.On
thebasisofasmallernumberofstudiesthanthoseundertakenformaleswithfragileX,itappearsthatfemaleswithfragileXshowsomesimilartraitstothoseofmales,
althoughtoalesserextent.ConditionsthattendtoaccompanymentalretardationinchildrenwithfragileXareADDandADHD,anxietyandmooddifficulties,aswell
asauditoryandvisualproblems(Dykensetal.,1994).ConsiderablecontroversyhassurroundedtherelationshipbetweenfragileXandautisticdisorder(chap.7,this
volumeI.L.Cohen,1995).Therehasbeensomespeculationthattherateofcooccurrencemaybeduetothelevelofmentalretardationratherthantoetiology
(Dykensetal.,1994).However,workbyI.L.Cohen(1995)suggeststhatboyswithbothautismandfragileXaremoresignificantlyimpairedthanwouldbeexpected
iftheeffectsofeachconditionweresimplyadditive.
Fetalalcoholsyndrome(FAS)referstotheconstellationofphysicalabnormalities,deficientgrowthpatterns,andcognitiveandbehavioralproblemsfoundinchildren
whosemothersdrankheavilyduringpregnancy.Fetalalcoholeffect(FAE)isacloselyrelateddiagnosisinwhichonlysomeportionoftheconstellationof
abnormalitiesdescribedforFASisseenintheaffectedchild(Stratton,Howe,&Battaglia,1996).
Althoughapossibleconnectionbetweenalcoholconsumptionbymothersduringpregnancyandsubsequentbirthdefectshasbeenknownthroughouthistory,onlyin
thelate1960sandearly1970swasFASformallydescribed(Strattonetal.,1996).Despiteitshavingreceivedconsiderableattentiononlyrecently,FAShasbeen
proposedasthemostcommonknownnongeneticcauseofmentalretardation(Strattonetal.,1996,p.7),withestimatesofincidencerangingfrom0.5to3birthsper
1000livebirths(Strattonetal.,1996).ThehigheroftheseincidencefiguresmakesFASamorefrequentcauseofmentalretardationthaneitherDownsyndromeor
fragileXsyndrome.
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Fig.6.3.TwoyoungboyswithFragileXsyndrome.
Inaddition,itisthoughttobewidelyunderdiagnosed(Maxwell&GeschwintRabin,1996).
Alcoholisoneofmanydifferentsubstanceswellknowntobetoxictothedevelopingcentralnervoussystem.However,thespecificmechanismbywhichalcohol
consumptionleadstothevarietyofdifficultiesseeninFASorFAEispoorlyunderstood(Baumeister&WoodleyZanthos,1996).Ingeneral,themagnitudeandnature
ofatoxinseffectsonprenataldevelopmentarethoughttobecloselyrelatedtotheamountofthetoxin,thetimingofexposure,andthegeneticmakeupofthemother
andchild(Strattonetal.,1996).Currently,however,littleisknownabouthowthosevariablesinteracttoproducethebroadrangeofeffectsseeninchildrenwithfull
FASorwithFAE.Particularlypuzzlingareobservationsthatsomewomenwhodrinkveryheavilythroughouttheirpregnancycangivebirthtounaffectedchildren,
whereasotherwomenwhodrinkfarlesscangivebirthtochildrenwithseveresymptoms.Thisuncertaintyabouthowdamageiscausedhasresultedinstrong
prohibitionsagainstdrinkingduringpregnancyuntilmoreisknownaboutwhat,ifany,degreeofexposureissafe.
Asagroup,childrenwithfullFAStendtohavemildmentalretardation,butforindividualchildren,cognitivelevelscanrangefromsevereretardationtonormalfunc
Page155
tion.Inadditiontomentalretardation,cardiacandskeletalabnormalitiesandvisionproblemshavealsobeennoted.Facialabnormalitiesapparentduringearly
childhoodincludethepresenceofepicanthalfolds(suchasthoseseeninDownsyndrome),eyelidsthatareoverlynarrowfrominnertooutercorner,aflatmidface,
smoothorlongphiltrum(areaabovetheupperlip),andthinupperlip(Sparks,1993).Thesefacialfeaturesaresometimeslesspronouncedininfancyandafter
childhood,sotheyarenotasusefulasindicatorsofthisproblemforsomeagegroupsasforothers.Congenitalhearinglossisanotherareaofincreasedrisk(Strattonet
al.,1996).Figure6.4showstwoyoungstersaffectedbyFAS.
NonorganicSuspectedCauses
Despitethegrowingfrequencywithwhichbiologicalcausesofmentalretardationareidentified,abouthalfofallcasesofmentalretardationdonothavesuchwell
definedexplanations.Insuchcases,thedegreeofretardationtendstobemilder,andtheretardationtendstobeassociatedwithafamilyhistoryofmentalretardation
andlowSES(Rosenberg&Abbeduto,1993).Historically,suchcaseswereclassifiedasnonorganicorfamilialmentalretardation.
Fig.6.4.Twoyoungsterswithfetalalcoholsyndrome.FromFetalAlcoholSyndrome:Diagnosis,Epidemiology,Prevention,andTreatment(Figure11,p.18),
byK.Stratton,C.Howe,&F.Battaglia(Eds.),1996,Washington,DC:NationalAcademyPress.Copyright1996byNationalAcademyPress.Reproducedwith
permission.
Page156
Despitetheimplicationsthatthesecasesinvolvesocialorexperientialbases,thereisconsiderablespeculationthatnonorganiccasesofmentalretardationmayactually
reflectourcurrentlackofknowledgeratherthantrulynonorganiccauses(Baumeister,1997Richardson&Koller,1994).Manycasesnowidentifiedasnonorganic
mayberecategorizedastherelationshipoflowSESandfamilyhistorytoexposuretoenvironmentaltoxins(e.g.,lead),poornutrition,andotherultimatelyorganic
causesareuncovered.Theonemajor,trulynonorganicfactorassociatedwithmentalretardationisseveresocialdeprivation,asaresultofeitherinadequateinstitutional
conditionsorlimitationsofachildsprincipalcaregiver(Richardson&Koller,1994).Yeteventhatmechanismmayactbydeprivingtheinfantsmaturingnervous
systemoftheproperinputstopromotespecificphysiologicalstatesrequiredforbraindevelopment.
SpecialChallengesinAssessment
Oneofthemostimportantthingstokeepinmindwhentryingtounderstandanychildishisorheruniquenesstheuniquenessofcurrentstrengthsandweaknesses,
history,andfamilysituation.Mostimportant,thereistheneedtorememberthatuniquenessthatmakesthemTracyorSethorJake,ratherthanjustthechildwith
aparticularsyndromeandpatternofdeficits.Assessingchildrenwithmentalretardationtemptssomeindividualstoequatethemwiththeirlevelofretardationorits
etiologyandtemptssomepeopletopayattentiontowhattheycannotdoratherthantowhattheyaredoingintheircommunications.PersonalPerspective6hintsatthe
negativeeffectsofsuchamistake.
PERSONALPERSPECTIVE
ThefollowingpassageistakenfromabookwrittenbyapairofyoungadultfriendswhohaveeachbeendiagnosedwithDownsyndrome.Thetitleoftheirbookis
CountUsin:GrowingupWithDownSyndrome(Kingsley&Levitz,1994,p.35).
August90
Mitchell:IwishIdidnthaveDownsyndromebecauseIwouldbearegularperson,aregularmainstreamnormalperson.BecauseIdidntknowIhadDown
syndromesincealongtimeago,butIfeelveryspecialinmanyways.Ifeelthatbeingwith,havingDownsyndrome,theresmoretoitthanIexpected.Itwasvery
difficultbutIwasabletohandleitverywell.
Jason:ImgladtohaveDownsyndrome.Ithinkitsagoodthingtohaveforallpeoplethatarebornwithit.Idontthinkitsahandicap.Itsadisabilityforwhat
yourelearningbecauseyourelearningslowly.Itsnotthatbad.(p.35)
Howdoyouavoidthesetemptations?First,planassessmentsusinginitialhypothesesaboutdevelopmentallevelsandpatternsofimpairment(whichwillbedescribedin
thenextsection)andoninformationobtainedfromcaregiversorotherswhoknow
Page157
thechildwell.Framingtheassessmentquestionswithspecialclaritycanhelpyouanticipatetheparticularchallengesindividualchildrenmightposetothevalidityof
conventionalinstruments.
Second,preparetoalteryourplanasneededtokeepthechildengagedandinteracting.Notonlydoesthismeanthatyoumayneedtoturnawayfromastandardized
instrumentmidstream(e.g.,ifitisdevelopmentallyinappropriate)infavorofamoreinformalordynamicassessmentmethod(seechap.10),youmayalsowantto
considertheuseofadaptations.
Testadaptationsarechangesmadeintheteststimuli,responserequiredofthechild,ortestingprocedures(Stagg,1988Wasson,Tynan,&Gardiner,1982).Onthe
onehand,theuseoftestadaptationsthreatensthevalidityofnormreferencedcomparisonsthatmaybemadeusingtheinstrument.Therefore,ifaclinicalquestionthat
reallyrequiresthatkindofcomparisonisatstake(e.g.,aninitialevaluationinwhichadifferencefromnormsmustbedemonstratedtohelpachildreceiveservices),the
clinicianwillavoidadaptationsifpossible.Ontheotherhand,whensomeaspectofthestandardadministrationotherthanthebasicskillorknowledgebeingtested
interfereswithachildsabilitytorevealhisorheractualskillorknowledge,onecanarguethatthevalidityofthecomparisonhasalreadybeenseverelycompromised.
Table6.4listssomeofthemostcommonadaptationsused.Regardlessofwhichadaptationsareused,theyshouldbedescribedinreportsoftestresultsandthe
clinicianshouldcom
Table6.4
ExamplesofTestingAdaptationsUsedFrequently
WithChildrenWithMentalRetardationandFrequentCoexistingProblems(Stagg,1988)
Reasonfor
Adaptation RecommendedAdaptations
l Increaseduseofsocial,tangible,andactivityreinforcers(Fox&Wise,1981)
l Breakingupadministrationintosmallerperiodsoftimetomaximizeattention
Attentionandmotivation
l Useofauditorycommandsorvisualcueing(e.g.,withalightpen)todirectattentionpriortoeachitem(Wasson,Tynan,
&Gardiner,1982)
l Replacementoftabletopadministrationtopositionachildtoachieveoptimalmotorperformance
l Useofalternativeresponsemodes(e.g.,gazel.,headpointers,oralinsteadofpointingWasson,Tynan,&Gardiner,
Motorskills 1982)
l Removalofresponsetimerestrictions
l Breakingupadministrationintosmallerperiodsoftimetoaddressfatigue
l Substitutionofsignfororalpresentation
Hearing l Additionofgestureorsigntooralpresentation(Wasson,Tynan,&Gardiner,1982)
l Positioningtoenhancechildsaccesstovisualinformationandtooptimizeresidualhearing
l Substitutionofstandardvisualstimulibyhighcontraststimuliorlargerstimuli
Vision
l Placementofallstimuliwithinthechildsvisualfield(asdeterminedpriortotesting)
Page158
mentontheextenttowhichtheseadaptationsarelikelytointerferewiththevaliduseofnorms.
RelatedtotheuseofadaptationsisamethodthatSattler(1988)hasproposedasafollowuptostandardizedtestadministrationtestingoflimits.Atestoflimits
involves(a)providingadditionalcues,(b)changingtestmodality(e.g.,fromwrittentooral),(c)establishingmethodsusedbythetestedchild,(d)eliminatingtimelimits,
and(e)askingprobingquestionsdesignedtoclarifyachildsthinkingleadingtoaresponse.Itismeanttohelpthecliniciangainanappreciationofhowachildhas
approachedthetaskandwhataspectsofitinterferedwithsuccess.Itiscloselyrelatedtodynamicassessmentapproaches,whichIdescribeingreaterdetailinchapter
10.
SpecialissuesintestingthatIdiscussinlaterchaptersofthebookareoutofleveltestinganddiscrepancytesting.Exceptforbriefdefinitions,thesetopicsarenot
addressedherebecausetheyarealsorelevanttosomeoftheothergroupsofchildrendiscussedinthenextfewchapters.Outofleveltesting(Berk,1984)refersto
theuseofaninstrumentdevelopedforchildrenofadifferentagegroupfromthatofthechildtobetested.Inthecontextofchildrenwithmentalretardation,thisisdone
inordertousecontentthatisdevelopmentallyappropriate.Thispracticeisdiscussedagaininchapter10.
Discrepancytestingreferstothecomparisonofperformancesintwodifferentbehavioralorskillareas(e.g.,betweenabilityandachievement)todeterminewhethera
discrepancyexists.Thiskindoftestingisimportantforchildrenwithmentalretardationbecauseitwilloftenberequiredaspartoftheproceduresdictatedwithinan
educationalsystemtojustifytheprovisionofspecifickindsofassistance.Thistopicisdiscussedrepeatedlythroughoutthisbook,butespeciallyinchapters9and10,
becauseitrepresentsoneofthegreatestcontemporarychallengestoassessment.
ExpectedPatternofStrengthsandWeaknesses
Inpsychologyandspecialeducation,levelofmentalretardationhasplayedamuchgreaterrolethanetiologyintheidentificationofparticipantsforresearchstudiesand
thedevelopmentoftreatmentapproaches(Baumeister,1997Hodapp&Dykens,1994).However,thereisagrowingsensitivitythatbothetiology(e.g.,Down
syndrome,fragileXsyndrome)andlevelofmentalretardation(viz.,mild,moderate,severe,profound)provideusefulbasesforsometentativepredictionsregarding
likelypatternsofbehavioralstrengthsandweaknesses(Miller&Chapman,1984).SyndromesforwhichcommunicationskillshavebeenextensivelystudiedareDown
syndromeand,toalesserextent,fragileXsyndrome.Severalothersyndromes,suchasWilliamsSyndrome(Bellugi,Marks,Bihrle,&Sabo,1993Mervis,1998),
PraderWilli(Donaldson,Shu,Cooke,Wilson,Greene,&Stephenson,1994),andTurnerSyndrome(Downey,Ehrhardt,Gruen,Bell,&Morishima,1989)have
beguntobestudied.
Table6.5summarizestentativepatternsofstrengthsandweaknessesastheyhavebeensuggestedforchildrenwithDownsyndrome,fragileX,FAS,andWilliams
syndrome,acongenitalmetabolicdiseaseusuallyassociatedwithmoderatetoseverelearningdifficulties.(Williamssyndromewasnotdiscussedpreviouslyinthis
chapter
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Table6.5
PatternsofStrengthsandWeaknessesAmongChildrenWithMentalRetardationAssociated
WithDownSyndrome,FragileXSyndrome,FetalAlcoholSyndrome,andWilliamsSyndrome
Morphology(Fowler,1990Rondal,1996)
l Strengths:
Syntax(Fowler,1990Rondal,1996)
l l Adaptivebehavior(Hodapp,1996)
l Phonology(Rondal,1996) l Pleasantpersonality(Hodapp,1996)
l Expressiveskillsrelativetoreceptiveskills Weaknesses:
l Semantics(Rondal,1996) (Dykens,Hodapp,&Leckman,1994) l Lowtaskpersistence(Hodapp,1996)
1996) l Visualmonitoring
l Increasedriskofhearingloss(Bellenir,1996) l Hypotonia(Hodapp,1996)
l Increasedriskoffluencydisorder l Sloworientingtoauditoryinformation
(Bloodstein,1995) (Hodapp,1996)
l Fluencyabnormalities(e.g.,perseverativeand Strengths:
l Expressivevocabularyskills(Rondal staccatospeech,rateofspeech,cluttering l Adaptiveskills(especiallyinpersonaland
(Continued)
Page160
Table6.5(Continued)
Strengths:
l Cognitivedelays,whenpresent,areusually
mild
Weaknesses:
l Comprehension
Fetalalcoholsyndrome l Mostareasoflanguagerelatively l Attentionalproblemsorhyperactivity
l Pragmatics(e.g.,frequentlytangential
andfetalalcoholeffect unaffected (Stratton,Howe,&Battaglia,1996)
responsesAbkarian,1992)
l Increasedriskforvisualandhearingproblems
(Stratton,Howe,&Battaglia,1996)
l Increasedriskforbehaviorproblems
(Stratton,Howe,&Battaglia,1996)
l Expressivelanguage(Rondal&
Edwards,1997)
l Morphologyandsyntax(Rondal&
Edwards,1997)
Strengths:
l Lexicalknowledge(Rondal&
l Facialrecognition(Rondal&Edwards,1997)
Edwards,1997) l Receptivelanguage(Udwin&Yule,1990).
Weaknesses:
l Metalinguisticknowledge(Rondal& l Pragmaticsskills(sociallyinappropriate
Williamssyndromeb l Severevisuospatialdeficits(Rondal&
Edwards,1997) content,pooreyecontactRondal&Edwards,
Edwards,1997)
l Fluency,prosody(Rondal& 1997)
l Hyperacusis(negativelysensitivetonoise),
Edwards,1997)
especiallyyoungerchildren
l Narrativeskills(Rondal&Edwards,
1997)
l Phonologicalskills(Rondal&
Edwards,1997)
aPatternsrelatealmostentirelytoaffectedmalesbecauseofthepaucityofdataonaffectedfemales.
bPatternsbasedonaverylimiteddatabase.
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becauseofitsrarity.)BecausethefourgroupsofchildrendescribedinTable6.4haveexperiencedverydifferentlevelsofscrutiny,theydifferinthecertaintywithwhich
thesestrengthsandweaknessesareknown(Hodapp&Dykens,1994).Specifically,childrenwithDownsyndromehavereceivedmuchmoreattentionthanthosewith
fragileX,whohave,inturn,receivedconsiderablymoreattentionthanthosewithWilliamsorFAS.Interestingly,therehasevenbeensomeworksuggestingthatthe
specifictypeofchromosomalabnormalityresultinginDownsyndromeresultsindifferentprognosesforcommunicationoutcomes,withbettercommunicationskills
predictedforthosechildrenwithmosaicDownsyndromethanwiththemorecommontrisomy21(Rondal,1996).
RelatedProblems
Childrenwithmentalretardationareatriskforavarietyofadditionalhealthrelatedandsocialproblems,particularlyiftheretardationismoresevere(American
PsychiatricAssociation,1994).Forexample,twomedicalconditionsthatoccurfrequentlyamongchildrenwithsevereorprofoundmentalretardationareepilepsyand
cerebralpalsy,whichhaveexpectedpercentageofoccurrenceratesof1936%forepilepsyand2040%forcerebralpalsy(Richardson&Koller,1994).
Overall,childrenwithmentalretardation,regardlessofetiology,appeartobeatfourtimesthenormalrisklevelforADHD,althoughthereissomequestionasto
whethertheirattentionproblemsarereallymanifestationsofmentalretardationratherthananindependentadditionalproblem(Biederman,Newcorn,&Sprich,1997).
Otherbehavioralandemotionalproblemsarealsoobservedmorefrequentlyamongindividualswithmentalretardationthanamongothers,includingconductdisorder,
anxietydisorders,psychozoidaldisorder,anddepression(Eaton&Menolascino,1982).
Often,theetiologyofmentalretardationiscloselyassociatedwithrisklevelsforparticularproblems.Forexample,differentkindsofvisualproblemsarefoundin
childrenwithDownsyndromethaninchildrenwithfragileXsyndrome.WhereaschildrenwithDownsyndromewillfrequentlyexperiencenearsightednessand
cataracts(Connor&FergusonSmith,1997Lubetsky,1990),childrenwithfragileXsyndromewillmorecommonlyhavestrabismus,aprobleminthecoordination
ofeyemovements(Maino,Wesson,Schlange,Cibis,&Maino,1991).
Childrenwithdevelopmentalandspeechdelayshavealsobeenfoundtobeatincreasedriskformaltreatment,includingphysicalabuse,sexualabuse,andneglect
(Sandgrund,Gaines,&Green,1974Taitz&King,1988).Giventheclosecontactthatspeechlanguagepathologistsfrequentlyhavewiththeirclients,thisincreased
incidenceofmaltreatmentmakesitparticularlyimportantforthemtobeawareofsignsofmaltreatment(Veltkamp,1994).
Summary
1.Mentalretardation,whichaffectsabout3%ofchildrenintheUnitedStates,involvesreducedintelligenceandreducedadaptivefunctioning.
2.Moreseverelevelsofmentalretardation(i.e.,moderate,severe,andprofound)areoftendiagnosedrelativelyearly,butarerelativelyuncommon,affectingonly15%
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ofthosechildrendiagnosedwithmentalretardation.Mildmentalretardationaffectsabout85%ofchildrenwithmentalretardationbuttendstobediagnosedlater
sometimesnotuntilschoolage.
3.DefinitionsofmentalretardationproposedbytheAAMRandtheAmericanPsychiatricAssociationdifferprimarilyintheircharacterizationofseverity,withthe
AAMRdefinitionproposinglevelsofsupportneededfornumerousintellectualandadaptivefunctionsinplaceoflevelsofimpairment.
4.Increasingly,organicfactors,asopposedtofamilialornonorganicfactors,arebeingidentifiedasreasonableexplanationsforcasesofmentalretardation.Thethree
mostcommonorganiccausesofmentalretardationareDownsyndrome,fragileXsyndrome,andFAE.
5.DownsyndromeandfragileXsyndromearethemostfrequentgeneticsourcesofmentalretardation.Downsyndromeisalmostalwaysassociatedwitha
chromosomalabnormality,whereasfragileXsyndromeisassociatedwithanerrorinvolvingasinglegeneontheXchromosome.
6.FAS,whichisusuallyassociatedwithmildmentalretardation,isconsideredthemostfrequentpreventablecauseofmentalretardation.
7.Assessmentchallengesincludetheneedforparticularlycarefulselectionofdevelopmentallyappropriateinstruments,increasedneedforlessformalmeasures
becauseofalackofappropriatestandardizedmeasure,andtheneedtoadaptteststohelpinsurethataspectsofthechildsdifficultiesthatareunrelatedtotheconcept
beingtestedarenotpreventingsuccessfulperformance.
8.Expectedpatternsofcommunicationperformancearerelatedtolevelofmentalretardationandtoetiology.
KeyConceptsandTerms
adaptivefunctioning:reducedabilitytofunctionineverydaysituationsinamannerconsideredculturallyanddevelopmentallyadequate.
autosomes:themostcommontypeofchromosomewithinthehumancell.Theyareusuallycontrastedwiththesexchromosomes,whichtypicallyconsistofasingle
pair(XXforwomenandXYformen).
chromosomes:structureswithinhumancellsthatcarrythegenesthatactasblueprintsforcellfunction.
dementia:asignificantdeclineinintellectualfunction,usuallyafteraperiodofnormalintellectualfunction.
discrepancytesting:thecomparisonofperformancesintwodifferentbehavioralorskillareas(e.g.,betweenabilityandachievement)todeterminewhethera
discrepancyexistsoftenusedasarequirementforservicesineducationsystems.
Downsyndrome:anautosomalgeneticdisorderthatisconsideredthemostcommongeneticabnormalityresultinginmentalretardation.Itisassociatedwithmildto
severementalretardationandparticularlymarkeddifficultieswithsyntaxandphonology.
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fetalalcoholeffect(FAE):adiagnosisrelatedtoFAS,inwhichsomebutnotalloftheabnormalitiesrequiredforadiagnosisofFASareobserved.
Fetalalcoholsyndrome(FAS):theconstellationofphysicalabnormalities,deficientgrowthpatterns,andcognitiveandbehavioralproblemsfoundinchildrenwitha
significantprenatalexposuretoalcohol.
fragileXsyndrome:themostcommoninheritedcauseofmentalretardationitisrelatedtoanXchromosomeabnormalitythatmaybepassedthroughseveral
generationsbeforebecomingsevereenoughtoresultinmentalretardation.Thesyndromemorecommonlyaffectsmenthanwomen.
mentalretardation:reducedintelligenceaccompaniedbyreducedadaptivefunctioning.
mosaicDownsyndrome:anuncommonformofDownsyndromeoccurringinlessthan5%ofcases,whentrisomy21affectsonlysomeratherthanallcellsinthe
body.
outofleveltesting:theuseofaninstrumentdevelopedforchildrenwhoseagediffersfromthatofthechildtobetested(Berk,1984).
premutation:agenethatissomewhatdefectivebutnotassociatedwithsignificantabnormalities,ascanhappeninfamilieswherefragileXsyndromeissubsequently
identified.
sexchromosomes:genebearingchromosomesassociatedwithgenderrelatedcharacteristicsthesearerelatedtonumerousbirthdefectsinwhichpatternsof
transmissionappeartobeaffectedbygender.
strabismus:aproblemineyemovementcoordination,sometimesreferredtoascrossedeyes.
trisomy21:themosttypicalchromosomalabnormalityinDownsyndrome,consistingofathirdchromosome21.
Williamssyndrome:acongenitalmetabolicdiseaseusuallyassociatedwithmoderatetoseverelearningdifficulties.
StudyQuestionsandQuestionstoExpandYourThinking
1.Whatarethemajorcommoncomponentsofthedefinitionsofmentalretardationprovidedinthischapter?
2.Describethreepossiblecooccurringproblemsthatmayaffectthecommunicationandtesttakingbehaviorsofachildwithmentalretardation.
3.Whatisthemostcommoninheritedcauseofmentalretardation?Whatisthemostcommonpreventablecause?
4.Determinethedefinitionformentalretardationusedinaschoolsystemnearyou.HowdoesthatdefinitioncomparetothoseoftheAAMRandtheAmerican
PsychiatricAssociation?
5.OnetestofadaptiveskillsthatisfrequentlyusedistheVinelandAdaptiveBehaviorScales(Sparrow,Balla,&Cicchetti,1984).Examinethatmeasureinterms
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ofitemsrelatedtocommunication.Whatlanguagedomains(e.g.,semantics,syntax,morphology,pragmatics)andwhatlanguagemodalities(speaking,listening,writing,
reading)areemphasized?
6.UsingaformatlikethatusedinTable6.5,identifyasyndromenotdescribedinthischapter(e.g.,PraderWillisyndrome,criduchat)andprepareabrieflistof
expectedpatternsoflanguageandcommunication.
7.Examinethetestmanualofalanguagetesttodetermine(a)what,ifanything,issaidabouttheappropriatenessofthemeasureforachildwithmentalretardation,and
(b)whataspectsofoneormoretasksincludedinthetestmightbeincompatiblewiththecharacteristicsofthefollowingchildren:
l achildwithseverecerebralpalsyandmoderateretardationwhoseonlyreliableresponsemodeisaslow,effortfulpointingresponse
l achildwithmildretardationbutsevereattentionandmotivationalproblemsand
l achildwithDownsyndromewhohasmoderateretardationandaseverevisualimpairment.
RecommendedReadings
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Dykens,E.M.,Hodapp,R.M.&Leckman,J.F.(1994).BehavioranddevelopmentinfragileXSyndrome.ThousandOaks,CA:Sage.
Hersen,M.,&VanHasselt,V.(Eds.).(1990).Psychologicalaspectsofdevelopmentalandphysicaldisabilities:Acasebook.NewburyPark,CA:Sage.
Rondal,J.A.,&Edwards,S.(1997).Languageinmentalretardation.SanDiego,CA:Singular.
StrayGunderson,K.(Ed.).(1986).BabieswithDownsyndrome:Anewparentsguide.Kensington,MD:WoodbinePress.
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CHAPTER
7
ChildrenwithAutisticSpectrumDisorder
DefiningtheProblem
SuspectedCauses
SpecialChallengesinAssessment
ExpectedPatternsofLanguagePerformance
RelatedProblems
Andrewisa4yearoldwhorarelyspeaksorvocalizes.Healsofailstorespondormakeeyecontactwhenothersspeaktohim.Hehassomeactivitieshewill
engageinincessantly,suchasspinningpartsofatoytruckortwirlinghisfingersinfrontofhiseyes.Andrewhasepilepticseizuresalmostdaily,isnotyet
toilettrained,risesearlyinthemorningandawakensonceortwiceeachnightproblemsthatprovideadditionalstresstohiscaring,beleagueredparents.
HewasinitiallyidentifiedashavingseveretoprofoundmentalretardationandhasmorerecentlybeenidentifiedashavingAutisticDisorder
Peterisa12yearoldwhospeaksinfrequentlyandoftenappearstoignoreremarksdirectedtohimbyothers.Heoccasionallyrepeatsthefulltextofa
televisioncommercialcontainingwordsheneitherusesnorappearstounderstandinothercontexts.Petersexpressiveandreceptivelanguage,asmeasured
throughstandardizedtests,appeardelayed,hisvocalintonationsoundsunmodulatedinpitchandherarely
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seemsabletopracticethegiveandtakerequiredforconversation.AlthoughPeterwasinitiallyidentifiedashavingautism,hehasrecentlybeendiagnosed
ashavingpervasivedevelopmentaldelaynototherwisespecified.
Ameliaisa10yearoldgirlwhowasconsiderednormalinherdevelopmentoflanguageuntilherextremedifficultyinusinglanguageforcommunication
wasnoticedwhensheenteredpreschool.Despitehavingnearnormallanguageabilitiesonstandardizedmeasures,herneedforsamenessandherdifficulty
inengaginginsocialinteractionmakeheraverysolitarychild.Sheperformsbestinschoolsubjectssuchasmathematicsandgeography,whichappearto
interesthergreatly.HerproblemshavebeententativelyidentifiedasassociatedwithAspergersDisorder.
DefiningtheProblem
Autisticspectrumdisorder,thediagnosticcategorythatencompassesmanyoftheproblemsofAndrew,Peter,andAmelia,isfoundin0.02to0.05%ofthe
population,orinabout2to5ofevery10,000people(AmericanPsychiatricAssociation,1994).Recently,somewhathigherestimateshavesuggestedasmanyas10
to14ofevery10,000individuals(Trevarthen,Aitken,Papoudi,&Robarts,1996).Evenwiththesehigherestimates,autismspectrumdisorderisrelativelyrare.The
magnitudeofitsimpactonaffectedchildrenandtheirfamilies,however,hascausedittobethefocusofconsiderableresearchandclinicalwriting.Itsimpactstemsfrom
theseverityofsymptoms,whichincludedelayedordeviantlanguageandsocialcommunicationandabnormalwaysofrespondingtopeople,places,andobjects.There
isalsosomeevidencetosuggestthatitisbecomingmoreprevalent(WolfSchein,1996cf.Trevarthenetal.,1996).
About75%ofchildrenwithautismarediagnosedwithmentalretardationaswell(Rutter&Schopler,1987),withabout50%reportedlyhavingIQslessthan50and
fewerthan33%havingIQsgreaterthan70(Waterhouse,1996).Thereisgreatuncertaintyassociatedwiththesefigures,however,becausethediagnosisofmental
retardationisoftenquestionablegiventhedifficultythesechildrenhaveinparticipatinginformalassessmentprocedures(WolfSchein,1996).
IntheinfluentialDSMIVsystemofnomenclature(AmericanPsychiatricAssociation,1994),autisticspectrumdisorderisreferredtoasPervasiveDevelopmental
Disorder(PDD),acategorythatincludesautisticdisorder,Rettsdisorder,childhooddisintegrativedisorder,Aspergersdisorder,andpervasive
developmentaldisordernototherwisespecified(PDDNOS)(Waterhouse,1996).Readersshouldbeawarethatanalternativeandsomewhatmorecomplicated
setofdiagnosesrelatedtoautismhasbeenformulatedbytheWorldHealthOrganization(WHO)intheInternationalClassificationofDiseases(ICDWHO,1992,
1993),althoughitisnotdiscussedhere.
AutisticdisorderissometimesreferredtoasKannersautismorinfantileautismandisthemostcommonofspectrumdisorders.Itssymptomsaresimilartotheother
disorderswithinthePDDcategory,includingseveredelaysinreciprocalsocialinteractionskills,communicationskills,andthepresenceofstereotypedbehavior,
interestsandactivities(AmericanPsychiatricAssociation,1994,p.65).Althoughchil
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drenwithautisticdisordersharemanycharacteristicswithchildrenwithotherPDDdisorders,theprimaryfocusofthischapterischildrenwithautisticdisorderandtheir
surprisingdegreeofheterogeneity,withregardtolevelsofcognitivefunction,languageoutcomes,andspecificsymptoms(Hall&Aram,1996Myles,Simpson,&
Becker,1995).Theconsiderabledifferenceswithinthissingledisorderareillustratedbytherangeofdifficultiesdescribedattheoutsetofthechapterinrelationto
PeterandAndrew.
TheAmericanPsychiatricAssociation(1994)definitionforAutisticDisorderispresentedinTable7.1.Besidescallingattentiontothesechildrensverymarked
problemsinsocialinteractionandlanguage,thisdefinitionemphasizestheabnormaland
Table7.1
ADefinitionofAutisticDisorder(AmericanPsychiatricAssociation,1994)
A. Atotalofsix(ormore)itemsfrom(1),(2),and(3),withatleasttwofrom(1)andoneeachfrom(2)and(3):
(1) Qualitativeimpairmentinsocialinteraction,asmanifestedbyatleasttwoofthefollowing:
markedimpairmentintheuseofmultiplenonverbalbehaviorssuchaseyetoeyegaze,facialexpression,bodypostures,andgesturestoregulatesocial
(a)
interaction
(b) failuretodeveloppeerrelationshipsappropriatetodevelopmentallevel
alackofspontaneousseekingtoshareenjoyment,interests,orachievementswithotherpeople(e.g.,byalackofshowing,bringing,orpointingout
(c)
objectsofinterest)
(d) lackofsocialoremotionalreciprocity.
(2) Qualitativeimpairmentsincommunicationasmanifestedbyatleastoneofthefollowing:
delayin,ortotallackof,thedevelopmentofspokenlanguage(notaccompaniedbyanattempttocompensatethroughalternativemodesof
(a)
communicationsuchasgesturesormime)
(b) inindividualswithadequatespeech,markedimpairmentintheabilitytoinitiateorsustainaconversationwithothers
(c) stereotypedandrepetitiveuseoflanguageoridiosyncraticlanguage
(d) lackofvaried,spontaneousmakebelieveplayorsocialimitativeplayappropriatetodevelopmentallevel.
(3) Restrictedrepetitiveandstereotypedpatternsofbehavior,interests,andactivities,asmanifestedbyatleastoneofthefollowing:
(a) encompassingpreoccupationwithoneormorestereotypedandrestrictedpatternsofinterestthatisabnormaleitherinintensityorfocus
(b) apparentlyinflexibleadherencetospecific,nonfunctionalroutinesorrituals
(c) stereotypedandrepetitivemotormannerisms(e.g.,handorfingerflappingortwisting,orcomplexwholebodymovements)
(d) persistentpreoccupationwithpartsofobjects.
Delaysorabnormalfunctioninginatleastoneofthefollowingareas,withonsetpriortoage3years:(1)socialinteraction,(2)languageasusedinsocial
B.
communication,or(3)symbolicorimaginativeplay.
C. ThedisturbanceisnotbetteraccountedforbyRettssyndromeorChildhoodDisintegrativeDisorder.
Note.FromDiagnosticandStatisticalManualofMentalDisorders(4thed.,pp.7071)bytheAmericanPsychiatricAssociation,1994,Washington,DC:Author.
Copyright1994bytheAmericanPsychiatricAssociation.Adaptedwithpermission.
Page171
oftenrigidpatternofinteractionwithobjectsandotheraspectsoftheirenvironmentthatischaracteristicofchildrenwithautism.Inthisdefinition,theonsetisspecified
asbeingpriortoage3becauseofthevarietyofagesatwhichmarkedchangesindevelopmentarereported:Althoughmanychildrenaredescribedbytheirparentsas
havingalwaysbeendistantandunresponsive,othersaredescribedashavingrespondedtosocialinteractionnormallyuntilage1or2(AmericanPsychiatric
Association,1994Prizant&Wetherby,1993).
Difficultiesindefiningautisticdisorderarisefromtheremarkableheterogeneityofchildrenwiththedisorderandfromtheextenttowhichtheirproblemsoverlapwith
thoseassociatedwithotherdevelopmentaldisordersandwithmentalretardation(Carpentieri&Morgan,1996Nordin&Gillberg,1996Waterhouseetal.,1996).
Table7.2liststheotherdisordersincludedwithinPDDandthecharacteristicsthatarethoughttodistinguishautisticdisorderfromthem.
Anumberofresearchers(e.g.,Rapin,1996Waterhouse,1996Wing,1991)haveexploredcommonfeaturesacrossspecificdisordersincludedwithinPDDand
havesuggestedthatfrequentchangesinterminologyandclinicalcategoriesarelikelytocontinueasmoreislearnedaboutthesechildren(Waterhouse,1996).In
particular,considerableresearchhasrecentlybeendevotedtothedefiningboundariesbetweenAspergerssyndromeandautisticdisorderinindividualswithhigher
measuredIQs(Ramberg,Ehlers,Nyden,Johansson&Gillberg,1996Wing,1991).
Theoverlapbetweenmentalretardationandautisticspectrumdisorderalsopresentsmajorchallengestoresearchersandclinicians.Asmentionedearlier,about75%of
childrenwithautisticspectrumdisorderarediagnosedwithmentalretardation.Inaddition,theseverityofmentalretardationappearstoberelatedtothefrequencyof
autisticsymptoms.Forexample,inonerecentSwedishstudy(Nordin&Gillberg,1996a),autisticspectrumdisorderwasidentifiedinabout12%ofchildrenwithmild
retardation,whereasitwasidentifiedin29.5%ofthosewithsevereretardation.Thefactthatnotallchildrenwithmentalretardationshowautisticsymptoms,however,
suggeststhatmuchmoreneedstobedonetounderstandtherelationshipofthesetwoconditions.Increasedunderstandingofthenatureoftherelationshipbetween
mentalretardationandthespecificcognitivedeficitsassociatedwithautisticspectrumdisordershouldhelpimprovethequalityofcaredirectedtochildrenwiththese
combineddifficulties.
Additionaldifficultiesindiagnosisareduetothechangingnatureofsymptomsassociatedwithautisticdisorderwithage,althoughcurrentlythereisconsiderable
disagreementoverthenatureanddirectionofthosechanges(i.e.,improvementvs.declinee.g.,seeEaves&Ho,1996Piven,Harper,Palmer,&Arndt,1996).
Despitepossiblechangesovertime,however,itisrareforindividualsdiagnosedasautisticinchildhoodtoenteradulthoodwithoutsignificantresidualproblems(e.g.,
seePivenetal.,1996).ApersonalexperiencewithanacquaintanceingraduateschoolwhoinretrospectwouldprobablyhavebeenidentifiedashavingAspergers
disorderandwhomIwillcallMatthewMetzcapturesthisgeneralityforme:AlthoughMatthewwouldeventuallycompleteaPh.D.inhistory,heinvariablygreeted
membersofourgraduatehousehesawoncampuswithanintroductionHi,youmaynotrememberme,butmynameisMatthewMetz.Thisgreetingpersisted
despitemonthsofhaving
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Table7.2
DifferentiatingAutisticDisorderFromOtherDisordersWithintheAutisticSpectrumDisorder
(CalledPervasiveDevelopmentalDisorders,PDD,bytheAmericanPsychiatricAssociation,1994)
l Differencesinsexratios(femaleonlyversuspredominately
l Anautosomaldisorderaffectingonlywomen(probablynomen maleinautism)
areidentifiedbecauseoffetalmortality) l HeadgrowthslowsdownafterinfancyonlyinRetts
l Normalpatternofearlyphysical,motordevelopmentwithlater Autisticdisordermayactuallybeassociatedwithanabnormally
lossofskillsanddecelerationinheadgrowth largeheadcircumference(Waterhouseetal.,1996)
Rettsdisorder
l Associatedwithsevereorprofoundmentalretardationand l Socialinteractiondifficultiesaremorepersistentintolate
limitedlanguageskills childhoodinautismthaninRettsdisorder
l Characteristichandmovements(wringingorwashingof l Differentiationfromautismdependsongoodevidenceof
hands) normaldevelopmentduringfirsttwoyearsotherwise,the
autismcategorizationispreferred
l Markedregressionafteratleast2yearsofseeminglynormal
development
Childhooddisintegrative l Social,communication,andbehavioralcharacteristicssimilarto
disorder autism
l Usuallyassociatedwithseverementalretardation
l Veryraredisorder,possiblymorecommoninmenthanwomen
l Absenceofsignificantlanguageandcognitivedeficitsin
l Preservedlanguagefunctioninthepresenceofsevereand Aspergersdisorder,butverysignificantdelaysinautism
sustainedimpairmentinsocialinteraction(p.75) l Exceptforsocialcommunicationdeficits,adaptiveskillsare
Aspergersdisorder
l Restricted,repetitivepatternsofbehavior,interests,and developmentallyappropriateinAspergers,butnotinautism
activities(e.g.,pronouncedinterestintrainschedules) l AspergersDisorderistypicallydiagnosedlaterthanautism,
oftenatschoolage,possiblyduetolateronsetthanautism
l Severeandpervasiveimpairmentinsocialinteractionand/or
verbalandnonverbalcommunicationand/orpresenceofrestricted,
PervasiveDevelopmental l Onsetorsymptomsfailingtoconformtocriteriaforother
repetitivepatternsofbehavior,interests,andactivities
DisorderNotOtherwise PDD,includingautism
l FailuretomeetspecificcriteriarequiredforotherPDD
Specified(PDDNOS) l Sometimesreferredtoasatypicalautism
categoriesdescribedabovewithregardtoseverityofsymptomsor
ageofonset
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shareddinnersatacommontablewiththeacquaintancesheaddressed.Asyoumayexpect,Matthewhadaveryrestrictedsocialspherethatwaslargelyconfinedto
fellowstudentsinhisgraduateprogram.WhenIlastheardofhim,hewaslivingwithhiselderlyparentsandearnedalimitedincomebywritingentriesonhistorical
subjectsforpublishersofanencyclopedia.Thus,eveninthepresenceoftheintellectualabilitiesrequiredforcompletionofagraduatedegree,significantchallengesfor
Matthewpersistedwellintoadulthood.
SuspectedCauses
Todate,discussionsofetiologyforautisticspectrumdisorderhavefocusedonsocioenvironmental,behavioral,andpurelyorganicpossibilities(Haas,Townsend,
Courchesne,Lincoln,Schreibman,&YeungCourchesne,1996Waterhouse,1996WolfSchein,1996).Thesocioenvironmentalperspectivehadstrongproponents
inthe1960s,especiallyamongpsychoanalystswhoheldthatpoorparentingwasthesourceofthesechildrensdifficulties(e.g.,Bettelheim,1967).Morerecently,
however,suchtheorieshavelostfavorwithalmostallresearchersandclinicians.Currently,thedominantperspectiveonautismisthatithasoneormoreorganicbases
intheformofunderlyingneurologicalabnormalities.
Thenatureofneurologicabnormalitiesunderlyingautismhasnotyetbeenwelldocumentedandconstitutesamajorareaofresearch(Rapin,1996).Proposedsitesof
suspectedneurologicabnormalitiesarethefrontallobe(Frith,1993),thereticularformationofthebrainstem(Rimland,1964),andthecerebellum(Courchesne,
1995)justtonameafew(cf.Cohen,1995WolfShein,1996).Inaddition,therolethattherighthemisphereofthebrainplaysinautisticsymptomshasreceived
someattention(e.g.,Shields,Varley,Broks,&Simpson,1996).Althoughlocalizedfunctionalabnormalitieshavebeensought,ithasfrequentlybeensuggestedthatthe
underlyingabnormalitiesareinfactlikelytobediffuse(Rapin,1996).
Asamoredistalcausalfactorleadingtothebrainabnormalitiesthatarethenbelievedtocauseautisticsymptomsmoredirectly,geneticfactorsareimplicatedforsome
casesofautism.Evidencesupportingthisreasoningincludes(a)thepreponderanceofmalesinallcategorieswithPDDexceptRettsdisorder(AmericanPsychiatric
Association,1994Waterhouseetal.,1996),1(b)thetendencyforPDDtooccurmuchmorefrequentlyinsomefamiliesthaninothers(Folstein&Rutter,1977),and
(c)thetendencyforPDDtooccurfrequentlyamongindividualswithfragileX,wheregeneticabnormalitiesarewelldocumented(Cohen,1995).
Manycasesofautism,however,haveyettobelinkedtogeneticabnormalities.Nonetheless,itissuspectedthatthesecasesarestillduetoorganicfactorsarising
beforeratherthanduringorafterthechildsbirth(Rapin,1996).Othersuspectedsourcesofthepresumedneurologicabnormalitiesincludemetabolicdisordersand
infectiousdisorders(e.g.,congenitalrubella,encephalitis,ormeningitisRapin,1996WolfSchein,1995).Insomecases,nolikelycausalfactorissuggestedleading
tocasesthataretermed
1ThereasoningisthatmalepreponderancemayexistbecausemalessingleXchromosomemakesthematspecialriskforXchromosomedefects.
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idiopathic,thatis,withoutaknowncause.Effortstoidentifytherealnatureofsuchidiopathiccasesandtoidentifythespecificmechanismsbywhichknowncausesact
tocreateautisticsymptomsrepresentsomeofthemostneededareasforresearchonPDD.
SpecialChallengesinAssessment
Childrenwithautisticspectrumdisorderpresentthegreatestimaginablechallengestothecliniciancontemplatingformaltestingasameansofcollectinginformation.
Frequently,thesechildrensessentialsocialinteractiondeficitsdramaticallylimittheirparticipationintheusualgiveandtakerequiredbymoststandardizedlanguage
instruments.Consequently,informalmeasures,especiallyparentquestionnairesandbehavioralchecklists,areusedveryfrequentlyforpurposesofscreening,diagnosis,
anddescriptionoflanguageamongchildrenandadultswithautisticspectrumdisorder(Chung,Smith,&Vostanis,1995DiLavore,Lord,&Rutter,1995Gillberg,
Nordin,&Ehlers,1996Nordin,&Gillberg,1996Prizant&Wetherby,1993Sponheim,1996).
Alternativestostandardizedtestsareparticularlyvaluableforthosechildrenwhosecommunicationrepertoireisverylimited,agroupthatincludesasmanyas50%of
allchildrenwithautism(Paul,1987).Wherethepurposeofanevaluationistoaidindiagnosisofthedisorder,ithasbeenarguedthatparentinterviewsmaybe
considerablybetterthanobservationalmethodsthatmaybeappliedbyclinicians(Rapin,1996).Table7.3listssomeofthemostcommonquestionnaires,interview
schedules,checklists,andotherinstrumentsusedinscreeninganddiagnosingautisticspectrumdisorders.Althoughmanyofthesefocusontheentirerangeofdifficulties
oftenseenaspartofautism,somefocusonselectedskillareas,suchascommunicationorplay.
Despitethefrequentneedfornontraditional,observationaltechniques,moretraditional,standardizedspeechandlanguagetestscanplayausefulroleinlanguage
assessmentsofsomechildrenwithautism.Inparticular,childrenwithmoreelaboratelanguageandcommunicationskillschildrenwhoareoftendescribedashigh
functioningmaybeamenabletostandardizedtestingwhenappropriateattentionispaidtomotivationandotherenablingfactors.Informationobtainedfromfamily
membersandotherindividualswhoareveryfamiliarwiththechildcanhelppinpointthereinforcersthatwillprovemosthelpfulinfacilitatingachildsparticipationand
warnagainstspecificstimuli(e.g.,typesofenvironmentalnoisesuchastrafficnoiseorthesoundofsomeelectricaldevices)thatarelikelytobedistractingordisturbing
totheindividualchild.
Forhigherfunctioningchildren,standardizedspeechandlanguagetestingmaynotonlybefeasible,butquitevitaltoathoroughunderstandingoftheirstrengthsand
weaknessesparticularlyforreceptiveskillsthat,unlikeexpressiveskills,cannotbeasreadilyobservableinspontaneousproductions.
Evenwhenexpressivelanguagetestingisfeasible,analysisofspontaneousproductionswillalmostalwaysconstituteaparticularlydesirabletoolforexpressivelanguage
assessment.Notonlydoesanalysisofspontaneouslanguageallowonetosimultaneouslyexaminevariablesrelatedtonumerousexpressivelanguagedomains(Snow&
Pan,1993),onecanarguethatthevalidityofsuchmeasureswillbeparticularlysuperiorforchildrenwhoaresoreactivetostandardizedtestingprocedures.In
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Table7.3
RecentBehavioralChecklistsandInterviewforScreeningandDescriptionofAutisticSpectrumDisorder
(Chung,Smith,&Vostanis,1995Gillberg,Nordin,&Ehlers,1996WolfSchein,1996)
Uses14itemsthatarerespondedtobyparent(n=9)andby
ChecklistforAutisminToddlers(CHAT Childrenfrom18to30 clinician(n=5items)foundtohavealowrateoffalsepositives
Screening
BaronCohen,Allen,&Gillberg,1992) months andreportedtohavegoodreliability(Gillberg,Nordin&Ehlers,
1996)
Uses12playbasedactiviteswith17associatedratings,with
PreLinguisticAutismDiagnosticObservation
Childrenunder6years itemsadministeredbytheexaminerorthroughoneofthechilds
Schedule(PLADOS)(DiLavore,Lord,&
ofage caregiversdesignedtorelatedirectlytotheDSMIVorICD10
Rutter,1995)
criteria
Ateacherquestionnairecontaining27itemsitappearsto
AspergerSyndromeScreeningQuestionnaire consistentlyidentifyAspergersdisorder,butitmayoveridentify
7to16years
(ASSQEhlers&Gillberg,1993) incasesofothersocialabnormalitiesoneofthefewmeasures
developedtobesensitivetoAspergersdisorder.
UsesinterviewofparentsorcaregiversofIndividualswith
Diagnosisand AutismDiagnosticInterviewRevised(ADIR Childrenfrom18
suspectedautisticdisorder.Designedtorelatedirectlytothe
Description Lord,Rutter,&LeCouteur,1994) monthstoadults
DSMIVorICD10criteria.
Usesdirectobservationofchildrenwithsuspectedautistic
ChildhoodAutismRatingScale(CARS)
Children disorder.Designedtobeusedindiagnosisanddescriptionof
(Schopler,Reichler,&Renner,1986)
severity.
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chapter10,theuseofspontaneouslanguagesampleanalysesisdiscussedatsomelength.
ExpectedPatternsofLanguagePerformance
Certainspecificlanguagebehaviorsarefrequentlyassociatedwithautism,althoughtheymayalsooccurinfrequentlyinnormallanguagedevelopmentandinother
languagedisturbances.Amongthesebehaviorsareecholalia,pronominalreversals,andstereotypicornonreciprocallanguage(Fay,1993Paul,1995).
Echolaliaconsistsoftheimmediateordelayedrepetitionofspeech,oftenwithoutevidentcommunicativeintent.Echolalicproductionscanoftenbequitecomplexin
theirlanguagestructurerelativetothelevelofthechildsspontaneouscommunicationsandmaysimplyrepresentmemorizedroutinesratherthancreativelygenerated
language.Thepresenceofecholalicproductionsoftenappearstoindicateachildsattempttostayengagedinthesocialinteractiondespitefailingtounderstandwhat
hasjustbeensaidorbeingunabletoproduceamoresuitableresponse.Suchproductions,consequently,maybecommunicativeinintentandthereforeprovide
informationaboutthenatureofthechildspragmaticskills(Paul,1995).
Pronominalreversalsinvolvesanapparentconfusioninpronounchoiceinwhichfirstandsecondpersonpronounsaresubstitutedforoneanother.Thus,forexample,
achildmightsayyougowhenapparentlyreferringtohimorherself.Althoughatonepointintimetheseerrorswerethoughttoreflectthechildsfailuretodistinguish
himorherselffromtheenvironment,theyarecurrentlytakentoreflectthechildsinflexibleuseoflanguageforms.Inshort,thechildtreatspronouns,whichare
sometimesreferredtoasdeicticshifters,asunchanginglabels,therebyfailingtorecognizetheshiftthatallowsItorefertoseveraldifferentspeakersinturnsimply
byvirtueoftheirroleasspeaker,andyoubyvirtueoftheirroleaslistener.Althoughonceconsideredahallmarkofthedisorder,pronominalreversalsarenot
necessarilyusedfrequently(Baltaxe&DAngiola,1996).ThePersonalPerspectiveincludedinthischaptercontainsthereflectionsofDonnaWilliams,anadultwith
autism,whoarguespersuasivelyfortherelativeunimportanceofpronounuseasatargetfortherapy,givenallofthewordsoneneedstolearn.
PERSONALPERSPECTIVE
Thefollowingpassagecomesfromabookwrittenbyayoungwomanwhodescribesherselfashavingautismassociatedwithhighfunctioning(Williams,1996,pp.
16061).Inthispassage,shediscusseswhichwordsareimportantandwhichareunimportanttolearn:
Wordstodowiththenamesofobjectsareprobablythemostimportantonestoconnectwithasitishardtoaskforhelpifyouhaventgotthese.Ifsomeonecan
onlysaybook,atleastyoucanworkoutwhattheymightwantdonewith
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it.iftheyjustsaylookbuthaventconnectedwithbook,youhaveawholehousefullofthingsthatcanbelooked(atorfor).
Wordstodowithwhatthingsarecontainedin(box,bottle,bag,packet),madeof(wood,metal,cloth,leather,glass,plastic,powder,goo)orwhatisdonewith
them(eating,drinking,closing,warming,sleeping)arealsoreallyimportanttolearn.Muchlater,lesstangible,lessdirectlyobservablewordssuchasthosetodowith
feelings(hadenough,hurt,good,angry)orbodysensations(tired,full,cold,thirsty)arereallyimportanttoconnectwith.
Wordstodowithpronouns,suchasI,you,he,she,weorthey,arentsoimportant.Toomanypeoplemakearidiculousbighoohaaboutthesethings,
becausetheywanttoeradicatethissymptomofautism,orforthesakeofmannersorimpressiveness.Pronounsarerelativetowhoisbeingreferredto,where
youareandwheretheyareinspaceandwhoyouaretellingallthisto.Thatsalotofconnectionsandfarmorethaneverhavetobemadetocorrectlyaccess,use
andinterpretmostotherwords.Pronounsare,inmyexperience,thehardestwordstoconnectwithexperienceablemeaningbecausetheyarealwayschanging,
becausetheyaresorelative.Inmyexperience,theyrequirefarmoreconnections,monitoringandfeedbackthaninthelearningofsomanyotherwords.
Toooftensomuchenergyisputintoteachingpronounsandthepersonbeingdrilledexperiencessolittleconsistentsuccessinusingthemthatitcanreallystrongly
detractfromanyinterestinlearningallthewordsthatcanbeeasilyconnectedwith.Igotthroughmostofmylifeusinggeneraltermslikeapersonandone,calling
peoplebynameorbygenderwithtermslikethewomanorthemanorbyagewithtermsliketheboy.Itdidntmakeagreatdealofdifferencetomyabilitytobe
comprehendedwhetherIreferredtothesepeoplesrelationshiptomeorinspaceornot.Thesethingsmighthavetheirtimeandplacebuttherearealotofmore
importantthingstolearnwhichcomeeasierandcanbuildasenseofachievementbeforebuildingtoogreatasenseoffailure.
Stereotypicornonreciprocallanguagereferstoidiosyncraticuseofwordsorevenwholesentences(Paul,1995).Oftentheparticularwordorphraseseemstobeused
becauseitwasfirstheardinaparticularsituationorinconjunctionwithaspecificeventorobjects.Thereafter,itisusedtostandfortheassociatedsituation,event,or
object,despiteitslackofmeaningtoanyoneexceptaveryperceptiveindividualpresentatthetimetheassociationwasformed.TempleGrandin,acollegeprofessor
whohasrecentlypublishedseveralbooksaboutherexperiencesassomeonewithautism,describesapersonalexampleofnonreciprocallanguage:
Teacherswhoworkwithautisticchildrenneedtounderstandassociativethoughtpatterns.Anautisticchildwilloftenuseawordinaninappropriatemanner.Sometimes
theseuseshavealogicalassociatedmeaningandothertimestheydont.Forexample,anautisticchildmightsaytheworddogwhenhewantstogooutside.The
worddogisassociatedwithgoingoutside.Inmy
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owncase,Icanrememberbothlogicalandillogicaluseofinappropriatewords.WhenIwassix,Ilearnedtosayprosecution.Ihadabsolutelynoideawhatitmeant,
butitsoundednicewhenIsaidit,soIuseditasanexclamationeverytimemykitehittheground.Imusthavebaffledmorethanafewpeoplewhoheardmeexclaim
Prosecution!tomydownwardspiralingkite.(Grandin,1995,p.32)
Inadditiontocharacteristickindsofatypicallanguageuse,patternsoflanguagestrengthsandweaknessesamongchildrenwithautisticdisorderandAspergers
disorderhavereceivedextensiveattentionbyresearchers.Table7.4summarizesthelanguagecharacteristicsdescribedforthreediagnosesinthespectrum:twoforms
ofautisticdisorderandAspergersdisorder.Thetwodescriptionsprovidedunderautisticdisorderareincludedbecauseoftherelativelyrichresearchbasethathas
identifiedverydifferentskillsseeninindividualswhocanbedescribedashighversuslowfunctioningintermsofseverityaswellasintermsofnonverbalintelligence
scores.AstudyperformedbyalargegroupofresearchersheadedbyIsabelleRapin(1996)providesthemostcomprehensivestudyofthelargestnumberofchildren
withautismtodateitmadeuseofnormalcontrolsandtwoothercontrolgroups(a)agroupoflanguageimpairedchildrentoactascontrolsforthehighfunctioning
childrenwithautismand(b)agroupofchildrenwithoutautismbutwithlownonverbalIQstoactasacontrolgroupforthelowfunctioningchildrenwithautism.That
multiyear,multisitestudyprovidedmuchoftheinformationincludedinTable7.4.Despitemyuseofthesubcategorieshighandlowfunctioning,itshouldbenotedthat
researchershaveidentifiedseveralsubgroupingsofautisticspectrumdisorderbeyondthosediscussedinthischapter,includingaloof,passive,andactivebutodde.g.,
Frith,1991Sevinetal.,1995Waterhouse,1996Waterhouseetal.,1996).
RelatedProblems
AutisticDisorder,andindeedmostofthedisordersontheautisticspectrum,arecharacterizedbyanumberofbehavioralproblemsinadditiontothosealready
discussedintermsofcommunicationandlanguage.Twooftheserestrictedrepetitiveandstereotypedpatternsofbehavior,interests,andactivitiesandlackof
varied,spontaneousmakebelieveplayorsocialimitativeplayappropriatetodevelopmentallevelareconsideredcentralenoughtothenatureofthedisordertobe
listedintheDSMIVdefinition(AmericanPsychiatricAssociation,1994).Theyarecloselyrelated.
Restrictedandstereotypedpatternsofbehavior,interests,andactivitiescanincludebehaviorssuchasthechildsrocking,flappingoneorbothhandsinfrontofhisor
herowneyes,repeatedlymanipulatingpartsofobjects(suchasspinningthewheelonatoyorrepeatedlyopeningandclosingahallwaydoor),or,morealarmingly,
repeatedlybitingorstrikingothersorhimorherself.Someoftheserepetitivebehaviorscanbeinterpretedasselfstimulatoryoraseffortsbythechildtodealwith
anxietyandavoidoverstimulation(e.g.,Cohen,1995)othersaremoredifficulttointerpret.Stereotyped,repetitivebehaviors(sometimesreferredtoasstereotypies)
willoftenneedtobeaddressedinordertofreethechildtoattendtoimportantinteractions(suchasassessmentorestablishingrelationshipswithpeers).Howthey
shouldbeaddressed
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Table7.4
PatternsofStrengthsandWeaknessesAmongChildrenWithAutisticDisorderHighFunctioning,
AutisticDisorderLowFunctioning,andAspergersDisorder
l Receptivelanguagemoreaffectedthan
expressivelanguage(Rapin,1996) Strengths:
l Expressivevocabulary(Rapin,1996) l Functionaluseofexpressivelanguagebelow l Preservedfunctiononvisuospatialandvisual
(Continued)
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Table7.4(Continued)
l Expressivevocabularyisarelative
l Verbalcommunicationmaybeabsentin
strengthandisgenerallybetterthan
abouthalfofthesechildren(Rapin,1996)
receptivevocabulary Strengths:
Autisticdisorderlow l Whenpresent,mostareasoflanguageare
l Patternsofstrengthandweaknesses l Nonverbalperformancesupperiortoverbal
functioning(ADLF) severelyaffected(Rapin,1996)
maybeespeciallydifficulttodetermine performance(Rapin,1996)
l Reportedtemporaryregressionoflanguage
becauseofflooreffectsonmany
skillsinearlydevelopment(Rapin,1996)
measures(Rapin,1996)
l Generallypreservedlanguageskills
Strengths:
(AmericanPsychiatricAssociation, l Pragmaticskills(Ramberg,Ehlers,Nyden,
l Normalnonverbalintelligence
AspergersDisorder 1994) Johansson,&Gillberg,1996Wing,1991)
Weaknesses:
(AD) l Phonology,exceptpossiblyinthe l Atypicalprosodyandvocalcharacteristics
l Motorclumsiness(Rambergetal.,1996
areasofprosody (Rambergetal.,1996)
Wing,1991)
l Syntax
Note.AspergersDisorderisconsideredequivalenttoAutisticDisorderHighFunctioningbysomeauthors(e.g.,Rapin,1996).
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mustbedeterminedinrelationtotheirpotentiallyadaptiverolefromthechildsperspective.Teamapproachesusingbehavioralinterventionsand,attimes,drug
interventionaresometimesuseful.
Thehighfrequencyofthesestereotypedpatternsofinteractioniscombinedwithalackofthespontaneous,imaginativeplayconsideredsocharacteristicofchildhood.
AlthoughthisdeficiencyhasbeennotedsinceautismwasfirstdescribedbyKannerin1943,ithasrecentlybeenseenasrelatedtothesechildrensapparentinabilityto
assumealternativeperspectivesanabilitythatalsosupportssocialinteraction.Ithasbeensaidthatoneofthechiefcognitivedeficitsinchildrenwithautisticdisorder
maybetheirlackofatheoryofmind,theabilitytothinkaboutemotions,thoughts,motiveseitherinthemselvesorothers(Frith,1993).
Sometimes,pronouncedsensoryabnormalitieshavebeeninferredinmanyautisticchildrenonthebasisoftheirapparentavoidanceofandnegativereactionstomany
auditory,visual,andtactilestimuli.Inparticular,hypersensitivityandhyposensitivityhavebeenassociatedwithautisticspectrumdisorders(e,.g.,Rouxetal.,1995
Sevinetal.,1995).Recently,acontroversialtherapytechnique,auditoryintegrationtraining(Rimland&Edelson,1995),hasbeendevisedinanattempttoeliminate
these,abnormalresponsestoauditorystimuliseeninsomechildren.
Inagrowingnumberofstudies,childrenwithautismspectrumdisorderhavebeenfoundtobeatincreasedriskformotorabnormalities.Forexample,inarecentlarge
scalestudy,childreninbothhighandlowfunctioninggroupsshowedagreaterfrequencyofmotorabnormalitiesthandidgroupsofchildrenwitheithermental
retardationwithoutautismorSLI(Rapin,1996).However,oromotorimpairmentstendedtobemorecommonandmoresevereamongchildreninthelowfunctioning,
group.Amongthedifficultiesnotedhavebeenakinesia(absentordiminishedmovement),bradykinesia(delayininitiating,stopping,orchangingmovementpatterns)
anddyskinesia(involuntaryticsorstereotypiesDamasio&Maurer,1978)aswellasproblemswithmuscletone,posture,andgait(Page&Boucher,1998).Of
particularinteresttospeechlanguagepathologistswhomaywishtoworkonoralmotoractivitiesineffortstofosterspeechoronmanualgestureshavebeenreportsof
oralandmanualdyspraxia,difficultiesintheperformanceofpurposefulvoluntarymovementsintheabsenceofparalysisormuscularweakness(Page&Boucher,
1998Rapin,1996).
Otherproblemsthataremorecommonamongchildrenontheautisticdisorderspectrumthanamongchildrenwithoutidentifiedproblemsareepilepsy,especiallya
formcalledinfantilespasms,andsleepdisorders(Rapin,1996).ADHD(discussedinchap.5),isalsomoreprevalent(Wender,1995).
Summary
1.Autisticspectrumdisorder,alsotermedPervasiveDevelopmentalDisorder(PDD),encompassesatleastfourrelatedandrelativelyraredisorders:Rettsdisorder,
autisticdisorder,Aspergerssyndrome,childhooddisintegrativedisorder,andpervasivedevelopmentaldisordernototherwisespecified(PDDNOS)accordingthe
diagnosticsystemoftheDSMIV(AmericanPsychiatricAssociation,1994).
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2.Difficultiessharedbychildrenwithautisticspectrumdisordersincludedelayedordeviantlanguage,socialcommunication,andabnormalwaysofrespondingto
people,places,andobjects.
3.Autisticspectrumdisordersfrequentlycooccurwithmentalretardation,perhapsbecauseofasharedcause:underlyingneurologicabnormalities.
4.Althoughthesourceofunderlyingneurologicabnormalitiesisgenerallyunknown,geneticfactorsandprenatalinfectionsaresuspectedinsomecases.
5.Childrenwithautisticspectrumdisorderareoftenunabletoparticipateinstandardizedtestingrequiredforthediagnosisoftheirdisorder,makingtheuseof
observationalmethodsandparentalquestionnairesaveryfrequentandrelativelywellstudiedalternative.
6.Echolalia,pronominalreversals,andstereotypiclanguageareabnormalfeaturesoflanguagethatareseenmorefrequentlyinautisticdisorderthaninother
developmentallanguagedisorders.
7.Otherproblemsaffectingchildrenwithautisticspectrumdisordersincludealackofspontaneous,imaginativeplayandrestrictedpatternsofbehavior,interests,and
activities.Inaddition,thesechildrenareatincreasedriskformotorabnormalities,seizures,andsleepdisorders.
KeyConceptsandTerms
akinesia:absentordiminishedmovement.
autisticdisorder:themajorandmostfrequentlyoccurringdisordercategorywithinthelargerDSMIV(AmericanPsychiatricAssociation,1994)definitionof
PervasiveDevelopmentalDisordersoftenusedsynonymouslywithinfantileautismorKannersautism.
Aspergersdisorder:anautisticdisorderwithinthelargerDSMIVcategoryofPervasiveDevelopmentalDisordersinwhichearlydelaysincommunicationare
absentoftenconsideredsynonymouswithhighfunctioningautism.
bradykinesia:amotorabnormalitycharacterizedbydelaysininitiation,cessation,oralterationofmovementpattern.
childhooddisintegrativedisorder:averyrareautisticdisorderwithinthelargerDSMIVcategoryofPervasiveDevelopmentalDisordersinwhichaperiodofabout
2yearsofnormaldevelopmentisfollowedbyautisticsymptoms.
dyskinesia:amovementabnormalitycharacterizedbyinvoluntaryticsorstereotypies.
dyspraxia:difficultiesintheperformanceofpurposefulvoluntarymovementsintheabsenceofparalysisormuscularweaknessforexample,oraldyspraxia,manual
dyspraxia,verbaldyspraxia(alsofrequentlyreferredtoasverbalapraxia).
echolalia:immediateordelayedrepetitionofapreviousspeakersoronesownutterance.
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epilepsy:achronicdisorderassociatedwithexcessiveneuronaldischarge,alteredconsciousness,andsensoryactivity,motoractivity,orboth.
PervasiveDevelopmentalDisorders(PDDs):thegroupofseveredisordershavingtheironsetinchildhood,characterizedbysignificantdeficitsinsocialinteraction
andcommunication,aswellasthepresenceofstereotypedbehavior,interestsandactivitiesconsideredsynonymouswithautisticdisorderspectrumdisorder.
pervasivedevelopmentaldisordernototherwisespecified(PDDNOS):WithintheDSMIVsystemofdisorderclassification,thisdiagnosisismadewhensome
butnotallofthemajorcriteriaforautisticdisorderaremetalsoreferredtoasatypicalautism.
pronominalreversals:incorrectuseoffirstandthirdpersonpronouns(e.g.,youwanttomeanIwant),whichareconsideredtypicalofautisticspeech.
Rettsdisorder:asevereautosomalpervasivedevelopmentaldisorderaffectingonlygirls,inwhichabriefperiodofnormaldevelopmentisfollowedbyregression
associatedwithsevereorprofoundlevelsofmentalretardation.
stereotypy:frequentrepetitionofameaninglessgestureormovementpattern.
theoryofmind:theabilitytothinkaboutemotions,thoughts,andmotiveseitherinoneselforothersconsideredtobeaprimarydeficitamongindividualswhose
difficultiesfallalongtheautisticdisorderspectrum.
StudyQuestionsandQuestionstoExpandYourThinking
1.OntheInternet,lookforsitesrelatedtoPDD.Forwhichdisorderswithinthatdesignationdoyoufindwebsites?Whoarethemainaudiencesforthesesites?How
dositesresponddifferentlytothesevariousaudiences?
2.OnthebasisofTable7.2,listthemajorcharacteristicsofachildsbehaviorthatwillbeneededtodeterminewhichPDDlabelismostappropriate.
3.OnthebasisofthediscussionofsuspectedcausesofPDD,outlinetwomajorresearchneedsthatshouldbepursuedbyfutureresearchers.
4.ListinorderofimportancetheproblemsotherthanthoseintrinsictoautismitselfpresentedtoadultswhowishtointeractwithchildrenwithPDD.
5.Whatfeaturesofachildscommunicationwouldcauseyoutobemostconcernedthatheorshewasshowingsymptomsofautism?Whatfeaturesofhisorher
language?
6.WhatpracticalproblemsmightaparentofachildwithPDDfacethataredifferentfromthosefacedbyotherparents?
7.Findoutwhatdefinitionofautisticspectrumdisordersisusedinalocalschoolsystem.HowdoesitdifferfromthesystemdescribedinDSMIV(American
PsychiatricAssociation,1994)?
Page184
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Campbell,M.,Schopler,E.,Cueva,J.E.,&Hallin,A.(1996).Treatmentofautisticdisorder.JournaloftheAmericanAcademyofChildandAdolescent
Psychiatry,35,124143.
Grandin,T.(1995).Thinkinginpicturesandotherreportsfrommylifewithautism.NewYork:Doubleday.
Schopler,E.(1994).Behavioralissuesinautism.NewYork:Plenum.
Strain,P.S.(1990).Autism.InM.Hersen&V.B.VanHasselt(Eds.),Psychologicalaspectsofdevelopmentalandphysicaldisabilities:Acasebook(pp.73
86).NewburyPark,CA:Sage.
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CHAPTER
8
ChildrenwithHearingImpairment
DefiningtheProblem
SuspectedCauses
SpecialChallengesinAssessment
ExpectedPatternsofOralLanguagePerformance
RelatedProblems
Bradleywas5yearsoldwhenitwasdeterminedthathehadamild,bilateralsensorineuralhearingloss.Priortoenteringkindergarten,hisparents
describedhimasashychildwhodislikedlargerplaygroupsandpreferredplayingaloneorwithoneclosefriend.Inanoisy16childclassroom,the
adequacyofhishearingwasfirstquestionedbyhiskindergartenteacher,whoreportedthatsheoftenhaddifficultygettinghisattentionandfoundhispoor
attentionduringcircletimeinconsistentwithhisgoodattentioninoneononesituations.Ahearingscreeningbyaspeechlanguagepathologist,whichwas
performedbecauseofconcernsaboutdelayedphonologicdevelopment,wastheimmediatesourceofareferralforthecompleteaudiologicalexaminationin
whichhishearinglosswasidentified.Afterdetectionofthehearingloss,Bradleywasfittedforbinauralbehindtheearaids.(Helovedthebrightblue
earmoldsandtubinghewasallowedtochoose.)Withinashorttimeofthefitting,Bradleyappearedmoreattentiveduringcircletimeandreadilymade
progressinworkontargetedspeechdistortions.
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Sammy,orSamanthaonformaloccasions,isa3yearoldwhosemoderatehighfrequencyhearinglosswasidentifiedshortlyafterbirthfollowingher
failureonahighriskscreeningconductedbecauseofherfamilyhistoryofhearingloss.Becauseinitiallyanearlevelfittingprovedunfeasible,Sammyused
abodywornaid,whichwasreplacedbyabehindtheearfittingatage1.Sixmonthsago,theuseofanFMtrainerwasextendedtothehomeafter
continuoususeinapreschoolgroupthatshehadattendedsinceage1.Althoughsheisexperiencingsomedelaysinspeech,hercommunication
developmentotherwiseappearsontarget.
Desmondsprofoundhearinglosswasidentifiedusingauditorybrainstemresponse(ABR)duringhis3weekstayinaneonatalintensivecareunit,following
hisprematurebirthat7monthsgestationalagewithabirthweightof3.1pounds.Herequiredventilatorsupportfor5daysafterbirth.Now5yearsold,
DesmondsparentshavebeenfrustratedbyDesmondsslowprogressinorallanguagedevelopmentdespiteyearsofparticipationinspecialeducationand
severalfailedattemptsatsuccessfulamplification.Desmondcurrentlyusesavibrotactileaidtoincreasehisawarenessofenvironmentalsoundsandhis
speechreceptionandisbeingconsideredasacandidateforacochlearimplant.
DefiningtheProblem
Estimatesoftheprevalenceofhearingimpairmentinchildrenvaryfrom0.1to4%orfrom1inevery25to1inevery1,000childrendependingonthedefinitions
used(BradleyJohnson&Evans,1991Northern&Downs,1991).Ofchildrenbetweentheagesof3and17,about52,000haveimpairmentssevereenoughtobe
termeddeafness,wheredeafnesscanbedefinedasahearingloss,usuallyabove70dB,thatprecludestheunderstandingofspeechthroughlistening(Ries,1994).
Whenalllevelsofhearinglossareconsidered,hearingimpairmentisthemostcommondisabilityamongAmericanschoolchildren(Flexer,1994).
Thenegativeimpactofdeafnessforthenormalacquisitionoforallanguagemayseemobvious:Youcannotlearnaboutphenomenawithwhichyouhavelimited
experience.Inaddition,forchildrenwithprofoundhearingloss,thisexperienceislargelyrestrictedtoasensorychannel(i.e.,vision)thatismismatchedtothemost
distinctivecharacteristicsofthatphenomenon(i.e.,orallanguage).Onelineofevidencesuggestinghowgreatthismismatchiscomesfromagrowingbodyofresearch
suggestingthatthestructureoforallanguagesdifferssubstantiallyfromthatofvisuospatiallanguages(suchassignBellugi,vanHoek,LilloMartin,&OGrady,1993).
Nonetheless,thereisresearchsuggestingthatlipreadingbecomesmoreimportanttoorallanguagedevelopmentashearingimpairmentworsens(MogfordBevan,
1993).
Becauselimitingauditoryexposurelimitslearningopportunities,evenchildrenwithmilderhearinglosseswhothereforeobtaingreateramountsofacousticinformation
aboutorallanguagethanchildrenwithgreaterhearinglossesexperiencesignificantconsequencesfortheirspokenlanguagereceptionineverydaysituations.
Therefore,althoughthischapterfocusesmostintentlyonchildrenwithgreaterdegreesofhearingimpairment,italsoalertsreaderstothejeopardyinwhichchildren
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withevenunilateralormildbilateralhearingimpairmentsareplacedwhenitcomestolanguagelearningandacademicsuccess(Bess,1985Bess,Klee,&
Culbertson,1986Carney&Moeller,1998Culbertson&Gilbert,1986Oyler,Oyler,&Matkin,1988).InthePersonalPerspectiveforthischapter,ateenager
describesthewaysinwhichdeafnesshasaffectedherschoollife.
PERSONALPERSPECTIVE
ThefollowingisanexcerptfromthetranscriptofastatementmadebyDarby,ahighschooljuniorwithaprofoundhearingimpairment.Shespeaksaboutthe
academicandpersonalchallengesfacingherinschool:
Ihavenever,andmostlikelyneverwill,hearsoundsinthesamewayasahearingperson.Asaresult,hearingpeopleexperiencethingseverymillisecondoftheday
thatIneverwill.Bythesametoken,Ihaveexperiencedthingsandwillexperiencethingsthatnohearingpersoncan.
Mydeafnessmakesmedifferent,andthatdifferencemakesmestrong.Iseemtogetrespectfromotherpeoplejustfordoingthingsahearingpersoncandowith
ease.Forexample,watchtelevision,usethetelephone,listentomusic,andsoon.Forwhateverreason,IneverthinkaboutthefactthatIamdoingsomethingthat
wouldnormallybedifficultforsomeonewhocouldnthear.Infact,Ihaveneverlookedatmyselfassomeonewhowaslimitedinanyway,someonewhocouldntdo
somethingthatanyotherhearingpersoncoulddoIvealwaysknowthatIwasdifferent,buteventhoughpeoplewouldintimatethatIwasntabletocompeteonthe
sameslevelashearingpeople,Iwouldignorethem,ormaybeIjustdidnthearthem.
IhavealwaysattendedDalton,aprivatehearingschool.Ithasneverbeen,andneverwillbe,easyforme.Ihaveexperiencedperiodsofrejectionandisolation,butI
haveprovenmyselfworthyoftheprivilegeofattendingthisschoolbyreceivinggradesasgoodasmanyofmyhearingpeersandbetterthanmost.
Ihavedefinitelysurvivedtheacademicchallengesofmyschoolandlife.Socially,IstillfeelthoughthatImnotacceptedasatrueequal,buthey,thatstheirproblem,
theydontknowwhattheyremissing.(Ross,1990,pp.304305)
Overalldegreeofhearingloss,ormagnitude,isamajordescriptorofhearingimpairment,usuallybasedonanestimateofanindividualsabilitytodetectthepresence
ofapuretoneatthreefrequenciesimportantforspeechinformation(500,1000,and2000HzBradleyJohnson&Evans,1991).Table8.1listsmajorcategoriesof
hearinglossandprovidessomepreliminaryinformationabouttheeffectsofthatlevelofloss.Althoughdeafnessisnotlistedasacategoryinthetable,itisfrequently
usedtorefertoahearinglossgreaterthanorequalto70dB(Northern&Downs,1991).
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Table8.1
EffectofDifferingMagnitudesofHearingLoss
Average
HearingLevel
(5002000 WhatCanBeHeard HandicappingEffects
Hz) Description WithoutAmplification (IfNotTreatedinFirstYearofLife) ProbableNeeds
Note.FromHearinginChildren(4thed.,p.14),byJ.L.NorthernandM.P.Downs,1991,Baltimore:Williams&Wilkins.Copyright1994byWilliams&
Wilkins.Reprintedwithpermission.
Page191
Thetermhardofhearingisusedtorefertolesserdegreesofhearinglossthatallowspeechandlanguageacquisitiontooccurprimarilythroughaudition(Ross,
Brackett,&Maxon,1991).
Inadditiontothemagnitudeofloss,relatedvariablesthatinfluencehowchildrenslanguageisaffectedinclude(a)variablesaffectingtheauditorynatureoftheloss
(suchastype,configuration,andwhetherthelossisunilateralorbilateral),(b)theageatwhichthehearinglossisacquired,(c)theageatwhichitisidentified,and(d)
howwellthelossismanaged.
Typeofhearinglossconductive,sensorineural,ormixedreferstothephysiologicalsiteresponsibleforreducedsensitivitytoauditorystimuli.Conductivehearing
lossesresultfromconditionsthatpreventadequatetransmissionofsoundenergysomewherealongthepathwayleadingfromtheexternalauditorycanaltotheinner
ear.Theycanresultfromconditionsthatblocktheexternalearcanalorinterferewiththeenergytransferringmovementoftheossicles(smallbones)ofthemiddleear.
Conductivelossesaregenerallysimilaracrossfrequenciesand,attheirmostsevere,donotexceed60dB(Northern&Downs,1991).Suchlossescanoftenbe
correctedorsignificantlyreducedusingmedicalorsurgicaltherapies(Paul&Jackson,1993).
Oneparticularlycommoncauseofconductivehearinglossismiddleearinfection,otitismedia.Thehearinglossassociatedwiththisconditionmaybethemostwidely
experiencedformofhearingloss,giventhat90%ofchildrenintheUnitedStateshavehadatleastoneepisodeofotitismediabyage6(Northern&Downs,1991).
Althoughnotallepisodesofotitismediaareassociatedwithhearinglosses,whentheyareobservedtheoverallmagnitudesoflosshavegenerallybeenfoundtofall
from20to30dBintheaffectedear(FrialCantekin,&Eichler,1985).
Sensorineuralhearinglossesresultfromdamagetotheinnerearortosomeportionofthenervoussystempathwaysconnectingtheinnereartothebrain.Theyare
responsibleforthemostserioushearinglosses,accountingfororcontributingtomosthearinglossesintheseveretoprofoundrange.Inaddition,theyaccountformost
congenitalhearinglosses(Scheetz,1993)andarerarelyreversible(Northern&Downs,1991).
Mixedhearinglossesrefertolossesinwhichbothconductiveandsensorineuralcomponentsareevident.Becausetheconductivecomponentsofamixedhearing
lossaregenerallytreatable,suchlossesoftenbecomesensorineuralinnaturefollowingeffectivetreatmentfortheconditionunderlyingtheconductiveloss.Forexample,
achildwithDownsyndromemayexperienceamixedlossconsistingofasensorineurallossexacerbatedbypooreustachiantubefunctionandchronicotitismedia.
Effectivemanagementofthemiddleearconditioncanreducethemagnitudeofthelosssubstantiallyinmanycases.Consequently,clinicianswhoworkwithchildren
whohavesensorineurallossesneedtobeespeciallyawarethatanalreadysignificantdegreeoflosscanbefurtherworsenedifmiddleeardiseasegoesundetected.
Centralauditoryprocessingdisordersrefertoabnormalitiesintheprocessingofauditorystimulioccurringintheabsenceofreducedacuityforpuretonesoratamore
pronouncedlevelthanwouldbeexpectedgiventhedegreeofreducedacuity.Inespeciallyseverecases,suchdifficultieshavebeendescribedasaspecifictypeof
languagedisorder:verbalauditoryagnosia(Resnick&Rapin,1991).Althoughcentralauditoryprocessingdisordersreceiveincreasingattentionbyaudiologists,their
sepa
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rabilityfromlanguagedisabilitiesandotherlearningdisabilitiescontinuestobedebated(Cacace&McFarland,1998Rees,1973).
Hearinglossconfigurationreferstotherelativeamountoflossoccurringatdifferentfrequencyregionsofthesoundspectrum.Forexample,ahighfrequencylossis
oneinwhichthelossislargelyorsolelyconfinedtothehigherfrequenciesofthespeechspectrum.Incontrast,aflathearinglossisoneinwhichthedegreeoflossis
relativelyconstantacrossthespectrum.
Knowingthemagnitudeandconfigurationofanindividualshearinglosscanhelpyoupredictwhatsoundswillbedifficultforhimorhertohearatspecificloudness
levels.Apairoffiguresmayhelpillustratethis.Figure8.1consistsoftwofrequencyintensitygraphs(likethoseofatraditionalaudiogram)onwhichareplotteda
varietyofcommonsoundsoccurringatvariousintensitylevelsandfrequencies.TheshadedareaonFigure8.1Aindicatesthesoundfrequenciesandintensitiesthat
mightnotbeheardbychildrenwithseverehighfrequencyhearinglosseschildrensuchasSammy,whowasdescribedatthebeginningofthechapter.Although
Sammywouldeasilyhearenvironmentalsoundssuchascarhornsortelephonesaswellasmanyspeechsoundswhentheyareproducedatconversationalloudness
levels,shewouldprobablymissmostfricativesoundsbecauseoftheirhighfrequency(highpitch)andlowintensity(softness)whentheyareproducedinthesame
conversations.
Figure8.1Brepresentsthekindoflossfrequentlyassociatedwithdeafness,thekindoflossdemonstratedbyDesmond.Thenegligibleamountofauditoryinformation
towhichDesmondhasaccessiswellillustratedbythisfigure.ThecentralityofvisualinformationtoDesmondsinteractionswiththeworldisfurtherbroughthome
whenyouaretoldthateventhebestavailableamplificationwouldprobablyfailtoimproveDesmondsaccesstosoundinformation.Consequently,itisnotsurprising
thatvisionhasbeencalledtheprimaryinputmodeofdeafchildren(Ross,Brackett,&Maxon,1991)andthatmanagementofthecommunicationneedsofsuch
childrenoftenveersawayfrommethodsinwhichauditoryinformationplaysamajorrole(Nelson,Loncke,&Camarata,1993),althoughgrowingeffectivenessof
cochlearimplantsmayincreasethatsomewhat,especiallyascochlearimplantsareusedatyoungerages(TyeMurray,Spencer,&Woodworth,1995).Acochlear
implantentailstheinsertionofasophisticateddevicethatincludesaninternalreceiver/stimulatorandanexternaltransmitterandmicrophonewithamicrospeech
processor(Sanders,1993).Theirrapiddevelopmentandincreasingapplicationmakethemanexcitingdevelopmentinthemanagementofseverehearinglosses.
Whetheroneorbothearsareaffectedrepresentsanotherimportantfactordeterminingthesignificanceofahearingloss.Unilateralhearinglosses,onesaffectingonly
oneear,usuallyhavefewernegativeconsequencesthanbilateralhearinglosses.Thatdoesnotmean,however,thatunilaterallossesareinsignificant.Adequatehearing
inbothearsisofparticularimportancewhenlisteningtoquietsoundsorinnoisysurroundingsespeciallyforchildren.Thisspecialimportanceofbilateralhearingin
childrenarisesbecausetheirincompletelanguageacquisitionmakesusinglanguageknowledgeandenvironmentalcontexttoguessthemessagebeingconveyedbyan
imperfectsignalmuchharderforthemthanitisforadults.InastudyconductedbyBessetal.(1986),aboutonethirdofthechildrenwhoexhibitedunilateralsen
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Fig.8.1.Figuresillustratingthetypesofsoundsthatarelikelytobeheard(unshadedareas)andnotheard(shadedareas)fortwodifferenthearinglosses:asevere
highfrequencyloss(8.1A)andaprofoundhearingloss(8.1B).Forpurposesofclarity,butcontrarytomostinstancesinreallife,thesefiguresrepresenthearinglossas
identicalforeachear.FromHearinginchildren(4thed.,p.17),byNorthernandDowns,Baltimore:Williams&Wilkins.Copyright1991byWilliams&Wilkins.
Adaptedbypermission.
Page194
sorineuralhearinglossesof45dBHLorgreaterwerefoundtohaveeitherfailedagradeorrequiredspecialassistanceinschool.
Despitetheimportanceofthenatureofhearinglossaffectingachildtothatchildsoveralloutcomeforspeechandorallanguage,severalnonauditoryfactorscanplaya
verysignificantrole.Forexample,theageatwhichahearinglossisacquiredhasatremendousimpactontheextenttowhichitwillinterferewiththeacquisitionoforal
language.Congenitalhearinglosses,thosepresentatbirth,aremoredetrimentalthanthoseacquiredinearlychildhood,whichinturnaremoredetrimentalthanthose
acquiredinlaterchildhoodoradulthood.Even3or4yearsofgoodhearingcandramaticallyalterachildslaterlanguageskills(Ross,Brackett,&Maxon,1991).This
facthasledtotheuseofthetermprelingualhearinglosstorefertoahearinglossacquiredbeforeage2,whichisthusthoughttobeassociatedwithamore
significantimpact(Paul&Jackson,1993).
Theageofdetectionofhearinglossinchildrenisyetanothervariableaffectingtheorallanguageofhearingimpairedchildren.Theearlierthedetectionofhearinglossin
children,thebettertheoutcomeforlanguageacquisitionassuming,ofcourse,thatadequateinterventionfollows.Recentlydevisedmethods,suchasthemeasurement
ofauditorybrainstemevokedresponsesandtransientevokedotoacousticemissions,permitthedetectionofevenmildhearinglossinchildrenfromshortlyafterbirth
(Carney&Moeller,1998Mauk&White,1995Northern&Downs,1991).Between10and26%ofhearinglossisestimatedtoexistatbirthortooccurwithinthe
first2yearsoflife(Kapur,1996),thusmakingeffortsatdetectionanongoingneed.
Despitethepossibilityofearlydetection,however,hearinglosswillescapedetectionforvaryingperiodsoftimeinchildrenwhosehearingisnotscreenedoris
screenedpriortotheonsetoftheloss.Inarecentstudy,HarrisonandRoush(1996)surveyedtheparentsof331childrenwhohadbeenidentifiedwithhearingloss.
Theyfoundthatwhentherewasnoknownriskfactor,themedianageofidentificationofhearinglosswasabout13monthsforseveretoprofoundlossesand22
monthsformildtomoderatelosses.Althoughthepresenceofknownriskfactorswasassociatedwithdecreasedageatidentificationformilderlosses(downtoabout
12months),identificationformoreseverelossesremainedaboutthesameinthisgroup(12months).Medianadditionaldelaysofupto10monthswereobserved
betweenidentificationofhearinglossandearlyinterventions.Thesedelaysrepresentpreciouslosttimeforchildrenwhoseauditoryexperienceoftheworldis
compromised.Onlyinlate1999haveeffortstomakeuniversalscreeningofinfanthearingareality(Mauk&White,1995)receivedmomentoussupportintheformof
TheNewbornandInfantHearingScreeningandInterventionActof1999.Thisfederallegislationprovidesnewfundingfornewbornhearingscreeninggrantsto
individualstates.Itishopedthatthisfundingwillcauseallstatestoimplementinfantscreeningprogramsleadingtoarevolutionintheearlyidentificationofhearingloss.
Afourthfactorinfluencinghowhearinglosswillaffectchildrenslanguagedevelopmentisthemanagementoftheloss.Forchildrenwithmildandmoderatebilateralor
unilaterallosses,thereisconsiderableagreementastotheapproachesthatwilloptimizetheiraccesstotheauditorysignalonwhichtheywillrelyforprocessinginfor
Page195
mationaboutorallanguage.Table8.2listssomeofthetypesofinterventionstypicallyconsideredinthehearingmanagementofchildrenwiththeselesserdegreesof
loss.
Whenitcomestochildrenwithgreaterlosses,however,thereismuchcontroversyamongprofessionalsaswellasmembersoftheDeafcommunity(Coryell&
Holcomb,1997).Afrequentbattlegroundforthoseinterestedininterventionsfordeafyoungstersconcernstheprimacyoforalversussignedlanguage.Arguments
favoringanemphasisonorallanguagestressthatthevastmajorityofsocietyareusersoforallanguageand,therefore,deafchildrenshouldbegiventoolswithwhichto
negotiateeffectivelywithinthatcontext.Further,itcanbestressedthattheirfamilieswillalmostalways(90%ofthetime)becomposedentirelyofhearingindividuals
(Mogford,1993).
ArgumentsfavoringanemphasisonsignlanguagestressthattheDeafcommunityisacohesivesubcultureinwhichvisuospatialcommunicationistheeffectivenorm.In
fact,inrecentyears,theDeafcommunityhasbeguntoadvocateforadifferenceratherthandisorderperspectiveonhearingimpairment,apoliticalperspectivethought
tobevitaltotheemotionalandsocialwellbeingofitsmembers(Corker,1996Harris,1995).Argumentsfavoringastrongemphasisonsignlanguagealsosadlynote
thatonlypoorlevelsofachievementinorallanguageandparticularlypoor
Table8.2
InterventionsUsedWithChildrenWhoHaveMild
andModerateHearingImpairment(Brackett,1997)
Method Function
PersonalamplificationFMradio IncreaseloudnesslevelsofacousticsignalsacousticsignalenhancedrelativetobackgroundnoiselevelsAfarsuperior
systemsusedwithremote meansofdealingwithanoisyclassroomthanpreferentialseating(Flexer,1994)oneofseveraltypesofspecialamplification
microphones systems(Sanders,1993)
Soundtreatmentofclassrooms(e.g.,
usingcarpets,acousticceilingtiles, Reductionofreverberationandothersourcesofnoise
curtains)
ReductionofdistancebetweenspeakerandchildcanincreaseaudibilityofasignalSittingnexttoachildisbetterthansitting
Preferentialseating infrontofthechild(Flexer,1994),althoughforchildrenwhorequirevisualinformation,thisstrategydecreasesaccessto
visualinformation
Inclusioninregularclassroomwith Provisionofthewealthofsocialandacademicexperiencesaffordedbyregularclassrooms,withsupportdesignedto
supplementationthroughpullout previewandreviewinstructionalvocabularyaswellasworkoncommunicationgoalsinconsistentwithclassroomsetting
services (e.g.,theearlieststagesinvolvedinacquiringanewcommunicativebehavior)
Auditorylearningprogram(e.g.,Ling,
Improvementofthechildsattentionanduseofauditoryinformationenhancedbypersonalandclassroomamplification
1989Stout&Windle,1992)
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levelsofachievementinwrittenlanguage(whichoftenplateausatathirdgradelevel)havebeenthenorminstudiesofindividualswithseveretoprofoundhearinglosses
(Dub,1996Paul,1998).
Totalcommunicationwasoriginallyproposedasthesimultaneoususeofmultiplecommunicationmodes(e.g.,fingerspelling,signlanguage,speech,andspeechreading)
selectedwiththechildsindividualneedsinmind.Asimplemented,however,totalcommunicationhasbeenfoundtypicallytoconsistofthesimultaneoususeofspeech
andoneofseveralsignlanguagesotherthanAmericanSignLanguage(ASL)thatusewordorderandwordinflectionscloselyresemblingthoseofspokenEnglish
(Coryell&Holcomb,1997).Themostprominentexamplesofthesesignlanguages,sometimesreferredtoasmanuallycodedEnglishsystems,areSigningEssential
English(SEE1),SigningExactEnglish(SEE2)andSignedEnglish.Althoughmostclassroomteachersreportusingthisrelativelylimitedformoftotalcommunication
(sometimestermedsimultaneouscommunication),itisinfrequentlyusedamongadultsintheDeafcommunity(Coryell&Holcomb,1997).
Inareviewofstudiesoftreatmentefficacyforhearinglossinchildren,CarneyandMoeller(1998)notedacurrenttrendtowardconsideringorallanguageasapotential
secondlanguagefordeafchildren,tobeacquiredaftersomedegreeofproficiencyinafirst(visuospatial)languageisattained.Thisapproach,termedthebilingual
educationmodel,isseenbysomeashavingthestrengthsassociatedwithlearningalanguage(i.e.,ASL)forwhichacohesivecommunityofusersexists,whileatthe
sametimevaluingtheimportanceofEnglishcompetenceasacurricularratherthanrehabilitativeissue(Coryell&Holcomb,1997Dub,1996).Datasupportingthis
approach,however,arerelativelysparseasyet.Todate,suchdataconsistofevidenceofstrongacademicperformanceinEnglishbydeafchildrenrearedbydeaf
parentswhoareproficientinASLandevidencethatskillsinEnglisharestronglyrelatedtoskillsinASL,independentofparentalhearingstatus(Moores,1987
Spencer&Deyo,1993Strong&Prinz,1997).
ArecentpositionstatementoftheJointCommitteeofASHAandtheCouncilonEducationoftheDeaf(1998)illustratesthegrowinginfluenceoftheDeafcommunitys
insistencethatdeafnessbeviewedasaculturalphenomenonratherthanaclinicalcondition(Crittenden,1993).Inthatpositionstatement,professionalsarecautioned
toadoptterminologythatrespectstheindividualandfamilyorcaregiverpreferenceswhilefacilitatingtheindividualsaccesstoservicesandassistivetechnology.
Sensitivitytoculturalfactorsisarequisiteforspeechlanguagepathologistsinallsettingsworkingwithallpopulations.Forspeechlanguagepathologistsworkingwith
membersoftheDeafcommunity,itisarequirementofcriticalimportancetothedeafchildssocialandemotionaldevelopment.
SuspectedCauses
Whatiscurrentlyknownaboutthecausesofpermanenthearingimpairmentinchildrenisalmostentirelyrestrictedtostudiesfocusedonmoreseriouslevelsofhearing
loss,especiallydeafness.Althoughtheremaybeconsiderableoverlapintheknown
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causesofdeafnessandmilderdegreesofimpairment,differencesalsoexist.Becausethissectionlimitsitselftocausesrelatedtothesemoreseverelevelsofhearing
loss,IremindreadersthatwhatIsayrelateslessclearlytochildrenwithmilderlosses.
Geneticfactorsaresuspectedinabouthalfofallcasesofdeafness(Kapur,1996Vernon&Andrews,1990).Ofthesegeneticallybasedinstancesofdeafness,about
80%areduetoautosomalrecessivedisorders,almost20%areautosomaldominantdisorders,andtheremainingaresexlinked(Fraser,1976).Becauserecessive
disordersdemandthatbothparentsofanindividualcontributeadefectivegenefortheiroffspringtodemonstratethedisorderwithoutnecessarilyshowingevidenceof
thedisorderthemselves,itisrelativelyuncommonforchildrenwithcongenitaldeafnesstohaveparentswhoarealsodeaf.Thisinformationisimportantforappreciating
thatmostcongenitallydeafchildrengrowupwithparentswhosefirstlanguageisoralandwhowillneedtoacquiresignasabelatedsecondlanguageiftheyaretoassist
theirchildsacquisitionofsign.
Geneticallycauseddeafnesssometimesoccurswithinthecontextofgeneticsyndromesinwhichoneormorespecificorgansystems(e.g.,theskeleton,skin,nervous
system)arealsoaffected.About70suchsyndromeshavebeenidentified,includingDownsyndrome,Apertsyndrome,TreacherCollins,PierreRobin,andmuscular
dystrophy(Bergstrom,Hemenway,&Downs,1971).Althoughmostgeneticallycauseddeafnesswillbesensorineuralintype,conductivecomponentsarealso
observed.Somesyndromesareassociatedwithhearinglossesthatareprogressive,causingincreasinghearinglossovertime,oftenatunpredictablerates.Examplesof
suchsyndromesareFriedrichsataxia,severeinfantilemusculardystrophy,andHuntersyndrome,aswellasthecloselyrelatedHurlersyndrome.
Nongeneticcausesofdeafnessincludeprenatalrubella,postnatalinfectionwithmeningitis,prematurity,rhfactorincompatibilitybetweenmotherandinfant,exposureto
ototoxicdrugs,syphilis,Menieresdisease,andmumps(Vernon&Andrews,1990).Fourofthesefactorsprenatalrubella,meningitis,syphilis,andmumpsare
infectiousdiseasesmeaningthattheirsuccessfulpreventioncandrasticallyreduceinstancesofdeafnessfromthosecauses.
Thethreenoninfectiousfactorsmostcommonlyassociatedwithhearinglossinchildrenarerhfactorincompatibility,exposurestoototoxicdrugs,andMenieres.Rh
factorincompatibilityreferstoaconditioninwhichamotherandtheembryosheiscarryinghavebloodtypescharacterizedbydiscrepantrhfactors,acircumstance
thatstimulatestheproductionofmaternalantibodiesagainstthedevelopingchild.Thisconditioniscurrentlyconsideredpreventablethroughmaternalimmunizationor
thetreatmentoftheinfantusingphototherapyortransfusions(Kapur,1996).
Ototoxicityreferstoadrugstoxicitytotheinnerear.Althoughtheuseofdrugswiththissideeffectisusuallyavoidedinpregnantwomenandinfants,theymaybe
requiredastheonlyeffectivetreatmentforsomediseases.Monitoringofhearingcanfrequentlypreventhearinglossinchildrenwhorequiretreatmentwithototoxic
drugsbecauseofinfectionsorcancer(Kapur,1996).
Prematurity,birth2ormoreweekspriortoexpectedduedate(Dirckx,1997),isanincreasinglyfrequentcorrelateofhearingimpairment.Whereasmortalitywas
once
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analmostcertainoutcomeofprematurity,improvedneonatalcareoverthepasthalfcentury(Vernon&Andrews,1990)hasresultedintheincreasedsurvivalof
childrenwhononethelessmayshowresidualeffects.Prematurebirthismostdirectlyassociatedwithhearingimpairmentandothercooccurringdifficulties(e.g.,mental
retardation,cerebralpalsy)throughtheneurologicstressesitplacesontheinfant.Indirectlinksbetweenprematurityandhearingimpairmentlieinthefactthat
prematurebirthisfrequentlyprecipitatedbyconditionsthatarethemselvesassociatedwithhearingimpairment(suchasprenatalrubella,meningitis,andrhfactor
incompatibility).Prematurityincreasesriskofdeafnessby20times(Kapur,1996).
SpecialChallengesinAssessment
Whenassessingtheoralcommunicationskillsofchildrenwithhearingimpairment,thespeechlanguagepathologistisconfrontedwithnumerousthreatstothevalidityof
hisorherdecisionmaking.Therefore,inadditiontotheusualcarethatmustbetakentodeterminetheprecisequestionspromptingassessmentandfactorsthatmay
complicateaccurateinformationgathering,cliniciansworkingwithchildrenwhosehearingistemporarily(e.g.,duringepisodesofotitismedia)orpermanentlyimpaired,
mustconsideralargerthanusualrangeofpossiblecomplicatingfactorsandnecessaryadaptations.Table8.3listssomeoftheconsiderationsrelatedtotheevaluation
oflanguageskillsofachildwithhearingimpairment.
Amajorfirstconsiderationforchildrenwithveryseverehearinglossisthechoiceoflanguageorlanguagesinwhichthechildistobeassessed.Often,testinginbotha
signandanorallanguageisreasonableforobtaininginformationaboutpotentiallyoptimalperformanceaswellasaboutdevelopmentwiththealternativeform.
Complexitiesofthechildshearinglossandofitsmanagementwillneedtobeconsideredinmakingthisdecision,becausechildrenwhomaybeconsidereddeafdonot
alwaysreceiveenoughexposuretosignlanguagetoconsiderittheirfirstlanguage(Mogford,1993).
AlthougheffortstostandardizeassessmentsofASLhavebegun(e.g.,LilloMartin,Bellugi,&Poizner,1985Prinz&Strong,1994Supallaetal.,1994),childrens
performanceinASL(themostcommonsignlanguagesystemintheUnitedStates)isusuallyinformallyassessedbyindividualswithhighlevelsofproficiencyinASL.A
smallnumberofstandardizedtoolshavebeendeveloped.AmongthesearetheCaro
Table8.3
ConsiderationsWhenPlanningtheAssessmentofaChildWithImpairedHearing
Determinewhatmodalityormodalitieswillbeused.
Matchdemandsplacedonhearingtoassessmentquestion.
Ensurethatinstructionsareunderstood.
Identifyanappropriatenormativegroupfornormreferencedinterpretations.
Ensureoptimalattentionandminimaldistractions.
Considertheuseofmodificationsanddescribeinreportsoftesting.
Relyonmultiplemeasuresandteaminputforpreparationandinterpretation.
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linaPictureVocabularyTest(Layton&Holmes,1985),whichisdesignedforusewithchildrenage2years8monthsto18yearswhoseprimarilymodeof
communicationissign.Dub(1996)discussesthecurrentpressingneedforbettermethodsofassessingchildrenscompetenceinbothASLandEnglish.
Forchildrenwithseveretoprofoundhearinglosses,assessmentoforallanguagemayalsorequireinteractionsinASL(e.g.,toassurethatataskisunderstood).
Maxwell(1997)reasonablypointedoutthatdeafindividualsoftenusebothsignandspokenlanguagedependingonthedemandsofthecommunicativesituation,andhe
pointedoutthatdeterminingwhatmodesofcommunicationachildusesaretoooftenbasedonhearsayorthecliniciansownlimitationsinidentifyingthe
communicationsystembeingused.Therefore,speechlanguagepathologistswhoworkfrequentlywithhearingimpairedchildrenshouldbeproficientinsignthemselves
and,ideally,inbothsignedEnglishandASLmodes.Thosewhoarenotproficientbutreceiveoccasionalrequeststoservehearingimpairedchildrenshouldproceed
carefullyindeterminingwhatcanbedoneintheabsenceofsuchproficiencyandshouldbepreparedtomakereferralsasneededtoensureoptimalassessmentdata.
Themajorityofthissectionofthechapterisdevotedtoconsiderationscomingintoplayduringorallanguagetesting.
Forchildrenwithalldegreesofhearingloss,oneofthefirstconsiderationsinorallanguagetestingisthelisteningconditionconfrontingthechild.Forexample,isthe
settinginwhichthetestingisdonerelativelyquiet?Ifveryquiet,optimalperformancemaybeassessed(assumingotherfactorsareoptimal).Iflessquiet,optimal
performancewillbeunlikely,butusefulinformationforextrapolatingtypicalperformanceinsimilarsettingsmaybeobtained.Inmanycases,languageestingis
performedforpurposesofexaminingoptimalperformance.However,ifthepurposeoftestingistodeterminethekindofdifficultyfacingthechildinaconventional
classroom,thentestinginnoisierenvironmentswouldbeindicated.Ying(1990)discussedasystematicapproachtoexaminingthechildsfunctionalauditoryskills
underconditionsvarying(a)accesstobothvisualandauditoryinformationversustoauditoryinformationonlyand(b)auditorystimulithatarecloseversusfarin
conditionsthatare(c)noisyversusquiet.
Knowledgeofthechildslisteningconditionsincludesnotonlyinformationabouttheambientenvironment,butalsoaboutthestatusofthechildshearingandhearing
aidatthetimeoftesting.Recallingthatchildrenshearingcanbeaffectedmorereadilybymiddleearinfectionsthancanadultsmakesitparticularlyimportanttoknow
whetherthechildhasanupperrespiratoryinfectionorisshowingsignsofreducedhearing,suchasalteredresponsetoauditorystimuliorappearingconfusedorinpain
innoisysituations(Flexer,1994).Ascertainingdirectlyorindirectlythatahearingaidhaschargedbatteriesandisfunctioningwellistimewellspentgivenstudies
indicatingthatchildrenshearingaidsarefrequentlyfoundtobefunctioningunacceptably(e.g.,Musket,1981Worthington,Stelmachowicz,&Larson,1986).In
addition,whenhearingaidsareinplacebutnotfunctioningbecauseofadeadbattery,theirusehasbeenfoundtoreducehearingbyanadditional25to30dBat
criticalspeechfrequencies(Smedley&Plapinger,1988).
Ensuringthatdirectionsareunderstoodisobviouslymostcrucialforreceptivelanguagetesting,butcanbecriticalforexpressivelanguagetestingaswell,particularly
whenverbalinstructionsareused.Besidesthestepsdescribedearlier,whichare
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aimedatimprovingthechildsauditoryaccesstoinformation,seatingtomakethetestersfacevisibleandwelllit(notbacklit)canhelp.Becausechildrenwithhearing
lossmayfailtosignaltheirincompleteunderstandingofdirections(Paul&Jackson,1993),theclinicianmustbeparticularlywatchfulforhesitationsorfacialexpressions
indicatingalackofunderstanding.Inaddition,studentsshouldbeencouragedtoaskquestionswhentheyareuncertain(BradleyJohnson&Evans,1991).
Whenthequestionsbeingaskedinanassessmentareinregardtowhetherthechildsperformanceislikethatofhisorherpeers,theticklishquestionofnormsis
presented.Sometimesitisassumedthatthosepeersshouldbeagroupthatissimilarinagetothetestedchild(e.g.,becausethesearethechildrenwithwhomachild
willbecomparedatschoolandwithwhomheorshesharesacommondevelopmentalhistoryBradleyJohnson&Evans,1991).Insuchcases,findingappropriate
normsisrelativelyeasy,andtheuseofpeerswithnormalhearingisquiteappropriate(Brackett,1997Ying,1990).However,usingthatnormativegroupwillnothelp
youfigureoutwhetheranyobserveddecrementsinperformancearedueprimarilytohearingdifferences,orwhetheradditionalcognitiveorenvironmentalbarriersto
languagelearningexist.Forthosequestions,normsshouldideallyconsistofchildrenwithsimilarpatternsofhearingimpairmentandsimilardevelopmentalexperiences.
Alternatively,interpretationsbasedoninformationotherthannormsshouldbeconsidered(fordetaileddiscussionofinformalmethods,seeMaxwell,1997Moeller,
1988Ross,Brackettt,&Maxon,1991andYoshinagaItano,1997).
Table8.4listslanguageteststhathavebeendevelopedforornormedonchildrenwithhearingimpairment(BradleyJohnson&Evans,1991).Evenwhensuchnorms
areavailable,determiningtheappropriatenessofthenormsstillhingesonthetestusersexaminationofthetestmanualforspecificinformationaboutthenormative
sample.Forchildrenwithhearingimpairment,factorsaffectingtherelevanceofnormsincludethegroupsageofonsetofthehearingloss,degreeandtypeofloss,
etiology,presenceofothersignificantproblems,andthecommunicationusedduringtesting(BradleyJohnson&Evans,1991).
Onceanappropriatemeasurehasbeenselected,increasingthechildsattentiontothetaskandminimizingdistractionsfurtherenhancethepossibilityofobtaining
informationreflectingoptimalperformance.Positioningoneselfclosetothechildandpayingcloseattentiontothechildsgazeasasignalofcurrentfocuscanhelp
increaseattentionwhilealsominimizingdistractions(Maxwell,1997).
Bymodifyingtestingprocedures,onerisksinvalidatingnormativecomparisons.However,whentestingmodificationsarenotedinreportsonthetestinganddiscussed
fortheirpossibleeffectsontestvalidity,theirusecanactuallyimprovevaliditybyremovingsourcesoferrorthatareunrelatedtotheskillorattributebeingtested.Ying
(1990)discussedanumberofpossiblemodificationstousewhentestingchildrenwithhearingimpairment.Theseincludeaskingthechildtorepeatallverbalstimulito
ensurethatpoorreceptionisnotunderminingperformanceandusingextrademonstrationitemstoensurethatthechildunderstandsthetaskdemands.Anotherpossible
modificationsherecommendedwasrepeatingverballypresentedtestitems.Also,whenstandardizedinstructionscallforsimultaneouspresentationofverbalandvisual
stimuli,shesuggestedalteringproceduressothattheverbalstimulusispresented
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Table8.4
LanguageTestsforChildrenWithHearingImpairmentThatWereDesignedorAdaptedfor
ChildrenWithHearingImpairment(BradleyJohnson&Evans,1991)
Testsacross5domains:personalsocial, l Althoughchildrenwithhearingimpairmentaredescribedasan
BatelleDevelopmental
adaptive,motor,communication,andcognitive appropriatepopulationfortesting,neithernormsnorstudies
Inventory(Newborg,Stock, Birthto8
purposeistoidentifychildrenwithhandicaps, validatingthatusearecontainedinthetestmanual
Wnek,Guidubaldi,&Svinicki, yearsofage
determinestrengthsandweaknesses,andhelpin l Adaptationsofitemsinthecommunicationdomainhavebeen
1984)
planninginstructionandmonitoringprogress describedasinappropriate
l Standardizedon150hearingimpairedchildrenenrolledinoral
GrammaticalAnalysisof Skillsassessedforcomprehension,prompted
educationalprogramswhosehearingimpairmentwasnot
ElicitedLanguagePre production,andimitatedproduction,withitems
3to6years described
sentenceLevel(GAELP at3levels:readiness,singlewords,andword
l Nodataforchildrenwhousemanualcommunication
Moog,Kozak,&Geers,1983) combinations
l Scoresexpressedaspercentiles
l Normsobtainedfor3groupsofchildrenwithhearing
impairmentandonenonhearingimpairedgroupconsiderable
informationisavailableaboutthesegroupsoneofthegroups
GrammaticalAnalysisof withhearingimpairmentcamefromtotaleducationbackgrounds
ElicitedLanguageSimple Skillsareassessedintermsofprompted andwastestedusingthatmethod
5to9years
SentenceLevel(GAELS productionandimitation. l 94itemsassessingarticles,modifiers,pronouns,subjectnouns,
Moog&Geers,1985) objectnouns,whquestions,verbs,verbinflections,copula
inflections,prepositions,andnegation
l Scoresexpressedaspercentilesorlanguagequotients
(M=100SD=15)
(Continued)
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Table8.4(Continued)
l Twogroupsofchildren,onewithandonewithouthearing
impairmentwerestudiedthehearingimpairedchildrenhad
severetoprofoundlevelsofimpairmentandwerewithoutother
problemareas
GrammaticalAnalysisof
l 16grammaticalcategoriesareassessed:articles,noun
ElicitedLanguageComplex Skillsareassessedintermsofprompted
8to12years modifiers,subjectnouns,objectnouns,nounplurals,personal
SentenceLevels(GAEL productionandimitation
pronouns,indefiniteandreflexivepronouns,conjunctions,
CMoog&Geers,1980
auxiliaryverbs,firstclauseverbs,verbinflections,infinitivesand
participles,prepositions,negation,andwhquestions.
l Scoresexpressedaspercentilesorlanguagequotients
(M=100SD=15)
l Normedon364childrenwithhearingimpairmentrangingfrom
moderatetoprofoundand283childrenwithouthearing
impairmentconsiderableinformationisavailableaboutthe
hearingimpairedgroup
l 100itemsareusedtoassess20sentencetypes,including
RhodeIslandTestofLanguage
simplesentences,imperatives,negatives,passives,dative
Structure(Engen&Engen, 5to17+years Designedtoassesscomprehensionofsyntax
sentences,expandedsimplesentences,adverbialclauses,relative
1983)
clauses,conjunctionsdeletedsentences,noninitialsubjects,
embeddedimperatives,andcomplements
l Testmaybeorallypresentedorpresentedthrough
simultaneouspresentationofsignedandspokenEnglish
l Resultsarepresentedaspercentilesorstandardscores.
l Standardizedon372childrenfrom2yearsto8years,11
ScalesofEarlyCommunication Verbalandnonverbalskillsareassessed
months,withprofoundhearingimpairmentsfromoralprograms
Skills(SECSMoog&Geers, 2to9years receptivelyandexpressivelythroughteacher
l Interexaminerreliabilitydataonlynotestretestdataor
1975) ratings
validityinformation.
Thereare3levelsofthetest:presentence,simplesentence,
TeacherAssessmentof Criterionreferencedteacherratingofchildrens l
andcomplexsentences
GrammaticalStructures grammaticalstructuresatfourlevels:
Notspecified CanbeusedwithchildrenwhousesignedorspokenEnglish
(TAGSMoog&Kozak, comprehension,imitatedproduction,prompted l
l Structuresexaminedarelesscomprehensivethaninother
1983) production,andspontaneousproduction
measuresdevelopedbyMoogandhercolleagues
Page203
firstfollowedbythevisualstimulus,thusallowingthechildtolookattheclinicianasheorshespeaks.UseofanFMlisteningsituationduringtestingcanalsobe
recommendedforobtaininginformationaboutoptimalperformance(Brackett,1997).
Itisunlikelythatonemeasureoronepersonwhointeractswithahearingimpairedchildwillcaptureallofthechildsstrengthsandweaknessesasacommunicator
(Moeller,1988).Consequently,thespeechlanguagepathologistwillneedtorelyonmultiplemeasuresandseekteaminputbothasanassessmentisplannedandasit
isinterpreted.Inadditiontotheaudiologist,thechildseducators,psychologists,andespeciallythosewhoknowthechildthebestthechildhimorherselfandthe
childsparentscanbevaluablesourcesofinformation.AnexcellentsourceofrecommendationsforeffectiveinteractionswithfamiliescanbefoundinDonahue
Kilburg(1992)andRoushandMatkin(1996).
ExpectedPatternsofOralLanguagePerformance
Despiteevidencethatevenchildrenwithmildorunilateralhearinglossesareatriskforacademicdifficulties(Bess,1985Bessetal.,1986Carney&Moeller,1998
Culbertson&Gilbert,1986Oyleretal.,1988),relativelylittleisknownabouttheiroralorsignlanguagedevelopment(MogfordBevan,1993).Todate,most
researchonorallanguagedevelopmentinchildrenwithhearingimpairmenthasfocusedonchildrenwithmoreseverecongenitallosses(MogfordBevan,1993)orwith
thefluctuatinghearinglossassociatedwithotitismedia(Klein&Rapin,1992).
Thefluctuatinghearinglossassociatedwithotitismediaappearsmoreimportantwhencombinedwithotherriskfactorsfordisorderedlanguagedevelopmentthanit
doeswhenviewedasasingleexplanatoryfactor(Klein&Rapin,1992Paul,1995).Incontrast,thereisconsiderableevidencethatdeafchildrenandthosewhoare
hardofhearingexperiencedifficultiesacrossallorallanguagedomainsandmodalitiesatleastwhencomparisonsaremadeagainstsameagepeers(MogfordBevan,
1993).
Syntaxhasbeendescribedasthemostseverelyaffectedaspectoflanguageinchildrenwithhearinglossthatoccurscongenitallyorinearlychildhood(Mogford
Bevan,1993).Phonologyisunderstandablyquiteaffected,althoughsomechildrenwhoappeartoderivealloftheirphonologicalinformationvisually(throughspeech
reading)demonstratetheabilitytousethephonologicalcodeandshowmanyphonologicalpatternsconsistentwithyounger,hearingchildren(MogfordBevan,1993).
Documentedsemanticdeficitsinvolvelexicalitemsreferringtosoundsandconceptsrelatedtotheorderingofeventsacrosstime,andpossibly,totheuseof
metaphoricallanguage(MogfordBevan,1993).Pragmaticdeficitsaresometimesdescribedandattributedtothecloserelationshipofpragmaticstosyntaxaswellas
tochangesthatoccurinconversationalinteractiononthepartofspeakerandlistenerwhenoneisdeaf.Adifferentpatternofconversationalinitiationandturntaking
representsthemilieuinwhichsuchchildrenacquiretheirknowledgeoflanguageuse(MogfordBevan,1993YoshinagaItano,1997).Therefore,ithasbeensuggested
thatcomparisonswithhearingpeersmaynotprovetobeausefulmeansofunderstandingthepragmaticdevelopmentofdeafchildren.Inarecentarticle,Yoshinaga
Itano(1997)
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describedacomprehensiveapproachtoassessingpragmatics,semantics,andsyntaxamongchildrenwithhearingimpairmentinwhichtheinterrelationshipsofthese
domainswasstressedandbothinformalandformalmeasureswereused.
RelatedProblems
Childrenwithhearinglossappeartobeatincreasedriskforanumberofproblems(e.g.,Voutilainen,Jauhiainen,&Linkola,1988).Thisincreasedriskmayarise
becausethecauseofthehearinglosshasmultiplenegativeoutcomes(e.g.,somegeneticsyndromesorinfectionscancausebothmentalretardationandhearingloss).
Alternativelyhearinglossmaymakechildrenmorevulnerable(e.g.,childrenwhoarelessabletocommunicateforanyreasonmaybeagreaterriskforpsychosocial
difficulties).Despiteaconvergenceofevidencesuggestingincreasedrisk,thespecificprevalenceofmultiplehandicapsinchildrenwithhearinglossisamatterof
considerabledebate(BradleyJohnson&Evans,1991).Theprevalenceofspecificproblemsalsoappearstoberelatedtoetiology.Forexample,whereaschildren
whosehearingimpairmentsareinheritedtendtohavefeweradditionalproblems(inheritedorunknownetiologies),thosewhosehearingimpairmentisdueto
cytomegalovirusareatincreasedriskforbehavioralproblems(BradleyJohnson&Evans,1991).
Ina1979studylookingatadditionalproblemsareasforchildrenwithhearingimpairment(Karchmer,Milone,&Wolk,1979),themostcommonadditionalproblems
werementalretardation(7.8%),visualimpairment(7.4%),andemotionalbehavioraldisorder(6.7%).Althougheachoftheseproblemswasfoundtooccurinless
than10%ofchildrenwithhearingloss,theirprevalencewasstillconsiderablyhigherthaninchildrenwithouthearingloss(BradleyJohnson&Evans,1991).
Theincreasedprevalenceofemotionalbehavioraldisordersisofinterestbecauseofthespecialmanagementissuesthataccompanyit.Biologicalfactorsmaybe
responsibleforemotionalbehavioraldisordersinchildrenwithhearingloss.However,ithasalsobeensuggestedthatmismatchesbetweenthechildscommunication
needsandcapacitiesandthoseofhisorhercaregiversandpeersmaycontributetospecialenvironmentalstressesthatincreaseachildsriskofthesedisorders(Paul&
Jackson,1993).PaulandJacksonprovidedafascinatingdiscussionoftheliteraturedescribingthesubtleandnotsosubtledifferencesinworldexperiencethat
accompanydeafness.
TheoneproblemareainwhichchildrenwithhearinglosswerefoundtobeatreducedriskinthestudybyKarchmeretal.(1979)waslearningdisorders,afindingthat
someauthorshaveattributedtotheeffectsofovershadowing(Goldsmith&Schloss,1986).Overshadowingisthetendencyforprofessionalstofocusonaprimary
problemtoadegreethatcausesthemtooverlookother,significantproblemareas.Althoughovershadowingmaybeonesourceofunderidentificationoflearning
disabilitiesinchildrenwithhearingloss,anotherpossiblesourceiscertainlythetendencyofresearchersandclinicianstodefinelearningdisabilitiesasspecificlearning
disabilities,inwhichproblemsknowntoaffectlearningareexcluded.Thequestionremains,however,whethersomechildrenwithahearinglosshavealearning
disabilitywhoseoriginisunrelatedtothathearingloss.
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Summary
1.Permanenthearinglossinchildrenencompassesboth(a)childrenwhoarehardofhearing,whowilllearnspeechprimarilythroughauditorymeans,and(b)children
whoaredeaf,whomayacquirespeechprimarilythroughvision.
2.Characteristicsofhearinglossesthataffecttheimpactofthelossincludedegreeofloss(mild,moderate,severe,profoundhardofhearing,deafness),typeofloss
(conductive,sensorineural,mixed),configuration(flat,highfrequency,lowfrequency),laterality(unilateralvs.bilateral),andageofonset(congenital,acquired).
3.Geneticsourcesaccountforabout50%ofallcasesofdeafness,withremainingcausesincludinginfectiousdisease,rhfactorincompatibility,andexposureto
ototoxicdrugs.
4.Evenmildorunilateralhearinglosscannegativelyaffectchildrenslanguagelearningandacademicprogress,andthereissomeevidencetosuggestthatthetransient
hearinglossassociatedwithotitismediacaninteractwithotherriskfactorstounderminechildrenslearning,(Peters,Grievink,vanBon,VandenBercken,&Schilder,
1997).
5.Managementofthehearinglossforchildrenwhoarehardofhearingideallyincludesamplification(hearingaidsandFMsystemuse),soundtreatmentofthechilds
languagelearningenvironment,speechlanguageintervention,andclassroomsupportasneeded.
6.Undermostcurrentprogramsofearlyidentificationandsubsequentinterventions,deafnessposesagrimthreattochildrensnormalacquisitionofanorallanguage.
7.Currentcontroversiesindeafnessincludetherelativeimportanceoforalversussignlanguagesinchildrensacquisitionofcommunicationcompetenceandtheroleof
theDeafcultureasapoliticalforce.
8.Challengesintheassessmentofcommunicationofchildrenwithhearinglossincludedifficultiesindeterminingthemode(s)inwhichtoconducttesting(e.g.,oral,
ASL,TotalCommunication)aswellasascarcityofbothappropriatedevelopmentalexpectationsforcommunicationacquisitionandstandardizednormreferenced
measuresforthispopulationinanymode.
KeyConceptsandTerms
cochlearimplant:aprostheticdevicethatprovidesstimulationoftheacousticnerveinresponsetosoundandisusedwithindividualswhohavelittleresidualhearing.
conductivehearingloss:ahearinglosscausedbyanabnormalityaffectingthetransmissionofsoundandmechanicalenergyfromtheoutertotheinnerear.
deafness:ahearinglossgreaterthanorequalto70dBHL,whichprecludestheunderstandingofspeechthroughaudition.
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FM(frequencymodulated)radiosystems:oneofseveralsystemsdesignedtoaddresstheproblemsoflowsignaltonoiseratiosandreverberationoccurringin
settingssuchasclassroomstheseareusedincombinationwithpersonalhearingaids.
hardofhearing:havingadegreeofhearinglossusuallylessthan70dBHL,whichallowsspeechandlanguageacquisitiontooccurprimarilythroughaudition.
hearinglossconfiguration:thepatternofhearinglossacrosssoundfrequenciesforinstance,ahighfrequencylossisoneinwhichthelossisgreatestinthehigh
frequencies.
mixedhearingloss:ahearinglosswithbothconductiveandsensorineuralcomponents.
otitismedia:middleearinfection.
ototoxicity:thepropertyofbeingpoisonoustotheinnerearthatisfoundforsomedrugsandenvironmentalsubstances.
otoacousticemissions:lowlevelaudiofrequencysoundsthatareproducedbythecochleaaspartofthenormalhearingprocess(LonsburyMartin,Martin,&
Whitehead,1997).
overshadowing:thetendencyforprofessionalstofocusonaprimaryproblemtoadegreethatcausesthemtooverlookother,significantproblemareas.
prelingualhearingloss:ahearinglossacquiredbeforeage2,whichisthoughttobeassociatedwithamoresignificantimpact.
prematurity:birth2ormoreweekspriortoexpectedduedate.
rhfactorincompatibility:conditioninwhichthebloodofmotherandinfanthavediscrepantrhfactorsresultinginmaternalantibodyproductionthatcanproveharmful
totheinfantifuntreated.
sensorineuralhearingloss:hearinglossduetopathologyaffectingtheinnerearornervoussystempathwaysleadingtothecortex.
StudyQuestionsandQuestionstoExpandYourThinking
1.Thetendencytohaveadiagnosissuchasdeafnessovershadowothersignificantbutlesssevereconditionsisanunderstandablebutquiteunfortunateclinicalerror.
Howmightyouavoidthiskindoferrorinclinicalpractice?
2.Protectiveearplugs(e.g.,EARClassic)producetheequivalentofamild(approximately2030dB)hearingloss.Findapairandusetheminthreedifferentlistening
conditions.Forexample,talkingwithafriendfacetofaceinaquietsetting,listeningtoalecturefromyourusualseatintheclassroom,andwatchingtheTVnewswith
theloudnesslevelsetatacomfortablelisteninglevel(beforeyouputtheplugsin).Writedownwhatyouhear.
3.RepeattheexperimentfromQuestion2usingonlyoneearplug.Besidesnotingwhatyouhear,notewhetheryouchangedanythingelseaboutyourbehaviorasyou
listenedandtalked.
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4.Brieflydescribeanargumentyoumightmakefavoringtheuseoftotalcommunicationwithadeafchildborntohearingparents.
5.RepeatQuestion4,butargueinfavoroftheuseofASLonlywiththesamechild.
6.Considertheetiologiesdescribedforhearinglossinthischapter.Whatpreventivemeasuresmighthelpreducetheoccurrenceofhearinglossininfants?Arethere
anyofthesemeasuresinwhichyoucouldplayaroleasaschoolbasedspeechlanguagepathologist?Asacitizenofyourlocalcommunity?
7.Listfourthingsyouwouldwanttobesuretorememberasyoupreparefortheorallanguageevaluationofachildwhoishardofhearingandwhoregularlyusesa
hearingaid,wherethepurposeoftheevaluationistodeterminethechildsoptimalperformance.
RecommendedReadings
Carney,A.E.,&Moeller,M.P.(1998).Treatmentefficacy:Hearinglossinchildren.JournalofSpeechLanguageHearingResearch,41,561584.
Northern,J.L.,&Downs,M.P.(1991)Hearinginchildren(4thed.).Baltimore:Williams&Wilkins.
Paul,P.V.,&Quigley,S.P.(1994).Languageanddeafness(2nded.).SanDiego,CA:Singular.
Scheetz,N.A.(1993).Orientationtodeafness.Boston:Allyn&Bacon.
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Bergstrom,L.,Hemenway,W.G.,&Downs,M.P.(1971).Ahighriskregistrytofindcongenitaldeafness.OtolaryngologicalClinicsofNorthAmerica,4,369
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PART
III
CLINICALQUESTIONSDRIVINGASSESSMENT
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Page213
CHAPTER
9
ScreeningandIdentification:DoesThisChildHaveaLanguageImpairment?
TheNatureofScreeningandIdentification
SpecialConsiderationsWhenAskingThisClinicalQuestion
AvailableTools
PracticalConsiderations
Sincehisinfancy,Sergesparentshadsuspectedthattherewassomethingdifferentabouttheirthirdchild.Althoughhewasahealthyandfriendlybaby,he
rarelyvocalizedandusedonlyafewintelligiblewordsbythetimehewas3.Healsoseemedabletoignoremuchofwhatwentonaroundhimwhilebeing
extraordinarilysensitivetoloudnoisessuchasmotorcyclesoraTVturnedupbyhisoldersiblings.OnthebasisofSergesmothersreportsandtheresults
oftheDenverII(Frankenburg,Dodds,&Archer,1990),anearlyeducatoratapreschoolscreeningrecommendedacompletespeechlanguageandhearing
evaluation.
Ameliahadjustgottenbyintheearlygrades.Althoughsheneverperformedparticularlywell,sherarelyfailedassignmentsandneverreceivedafailing
grade.Shewaswellorganized,attentive,andeversoeagertoplease.Herparentswereacceptingofherperformancebecausethey,too,hadneverdone
terriblywellinschooltheyhadjustbeenhappythatshewasenjoyingitsomuch.Allofherenjoymentvanished,
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however,inthefourthgrade,whenthelanguageoftheclassroombecamemorecomplexandmoredependentonthebooksbeingused.Shepretendedtobe
sickinordertoavoidschoolandcriedinfrustrationwhentheworkseemedtoohard.Herteacherandtheschoolspeechlanguagepathologistwereso
alarmedbyherbehaviorandbythequalityofherwrittenandoraldiscoursethattheydecidedanindepthexaminationofherorallanguageandliteracy
skillswasnecessaryimmediately.
TheNatureofScreeningandIdentification
Screeningandidentificationoflanguagedisordersarecloselyrelatedenterprises.ScreeningproceduresaidcliniciansinmakingarelativelygrossdecisionShouldthis
childscommunicationbescrutinizedmorecloselyforthepossiblepresenceofalanguagedisorder?Identification,ontheotherhand,takesthatquestionseveralsteps
further.Doesthischildhavealanguagedisorder,adifferenceinlanguage,orboth?Oftenthiscomplexquestionistiedtoyetanotherquestion:Isthischildeligiblefor
serviceswithinaparticularsetting?
Screening
Inmanycases,referralsbyconcernedparents,teachers,orphysiciansfunctionasindirectscreeningmechanisms.Nonetheless,alternativeproceduresareneededin
caseswhensuchindirectmethodsareunlikelytooccurorareunsuccessful.Althoughdetectionmayreadilyoccuratthebehestofconcernedfamiliesfacingsevere
problems,detectionmaybedelayedwhentheproblemsaremild(e.g.,whentheyconsistofsubtledifficultiesincomprehension)orwhentheyareunaccompaniedby
obviousphysicalorcognitivedisabilities(Prizant&Wetherby,1993).
Screeningistypicallyusedwhenthenumberofindividualsunderconsiderationmakestheuseofmoreelaboratemethodsimpracticalusuallyfromtheperspectivesof
bothtimeandmoney.Muchofthecurrentthinkingaboutscreeninganditsrelationshiptoidentificationareborrowedfromtherealmofpublichealth(e.g.,Thorner&
Remein,1962).Inthatcontext,screeningsaredesignedtobequick,inexpensive,andcapableofbeingconductedbyindividualswithlesseramountsoftraining.
Similarly,inspeechlanguagepathology,theadministrationandinterpretationofscreeningmethodsshouldrequireminimaltimeandexpertise.Nonetheless,validity
continuestobeofcriticalimportancebecauseaninaccuratescreeningprocedureisuselessnomatterhowquickorinexpensiveitmaybe!
Anumberofdifferentkindsofscreeningmechanismsoccurinthedetectionandmanagementoflanguagedisorders.Ofgreatestimportanceforourpurposesis
screeningforthepresenceofalanguagedisorder.Suchascreening,forexample,mightbeperformedonall35yearoldsinagivenschooldistrict,oftenaspartofa
broaderscreeningforavarietyofhealthanddevelopmentalrisks.Anotherexampleofsuchacomprehensivescreeningwouldoccuraspartofneonatalintensivecare
followup.Whenexaminedalone,communicationisscreenedusingagreatvarietyofmeasureswithselectedaspectsofspeech,language,andhearingastheirmajor
foci.
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Inpractice,suchmeasuresareofteninformalandfrequentlymakeuseofseveralmeasuressomeformalandsomeinformaltoincreasethecomprehensivenessof
theexamination.SpecifictoolsusedinamorefocusedapproachtolanguagescreeningarediscussedintheAvailableToolssectionofthischapter.
Whenexaminedaspartofabroaderscreeningeffort,communicationisfrequentlyassessedusingameasuredesignedtoaddressavarietyofmajorareasof
functioning.OneexampleofthesekindsofscreeningmeasuresistheDenverDevelopmentalScreeningTestRevised(Frankenburg,Dodds,Fandal,Kazuk,&
Cohrs,1975Feeney&Bernthal,1996),ascreeningtoolforchildrenfrombirthtoage6thatmakesuseofdirectelicitationandparentalreports.Anotheristhe
DevelopmentalIndicatorsforAssessmentofLearningRevised(DIALRMardellCzudnoswki&Goldenberg,1983),ascreeningtoolforchildrenages26that
isoftenusedtoscreenlargernumbersofchildrenthroughtheuseofateamofevaluators,eachofwhomelicitbehaviorsfromananindividualchildwithinagivenarea.
Ina1986studyofthe19measuresmostcommonlyusedinfederallyfundeddemonstrationprojectsaroundtheUnitedStates,Lehr,Ysseldyke,andThurlow(1986)
foundonly3thattheyjudgedtobetechnicallyadequate:theVinelandAdaptiveBehaviorScales(Sparrow,Balla,&Cicchetti,1984),theMcCarthyScalesof
ChildrensAbilities(McCarthy,1972),andtheKaufmanAssessmentBatteryforChildren(Kaufman&Kaufman,1983).Bracken(1987)notedsimilarproblems
withavailablescreeningmeasures,especiallyamongmeasuresdesignedforchildrenyoungerthan4.Thislackofwelldevelopedcomprehensivescreeningtestsis
particularlyproblematicgiventhedemandinherentintheIndividualswithDisabilitiesEducationAct(IDEA,1990)whichcompelsidentificationofatriskchildrenat
veryyoungages.
Screeningproceduresarealsousedbyspeechlanguagepathologistsduringcomprehensivecommunicationassessmentstodetermine(a)whetherspecificareasof
communication(e.g.,voice,fluency,hearing)needindepthtestingand(b)whetherproblemsexistandthusrequirereferralsinothermajorareasoffunctioning(e.g.,
vision,cognition).Nuttall,Romero,andKalesnik(1999)providedawiderangingdiscussionofvarioustypesofdevelopmentalpreschoolscreenings.
Identification
Essentially,identificationproceduresforlanguagedisordersinchildrenareintendedtoverifytheexistenceofaproblemthatmayhavebeensuspectedbyreferral
sourcesoruncoveredthroughascreeningprogram.Forthepurposesofthisbook,identificationisseenassynonymouswiththetermdiagnosis,whenthattermis
definedastheidentificationofadisease,abnormality,ordisorderbyanalysisofthesymptomspresented(Nicolosi,Harryman,&Kresheck,1996,p.86).Diagnosis
isoftendefinedsothatitincludesthelargersetofquestionsleadingtoconclusionsregardingetiology,prognosis,andrecommendationsfortreatment(e.g.,seeHaynes,
Pindzola,&Emerick,1992).Here,however,thetermidentificationispreferredasameansofexpeditingourfocusonthespecialmeasurementconsiderationsit
entails.
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Identificationdecisionsinvolvingchildrenarecrucialforatleasttworeasons.First,identificationisusuallythefirststepthatenablesthechildtoreceivehelp,ofteninthe
formofintervention.Thisstepisacriticalonebecauseoftheemotional,monetary,andtemporaldemandsthataccompanyinterventionthatwillbemettovarying
degreesbythechild,theparents,thespeechlanguagepathologist,aswellasthelargercommunity.Second,byleadingtoeffectiveintervention,correctidentification
canhelppreventormitigatetheadditionalsocialandscholasticproblemsthatmayaccompanylanguageimpairment.Identificationdecisionsareamongthemost
importantonesmadebyspeechlanguagepathologistsand,therefore,shouldbeamongthemostcarefullymade.
Becauseidentificationdecisionsofteninvolvetheassignmentofalabel,theyareoftenassociatedwithafearonthepartofmanyparentsandsometheorists(Shepard,
1989)thatthechildwillbeequatedwiththedisorder.Forexample,theparentsmayfearthattheirchildwillnolongerbeseenasacute,complicatedchildwhenhe
orshebecomesanautisticchild.Althoughpersonfirstnomenclature(e.g.,referringtoapersonwithautismratherthananautisticpersonor,worseyet,an
autistic)isintendedtomaketheprocessoflabelingmorebenign,thenegativeimplicationsofbeingidentifiedashavingacommunicationdisorderexistnonethelessin
themindsofparentsandperhapsintheunderstandingsofnaiveobservers.Thisisevidentwhenparentsfindonelabelforexample,languageimpairedmore
acceptablethananothersuchaslanguagedelayedascliniciansfrequentlydiscoverduringtheirinteractionswithfamilies(Kamhi,1998).Concernsaboutlabeling
inthespecialeducationcommunityareintenseandhaveledtorecommendationstoavoidlabelsasmuchaspossible,particularlyforyoungerchildrenandincases
whereonlyascreeninghasbeenconducted(Nuttalletal.,1999).
Manyofthemeasurementissuesassociatedwithidentificationmirrorthoseofscreening.However,themorepermanentnatureofidentificationanditsassociationwith
decisionsaboutaccesstocontinuingservicesraisethestakesinthequalityofdecisionmakingrequired.Inthenextsection,specialmeasurementconsiderations
affectingbothscreeningandidentificationarediscussedinsomedetail,witheffortsmadetocallreadersattentiontopointswherethetwodiffer.
SpecialConsiderationsWhenAskingThisClinicalQuestion
IfIwerereadingthisbookasastudent(orasaclinicianwhofindsmeasurementlessinterestingthanIdo),Iwouldbehopingthatmyfriendlyauthorwouldoffer
severaleasystepstowardaccurateandefficientscreeningandidentification.Betteryet,perhapsshewouldtellmeexactlywhichscreeningandidentificationmeasuresI
shouldpurchaseandexactlywhichthreesimplestepsIshouldfollowforinfallibleclinicaldecisionmaking.Sadly,asmuchasIwouldliketohelp,ablanketprescription
fortestpurchasingandusecannotbemadeforallofthetestingsituationsfacingevenaverysmallgroupofreaders.Instead,whatIcandoisprovidebasicinformation
aboutsomespecialconsiderationsandthen,inthenextsection,introducesomeofthemanyavailablemeasuresthatcanbeusedforscreeningandidentification.
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Inthissectionofthechapter,severalspecialconsiderationsareexploredtohelpreadersengageintheprocessoftestselectionandinterpretationforthepurposesof
screeningandidentification.Thesespecialconsiderationsrepresentrefinementsofsomeoftheinformationpresentedinearlierchaptersrefinementsdictatedbythe
particulardemandsofscreeningandidentificationastestingpurposes.
Inlearninghowtochoosethebestpossiblemeasureforagivenpurpose,thetiebetweenmeasurementpurposeandmethodologywasnotalwaysobvioustome.Some
timeago,inmyfirstpublishedarticle,acolleagueandIused10operationaldefinitionsofpsychometricguidelinesofferedbytheAPA,AERA,andNCME(1985)to
evaluate30languageandarticulationtestsusedwithpreschoolchildren(McCauley&Swisher,1984a).Thecriteriaincludedanadequatedescriptionoftester
qualifications,evidenceoftestretestreliability,informationaboutcriterionrelatedvalidity,andothers.Almostinstantly,awellknownlanguageresearcher,JohnMuma
(1985),chastisedus,citing,amongotherreasons,thedangerthatreaderswouldassumethateachofthecriteriaweincludedwasequallyasimportantaseveryother.
Today,asin1985,itseemstomethatalthoughMumafailedtounderstandthebasicintentofthearticle,hewasabsolutelyonthemarkinhisconcernaboutits
fosteringmisunderstanding.Infact,asyouwillseeinthenextchapters,differentpurposesoftestingwilldrawspecialattentiontodifferentaspectsofthemeasuresone
mightuse.Itisimportanttopayattentiontothisironcladconnectioninordertomakeethicaldecisions.
Theappropriatenessofstandardizednormreferencedtestsforpurposesofidentifyingalanguagedisorderordifferenceisalmostuniversallyacceptedintheclinical
literature(e.g.,seeKelly&Rice,1986Merrell&Plante,1997Sabatino,Vance,&Miller,1993cf.Muma,1998).Inaddition,suchinstrumentsarewidelyfavored
forthatpurposebypracticingspeechlanguagepathologists(e.g.,seeHuang,Hopkins,&Nippold,1997).Often,theiruseismandatedasthebackboneofscreening
andidentificationefforts.
Inanidealworld,speechlanguagepathologistswouldbeabletopredictflawlesslywhichchildrenwouldexperiencepersistent,penalizingdifferencesincommunication
basedonadescriptionofeachchildscurrentlanguagestatus.Thus,criterionreferencedmeasureswouldgenerallysufficeforbothidentificationandtreatment
planning.However,giventhecurrentlevelofunderstanding,thebeststrategyisto(a)identifythosechildrenwhoseperformanceseemssufficientlydifferentfromthe
performancesofarelativelylargegroupofpeersastowarrantconcernand(b)supplementthatinformationwithothersourcesofinformation,particularlyfrompersons
familiarwiththechildsfunctionalcommunication.
Becauseofthetiebetweennormreferencedmeasuresandidentificationprocedures,mostofthespecialconsiderationsregardingscreeningandidentificationdiscussed
nextrelatetotheuseofnormreferencedmeasuresindecisionmaking.Thesixspecialconsiderationsinvolve(a)weighingmeasuresensitivityandspecificityintest
selection,(b)decidingoncutoffscores,(c)rememberingmeasurementerrorinscoreinterpretation,(d)wrestlingwiththedisorderdifferencequestion,(e)conducting
comparisonsbetweenscores,and(f)takingintoaccountbaseratesandreferralratesinevaluatingscreeningmeasures.Thefirsttwooftheseconsiderationsaddress
concernsthatwillpri
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marilybedealtwithbytheclinicianpriortouseofaninstrumentinaparticularcase.Thesecondthreeaddressconcernsarisingduringtheprocessoftestuse.Thelast
considerationrelatestoonesthinkingabouthowtoimplementandpotentiallyevaluateascreeningprogramamorespecificconcernthantheotherfive.
WeighingMeasureSensitivityandSpecificityinTestSelection
Onthebasisofpreviousdiscussionsofvalidity,readerscananticipatethatameasureusedtoscreenoridentifychildrenforlanguagedisordersshouldprovideasa
cornerstoneofevidencesupportingitsvalidityconvincingempiricaldocumentationofitsabilitytodistinguishchildrenwithandwithoutsuchdisorders(Plante&Vance,
1994).
Onemethodusedtoexaminetheaccuracyofclassificationachievedbyscreeningandidentificationmeasuresentailsthecomparisonofthemeasureunderstudywitha
measurethatisconsideredvalidoratleastacceptablegiventhestateoftheart.Comparisonagainstanidealisoftendescribedasacomparisonwithagoldstandard,
ameasurethathasbeensothoroughlystudiedthatitisthoughttorepresenttheverybestmeasureavailableforagivenpurpose.Becauseofthescarcityofgold
standardsinarenasrelatedtochildlanguageassessment,themoretypicalscenarioinvolvesacomparisonwithawellstudiedandrespectedmeasure.
Inthecaseofascreeningmeasure,thecomparisonisoftenmadebetweentheresultsofascreeningprocedureandthoseofamoreelaborateandestablishedmethod
ofidentification.Thecomparisonmayinvolvetheuseofamorewellestablishedtestortestbatterythathasbeenindependentlyvalidated.Asyoumayrecognizeinthe
discussionthatfollows,themethodusedtocomparetheseperformancesislargelyanelaborationofthecontrastinggroupsmethoddescribedinchapter3.
Thecomparisonoftenmakesuseofacontingencytable,suchasthatportrayedinFig.9.1andinearliersectionsofthebook.InFig.9.1,twotablesareusedoneto
illustratethecomponentsofthistypeoftableandtheothertoshowahypotheticalexample:theresultsoftheHopefulScreeningTestcontrastedwiththoseofthe
FirmlyEstablishedIdentificationMeasureforagroupof1000individuals.
Asyoucanseefromthefirsttableinthefigure,sensitivityissimplytheproportionoftruepositivesproducedbythemeasure.Thus,itreflectshowfrequentlythose
childrenneedingfurtherevaluationareaccuratelyfoundusingthismeasure.Accordingtoamoreformaldefinition,sensitivityisameasureoftheabilityofatestor
proceduretogiveapositiveresultwhenthepersonbeingassessedtrulydoeshavethedisorder.Specificityisameasureoftheabilityofameasuretogiveanegative
resultwhenthepersonbeingassessedtrulydoesnothavethedisorder.Itisusuallydescribedastheproportionoftruenegativesassociatedwiththemeasure.Thusfor
ascreeningmeasure,specificityreflectshowfrequentlyindividualswillbeheldbackfromadditionalevaluationwhoactuallyshouldntbeevaluatedbecausetheyare
problemfree.Inotherwords,atestorprocedurethatunderidentifieschildrensuffersfrompoorsensitivity,andatestorprocedurethatoveridentifieschildrensuffers
frompoorspecificity.
InthecaseofthehypotheticalHopefulScreeningTestofLanguage,sensitivityseemstobelessthanmostpeoplewouldbehappywith:onthebasisofitsresults,
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Fig.9.1.Informationcontainedinacontingencytableandanexampleshowinghowitcanbeusedtocalculatesensitivityandspecificity.
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22%,orabout1/5,ofchildrenwiththedisorderwouldgoundetectedandthusbeexcludedfromfurtherassessment.Incontrast,themeasuresspecificityisexcellent,
withonlyabout5outofevery100childrenwhoareperformingnormallyrecommendedforunnecessarytesting.
Indiscussionsofwhatconstitutesacceptablelevelsofoverallaccuracyforlanguageidentificationmeasures,Plante&Vance(1994)notedthatoverallaccuracy(i.e.,
thepercentageoftruepositivesplustruenegativesgivenoutoftheentirepopulation)shouldbeatleast90%foranevaluationofgoodand80%foranevaluationof
fair.Thus,althoughtheHopefulScreeningTestofLanguagemightbeconsideredgoodinitsoverallaccuracy(about94%),itssensitivitycannotberegardednearly
sohighly(78%).
Withregardtosensitivityandspecificityforlanguagescreeningprocedures,PlanteandVance(1995)recommendedthatahigherstandardbemetforsensitivitythan
forspecificity.Specifically,theyrecommendedthatsensitivityshouldbeat90%orabove,whereasforspecificitytheyacceptedlevelsof80%asgoodand70%as
fair.Thus,althoughsensitivityandspecificityarebothinverselyrelatedtothefrequencyoferrors(alsocalledmisses)indecisionmakingassociatedwitha
particulartestorprocedure,itisimportanttowanttoexaminethemindependentlyratherthanlumpedtogetherinasinglemeasureofaccuracybecausetheireffects
differ.AsPlanteandVancenoted,sensitivityismoreimportantforscreeningmeasuresthanspecificitybecausetheunderreferralsassociatedwithpoorersensitivitymay
havegreaternegativeeffectsonchildrenthanoverreferralsassociatedwithpoorerspecificity.
TakingPlanteandVances(1995)lineofthoughtonestepfurther,notonlyshouldcliniciansgobeyondoverallaccuracyofclassificationintheirevaluationsof
measures,theyshouldalsoconsidertheimplicationsofameasuressensitivityandspecificitylevelsinlightofthespecifictestingsituation.Propertiesofthattesting
situationincludethegravityofthedecisiontobemadeanditsirreversibility.Forexample,lowersensitivitymaybemoreacceptableinsettingswherefailurestoreferfor
testingortotakestepstowardidentificationwillbecorrectedsuchasasituationinwhichawellinformedteachingstaffwillbelikelytobringachildtotheclinicians
attentionregardlessofpreviousscreeningresults.Similarly,lowerspecificitymaybetoleratedinsituationswheretestingresourcesarenotsorelytaxed(iftherearesuch
places).
Finally,asapointthatcannotbeoverstressedtherelativesensitivityandspecificityofaccessiblealternativesneedstoenterintothecliniciansdecisionmaking:It
makeslittlesensetojumpfromarockingboattoasinkingone.Yetthisistheactionthatmaybetakenregularlybyclinicianswhochooserelianceontheirown
untestedjudgmentoveraflawedbutbetterunderstoodscreeningmechanism.
Lestthereaderhopethatifotherindicatorsofvalidityandreliabilitylookpromisingallislikelytobewellwithregardtoatestssensitivityandspecificity,considera
relevantfindingofPlanteandVances(1994)research.UsingcriteriacloselyrelatedtothoseusedinMcCauleyandSwisher(1984a),PlanteandVancerated21
languagetestsdesignedforusewith4to5yearolds.Theresearchersthenconductedastudyof4oftheteststhatmetarelativelylargernumberofcriteria(6outof
10)todeterminetheirsensitivityandspecificity.Ofthe4theyexamined,onlyoneachieved
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acceptablelevels.Thus,itpaystolookforspecificinformationonsensitivityandspecificityandtodemanditfrompublishersasaprerequisitetopurchase.
Insummary,sensitivityandspecificitydataprovidespecialinsightintothewaythatmeasuresfunctionforpurposesofscreeningandidentification.Thus,theycan
provideenormouslyvaluableevidenceofameasuresvalueforthosepurposes.Whereasformanypurposessensitivityisevenmoreimportantthanspecificity,the
specificcontextinwhichthemeasureisusedandtheavailabilityofpreferablealternativeswillultimatelyaffectclinicalperceptionsofacceptablelevels.Finally,itseems
quiteprobablethattheabsenceofthisinformationfromtestmanuals,althoughcurrentlycommonplace,willberectifiedonlywhencliniciansbegintodiscriminateamong
testsonthisbasisandtodirectlyurgepublisherstotakeaction.
ChoosingaCutoffScore
Onefactorthataffectsbothsensitivityandspecificityisthecutoffusedtodeterminewhetherapositiveornegativeresulthasbeenobtained.Whenascreeningor
identificationdecisionismadeusinganormativecomparison,acutoffscoreisselectedtoindicatethescoreatwhichachildsperformanceisseenascrossingan
invisibleboundarybetweenaregionofnormalvariationforthatparticulargrouponthatparticularmeasureintoaregionsuggestingadifficultyordifferenceworthyof
attention.Clearly,however,thelocationofthecutoffpointisbotharbitraryandsignificant.Shiftingitslocationcandecreaseatestsspecificitywhileincreasingits
sensitivity,orviceversa.Thus,thechoiceofacutoffisnotatrivialmatter.
Clinicallyorientedauthorswritingaboutlanguagedisordershaverecommendedavarietyofpossiblecutoffsforusewhennormreferencedinstrumentsareusedaspart
ofdevelopmentallanguageassessments.Forexample,Owens(1995)notedthatscoresfallingbelowthe10thpercentileareoftenconsideredotherthannormal.
Leonard(1998)alsoobservedthatresearchersfrequentlyusecutoffsfalling1.25or1.5standarddeviationsbelowthemean,thusfallingclosetoOwens10th
percentile.Similarly,Paul(1995)endorsedacutoffatthe10thpercentile,correspondingtoastandardscoreofabout80andazscorefalling1.25standarddeviations
belowthemeanforscoresthatarenormallydistributed.Sheindicatedthatshebasedherrecommendation,inpart,onsimilarlevelspreviouslyrecommendedbyFey
(1986)andLee(1974).However,becauseofconcernsaboutitsarbitrarinessandquestionablepsychometricdefensibility,Paulscompletecriterionissomewhatmore
elaborate.Specifically,sherequired
thatachildthoughtbysignificantadultsinhisorherlifetohaveacommunicationhandicapshouldscorebelowthetenthpercentileorbelowastandardscoreof80on
twowellconstructedmeasuresoflanguagefunctiontobethoughtofashavingalanguagedisorder.(p.5)
Paulsintentionwastomakesurethatthisdefinitionwouldnotstrongarmchildrenwhohadnoreallifeproblemsintodiagnosessimplybecauseofdifferencesintest
scoresthat,althoughdetectable,areoflittleornopracticalsignificance.(Seealongerdiscussionofclinicalorpracticalsignificanceinchap.11.)
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ItisalsoimportanttonotethatPaul(1995)recommendedtheuseoftwowellconstructedmeasures,giventhattheuseofoneortwomeasuresthatarelessthanthat
willunderminetheintentoftherecommendation.Justasachainisnostrongerthanitsweakestlink,abattery(evenofjust2measures)willbenomoreaccuratethanits
leastaccuratemember(Plante&Vance,1994Turner,1988).Becauseofthisconcern,Plante(1998)recentlyrecommendedthatasinglevalidtestalongwitha
secondfunctionalindicator(e.g.,clinicianjudgment,enrollmentintreatment)beusedforverificationofspecificlanguageimpairmentforresearchpurposes.This
recommendationleadstoanobviousparallelforinitialimplicationsandonethatcanbeseenasconsistentwithIDEA(Plante,personalcommunication).
Sometimes,whencutoffsareselectedinaccordancewithtestdeveloperrecommendations,cliniciansandresearchersusedifferentcutoffsfordifferenttests.Usually,
therecommendationsofthetestdevelopersresultinverysimilarcutoffstothosediscussedearlier.Lookingbackatthenormalcurveanditsrelationshiptodifferent
typesofscoresinFig.2.5suggeststhatsmalldifferencesincutoffsshouldresultinonlysmallshiftsinselection,thussuggestingthatthemethodusedtoselectacutoff
probablydoesnotmatter.Surprisingly,however,PlanteandVance(1994,1995)demonstratedthatanempiricallyderivedcutoffcangreatlyenhanceameasures
sensitivityandspecificity.Further,theyshowedthatempiricallyderivedcutoffsarelikelytovaryfromtesttotest,thusmakingtheuseofaonecutofffitsalltests
practicesomethingthattheywouldadviseagainst.Theirworkisdescribedbrieflyinthenextparagraphstohelpillustratethevalueofresearchintobasicmeasurement
issuessuchascutoffselection.
Intheirstudies,PlanteandVance(1994,1995)usedastatisticaltechniquecalleddiscriminantanalysisaformofregressionanalysistoexamineoutcomes
associatedwithdifferentcutoffs.Usingthistechnique,theexperimenterdeterminestowhatextentvariationinscoresisaccountedforbygroupmembershipandthen
examinestheaccuracyofpredictionsofgroupmembershipmadefromaresultingregressionequation.Itallowsonetoexaminethewaysinwhichchangingthecutoff
affectssensitivityandspecificity.
PlanteandVance(1994,1995)recommendedtwostrategiesforensuringtheavailabilityofempiricallyderivedcutoffssuchasthosethatcanbeobtainedthrough
discriminantanalysis.First,theyadvisedclinicianstoinsistthatstandardizedmeasuresoffersuchcutoffsalongwithdataconcerningsensitivityandspecificity.Second,
theynotedthepossibilityofdevelopinglocalcutoffs,aprocessthatrequiresfewerparticipantsthanlocalnormingbutthatcanrequireclinicianswhoattemptittoseek
statisticalassistance(Plante&Vance,1995).
AlthoughnotendorsedbyPlanteandVance(1995),thedevelopmentoflocalnormsmayalsorepresentaresponsiblestrategyforincreasingtheavailabilityofdata
concerningsensitivityandspecificityofdecisionsinsettingswheresufficientresourcesandnumbersofchildren(includingthosewithdisorders)exist(e.g.,seeHirshoren
&Ambrose,1976Norris,Juarez,&Perkins,1989Smit,1986).Softwaredesignedtoaidintheconstructionoflocalnorms(Sabers&Hutchinson,1990)makesthis
strategymorefeasiblethanitoncewas(Hutchinson,1996).Inaddition,thedevelopmentanduseoflocalnormshasbeenrecommendedasameansofdealingwith
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biasintestingthatresultsfromtheuseofinappropriatenorms(e.g.,seeVaughnCooke,1983).
Insummary,then,thecutoffsusedtoidentifychildrensperformanceasfallingbelowexpectationsareoftenarbitrarilysetatabout1.25to1.5standarddeviations
belowthemean.However,greatersensitivityandspecificitycanbeachievedwhenempiricalmethodsareusedtooptimizetheperformanceofthemeasuresused.Not
onlydoesthispracticeconstituteanotherstepthatcanbetakenbytestauthorsandpublisherstoimprovethequalityofclinicaldecisionmakinginthefield,itrepresents
atopicofsuchpracticalsignificanceastoinviteawealthofappliedresearch.Inaddition,asPaul(1995)suggested,thecurrentstateoftheartprecludesrelianceona
singlemeasureorevenasinglebatteryofmeasurestoleadinalockstepfashiontodecisionmaking.Integrationoffunctionaldataaboutthechildwillremaina
necessarycomponentofscreeningandidentificationfortheforeseeablefuture.Asunderstandingoffunctionalorqualitativedatasuchasportfoliosandteacher
reportsofcriticalincidentsincreases(e.g.,Schwartz&Olswang,1996),theirrolewillprobablyincreaseaswell(seechap.10),withbeneficialresultsforthe
sensitivityandspecificityoftheprocess.Further,inmanyclinicalandespeciallyeducationalsettings,thechoiceofcutofftobeusedcanseemandinsomecasesmay
beoutsidethecontrolofthespeechlanguagepathologist.Theroleplayedbyeducationalagenciesinestablishingguidelinesformeasurementuseandclinicians
productiveresponsestothesearediscussedlaterinthischapterinthesectioncalledPracticalConsiderations.
Therearetheoreticalconcerns,too,abouttheuseofcutoffsthatrelatetoourunderstandingoftheverynatureoflanguageimpairmentinallchildren,butparticularlyin
thoseforwhomnoobviouscauseexists:childrenwithSLI.DollaghanandCampbell(1999)recentlycalledattentiontothefactthattheuseofanarbitrarycutoffata
pointalonganormaldistributionofscoresisatoddswiththeoreticalnotionsthatlanguageimpairmentrepresentsanaturalcategory,ortaxon.Instead,theysaythatit
impliesanassumptionthatchildrenwithimpairedlanguagemaysimplyrepresentthosechildrenwhohavelesslanguageability,inthesamewaythatshortpersons
havelessheight.ThispossibilityhasbeenpointedoutbyseveraltheoreticiansaddressingthequestionofetiologyforchildrenwithSLI(e.g.,seeLahey,1990Leonard,
1987)buthasfailedtoreceivesustainedattention.Asanimportantsteptowardrevivingconsiderationofthishypothesis,DollaghanandCampbellnotedthatthe
questionofwhetherlanguageimpairmentrepresentsadistinctcategoryversusthelowerrangeofacontinuumofperformanceisanempiricalonewithpotentially
powerfulrepercussionsforbothassessmentandtreatment.Specifically,asaworkinghypothesistheypredictthatiflanguageimpairmentistaxonic,languagedeficits
wouldbelikelytobemorefocusedandwouldthereforerequiremorefocusedassessmentsandtreatments.
DollaghanandCampbell(1999)alsonotedthatthetimemayberipeforaddressingthequestionofthenatureoflanguageimpairmentbecauseparallelconcernsin
clinicalpsychologywithregardtoschizophreniaanddepressionhavespawnedrichadvancesinmethodology(Meehl,1992Meehl&Yonce,1994,1996).They
conjecturedthattheseadvancesmightprovideanauspiciousstartingpointforadditionalefforts.Amongtheimplicationsofthisworkarethepossibilityofidentifying
thosecutoffsthattrulyidentifychildrenwhoarecategoricallydifferentintheirlanguage
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skillsfromotherchildrenratherthanthosewhosimplyseemquantitativelysuspiciousbecauseoftheirlowerperformances.Thus,thesemethodsmayprovetoprovide
additionalstrategiesformorerationalcutoffselection.
RememberingMeasurementErrorinScoreInterpretation
Onceameasurehasactuallybeenselectedandadministeredandacutofflevelsettledon,theclinicianusesthetesttakersscoretoassistinadecisionregarding
screeningoridentification.Duringthisprocess,becauseoftheweightattachedtoindividualscoresinscreeningandidentificationdecisions,rememberingmeasurement
errorinscoreinterpretationbecomescriticaltosolidclinicaldecisionmakingevenwhenfunctionalcriteriaareincorporated.
Recallthatinchapter3theconceptofSEMwasdescribedasameansofconveyingtheimpactofatestsreliabilityonanindividualscore.Specifically,thelowerthe
reliabilityoftheinstrument,thehighertheerror(quantifiedusingSEM)attachedtotheindividualscore.TheimportanceofreliabilityandSEMisnotduetotheirability
toremoveerror(becausetheycant),butrathertotheirhelpingusunderstandthemagnitudeoferrorweface.
Figure9.2isintendedtoprovideanexampleillustratingtheeffectofSEMonascreeningdecision.Itshowsthesamescoreachievedbyachildontwodifferent
screeningmeasuresonewithalargerSEMandtheotherwithasmallerSEMforthatchildsagegroup.Aroundeachofthesescores,thereisa95%confidence
interval.Theconfidenceintervalrepresentsarangeofscoresinwhichitislikely(althoughnotabsolutelyassured)thatthetesttakerstruescorefalls.A95%
confidencelevelmeansthatthereisaprobabilityof95%thattheintervalcontainsthechildstruescoreand,ofcourse,5%thatitdoesnot.Itisoftenrecommended
thatclinicianscharacterizechildrensperformanceusingtherangeofscoresencompassedwithintheconfidenceinterval,ratherthanasinglescore.Further,ithasbeen
suggestedthattheSEMforameasureshouldbenomorethanonethirdtoonehalfofitsstandarddeviation(Hansen,1999).
Ifascoreof75isusedasacutoffoneachtestintheexample,clearlythetaskofdecidingthatthechildsperformancefallsbelowthatvaluebecomesmuchtrickierfor
testAthanfortestB,despiteidenticalscores.Infact,onemightbetemptedtorefrainfromusingtestAinfavoroftestBwhenscreeningchildrenofthisparticularage.
However,perhapstestAispreferableasascreeningtoolforotherreasons,forexample,becauseithasamoreappropriatenormativesampleandbetterevidenceof
validityforchildrensimilartotheonebeingtested.Inthatcase,theclinicianmaydecidetousethemeasurebutviewtheresultingdatawithgreatercircumspection.
Sometestsmakeitquiteeasytotakeerrorintoaccountduringscoreinterpretationbecauseofthewayinwhichachildsscoresareplottedonthetestform.Fortests
thatdonotprovidethisuserfriendlyfeature,however,thetestusercancalculateaconfidenceintervalusingthetablesandfollowingtheexamplelaidoutinFig.9.3.
Althoughthechoiceofconfidencelevelissomewhatarbitrary,morestringentlevelsareusuallyselectedformoremomentousdecisions.Confidenceintervalsof68,95,
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Fig.9.2.Two95%confidenceintervalscalculatedforthesamescoreusingtwodifferentscreeningmeasures,onewithalargerSEM,ontheleft,andtheotherwitha
smallerSEM,ontheright.
and99%aretheonesmosttypicallyreported,with85and90%usedlessfrequently(Sattler,1988).1
Theoldadageknowyourlimitationsincludingknowthelimitationsofyourdatawouldworkasanaptsummaryofthisbriefsection.InformationaboutSEMcan
helpclarifythesignificanceofreliabilitydataforindividualclientsandcanthusbeusedtohelptheclinicianmakechoicesinthemeasuresheorsheadopts.Further,
throughthe
1AlsonotethatSalviaandYsseldyke(1991)andothers(includingMcCauley&Swisher,1984b,Nunnally,1978)recommendedaslightlymorecomplexprocedure
inwhichanestimatedtruescoreiscalculatedfirst.Thisprocedureisofferedasafirststepinappreciatingthe.potentialvalueofconfidenceintervalsbutshouldnotbe
takenasdefinitive.
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Fig.9.3.Tabletobeusedincalculatingconfidenceintervals,withanexample.FromThetruthaboutscoreschildrenachieveontestsbyJ.Brown,1989,
Language,speech,hearingservicesinschools,20,p.371.Copyright1989byAmericanSpeechLanguageHearingAssociation.Reprintedwithpermission.
useofconfidenceintervalsduringinterpretationofanindividualsperformance,theclinicianisgiventheopportunitytogaugethepossibleeffectofameasuresknown
imperfection(imperfectreliabilityinthiscase).Therefore,whatmayhavebeguntosoundlikearepeatedrefraininthelastthreesectionscanbesoundedagainhere.
Oneshouldalwaysmakeuseofsuchinformationwhenitisreadilyavailable,calculateitifpossible,andencouragetestpublisherstoprovideitwhenitisneitheroffered
norcalculable.
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WrestlingwiththeDisorderDifferenceQuestion
Thediversityofculturalandlanguagebackgroundsrepresentedamonganygroupofchildrencanbequitebreathtaking.EveninVermont,whichisoftencitedasoneof
theleastdiversestatesinthecountry,theschooldistrictofthestateslargestcity,Burlington(population40,000),haschildrenwhosefirstlanguagesinclude
Vietnamese,SerboCroatian,Mandarin,andArabic.Infact,in1998and1999,about25languagesotherthanEnglishwerespokenbychildrenwhoseproficiencyin
Englishwassufficientlylowtorequirespecialintervention.Duringthetimeframe19871988to19981999,thenumberofsuchchildrengrewfromjustbelowto20to
justabout300(Horness,personalcommunication).BecauseseveralnationalcompaniesarerepresentedinBurlington,therearenumerouschildrenwhohavemoved
herefromdifferentregionsoftheUnitedStateswiththeirparents.WhereassomeofthesefamilieshavemovedfromotherNewEnglandregionswithsimilarregional
dialectstoVermont,othershavemovedfromtheDeepSouthorotherregionsclaimingdistinctregionaldialects.Further,childreninthissameschooldistrictcomefrom
familieswithincomesbelowthepovertyleveltothosewithincomesinthestratosphereofaffluence.Onthebasisofthesefewfacts,itseemssafetosaythateach
speechlanguagepathologistworkinginthisschooldistrictconfrontsissuesrelatedtodifferencesinculture,regionaldialect,socialdialect,andprimarylanguageona
dailybasis.EveninVermont!
Asthisexampleillustrates,diversityaffectinglanguageuseamongyoungnativespeakersofEnglishandlanguageusebychildrenwhoareacquiringEnglishasasecond
languageistheruleratherthantheexception.Consequently,professionalswhoworkwithchildrenarechallengedtoremainvigilanttoculturalandlinguisticfactorsin
theselectionanduseofscreeningandidentificationmeasures.
Clearly,themagnitudeofthechallengedifferssubstantiallywhentheclinicianworkswithchildrenwhospeakaminoritydialectofEnglishcomparedwiththosewhoare
beingexposedtoEnglishforthefirsttimeinaschoolsetting.ThislattergroupofchildrenaresometimesreferredtoashavinglimitedEnglishproficiency(LEP).
Regardlessofwhethertheyareseenashavingalanguagedisorder,theywilloftenbeservedthroughanEnglishasaSecondLanguage(ESL)programinschool
systems.Incontrast,thechildrenwhospeakaminoritydialectofEnglishareperhapsmoreeasilymisunderstoodbytheSLPbecausetheirdifferencesindialectmaygo
unappreciated,intheassumptionthattheyarebidialectalthatis,abletousethedialectoftheschoolandaregionalorsocialdialectaswell.Theymayalsoinclude
childrenwhosefirstdialectisunknowntoboththeirclassmatesandthespeechlanguagepathologist,thusfurtherincreasingthecomplexityofthespeechlanguage
pathologistswork.
Regardlessofthedifferencesbetweenthesegroupsofchildren,anytimethereisamismatchbetweenthetoolsbeingusedorbetweentheclinicianslanguageand
cultureandthelanguageandcultureofthechild,theissueofdifferenceversusdisorderbecomesrelevant.Table9.1offersapairofhypotheticalscenariosinwhich
challengesofthistypearepresented.
Beforefiguringoutexactlyhowtorespondtothechallengesoflinguisticandculturaldiversity,however,weneedtoremindourselvesofwhatthreatstovalidityare
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Table9.1
ScenariosIllustratingtheChallengesofCulturalandLinguisticDiversity
LittleEnglish,LittleVietnameseAnExperientialDeficitoraDisorder?
AlthoughVanandatwinsisterwerebornintheSouthwesternUnitedStatestoparentsofVietnameseheritage,Vanwasadoptedatage5byaprofessionalcouplein
NewEnglandafterhewasremovedfromhishomebecauseofsevereneglect.Notmuchwasknownabouthislifebeforetheadoption.However,informants
knowledgeableinVietnameseindicatedthatalthoughhisunderstandinginthatlanguageseemedexcellent,hespokelittle.Duringafosterplacementimmediately
precedinghisadoption,hehadbeguntouseEnglishasfrequentlyasVietnamese,buthecontinuedtobeveryquietaroundeveryoneexcepthisnewparents.The
speechlanguagepathologistandtheeducationalteamassignedtoworkwithVanandhisnewfamilywasinterestedinobtaininginformationaboutVanslanguage
statusinbothlanguages.
AmericanEnglishDialect,ProbablyNotaDisorder,butaProblematicDifference
RaymondmovedfromaschooldistrictinNewOrleansinwhichabout95%ofhisclassmatesinkindergartenwereBlack,toaraciallymixedsuburbofChicagoin
whichaWhitespeechlanguagepathologistwhohadbeenraisedinToronto,Canadawasassignedtoserveashisspeechlanguagepathologist.Concernshadbeen
raisedabouthisspeechintelligibilityandhisvocabularyuseandunderstandingbyhisclassroomteacher,whowasaWhitenativeofIndiana.Althoughboth
professionalshadmanyyearsofexperienceworkingwithchildrenandcolleaguesintheirraciallydiverseschool,neitherhadhadsuchadifficulttimeinunderstandinga
speakerofBlackEnglish.TheywantedtodeterminewhetherRaymondsspeechwassimplydifferentbecauseofhisdialectorwhetheritrepresentedagenuine
problem.AlthoughtheywererelievedtofindoutthatRaymondsfamilyconsideredhimacompetent,ifyoungspeaker,theywereevenmoreperplexedabouthow
theymightsmoothhistransitionintohisnewschool.
interwovenwithdiversity.IbeginbyconsideringthethreatsthatoccurininstanceswhereachildspeaksadialectofEnglishorisacquiringEnglishasasecond
languageforexample,BlackEnglishorSpanishinfluencedEnglish.AmongthethreatstovalidtestinginEnglishthathavebeenmostthoroughlydiscussedarethose
arisingfromthepotentialformeasurestousesituations,directions,formats,orlanguagethatareinconsistentwiththechildspreviousexperience(Taylor&Payne,
1983).Here,thechiefconcernisincorrectlyrespectingthepresenceofalanguagedifference,adifferenceinlanguageuseassociatedwithsystematicvariationin
semantics,phonology,andsoon,whencomparedwiththeidealizeddialectthatistypicallyrepresentedinstandardizedlanguagemeasures.Thedanger,ofcourse,is
erroneouslyidentifyingadifferenceasadisorder.ASHA(1993)hasdefinedlanguagedifferencemoreelaborately
asavariationofasymbolsystemusedbyagroupofindividualsthatreflectsandisdeterminedbysharedregional,social,orcultural/ethnicfactors.Aregional,socialor
ethnicvariationofasymbolsystemisnotconsideredadisorderofspeechorlanguage.(p.41)
Forchildrenusingminoritydialects,Englishlanguagemeasuresdevelopedwithoutattentiontodialectalandaccompanyingculturalvariationareespeciallyproblematic
forpurposesofscreeningandidentification.Theadvantagesanddisadvantages
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ofalternativesforchildrenwhospeakBlackEnglishandotherminoritydialectsfuelcontinuingdiscussion(e.g.,seeDamico,Smith,&Augustine,1996Kamhi,
Pollock,&Harris,1996Kayser,1989,1995Reveron,1984Taylor&Payne,1983Terrell&Terrell,1983VanKeulen,Weddington,&DeBose,1998Vaughn
Cooke,1983).
Notsurprisingly,manystrategiesforcopingwiththiscomplexissuehavebeenconsidered,butnonearecompletelysatisfactoryforusewithchildrenspeakingminority
dialects(VaughnCooke,1983Washington,1996).Whenthecontinuinguseofnormreferencedinstrumentsforthesechildrenisentertained(e.g.,seeKayser,1989
VaughnCooke,1983),itisgenerallyrecognizedthattherearefewexistingmeasuresthathavebeenfoundtobesuitable.Thestrategiesthathavebeenrecommended
andtriedincludethedevelopmentofalternativenorms,eitherthroughaddingminoritiesinsmallnumberstonormativesamplesorobtainingnormativedataforminority
childrenideasthatare,respectively,ineffectiveorimpracticalinaddressingaproblemswiththenorms(e.g.,VaughnCooke,1983).Asecondmethodinvolves
modifyingobjectionabletestcomponents(e.g.,Kayser,1989),andathirdinvolvesdevelopingalternativescoringrulesdesignedtogivecreditforcorrectanswersin
thedialectbeingconsidered(e.g.,Terrell,Arensberg,&Rosa,1992).Bothoftheselattermethodshavebeenfoundlackingbecausetheyinvalidatethenorms,thus
transformingthetargetedmeasureintoaninformalcriterionreferencedmeasure.Table9.2listssomemodificationsintestadmin
Table9.2
ModificationsofTestingProcedures
1. Rewordinstructions.
2. Provideadditionaltimeforthechildtorespond.
3. Continuetestingbeyondtheceiling.
4. Recordallresponses,particularlywhenthechildchangesananswer,explains,comments,ordemonstrates.
Comparethechildsanswerstodialectortofirstlanguageorsecondlanguagelearningfeatures.Rescorearticulationandexpressivelanguagesamples,giving
5.
creditforvariationordifferences.
6. Developseveralmorepracticeitemssothattheprocessoftakingthetestisestablished.
Onpicturevocabularyrecognitiontests,havethechildnamethepictureinadditiontopointingtothestimulusitemtoascertaintheappropriatenessofthelabel
7.
forthepictorialrepresentation.
8. Havethechildexplainwhytheincorrectanswerwasselected.
Havethechildidentifytheactualobject,bodypart,action,photograph,andsoforth,particularlyifheorshehashadlimitedexperiencewithbooks,line
9.
drawings,orthetestingprocess.
10. Completethetestinginseveralsessions.
11. Omititemsyouexpectthechildtomissbecauseofage,language,orculture.
12. Changethepronunciationofvocabulary.
13. Usedifferentpictures.
14. Acceptculturallyappropriateresponsesascorrect.
15. Haveparentsorothertrustedadultadministerthetestitems.
16. Repeatthestimulimorethanspecifiedinthetestmanual.
Note.FromSpeechandLanguage,AssessmentofSpanishSpeakingChildren,byH.Kayser,1989,Language,Speech,andHearingServicesinSchools,20,
p.244.Copyright1989byAmericanSpeechLanguageHearingAssociation.Reprintedwithpermission.
Page230
istrationthathavebeenproposedforusewithminoritychildrenwhohavebeentestedwithexistingnormreferencedteststhesemodificationsmightprofitablybe
appliedincaseswhereadescriptionofthechildsresponsestocertainkindsofstimuliiswanted.Usually,however,thosecaseswillexistnotduringidentificationofa
languageimpairment,butduringthedescriptiveprocessthatfollowsit(seechap.10).Afourthmethodconsistsofsupplementingexistingnormreferencedmeasures
withdescriptivetools(VaughnCooke,1983),whichseemstopresentaverydifficultinterpretationchallengetotheclinicianbecausenormreferencedmeasureswillbe
assumedtobebiased,anddescriptivemeasuresareusuallynotuptothechallengeofidentification.
Findingmorewidespreadapprovalthanthosemethodsjustdiscussedarestrategiesthatentailtheabandonmentofcurrentlyavailablemeasures.Theseinclude(a)the
substitutionofdescriptivemethods(suchaslanguagesampleanalysisorcriterionreferencedmeasurese.g.,seeDamico,Smith,&Augustine,1996Leonard&
Weiss,1983Schraeder,Quinn,Stockman,&Miller,1999)and(b)developmentofnew,moreappropriatenormreferencedinstruments(VaughnCooke,1983
Washington,1996).Soleuseofcriterionreferencedapproaches,suchaslanguagesampling,hasthechiefdisadvantageofinsufficientdatasupportingthatstrategyin
screeningandidentification.WashingtonalsonotedthatlanguageanalysesthatmightbeconductedforyoungspeakersofBlackEnglisharehamperedbytheabsence
ofappropriatenormsbecausenormativedataarecurrentlyavailableonlyforadolescentsandadults.However,themanyproponentsofacriterionreferencedor
descriptiveapproach(e.g.,seeDamico,Secord,&Wiig,1992RobinsonZaartu,1996)wouldarguethatdespitetheirdrawbacks,descriptivestrategiesofferthe
leastdangerousofthechoices.Notmuchprogresshasbeenmadeinthedevelopmentofappropriatenormreferencedinstrumentshowever,thatmaychangein
responsetopressuresforimprovednonbiasedassessment.Inaddition,perusalofrecentlydevelopedtestssuggeststhatmoresophisticatedeffortsarebeingmadeto
considerdialectuseinthedevelopmentoftestsformorediversepopulations.Thishasincludedthetestdevelopersexaminationofitembiasforminoritychildren
(Plante,personalcommunication).Dependingonwhenitisobtained,theresultingdatacanbeusedinthetestsearlydevelopmenttoleadtolessbiasedtestingorcan
bepresentedtoshowthatarelativelyunbiasedmeasurehasbeenachieved.
Beyondtherealmoftraditionalrecommendationsforimprovinglanguageassessmentvalidityfordiversegroupsofchildren,attentionhasbeenpaidrecentlytothe
developmentofmethodsthatseektoreducetheeffectsofpriorknowledgeandexperienceonperformance.Twoapproachesofparticularinterestareprocessing
dependentmeasuresanddynamicassessmentmethods.Thedevelopmentofprocessingdependentmeasuresinvolvestheuseoftaskswitheitherhighnoveltyorhigh
familiarityforallparticipants(e.g.,Campbell,Dollaghan,Needleman,&Janosky,1997).Dynamicassessmentmethodsfocusonthechildslearningofnewmaterial
ratherthanacquiredknowledge.Thisisdoneasameansoflevelingtheeffectsofpriorexperienceandobtaininginformationabouthowtosupportthechildslearning
beyondtheassessmentsituation(e.g.,GutierrezClellan,Brown,Conboy,&RobinsonZaartu,1998Olswang,Bain,&Johnson,1992Pea,1996).Although
proposedasbeingapplicabletoidentificationdecisions,thesetwotypesofmeasuresaremorefrequentlyusedfordescriptivepurposesandarediscussedmore
thoroughlyinthenextchapter.
Page231
AssessmentsdesignedtoaddresstheneedsofchildrenwhocanbedescribedashavingLEParegrowinginnumber.Table9.3illustratessomeofthemeasuresthatare
beingdevelopedforusewithchildrenfromdiverselinguisticandculturalbackgrounds.Clearlyatthispoint,themajorityofthesemeasureshavebeendevelopedfor
childrenwithSpanishastheirfirstlanguage.Someofthesemeasuresaredevelopedfromscratchandthuscantakeadvantageoftheexistingknowledgebase
concerningdevelopmentanddisordersinthetargetlanguages.Incontrast,othersarelittlemorethantranslationsofexistingtestsapracticethatrequiresconsiderable
careandmaystillresultinmeasuresthatdonotgetattheheartofmajordevelopmentaltasksinthelanguage.Forexample,translationscanbehamperedbyitemsthat
donothavetruecounterpartsorthatwillrequiregreaterlinguisticcomplexitytoconveyinformationinthetargetlanguagethanintheoriginal.Consumersshouldbe
cautionedtobeskepticaloftheirowncomfortlevelwithsuchadaptationsoffamiliartests.Further,theywillwanttobecarefulofthematchbetweenthedialectspoken
bythechildandthedialectinwhichatestiswritten.
Iencourageyoutolookatmorethoroughdiscussionsofthespecialchallengesposedduringtheidentificationoflanguageimpairmentinseveralgroupswhosefirstor
majorlanguageordialectiseithernotEnglishornotthedialectofEnglishtypicalofstandardizedtests.Sourceswarrantingparticularattentionexistforchildrenwhoare
NativeAmerican(Crago,Annahatak,Doehring,&Allen,1991Leap,1993RobinsonZaartu,1996),HispanicAmerican(Kayser,1989,1991,1995),Asian
American(Cheng,1987Pang&Cheng,1998),andwhospeakBlackEnglish(Kamhietal.,1996VanKeulenetal.,1998)andregionaldialects(Wolfram,1991).
ConductingComparisonsbetweenScores
Cliniciansrarelycomparescoresondifferentinstrumentsaspartofscreening.Instead,suchcomparisonsoccurmorecommonlyduringidentification.Theyare
particularlycommoninsettingsrequiringacomparisonofnonverbalandverbalskillscalledcognitivereferencing.Despitewidespreadcriticismofthispractice(Aram,
Morris,&Hall,1993Fey,Long,&Cleave,1994Kamhi,1998Krassowski&Plante,1997Lahey,1988),itsuseisnonethelessmandatedinseveralstatesto
justifyservices.Inaddition,ithassometimesbeenusedinresearchdefinitionsofSLIandotherlearningdisabilities(seealengthierdiscussionofthispointinchap.5).
Comparisonsofthiskindarealsousedasameansofidentifyingstrengthsandweaknessesinpreparationforplanninginterventionadescriptiveusethatistouchedon
inthenextchapter.
Whensinglepairsofscoresarecompared,thecomparisonisfrequentlyreferredtoasdiscrepancyanalysiswhenlargernumbersofscoresarecompared,itismore
frequentlyreferredtoasprofileanalysis.Numerousdiscussionsofthehazardsofthistypeofcomparisonareprovidedintheliterature(e.g.,McCauley&Swisher,
1984bSalvia&Ysseldyke,1998).Thefocusofthecurrentdiscussionistheuseofsuchcomparisonsinidentification.
Forpurposesofillustration,imaginethatachildsoverallscoreonalanguagemeasureistobecomparedwithherperformanceonanonverbalmeasureofintelli
Page232
Table9.3
SelectedTestsDesignedforChildrenWhosePrimaryLanguageIsNotEnglish
(Compton,1996Roussel,1991)
OralLanguage
Modalities&
Test Ages Language Domains Reference
BilingualSyntaxMeasure Tsang,C.(n.d.)BilingualSyntaxMeasureChinese.
GradesK12 Chinese ESem
Chinese(Tsang,n.d.) Berkeley,CA:AsianAmericanBilingualCenter.
SpanishStructured
Werner,E.O.,&Kresheck,J.S.(1989).Spanish
PhotographicExpressive 30to511
Spanish E StructuredPhotographicExpressiveLanguageTest.
LanguageTest(Werner& 40to95
Sandwich,IL:Janelle.
Kresheck,1989)
BerSilSpanishTest(Beringer, Beringer,M.(n.d.).BerSilSpanishTest.RanchoPalos
4to12years Spanish RSem,Morph
n.d.) Verdes,CA:TheBerSilCompany.
CarrowWoolfolk,E.(n.d.).AustinSpanish
AustinSpanishArticulationTest
3yearstoadult Spanish EPhon ArticulationTest.Allen,TX:DLMTeaching
(CarrowWoolfolk,n.d.)
Resources.
ComptonSpeechand
Compton,A.J.,&Kline,M.(n.d.).ComptonSpeech
LanguageScreening
3to6years Spanish R&EPhon,Sem,Syn andLanguageScreeningEvaluationSpanish.San
EvaluationSpanish(Compton
Francisco:InstituteofLanguage.
&Kline,n.d.)
TestdeVocabularioen Dunn,L.M.,Lugo,D.E.,Padilla,E.&R.,EDunn,L.M.
ImagenesPeabody(Dunn, 26to1711 Spanish RSem (1986).TestdeVocabularioenImagenesPeabody.
Lugo,Padilla,&Dunn,1986) CirclePines,MN:AmericanGuidanceService.
Page233
ExpressiveOneWordPicture Gardner,M.E(n.d.).ExpressiveOneWordPicture
VocabularyTestSpanish 2to11 Spanish ESem VocabularyTestSpanish.SanFrancisco:Childrens
(Gardner,n.d.) HospitalofSanFrancisco.
PreubadelDesarrolloInicial Hresko,W.P.,Reid,D.K.,&Hammill,D.D.(n.d.).
delLenguaje(Hresko,Reid,& 3to7 Spanish RSem,Syn PreubadelDesarrolloInicialdelLenguaje.San
Hammill,n.d.). Antonio,TX:ProEd.
ClinicalEvaluationofLanguage Semel,E.,Wiig,E.H.,&Secord,W.(n.d.).Clinical
R&ESem,Morph,
Function3SpanishEdition 6to21 Spanish EvaluationofLanguageFunction3SpanishEdition.
Syn,Prag
(Semel,Wiig,&Secord,n.d.) SanAntonio,TX:PsychologicalCorporation.
DelRioLanguageScreening Toronto,A.S.,Leverman,D.,Hanna,C.,Rosenzweig,
Test(Toronto,Leverman, P.,&Maldonado,A.(n.d.).DelRioLanguage
3to6 Spanish RSem
Hanna,Rosenzweig,& ScreeningTest.Austin,TX:NationalEducational
Maldonado,n.d.) Laboratory.
PreschoolLanguageScale3 Zimmerman,I.L.,Steiner,V.,&Pond,R.(1992).
(Zimmerman,Steiner,&Pond, Birthto6years Spanish E&R PreschoolLanguageScale3.SanAntonio,TX:
1992) PsychologicalCorporation.
Hedrick,D.L.,Prather,E.M.,Tobin,A.R.,Allen,D.
SequencedInventoryof
Y.,Bliss,L.S.,&Rosenberg,L.R.(1984).Sequenced
CommunicationDevelopment 04to40 Spanishtranslation E&R
InventoryofCommunicationDevelopmentRevised
Revised(Hedricketal.,1984)
Edition.Seattle,WA:UniversityofWashingtonPress.
BilingualSyntaxMeasure Tsang,C.(n.d.).BilingualSyntaxMeasureTagalog.
GradesK12 Tagalog E
Tagalog(Tsang,n.d.) Berkeley,CA:AsianAmericanBilingualCenter.
Note.E=Expressive.R=Receptive.ESem=ExpressiveSemantics,etc.Morph=Morphology.Phon=Phonology.Syn=Syntax.Prag=Pragmatics.
Page234
gence.Imaginethatshereceivesastandardscoreof70ontheformerand90onthelatter.Onthefaceofthiscomparison,itlookslikethereisquiteadifference.
However,differencesbetweenscores,alsocalleddifferencescoresordiscrepancies,areoftenlessreliablethanthescoresonwhichtheyarebased.Infact,the
likelihoodthatobserveddifferencesareduetoerrorratherthanrealdifferencesisaffectedbythreefactors:thereliabilityofeachmeasure,thecorrelationofthetwo
measures,andthesimilarityoftheirnormativesamples(Salvia&Ysseldyke,1998).
Thetaskofassessingnormcomparabilityisasstraightforwardaslookingoverdescriptionsofeachnormativegrouptodeterminewhethertheyseemtodifferinways
thatcouldaffectthescorestobecompared.Toseewhythisisnecessary,recallthatthestandardscoresbestusedtosummarizetestperformanceincludethegroup
meanintheircalculation.Therefore,somethingaboutthenormativegroupmaypushonegroupmeanhigher(e.g.,onegroupismoreeliteinsomesensethanthe
other).Consequently,onewouldfaremorepoorlyinacomparisonagainstthatgroupthanagainstagroupwithalowermean,evenifonestrueabilitiesinthetwo
areaswerecomparable.Toprovideapoignantexample,imaginearuthlessclinicianhasdecidedtocompareyourlanguageandnonverbalskillsusingscoresobtained
bycomparingyourperformancesagainstthoseofNobellaureatesinliteraturefortheformerandfifthgradersforthelatter.Notonlycouldyoulegitimatelyquestionthe
inappropriatenessofthenormsasabasisofeachofthescores,youcouldalsovehementlyprotesttheresultingcomparison.Thankfully,flagrantmismatchesbetween
testnormsusedincomparisonsmaynotoccuroutsideofexampleslikethisone.However,ifoverlooked,moresubtlemismatchescannonethelesscontributetopoor
decisionsandinappropriateclinicalactions.
Takingtesterrorandtestcorrelationintoaccountislessstraightforwardthaninspectingnorms.Onthebasisofideasanalogoustothoseusedforcalculatinga
confidenceintervalaroundasinglescore,however,itispossibletocalculateaconfidenceintervalaroundadifferencescore.SalviaandYsseldyke(1998)described
twomethodsbasedondifferingassumptionsaboutthecausalrelationshipofthetwoskillsbeingcompared.Inadditiontotheactualscoredata,bothmethodsrequire
informationaboutthereliabilityofthemeasuresbeingusedandabouttheircorrelation.Whereastherelevantinformationaboutreliabilityandthenatureofnormative
samplesshouldbereadilyavailableforindividualmeasures,informationaboutthecorrelationbetweenmeasureswilloftenbelacking.Inthatevent,abandoningadirect
comparisonandinsteadnotingtheresultsofeachtestassupportingornotsupportingtheidentificationofaprobleminagivenareamayrepresentthebestalternative
(McCauley&Swisher,1984b).
Evenwhenadifferencebetweentwoscoresisfoundtobereliable,SalviaandGood(1982)pointedout,adifferenceofthatmagnitudemaynotbeparticularly
uncommon,or,evenmoreimportantly,itmaynotbefunctionallymeaningful.Becauseoftheresourcesinvolved,determiningthefunctionalsignificanceofdifferencesin
skilllevelsrepresentsyetanotherareainwhichcliniciansmustlooktotheresearchliteraturetohelptheminterprettheirclinicaldata.Fortunately,incaseswhere
comparisonsbetweenscoresaffectidentificationdecisions,thereisarichliteratureexaminingtheseissues(e.g.,forSLI).Clinicianscanbemoreactiveandworkto
changepolicyinsettingsinwhichtheuseofdiscrepanciesismandatedforpurposesforwhichtheyhavebeenfoundtolackmeaning.
Page235
Insummary,comparingscoresisamorecomplicatedendeavorthanitfirstappears,involvingasitdoesnotonlythechildstestscoresbutalsothepropertiesofthe
twotests,especiallytheirnormsandintercorrelaltion.Awellreasonedconservatisminundertakingidentificationsbasedonsuchcomparisonsshouldbejoinedbya
healthyappetitefortheclinicalliteratureexploringtheirsignificance.
TakingintoAccountBaseRatesandReferralRates
Eachofthespecialconsiderationsaddressedearlierhadamorespecificfocusontestselectionorontheuseoftestswithaparticularchild.Twootherfactorsthat
affectscreeningandidentificationdecisionsreallyrepresentfeaturesoftheclinicalenvironment:therarityofthedisorder(thebaserateofthedisorder)andthe
frequencywithwhichreferralsaremadeinaparticularsetting(thereferralrate).Inthissection,thesetwotopicsarediscussedbrieflybecauseoftheireffecton
screeningprograms.
Thelowerthebaserateofthedisorderthatis,therarerthedisorderinthegeneralpopulationthemorelikelyitbecomesthatthepositiveresultsofscreeningor
identificationareactuallyfalsepositivesratherthantruepositives(Hummel,1999).Shepard(1989)pointedoutthatalthoughpeopleunderstandthatclassificationerror
willoccurbasedonfalliblemeasuresanddecisionprocesses,theyfailtoappreciatethatthaterrorwillfallequallyonthosechildrenwhoareidentifiedashavinga
disorderasthosewhoarenot,evenwhenthevaliditycoefficientforthemeasurebeingusedisquitelarge.Sheconcludedthatwhenbaseratesarelow,evenwith
reasonablyvalidmeasures,theidentificationswillbeequallydividedbetweencorrectdecisionsandfalsepositivedecisions(Shepard,1989,p.551).Thisproblemis
particularlyacutewhenmeasuresarelessvalidforagivenpopulation,suchasminoritychildren,whereoveridentificationisverylikelytoresult(Schraederetal.,1999).
Concernaboutlowbaserateshasledpublichealthresearchersandpsychologistsinterestedinrarepsychiatricoutcomes(e.g.,suicide)todevelopseveralstrategies
designedtotargetscreeningatsubsetsofthelargerpopulationwithhigherbaserates.Theseincludestrategiesthatincludetheuseofmultistepscreeningprocedures
andtheapplicationofscreeningprocedurestosubgroupswhoareexpectedtohavehigherprevalenceratesthanthegeneralpopulation(Derogatis&DellaPietra,
1994).Currently,theprevalenceofchildhoodlanguagedisordersacrossalltypesisnotparticularlylow,ascanbeillustratedbythefactthatitisestimatedthatchildren
withlanguagedisordersconstitute53%ofallspeechlanguagepathologistscaseloads(Nelson,1993).Nonetheless,itissufficientlylowthatcarefulselectionof
groupsforlanguagescreeningmakesgoodsense.Childrenaboutwhomconcernsareexpressedorwhoaredemonstrativelyfailinginsomeaspectoftheiradaptation
toschoolorhomeenvironmentsmakeobviouscandidatesformorefocusedscreeningsandindeedareoftenseenforscreeningpriortomorecomprehensive
evaluations.
Screeningprogramsinpreschooleducationareassociatedwithenormousdifferencesinreferralrates(Thurlow,Ysseldyke,&OSullivan,1985,ascitedinNuttallet
al.,1999),theratesatwhichchildrenwhoarescreenedarereferredonforadditionalassessment.Thisvariabilityleadstoconcernsaboutoverreferralwhenreferral
ratesareparticularlyhighandunderreferralwhentheyareparticularlylow.Because
Page236
overreferralsneedlesslytaxclinicalresources,parentalconcern,andthechildspatience,whereasunderreferralsdeprivechildrenofneededattention,stepstostudy
andalterreferralrateshavebeenrecommended.Changesinthetargetsforscreeningandthecriteria(includingcutoffs)usedcanbemadetoaddressverified
inadequaciesinthescreeningmechanism.Inaddition,theuseofasecondlevelscreeningusingmeasuresthatareintermediateintheirefficiencyandcomprehensiveness
betweeninitialscreeningsandfullfledgedassessmentshasbeenrecommended(Nuttalletal.,1999).
AvailableTools
Screening
Availablescreeningmeasuresdifferintermsofwhetherinformationisobtaineddirectlybythespeechlanguagepathologistandwhetherthemeasurementisformalor
informal.Screeningmethodsincludetheuseofnormreferencedstandardizedtoolsaswellasinformalcliniciandevelopedmeasures.Overthepastfewyearstherehas
beengrowinginterestinthedevelopmentofquestionnairesthatmightbeusedtoincreasetheinvolvementofparentsandothersfamiliarwiththechildandimprovethe
qualityofinformationobtainedfromthem.Morerecentlystill,therehasbeenaninterestinthedevelopmentofcriterionreferencedauthenticassessmentsinwhich
specificminimalcompetenciesareevaluatedinafamiliarsetting.Schraederetal.(1999)describedsuchaprotocolthatwasdevelopedforusewithyoungspeakersof
BlackEnglish.BecauseitselementswereselectedfortheirhighdegreeofoverlapwithfeaturesofStandardAmericanEnglish,Schraederandhercolleaguessuggested
itspotentialrelevanceformanychildreninthetargetedagegroupof3yearolds.
ParentQuestionnairesandRelatedInstruments
Althoughhistoricallysomeinstrumentshaveincorporatedtheuseofparentreportforveryyoungchildren(e.g.,theSequencedInventoryofCommunicative
Development,Hedrick,Prather,&Tobin,1975),extensivedevelopmentofparentquestionnairesforlanguagedisorderscreeninghasblossomedonlyinthepast
decade.Theuseofsuchinstrumentsiswelcomedfromafamilycenteredperspective(Crais,1993)becauseparentsaregiventheopportunitytosharetheirexpertise
concerningthechildaspartoftheircollaborationintheassessmentprocess.Inaddition,thesemeasuresalsoshowgoodpotentialforefficient,validusefroma
psychometricpointofview.Oneobviousadvantagethattheyhaveovertheclinicianadministeredproceduresistheirabilitytoobtaininformationthathasbeen
accumulatedbytheparentovertimeusingquestionsthatcoveravarietyofsituationsandsettings.Forsomechildrenandatsometimes,thetestingadvantageis
irrefutable:Thechildwillsimplynotcooperateformoredirecttestingorissothoroughlyaffectedbythetestingsituationastomaketheresultsofstructured
observationshopelesslyflawed.Evenwhenchildrenaremoreamenabletointeractingwithstrangers,parentquestionnairesmayhelpremovethesubtlerinvalidating
influenceoftheclinicianonthechildsbehavior(Maynard&Marlaire,1999).
Page237
Onthebasisofagrowingnumberofstudies,itappearsthatparentquestionnairesmayreliablyandvalidlybeusedtoobtaininformationaboutanumberoflanguage
areas,especiallyexpressivevocabularyandsyntaxalthoughmostindividualmeasuresarestillveryundeveloped.Leadingthetrendtowardincreaseddevelopmentof
thesemeasures,theMacArthurCommunicationDevelopmentInventories(Fensonetal.,1991)hasbeenthoroughlystudied(e.g.,Bates,Bretherton,&Snyder,
1988Dale,Bates,Reznick,&Morisset,1989Reznick&Goldsmith,1989).Inaddition,ithasalsobeeneffectivelyadaptedforusewithotherlanguages,including
Italian,Spanish,andIcelandic(Camaioni,Castelli,Longobardi,&Volterra,1991JacksonMaldonado,Thal,Marchman,Bates&GutierrezClellan,1993
Thordardottir&EllisWeismer,1996).Othertoolsthatassesscommunicationmorebroadlyhavealsobeendevelopedbuthavereceivedlesswidespreadattentionand
validation(e.g,Girolametto,1997Hadley&Rice,1993Haley,Coster,Ludlow,Haltiwanger,&Andrellos,1992).Table9.4listsfiveinstrumentsforusewith
Englishspeakingchildrenundertheageof3,eachofwhichconsistsofaparentquestionnaireormakesuseofparentreportforatleastsomeitems.
Questionnairesthattakeadvantageofthefamiliarityofotheradultswiththechildusuallyclassroomteachersarealsobeingdeveloped(Bailey&Roberts,
Table9.4
InstrumentsforUseWithChildrenUnder3YearsofAge,
IncludingParentReports
Receptiveor AreasofLanguage
MeasureandSource Agescovered
Expressive Covered
LanguageDevelopmentSurvey(Rescora,1989).FromThelanguagedevelopment
survey:Ascreeningtoolfordelayedlanguageintoddlers.JournalofSpeechand 2yearolds E Semantics
HearingDisorders,54,587599.
MacArthurCommunicativeDevelopmentInventories(Fenson,Dale,Reznick,Thal,
Bates,Hartung,Pethick,&Reilly,1991).SanDiego,CA:SanDiegoStateUniversity, 8monthsto2years E Semantics
CenterforResearchinLanguage.
ReceptiveExpressiveEmergentLanguageTest(2nded.Bzoch&League,1971).
0to3years RandE
Austin,TX:ProEd.
Pragmatics,play,
RosettiInfantToddlerLanguageScale(Rosetti,1990).EastMoline,IL:
0to3years RandE comprehension,
LinguiSystems.
expression
Phonology,
SequencedInventoryofCommunicationDevelopmentRevised(Hedrick,Prather,&
4monthsto4years RandE morphology,syntax,
Tobin,1984).Seattle,WA:UniversityofWashingtonPress.
semantics
Page238
1987Sanger,Aspedon,Hux,&Chapman,1995Semel,Wiig,&Secord,1996Smith,McCauley,&Guitar,inpressStokes,1997).Resultsofthesehavealso
beencomparedwithparentquestionnaires(Whitworth,Davies,&Stokes,1993)andagainstformalassessments(Botting,ContiRamsden,&Crutchley,1997).
Usually,however,thesequestionnaireshavenotbeendevelopedforuseintheidentificationprocess,butrathertodescribethenatureofproblemsfacingthechildinthe
classroom.Thus,theywillbeconsideredinthenextchapter,whichdealswithdescription.
NormReferencedStandardizedMeasures
Standardizedmeasuresarenotwellestablishedasscreeningtoolsinthefield.Only50%ofthe109cliniciansinOregonrespondingtoasurveyconcerningtheirtestuse
reportedthattheyusedstandardizedmeasuresforscreening(Huangetal.,1997).AnotherrelatedresultfromthatsamestudywasthatonlyIscreeningtest(the
ScreeningTestofAdolescentLanguage,Prather,Breecher,Stafford,&Wallace,1980)appearedinthelistof10teststhataremostcommonlyusedbyspeech
languagepathologistsintheirworkwithfouragegroups(03,45,612,and1319).Nonetheless,standardizedscreeningofyoungerchildrenhasreceivedincreased
attentionwiththeIDEArequirementthatchildrenwithcommunicationdisordersbeidentifiedbeforeenteringschool(Nuttall,Romero,&Kalesnik,1999Sturner,
Layton,Evans,Heller,Funk,&Machon,1994).
Stumeretal.(1994)reviewed51measuresavailableforspeechandlanguagescreeningcoveringatleastsomepartofthe36yearagespan.Inthatreview,the
researchersfoundthatonly6ofthemeasurestheyexaminedprovidedsufficientnormativedata,andwerebothbrief(i.e.,requiring10minutesorless)and
comprehensive(i.e.,coveringmorethanonemodalityordomain).Thus,despiteaplayingfieldfilledwithmanyplayers,thenumberofinstrumentsthatwarrantserious
considerationasacomprehensivelanguagescreeningtoolarerelativelyfew.Table9.5describesthefourtoolssupportedinSturneretal.sreview.
DespitethefocusofSturneretal.(1994)onpreschoolscreeningmeasures,manyofthemeasuresstudiedbySturneretal.alsoextendtocoverschoolagechildren.
Nonetheless,theavailabilityofmeasuresforbothyoungerschoolagechildrenandadolescentsisgreatlyreducedcomparedwiththoseavailableforpreschoolers.This
isprobablydue,forthemostpart,tothevariousreferralmechanismsthatcanreducetheneedforformalscreenings.Also,thepersistentnatureoflanguageproblems
meansthatscreeningofolderchildrenandadolescentsforlanguagedisorderswillusuallyonlybeneededifscreeningshavebeenabsentorineffectiveatyoungerages.
Identification
NormReferencedStandardizedInstruments
Evenchildrenwithinanyspecificcategoryofdevelopmentallanguagedisorders(i.e.,languagedisorderassociatedwithhearingloss,autismspectrumdisorder,mental
retardation,andSLI)varyconsiderablyintheareasoflanguagethatareaffected.Thus,itisimportanttobequitecomprehensiveintheidentificationprocess,
particularlybecause
Page239
Table9.5
CommunicationScreeningMeasuresforChildrenBetween3and7YearsofAgeThatWereFoundtoBeBrief,NormReferenced,andComprehensive(Definedas
Phonology[Articulation]andOtherLanguageDomains)
bySturner,Layton,Evans,Heller,Funk,andMachon(1994)
Ages Reviewedin
Test Covered Expressive Receptive Semantics Morphosyntax Phonology Pragmatics MMY?
CommunicationScreen
3to7
(Striffler&Willis,1981) X X X
years
FluhartyPreschoolSpeechand
LanguageScreeningTest
2to6
(Fluharty,1978) X X X X X X
years
PhysiciansDevelopmentalQuick
<1to6
Screen(Kulig&Baker,1975) X
years
StephensOralLanguageScreening
PreKlst
Test(Stephens,1977) X X X
grade
SentenceRepetitionScreeningTest
(Sturner,Kunze,Funk,&Green,1993) 4to5
X
years
TexasPreschoolScreening(Haber&Norris,
4to6
1983) X X
years
Note.MMY=MentalMeasurementYearbooks.
Page240
partofthatprocesswilloftenbetheidentificationofwhichaspectsoflanguageareaffectedMorecomprehensivecoverageacrossmodalities(receptive,expressive)
anddomainsoflanguage(e.g.,syntax,phonology)canbeachievedthroughtheuseofameasuredesignedforthatpurpose(e.g.,theTestofLanguage
DevelopmentPrimary:3Newcomer&Hammill,1997).Itcanalsobeachievedthroughtheuseofabatteryofteststhatprovidemorecomprehensivecoverageor
throughacombinationofthesemethods.Evenwhenacomprehensivemeasureisused,however,certainaspectsoflanguagefunction(especiallypragmaticsand
discourse)arealmostcertainlyoverlooked.
TheAppendixlistsover50teststhathavebeendescribedasusefulintheidentificationprocess.Thetableincludesverybasicinformationaboutthetestsidentifying
information,content,andintendedpopulation.Almostallofthemeasurespublishedbetween1989and1996havebeenreviewedfortheMentalmeasurements
yearbookonlinereviewservice,thusallowinganyonewithaccesstotheInternetanopportunitytoexamineatleastone,andoftentwo,independentreviews.Earlier
testsarelikelytohavebeenreviewedintheMentalmeasurementyearbookprintedvolumes.Testspublishedafterabout1996arelikelytobereviewedsoon,
perhapsevenbeforethepublicationofthisbook.
AlthoughtheAppendixisnotintendedtobeexhaustive,thenumberoftestsitincludesillustratesthestaggeringtaskfacingclinicianswhomustchooseamongthem.Itis
interestingtonotetherelativelylargenumberofteststhathavebeencreatedinthe1990sandtherelativelysmallnumberofpublishinghousesresponsiblefortheir
availabilityifnottheiroriginalconstruction.Ontheplusside,thismeansthatineffortstoincreasethequalityofavailablemeasures,individualcliniciansandthe
professioncanfocustheircooperativeinteractionswithfewerparties.Onthenegativeside,itmeansthatpublishersareofteninthepositionofcompetinglargelywith
theirownproductsaprospectthatmakesitunlikelyforfreemarketpressurestohelpdrivethequalityoftestshigher.
CriterionReferencedMeasures
Intherealmofcriterionreferencedmeasures,specificmeasuresobtainedthroughlanguageanalysis(e.g.,meanlengthofutterance,orMLU14morphemecount
typetokenratio)aregainingincreasingsupportintheidentificationprocess(e.g.,Arametal.,1993).Inparticular,someresearchershaveusedMLUasan
identificationtoolandfoundittobemoreconsistentwithclinicianjudgmentsthancertaintestdata(M.Dunn,Flax,Sliwinski,&Aram,1996).Usually,however,MLU
isusedincombinationwithnormreferencedmeasures(Leonard,1998).Becauselanguageanalysismeasuresaretypicallyconsideredmoreusefulindescriptionthan
identification,thenextchaptercontainsamoredetailedaccountofrecentstudiesinwhichtheirstrengthsandlimitationsareexamined.Nonetheless,itisimportantto
reiterateherethattheiruseinidentificationisgrowinginsignificance.
PracticalConsiderations
Inchapter4,severalvariablesaffectingclinicianswerehighlightedfortheirpotentialeffectsonspeechlanguagepathologists.Thesevariablesincludedfederal
legislation,localregulations,andglobalchangesinperspectivetowardbehavioralproblems.In
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casesofscreeningandidentification,particularlyastheyarepracticedinschoolsettings,thosevariablescandramaticallyaffecttheshapeofpracticebothforbetter
andforworse(Cirrinetal.,1989).Inthisbriefsection,theeffectsofthesefactorsonscreeningandidentificationareprimarilydiscussedthroughpracticeconstraints
relatedtodeterminingchildrenseligibilityforservices.
In1989,NyeandMontgomeryexaminedthecriteriausedin47statestoidentifychildrenashavingalanguagedisorder.Theyusedacaseexampleinwhicha13year
oldgirlwhomovedfrequentlybecauseherfatherwasinthemilitaryhadvariouslybeenconsideredlanguagedisorderedinonestate,learningdisabledinanother,
ineligibleinathird,andeligibleonlyfortutorialsupportinafourth.(Nye&Montgomery,1989,p.26).Inthe47statestheyexamined,theyfoundthatalthoughmost
providedspecificdefinitionsoflanguagedisorder,thedefinitionswerehighlyinconsistentfromonestatetothenext.Onlyaboutahalfofthestatesmadesome
referencetothecomponentsoflanguage,andamongthosethatdid,semanticsandsyntaxwereincludedfarmorefrequentlythanphonology,morphology,and
pragmatics.Twentyonestatesrequiredtheuseofatleastonestandardizedlanguagetestandonly7requireduseofalanguagesample.Threedifferentmeansoffinding
eligibilitywereidentifiedacrossthestatestheuseofadiscrepancyformula,aratingseverityscale,andprofessionalreport.NyeandMontgomerynotedthepoor
reliabilitylikelytobeattachedtotheuseofratingseverityscales.Consistentwiththepoorevaluationofdiscrepancyscoreseveninthe1980s,theauthorsexpressed
dismayattherelativefrequencywithwhichdiscrepancyformulaswereused.However,theyseemedtohavecombinedinstancesinwhichacutoffisused(e.g.,1.5
standarddeviationsbelowthemeanonastandardizedmeasure)withthetrulymorenotoriousinstancesofcognitivereferencinginwhichadiscrepancyisfound
betweentwomeasuresforagivenchild.Thispracticemakestheextentofcognitivereferencingdifficulttodeterminefromtheirreport.Intheirconclusions,Nyeand
Montgomerypointedouttheneedforgreateruniformityinterminologyandcriteriausedwiththispopulation.
Incaseyouhavebeenreadingthisaccountandhopingthatthingschangedrapidly,abrieflookatsimilarvariables4yearslater(Apel,Hodson,Shulman,&Gordon
Brannan,1994)willbeofinterest.Apelandhiscolleaguesexaminedtheeligibilityguidelinesformoststates(dataforTennesseecouldnotbeobtained)andforthe
DistrictofColumbia.Thedatashowedcontinuinginadequacyinthedefinitionsbeingused.DefinitionsoflanguageusedbystateDepartmentsofEducationincluded
referencetobothoralandwrittenlanguageonly40%ofthetime,withthemajorityofstatedefinitionsincludingeithernoreferencetooralorwrittenlanguage(40%)or
definitionsaddressingorallanguageonly(20%).Specificguidelinesforeligibilitywereoftenmissing(46%)orwerequiteheterogeneous.Althoughstandardscores
oftenfiguredinavailableguidelines,cutoffswerequitevariable(rangingfrom1.5togreaterthan2standarddeviationsbelowthemean),encouragementtousemultiple
standardizedmeasureswasoftenabsent,andseverityratingsweresometimesusedasbasesforeligibility.Whenspecificcriteriaforpreschoolchildrenweresought,
only8states(16%)haddevelopedcriteriaforthatpopulationandthetypesofcriteriausedwerequitevariable.Amongthepracticesincorporatedintheseguidelines
weretheuseofpercentagedelayasthesolecriterionoraspartofamorecomplexcriteriona
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practicethat,unfortunately,reliesontheuseofnotoriouslyunreliableageequivalentscores.
Inshort,4yearsdidnotappeartohaveresultedinmanyimprovementsinthepracticesreflectedinstateregulations.Wherearewetoday?Astudyofstateregulations
comparablewiththoseofNyeandMontgomery(1989)andApeletal.(1994)iscurrentlyunderwaybyASHA(SusanKarr,personalcommunication).Althoughthese
dataareintheprocessofbeinganalyzed,itseemsunlikelythatthefitbetweenlegislativelyinfluencedpracticeandbestpracticeswillhavebeenbroughtintomuch
betteralignmentthanthatreportedadecadeagobyNyeandMontgomery.Onepositivetrend,however,istheintentionofthedevelopersofthismostrecentreportto
pairrecommendationsforcomponentscomprisingadefensiblesetofguidelineswithpreliminaryfollowupeffortsdesignedtoresultintheredraftingofguidelinesinat
leastasmallnumberofstates(SusanKarr,personalcommunication,October,1999).
In1997,MerrellandPlantecalledattentiontotheneedformorestudiesaimedatfurtheringthedevelopmentofempiricalbasesfortestselection.Inparticular,they
notedthatsuchstudiescanminimizetestselectionbasedonsubjectivegrounds,suchastestfamiliarityandtherecommendationsormandatesofsupervisorsor
districts.Althoughrespondingtolegalandworkplaceobligationsisanecessarypartofclinicalpractice,thenatureoftheresponsecangobeyondasimplecompliance
withanunsatisfactorystatusquo.Moresatisfyingandethicalresponsesincludeincreasingtheknowledgebaseoftheprofessionthroughstudiesintendedtoidentifybest
practices,increasingtheknowledgebaseofindividualsaroundmeasurementissues,andworkingwithprofessionalorganizationsatthestateandnationallevelstoeffect
neededchanges.
Summary
1.Screeningprocedures,whichtypicallyaredesignedtobeefficientintermsoftimeandotherresources,leadtodecisionsthatachildreceivefurtherassessment.
Strategictargetingofgroupstobescreenedandtheuseofmultiplestepsinscreeningprocedurescanimprovescreeningaccuracywhenconcernsaboutrarityofthe
disorder(lowbaserates)andaboutoverlyhighreferralratesareencounteredinaparticularsetting.
2.Identificationinvolvesthedeterminationthatalanguageproblemexists,usuallythroughtheuseofnormativecomparisonsfacilitatedbynormreferencedmeasures.
MethodsusedinidentificationareoftenaffectedbytheeligibilityrequirementsinstitutedbystateDepartmentsofEducation.
3.Measuresofsensitivityandspecificityprovideimportantempiricalbasesfortestselection.
4.Cutoffscoresareusedinresearchandclinicalpracticetostandardizeidentificationdecisions.Althoughtheirempiricaldeterminationisfeasible,theyareoftenrelated
tostateeligibilityrequirementsandarebestusedinconjunctionwithawarenessofthepossibleinfluenceofmeasurementerrorandfunctionalcriteriathatassociatetest
performancewithrealworldeffectsonthechildssocialfunctioning.
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5.Forallchildren,butparticularlyforthosewithlimitedEnglishproficiencyordialectusethatdifferssubstantiallyfromtheclinicians,thecliniciansattentiontothe
effectsoflanguagedifferenceandculturaleffectsonassessmentcanenhancevalidity.Althoughcontroversypersistsinthefaceofaninadequatebutgrowingliterature
onthesubjectoflanguageandculturalinfluencesonassessment,clinicalstrategiesformitigatingnegativeeffectsonassessmentabound.
6.Whenscoresondifferentmeasuresarecomparedwithoneanotherduringtheidentificationprocess,factorsrequiringconsiderationincludetheeffectsoftesterror,
testcorrelation,anddifferencesinnormativegroups.
7.Althoughmostmeasuresusedinscreeningofolderchildrenarestandardizednormreferencedtests,theuseofparentquestionnairesforyoungerchildrenand
criterionreferencedmeasuresderivedfromlanguageanalysesisbecomingmorecommonwithincreasingresearch.
8.Amongpracticalfactorsaffectingtheselectionofmeasuresforuseinscreeningandidentificationarestateguidelines,whichhavehistoricallybeenslowtorespondto
professionalrecommendationsregardingbestpractices.
KeyConceptsandTerms
cutoffscore:thescorethatservesasadecisionboundaryinscreeningoridentification,suchthatscoresaboveaparticularlevelareseenarepresenting
nonproblematicperformanceandthosebelowthatlevelareseenasindicativeofpotentialdisorderordifference.
goldstandard:ameasureusedasthebasisforcomparisonwhenasecondmeasureisbeingevaluated.Itisthoughttoprovideatruemeasurementofthebehavioror
characteristicbeingmeasured.
languagedifference:adifferenceinlanguageusereflectingsystematicvariationinphonology,syntax,semantics,andsoforth,whencomparedwiththedialectthatis
typicallyrepresentedinstandardizedlanguagemeasures.
limitedEnglishproficiency(LEP):languagedifficultiesinEnglishthatappeartoberelatedprimarilytoineffectiveorinsufficientexposuretothelanguageratherthan
toalanguagedisorder,whichmaynonethelessbecoexisting.
personfirstnomenclature:usingtermssuchasachildwithimpairedlanguageinsteadofalanguageimpairedchildtoavoidundueemphasisontheroleofthe
probleminunderstandingthechild.
referralrate:therateatwhichchildrenwhoarescreenedarereferredonforadditionalassessment.
sensitivity:theabilityofameasuretogiveapositiveresultwhenthepersonbeingassessedtrulyhasthedisorder.
specificity:theabilityofameasuretogiveanegativeresultwhenthepersonbeingassessedtrulydoesnothavethedisorder.
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StudyQuestionsandQuestionstoExpandYourThinking
1.Whatmighttheeffectsofpoorsensitivitybeonthefollowingdecisions?
Screeningsforhearinglossinchildrenwithknownlanguageimpairments
Identificationtestingforchildrenseligibilityforcommunicationproblemswarrantingearlyinterventionservicesand
Determinationofthepresenceofalanguagedisorderinabilingualchild.
2.Whatmighttheeffectsofpoorspecificitybeonthefollowingdecisions?
Screeningsofalargegroupofkindergartenchildrenforspeechandlanguagedisorders
Identificationoforallanguagedisorderinchildrenwhoarefailingacademicallyand
LanguagescreeningsforchildrenwhospeakSpanishinfluencedEnglish.
3.Imaginethatyouareaschoolspeechlanguagepathologistwhoisinterestedinobtaininginformationaboutthespecificityandsensitivityofyourownscreening
procedures?Howmightyouobtaintheinformationyouneedforlookingatbothhitsandbothkindsofmissesfalsepositivesandfalsenegatives?Whichkindof
informationwillbemostdifficulttoobtain?
4.UseAppendixAandyourreadingofthischaptertoconsiderthefollowingquestions.Whatdomainsoflanguageandwhatagegroupsappeartobelesswell
representedinstandardizedtests?Besidesthosereasonsgiveninthetext,canyouthinkofreasonsforthesepatterns?
5.TaketwomeasureslistedinAppendixAthataresaidtotargetoneormorelanguagedomainsandmodalitiesincommon.Compareandcontrastthecontentofthese
sharedcomponentsintermsofnumbersandkindsofitems,tasks,andstimuli.
6.Onthebasisofwhatyouhaveread,createalistof5researchquestionsthat,ifanswered,wouldgreatlyimprovescreeningandassessmentpracticesinspeech
languagepathology.
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CHAPTER
10
Description:WhatIstheNatureofThisChildsLanguage?
TheNatureofExaminingChange
SpecialConsiderationsforAskingThisClinicalQuestion
AvailableTools
PracticalConsiderations
Nigelisa9yearoldwithmildmentalretardationwhoseplacementinamultiageclassroomiscomplicatedbyamoderatehearinglossandADD.A3year
reevaluationconductedatthebeginningoftheschoolyearincludedextensiveaudiologicalassessmentaswellasstandardizedlanguagetestingthat
confirmedparticulardifficultiesinexpressivephonologyandmorphosyntax.Languagesamplingandaclassroomchecklistwereusedtohelpdeterminethe
educationalimpactofNigelsdifficultiesandtohelpplanaccommodationsanddevelopNigelsindividualizededucationalplan.
Taohasalonghistoryofcommunicationproblemsthathavechangedwithage.Shewasdiagnosedwithautismatage4,thenAspergerssyndromeatage
8.Now,atage12,withappropriateaccommodationsandintensivetreatment,sheisinaregularjuniorhighschool.Speechlanguageinterventionhas
centeredonaddressingherpragmaticchallengeswithpeersandteachers.Goalsinthisareahavebeenidentifiedandtrackedduringthesemesterusinga
varietyofdescriptivemeasures
Page251
createdbyherclinicians.RecentlyadynamicassessmentdesignedtoexamineTaosemergingawarenessoftheperspectivesofotherswasundertakenas
partofthisprocess.
TheNatureofDescription
Describingtheirskillsandtheproblemsfacedbychildrenwithsuspectedlanguageimpairmentssometimesoccursaspartofscreening,thusprecedingtheuseofformal
proceduresassociatedwithidentification.Moreoften,descriptionrepresentsacriticalcomponentofinitialassessmentsandcontinuesthroughoutallofthelatersteps
involvedinspeechlanguagemanagement.Withsuchpervasiveness,descriptionundoubtedlyconstitutesthemajormeasurementtaskfacingclinicians.
Thepurposesservedbydescriptionarevaried.Descriptivemeasuresareinitiallyusedtocharacterizethespecificareasoflinguisticorcommunicativedifficultyfacinga
child,thefunctionallimitationsthosedifficultiesimpose,andincreasinglytheeffectsonthechildssocialrolesthatareassociatedwiththechildslanguagedisorder
(Goldstein&Geirut,1998).Atthesametime,descriptivemeasurescanbeusedtohelpplaninitialtreatmentstrategies,choosespecifictreatmentgoals,andprovide
thebasisforlatercomparisons.Duringtreatment,descriptiveprobesespeciallyofuntreatedbutrelatedstimuliandotherdescriptivemeasuresarelikelytoprovide
someofthebestevidenceoftreatmenteffectiveness(Bain&Dollaghan,1991Olswang&Bain,1994Schmidt&Bjork,1992)becausetheyreflecttheextentto
whichgeneralizationisoccurring.Infact,muchoftheprofessionsrecentfocusonmeasuringoutcomestodocumentthevalueoftreatment(seeFrattali,1998)involves
thedevelopmentanduseofdescriptivemeasures.
Despitetheubiquityofdescriptivemeasures(andperhapsbecauseofit),themeasurementchallengestheypresentcanbeoverlooked,oratleastunderappreciated
(Leonard,Prutting,Perozzi,&Berkley,1978McCauley,1996Minifie,Darley,&Sherman,1963).Illustratingagrowinginterestinthosechallenges,Secord(1992)
devotedanentirebooktodescriptive,nonstandardizedlanguageassessment.Inanearlychapterofthatbook,Damico,Secord,andWiig(1992)notedthateffective
descriptiveassessmentproceduresneedtobeasrigorousasnormreferencedtests(p.1).Thesourceofthatrigor,however,ismuchlessobviousthanthat
associatedwithmeasuresusedforpurposesofclassification.
Muchoftherigorassociatedwithmethodsusedintheidentificationoflanguageimpairmentappearstoresideinthehandsofothers(e.g.,testauthorsandpublishers,
individualresearchers).Incontrast,fordescriptivemeasures,theresponsibilityforrigorfallslargelyintothehandsoftheclinician.AsLeonard(1996)observed,such
measuresareessentiallyexperimentaltasksoftencreatedbycliniciansandsometimesborroweddirectlyfromexperimenters.Fortunately,increatingand
understandingsuchmeasures,theclinicianhasalliesintheincreasingnumberofclinicianresearchersinspeechlanguagepathologyandrelatedfieldswhodevelopand
shareindividualmethodsandreflectionsonthemeasurementchallengestheypresent.Inthischapter,Itrytopassalongsomeoftheirinsightsanddirectreadersto
particularlyhelpfulexamples.
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SpecialConsiderationsforAskingThisClinicalQuestion
Theprocessofdescriptioncansometimesusenormreferencedmeasurement.Whenprofilesofperformanceareexaminedtoassessbroaderpatternsofstrengthsand
challengeswithindifferentareasofcommunication,standardizednormreferencedmeasurescanprovideusefulinformation(Olswang&Bain,1991).Thisisespecially
truewhenlimitationsduetotestcontentandmeasurementerroraretakenintoaccount(McCauley&Swisher,1984Salvia&Ysseldyke,1981).
Usually,however,theprocessofdescriptionmakesuseofcriterionreferencedmeasurement.Suchmeasurementcanfunctionatseverallevelsofdetailfrommore
globalcategorizationsoflanguagefunctionindifferentmodalitiestothedetaileddescriptionofaspecificlanguageorcommunicationskill(e.g.,frequencyofuseofa
particulargrammaticalmorphemeorcommunicativeintentinagivenconversationalcontext).Althoughsuchdescriptionsmaynotalwaysfitwithinaviewof
measurementastheassignmentofnumberstobehaviors,theyfitwithinthebroaderviewofbehavioralmeasurementasasimplificationprocessorasinformation
compressionusedtoaiddecisionmaking(Barrow,1992Morris,1994).Thus,aswithallcasesofmeasurement,ourcentralconcernwithvalidityremains(APA,
AERA,&NCME,1985Messick,1989).However,validityisfosteredthroughmeansthatmaysuperficiallyappearunrelatedtothepsychometricconcernsdescribed
fornormreferencedinstruments.Forexample,ratherthanastudyofcriterionrelatedvalidityusingnumerousparticipantsandothernormreferencedmeasures,
evidencefordescriptivemeasuresmayinvolvethecollectionofsupportingqualitativeandsubjectivedataforamuchsmallernumberofcases,orevenasinglecase.
Becauseaprincipalvalueofsuchmeasuresistheirclosetietoaspecificconstruct,theusersalertnesstothenatureofatargetedconstructandthedegreetowhicha
specificmeasureservesasanacceptableindicatorofitrisesinimportancefromlargetogargantuanproportions.
Damicoetal.(1992)discussedthreecomplexcharacteristicspivotaltoeffectivedescriptiveassessmenttechniques:authenticity,functionality,andrichnessof
description.Authenticityisusedtorefertothreerelatedconcepts:linguisticrealism,ecologicalvalidity,andpsychometricveracity.Linguisticrealisminvolvesthe
treatmentofcommunicationindatacollectionandanalysisasacomplexandsynergisticprocesswiththesharingofmeaningasitsgoal,whereasecologicalvalidity
referstothepreservationofnaturalcommunicativecontextsinassessment.Thethirdconcept,psychometricveracity,encompassesthetraditionalconceptsofreliability
andvalidityaswellastheclinicalpracticalityofthemeasuresintermssuchastimeandrequiredresources.Concernsregardingauthenticityhaveledtotheuseofthe
termauthenticassessmenttorefertoassessmentsdesignedwithauthenticityastheirparamountvirtue(e.g.,Schraeder,Quinn,Stockman,&Miller,1999).
ThetermfunctionalityasusedbyDamicoetal.(1992)relatestoeffectiveness,fluency,andappropriatenessofconveyedmeaning.Thiscriterionfocusesnotjuston
obtaininginformationaboutclientsunderlyingcompetencebutalsoabouttheirabilitytoputknowledgeintoplayeffectivelytoachievecommunicationgoals.Thecrite
Page253
rionofrichnessofdescription,citedbythosesameauthors,entailstheuseofassessmentproceduresdesignedtoprovidedetaileddescriptionsofcommunicative
performanceleadingtoexplanatoryhypothesesfordetectedcommunicationdifficulties.Thiscriterion,then,associatesdescriptivemeasureswiththemanipulationof
variablesintheenvironment(materialsused,identityofcommunicationpartner,etc.)thatcanbestudiedfortheirimmediateeffectonperformance.
Iurgereaderstoexaminetheoriginalsource(Damicoetal.,1992)inordertogetadeeperfeelfortheintricaciesinvolvedinassessmentthatpreservethose
characteristicsofcommunicationthatmakecommunicationwhatitis.Ialsosuggest,however,thattheoverarchingpointDamicoandhiscolleaguesweremakingisthat
descriptivemeasuresofcommunicationneedtobevalidtheyneedtomeasurewhattheypurporttomeasure.Specifically,totheverygreatextenttowhich
communicationisembeddedinsocialinteraction,intendedtosharemeaning,andconstrainedbythephysiologicalandsocialmakeupofitsusers,itsmeasurementmust
honorthosepropertiesorsufferthefateofreducedvalidity.TheworkofDamicoetal.andnumerousothers(e.g.,Kovarsky,Duchan,&Maxwell,1999Lund&
Duchan,1983,1993Muma,1998)isextremelyvaluableincallingattentiontothesespecialpropertiesanendeavormadeallthemorenecessarybythefrequent
equatingofprinciplessuchasvalidityonlywithnormreferencedmeasurement.
Becauseofgrowingsensitivitytothedemandsforawideningrangeofdescriptivemeasures,adviceaboutconstructionofsuchmeasuresbycliniciansthemselveshas
becomeincreasinglyavailable(e.g.,Miller&Paul,1995Vetter,1988).Providingasuccinctfoundationfortheserecommendations,Vetteroutlinedasystematic
processfordevelopinginformalassessmentprocedures.Inanearlierpublicationoncriterionreferencedmeasures(McCauley,1996),Imodifiedthatprocess
somewhatandhavemodifieditfurtherinFig.10.1throughtheadditionofastepencouragingclinicianstoseekoutexistingprobesforpossibleuseoradaptation.
IntheprocessoutlinedinFig.10.1,thecrucialfirststepistheformulationofthespecificclinicalquestion.Inquestionsofdescription,theclinicianisrelatively
unencumberedbytheexternal,regulatoryforces(e.g.,staterequirements)thataffectboththekindsofclinicalquestionsthatareaskedandthemethodsusedtoanswer
them.However,thatdoeslittletodecrease,andmayevenincrease,theclinicalperspicacityrequiredatthisstep.ThemultiplelevelsofWHOsclassificationsystems
(WHO,1980,1998)comeintoplayinthecomplexityofthisstep.Recallthattheselevels(e.g.,impairment,disorder,disability,andhandicapinthe1980version)
considerthebroadereffectsofhealthconditionsandtherolethatsocietyplaysindeterminingtheimplicationsofagivenconditionfortheindividual.Theselevelsbring
tomindthechallengeofdescribingachildscommunicationintermsofeffectsonthechildsparticipationinsocialroles,aswellasinthespecificsoflexicon,grammar,
andsoforth.Consequently,theclinicianwhowishestodescribeachildscommunicationwillneedtochooseselectivelyfromalargenumberofpossiblelevelsand
areasforwhichdescriptionispossible.Insodoing,thecliniciancanfocusonasmallernumberofclinicalquestionswhoseanswerscanhaveapowerfulimpactonthe
childstreatmentandsubsequentfunctioning.
TheremainingstepsinVettersprocessentailtailoringtheproceduretomeetthedemandsofaspecificclinicalquestionandclient,implementingit,andthenevaluat
Page254
Fig.10.1.Stepsinthedevelopmentofaninformalmeasure.
ingitseffectivenessideallythroughtheaccumulationofdataspanningseveralclients.Thecliniciansreactionstothisevaluativestepintheprocesscaninclude
changinginstructionsorthespecificitemsused,increasingthenumberofitemsusedinordertoincreasereliability,orabandoningtheprocedurealtogether.
Particularlywhenameasurelendsitselftousewithnumerouschildren,additionalstepssuchasamorerigorousevaluationofreliabilityandthedevelopmentoflocal
Page255
normscanbewellworththeadditionaleffort.CirrinandPenner(1992)discussedhowdescriptivemeasurescanbeimplementeddistrictwide.Theirrecommendations
makeuseofmultiplestagestoensurefeasibilityandvalidity.Amongfactorsthattheystressedaretheneedto(a)usepilotprocedureswithasmallnumberofclinicians
priortowidespreaduse,(b)conductinitialtrainingandfollowupsessionsforallusers,and(c)undertakeadistrictwidetrialperiod.CirrinandPennerstressedthe
valueoflocalnormsasameansofimprovingeligibilitydecisions,buttheyalsoacknowledgedtheheavyadministrativedemandsthisentailsintermsofexpertiseand
stafftime.Insodoing,theypointtooneofthechiefchallengesofdescriptivemeasuresmakingtheirconstructionandusefitwithinthesometimesharshdemandsfor
efficiency(especiallytimedemands)facingmostspeechlanguagepathologists.However,itshouldalwaysberememberedthatcuttingcornersbypayingtoomuch
attentiontobeingefficientcanresultinanincompletepictureofachildsproblemthatwillresultinthelongruninfargreaterlossesoftime.Thisissuewillreceive
additionalattentionlaterinthechapterinthesectionentitledPracticalConsiderations.
AvailableTools
Onereasonthatdescriptioncanseemrelativelyperplexingfromameasurementperspectiveisthediversityofavailabletoolsandstrategies.Thisdiversityincludestools
thatarequitestandardized,toolsproposedinformallyinresearchorclinicalpublications,andtoolsthattheclinicianmaydecidetodevelopondemandtoaddressa
specificclinicalquestionforwhichnocommerciallydevelopedalternativeisavailable.Althoughnotexhaustive,arelativelydetailedlistofavailabletypesofsuch
measureshasbeenofferedbyDamicoetal.(1992)languagesampleanalyses,probes,ratingscales,andonlineobservations.Althoughonecanbroadlycategorize
thetoolsandstrategieslistedbyDamicoetal.(1992)asnormreferencedandcriterionreferencedmeasuresfallingatvariouslevelsofstandardization,considering
themingreaterdetailseemswarranted.Consequently,allofthecategoriesdescribedbyDamicoetal.aswellasstandardizednormreferencedmeasuresand
standardizedcriterionreferencedmeasuresarebrieflydiscussedinthissection.
Twoadditionalassessmentstrategiesarealsohighlighteddynamicassessment(GutierrezClellen,Brown,Conboy,&RobinsonZaartu,1998Lidz,1987,Lidz&
Pea,1996)andqualitativemeasures(Olswang&Bain,1994Schwartz&Olswang,1996).Thesetechniquesaresingledoutforspecialattentionbyvirtueoftheir
emergingstatusasinnovativeapproachestodescription.Althoughdynamicassessmenthasreceivedconsiderableattentionintheprofessionalliterature(Butler,1997),
theuseofqualitativemeasuresrepresentsarefinementofclinicalpracticethathasreceivedlessdirectcriticalattention.
1.StandardizedNormReferencedMeasures
Standardizednormreferencedmeasuresarefrequentlyusedtocharacterizeareasofgreaterorlesserdeficitatypeofdescriptionthatinvolveswhatissometimes
termedprofileanalysisordiscrepancyanalysis.Forexample,manycliniciansmakeuseof
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thestructureofavailablenormreferencedtestsinwhichbothreceptiveandexpressiveskillsareexaminedtodeterminetheextentofproblemsineacharea.
Additionally,theymaymakeuseofsubteststructure,whenitisavailable,tofurtherrefinealistofmorespecificstrengthsandchallenges.Forexample,theclinicianmay
noteachildsbetterperformanceonreceptivesubtestswithlongerstimuli(e.g.,listeningtoparagraphs)thanonthosewithshorterstimuli(e.g.,wordclasses).
Inchapter9,problemsinprofileanalysiswerediscussedinrelationtousingprofilesinidentificationdecisions(seethesectiononconductingcomparisonsbetween
scores).Asabriefreprise,theseproblemsrelatetothedifficultyindistinguishingrealdifferencesbetweenscoresfromthoseduetomeasurementerrorortodifferences
innormativegroups.Inaddition,whenmeasuresusedinaprofilearehighlycorrelated,thecomparisonmayofferlittleornonewinformation(Olswang&Bain,1994
Turner,1988).Finally,evendifferencesbetweentestsorsubteststhatarereal(i.e.,arenotduetoerror)andhaveoccurredonmeasuresofindependentskillsmaynot
representdifferencesthatareanygreaterthanthosethatmaybeobservedinnormaldevelopment(Berk,1984Olswang&Bain,1991).Thestrategyofsimply
distinguishingbetweenageappropriateandnonageappropriatefunctioningseemsausefulalternativetomoreelaboratebutproblematicstrategiesofinterpretation
(McCauley&Swisher,1984).Thisstrategyconsistsofmakingdecisionsabouttheadequacyoffunctioninginagivenareaindependently,ratherthaninrelationto
functioninotherareas.
Severaldifficultiesinadditiontothosedescribedinchapter9arisewhennormreferencedtestsareusedtoidentifyadetailedsetofstrengthsandchallengesfor
purposesofdescription.Onedifficultyliesintherelativelysmallnumberofcontentareasforwhichsubtestsareavailable.Lookingonlyatthoseareasforwhich
subtestsdoexistisquiteakintothestoryoftheintoxicatedsoulwholooksunderthelamppostforlostkeys.Turningtononnormreferencedmeasurespresentsa
logical,soberalternativeinmanysuchcases.
Evenwhenasubtestcontainsitemsthatseemperfectlyrelevanttoadescriptionofachildscommunication,however,normreferencedtestscanalsobeused
erroneouslyineffortstoprovidedetailedinformation.Treatingindividualitemsorevensubtestsasreliabledescriptorsislikelytobeerroneousinpartbecauseofthe
unreliabilityofsmallsamplesizes(i.e.,thesmallamountofthechildsbehaviorthatwassampledMcCauley&Swisher,1984).Inaddition,becauseitemsinsuchtests
areusuallyselectedmoreoftenbecausetheydiscriminatebetweenindividualsthanbecauseofthespecificcontenttheyreflect,theycanprovideaspottyrepresentation
ofthespecificcontentarea(McCauley&Swisher,1984).
Inadditiontotheiruseinprofiles,normreferencedtestsareusedinoutofleveltesting,thepracticeofusingatestthatmaynotbeappropriateforaclientofagiven
agetosampleasetofbehaviors.Thisdescriptiveinformationisintendedtohelpdefinewhatanindividualdoesanddoesnotdoinresponsetoastandardtaskandset
ofstimuli.Althoughthispracticeisprobablymostfrequentlyusedwithindividualswithmentalretardation,itcanbeusedatanytimewhenmoreappropriatemeasures
arewanting(Berk,1984).Whenusedinthisway,themeasureistreatedasifitwerecriterionreferenced,withthesamplingofcontentbecomingcriticallyimportantto
itsvalue.Theproblemofsmall,unrepresentativesamplesofbehaviordescribedearlierwillrequirecautiousinterpretationor,moreprobably,asearchforamore
appropriatetool.
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2.StandardizedCriterionReferencedMeasures
Criterionreferencedmeasureshavetraditionallybeenapplaudedfortheirdescriptivepowers.Afterall,theyaregenerallyconstructedtoenableadescriptionofan
individualsknowledgebase,ratherthantofacilitatecomparisonsbetweenindividuals.However,therearerelativelyfewcriterionreferencedmeasuresof
communicationthatdemonstratethesamedegreeofstandardizationseeninnormreferencedtests.Becausecriterionreferencedmeasuresrequiremorecomprehensive
coverageofsmallercontentareas,thedemandforanysinglemeasuremaynotbesufficienttosupportmoreextensivedevelopment.Recallingalsothatinterestinthe
measurementcommunityhasonlylatelyturnedtocriterionreferencing,itiseasytounderstandwhyinformalcriterionreferencedmeasuresabound.Nonetheless,afew
moreelaboratelydevelopedcriterionreferencedmeasuresexist,andmanyareinvariousstagesofdevelopment.
Specifictypesofproceduresusedtocollectdataforcriterionreferencedinterpretationvarysignificantlyandincludeeachofthemeasurementtypesdiscussedinthe
remainderofthischapter.Thedecisiontohighlightstandardizedcriterionreferencedmeasuresinthisseparatesectionwasbasedonadesiretoemphasizethepotential
valueofstrengtheningsuchmeasuresthroughtheadditionalempiricalscrutinythataccompaniestheirformaldevelopment.
Table10.1providesseveralexamplesofcriterionreferencedmeasuresencompassingdiversecommunicationdomainsandmodalities.Theyvaryintheextenttowhich
theyhavebeenstandardized.However,ataminimumtheydemonstrateseveralofthehallmarksofstandardizationforacriterionreferencedinstrument:developmentof
guidelinesforappropriateuse,administrationprocedures,scoringprocedures,andmethodofinterpretation.
3.Probes
Probesinvolvetheuseofstructuredtasksorcontextsintendedtoelicitagivenbehavior(Damicoetal.,1992).Althoughthatdefinitioncanalsoapplytothecontents
ofstandardizedmeasures,thetermprobeismoretypicallyreservedformoreinformalmeasures.Elicitationgreatlyincreasestheprobabilityofobtaininginformation
aboutagivenbehaviorwithinagiventimespan,particularlyforthosebehaviorsthatoccurlessfrequentlyinnaturalconversation.However,elicitationprocedures
representpotentialintrusionsonthenaturalnessoftheelicitedbehavior.Thispotentialmeansthat,insofarasnaturalnessisamajorconcernindescription,theiruse
shouldprimarilybelimitedtobehaviorsthatoccuronlyrarelywithoutelicitation.Inaddition,specialcareshouldbetakenduringtheirconstructiontopreservethe
authenticityofthecommunicationexchangeinwhichtheyareembedded.Whensuchcareisseenasimpractical,theresultingdatamorecloselyresemblea
standardizedtestinminiaturethanadescriptiveproceduremeetingthemoreintensedemandsfornaturalnessofcontextdesirableforthistypeofmeasurementquestion.
Dataobtainedfromprobesarefrequentlyevaluatedbytheclinicianintermsofnumberorpercentagecorrect.(SeethediscussionofobservationalcodesunderOn
LineObservationslaterinthischapter.)
Page258
Table10.1
AListofSomeCriterionReferencedMeasuresAvailablefortheDescriptionofLanguageDisordersinChildren
Reviewedin
Mental Receptive
Measurements and/or
TestName Reference Yearbooks Ages Expressive Phonology Semantics Morphology Syntax Pragmatics
Foster,R.,Giddan,J.J.,&
Assessmentof
Stark,J.(1983).Assessmentof 3yearsto
Childrens
ChildrensLanguage 6years,11 R X X
Language
Comprehension.PaloAlto,CA: months
Comprehension
ConsultingPsychologistsPress.
MillerYoder Miller,J.F.,&Yoder,D.E.
Language (1984).MillerYoderLanguage 4to8
R X X
Comprehen ComprehensionTest.Austin, years
sionTest TX:ProEd.
Blank,M.,Rose,S.A.,&
Preschool Berlin,L.J.(1978).Preschool 2years,9
Language LanguageAssessment monthsto5
R/E X X
Assessment Instrument(PLAI).San years,8
Instrument Antonio,TX:Psychological months
Corporation.
Receptive
Bzoch,K.R.,&League,R.
Expressive
(1991).ReceptiveExpressive 0to3
Emergent R/E X X X X
LanguageTest2.Austin,TX: years
LanguageTest
ProEd.
2
WiigCriterion Wiig,E.(1990).WiigCriterion
Referenced ReferencedInventoryof 4to13
E X X X X
Inventoryof Language.SanAntonio: years
Language PsychologicalCorporation.
Page259
Anextendedexampleinwhichmeasuresvaryinginnaturalnessaredescribedmayhelpreadersseethetradeoffsbetweennaturalness,efficiency,andtheclinicians
controlofvariablesaffectingperformance.Theproceduresinthisexamplederivefromattemptstoexaminephonologicalperformanceonasinglesoundorsound
patterninsomedetailandovertime.Thefirstpartofthisexamplewascreatedin1967,whenElbert,Shelton,andArndtdevelopedtheSoundProductionTask(SPT).
Inthattask,theclientimitatedtheproductionof30to60itemscontainingaparticulartargetsound.SomeitemsontheSPTconsistedofnonsensesyllables,othersof
singlewords,andothersofshortphrasescontainingthesound.TheSPTwasdesignedtoobtainrelativelylargenumbersofobservationsinvaryingphoneticand
linguisticcontexts,whileavoidingrepeated,inappropriateuseofentirenormreferencedtestsoritemsfromthem.
Inastudyofpatternsofacquisitionfor/s/and/r/intreatment,DiedrichandBangert(1980)usedtheSPT,buttheyalsodevisedalessreactiveprocedure,thatis,one
thatwasmorecovertintermsofitsfocusandthuslessapttoelicituncharacteristicallycarefulspeechfromthetestedchild.Forthissecondprocedure,calledthe
TalkingTask(TT),theclinicianengagedina3minuteconversationwiththechildandcovertlynotedthenumberofcorrectproductionsoutofthoseattempted.
AlthoughtheTTrepresentedaninterestinginnovation,itlefttheclinicianatthemercyofchance,inthatinfrequentlyoccurringsoundsmightoccuronlyafewtimes
duringthe3minutesamplesomethingthatmightbeaddressedbydefiningthesamplelengthintermsofacertainnumberofattempts,ratherthanintermsoftime.
In1981,Secorddevelopedasetoftasks,theClinicalProbesofArticulationConsistency(CPAC),recentlyreplacedbytheSecordContextualArticulation
Tests(SCATSecord&Shine,1997),whichbearssomerelationshiptoeachoftheseprevioustwotasks.IntheSCAT,probesforeachconsonant/r/andvocalic/
/areelicitedinprevocalicandpostvocalicpositions,aswellasinclustersinimitationsofsinglewords,shortphrases,andsentencesaswellasindelayedretellings
ofastorycontainingmanywordswiththetargetsound.Thus,thissetofprobescanefficientlyhelptheclinicianconsiderthepossibleeffectsoflinguisticcomplexity
(singleword,sentence,narrativecontexts)andphoneticcontext(postvocalic,prevocalic,andclustercontexts).However,naturalnessissomewhatreducedinastory
retellingformatandisreducedstillfurtherinimitation.Thesekindsoftradeoffsaboundintheconstructionofprobes,makingthesharingofsuccessfulcreationswith
colleaguesasubstantialandtimesavingcontribution.
InabookentitledAssessingchildrenssyntax(McDaniel,McKee,&Cairns,1996),avarietyofelicitationstrategiesforbothcomprehensionandproductionare
discussedindetailbyresearcherswhohaveconsiderableexperienceintheirapplication.Table10.2listsanumberoftheseelicitationstrategies.Thedescriptionsof
thesestrategiesrevealthecommontechniquesavailabletobothprofessionaltestauthorsandclinicianswishingtoconstructasyntacticprobeforaparticularclient.
Informalprobeshavealsobeendevelopedtoexaminepragmaticskillsanareainwhichthereisadearthofstandardizedmeasures(Lund&Duchan,1993).For
example,Lucas,Weiss,andHall(1993)describedthedevelopmentofaprobedesignedtoexaminetheextenttowhichchildrenwithcommunicationdisordersare
sufficiently
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Table10.2
ElicitationStrategiesforAssessingtheComprehensionandProductionofSyntaxinChildren
Production
lStrengths:Youcanchoosestimuliverypreciselyandknow
whatthechildisattemptingtosay.Studiesshowgoodagreement
withcomprehensionandotherdata.Thetechniqueisapplicable
Thechildisaskedtorepeatanutterance(usuallyasingle
withsmallchangesforchildrenfromawiderangeofculturesand
sentence)exactlyasproducedbyanadult.Itisassumedthatonly
Elicitedimitation(Lust,Flynn, languagesandcanbeusedatrelativelylowdevelopmentallevels.
structuresreflectingthechildsgrammaticalcompetencewillbe
&Foley,1996) Weaknesses:Stimulusdesigniscomplexduetotheneedto
produced.Aneasytechnique,evenforchildrenasyoungas1or l
controlvariablesthatarenotofdirectinterest(e.g.,cognitive
2.
demand,attention,grammaticalcomplexity,sentencelength).The
techniquehasbeencriticizedforrelyingundulyonshortterm
memory.
l Strengths:Generationofthetargetedstructurerestsmore
entirelywiththechildandisunlikelytobeduetochance.Alarge
numberofsuchprobeshavebeendescribedintheresearch
Situationsarecreatedtoincreasethelikelihoodthatthechildwill
literature.
attempttoproduceagivenstructure,usuallyincludingtheuseofa
Weaknesses:Thechildsenjoymentleveliskeytothesuccess
leadinsentencethatisproducedbytheadulttoprovidethe l
ofthestrategybecausesheorheneedstobeanactive
Elicitedproduction(Thorton, contextandingredientsforproductionofthestructurewithout
participant.Theawkwardnessassociatedwithanoresponse
1996) modelingit.Sometimesthistechniquemakesuseofapuppet
fromthechildmaybeintensifiedrelativetoothermethodsand
whocanbeaskedquestions,directedtodothings,orcorrected.
maymakechildrenlesswillingtocontinue.Workingoutthe
Typicallyusedwithnormallydevelopingchildren3yearsand
detailsrequiredtoelicitproductionmayrequireconsiderable
older.
pilotingwithadultsornormallydevelopingchildren.Similarly,
correctproductionsarefarmorestraightforwardlyinterpreted
thanincorrectoruntargetedproductions.
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Thechildisseatedonaparentslap,hearsastimulusandthenis l Strengths:Minimalactionisrequired.Useofvideosallowsthe
presentedsimultaneouslywithtwonovelvideoimagesone presentationofdynamicrelationships.Canbeusedatlower
Comprehensionintermodal
matchingandtheothernotmatchingwhathasbeensaid.Greater developmentallevelsthanmanyothertasks.
preferentiallooking(Hirsh
timespentwatchingthematchingvideoisexpectedfor l Weaknesses:Considerabletimeandexpertisearerequiredto
Pasek&Golinkoff,1996)
comprehendedstructures.Usedforchildrenbetween12months createthevideostimuli.Onlyafewstimulicanbestudiedatany
and4yearsofage. pointintime.
Strengths:Thistechniquehasbeenwidelyusedtoassess
l
understandingorgrammaticalityofspecificphonological
distinctions,lexicalcomprehensionorcomprehensionofspecific
Thechildhearstheadultorarecordedvoicepresentingaverbal morphosyntacticstructure.Ittendstoproduceresults
Pictureselectiontask(Gerken stimulusandthenpointstooneoftwotofourpictures.Typically comparabletoobjectselectionwhereeithertaskisfeasible.
&Shady,1996). thistaskisusefulwithnormallydevelopingchildren20to24 l Weaknesses:Considerabletimecanberequiredtoproduce
monthsandolder. comparabletargetandfoilitems.Althoughuseoftaperecorded
speechorsyntheticspeechcanhelpincreasechildrensattention,
itincreasesthecomplexityoftaskconstruction.Failuresto
respondaredifficulttointerpret.
Strengths:Thetaskhasalonghistoryofuseandiseasyand
l
inexpensivetouse.Itcanbefunforthechildandcanbe
particularlyeffectiveinassessingunderstandingofanaphoraand
pronominalization.Itisrelativelyopenendedtaskthatmaybe
lesssensitivetoresponsebiasthanmanyothers,yetmaybe
Thechildisaskedtouseprovidedpropstoactoutasentence associatedwithatendencytorepeatedlyuseaproponceitis
ActingOutTasks(Goodluck,
thatisreadorplayedbackfromtape.Typicallyusedforchildren pickedup.
1996)
olderthan3years. l Weaknesses:Itcannotbeusedwithconstructionsor
predicatesthataredifficulttoactoutandcanbeassociatedwith
responsesthataredifficulttointerpret.Becauseofthecognitive
complexityofthetask,ittypicallyisusedfornormallydeveloping
childrenolderthan3years,thuslimitingusewithchildrenwith
languagedifficulties.
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informativeintheirutterancesastheyparticipateinaroleplayinggame.Thechildisassignedtheroleofwarehousemanagerandisapproachedbythecliniciantoy
buyerandaskedwheredifferenttoysmightbefoundinthewarehouse.Inasimilarvein,Roeper,deVilliers,anddeVilliers(1999)recentlydescribedtheirongoing
effortstodesignanextensivenumberofprobesforassessingimportantinteractingknowledgeinpragmatics,semantics,andsyntaxfor5yearoldsforexample,the
needtoknowspecificsemanticandsyntacticformstoachieveparticularpragmaticfunctions.Elaboratelydevelopedintermsofthematerials,instructions,andscoring
procedures,boththeprobesdevelopedbyLucasetal.andthosedevelopedbyRoeperetal.illustratethatameasuresformalityisbetterconceivedofasacontinuum
thanadichotomy.Further,thethoroughdescriptionoftheprobesofferedbyLucasetal.illustratetheextenttowhichsharingtheresultsofwelldevelopedprobescan
increasetheefficiencyofcliniciansefforts.
Professionaljournalsandagrowingnumberofbooksonlanguagedevelopmentanddisordersdescribenumerousclinicalandresearchprobes(e.g.,Brinton&Fujiki,
1992Lund&Duchan,1993Miller,1981Miller&Paul,1995Simon,1984).Table10.3showcasesamodestsampleoftheseprobesforchildrenacrossawide
rangeofagesanddevelopmentallevels.Itisofferedtohelpprovideafeelfortheheterogeneityandconsiderablepotentialofsuchmeasures.
4.RatingScales
Ratingscalesconsistofassigningnumeralsorlabelstoanindividualsbehaviorinaparticularcontext.Ratingscalesaretypicallycompletedbytheclinicianorother
observeraftertheobservationofindividualcommunicationevents.Attimes,suchscalescanbeusedtohelpobserverssummarizetheirexperienceacrossmultiple
observationexperiences.Ratingscalesdifferfromonlineobservations,anothertypeofdescriptivemeasure,inthatonlinejudgementsaremadeduringratherthan
aftertheactualcommunicativeevent.
Ratingscaleshavealengthyhistoryinpsychologyandspeechlanguagepathology(e.g.,seeSchiavetti,1992),butprimarilyinresearchratherthanclinicalsettings(e.g.,
Burroughs&Tomblin,1990Campbell&Dollaghan,1992).However,increasingattentiontothedocumentationofchildrensfunctionallimitations(Goldstein&
Gierut,1998)maycauseratingscalestobeusedwithgreaterfrequencyinthefuture.
Twotypesofratingscalesthathavebeenmostinfluentialinspeechlanguagepathologyareintervalscalinganddirectmagnitudeestimation(Campbell&Dollaghan,
1992Schiavetti,1992).Theseratingscalesareusuallyusedtocomparealargenumberofstimulusexamplessomethingthatisnotalwaysdonewithratingscales.
Whenintervalscalingisused,theraterassignseachcharacteristicorbehaviorbeingratedtoalinearlypartitionedcontinuum,whichismarkedoffusingnumeralsor
descriptivelabels.Thus,forexample,aratermightbeaskedtorateabehavioronacontinuumfromuncommontomostcommon,usinga6or7pointscalethatmight
looksomethinglikethis:
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orthis:
Whendirectmagnitudeestimationisused,theraterisaskedtorateeachcharacteristicorbehavioreitherasaproportionofastandardstimulusprovidedaspartof
theratingsystemorasaproportionofotherratedstimuli.Thus,forexample,Camp
Table10.3
ASampleofProbesUsedintheDescriptionofChildrensLanguage
ApproximateAgeofChildfor
WhomtheTaskCouldBe
Used
Procedure(Source) (IfSpecified) Description
Childisaskedtoperformactionsthatthechildsparent(s)believesheorshemayunderstandon
Comprehensionofactionwords
12to24months familiarobjectsandpeople.Unconventionalactionsmayberequestedtohelpdistinguishaction
(Miller&Paul,1995)
unconnectedtotherequestfromintentionalresponses.
Bellugisnegationtest(Miller, Thechildisaskedtoprovidethenegativeofanutteranceproducedbyanadult.Variationscan
1981) includedifferentauxiliaries,negativewithindefinites,imperatives,andmultipropositionalsentences.
Productionofquestionforms TheMessengerGame.Thechildisaskedtogetinformationfromathirdparty,ideallyonewhois
(Lund&Duchan,1993) outofview.Forexample,Askherhowshegottothisschool?
Comprehensionofnonliteral
meaning(Lund&Duchan, Earlyadolescence Jokeexplanations.Thechildisaskedtoexplainajokethatheorshefindshumorous.
1993)
Comprehensionofclassroom
Classroomdirectionsandvocabularythatarethoughttobedifficultforthechildareincorporated
directionvocabulary(Miller& 6to12years
ininstructionsthatthechildmustfollowusingpaperandpencil.
Paul,1995)
Productionofsequential MiddleandHighschool Descriptionforusingapayphone.Childisshownapictureofapayphoneandaskedtogiveastep
description(Simon,1984) students bystepdescriptionofhowitisused.
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bellandDollaghan(1992)describedamethodinwhichnostandardstimulusisprovided.Intheirstudy,listenerswereinstructedtoassignanynumberoftheirchoiceto
thefirstof36speechsamplestheywereaskedtorate.Latersampleswerethenratedsubjectivelyonthebasesof(a)theirproportionalinformativenessrelativetothe
otherjudgmentsmadeinthesampleand(b)theunderstandingthathighernumbersweretobeassociatedwithgreaterinformativenessthanlowernumbers.
TheObservationalRatingScalesthatareincludedaspartofthethirdeditionoftheClinicalEvaluationofLanguageFundamentals(Semel,Wiig,&Secord,1996)
provideanexampleofhowaratingscalecanbeusedtoenrichthecliniciansunderstandingoftheschoolagechildandhisorhercommunicationenvironment.They
arementionedherebecauseoftherelativedearthofsuchscalesforschoolagechildren,althoughtheyarebecomingmorecommonforexample,theFunctional
StatusMeasures(EducationalSettings)ofthePediatricTreatmentOutcomesForm(ASHA,1995)andtheTeacherAssessmentofStudentCommunicative
Competence(Smith,McCauley,&Guitar,inpress).Inaddition,theObservationalRatingScalesareofparticularinterestbecauseoftheirnovelinclusionofparallel
ratingformssothatcomparableinformationcanbeobtainedfromthechild,hisparent(s)andteacher(s).Theyrepresentanexampleoftheintervalscalingmethod,one
inwhichindividualsareaskedtorespondinasummativefashiontopastobservations.
EachscaleoftheObservationalRatingScalesconsistsof40itemsaddressingtroublesfacingthechildinlistening(9items),speaking(19items),reading(6items),
andwriting(6items).Toillustratethenatureoftheseitems,letmeindicatethatthefirstlisteningitemisIhavetroublepayingattentionforthestudentversion(often
completedwiththespeechlanguagepathologist)MychildhastroublepayingattentionfortheparentversionandThestudenthastroublepayingattentionforthe
teacherversion.Eachitemisratedasoccurringnever,sometimes,often,oralways,withDK(Dontknow)usedtomarkitemsforwhichtheraterfeelsunabletopass
judgment.TheObservationalRatingScalesalsodescribeproceduresfortheobserverstoidentifyandprovideexamplesoftheirtopfiveconcerns,thuspavingtheway
forfunctionallyorientedinterventionplanning.
Thechiefappealsofratingscalesaretheapparenteasewithwhichtheycanbecreatedandadministered,aswellastheirwideapplicability(Pedhazur&Schmelkin,
1991Salvia&Ysseldyke,1998).Thesevirtues,however,maymasktheirsusceptibilitytoanumberofproblems,especiallyonesstemmingfrompoorlydefinedpoints
alonganintervalscaleandfromdifferencesintroducedbydifferentraters.Inabriefreviewofsuchmeasurementissuesfacingratingscales,PedhazurandSchmelkin
(1991)concludedthatratingsmayoftentellmoreabouttheratersthanabouttheobjectstheyrate(p.121).Theycitedarichliteratureinwhichtheperceptual
aspectsoftheratingtaskmakeratersvulnerabletoanumberoftypesofbias.Twocommontypesofbiasincludehaloeffects,inwhichratersallowimpressionsof
generalcharacteristicsorpreviousknowledgetohaveaconsistenteffectonratings,andleniencyeffects,inwhichoverlypositivejudgmentsappeartooccurbecause
theraterisfamiliarwiththepersonwhosecharacteristicsarebeingrated(Primavera,Allison,&Alfonso,1996).
Anadditionalchallengetovaliduseofratingscalesliesintheneedtoachieveasuccessfulfitbetweenthenatureofthecharacteristicbeingratedandthetypeofscal
Page265
ingmethodusedtorateit(Campbell&Dollaghan,1992Schiavetti,1992).Inparticular,researchershavenotedadifferenceinwhatkindofscaleisappropriate
dependingonwhethertheratedcharacteristicfallsalongametatheticversusaprotheticcontinuum.Onametatheticcontinuum,ratersresponsestodifferences
betweenratedentitiesseemtoreflectqualitativedistinctionswhereasonaprotheticcontinuum,ratersresponsestodifferencesbetweenratedentitiesappearto
reflectquantitativedistinctions(Stevens,1975).Theclassiccontrastivepairillustratingthesetwotypesofcontinuumarepitchandloudness.Withoutlookingaheadto
thenextparagraph,canyouanticipatewhichofthosetwocharacteristicsofsoundisprothetic(i.e.,characterizedbyquantitativeratherthanqualitativedifferences)?
Ifyoudecidedthatloudnesswasprothetic,youareinagreementwithalargebodyofresearchsuggestingthatpeopletendtotreatjudgmentssuchasloudnessasif
theywerejudgementsaboutwhetherastimulushadmoreorlessofsomething(Stevens,1975).Incontrast,pitchdifferencestendtobejudgedasiftheyrepresent
qualitativelydifferentstimuli.Well,thechallengetodevisingappropriateratingscalesisthatwhereasdirectmagnitudeestimationcanvalidlybeusedtomeasureeither
typeofcharacteristic,intervalscalingappearstoonlybevalidformeasuringcharacteristicsthataremetathetic.
CampbellandDollaghan(1992)suggestedthatbecauseofthelackofresearchdeterminingwhichlanguagecharacteristicsaremetatheticversusprothetic,direct
magnitudeestimationisalessriskychoiceforresearchersandclinicianswhowishtouseratingscalesintheirdescriptionsofchildrenslanguagedisorders.Theynoted
thatdirectmagnitudeestimationcanbeusedtoprovideacomparisonofchildrensspontaneouslyproducedlanguageagainstthatoftheirpeers.Amongthemost
importantusestheysawforsuchjudgmentsweretheexaminationofchangeoccurringasresultoforintheabsenceoftreatment.Inparticular,CampbellandDollaghan
describedamethodinwhich10to15listenerscouldbeusedtoprovideratingswithastablepercentageofvariability.
Specifically,CampbellandDollaghan(1992)had13listenerscomparetheinformativenessamountofverbalinformationconveyedbyaspeakerduringaspecified
periodofspontaneouslanguageproduction(p.50)achievedbythreechildrenwhohadsustainedseverebraininjurywiththreeagematchedcontrols,whenboth
setsofchildrenwereengagedinavideonarrationtask(Dollaghan,Campbell,&Tomlin:1990).(Recallthattheparticularsofthedirectestimationmethodinvolvedin
thisstudyweredescribedearlierinthechapterwhenthatratingmethodwasintroduced.)Theuseofthistechniqueprovidedsocialvalidationtotherecoverypatterns
shownbythe3childrenwithbraininjurywhoparticipatedinthestudy.Therelativelylargenumberofratersrequiredforuseofdirectmagnitudeestimationmay
precludeitsuseinmanyclinicalsituations.However,itmayprovevaluableasameansofvalidatingmoreefficientmethodsofsocialvalidation.Inaddition,itmayprove
valuableasamethodthatcouldprovideexactlytheinformationrequiredforcertainclinicalsituations.Forexample,itmightbeusedasdescribedbyCampbelland
Dollaghantosupporttoarelativelycostlyorlengthytreatmentapproachforagivenchildorgroupofsimilarchildren.
Notsurprisingly,then,itappearsthattheuseofratingscalesasadescriptivemeasurementtool,likeothersdiscussedinthissection,hasagreatercomplexitythanmight
Page266
atfirstbeapparent.Thus,wiseuserswillrequireasmuchevidenceregardingvalidityaspossibleforspecificmethodspriortodecidingtoimplementthemclinically.
Furtherevidenceoftheirpromiseshouldpromptuserstowanttoparticipateinprovidingsuchevidence.
5.LanguageAnalysis
Languagesamplingandanalysishaveenjoyedalonghistoryofuseinstudiesofchildrenslanguageacquisition(e.g.,Brown,1973Miller,1981Templin,1957).The
varietyofproceduresrecommendedforelicitationoflanguagesamplesandforthederivationofmeasuresbasedonthemhasgrownappreciablyoverthepast40years
andhaschangedasunderstandingsofthenatureoflanguageimpairmentshavechanged(Evans,1996aGavin,Klee,&Membrino,1993Miller,1996Stromswold,
1996).
Inastudyofsome253Americanspeechlanguagepathologistswhoworkwithpreschoolchildren,KempandKlee(1997)foundthat85%ofthemusedlanguage
analysisintheirpractice,withmostpreferringnonstandardizedformstoformalprocedures.Languageanalysesaresometimesavoidedbyclinicianswhoreportthatthey
donothavethetimetoincorporatethemintopracticeorthattheylackthecomputerresourcesthatwouldmaketheirusemoretimeefficient(Kemp&Klee,1997).
However,theseobjectionsarerapidlybeingaddressedbytherefinementandproliferationofcomputerizedanalysisprograms(Long,1999).Innovationssuchas
transcriptionlaboratoriesstaffedbynonprofessionaltranscribers,thecreationofdatabasesreportingfindingsforlargenumbersofchildren,andtheavailabilityof
analysisproceduresatnocostalsopointtogreaterpracticalityoflanguageanalysisinthefuture(Evans&Miller,1999Miller,1996Long,personalcommunication,
January7,2000Miller,Freiberg,Rolland,&Reeves,1992).
Amongthenumerousdiscussionsextollingthevirtuesoflanguagesamplingandanalysis,EvansandMiller(1999)offeredonethatisparticularlypowerful:
Thelanguagesample,bycontrast[withavailablestandardizedtools],representsthechildsintegrationofspecificinterventiongoalswithinthelargercommunication
contextandprovidesclinicianswithanopportunitytoassesschildrenslanguageskillsdynamicallyacrossarangeofsituationsthatvaryincommunicativedemand(e.g.,
freeplay,interview,narration,picturedescription).Languagesamplescanbecollectedasoftenasnecessarywithoutperformancebias,andchangesinchildrens
abilitiescanbedocumentedacrossawiderangeoflinguisticlevels.(Evans&Miller,1999,pp.101102)
Additionally,suchanalysescanexaminenotonlymanyaspectsoflanguage,butcanalsobeusedtoexaminehowcomplexityinoneareamayimpactanotheratheme
ofgrowinginterestintheevolutionoflanguageassessmenttools.Althoughlanguageanalysesaretypicallyusedtoassessaspectsofexpressivecommunication,theyare
alsofrequentlyusedasameansofexaminingreceptiveskills.Inparticular,itseemsthatchildrensresponsestothedirectionandcommentsoftheirconversational
partnersprovidedatathatarevaluedbymanyclinicians(Beck,1996).Inthenextsection,theevolution
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oflanguagesamplingandanalysisisdescribedtohelpreadersunderstandthevarietyofavailablemeasuresandhowthesemeasureshavechangedovertime.
TheEvolutionofLanguageAnalyses
In1996a,Evansreviewedthechangesinemphasisinlanguagesamplingtechniquesthathaveaccompaniedchangesintheoreticalperspectivesonlanguage
developmentandlanguagedisorders.Inparticular,shediscussedtheinfluenceofthreedominantresearchparadigmsspanningthepasthalfcentury:(a)thebehaviorist
learningparadigm,(b)theformalistcompetencebasedparadigm(encompassinggenerativesyntax,generativesemantics,andanarrowinterpretationofsyntax,
Evans,1996a,p.208)and(3)thefunctionalistparadigm.Abriefsummaryofhercommentsisrelevanttoanyoneusinglanguageanalysisbecausesomanyofthe
measuresassociatedwithearlierparadigmsremainavailableandinwidespreadusesometimesinrevisedversionsandsometimesintheiroriginalform(Kemp&
Klee,1997).
Intheheydayofthebehavioristlearningparadigm,therolesoftheenvironmentonlearningandthewordastheunitofanalysiswereemphasized.Languageacquisition
wasunderstoodtooccurthroughthereinforcementofcorrectuseofwordsandsentences(wordsequences).Althoughstandardizedlanguagetests(e.g.,thePeabody
PictureVocabularyTest,IllinoisTestofPsycholinguisticAbilities)dominatedlanguageassessmentmethodsduringthisperiod,languageanalysistechniqueswere
usedaswellandemphasizedcountsordescriptionsofdifferentverbalbehaviors(e.g.,typetokenratio,measuresofsentencelength).
ThesecondparadigmdiscussedbyEvans(1996a),theformalistcompetencebasedparadigm,wasdesignedtoaddressthegenerativityofchildrenslanguage,thatis,
theuseofnovelandthereforeunmodeledandpresumablyunreinforcedutterances(e.g.,overregularizationofpasttense,asinhegoed.).AsEvansnotes,this
paradigmwasmadepossiblebylinguistictheoryoftheday(particularlytheworkofChomsky),inwhichamajorgoaloflinguistsbecametheidentificationoflanguage
independentcompetencies,termedlinguisticuniversals.Suchuniversalswerethoughttosuggestfeaturesoflanguagesandlinguisticstructurethatwerelikelytooccur
inalllanguages.
Evans(1996a)suggestedthatinitialorientationswithintheformalistparadigmwerelargelysyntacticinnatureandproceededontheassumptionthatdomainsof
languagesyntax,semantics,andsoforthcouldbeviewedindependently.Anassumptionwasalsomadethatvariabilityinperformancewasmorelikelytobea
functionofachildsknowledgethanafunctionofcontextualfactors.AccordingtoEvanssaccount,laterdevelopmentsinthisparadigm,fueledbytheoryanddata
fromavarietyofsources,shiftedthefocussomewhatfirsttosemantics,thentopragmatics.Evanspointedoutthatlanguageanalysesassociatedwiththeformalist
periodsimilarlyshifted,althoughsometimessubtly,fromlargelysyntacticmeasures(e.g.,DevelopmentalSentenceScoring,DSSLanguageSampling,Analysis,and
Training,LSATandLanguageAssessmentRemediationandScreeningProcedure,LARSP)tomeasuresfocusingonsemantics(e.g.,meanlengthofutterancein
morphemes,MLUm)and,later,onpragmatics(e.g.,Roth&Spekman,1984).
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Evans(1996a)notedthat,throughoutthisperiod,thechildstaskinlanguageacquisitionwaslargelyseenasthatofacquiringcompetenceintheunderlyingrulesofthe
ambientlanguage.Predictably,then,childhoodlanguagedisorderswithinthisparadigmwereseenasdifficultiesinacquiringtherulesoftheindividualsubsystemsof
language.InEvanssview,languageassessmentshavethusgrownthroughaccretiontorequireelaborateanalysesacrosssemantics,syntax,andpragmaticsaprocess
thathasbeenmademorefeasiblethroughmoderntechnology.AmongtheanalysessheassociateswiththisperiodaretheSystematicAnalysisofLanguageTranscripts
(SALTMiller&Chapman,1982,1998)andtheChildLanguageAnalysisprograms(CLANMacWhinney,1991).
Evans(1996a)suggestedthatfunctionaltheories,thelastofthethreeparadigms,werepromptedbydifficultiesinaccountingforchildrensvariabilityacrosscontexts.If
ruleacquisitioniswhatistakingplace,thenaformevidencingthatruleshouldeitherbepresentornotpresentinachildsproductionsnotpresentinsomesituations,
butnotothers,withsomeconversationalpartners,butnotothers.ThefunctionalistparadigmisreflectedinworkssuchasBatesandMacWhinney(1989).According
toEvans,itisbasedonthefollowingpremise:
Variabilityinspeakerperformanceissimplythefinalsolutiontotheinteractionamongtheinternalstateofacomplexsystem(i.e.,theunderlyingspeakercompetence),
thestructureofthesystem(e.g.,wordorder,lexicalitems,morphonology,suprasegmentals),andtheimpactofexternalconstraintssuchasrealtimelanguage
processingdemands.(Evans,1996a,p.254)
Withinthefunctionalistparadigm,then,variabilitybecomesamajorsourceofinformationaboutthecurrentstateofachildsdynamicsystem(linguisticand
nonlinguistic)asitrespondstoexternalconditions(e.g.,situationalorattentionalfactors).Increasedvariabilityisseenasanopportunityforpositivechange.Inaddition,
thisparadigmemphasizesthenecessityofexaminingtheinterplayoflanguagedomains,anareaidentifiedbynumerousauthorsasamongthemostexcitingchallenges
facingcliniciansthisdecade(Howard,Hartley,&Muller,1995).
Evans(1996b)providedanexampleofsuchinteractionswhenshefoundfewermorphosyntacticomissionsinthespeechofchildrenwithSLIwhentheirutterances
occurredwithinaconversationalturnratherthanadjacenttoashiftinconversationalturn.Numerousstudiesbeyondthosejustcited(e.g.,Crystal,1987Panagos&
Prelock,1982Paul&Shriberg,1982)arguedthatrichandpowerfulunderstandingsofchildrensspeechandlanguagedevelopmentemergefromthekindsofdetailed
analysescalledforbycurrenttheory.
Certainlyoneofthemajoradvantagesoflanguagesampling,then,isthevarietyofquestionstowhichtheresultingsamplecanbeput.Forexample,Dollaghanand
Campbell(1992)describedataxonomyofwithinutterancedisruptionsarisingfromlanguageratherthanfluencydisorderstohelpcharacterizethesubtledeficitslying
acrosslanguagedomainsthatplagueyoungspeakerswithlanguagedisorders,bothdevelopmentalandacquired.
Table10.4listssomeofthestandardizedmeasurescurrentlyusedtodescribechildrenslanguageskillsbasedonlanguagesamples.Inthistable,avarietyofinforma
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Table10.4
ToolsAvailableforDetailedAnalysesofLanguageSamples
(Evans,1996aLong,1999Owens,1998)
Assigningstructuralstage(Miller,1981) Morphology,Syntax
Communicationanalyzer(Finnerty,1991) Morphology,Syntax
ComputerizedLanguageAssessment,Remediation,andScreeningProcedure(LARSPBishop,1985) Morphology,Syntax
Computerizedprofilingversions6.2and1.0(Long&Fey,1989) Morphology,Syntax,Narrative
Computerizedlanguageanalysis(CLANMacWhinney,1991) Morphology,Syntax,Narrative
Computerizedlanguageerroranalysisreport(CLEARBakervandenGoorbergh,1990) Morphology,Syntax,Pragmatics
Computerizedprofiling(CPLong,Fey&Channell,1998) Morphology,Syntax
Developmentalsentencescoring(DSS)ComputerProgram(Hixson,1985) Morphology,Syntax
Semantics,Morphology,
Content,form,anduseanalysis(Lahey,1988)
Syntax,andPragmatics
IndexofProductiveSyntax(IPSynScarborough,1990) Morphology,Syntax
Languageassessment,remediation,andscreeningprocedure(LARSP:,Crystal,Fletcher,&Garman,1989) Morphology,Syntax
Languagesampling,analysis,andtraining(LSATTyack&Gottsleben,1974) Morphology,Syntax
Lingquest(Mordecai,Palin,&Palmer,1985) Morphology,Syntax
Parrotearlylanguagesampleanalysis(PELSAWeiner,1988) Morphology,Syntax
Profileinsemanticsgrammar(PRISMGCrystal,1982) Semantics
Profileinsemanticslexicon(PRISMLCrystal,1982) Morphology
Pyeanalysisoflanguage(PALPye,1987) Morphology,Syntax
Systematicanalysisoflanguagetranscripts(SALTMiller&Chapman,1998) Morphology,Syntax,Narrative
tionabouttheprocedureandchildrenforwhomitwouldbeusefulareprovided.Inaddition,thoseproceduresthatareavailableoncomputerareindicated.Recently,
oneofthesecomputerizedprograms,CP(Long,Fey&Channell,1998)hasbeenmadeavailablewithoutchargeatthefollowingInternetwebsite:
http://www.cwru.edu/artsci/cosi/cp.htm(Long,January7,2000,personalcommunication).
Readersareremindedthatcomputerizedmeasuresshouldbeviewedhopefully(Long,1991,1999Long&Masterson,1993),butwithcautionaswell(Cochran&
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Masterson,1995).Afterall,computersrenderitpossibletoconductlanguageanalysesthatwouldbeprohibitivelytimeconsumingifperformedbyhand,buttheyalso
makeitpossibletomakereallysillyorwrongheadedmistakesmorequicklythaneverforexample,tousethewronganalysisforaparticularchild.Theuserofsuch
measuresmustexerciseasmuchcautionaseverinselectingthespecificsampletobeusedasinputandinbuyingintothespecifictechniquesused.Further,one
shouldrecognizethatalthoughlanguagesamplesarenaturalinthesensethattheyareoftennotconsciouslystructuredbytheclinician,theyarenonethelesssubjectto
thesamecontextualeffectsthataffectnormreferencedtestperformance(Plante,February18,2000,personalcommunication).Agrowingliteratureonthesubjectof
languageanalysescanhelpcliniciansdeterminewhatisavailableandlikelytobeusefulfortheirclients(Cochran,&Masterson,1995Long,1991,1999Long&
Masterson,1993).
Althoughadetailedaccountofevenasingleanalysistoolisbeyondthescopeofthisbook,asummaryofsomerecentresearchmayhelpthereaderseethewealthof
informationobtainablethroughlanguageanalysis.Table10.5listssomepatternsofdisorderedlanguageperformancethatcanbedescribedusingtheSALT(Miller,
1996).MillerandKlee(1995)usedthesecategoriestocharacterizeproblemsof256childrenfromages2years,9monthsto13years,8months.Thedatawere
basedonconversationalandnarrativesamples,contextsthatwereselectedbecauseofthewealthofresearchontheformerandtheimportantconnectiontoliteracyof
thelatter(Miller,1996).MillerandKlee(1995)foundsignificantnumbersofchildrenatvaryingagesfallinginoneormorecategories,withonly20childrennot
describedbyanycategory.
Forpreschoolchildren,oneveryspecificmeasurethathasremainedinuseinarelativelyconsistentformacrosstheparadigmsdescribedbyEvanshasbeentheMLU,
measuredinmorphemes.GuidelinesforthecalculationofMLUasdescribedChapman(1981)areshowninTable10.6.MLUisregularlyusedclinically(Kemp&
Klee,1997Miller,1996)andhasbeenincorporatedinseveraloftheproceduresdescribedinTable10.4,includingSALT.Itsuseisbasedonthepremisethat,at
leastinyoungerchildren,increasingsyntacticcomplexitywillalsorequireincreasingutterancelengthespeciallywhenlengthismeasuredinmorphemesandtherefore
wouldbesensitivetoincreasesineitherwordsorgrammaticalorderivationalmorphemes.
NumerousstudieslendcredencetothevalueofMLUindescribinglanguagechangethroughthepreschoolyears(Conant,1987Rondal,Ghiotto,Bredart,&
Bachelet,1988Scarborough,Wyckoff,&Davidson,1986).In1993,Blake,Quartaro,andOnoratifoundevidencethatMLUcorrelatedhighlywithameasureof
grammaticalcomplexityobtainedusingtheLARSPuntilanMLUof4.5wasreached.FindingssuchasthesehaveprovidedconsiderablesupportforMLUs
widespreaduseinresearchasameansofgroupingchildrenaccordingtolanguageskill(Miller,1996),buttheappropriatenessofMLUdependsontheprecisefocus
ofthestudy.1Recentresearch(e.g.,Aram,Morris,&Hall,1993)hasalsosuggestedthediagnosticutility
1Leonard(1996)describedseveralalternativemeasuresforequatingresearchgroupsthatwillbemoreappropriateincertaincircumstances,includingmeannumberof
argumentsexpressedperutterance,meannumberofopenclasswordsperutterance,measuresofunstressedsyllableproductionorwordfinalconsonantproduction,
andexpressivevocabulary.
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Table10.5
AClinicalTypologyofDisorderedLanguagePerformance
BasedonUseoftheSALT
Clinicaltypes Characteristics
Utteranceformulation MazerevisionsatwordandphraselevelunitsincreasedMLUpauseswithinandbetweenutteranceswordordererrors
Wordfinding Mazerevisionsandrepetitionsatwordandpartwordlevelunitspauseswithinutteranceswordomissionswordchoiceerrors
Hypoverbalrate Decreasednumberofutterancesandwordsperminutepauseswithinandbetweenutterances
Hyperverbalrate Increasednumberofutterancesandwordsperminute,whichmaybecombinedwithreducedsemanticcontent
Noncontingentutterancespronominalreferenceerrorsproblemswithtopicmaintenance,newversusoldinformation,andnarrative
Pragmaticordiscourse
structure
Semanticorreference Overgeneralization,wordchoice,andNounPhraseVerbPhrasesymmetryerrorsabandonedutterancesredundancy
DecreasednumberofdifferentwordsandtotalnumberofwordsdelayedsyntacticdevelopmentasmeasuredinMLUandother
Delayeddevelopment
detailedsyntacticanalyses
Note.SALT=SystematicAnalysisofLanguageTranscriptsMLU=meanlengthofutteranceNPVP=n.FromProgressinAssessing,Describing,andDefining
ChildLanguageDisorder,byJ.Miller,1996,inK.N.Cole,P.S.Dale,andD.J.Thal(Eds.),AssessmentofCommunicationandLanguage(p.319),Baltimore:
BrookesPublishing.Copyright1996byBrookesPublishing.Reprintedwithpermission.inclinicalsettings,particularlywhereproductiondifficultiesareprominent
featuresofthechildsdifficulties.
TechnicalConsiderations:SampleSizeandVariationsinLanguageSamplingConditions
Recently,Mumaetal.(1998)reportedonastudyconductedseveralyearsearlierinwhichlanguagesampleswereobtainedfromagroupofsevennormallydeveloping
childrenbetweentheagesof2years,2monthsand5years,2months.Theynotedthat200300utteranceswereneededtoobtainacceptableerrorratesonmany
grammaticalstructuresrelatedtothechildsuseofdifferentgrammaticalsystems(nominal,auxiliary,verbal)andgrammaticaloperations(useofrelativeclauses,do
insertion,participleshifts,etc.).Specificallytheyfounda15%errorrateforthe200300utterancesamplesversuserrorratesof55and40%,respectively,for50
utteranceand100utterancesamples.Notsurprisingly,then,thesedatasuggestthatthemorespecificthenatureoftheinformationthatwillbelookedforinthe
languageanalysis(i.e.,whetherdetailedinformationaboutspecificstructuresissought),thelongerthesamplewillneedtobe(Plante,February20,2000,personal
communication).
Inasimilarstudy,GavinandGiles(1996)conductedaSALTanalysisonlanguagesamplesofvaryingsizesbasedoneitherincrementsoftime(12or20minutes)or
numberofutterances(25175,in25wordincrements).Studyparticipantswere20childrenfrom31to46monthsofage.Theresearchersexaminedthetestretest
relia
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Table10.6
ASummaryoftheMethodforCalculatingMeanLengthofUtterance(MLU)in
Morphemes,asDescribedbyChapman(1981)asanAdaptationFromBrown(1973)
PreparingthespeechsampleforcalculationofMLU
l Thechildsspeechissegmentedusingthecriterionofterminalintonation(risingorfalling).
l TheseproceduresdifferfromthoseofBrown(1973)inthatasampleofthefirstconsecutive50utterances(includingthefirstpageoftranscription)ratherthan
100utterances(excludingthefirstpage)isrecommended.
l Excludedfromthesampleofutterancesareunintelligibleorpartiallyunintelligibleutterances.Includedaredoubtfultranscriptionsandexactutterancerepetitions.
Countingmorphemesineachutterance
Morphemesaredefinedasminimalmeaningfulunitsofalanguage,withdogandsgivenasexamples.CountingrulesbasedonthoseofBrown(1973)aregivento
addressthegreateruncertaintyofwhatconstitutesamorphemeinthespeechofachild.Thetotalcountforeachutteranceiscalculated,summed,anddividedbythe
totalnumberofutterancesspokentoyieldtheMLU.Thecountingrulesaregivenverbatim:
Stutteringismarkedasrepeatedeffortsatasinglewordthewordiscountedonceinthemostcompleteformproduced.Inthefewcaseswhereaword
(1)
isproducedforemphasis,orthelike(no,no,no),eachoccurrenceiscountedseparately.
(2) Suchfillersasmmoroharenotcounted,butno,yeah,andhiare.
Allcompoundwords(twoormorefreemorphemes),propernouns,andritualizedreduplicationscountassinglewords.Someexamplesarebirthday,
(3) racketyboom,choochoo,quackquack,nightnight,pocketbook,seesaw.Thejustificationforthisdecisionisthatthereisnoevidencethatthe
constituentmorphemesfunctionassuchforthesechildren.
(4) Allirregularpastsoftheverb(got,did,went,saw)countasonemorpheme.Again,thereisnoevidencethatthechildrelatesthesetopresentform.
Alldiminutives(doggie,mommie)countasonemorphemebecausethesechildrendonotseemtousethesuffixproductively.Diminutivesarethestand
(5)
formsusedbythechild.
Allauxiliaries(is,have,will,can,must,would)countasseparatemorphemesasdoallcatenatives(gonna,wanna,hafta,gotta)Thecatenativesare
(6) countedassinglemorphemes,ratherthanasgoingtoorwantto,becauseevidenceisthattheyfunctionassuchforchildren.Allinflections,forexample,
possessive(s),plural(s),thirdpersonsingular(s),regularpast(ed),andprogressive(ing),countasseparatemorphemes.(Chapman,1981,p.24)
Chapman(1981)identifiedseveralspecialcharacteristicsofasamplethatmayaffecttherepresentativenessoftheMLU:highrateofimitation(i.e.,>20%ofthe
childsutterances),frequentselfrepetitionswithinaspeechturn,ahighproportionofanswersoccurringinresponsetoadultquestions(i.e.,>3040%ofthechilds
utterances),frequentuseofroutines(suchascounting,sayingthealphabet,nurseryrhymes,songfragments,commercialjingles,orlongutterancesmadeupby
listingobjectsinabookortheroom),andahighproportionofutterancesinwhichclausesareconjoinedbyand.Amongthestrategiesshesuggestedfor
addressingtheseproblemsarecalculationsconductedwithandwithoutimitations,selfrepetitions,frequentroutines,andresponsestoquestions.Inaddition,she
suggestedobtainingadditionalsampleswithanotheradultwhoasksfewerquestionswhenhighratesofquestionresponsesarenotedandtheuseofanothermeasure
(theTunit)whenahighproportionofutterancesconsistofclausesconjoinedbyand.
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bilityoffourmeasures(MLU,numberofdifferentwords,totalnumberofwords,andmeanssyntacticlength)insamplesatthesedifferentlengths.Theyfoundthatonly
atthelargestnumberofutterances(about175)didreliabilitycoefficientsmeetorexceed.90,thevalueconsideredacceptablefordiagnosticuse.
Theimplicationofthesefindingsextendsbeyondasimpleadmonitionforclinicianstoattempttoobtainlargersamplesizesonwhichtobaselanguageanalysesorfor
themtobeveryawareofthepotentialforerrordogginganalysesbasedonsmallersamplesalthoughthoseareclearandpotentimplications.Evenmoreimportantly,
however,theyillustratetheconnectionbetweenreliabilityandsamplesizethathauntsmanyifnotmostdescriptivemeasures.Obviously,rarerstructuresorphenomena
aremorelikelytobevulnerable,butadditionalresearchwillprovehelpfulinguidingustowardbestpracticesinourchoiceoftoolsandsamplesizes.
Theconditionsunderwhichlanguagesamplesarecollectedareknowntoaffectnumerousmeasuresobtainedinlanguageanalyses(Agerton&Moran,1995Landa&
Olswang,1988Miller,1981MoellmanLanda&Olswang,1984Terrell,Terrell,&Golin,1977).Evenapartiallistingofsomeofthevariablesaffectingachilds
productionscanleaveonequitedauntedforexample,raceandfamiliarityofcommunicationpartner,stimulusmaterials,numberofcommunicationpartners,number
andtypesofquestionsasked,typeofcommunicationrequired(e.g.,narrative,descriptionofaprocedure),tonameafew!Itispossibletoleavethesevariables
uncontrolledasisoftendonewhenanunstructuredconversationbetweenclinicianandchildisusedasthesample.Insuchcases,theclinicianwillwanttoconsider
thesevariablesinhisorheranalysisandinterpretationprocess.
Asanalternativetounstructuredlanguagesamples,structuredsamplingtaskshavebeenrecommendedasprovidingmorerelevant(i.e.,valid)informationforsome
clinicalquestions.Followingisalistoffivesetsoftasksdesignedtoelicitstructuredlanguagesamplesforschoolagechildren(Cirrin&Penner,1992):
1. describinganobjectorpicturethatisintheview
2. recallingatwoparagraphstorytoldbytheclinicianwithoutpictures
3. describingaperson,place,orthingthatisnotpresentintheimmediatesurroundings
4. providingadescriptionofhowtodosomethingfamiliar(e.g.,makingasandwich)and
5. tellingwhatthechildwoulddoinagivensituation(e.g.,wakinguporseeingahouseonfire)
Thislistillustratestasksthatmanipulatesomeofthevariablesthatmaypresentachildwithparticulardifficulty,thusallowingthecliniciantotargetlanguagesamplingfor
thoseareasofspecialimportancefortheindividualchild.However,itisimportanttorememberthateachoftheseconditionsislikelytoaffectmoreaboutthechilids
productionsthansimplythevariablethatappearstobemanipulated.Forexample,onthebasisoftheprecisewayinwhichthetaskissetupbytheclinician,variables
beyondthedesiredtopicorleveloflanguagecomplexitywillprobablybeaffected.
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Inanotherefforttohelpcliniciansstandardizetheconditionsunderwhichtheycollectconversationallanguagesamples,CampbellandDollaghan(1992)offereda
sequenceoftopicquestionsthattheysuggestedbeusedinorder,butonlyasspurstoconversation.Thus,onlytopicsthatthechildwouldshowgenuineinterestin
wouldbecontinued.Further,additionaltopicsintroducedbythechildwouldbepursuedaslongastheycontinuedtointerestthechild.Theintendedresultwas
increasedconsistencyacrossexaminers.Inbrief,thesequencebeginswithquestionsaboutthechildsage,birthdate,andsiblingsthenproceedstoquestionsabout
familypets,favoritehomeactivities,andschoolaffairsandcloseswithquestionsaboutvacations,favoritebooks,andTVshows.Althoughthislistisrelatively
conventional,thedecisionofagroupofcolleaguestoadoptitorsomeotherconsistentsetofstarterquestionsmighthelplendgreaterconsistencytothelanguage
samplesobtainedacrosschildren.This,inturn,wouldincreasetheintegrityoflocalmeasuresthatmightbemadeusingthedatafromanumberofclients.However,it
shouldbenotedthatstandardizationinthiswayisnotnecessarilygoingtoaddtotherepresentativenessofthesamplefortheindividualchildthatmaybestbe
achievedbyenteringoneofachildsfavoriteactivitiesandsimplyobservingwhathappensthere.
6.OnLineObservations
ThiscategoryofdescriptivemeasuresischaracterizedbyDamicoetal.(1992)asrealtimeobservationandcodingofbehaviorsexhibitedduringcommunicative
interactionsastheyhappen.Thus,thesemeasuresdifferfromratingscalesthatarecompletedoutsideofthattimeframe.Althoughnotatallrareinresearchon
communication,Damicoetal.notedtherelativeraritywithwhichtheyareappliedbyspeechlanguagecliniciansinclinicalpractice.
McReynoldsandKearns(1983)describedfivekindsofobservationalinformationorcodesthatarefrequentlyusedinappliedresearchsettingstoobtainonline
measures:(a)trialscoring,(b)eventrecording,(c)intervalrecording,(d)timesampling,and(e)responseduration.Aseachoftheseisdescribed,thereaderwillsee
thatthesesamecategoriescanbeusedtodescribetheoutcomesofprobes.Thechiefdifferencebetweenprobesandonlineobservationsisthatthelatterinvolves
responsestoamorenaturalisticcommunicationevent,whereastheformerinvolvesagreaterlevelofcontrivanceonthepartoftheclinician.
Intrialscoring,responsesfollowingaspecificstimulusortrialarescoredascorrectorincorrect.Suchresponsescanoccureithernaturallyorwithprompting.
Althoughcorrectversusincorrectarethemostcommonlyusedlabelsappliedtoresponsesintrialscoring,anumericalcode(whichmayinfactrepresentatypeof
ratingscale)maybeusedtoprovidegreaterdetailaboutthenatureofresponses.Oneexampleofanumericalcodeisthemultidimensionalscoringsystemusedinthe
PorchIndexofCommunicativeAbilityinChildren(Porch,1979),whichusesa16pointscoringsystemtoreflect5dimensions(accuracy,responsiveness,
completeness,promptness,andefficiency).Readersshouldnotethatonlyrarelyaresuchcombinationsofratingscalesandtrialscoringusedinonlinesituations
becauseoftheintensedemandsontherater,whichleavessuchmeasuresquitevulnerabletoproblemswithreliability.
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Ineventrecording,acodeisestablishedconsistingofbehaviors(includingverbal,nonverbal,orboth)ofinterest.Thatcodeisthenusedtosummarizethetargeted
childsbehaviorsoveragiventimeperiod(e.g.,a15minuteperiod).Oneexampleofacodethatmightbeusedineventrecordingwouldbetheonedevelopedby
DollaghanandCampbell(1992).Thatcodehadbeendevelopedtodescribewithinutterancespeechdisruptions(i.e.,pauses,repetitions,revisions,andorphans
linguisticunitssuchassoundsorwordsthatarenotreliablyrelatedtoothersuchunitswithinanutterance).WhereasDollaghanandCampbellusedthatcodeinan
analysisofpreviouslyrecordedlanguagesamples,itcouldalsobeusedforonlineobservation.
Intervalrecordingandtimesampling,twosamplingmethodsthatarecloselyrelated,arealsocloselyrelatedtoeventrecording(McReynolds&Kearns,1983).In
intervalrecording,asettimeperiodisdividedintoshort,equalintervals(e.g.,10seconds)andeventsarenotedashavingoccurredonceiftheyoccuratanypoint
duringtheinterval.Intimesampling,asettimeperiodisagaindividedintointervals,butonlythepresenceofthebehaviorattheveryendoftheintervalisrecorded.
Inadditiontothedesignationofintervalsdevotedtoobservation,thisapproachalsoincludesrecordingintervalsinwhichnoobservationsareattempted.Intime
sampling,therefore,a7.5secondobservationintervalmightbefollowedbya2.5secondrecordinginterval.Timesamplinghasbeenthoughttobeassociatedwith
fewerproblemsaffectingaccuracythanintervalrecording.However,bothmethodsrequirethatcarebetakenintheselectionofintervalsizes(McReynolds&Kearns,
1983).Intervalsthataretooshortarelikelytoincreaserecordingerrorsthosethataretoolongarelikelytoloseinformationduetowantingobserverattention.
ThelastoftheobservationalcodesdescribedbyMcReynoldsandKearns(1983)istherecordingofresponseduration,inwhichthedurationofaspecificeventof
interest(e.g.,pauseduration)isrecordedusingastopwatchorothertimingdevice.Althoughresponsedurationmaynotbeapplicabletomanylanguagephenomena,it
cannonethelessprovequiteusefulfromtimetotimeforchildrenwithlanguagedisorders.Forexample,afunctionalmeasureforachildwithSLIwhodemonstrates
pragmaticdifficultiesmightconsistoftimespentengagedinconversationwithoneormorepeersduringrecess.Alternatively,timespentinperseverativeor
noncommunicativespeech(e.g.,repeatedrecitationofatelevisioncommercial)duringagroupactivitymightbeusedasafunctionalmeasureforachildwithautism.
Damico(1992)providedanexampleofanonlineobservationalsystem,calledSystematicObservationofCommunicativeInteraction(SOCI),whichmakesuseof
eventrecordingandtimesampling.InSOCI,problematicverbalandnonverbalbehaviorsarerecordedalongwithinformationaboutseveraldimensions(suchas
illocutionarypurpose)eachtimeitoccurswithinafixedtimeperiod(a10secondperiodthatconsistsofa7secondobservationand3secondrecordinginterval).
Recordedbehaviorsincludefailuretoprovidesignificantinformation,nonspecificvocabulary,messageinaccuracy,poortopicmaintenance,inappropriateresponse,
linguisticnonfluency,andinappropriateintonationcontour.Fourtosevenrecordingperiodsofapproximately12minuteseacharerecommended.Althoughsomedata
regardingreliabilityofthisprocedurearementionedinDamico(1992),clearlythistypeofprocedurewarrantsadditionalevidencetoprovidebetterguidanceregarding
itsinterpretationandvalidity.
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7.DynamicAssessment
Dynamicassessmentproceduresrepresentalargenumberofproceduresthataredesignedtoexamineachildschangingresponsetolevelsofsupportprovidedby
theclinician.Proponentsofdynamicassessmentmightbalkatitsinclusioninthelistofmeasuresreviewedinthischapter,maintainingthatitrepresentsanapproachto
assessmentthatisentirelydifferentfromtherest.Infact,forproponentsofdynamicassessment,mostotherformsofdescriptiveassessmentcanbelumpedintothe
single,usuallylessdesirablecategorystatic.Withinthisconceptualization,staticassessmentsassumeaconstantsetofstimuliandinteractionsbetweenthechildand
tester,whereasdynamicassessmentsassumeachangingsetofstimuliandinteractionsthataremanipulatedtoprovidearicherdescriptionofhowthechilds
performancecanbemodified.Referredtoasdynamicassessmenthere,awidevarietyofrelatedassessmentstrategiesfallwithinthiscategory.
Tothoseunfamiliarwiththetermdynamicassessment,OlswangandBain(1991),twoofitsforemostadvocatesinlanguageassessment,helpfullynoteditsstrong
resemblancetoamorefamiliarandvenerableconcept.Specifically,theycompareitwithstimulability,inwhichunaidedproductions(usuallyinarticulationtesting)are
followedbyeffortstoobtainthechildsbestproductionswhenaidedbythecliniciansvisual,auditory,andattentionalprompts.Inbothstimulabilityandindynamic
assessmentprocedures,facilitatingactionsonthepartoftheclinicianaredesignedtohelpdeterminetheupperlimitsofachildsperformance.Asaresult,the
boundariesofassessmentandtreatmentareblurred.Thisblurringhasledtotheuseofthetermmediatedlearningexperience(Feuerstein,Rand,&Hoffman,1979
Lidz&Pea,1996)torefertoonemodelofdynamicassessment.Italsoforeshadowstheintegrationofsuchassessmenttechniquesintotreatment(e.g.,Norris&
Hoffman,1993).
InitiallyappliedincognitiveandeducationalpsychologybyFeuersteinandothers(e.g.,Feuerstein,Rand,&Hoffman,1979Feuerstein,Miller,Rand,&Jensen,1981
Lidz,1987),dynamicassessmentmodelsaretypicallybasedontheworkofVygotsky(1978),whoproposedthezoneofproximaldevelopment(ZPD)asa
conceptualizationofthemovingboundaryofachildslearning.Thezoneofproximaldevelopmentisdefinedasthedistancebetweentheactualdevelopmentallevelas
determinedbyindependentproblemsolvingandthelevelofpotentialdevelopmentasdeterminedthroughproblemsolvingunderadultguidanceorincollaborationwith
morecapablepeers(Vygotsky,1978,p.86).Problemsolvingorbehaviorslyingwithinthiszonearethoughttorepresentthoseareaswherematurationisoccurring
andtocharacterizedevelopmentprospectivelyratherthanretrospectivelyasisdonewithtypical,staticassessment(Vygotsky,1978).
TheZPDhasbeeninterpretedasbeingindicativeoflearningreadiness.Therefore,itsdescriptionthroughdynamicassessmenthasbeenconsideredespeciallyusefulfor
identifyingtreatmentgoals(Bain&Olswang,1995Olswang&Bain,19911996).Specifically,OlswangandBain(1991,1996)suggestedthattasksthatchildren
performwithlittleassistancedonotwarranttreatment,andthosethatchildrenfailtoperform,evenwhenprovidedwithmaximalassistance,arenotyetappropriate
targets.Instead,themostappropriatetargetsarelikelytobethosethatchildrenperformonly
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whengivenconsiderableassistance.Modifiabilityofperformanceinresponsetoadultfacilitationhasalsobeenshowntopredictgeneralizationofperformancetonew
situations,suchthatchildrenwhodemonstratelessmodifiabilityshowlesstransfer(Campione&Brown,1987Olswang,Bain,&Johnson,1992).
AnotherbenefitofdynamicassessmentobservedbyOlswangandBain(1991)isthatdynamicassessmentstrategiesallowthecliniciantodeterminenotonlywhatthe
childislearning,butalsohowthatlearningcanbesupportedthroughthemanipulationofantecedentandconsequentevents.Theynotethatwhereasconsequentevents
suchasthenatureofreinforcement(e.g.,tangiblevs.social)andscheduleofreinforcement(e.g.,continuousvs.variable)havereceivedattentionformanyyearsin
speechlanguagepathology,antecedenteventsreceivegreaterattentionindynamicassessment.Amongtheantecedenteventshighlightedindynamicassessmentarethe
useofmodelsorprompts,theselectionofthemodalitiesofstimuliorcuesthatareused,andthenumberofstimuluspresentationsthatareprovided.
Table10.7providesahierarchyofverbalcuesusedtoprovidedifferinglevelsofsupportforchildrenwithspecificexpressivelanguageimpairmentlearningtwoword
utterances(Bain&Olswang,1995).Inthestudy,whichwasdesignedtovalidatethe
Table10.7
ASampleHierarchyofVerbalCues
Condition Cue
Opportunitytochildsattention
Generalstatement
Ohlookatthis.
Opportunityplusanelicitationcue
Elicitationquestion Whatshappening?
Whatshedoing?
Moresalientopportunitycontrastingparticularfeatureofwhatistobecoded
Closeorsentencecompletion Lookthedogissittingand__.
(manipulatingdogsoitiswalking)
Repetitionofopportunity+embeddedordelayedmodelandelicitationcue
Indirectmodel
See,thedogiswalkingwhatishedoing?
Opportunityplusadirectmodelofdesiredutterancewithoutelicitationcueparticipantspontaneouslyimitatesthe
Directmodelevokingspontaneousimitation utterance
Dogwalk.
Opportunityplusadirectmodelofdesiredutterancewithanelicitationstatement
Directmodelplusanelicitationstatement
Tellme,dogwalk.
Note.Thistablerepresentsasamplehierarchyofverbalcuesarrangedfromthoseprovidingleasttomostsupportfortheproductionoftwowordutterancesin
childrenwithspecificexpressivelanguageimpairmentwhoareproducingfewornoutterancesofthistype.ThisexampleusescuesdesignedtoelicitAgent+Action
(dogwalk)asrelevantobjectsaremanipulated.FromExaminingReadinessforLearningTwoWordUtterancesbyChildrenWithSpecificExpressiveLanguage
Impairment:DynamicAssessmentValidation,byB.A.BainandL.B.Olswang,1995,AmericanJournalofSpeechLanguagePathology,4,p.84.Copyright
1995byAmericanSpeechLanguageHearingAssociation.Reprintedwithpermission.
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useofdynamicassessment,15childrenwhowereproducingfewornotwowordutteranceswereassessedusingstandardizedmeasures,languagesamples,and
dynamicassessment,thentreatedfor3weeks.Constructvaliditywassupportedthroughthedemonstrationthatmoresupportivecues(i.e.,thoseprovidingmore
information)resultedinmorecorrectlyproducedtwowordutterancesthanlesssupportivecues.Inaddition,predictivevaliditywassupportedthroughthe
demonstrationthatchildrenwhoshowedthegreatestresponsivenesstothehierarchy(respondedtothelesssupportivecues)showedthegreatestlanguagechangeover
thestudyperiod.Oneunexpectedfindingwasthatlanguagesamplingwasassociatedwithagreatervarietyofwordcombinationsandtwowordutterancetypesthan
wasdynamicassessment.Thisfindingwasinconsistentwiththeoutcomeneededtosupportconcurrentvalidity,thussuggestingtheneedforfurtherstudy.
Thecollaborativenatureoftheinteractionpromotedindynamicassessmentisthoughttohaveimmediatebenefitstothechildsmotivation.Lidz(1996)describedthis
interactionaspromotingrapportbuildingandmotivationalvariables,includingreducedanxiety,[suchthat]assessmentbecomesmoreofaninstructionalconversation
thanatest(p.11).Atthesametime,anumberofauthors(GutierrezClellen,Brown,Conboy,&RobinsonZaartu,1998Lidz,1996)notedthattheuseofdynamic
assessmentallowsthecliniciantodeterminehowassessmentconditionsfacilitateorobstructthechildsattentionorarousal,perception,memory,conceptual
processing,andmetacognitiveprocessing.Thus,dynamicassessmentmayprovideinformationnotonlyaboutthechildscurrentandpotentialleveloffunctioningona
giventask,butalsoaboutthechildslearningneedsandstylethatextendbeyondthetaskathand.
Becauseofitscomplexity,dynamicassessmentisrecommendedforsome,butnotallchildrenwhoselanguagerequiresdescription.Muchoftheearlyworkondynamic
assessmentwasdirectedatitsuseforchildrenwithmentalretardation(Feuersteinetal.,1979).Morerecentlyithasreceivedconsiderableattentionasanonbiased
approachforusewithchildrenwhocomefromlinguisticallyorculturallydiversecommunities(GutierrezClellenetal.,1998Lidz,1996Lidz&Pea,1996Pea,
Quinn,&Iglesias,1992).Reducedbiasisexpectedforatleastthreereasons.First,dynamicassessmenttechniquescaneithercircumventoralterasneededthe
unfamiliarlanguageandinteractionroutinesthatmaypenalizechildrenfromnondominantculturalbackgrounds.Second,thecollaborativenatureoftheinteractionof
childandcliniciancanfacilitatemorerelaxed,confident,and,consequently,valideffortsfromthechild.Third,theembeddingofinstructionindynamicassessmentcan
reducetheeffectsofpreviousexperience,amajorsourceofbiasforchildrenwholacktheexperiencesofthemainstreamculture(Lidz,1996).
BainandOlswang(1995)summarizedthepromiseofdynamicassessmenttechniquesasfollows:
Dynamicassessmentoffersclinicianstheopportunitytoobtaininformationastowhototreat,whentotreat,whattotreat,howtotreat,andtodetermineprognosis.
Suchinformationwillenableclinicianstomakeinformeddecisionsastheyprovideservicestochildrenwithlanguageimpairment.(p.90)
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Agrowingbodyofdatabolstersportionsoftheseclaims(e.g.,seeLong&Olswang,1996Olswang&Bain,1996).However,thecomplexityandvarietyof
proceduresfittingwithintheumbrellaofdynamicassessmentmeanthatmuchworkremainstobedonetooptimizethevalidityoftheseproceduresforindividual
childrenandassessmentpurposesoreventounderstandtheextenttowhichtraditionalpsychometricconceptscanbeappliedtotheirevaluation(Embretson,1987).
8.QualitativeMeasures
Speechlanguagepathologistshavealwayspaidattentiontoaverywiderangeofinformationsourcesbeyondthosedescribedthusfarinthechapter,includingteacher
andparentcomments,clientobservations,interviews,andofficialdocuments.Morerecently,sourcessuchasstudentjournals,portfolios,clinicianjournals,andcritical
incidentreports,orstandouts,havebeenadded(Schwartz&Olswang,1996Silliman&Wilkinson,1991).OlswangandBain(1994)usedthetermsdescriptive
andqualitativetorefertothesesourcesofinformationanddescribedthemassubjective,incontrasttothemoretypical,operationallydefinedquantitativedata.
OlswangandBainbasedtheirdiscussionofsuchmeasuresontheworkofauthors(e.g.,Bogdan&Biklen,1992Glesne&Peshkin,1992)describingqualitative
research,anumbrellatermusedtodescribeseveralresearchstrategiesinwhichsubjective,inductive,andrichlydescriptivemeasuresaresystematicallyusedto
examineparticipantsperspectivesonphenomenaofinterest.Becauseofthiscloseconnectiontoatypeofresearchthatmaybeunfamiliartomanyreaders,abrief
discussionofqualitativeresearchisofferedasbackground.
Historically,qualitativeresearchmethodshavebeendevelopedsomewhatindependentlyinanthropology,nursing,education,sociologyandsocialwork,amongother
disciplines(Bogdan&Biklen,1998Lancy,1993),buthaveshownincreasingcrossfertilization.Recently,thesemethods.,especiallythosedescribedas
ethnographic,havebeguntobeadoptedinresearchand,toalesserextent,inclinicalpracticeinspeechlanguagepathology(Kovarsky,1994Kovarskyetal.,
1999Silliman&Wilkinson,1991Westby,1990).Athoroughdescriptionofqualitativeresearchisbeyondthescopeofthistext,having,infact,servedasthefocus
foradazzlingarrayoftextsinjustthepastdecade(e.g.,Berg,1998Bogdan&Biklen,1998Creswell,1998Denzin&Lincoln,2000Kelley,1999Lancy,1993
Taylor&Bogdan,1998).Nonetheless,abriefoverviewofsomeofthetheoreticalthreadsunitingdifferentapproacheswithinqualitativeresearchcanhelpguideour
thinkingabouthowqualitativedatamaybeusedintheassessmentofchildrenslanguagedisorders.
Qualitativeresearchstrategieshavebeendescribedasdemonstrating,togreaterorlesserdegrees,thefollowing5features,manyofwhichclearlycontrastwith
quantitativestrategies(Bogdan&Biklen,1998).First,thefocusofqualitativeresearchisanaturalcontextinwhichtheresearcherservesastheprimaryinstrument.
Second,dataaredescriptive,ratherthanquantitative,innature.Third,interactivesocialprocesses,ratherthanproducts,areofinterest.Fourth,methodsareinductive
thus,abstractionsaremadefromthedatathatarepresent,ratherthantestedfromdatathat
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aresoughtout.Fifth,meaningasexperiencedbyindividualsfromtheirpersonalperspectivesisofparamountinterest.Fromaclinicalvantagepoint,oneofthechief
attractionsofqualitativemethodsistheirpotentialtoguidecliniciansintheuseofdatathatmayhavepreviouslybeenseenasillicit.
Oneofthemajorsourcesofevidenceforthevalidityofqualitativedataliesintheprocessoftriangulation,whichcanbedefinedasthebelievabilityprovidedby
repeatedexamplesofagivenbehaviorobtainedinavarietyofsettingsorusingavarietyofmethods(Schwartz&Olswang,1996).Janesick(1994)describesfive
kindsoftriangulation:triangulationacross(a)datasources,(b)researchersorevaluators,(c)multipleperspectives,(d)multiplemethods,and(e)disciplines.Itisthe
preponderanceofevidencegainedundertheseconditionsthatvalidatesfindings(Berg,1998).Someauthors(e.g.,Bogdan&Biklen,1998)objectthattheterm
triangulationisuseddifferentlybydifferentauthorsandthusarguethattheexactmethodsusedtoproviderichsupportforvalidityneedtobespecified.However,itis
ausefultermforcapturingthewayinwhichvalidity,orbelievability,isalternativelycharacterizedwithinthisresearchparadigm.Also,interestingly,itisrelatedtothe
conceptpervadingmainstreampsychometricdiscussionsthattheoreticalconstructsneedtobestudiedusingseveralindicators(Pedhazur&Schmelkin,1991
Primavera,Allison&Alfonso,1996).Whenthinkingabouthowqualitativedatamaycomplementquantitativedescriptionsofthelanguageandlinguisticcontextfor
childrenwithlanguageimpairment,theconceptpointstowardaneedformultiplesourcesandsettings.
Althoughadditionalresearchmayhelpusunderstandhowsuchdatacanbestbeusedincombinationwithmoreestablished,quantitativemeasures,existingworkon
qualitativeresearchcanpointtothetypesofquestionsforwhichqualitativedatamaybebestsuited(Schwartz&Olswang,1996).Specifically,questionsthatrelateto
thediversewaysinwhichachildisviewedinhisorherlinguisticcommunityortothespecialexpectationsfallingonaspecificchildinaspecificcommunitymaybestbe
addressedusingqualitativedata.Thus,questionsthataddressconcernsabouthandicapanddisability,whichrelatetofunctionalandparticipativeeffectsofimpairments
(WHO,1980),maybeveryeffectivelyansweredusingqualitativemethods.
PracticalConsiderations
Numerouspracticalconsiderationsaffectthewayinwhichspeechlanguagepathologistscurrentlydescribelanguagedisordersinchildren.Influencesrelatedtothe
considerationofthelargercontextsinwhichlanguageimpairmentsoccurincludemovementstowardincreasinguseofassessmentsinwhichseveralprofessionals
contributetheirinsightsintothefunctioningofachild(coordinatedassessmentstrategies).Inaddition,therehasbeenacontinuingmovementinthepastfewdecades
towardassessmentsforschoolagechildreninwhichthefunctionaldemandsofacademicsettingsarerecognizedasthechiefchallengesfacingthem(curriculumbased
assessment).Thesecoordinatedapproachestowardassessmentcouldhavebeenprofitablydiscussedinchapter9,whichdealtwithidentification.Nonetheless,they
arediscussedherebecauseofthecloserconnectionofdescriptionthanidentificationto
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treatmentplanningtheareaofclinicaldecisionmakingthoughttobenefitmostfromcoordination.
Beyondtheseassessmentstrategies,perhapsthemostimportantpracticalconsiderationaffectingthedescriptivemeasureschosenbycliniciansisthatoftimeandother
practicalresources.Inthissection,theroleofcoordinatedassessmentstrategiesandotherpracticalfactorsisdiscussedbrieflytoillustratesomeoftheforcesshaping
descriptivepracticesinworkwithchildrenwithlanguageimpairments.
CoordinatedAssessmentStrategies
Childrenwithlanguageimpairmentexperiencearangeofneedsthatrequiretheattentionandcareofindividualsfromavarietyofdisciplines,forexample,speech
languagepathologyandaudiology,psychology,socialwork,occupationaltherapy,physicaltherapy,andavarietyofotherhealthprofessionals.Asachildsphysical
problemsandotherproblemsincreaseinnumber,coordinationofassessmentsandinterventionsconductedbytheseprofessionalsbecomecrucial(Linder,1993
Rosetti,1986).Withoutcoordination,professionalsmayworkatcrosspurposeswithfamilies,overwhelmthemwithexcessiveorcontradictoryrecommendationsand,
asaresult,facilitatesmallgainsinindividualdomainswhileunderminingtheoverallqualityofthechildslife(Calhoon,1997Raver,1991).Rosettidescribedthe
difficultyfacingaprofessionalworkingalonewithachildwithmanyproblemsassufferingfromtunnelvision,inwhichthechildmaybeviewedfromtheexceedingly
narrowperspectiveofthatsingleindividualsacademicandprofessionalbackground.Particularlyforveryyoungchildrenwithmultipleneeds,theneedforcoordination
hasbeenrecognizedinlegislationandinthedevelopmentofsophisticatedstrategiesofcoordination.Threegeneralstrategiesthatattempttomeettheneedsofchildren
andfamiliesaremultidisciplinary,interdisciplinary,andtransdisciplinaryapproaches(Calhoon,1997Raver,1991).
Multidisciplinaryassessmentinvolvesparallelplanning,administration,andinterpretationprocessesinwhichparentsinteractindependentlywithindividual
disciplines.Interdisciplinaryassessmentinvolvescoordinationthroughteamplanningofassessmentconsultationwithteammembersasassessmentsoccurwithin
individualdisciplinesandparentinvolvementisencouraged.Transdisciplinaryassessmentinvolvessharedassessmentsconductedbytheentireteam.Thisapproach
involvesparticipationofallteammembersaswellasthechildsparentsthroughouttheplanning,administration,andinterpretationprocess.Twoexamplesofspecific
transdisciplinaryapproachesincludeplayandarenaassessment,inwhichacriterionreferencedmeasurementstrategyisimplementedwithinanaturalisticcontext.
Whereasmultidisciplinaryandinterdisciplinaryapproachestendtopredominateinsystemsdesignedforolderchildren,transdisciplinaryapproacheshavebecome
particularlypopularfortheassessmentofinfantsandtoddlers(Calhoon,1997).
Attemptsatthecoordinationofdisciplines,particularlythosethatincreasetheinvolvementofparents,arepresumedtoincreasethevalidityofmeasurementandthe
effectivenesswithwhichclinicaldecisionscanbeimplemented(Crais,1993).Further,greatercoordination,particularlywithparents,isrequiredthroughIDEA(1990).
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Asaconsequence,itislikelythatincreasingattentionwillbepaidtothevalidationofcoordinatedapproachestoassessmentandtothedevelopmentofmethodsto
increasetheirefficiency.
CurriculumBasedAssessment
Forschoolagechildrenwithlanguageimpairments,coordinationofdisciplinesisoftenmorelimitedthanforyoungerchildren,althoughitisatleastasvital.Forschool
agechildren,coordinationwillentailcollaborationbetweenclassroomteachers,specialeducators,andspeechlanguagepathologists.Forthisagegroup,collaborative
assessmentapproachisthetermmostfrequentlyusedtorefertothewayinwhichprofessionals(speechlanguagepathologistsinthiscase)attempttocoordinate
theiractivitieswiththoseoftheotherprofessionalsservingthechildinaschoolsetting.Curriculumbasedassessmentisoneparticularlywidespreadcomponentof
collaborativeassessmentapproaches(Prelock,1997).
Collaborationenablesthespeechlanguagepathologistandothermembersoftheeducationalteamtounderstandthespecificlanguageandcommunicationdemands
facingthechildwithagiventeacher,classroom,andcurriculum.Thepurposesofthiscollaborationaretodeterminewhatdemandspresentparticularchallengestothe
childandtoidentifyteamresourcesforaddressingthem(Creaghead,1992Prelock,1997Silliman&Wilkinson,1991).
Curriculumbasedassessmenthasbeendefinedbroadlyasevaluationofastudentsabilitytomeetcurriculumobjectivessothatschoolsuccesscanbe
achieved(Prelock,1997,p.35).Addingmoredetailtothisconcept,Nelson(1989,1994)calledattentiontothepresenceofnumerouskindsofcurricula.Thus,for
example,inadditiontotheofficialcurriculumoftheschooldistrict,therearetheculturalcurriculumconsistingofunspokenexpectationsbasedonthemainstreamculture
andtheundergroundcurriculumconsistingoftherulesaffectingpeersocialinteractions.
Inordertounderstandandrespondtoschoolcurriculainboththebroadandmoredetailedsenses,thespeechlanguagepathologistwillalmostalwaysneedtouse
criterionreferencedmeasures.Suchmeasuresaresometimesaimedatcharacterizingtheeducationalsettinganditsdemandsandsometimesaimedatdetermining
whetherthechildisorisnotabletomeetthosedemands.Identifyingthetaxingaspectsoflanguageandcommunicationwithintheclassroomwillbenefitnotjustthe
childwithlanguageimpairmentsbutallstudentswithinthatclassroom(Prelock,1997).Obviously,thebenefitofcollaborativecurriculumbasedassessmentstochildren
withlanguageimpairmentsisthepossibilityofdescribingandthenrespondingtotheirdifficulties.Theseresponsesbythespeechlanguagepathologistandotherteam
memberscanresultinaccommodationsorotheractivestepstofostergreatersuccessintheregularclassroom.Inessence,curriculumbasedassessmentscanhelp
preventimpairmentfromnecessarilybeingrealizedasadisabilityorhandicap,intheterminologyoftheICIDH(WHO,1980).Alternatively,itcanalsobeseenas
preventingimpairmentfrombeingrealizedasalimitationinactivitiesorparticipationopportunities,intheterminologyofICIDH2(WHO,1998).
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OtherPracticalFactors
Practicalfactorsbeyondthosediscussedinthischapter,suchastimeandmoney,appeartoaffectthewaysinwhichcliniciansconductlanguageassessments(Beck,
1996Wilson,Blackmon,Hall,&Elcholtz,1991),includingassessmentsdesignedtoplanfortreatment(Beck,1996).Timedemandsseemtostemfromthepressures
oflargecaseloads.Inparticular,whereasASHA(1993)recommendedcaseloadsizesof40,ShewanandSlater(1993)foundthatschoolclinicianshaveaverage
caseloadsof52!Beckssurveyfoundthatcliniciansfrequentlyreportedthattheydidnothavesufficienttimetoconductcompleteassessments.Inaddition,clinicians
alsoreportedinsufficientfundstobuyadequatematerialsforassessment.OtherdatafromthesamesourceledBecktoponderwhetherfrequencyofusemightresult
frompropertiesofatestassimpleasitsbeingappropriateforawideagerangeanditsaddressingbothreceptiveandexpressiveconcerns.Thispossibilityledherto
commentthesearecertainlynottheidealcriteriaonwhichtobaseselectionofassessmentmethods(Beck,1996,p.58).
Further,Beck(1996)andWilsonetal.(1991)didnotobtaindetailedinformationabouttheentirerangeofdescriptivemeasuresusedbyclinicians.However,theydid
findthatlanguagesamplingisverywidelyused.Giventheexpressedconcernsabouttimeandmoney,however,itseemslikelythatthetimeconsumingdescriptive
measuresandmanyoftheexcitingbutemergingdescriptivemeasuresdescribedinthischaptermaynotmakeitintotherepertoireoftechniquesusedbyclinicians.At
leastthisconclusionseemsreasonableintheabsenceofconsiderableeffortonthepartofindividualcliniciansandtheprofession.Theseeffortsmaytaketheformof
workingtoreducecaseloadsizesandincreasebudgets.Alternatively,theymaytaketheformofresearchstudiesaimedatincreasingtheefficiencyandvarietyof
descriptivemeasures.Fortunately,thereiswidespreadrealizationthatdescriptivemeasuresarethemostappropriatetoolstouseinaddressingmanycriticalclinical
questionsthefirststepneededtoengagetheattentionofindividualcliniciansandoftheprofessionasawhole.
Summary
1.Descriptivemeasurementoflanguagepresentsbothgreaterchallengesandgreaterrewardstothepracticingclinicianthandoesassessmentaimedatscreeningor
identificationbecauseofitssteadfasttietotheheartofclinicalpractice:interventionsdesignedtoimprovethesocial,communicativelivesofchildren.
2.Evenmorethanmeasuresusedinidentification,descriptivemeasuresoflanguagerequirescrupulousattentionbythecliniciantoachieveamatchbetweenthespecific
clinicalquestionbeingposedandmethodusedtoachieveit.Thisistruelargelybecausethespecificityofthequestionbeingaskednecessitatestheuseofinformal
measuresthatcanonlybevalidatedthroughtheactionsoftheindividualclinician.
3.Damicoetal.(1992)describedauthenticity,functionality,andrichnessofdescriptionascriticalcharacteristicsfordescriptivemeasures.
4.
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Awealthofstrategieshavebeenproposedforuseindescription,includingstandardizednormreferencedmeasures,standardizedcriterionreferencedmeasures,
probes,ratingscales,languageanalysis,onlineobservations,dynamicassessment,andqualitativemeasures.
5.Becausechildrenwithspeciallanguageneedsoftenrequiretheattentionofotherprofessionalsaswell,assessmentframeworkshavearisenthatreflectdiffering
degreesofcoordinationacrossdisciplines,aswellasdifferingdegreesofparentinvolvement.Theserangefrommultidisciplinarytointerdisciplinarytotransdisciplinary
assessments.
6.Thenatureofcoordinatedassessmenteffortschangesaccordingtotheageofthechild,withyoungerchildrenmorefrequentlyservedusingmethodsthatinvolvea
greaterdegreeofintegrationacrossprofessionsandolderchildrenservedusingmethodsthatacknowledgetheprimacyoftheschoolenvironmentfortheschoolage
child.Termsassociatedwithcoordinatedassessmentsincludearenaandplaybasedassessmentmethodsforyoungerchildrenaswellascurriculumbased
assessmentforolderchildren.
7.Recentinnovations,suchasdynamicassessmentandthethoughtfuluseofqualitativemeasures,challengeresearchersandclinicianswithopportunitiesforaricher
descriptionoftheeffectsoflanguagedisordersonchildren,includingthosefromnonmainstreamcultures.
8.Futuredevelopmentswithregardtodescriptivemeasuresarelikelytoincludethedevelopmentandvalidationofnewmethodsaswellasthedevelopmentofbetter
practicesleadingtomoreefficientandeffectiveapplicationofexistingapproaches.
KeyConceptsandTerms
authenticassessment:assessmentoccurringwhenskillstobeassessedareselectedtorepresentrealisticlearningdemandsconductedinreallifesettings,suchas
classrooms,inwhichartificialandstandardconditionsareavoided(Schraederetal.,1999).
authenticity:themostcomplexofthreeprimarycharacteristicsdescribedbyDamicoetal.(1992)asnecessaryfordescriptivemeasuresitincludesrespectforand
preservationoftheintricateandmeaningdirectednatureofcommunicationaswellastraditionalconceptsofreliabilityandvalidity.
collaborativeassessmentapproach:anyofseveralapproachesinwhichprofessionalsfromdifferentdisciplines(e.g.,speechlanguagepathologists,audiologists,
specialeducators)worktogethertoprovideinformationleadingtoeffectiveandefficientinterventionforagivenchild.
curriculumbasedassessment:assessmentaimedatexaminingachildsskillsandchallengesinrelationtocurriculardemandsforpurposesofplanninginterventions
thatmayoccurwithinandoutsideoftheclassroom.
directmagnitudeestimation:atypeofratingmethodinwhichstimulitoberatedarecomparedwithoneanotheroragainstastandardstimulus.
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dynamicassessment:avarietyofapproachestodescriptioninwhichstimuliandproceduresaremodifiedtoidentifythechildspotentialperformancewithadult
collaborationtohelpdeterminetreatmentgoalsandfacilitativemethodsconsideredespeciallyusefulasameansofnonbiasedassessmentforchildrenwhoarebilingual
orfromnondominantculturalbackgrounds.
eventrecording:anobservationalmethodinwhichthefrequencyofspecificbehaviors(events)isrecordedacrosstheentireobservationaltimeperiod.
functionality:oneofthreeprimarycharacteristicsdescribedbyDamicoetal.(1992)asnecessaryfordescriptivemeasures,consistingoftheirabilitytocapturea
childsskillintransmittingmeaningeffectively,fluently,andappropriately.
intervalrecording:Amethodofobtainingonlineobservationaldatainwhichtheobservernotesthepresenceofabehaviorortargetedcharacteristicwithina
relativelyshorttimeframe(e.g.,10seconds).
intervalscaling:Aratingtechniqueinwhichratersareaskedtoassignanumberorverballabeltoasetofrelatedstimuli.
metatheticcontinuum:thetypeofratingshownwhenratersresponsestodifferencesbetweenratedentitiesseemtoreflectqualitativedistinctions.Auditorystimuli
differinginpitchappeartobetreatedinthisfashionbyraters.
multidisciplinaryassessment:assessmentinwhichprofessionalsinvolvedwithachildworkinparalleltoplan,conduct,andinterprettheirindividualassessmentswith
interactionsbetweenprofessionalsoccurringinalessstructuredfashionthaninterdisciplinaryortransdisciplinaryassessments.
probe:aninformalmeasureinwhichtheclinicianattemptstodeviseconditionsthatwillelicitaresponsedemonstratingachildsknowledgeofaparticularareaofform,
content,oruse.
protheticcontinuum:thetypeofratingshownwhenratersresponsestodifferencesbetweenratedentitiesappeartoreflectquantitativedistinctions.Auditorystimuli
differinginloudnessappeartobejudgedinthisfashionbyraters.
qualitativeresearch:arangeofresearchstrategiesdesignedtobenaturalistic,descriptive,inductiveinnature,andconcernedwithprocessandmeaning(Bogdan&
Biklen,1998).
richnessofdescription:oneofthreeprimarycharacteristicsdescribedbyDamicoetal.(1992)asnecessaryfordescriptivemeasuresitentailstheuseofsufficient
detailtoleadtoanunderstandingofcausalitythatmaybeusedinplanningtreatment.
timesampling:amethodofobservationinwhichtheobservationtimeperiodisdividedintointervalsandthepresenceofatargetedbehaviorisrecordedattheendof
eachinterval.
transdisciplinaryassessment:assessmentsinwhichteammembersfromdifferentdisciplinessharemaximallyintheassessmentprocessspecificexamplesofthis
typeofassessmentincludearenaandplaybasedassessments,whichareusedmostfrequentlywithinfantsandtoddlers.
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trialscoring:therecordingofaresponseascorrectorincorrectfollowingaspecificstimulusortrial(McReynoldsandKearns,1983).
triangulation:anapproachtovalidationinwhichconvergentfindingsaresoughtacrossvaryingmethods,datacourses,anddatasourcesrecentlyemphasizedin
relationtoqualitativeresearchmethods.
zoneofproximaldevelopment(ZPD):therangeofbehaviorslyingbetweenindependentfunctioningandfunctioningthatmustbefacilitatedbyamoreexpert
interactionpartnerthoughttoillustrateachildsemergingmasteryorlearningreadiness.
StudyQuestionsandQuestionstoExpandYourThinking
1.Onthebasisofyourreadingofthischapter,formulatethreeideasforresearchprojectsaimedatclarifyingsomepsychometriccharacteristic(e.g.,validityfora
purpose,reliability)ofaspecificdescriptivemeasure,thusmakingitmoreclinicallyuseful.
2.Lookatarecentissueofajournalcontainingarticlesonchildrenwithlanguageimpairments.SeeifyoucanfindexamplesofprobesthatcouldbeaddedtoTable
10.3.
3.Engageinaconversationwithtwodifferentpeopleforaperiodof10minuteseach,ideallytaperecordingitwiththeirknowledgesothatyoucangobackoverthe
conversations.Thencreatealistofthefactorsaffectingyourwordchoice,thelengthofyoursentences,thestructureofyoursentences,thenatureofyourturntaking,
andsoforth.Canyougrouptheitemsonyourlistintorelatedfactors?Onceyouhavedonethis,considertheextenttowhichchildrenscommunicationsarelikelytobe
similarlyaffectedinthecourseofcollectingalanguagesample.
4.Considerwaystotriangulateinformationaboutachildslackofsuccessinareadingclassinaregularfirstgradeclass.Developasmallsetofrelatedquestionsabout
thechildandthecontextandthenconsiderwhatkindsofmeasuresmightprovideyouwitharichunderstandingofthechildsdifficulties.
5.Findoutwhatcoordinatedassessmentmethodsexistinanyclinicalsettingsthatservechildrentowhichyouhaveaccess.Considerwhatbenefitsmightbegained,
andatwhatcosts,ifgreaterintegrationweretooccuracrossprofessionalroleswithinthatsetting.
RecommendedReadings
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Kovarsky,D.(1994).Distinguishingquantitativeandqualitativeresearchmethodsincommunicationsciencesanddisorders.NationalStudentSpeechLanguage
HearingAssociationJournal,21,5964.
Olswang,L.B.,&Bain,B.A.(1991).Whentorecommendintervention.Language,Speech,andHearingServicesinSchools,22,255263.
Page287
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CHAPTER
11
ExaminingChange:IsThisChildsLanguageChanging?
TheNatureofExaminingChange
SpecialConsiderationsforAskingThisClinicalQuestion
AvailableTools
PracticalConsiderations
Davidis8yearsoldandwasdiagnosedattheageof7withafatalformofageneticneurodegenerativedisease,adrenoleukodystrophy.Hehaddeveloped
normallyuntilaboutage6,whenhebeganshowingsignsofclumsinessandbehaviorproblemsthathadinitiallybeenattributedtothestressesofacross
countrymoveandbeginningfirstgrade.Currently,hefollowssimpleverbaldirectionswithsomeconsistencybutrarelyspeaks.Hisfamilyisinterestedin
bothhiscurrentlevelofcomprehensionandininformationabouttherateatwhichhiscommunicationskillsaredecliningsothattheycanfacilitatethe
childsparticipationinthefamilyandplanmoreforhisongoingcare.
Tamika,a5yearoldgirlwithspecificexpressivelanguageimpairment,hasbeenseenfortreatmentsinceage3.Initiallyhertreatmentwasaimedat
increasingthefrequencyandintelligibilityofsinglewordproductionsmorerecentgoalshavefocusedonheruseofgrammaticalmorphemesand
monitoringcomprehensionofdirections.InhereffortstoadjustTamikastreatmentandmonitorheroverallprogress,Tamikasspeechlanguage
pathologistusesperiodicstandardizedtestingalongwithfrequent
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informalprobes,includingprobesoftreated,generalization,andcontrolitems.Thespeechlanguagepathologistisconcernedaboutherabilitytoassessthe
trueimpactoftreatmentonTamikassocialcommunicationwithpeersandfamilymembersbecauseTamikasfamilyspeaksBlackEnglish,whereasthe
cliniciandoesnot.ShewouldliketofindanappropriateassessmentstrategytohelpdocumentTamikasongoingcommunicationskills.
ThefivecertifiedspeechlanguagepathologistsworkingwithinasmallVermontschooldistrictareeagertodemonstratetheefficacyoftheirworkwith
schoolagechildrenbecauseofconcernsaboutcutbacksinneighboringspecialeducationbudgets.TheydecidetoparticipateinASHAsNationalOutcomes
MeasurementSystemandbegincollectingdataforeachoftheirstudents.Inaddition,becauseoftheircommitmenttoimprovingthequalityoftheir
practice,theyalsodecidetouseacomputerizedlanguagesamplingsystemwithalloftheirpreschoolandfirstgradechildrenwithlanguageproblems.
TheNatureofExaminingChange
TheexaminationofchangeinchildrenslanguagedisordersactuallyencompassesafairlylargenumberofrelatedquestionsIsthischildsoveralllanguagechanging?
Whataspectsinparticulararechanging?Isobservedchangelikelytobeduetotreatmentratherthantomaturationorotherfactors?Shouldaspecifictreatmentbe
continued,orhasmaximumprogressbeenmade?Shouldterminationoftreatmentoccur?Howeffectiveisthisparticularclinicalpracticegroupinachievingchangewith
thechildrenitserves?Theseassessmentquestionspresentsomeofthemostchallengingissuesfacingspeechlanguagepathologyprofessionals(e.g.,Diedrich&
Bangert,1980Elbert,Shelton,&Arndt,1967Mowrer,1972Olswsang,1990Olswang&Bain,1994).
Describedwithregardtoasinglechild,methodsusedtoexaminechangewillfueldecisionsregardinghowthechildmovesthroughagiventreatmentplan,whether
alternativetreatmentstrategiesshouldbeexplored,and,finally,whethertreatmentshouldbeterminated.Providingamoreformalcategorization,CampbellandBain
(1991)drewontheframeworkofRosenandProctor(1978,1981)todescribethreedimensionsorkindsofchange:ultimate,intermediate,andinstrumental.
Ultimateoutcomesconstitutegroundsforendingtreatment,andtheyshouldbeestablishedattheinitiationoftreatment.Theyaresimilartolongtermtreatment
objectives,withlevelsoffinalexpectedperformancedefinedintermsofageappropriate,functional,ormaximalcommunicativeeffectiveness(Campbell&Bain,
1991,p.272).Modificationofanultimateoutcomemightoccur.Forexample,afunctionaloutcomelevelmightinitiallybesetforachildbecauseofexpectationsthat
performanceatalevelwithsameagepeerswasunrealistic.However,iftreatmentdatasuggestedotherwise,arevisioninoutcomelevelwouldbeappropriate
(Campbell&Bain,1991).
IntermediateoutcomeswereseenbyCampbellandBain(1991)asmorespecificandnumerousforagivenclient.Theyrelatetoindividualbehaviorsthatmustbe
acquiredinorderfortheultimateoutcometobeachievedandforprogressionthrough
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agivenhierarchicallyarrangedtreatmenttooccur.Datafromtreatmenttaskswithinasessionaregivenasanexampleofsuchdata.
Instrumentaloutcomesillustratethelikelihoodthatadditionalchangewilloccurwithoutadditionaltreatment(Campbell&Bain,1991).Datadocumenting
generalizationfitintothisthirdcategory.CampbellandBainacknowledgedthatthistypeofoutcomeischallengingtoidentifybecauseofthedifficultyinknowingat
whatpointevidenceofgeneralizationreliablypredictsimprovementtowardsultimateoutcomes.
Thefeaturethatmostcomplicatestheassessmentofchangeinchildrenisthatchildrensbehaviorischaracterizedbychangestemmingfromavarietyofsources,most
ofwhicharerelatedtogrowthanddevelopment.Withfewexceptions,childreneventhosewithquitesignificantdifficultiesarebenefitingfromdevelopmental
advancesthatenhancetheircommunicationskills.Sometimeschangeoccursbroadlyandsometimesinsomeareasmorethanothers.Evenchildrenwhohavesustained
severebraindamageduringearlychildhoodwillexperiencedevelopmentalbenefitsaswellasthephysiologicalbenefitsofbiologicalrecovery.Onlyafewexceptionsto
thisupwardtrendexistforexample,inchildrenwithverysevereneurologicdamageorwithneurodegenerativediseaseandinchildrenwhotendtoregressin
performancewhentherapyiswithdrawn(e.g.,somechildrenwithdevelopmentaldyspraxiaofspeechormentalretardation).Inallcases,however,thespeech
languagepathologistsassessmentofwhetherchangeisoccurringandwhyitisoccurringmustbegaugedonanterrainthatisrarelyflatandissometimesaseriesof
foothills.
Clinicalquestionsinvolvingchangemakeuseofmanyofthesametypesofmeasuresdiscussedinchapters9and10andoftenexaminesimilarissuesacrosstheadded
dimensionoftime.Nonetheless,despitetheirimportanceforworkwithchildrenwithlanguagedisorders,atleastuntilrecentlysuchquestionshavegenerallyreceived
lessattentionthanquestionsrelatedtoscreening,identification,ordescriptionatagivenpointintime.Thankfully,avarietyofexternalfactorsaffectingclinicalpractice
describedinprecedingchapters,suchasthedemandforgreateraccountabilityinschoolsandhospitals,arehelpingtoencourageandevenmandategreaterresearch
attentiontotheassessmentofchange(Frattali,1998bOlswang,1990,1993,1998).
Once,broadquestionsregardingthevalueoftreatmentapproacheslayprincipallywithinthepurviewofresearchers,whoconductedtreatmentefficacyresearchin
highlycontrolledconditions.Overthepastdecade,however,concernsaboutaccountabilityhavecausedindividualprofessionalsinspeechlanguagepathologyto
becomemoreactiveincollectingandusingsuchdataaswell(Eger,1988Eger,Chabon,Mient,&Cushman,1986).Theprimaryemphasisonevidenceobtainedin
tightlycontrolledconditionshasbeenshiftedtoincludeemphasesonevidenceobtainedundertheveryconditionsinwhichtreatmentistypicallyconducteddatathat
aretypicallyreferredtoasoutcomes.
Inthischapter,thespecificconsiderationsaffectingtheassessmentofchangeinclinicalpracticeareaddressed,followedbythespecialconsiderationsrelatingtotools
thatareavailabletoaddressthisissue.Finally,practicalconsiderationsrelatedtooutcomeassessmentarediscussedforthewaysinwhichtheyshapeprofessional
practicesinthisareaofassessment.
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SpecialConsiderationsforAskingThisClinicalQuestion
Atleastfourspecialconcernscomplicatetheprocessofansweringclinicalquestionsregardingchange:(a)identifyingreliable,orreal,change(b)determiningthatthe
changethatisobservedisimportant(c)determiningresponsibilityforchangeand(d)predictingthelikelihoodoffuturechange(Bain&Dollaghan,1991,Campbell&
Bain,1991McCauley&Swisher,1984Schwartz&Olswang,1996).Theseconcernsaffectbothglobalinferencesregardingachildsoverallprogressultimate
outcomesaswellasthemorespecificdecisionsinvolvedinspecifictreatmentgoalsintermediateandinstrumentaloutcomes(Bain&Dollaghan,1991Campbell&
Bain,1991Olswang&Bain,1996).
IdentificationofReliableandValidChange
Becauseexaminationofchangedependsonacomparisonofmeasurementsmadeonatleasttwooccasions,reliabilityinthemeasurementofchangeisnomorecertain
thanthereliabilityofasinglemeasurement.Infact,thereiseveryindicationthatitislessso(McCauley&Swisher,1984Salvia&Ysseldyke,1995).Inordertoget
anideaoftheeffectofmeasurementerrorontheexaminationofchange,considerthecaseofachildwhosescoreonaspecificmeasuretaken4monthsapartchanges
from15to30,where80isthehighestpossiblescore.Initially,thischangewouldappeartobecauseforsomedegreeofcelebrationmorerestrainedifyoulooked
justatthenumberofpointsgainedoutofthenumberpossiblelessrestrainedifyoulookedatthefactthatthechildhaddoubledhisscore.However,onceyouremind
yourselfthatmeasuresvaryintheirreliability(sometimesquitewildly),yourealizethatmoreinformationisneededbeforepartyinvitationscanbesentout.Depending
onthereliabilityofthemeasure,eachobservedscorecouldfallquiteoffthemarkofthetesttakersrealscore,withunfortunateconsequencesforthebelievabilityof
observationsaboutthedifferencebetweenthetwotestings.Thedifferencebetweenthesetwoscorescouldbedescribedasadifferencescoreor,morefrequentlyin
thiskindofsituation,againscore.
Infact,gainscoresareoftenlessreliablethanthemeasuresonwhichtheyarebased(Mehrens&Lehman,1980Salvia&Ysseldyke,1995).Althoughconcernsabout
gainscoresaretypicallyexpressedinrelationtostandardizednormreferencedmeasures,theyapplyequallytootherquantitativemeasures.Thenatureofthemeasure
usedintheprecedingexamplewasintentionallyambiguousinordertoemphasizethatpoint.
Theadvantageofsomestandardizednormreferencedtestsistheavailabilityofinformationallowingonetoestimatetheriskoferrorassociatedwithindividualgain
scores.Usingthestandarderrorofmeasurementandmethodslikethoseusedtoexaminedifferencescoreswhentheyoccurinprofiles,itispossibletoexaminethe
likelihoodthatadifferencescoreisreliable(Anastasi,1982Salvia&Ysseldyke,1995).Indeed,sometestsincludegraphicdevicesontheirscoringsheetsthatwill
helpusersdeterminewhetheradifferenceislikelytobereliable.However,thereisstillreasontobelievethatnumerousnormreferencedtestscontinuetofailtoprovide
thisinformationforusers(Sturneretal.,1994).
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Theproblemfacingnormreferencedinstruments,however,isequallysharedorevenmoreintenseforinformalmeasures:Informalquantitativemeasureswillalmost
neverprovidethatinformation.Thus,additionalstrategiesareneededforprovidingevidenceofreliabilitythatis,evidencethatameasureislikelytobeconsistent
overshortperiodsoftime,whenusedbydifferentclinicians,andsoforthandisthusabletoreflectrealchange,ratherthanerror,whenitoccurs.Asyouwillseelater
inthischapter,singlesubjectdesignsconstitutethemostpowerfulofthesestrategies.
Asasophisticatedobserverofpsychometricproperties,youmaybewaitingfortheothershoetodropthevalidityshoe.Althoughitmightbepossiblefordevelopers
ofhighlydevelopedstandardizedmeasurestostudytheabilityoftheirmeasuretocapturesignificantchangeasaformofcriterionrelatedvalidityevidence,theyalmost
neverdoso.Instead,formostmeasuresinspeechlanguagepathologyandotherappliedbehavioralsciencesaswell,theexaminationofvalidityhasbeencouchedin
termsofdiscussionsofimportance:Isobservedchangethatappearstobereliablealsoimportant?
DeterminingThatObservedChangeIsImportant
Issuesabouttheimportanceofchangecanbecomplex.Theyincludequestionssuchas,Isthechangelargeenoughtobesignificant?andIsthenatureofthechange
suchthatitislikelytoaffectthechildscommunicativeandsociallife?ThesearesomeofthequestionsthatBainandDollaghan(1991)exploredunderthenotionof
clinicallysignificantchange.
Anumberofcomplementaryindicatorsofimportancehavebeenputforward.Themostimportantoftheseare(a)effectsizeDidmuchhappen?(Bain&
Dollaghan,1991)(b)socialvalidationDiditmakeadifferenceinthispersonscommunicativelife?(Bain&Dollaghan,1991Campbell&Bain,1991Kazdin,
1977,1999Schwartz&Olswang,1996)and(c)theuseofmultiplemeasures(Campbell&Bain,1991Olswang&Bain,1994Schwartz&Olswang,1996).
EffectSize
Inthestatisticalandresearchdesignliterature,adistinctionismadebetweenstatisticalsignificanceandsubstantiveimportance,ormeaningfulness.Thatdistinction,
althoughoftenoverlookedbyresearcherswhofocusonstatisticalsignificanceasifitweretheholygrail(Young,1993),isavaluableoneforourthinkingaboutthe
clinicalimportanceofchangeweobserveinchildren.Effectsize,whichreferstothemagnitudeofdifferenceobserved,isfrequentlydiscussedinrelationtosubstantive
importance,orclinicalsignificance,andisdiscussedatsomelengthlaterinthissection.
Statisticalsignificanceisarelativelystraightforwardconcept.Specifically,whenaresearchfindingisstatisticallysignificant,astatisticaltesthassuggestedthatthefinding
isunlikelytohaveoccurredbychance,thatitisrare(PedhazurandSchmelkin,1991).Morecomplex,however,isthematterofdeterminingwhetherastatistically
significantfindingismeaningful,thatis,whetheritsaysanythingimportantaboutthematterunderstudy(PedhazurandSchmelkin,1991).Atermfrequentlyusedto
refertothemeaningfulnessorsubstantiveimportanceofadifferencetoclinicaldecisionmak
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ingisclinicalsignificance(Bain&Dollaghan,1991Bernthal&Bankson,1998).Othertermsappliedtothisconceptintherichpsychologicalliteratureonthetopic
includesocialvalidity,clinicalimportance,qualitativechange,educationalrelevance,ecologicalvalidityandculturalvalidity(Foster&Mash,1999).
Aresearchexampleusingadifferencebetweentwogroupsatasinglepointintimecanhelpillustratethedistinctionbetweenstatisticalsignificanceandsubstantive
importance.Inaresearchstudyonemightcomparetheperformanceoftwogroupsonagiventestwith100itemsandfindthatthetwogroupsdifferedintheir
performancebyjust2items.Further,thedifferencemightbeshowntobestatisticallysignificant.Despitethestatisticalsignificance,however,mostobservers,ifaware
ofthesizeofthedifference,wouldconsideradifferenceofjust2pointstomeritnomorethanayawnnomatterhowmuchverbalarmwavingtheresearcherin
questionmightusetoinspireinterest.Incontrast,ifamuchlargerdifferencehadbeenobtainedandfoundtobestatisticallysignificant,mostobserverswouldbemoved
toraptattention,havingbeenpersuadedthatthebasisforgroupassignmentshadatleastsomesortofimportantrelationshiptothesubjectcoveredbythetest.
Usingananalogousclinicalexample,onecanimagineachievingaveryconsistentresultwhenusingaparticulartreatmentwithagivenchildforinstance,Tamika,from
theintroductionofthischapter.PerhapsTamikamakesgainsofoneortwoitemsonuntreatedprobesthatareusedoverthecourseofasemestertomonitorher
progressintheuseofgrammaticalmorphemes.Thatrelativelyhighconsistency(orreliability)ofchange,however,wouldprobablynotpleaseyou(orTamika)and
wouldprobablysendyouscramblingtofindanalternative,moreeffectiveinterventionstrategy.TheclinicalsignificanceofchangeobservedforTamikasimplywould
notwarrantcontentmentwiththecurrenttreatment.
Effectsize,whichcanbemeasuredinavarietyofways,generallyreferstothemagnitudeofthedifferencebetweentwoscoresorsetsofscores,orofthecorrelation
betweentwosetsofvariables(Pedhazur&Schmelkin,1991).Authorsregularlysuggestthatresearchersinspeechlanguagepathologyandelsewhereappeartofixate
onstatisticalsignificanceattheexpenseofeffectsizeorothermeasuresthataremoreamenabletodecisionsaboutthevalueofinformationtodecisionmaking(e.g.,
Pedhazur&Schmelkin,1991Young,1993).Becauseinformationaboutthereliabilityofdifferencescoresisdifficultandoftenimpossibletocomebyforthemeasures
cliniciansusetoexaminechange,cliniciansandtheirconstituentsaremuchmorelikelytowanttoinspecttheactualmagnitudeofchangeswithaneyetowarditsclinical
meaning.Effectsizealonecannotbethesoledatausedtodeterminethemeaningofaparticulardifferencebecauseotherfactorswillneedtobetakenintoaccount
(e.g.,thesocialsignificanceofthedifference,thelikelygeneralizabilityofthedifference).However,itcanbeanimportantelementinthatprocess(Bain&Olswang,
1995).
BainandDollaghan(1991)describedacoupleofstrategiesforlookingateffectsize.Oneofthesestrategiesusesstandardscores,takesintoaccounttheabsolute
amountofchangethathasoccurred,andisthereforeprimarilylimitedtousewithnormreferencedstandardizedmeasures.Theotherusesageequivalentscores,looks
attherelativesizeofchange,andissubjecttothevagariesassociatedwiththatinferiormethodofcharacterizingperformance.
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Usingstandardscorestoexaminechange,BainandDollaghan(1991)notedthattheamountofchangecanbeexpressedintermsofstandarddeviationunitsand
comparedagainstanarbitrarystandard.Thus,adifferencemightbeconsideredofpracticalsignificanceifitmetorexceededachangeofsomanystandarddeviation
unitswiththoseauthorsciting1standarddeviationasafrequentlyusedstandard.Forinstance,imaginethatatTime1,achildreceivesastandardscoreof70ona
testwithameanof100andstandarddeviationof10.Then,atTime2,thechildreceivesascoreof81onthatsametest.Theamountofchangewouldbeconsidered
ofclinicalsignificancebecauseitcorrespondedtoslightlymorethanonestandarddeviation.
Aslongasthemeasurethatisbeingusedhasbeencarefullyselectedforitsvalidityforthegivenchildandcontentarea,thismethodseemsareasonableoneformany
purposes.Inparticular,itsuseisstrengthenedifthetimeperiodencompassedbythecomparisonresultsinacomparisonagainstasinglenormativesubgroup.
Specifically,ifachildsperformancecanbecomparedwithjustasinglenormativesubgroupovertime(e.g.,allofthechildrenage5years,1monthto6years),then
theextravariabilityintroducedbycomparinghisherfirstperformancewithonesetofchildren(e.g.,thechildrenfrom5yearsto5years,6months)andthenwith
another(e.g.,thechildrenfrom5years,7monthsto6years)canbeavoided.
Theuseofstandardscoresisalsopreferabletothesamemethodappliedusingageequivalentscoresandacutoffestablishedaroundacertainageequivalentgain
(Bain&Dollaghan,1991)becauseofthepoorreliabilityofsuchscores(McCauley&Swisher,1984).Admittedly,atthispoint,selectionofthecutoffinthisstrategy
usingstandardscoresisarbitraryhowmuchchangeshouldberegardedasclinicallysignificantcanserveasapointofconsiderableargument.However,additional
researchbytestdevelopersandotherscouldvalidatespecificlevelsinamannerquiteanalogoustothatproposedforcutoffsusedinotherareasofclinicaldecision
making(Plante&Vance,1994).
TheProportionalChangeIndex(PCI),thealternativestrategyforexaminingeffectsizedescribedbyBainandDollaghan(1991),providesarelativemeasureof
changearisingfromtheworkofWolery(1983).Themeasureisrelativeinthesensethatitattemptstoexaminetherateofchangecharacteristicofthechildsbehavior
fortheperiodbeforetreatmentascomparedwiththerateobservedduringtreatment.Specifically,thePCIistheproportioncreatedwhenthechildspreintervention
rateofdevelopmentisdividedbythechildsrateofdevelopmentduringintervention.Thepreinterventionrateofchangeisestimatedbydividingthechildsage
equivalentscoreonameasuretakenjustbeforethebeginningoftreatmentbyhisageinmonths.Therateofdevelopmentduringinterventionisestimatedbydividingthe
gainscoreobtainedforthatmeasurewhenitisreadministeredafteraperiodoftreatmentbythedurationoftreatment.Forachildwhosebehaviorisbeingmonitored
overtimewithoutintervention,themeasuremightbeusedtoexaminetheperiodbeforeobservationwiththatobservedduringtheperiodofobservation.Themeritof
thisparticularmeasureisthatittakesintoaccountthenumberofmonthsactuallygained,thenumberofmonthsinintervention[orobservation]andthechildsrateof
developmentatthepretestdate(Wolery,1983,p.168).Figure11.1illustratesthecalculationofPCIfortwochildren:Shana,whoshowsexcellentgainsinreceptive
vocabulary,withtwiceas
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Fig.11.1.AhypotheticalexampleshowingthecalculationoftheProportionalChangeIndex(Bain&Dollaghan,1991Wolery,1983)fortwochildren.
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muchprogressintreatmentaspriortotreatmentandJason,whoshowsprogressinreceptivevocabularyacquisitionthatisnobetterintreatmentthanithadbeenprior
totreatment.
IfthetworatesofchangeusedintheequationforPCIaresimilar,thecalculatedvalueforPCIwillapproachavalueofone.Ontheotherhand,iftreatmentorother
factorshaveaccelerateddevelopment,thePCIshouldbepositive,withlargerPCIsindicatinggreateracceleration.Thus,forexample,aPCIof3wouldimplythat
changehadoccurredthreetimesasquicklyduringtreatmentasprecedingit.Alternatively,aPCIof.5wouldsuggestthatchangehadoccurredathalftherateduring
thetreatmentorobservationperiodasprecedingit.
Asdescribedearlier,thePCIisusuallyrecommendedforitsutilityinexaminingchangeduringaperiodofinterventioninwhichpositivechangeisexpected.
Nonetheless,itmightalsobeusedifonewereinterestedinexaminingalterationsinratesofchangeoccurringunderconditionslikethosedescribedforDavidatthe
beginningofthechapter.RecallthatDavidhadbeendiagnosedwithaneurodegenerativediseasethatwaspredictedtoresultinskillloss.Itmightalsobeusedunder
conditionsinwhichproblemsindevelopmentweresuspected(asinthecaseofasuspectedlatetalker),butthechildsclinicianhadoptedforawatchandsee
strategywithaplanned6monthreevaluation.
Bain&Dollaghan(1991)notedthatthePCIrestsontwoproblematicassumptions,withthefirstbeingthatchangeinchildrensskillsoccursataconstantrateinthe
absenceofintervention.Aplausiblealternativetothisassumptionisthatchangemayoccuratvaryingratesduringdevelopmentwithchildrensbehaviorssometimes
racingahead,sometimesholdingsteady,andsometimes,perhaps,evenregressingforatime.TheproblemwiththeassumptionofconstantchangeembodiedinthePCI
isaddressedtosomeextentbytheuseofsinglesubjectdesigns,aspecificmethodthatisdescribedingreaterdetaillaterinthechapter.Singlesubjectdesignsescape
thisassumptionthroughthecliniciansactiveexaminationofchangepatternsduringperiodsinwhichinterventionisnotoccurringaswellaswhenitis.Thankfully,too,
thequestionofwhetherchangeisconstantcanbeaddressedempirically.Althoughadditionalinformationisneededtodeterminetheextenttowhichthisassumptionis
tenable,effortstoexaminepatternsofchangeareunderwayandsuggestthatovershortertimeperiodstheassumptionofaconstantrateofchangeisprobablyfalse
(Diedrich&Bangert,1980Olswang&Bain,1985).
ThesecondproblematicassumptionofthePCIliesinitsuseofageequivalentscoresandthetemptationthatitpresentsforclinicianstouseteststhatpresentsuch
scoreswithoutmuchinthewayofempiricalsupporteitherfortheageequivalentscoresorforthetestinitsentirety.BainandDollaghan(1991)acknowledgedthis
potentialdrawbackandimplicitlyrecommendedthatcliniciansshouldsearchforthehighestqualitymeasurestousefordocumentingchange.However,theyalso
suggestedthatintheabsenceofsuchmeasures,thePCImayofferabetteralternativethanthesimpleassumptionthatagaininageequivalentscoresovertime
representsprogress.
AnadditionallimitationaffectingthePCIistheneedforuserstoadoptanarbitrarybasisfordeterminingwhenacertainamountofchangeissufficienttosupporttheuse
oftimeandotherresourcesrequiredtoachieveaparticulargain.Thusfar,nomeas
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uredescribedhereinorproposedelsewherehasbeenabletoclaimarationalbasisforitsparticularstandardorcutoff.
Inprinciple,then,thetwomeasuresofeffectsizethatIhavedescribed(standardscoregainscoresandPCI)seemtorepresentstrongcontendersforuseindecisions
abouttheimportanceofobservedchangebothforchangeobservedduringtreatmentorforchangeobservedoveraperiodoftimeinwhichinterventionisnotused
butachildsperformanceismonitored.However,additionalresearchisneededtovalidatetheiruseindecisionmaking,particularlyinthecaseofthePCIinwhichthe
strengthofthelogicbehindthemeasureisunderminedbyitsdependenceonageequivalentscores.Ialsocallreadersattentiontothefactthatbothofthesemethods
willmorereadilybeimplementedforstandardizednormreferencedteststhanforothertypesofmeasuresthatmightbeusedtodescribeachildslanguage.
SocialValidation
Inexaminingtheimportanceofchange,cliniciansarealmostalwaysinterestedinconsideringwhetherobservedchangesconformtotheoreticalexpectations,especially
developmentalexpectations,thatimplyahierarchyoflearninginwhichsomebehaviorsareseenasprerequisitestoothers(Bain&Dollaghan,1991Lahey,1988).Put
differently,cliniciansareinterestedindeterminingwhetherthechildhasmadegainsthattheoreticallyappeartobemovementsalongtherightpath.Gainsonthose
behaviorsthatareseenasprecursorstofurtheradvancementarejudgedtobemoreimportantthanthosethatarenot.
Additionally,clinicianshavealwaysvaluedandsometimessolicitedfamilyandteacherreportsassertingprogressasdefactoevidencethatchangehasoccurredandis
important.Thiswayofthinkingabouttheimportanceoflanguagechangefallsunderthetermsocialvalidation.Socialvalidationalsocomplementstheuseofeffectsize
infosteringtherichestpossibleconceptualizationofimportance.Acknowledgingthatsuchevidencehasvalueisconsistent,firstofall,withanappreciationthatthe
functionalandsocialeffectsofcommunicationdisorderswarrantgreaterincorporationintoclinicalpractice(Frattali,1998bGoldstein&Geirut,1998Olswang&
Bain,1994).
Inadifferentcontext(discussingresearchsignificanceasopposedtoclinicalsignificance),PedhazurandSchmelkin(1991)offeredaquotationfromGertrudeStein:A
differenceinordertobeadifferencemustmakeadifference(p.203).Ifrephrasedslightly,thisquotationalsoseemstospeaktoeffortstoexaminetheimportanceof
changeinchildrenslanguage:Forchangeinachildslanguagetobesignificant,itmustmakeadifferenceinthechildslife.
Useofmeasurestoexaminethefunctionalandsocialimpactofchangeisalsoconsistentwiththegrowingappreciationofqualitativedatadescribedinthelastchapter.
Becausequalitativedataareunapologeticallysubjectiveinnature(Glesne&Peskin,1992),theymaybeusedveryeffectivelymoreeffectivelythanreamsof
quantitativedatatoaddressquestionsrelatedtothesocialcontextsupportingandaffectingachildandtohowthechildisviewedinthatcontext.Overthepastfew
decades,quantitativeaswellasqualitativemeasureshavereceivedgrowingattentionforthepurposeofassessingfunctionandsocialimpactsoftreatment(Bain&
Dollaghan,1991
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Campbell&Bain,1991Campbell&Dollaghan,1992Koegel,Koegel,VanVoy,&Ingham,1988Olswang&Bain,1994Schwartz&Olswang,1996).
Kazdin(1977)describedaprocessbywhichsuchmeasurescanbeusedtolookattheimportanceofbehavioralchange.Inparticular,hefocusedonbehavioral
changeachievedthroughappliedbehavioranalysisandbasedhisworkonthatofWolfandhiscolleagues(e.g.,Maloneyetal.,1976Minkinetal.,1976Wolf,
1978).Kazdindefinedsocialvalidationastheassessmentofthesocialacceptabilityofintervention,wheresuchacceptabilitycouldbeassessedwithregardto
interventionfocus,procedures,andimportantlyforthisdiscussionbehaviorchange.Morerecently,hehasdefinedclinicalsignificanceasthepracticalorapplied
valueorimportanceoftheeffectofaninterventionthatis,whethertheinterventionmakesreal(e.g.,genuine,palpable,practical,noticeabledifferenceineverydaylife
totheclientsorotherswithwhomtheclientsinteract(Kazdin,1999,p.332).AlthoughKazdinandnumerousotherauthorsworkingintheareaofclinicalpsychology
(e.g.,Foster&Mash,1999Jacobson,Roberts,Berns,&McGlinchey,1999Kazdin,1999)havecontinuedtoelaborateontheconceptsoutlinedinKazdin(1977),
basicissuesraisedinthatearlierworkremainrelevant.Inparticular,thisrelevancederivesfromthelackofempiricalvalidationsupportingmanyofthehighlydeveloped
measuresofclinicalsignificanceproposedintheclinicalpsychologyliterature(Kazdin,1999).
Kazdin(1977)recommendedtwogeneralapproachestothesocialvalidationofbehaviorchangethathavebeenembracedbyanumberofresearchersinchild
languagedisorderssocialcomparisonandsubjectiveevaluation(Bain&Dollaghan,1991Campbell&Bain,1991Campbell&Dollaghan,1992Olswang&Bain,
1994Schwartz&Olswang,1994).Socialcomparisoninvolvescomparisonsconductedpreandpostinterventionbetweenbehaviorsexhibitedbythechildreceiving
interventionwiththoseofagroupofsameagepeerswhoareunaffectedbylanguageimpairment(Campbell&Bain,1991).Astutereaderswillfindthismethod
reminiscentofanormativecomparison.However,insteadofcomparisonsonastandardizedmeasureagainstarelativelylargegroupofostensiblepeers,herethe
childsperformanceonamoreinformalmeasure(usuallyacliniciandesignedprobe)iscomparedagainstthatofarelativelysmallgroupofactualpeers.Thevalueof
thistechniquewillcertainlybeaffectedbythecaretakentochoosearepresentative,ifsmall,comparisongroup.Inaddition,itmayalsoprovemostvaluableincases
whereanormreferencedcomparisonusingalargergroupisunavailablebecausenoappropriatemeasuresorappropriatenormativesamplesexistforthetargeted
behaviorandparticularclient.
Subjectiveevaluationinvolvestheuseofproceduresdesignedtodeterminewhetherindividualswhointeractfrequentlywiththechildseeperceivedchangesas
important(Kazdin,1977).Methodsthathavebeenproposedforthesepurposesinspeechlanguagepathologyrangefromquiteinformaltorelativelysophisticated.
Thus,forexample,attheinformalendofthecontinuum,ithasbeensuggestedthatparents,teachersandotheradultswhoarefamiliarwiththechildbeaskedto
appraisetheadequacyofachildsperformancefollowingaperiodofintervention(Bain&Dollaghan,1991Campbell&Bain,1991).Clearlythesedatamaybe
qualitativeinnature(Olswang&Bain,1994Schwartz&Bain,1995)andwouldbenefitfromthecliniciansuseoftriangulationwithothersources,asdiscussedinthe
previouschapter,
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thusimplyingtheuseofmultiplemeasures.ThisisconsistentwiththeideaemphasizedinKazdins(1999)recentwork,thatclinicalsignificanceinvariablyincludesa
frameofreferenceorperspective(p.334).
Amoreintermediatelevelofcomplexitymightinvolveuseofanexistingratingscale,suchastheObservationalRatingScalesoftheClinicalEvaluationofLanguage
Functions3(Semel,Wiig,&Secord,1996),inwhichasimilarratingscaleiscompletedbythechild,theparent(s),andaclassroomteacher.Thegrowinginterestin
thedevelopmentoffunctionalmeasuresforusewithchildreninschoolsettingswillcertainlyprovidemanynewalternativesofthiskind.Additionofthistypeofmeasure
totheverydetailedmeasuresofprogressbeingusedforTamikamaynotonlyprovidestrongevidenceoffunctionalimpact,butmayalsohelpreducepossiblebiasin
theassessmentofprogressachievedbyachildwhospeaksadialectusuallyunderrepresentedinstandardizedmeasures.
Ahigherlevelofcomplexityintheuseofsubjectiveevaluationwouldinvolvetheuseofapanelofnaivelistenerswhocouldbeaskedtousearatingstrategysuchas
directmagnitudeestimationtomakejudgmentsaboutsomeaspectofthecommunicativeeffectivenessofachildsproductions.CampbellandDollaghan(1992)
describedtheuseofa13personpanelthatwasaskedtoratetheinformativeness(amountofverbalinformationconveyedbyaspeakerduringaspecifiedperiodof
spontaneouslanguage,p.50)ofutterancesproducedbyninechildrenwithbraindamageandtheircontrols.Thisexampleofsocialvalidationisparticularlycomplex
giventhatCampbellandDollaghanappliedahybridmethodthatusedbothsocialcomparisonandsubjectiveevaluationcomponents.Althoughmethodsascomplexas
theseareprobablynotpracticalinmanyclinicalsettings,theyprovideavaluableillustrationofhowflexiblesocialvalidationprocedurescanbe.
Insummary,socialvalidationmethodsaddgreatlytoourestimationofhowimportantanobservedchangeis.Inparticular,theycanhelpusseehowobserved
differencesmakeachangeinachildscommunicativeandsocialfunctionsandopportunities.Theyvarydramaticallyintermsoftheircomplexityandsophistication.
Further,becausetheycanbeappliedtoqualitativeaswellasquantitativedata,theuseofinformalmeasuresisanespeciallyattractivefeature.
UseofMultipleMeasures
Theaugmentationofmeasuresdesignedtodirectlyassesslinguisticbehaviorswithmeasuresintendedtoprovidesocialvalidationconstitutesoneveryimportantwayin
whichmultiplemeasuresmaybeusedtoenhanceourabilitytoteaseoutthecontributionoftreatmenttochange.However,thekindsofmultiplesourcesofdata
recommendedbyclinicalresearchersdonotstopthere(Campbell&Bain,1991Olswang&Bain,1994Schwartz&Olswang,1996).Theyextendtoconsidering
thevalueofmultipleindicatorsinhelpingonebestaddresstheconstructofinterestanideathatwasintroducedinFig.2.2andinchapter2.Whethertheconstructis
onerelatedtoaparticularlinguisticskillortoachildscommunicativefunctionwithinagivensetting,thereisgeneralagreementthatmakinguseofseveralmeasurescan
bestsupportconclusionsabouttheconstructunderconsideration.
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Writingfromaresearchperspective,Primavera,Allison,andAlfonso(1996)notedthatCookandCampbell(1979)introducedtheideaofmultioperationalisminto
behavioralresearch,inwhichaconstructisoperationalizedusingasmanyindicatorsaspossibleinordertotrulycaptureitsessence.Inasimilarvein,Pedhazurand
Schmelkin(1991)offeredadetailedaccountexplainingwhytheuseofasingleindicatorofaconstructalmostalwaysposesinsurmountableproblems(p.56)related
toknowingtowhatextenttheindicatorreflectstheconstructratherthanerror.Whereasresearchersmayhavegreateropportunitiesandrewardsforpracticing
multioperationalism,clinicians,too,canbenefitfromitsapplication.Whenaclinicianusesasinglemeasure(e.g.,asingletestofreceptivevocabulary)tosupport
conclusionsaboutaconstruct(e.g.,receptivelanguage),boththeclinicianandhisorheraudienceeitherimmediatelyfeelskepticalthatthepart(receptivevocabulary)
representsthewhole(receptivelanguage)orshouldfeelskepticaliftheygiveitmuchthought.Evenifconclusionsarelimitedtothoseaboutreceptivevocabulary,
however,aquickreminderaboutthenatureofmostsuchteststhattheyfrequentlyaddressonlypictureablenounsshouldcausethecliniciantopause.Clearly,the
singleindicatorseemsunlikelytocapturetheconstructofinterest.Thetimedemandsofclinicalpracticecansometimesmakethecollectionofevenonemeasureseem
onerousandtheideaofmultiplemeasuresanauthorsfantasyandcliniciansnightmare.However,becomingawareofthevalueofsuchmeasuresmayhelpclinicians
decidetotaketheextratimeandprovidesupportforthatdecisioninselectcases.Further,incaseswheretheuseofmultiplemeasureshasnotseemedpractical,itcan
helpleadtomorelimitedandthereforemorevalidinterpretations.
Inthissection,threeprincipalstrategiesforexaminingtheimportanceofchangewerebrieflyintroduced:useofmultiplemeasures,socialvalidationandeffectsize.
AuthorssuchasBain,Campbell,Dollaghan,andOlswanghavebeguntoventuredeepintotheliteraturesofrelateddisciplinestoexplorethisrelativelynewterritoryfor
theresourcesitmightcontributetomeasurementincommunicationdisorders.Giventhevalueoftheirworktodate,theireffortswillundoubtedlycontinueandbejoined
bythoseofotherswhorespondtorecentcallsformorepersuasiveevidencethatspeechlanguagepathologyservicesmakeadifferenceforchildrenwith
communicationdisorders.
DeterminingResponsibilityforChange
Whereasdeterminingtheextenttowhichchangeinlanguagehasoccurredanddeterminingitsimportancearecloselyrelatedtasks,verifyingtheclinicianscontributions
tothatchangeisanaltogetherdifferentandmoredauntingtask.Granted,simplynotingtheextenttowhichchangehasoccurredanditsnaturecanbeusefulininstances
wherenointerventionhastakenplaceforexample,incaseswhereachildsdevelopmentisbeingmonitoredbecauseofsuspicionthatthechildisalatetalker.More
commonly,assessmentofchangeforchildrenintreatmentinvolvescaseswhereallstakeholdersarecomfortablewiththeunexaminedassumptionthatchangewillbe
primarilytheresultofinterventionefforts.However,therearetimeswhendemonstratingthattreatmentisresponsibleforobservedchangesiscrucial.Inthiseraof
growingattentiontoaccountabilityandqualityassurance,thesetimesarebecomingmorecommon(Eger,1988Frattali,1998a1998b).
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Thedifficultyinpinningdowncausalexplanationsforhumanbehaviororbehaviorchangeisadrivingforcebehinddevelopmentsinpsychologyandrelateddisciplines
overthepast100years.Againandagain,theproblemwithdeterminingcausalityseemstoberulingoutalternativeexplanationsincaseswherestringentcontrolover
potentialcausesiseithernotpossibleornotethical.Treatmentforlanguagedisordersinchildrenpresentstheclassicdifficultyinthisregard.Thepossibilityoffactors
otherthantreatmentsuchasdevelopment,environmentalinfluences,andchangesinthechildsphysiologythroughrecoveryfromadiseaseprocessortraumamake
itverydifficulttoidentifytreatmentsorindirectmanagementstrategiesashavingcausedgainsthatareseeninachildsperformance.
Atleasttwodesignelementshaveprovidedalogicalbasisforincreasingtheplausibilitythatgainsinperformanceseenwhileachildisundergoingtreatmentare
attributabletotreatmentratherthantoalternativeexplanations.Thesetwoelementsarerepeatedobservationsoveraperiodoftimepriortotheonsetoftreatmentand
theuseoftreatment,generalization,andcontrolprobes.Bothoftheseelementshavebeenincorporatedintotheframeworkofresearchknownassinglesubject
experimentaldesign(Franklin,Allison,&Gorman,1996Kratochwill&Levin,1992McReynolds&Kearns,1983).Inaddition,eachhasbeenidentifiedseparately
asameansofenhancingsupportfortreatmentasacausalfactorincasesofbehavioralgains(Bain&Dollaghan,1991Campbell&Bain,1991Olswang&Bain,
1994Schwartz&Bain,1996).
PretreatmentBaselines
TheuseofmultipleobservationsoveraperiodoftimepriortotheinitiationoftreatmentisfrequentlyreferredtoasabaselineortheAconditioninasinglesubject
experimentaldesign.Multipleobservationsfunctionasawindowintothestabilityofthebehaviorandthemeasureusedtocharacterizeit.Iflittlevariationisobserved,it
seemsmostlikelythatthebehaviorisnotchangingandthatthemeasurebeingusedtotrackthebehaviorisnotintroducingerror(i.e.,thatitisprobablyreliable).This
meansthatdeparturesfromstabilityobservedaftertheonsetoftreatmentcanbemorereadilyattributedtotreatmentthantoeithertheinstabilityofthebehaviorbeing
measuredortomeasurementerror.Thepresenceofstabilityduringbaselineobservationsmightalternativelybeinterpretedassuggestingthatthebehaviorbeing
measuredandthemeasurebeingusedforthatpurposearevarying:inwaysthatcanceleachotheroutamostunlikelyprospect.
Incontrast,whenconsiderablevariationisobserved,itcanbedifficulttodeterminewhichofthetwopossiblesourcesofvariation(changeinthebehaviorvs.errorin
themeasurement)istheculprit.Consequently,asarule,baselinesareeasiesttointerpretandtheyprovidethestrongestsupportforobservingchangesthatmightoccur
underconditionssuchastreatment,whentheyaresufficientlylengthy,shownoobvioustrends,andappeartobestable(McReynolds&Kearns,1983).Withregardto
length,threeobservationsisoftenreferredtoasaminimum(McReynoldsandKearns,1983),withlongerbaselinesrequiredifthebehaviorshowsatrendorotherlack
ofstability.Thepresenceofatrend(consistentincreaseordecreaseindatavaluesinthedirectionofexpectedchangewithtreatment)canbeproblematic,ascanlack
ofstabilityin
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whichbothincreasesanddecreasesinaspecificmeasurearenoted.Becausestabilityisarelativequality,weagainareinapositionoflookingtowardexpertadviceto
helpusagreeonanacceptablerangeofvariation.McReynoldsandKearns(1983)pointedtoahistoricstandardof5to10%.However,theynotedthatlowerlevels
ofstabilityachievedduringabaselinewillsimplynecessitategreateramountsofchangetojustifyclaimsofeffectivetreatment.
Proponentsofsinglesubjectexperimentaldesignswhoarethechiefresourcesforinterpretingbaselinedatahaveoftensuggestedthatvisualinspectionofsuchdatais
sufficientforthedetectionofstabilityandsystematicchange.Recently,however,thecomplexityofthisjudgmenttaskhasledtoquestionsaboutitsuse(Franklin,
Gorman,Beasley,&Allison,1996Parsonson&Baer,1992).Inparticular,researchershavenotedatendencyforvisualanalysistofailtodetectchangewhenithas
actuallyoccurred,thussuggestingalackofsensitivitytosmallerlevelsofchange.Thisreducedsensitivitymaypresentseriousproblemsforclinicianswhobelievethat
smallamountsofchangewillbeimportanttodocumentingtheeffectoftheirtreatment.Ontheotherhand,forthosewhoattempttotargetbehaviorsonwhichthey
expectlargerchanges(largereffectsizes,touseourpreviousterminology)thereductioninsensitivitymayrepresentareasonabletradeoffagainsttherelativesimplicity
ofgraphicanalysis.Nonetheless,clinicianswhomaywishtorelyonvisualanalysiswoulddowelltolookintotheemergingcomplexitiesofthisaidtodatainterpretation
(Franklinetal.,1996Parsonson&Baer,1992).Researchersandclinicianswithsufficientresourcesmightalsoconsideralternativeinterpretationsthatmakeuseof
emergingmethods(Gorman&Allison,1996).
Treatment,Control,andGeneralizationProbes
Theideaoftreatmentandcontrolprobesdrawsonceagainonthesinglesubjectexperimentaldesignliterature(Bain&Dollaghan,1991).Inthatcontext,treatment
probesrepresentquantitativemeasuresfocusingonbehaviorsthatareorwillbethetargetoftreatment.Theyareusuallytheminimumtypeofdatacollectedtoprovide
evidenceofchange.Incontrast,controlprobesrepresentquantitativemeasuresobtainedperiodicallyoverthecourseofastudytoallowthecliniciantomonitorthe
effectsofextraneousvariablesonanindividualsbehavior.Theyareusuallyconstructedorselectedsothattheymeasurebehaviorsthatareunrelatedtothetreated
behavior.Ifthetreatedbehaviorshowschangewhereastheuntreated,controlbehaviormonitoredusingcontrolprobesdoesnot,thenthecliniciancanfeelconfident
thatmaturationandotherfactorshavenotproducedglobaladvancesfromwhichtreatedstimuliwouldhavebenefitedwithorwithouttheimplementationoftreatment.
(Ofcourse,oneoftheperilsinvolvedintheselectionofcontrolprobesisthatdevelopmentalforcesmaycausechangesinthebehaviortheyareusedtotrackeven
withoutadirecteffectoftreatmentDemetras,personalcommunication,February,2000).
Generalizationprobesareusedtotrackbehaviorsthatarerelatedbutdistinctfromthosereceivingtreatment.Thus,theiruseinvolvesaviolationoftheexpectedlack
ofrelationshipfromtreatedbehaviorscharacteristicofcontrolprobeswithinsinglesub
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jectdesigns(Bain&Dollaghan,1991Fey,1988).Intheconstructionofgeneralizationprobes,theclinicianlooksforbehaviorsthatarerelatedtotreatedbehaviorsin
amannerthoughtlikelytocausegeneralizationthatwillaffectthem.Onthebasisofthecurrentunderstandingofgeneralization,generalizationprobeswouldbe
expectedtoshowsimilarbutsmallerchangesthantreatmentprobesinresponsetotheimplementationofaneffectivetreatment.Althoughgeneralizationacross
behaviorsmaybethemostcommondimensioninwhichgeneralizationprobesarestudiedclinically,generalizationacrosssituationswillalsoproveofinterestaswill
generalizationacrosstime(McReynolds&Kearns,1983).
Theuseofgeneralizationandcontrolprobesallowsforacleardemonstrationthattreatmentisbehavingaspredictedrelativetothetargetedbehavior.Specifically,their
usecanhelpdemonstratethattreatmentishavingitsgreatesteffectontreatedbehaviors,alessereffectonuntreatedorothergeneralizationbehaviors,andnoeffecton
controlbehaviors.Theirusecanthuscontributetotheplausibilityofargumentsthattreatment,ratherthanthemyriadofothervariablesthatmighthelpachildsbehavior
improve,istheagentresponsibleforobservedchange.CampbellandBain(1991)furtherarguedthatevidenceofgeneralizationobtainedduringtreatmentoffers
speechlanguagepathologiststheirclearestopportunitytoshowinstrumentaloutcomes(i.e.,outcomessuggestingthelikelihoodthattreatmentwillleadtoadditional
outcomeswithoutfurthertreatment).Moresupportforthesevariedmeasurescomesfromthemotorlearningliterature,inwhichitwasobservedthatdataobtained
duringalearningcondition(e.g.,atreatmentsession)canoverestimatelearningcomparedtogeneralizationormaintenancedata(e.g.,seeSchmidt&Bjork,1992).
Anexampleillustratingtheuseoftreatment,generalization,andcontrolprobesisdescribedinBainandDollaghan(1991)aspartofasinglesubjectdesign.Usingthe
caseofahypotheticalpreschoolerwithSLI,theysuggestedatreatmenttargetconsistingoftheproductionofatwowordsemanticrelationAgent+Action.Asa
generalizationbehavior,theyproposedtheproductionofAction+Objectbecauseitssharedcomponent,Action,wasthoughttomakegeneralizationlikely.Finally,as
acontrolbehavior,theyproposedtheproductionofEntity+Locativebecauseitseemedunlikelytochangewithoutdirecttreatment.Eachprobeconsistedofthe
childspercentageofcorrectproductionof10unfamiliarexemplarsthattheclinicianattemptedtoelicitthroughmanipulationofseveraltoysandthecontext.
Treatment,generalization,andcontrolprobesofteninvolveelicitedbehaviorssuchasthosedescribedunderthatheadingintheprecedingchapter.However,other
measures,suchasperformanceonlanguagesamplesandanalyses,couldalsoserveasmeasuresthatmightbeusedtoexaminetreatment,generalization,andprobe
behaviors.Althoughthereisatendencyfortreatmentprobestobeobtainedfrequentlysothattheprocessoftreatmentaswellastheproductmaybeilluminated
(McReynolds&Kearns,1983),generalizationandcontrolprobesarefrequentlyevaluatedonalessfrequentbasis(Bain&Dollaghan,1991).Thefrequencywith
whichtreatmentprobesareusedmaydependontheexpectedrateofchangeBainandDollaghanpointedoutthatthebehaviorsofachildwithcognitivedelays
indicativeofanoverallslowerrateoflearningmayrequirelessfrequentcollectionofdata.
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DeterminingWhetherAdditionalChangeIsLikelytoOccur
Asanadditionalaspectofexaminingchange,authorshavesometimescalledattentiontothevalueofpredictingwhetherfuturechangeislikely.Inparticular,thisgeneral
questionhasbeenaskedspecificallywithregardtoaddressingpredictionsofchangeattwodifferentendsofthetreatmentprocess:initiationandtermination.First,
successfulpredictionofwhetherchangeislikelymighthelpinjudgingwhethertreatmentshouldbeinitiatedbecauseofachildsreadinessforchangeinaparticular
area(Bain&Olswang,1995Long&Olswang,1996Olswang&Bain,1996).Second,successfulpredictionmighthelpinjudgingwhethertreatmentshouldbe
terminated,oratleasttemporarilydiscontinued,becauseadditionalchangeisunlikely(Campbell&Bain,1991Egeretal.,1986).Bothkindsofquestionswillrequire
substantialempiricalinvestigationstoarriveatuniversalrecommendationsforbestpractices.Nonetheless,eachdependsonevidencethataparticulartechniqueisvalid
forpredictingagivenoutcomethussuggestingthatevidenceofpredictivecriterionrelatedvalidityisattherootofbothofthesequestions.Thisrealizationisimplicitin
theworkofBainandOlswang(1995),inwhichtheysoughttodemonstratethepredictivevalidityofdynamicassessmenttosupportitsuseindeterminingreadinessfor
theproductionoftwowordphrases.
Posingthequestionofwhentreatmentmightmostprofitablybeinitiatedgoesbeyondtheclinicalassumptionthattreatmentshouldbeundertakenanytimeachildis
foundtodemonstrateasignificantprobleminlanguageorcommunicationskills.Thequestionitselfsuggeststhepossibilitythattherearetimeswhenchildrenmayexhibit
evidenceofalanguagedisorderbutthattreatmentwouldbeunlikelytobeeffectiveeitherinaglobalsenseorinrelationtoaspecificdomainorbehavior.Timingthe
onsetoftreatmentoratleasttheonsetoftreatmentaimedatspecifictargetstocoincidewithchildrensareasofreadinesscouldbeexpectedtoyieldmajor
enhancementstotreatmentefficiency(Long&Olswang,1996).
OlswangandBain(1996)discussedtheuseofprofilinginstaticassessmentversusdynamicassessmentastoolstouseinaddressingthequestionofreadiness.Theuse
ofprofiles,whicharemostoftencreatedbycomparingachildsperformancesonseveraltestsorsubtests,wasdiscussedatsomelengthinchapter9.Eventhoughthe
useofprofileshasbeenlargelydebunkedasastrategyforhighlightingdomainsorchildrenthatmightexhibitthegreatestchangeintreatment,OlswangandBain(1996)
decidedbothtopursueitasoneofthefewmethodsinstaticassessmentthathasbeenproposedforaddressingthepredictionoffuturechangeandtocompareitwith
techniquesfromdynamicassessment.
Oneofthegreatestpromisesofdynamicassessmenthasbeenitsuseinidentifyingthemovingboundaryofachildslearning,orzoneofproximaldevelopment(ZPD
Olswang&Bain,1996Vygotsky,1978).Asdescribedinchapter10,theZPDisthoughttoreflectthelociofachildsactivedevelopmentalprocessesandthusto
suggestareasinwhichtreatmentmightbeaimedtoachieveoptimalchange.Asaresultofthispromise,OlswangandBain(1996)decidedtocomparetherelative
meritsofprofilesbasedonstaticassessmentsaswellasperformancesonotherselectedvariablesversusmeasuresofdynamicassessmenttechniquesinpredicting
responsesto
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treatment.Thedynamicmeasureswerefoundtohavethestrongercorrelationthanthestaticmeasurestoameasureofchange(PCI)calculatedfollowinga3week
treatmentperiod.
TheresultsoftheirstudyledOlswangandBain(1996)toproposethatdynamicassessmentproceduresarebetterthanothertechniquesatdeterminingthelikelihoodof
immediatechange.However,theynotedthatadditionalresearchisneededtodeterminewhetherobservedchangeswouldhaveoccurredevenintheabsenceof
treatment.Theymightalsohavenotedthatadditionalresearchisneededtodeterminewhetherthepredictivepowersofdynamicassessmentwouldhaveperformedas
welloverlongerperiodsoftreatment.
AsCampbellandBain(1991)advised,decisionsregardingtreatmentterminationcanbebasedonpredeterminedexitcriteriaorondemonstrationsthatnochangehas
occurredoveragivenperiodoftime.Suchdecisions,however,canalsobebasedonempiricalevidencethatadditionalchangeisunlikely.Thislastalternativethus
demandsapredictionoffuturechangelevelsakintothatsoughtbyOlswangandBainintheireffortstoidentifyharbingersofchangepriortotreatmentinitiation.
CampbellandBain(1991)touchedonthepossibilityofpredictingfuturechangeforpurposesofmakingarationaldecisionabouttheendoftreatmentintheir
discussionofultimateorinstrumentaloutcomes.Whereasultimateoutcomescanbedefinedasachildsachievementofageappropriateormaximalcommunicative
effectiveness,suchoutcomescanalsobedefinedasfunctionalcommunicativeeffectiveness,whichimpliesthatthechildhasachievedhisorherbestapproximationof
maximalcommunicativeeffectiveness.Additionally,instrumentaloutcomescanbedefinedasoutcomessuggestivethatadditionalchangewillbeforthcominginthe
absenceoftreatment.Thenotionsoffunctionalcommunicativeeffectivenessandinstrumentaloutcomeseachinvolveimplicationsrelatedtothepredictionoffuture
change.Specificallywhenfunctionalcommunicativeeffectivenessisseenasalegitimateultimateoutcome,itisalmostinvariablybecausetheprospectofadditional
changeisseenasunlikelyorasprohibitiveintermsofthetimeandeffortrequiredtoproduceit.Similarly,instrumentaloutcomesdependonthenotionthatadditional
changeislikely.
Atthispointintime,itappearsthatgeneralizationdata,suchasthatdescribedintheprecedingsection,mayrepresentthebestmethodforaddressingquestions
regardingfuturechange.Researchdesignedtoidentifymoreappropriatemethodsofpredictingfuturechangewillundoubtedlyneedtoproceedhandinhandwith
researchaimedatunderstandingthenatureoflanguagelearningandofthreatstolanguagelearningposedbylanguagedisordersbeforesubstantialprogressonthese
clinicalquestionscanbemade.Measuresofpredictivevaliditywillalsoundoubtedlyplayaroleinhelpingusarriveatsatisfyinganswers.
AvailableTools
Thekindsoftoolsavailableforuseinaddressingquestionsofchangeinchildrenslanguagedisorderslargelyoverlapthoseavailablefordescriptionthatweredescribed
intheprecedingchapter.Therefore,inthischapter,discussionofavailabletoolsis
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quitebriefandfocusesonthosemeasuresthataremostfrequentlyusedtoexaminebehavioralchangeandthespecialconsiderationsthatarisewhentheyareusedfor
thatpurpose.Theonlynewtooltobeintroducedinthischapterissinglesubjectdesigns,afamilyofmethodsthathasbeenalludedtothroughoutthischapterbuthas
notbeenadequatelyintroducedasaspecificmethodforexaminingchange.
Standardized,NormReferencedTests
Repeatedadministrationofstandardized,normreferencedtestsisprobablythemostwidespreadmethodusedbyspeechlanguagepathologiststoexaminebroad
changesinlanguagebehaviorsovertime(McCauley&Swisher,1984).Moresothanothermeasuresusedtoexaminechange,standardizednormreferenced
measuresareoftenaccompaniedbydataconcerningtheirreliabilityandvalidity.Thisrepresentsadistinctpotentialadvantagebecausesuchdatacanenhancethe
cliniciansabilitytodeterminewhetherobservedchangesarelikelytobereliableandimportant.Regrettably,however,normreferencedmeasuresoftendonotprovide
sufficientlydetaileddatatomakethispotentialareality(Sturneretal.,1994).
Asadditionalbarrierstotheireffectiveuseforevaluatingchange,thereareanumberofpitfallsthatmustbeavoided.Themostimportantoftheserelatestothe
tendencyforsuchmeasurestohavebeendevisedsothattheyaremoresensitivetolargedifferencesinknowledgebetweenindividualsthantosmalldifferences
(Carver,1974McCauley&Swisher,1984).Yetitissmalldifferencesthatarecharacteristicofthechangesmostlikelytooccurintreatmentwithinagivenindividual
(Carver,1974McCauley&Swisher,1984).Thus,clinicianswhousesuchmeasurestoassesschangemustbeawarethattheireffortsarelikelytoproveinsensitiveto
veryimportantchangesinbehaviorsthatsimplyarenotaddressedbyagiventest.Suchtestsshouldbeusedwhenbroadchangesareofinterest.
AmongotherpossiblepitfallscitedbyMcCauleyandSwisher(1984),aswellasothers,aretheneedtoavoidsituationsinwhichthetestisexplicitlytaughtbyawell
meaningclinicianorimplicitlytaughtthroughrepeatedadministrationsthatoccursocloselyintimeastoallowthechildanunwarrantedadvantageatthesecond
administration.Anotherpitfallistheuseofnormreferencedinstrumentstoassesschange,whichcanbeproblematicifchangesinthenormativegroupsoccuroverthe
timeintervalstudiedorifdifferentmeasures(albeitthosethatostensiblytapthesamebehavior)areusedatdifferenttimes.Now,itmaybetemptingtoviewchangeas
havingoccurredbecauseachildhasreceivedarelativelybetterscoreonTestBofLanguageBehaviorXthansheorhedidonTestAofLanguageBehaviorX.
However,thehugeamountoferrorthatcouldbeintroducedbydifferencesinthecontentofTestsAandB(despitetheirsimilarnames)aswellasbydifferencesin
theirnormativesamplesarelikelytomakesuchaconclusioncompletelyerroneous.
Onemethodthathasbeenrecommended(e.g.,McCauley&Swisher,1984)ashelpingremovetheadditionalerrorassociatedwithgainscoreshasbeentosimply
reexamineachildwiththesameinitialquestion:Isthischildslanguage(ortheparticularaspectofitthatisunderscrutiny)impaired?However,arecentstudylookingat
remissionratesforreadingdisabilityamongchildrenexaminedintwostudiesover
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a2yeartimeperiodsuggestedthatmeasurementerrorcanleadtosignificantoverestimatesofrecoveryratesevenwhenthismorecautiousstrategyisapplied
(Fergusson,Horwood,Caspi,Moffitt,&Silva,1996).However,thechiefsourceofdifficultywasnotinhowchangewasexamined,butthatthequestionof
measurementerrorhadnotbeenexploredsufficientlybytheoriginalinvestigatorsatthetimeofthechildrensoriginaldiagnoses.CarefulanalysisbyFergussonandhis
colleaguessuggestedthattheoveridentificationofmanychildrenattheirfirsttesting,duetoalackofappreciationoftestingerror,wasthevillain.Itisnowanempirical
questiontodeterminewhetherthefindingsofFergussonetal.areechoedintheidentificationofchildrenashavingalanguageimpairment.However,Iincludethisbrief
descriptionoftheirworkhereasacautionarytalesuggestingthatcarefuluseofnormreferencedmeasuresinassessingchangebeginswiththeircarefulusein
identificationprocesses.
Inshort,despitetheirfrequentusefortheassessmentofchange,normreferencedtestsaremostusefulwhenbroadchangesareexpectedandwhencliniciansare
carefultoavoidtheseveralproblemsthatcanunderminethevalidityoftheiruseforthispurposeaswellasforpurposesofidentification.
StandardizedCriterionReferencedMeasures
Becausecriterionreferencedmeasuresaremoreoftendevelopedsothattheyexhaustivelyexamineknowledgewithinagivendomain,theyhavebeenhailedas
superiortonormreferencedmeasuresforpurposesofexaminingchange(Carver,1974McCauley,1996McCauley&Swisher,1984).However,theirrelativerarity
(asshownbythesamplingofsuchtoolsinTable10.1)meansthattheirvalueinassessinglanguagechangeinchildrenhasnotbeenextensivelyevaluated.
Cliniciansneedtoexaminedocumentationforsuchmeasurestodeterminewhethertheauthorhaspresentedareasonableevidencebasesupportingtheirusetoexamine
changeovertime.Especiallydesirableisevidencesuggestingthatchangesinperformanceofspecificmagnitudesarelikelytoreflectsignificantfunctionalchangesin
performance.Nonetheless,wheretheyareusedasasimpledescriptionofthespecificcontentonwhichgainshavebeenachieved,suchevidenceisnotascritical.
ProbesandOtherInformalCriterionReferencedMeasures
Asarguedthroughoutthisbook,probeshavearelativeadvantageintheirmalleabilitytothespecificclinicalquestionsposedbythespeechlanguagepathologist.Thus,
theycanbedevisedorselectedtoaddressveryspecificquestionsaboutchangethatcoincidewiththeveryfocusoftreatmentforagivenchild.Thattheyareoften
relativelybriefandstraightforwardininterpretationrepresentfurtheradvantages.
Tocontemplatethepossiblepitfallsoftheuseofprobes,however,readersneedonlyreturntotheirdescriptioninchapter10.Withouttheconsiderableeffortentailed
instandardization,cliniciandevisedprobesorprobesthatareborrowedfromothernonstandardizedsourcesareunknownwithrespecttoreliabilityandvalidity.
Althoughtheirpossiblefittothequestionbeingaskedpresentsagreatpotentialforexcellentconstructvalidity,thetendencyforprobestobehaphazardlyconstructed,
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administered,andinterpretedrepresentsapotentiallydevastatingthreattothatpotential.Becauseoftheexpectationthatrepeateduseofprobeswillberequiredifthey
aretobeusedtoassesschange,thestandardizationstrategiesdescribedinFigure10.1becomeparticularlyvitaldefensesagainstthosethreats.
DynamicAssessmentMethods
Thegrowingliteratureaimedatexploringtheutilityofdynamicassessmentmethodsinpredictingreadinessforlanguagechange(Bain&Olswang,1995Long&
Olswang,1996Olswang&Bain,1996)supportsahopefulbutquestioningviewregardingtheuniformitywithwhichsuchtechniquessucceed.Althoughbydefinition
suchmethodsareintendedtoelicitconditionsthatchangeachildslikelihoodofacquiringamorematurebehavior,theymayattimesprovidenomorethantransient
predictionswithatenurethatmakesthemoflesservalueforsignalingtreatmentfocus.Nonetheless,explorationoftheirpredictivevalueinspecificdomainsandfor
specificclientswarrantsfurtherinvestigation.Inthemeantime,theirgreatestpromiseappearstolieintheinsightstheyprovideregardinghowinterventionmightbest
takeplaceandinprovidingmorevalidassessmentsforchildrenwhoarehighlyreactivetoatesting.Therearealsonumeroussuggestionsthattheypromisetoprovide
morevalidassessmentsthanotheravailablemethodsforchildrenfromdiversebackgroundswhomaylacktheexperiencesassumedbymoreconventionaltesting
methods.
SingleSubjectDesigns
Intheirgroundbreakingworkontheapplicationofsinglesubjectexperimentaldesignstospeechlanguagepathology,McReynoldsandKearns(1983)notedthat
suchdesignshadthepromiseofwideapplicationbycliniciansbecauseoftheirpracticalityandclinicalrelevance.Despitetheirwideacceptanceasanalternative
methodofscientificinquiry,however,suchdesignshavebeenresistedbyspeechlanguagecliniciansindailypracticeprobablybecausetheirpracticalityfallsshortof
thatdemandedbymostclinicalsettings.Nonetheless,theyremainthestrongestavailablemethodwhentheclinicalquestionathandcentersonwhethertreatmentisthe
likelycauseofobservedchangesinbehavior.
Themostfrequentlyusedmeasuresinsinglesubjectdesignsareelicitedprobesandotherinformalmeasures,whicharereferredtoasdependentmeasuresinthis
context.Theseinformalmeasuresoftenlackthedocumentationregardingvalidityandreliabilitythatcanadornmoreformalmeasures.Nonetheless,theiruseis
strengthenedbytheirclosetietothespecificconstructforwhichtheyhavebeencreatedorselected.Ideally,theyrepresenthighlydefensibleoperationalizationsofthe
behaviororabilityofinterest.Theiruseisfurtherstrengthenedwhenmeasuresofinterandintraexamineragreement,orotherbasicmeasuresaimedatdemonstrating
reliability,areobtained.Theycanalsobeenhancedbyblindmeasurementproceduresinwhichthepersonmakingthemeasurementisunawareofthepurposeitwill
serveor,ideally,theindividualonwhomitwasobtained(Fukkink,1996).
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Aspartofthesystematicstructuringofobservationsthatunderliestherationalebehindsinglesubjectdesigns,dependentmeasuresareobtainedfrequentlyandcanthus
providepersuasiveevidenceofconsistencyorchange.Inaddition,thetemporalstructureofsuchdesignsisintendedtoprovidelogicalsupportfortheroleoftreatment
versusalternativeexplanationsasagentsofchange.Onthebasisoftheseideals,singlesubjectexperimentaldesignshavebeenlaudednotonlyfortheirabilityto
providesuperiorevidenceaboutcausationattheleveloftheindividualbutalsoaboutboththeoutcomeandprocessoftreatment(McReynolds&Kearns,1983
McReynolds&Thompson,1986).
Asimpleconsiderationofafewofthebooksonthesubjectsuggeststhatdetaileddiscussionofthemethodsandlogicsupportingtheapplicationofsinglesubject
designsincommunicationdisordersiswellbeyondthescopeofthisbook(e.g.,Franklin,Allison,&Gorman,1996Kratochwill&Levin,1992McReynolds&
Kearns,1983).Nonetheless,asimpleexamplecanbeusedtoillustratethelogicthatsupportscausalinterpretationofsuchdesignsandthustheirpotentialfor
addressingthequestionofwhethertreatmentislikelytoberesponsibleforachildsbehavioralchange.TheexampleIshowinFig.11.2isahypotheticalexamplefrom
BainandDollaghan(1991).Itwasdescribedpreviouslyforitsuseofcontrol,generalization,andtreatmentprobes.Itisdescribedhereforthewayinwhichthestability
ofdata,timingoftreatment,anddemonstrationsofchangeleadonetotheconclusionthatobservedchangesprobablyresultedfromtreatment.
AsyoulookatFig.11.2,noticefirstthetopgraph,inwhichprobesfortheprimaryfocusoftreatment(Agent+Action)arestudiedfirstwithoutthepresenceof
treatmentduringabaselinecondition.Becausethebaselineisclearlyunchanging,itisreasonabletoconcludethatfactorssuchasmaturation,informalinstructionbya
parent,andsofortharenotplayingaroleinthechildsacquisitionofthetargetformpriortotheinitiationoftreatment.Althoughtheinitiationoftreatmentdoesnot
resultininstantaneouschange,changedoesoccuroverthecourseofthetreatmentinterval.Further,thatchangeseemslikelytobeduetotheeffectsoftreatmentrather
thanalternativeexplanatoryfactorsbecauseoftheimplausibilitythatsuchfactorswouldcommencebychanceinsuchcloseproximitytotheonsetoftreatment.
Whereasinmostsinglesubjectdesigns,theperiodlabeledwithdrawalisconsideredasecondbaseline,hereitisdescribedaswithdrawalbecausetheexperimenter
wouldprobablyexpectsomeadditionalgrowth(generalization)duetolearningeffects.Thiskindofdesigninwhichtreatmentisabsent,thenpresent,thenabsentagain
isoftenreferredtoasanABAorwithdrawaldesign.
ABAdesignsareoftenavoidedinclassicalsinglesubjectdesignsincaseswhereaneffectivetreatmentwouldbeexpectedtoshowcarryoverinthisway.Instead
suchdesignswouldmoretypicallybeusedforbehaviorsthatareexpectedtoreturntobaselinewhentreatmentisended.Whenlanguagedevelopmentisstudied,
however,thepresenceofgeneralizationisnotconsideredaseriousdetractorfromthelogicofanexperimentwhenitoccursaspartofasetofpredictionsmadein
advancebytheclinicianorexperimenter.
InthesecondgraphofFig.11.2,aseconddependentmeasure(orgeneralizationprobe),Action+Object,isobservedwiththeexpectationthatitsrelationshiptothe
targetedvariable,Agent+Action,willcausesomedevelopmentalchangetooccur
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Fig.11.2.Ahypotheticalmultiplebaselinesinglesubjectdesignthatmakesuseoftreatment(Agent+Action),generalization(Action+Object),andcontrol(Entity+
Locative)probes(Graphs1,2,and3,respectively).FromTheNotionofClinicallySignificantChange,byB.A.BainandC.A.Dollaghan,1991,Language,
Speech,andHearingServicesinSchools,22,p.266.Copyright1991bytheAmericanSpeechLanguageHearingAssociation.AmericanSpeechLanguage
HearingAssociation.Reprintedwithpermission.
duringtreatmentandpossiblybeyond.However,thepresenceofaninitialperiodofstabilitypriortotheonsetofchangeinthismeasureisagainhelpfulinstrengthening
theplausibilityoftheargumentthattheobservedchangeislikelytoresultfromthetreatmentratherthanotherfactors.Inaddition,thatargumentisstrengthenedifthe
generalizationprobedoesnotimprovetothesameextentasthetargetprobe,ordoessofollowingadelayrelativetotheactualtargetoftreatment.
InthethirdgraphofFig.11.2,thecontrolprobe,Entity+Locative,isshownwithastablebutlongerbaseline,thusindicatingthatextraneousvariablesareunlikelyto
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beactingonthechildslanguagedevelopmentfortheentiredurationofthebaseline.Itisimportantthatthebaselineforthisvariable,whichwaspredictedtobe
unaffectedbygeneralization,remainedstablethroughouttheentiretyoftreatmentdirectedatAgent+Actionanditswithdrawalperiodinordertosupportthetreatment
effectontheothervariables.Asimportantly,itbeginstoshowimprovementonlyaftertheinitiationoftreatmentinwhichithasbecomethedirecttarget.
Thepracticalrequirementsintermsofdatacollectionanddisplayarenotinconsequentialforsinglesubjectdesigns.However,asthisexampleillustrates,theydonot
havetobeoverlyburdensomeeither,withthechiefinvestmentherebeingtheperiodic(andstaggered)collectionofprobedatafortwoadditionalforms.Thiscost
seemswellworthitwhenweighedagainstthevalueofevidencedocumentingtheeffectivenessofthetreatmentusedfortwodifferenttargetsandofrealtimeinsights
intothegeneralizationpatternsoftheindividualchild.
Inadditiontonumerousbooksdealingmorecomprehensivelywiththelargenumberofdesignsthatcanbeappliedinclinicalsettings(Franklin,Allison,&Gorman,
1996Kratochwill&Levin,1992McReynolds&Kearns,1983),asetofthreeclassicarticles(Connell&Thompson,1986Kearns,1986McReynolds&
Thompson,1986)representawonderfulinitiationtothepromisesuchdesignsholdforcliniciansinterestedinchildrenslanguagedisorders.
PracticalConsiderations
Withregardtoassessingchange,thelargestpracticalconsiderationappearingonthehorizonhasbeenthepresenceofprofessionalandsocietalforcesurgingclinicians
tofindmeasuresthatdocumentthevalueofwhattheydoonabroaderscaleandwithgreaterregularity.Therefore,althoughotherpracticalissuesexistasveryreal
pressuresoncliniciansdecisionmakingregardingalloftheareasofchangediscussedinthischapter,theissueofoutcomemeasurementseemstowarrantthefull
attentionoftheremainingpagesofthischapterand,indeed,theconcludingpagesofthisbook.
Inspeechlanguagepathology,interestinhowlanguagetreatmentaffectschildrenhasbeenaroundforquitesometime(e.g.,Schriebman&Carr,1978Wilcox&
Leonard,1978).However,acontinuingcomplainthasbeenthatnotenoughsuchresearchontreatmentisbeingdone(e.g.,McReynolds,1983Olswang,1998),and
theresearchthatisbeingdoneinvolvestreatmentproceduresthat,althoughusefulforpurposesofscientificrigor,cannotreadilybeappliedtorealclinicalsettings.
Thus,thegeneralizabilityofasmallresearchbasehasbeenatissue.Nonetheless,existingtreatmentresearchhasprovidedatleastsomepreliminaryevidenceofthe
effectivenessoftreatmentextendingbeyondtheleveloftheindividualclinician.
Morerecently,interestinaccountability(e.g.,Eger,1988Egeretal.,1986Mowrer,1972)hasarisenatagrassrootslevelbecauseofgrowingdemandsfrom
individualconsumersandtheiradvocates.ThisinteresthasbeenjoinedinanintensetopdownfashionbyASHAasitrespondstoprotectitsmembersrolesinfast
changinghealthcareandeducationalsystems(Frattali,1998a,bHicks,1998).Inachapteraddressingthespecificnatureoftopdownpressuresnecessitatinggreater
attentiontooutcomes
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assessmentinspeechlanguagepathology,Hicks(1998)describedatleastthreesourcesofinfluencetowhichtheprofessionmustrespond:
1. accreditingagencies(e.g.,theRehabilitationAccreditationCommissiontheJointCommissiononAccreditationofHealthcareOrganizations,JCAHOASHAs
ProfessionalServicesBoard,PSB)
2. payerrequirements(e.g.,MedicareMedicaidandManagedCareOrganizations,MCOs)and
3. legislativeandregulatoryrequirements(e.g.,OmnibusBudgetReconciliationActof1987,PublicLaw100203,andtheSocialSecurityAct,Part484)
Atfirstglance,theseforceswouldseemtocomeprimarilyfromthoseclinicalsettingsthatserveadultsand,thus,itmightbethoughtthattheywouldnotaffectclinicians
whoworkwithchildreninprimarilyeducationalsettings.However,asappreciationofthevalueofoutcomesmeasureshasbecomemorewidespreadandasthegreat
dividebetweeneducationandhealthcarebreaksdown(asillustratedinMedicaidfundingforsomechildrenenrolledinschoolprograms),theblissfulluxuryof
consideringtreatmentoutcomessomeoneelseschallengehasallbutdisappeared.Eger(1998)notedthatCongressspassingoftheEducationofAllHandicapped
ChildrenActof1975(P.L.94142)servedasapossibleprecursortoformaloutcomesmeasurementactivitiesinspecialeducationbecauseitincludedasoneofits
fourmaingoalstheassessmentandassuranceofeducationaleffectiveness.Thepassageofthe1997amendmentstoIDEA(P.L.10517)furtherreinforcesthe
importanceoffurtherdevelopmentsinthisarea.Inordertorespondtothechallengesfacingtheprofessionsacrosssettings,ASHAhasbegunthedevelopmentof
treatmentoutcomesmeasuresthatcanbeusedbygroupsofclinicianstodocumenttheirvalueandprovideabasisforcomparisonsbyimportantgroups(e.g.,school
districts,thirdpartypayers).
Atthispoint,readerswhoareunfamiliarwiththeterminologythataccompaniesoutcomesmeasurementmayfeelatadbewildered.Therefore,somebackgroundonthe
relationshipbetweentreatmentefficacyresearchandtreatmentoutcomesresearchseemsinorder.Despitesomeimportantunderlyingsimilaritiesandoverlapping
methods,animportantdistinctioncanbemadebetweenthesetwoterms(Frattali,1998aOlswang,1998).Olswang(1998)pointedoutthatbothefficacyresearchand
outcomeresearchrepresentstrategiesforexaminingtheinfluenceoftreatmentonindividualswithcommunicationdisorders.Nonetheless,whereasefficacyresearch
emphasizestheimportanceofdocumentingtreatmentasacauseforchange,outcomesresearchemphasizesthebenefitsassociatedwithtreatmentasitisadministered
inrealworldcircumstances.Frattali(1998a)describedthedistinctionquitesuccinctlybysayingthatefficacyresearchisdesignedtoprove,whereasoutcomes
researchcanonlyidentifytrends,describe,ormakeassociationsorestimates(p.18).Whereaspastefficacyresearchhasfocusedprimarilyonthebehaviorsthat
fallattheimpairmentlevelintermsoftheICIDHclassificationsystem,abroadeningofconcernstoembracebehaviorsfallingatthelevelsofdisorderandhandicapis
anemergingtrend(Olswang,1998).
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Treatmentefficacyisoftendefinedasencompassingtreatmenteffectiveness,efficiency,andeffects(e.g.,seeKreb&Wolf,1997Olswang,1990,1998).Treatment
effectivenessreferstothetraditionalideaofwhetherornotagiventreatmentislikelytoberesponsibleforobservedchangesinbehavior.Treatmentefficiency
referstotherelativeeffectivenessofseveraltreatmentsortotheroleofcomponentsofatreatmentincontributingtoitseffectiveness.Finally,treatmenteffectsrefers
tothespecificchangesthatcanbeseeninaconstellationofbehaviorsinresponsetoagiventreatment.Similarcomponentshavealsobeenidentifiedasfallingwithinthe
provinceoftreatmentoutcomesaswell(Kreb&Wolf,1997).
Whereastreatmentefficacyresearchisusuallyconductedunderoptimalconditions,oratleastwellcontrolledclinicalconditions,outcomesmeasurementis,by
definition,conductedundertypicalconditions(Frattali,1998bOlswang,1998).Onthedownside,thismeanstreatmentoutcomesresearchwillalmostneverbeableto
contributetoargumentsaboutthecauseandeffectrelationshipsoftreatmentsandobservedbenefits.Nonetheless,outcomesresearchwillalmostalwaysbeinabetter
positionthantreatmentefficacyresearchtoaddressconcernsaboutthevalueofservicesofferedtoprofessionalconstituencies(e.g.,withinagivenhospitalorschool
district).Consequently,outcomesresearchhasaveryspecialvaluetoindividualclinicians.Itcanenablethemtodemonstrateaccountabilitynotintheabstract,based
ontreatmentsconductedsolelybyotherclinicianresearchersworkingundercontrolledconditions,butbycomparingtheirownoutcomeswiththoseobtainedbyothers
throughparticipationinthelargescale,multisiteeffortsthatarecharacteristicofsuchresearch.
In1997,theNationalCenterforTreatmentEffectivenessinCommunicationDisordersbeganworkonadatabasethatwillinvolvecliniciansinthecollectionof
outcomesdataonanationalbasis.Thiscomplexdatabase,theNationalOutcomesMeasurementSystem(NOMS),willeventuallyincludeinformationaboutallof
thepopulationsservedbyspeechlanguagepathologistsandaudiologists.Currently,however,NOMSislimitedtoinformationaboutadultsseeninhealthcaresettings,
preschoolchildrenwhoareservedinschoolorhealthcaresettings,andchildreninkindergartenthroughthesixthgradewhoareseeninschools.(Notethatdata
concerninginfanthearingscreeningsarejustbeginningtobecollected.)Inordertoparticipate,schoolbasedcliniciansworkcooperativelytoprovidedataforagiven
schoolsysteminwhichatleast75%ofthespeechlanguagepathologistsholdASHAcertificationandinwhichallstudentswillbeincludedinthedatathatare
collected.Thesetworestrictionsaredesignedtoimprovethequalityandrepresentativenessofthedata.
Forschools,datafortheNOMSarecollectedatthebeginningandconclusionofservices,oratthebeginningandendoftheschoolyear,withdatacollection
proceduresdesignedtotakenomorethan5to10minutesperchild.Dataincludeinformationaboutdemographics,eligibilityforservices,thenatureoftreatment(i.e.,
modelofservices,amount,andfrequencyofservices),teacherandfamilysatisfaction,andtheresultsoftheFunctionalCommunicationMeasures(FCMs),a7
pointscaledevelopedbyASHA.Thescaleaddressesfunctionalperformancewithintheeducationalenvironment.ItincludesitemssuchasThestudentrespondsto
questionsregardingeverydayandclassroomactivitiesandThestudentknowsandusesageappropriate
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interactionwithpeersandstaff.Theseitemsareratedonthefollowingscale:0=Nobasisforrating1=Doesnotdo2=Doeswithmaximalassistance3=
Doeswithmoderatetomaximalassistance4=Doeswithmoderateassistance5=Doeswithminimaltomoderateassistance6=Doeswithminimal
assistanceand7=Does.
ASHAsgoalsfortheNOMSarelofty.Besidesdemonstratingpositiveoutcomesforchildrenreceivingspeechlanguagepathologyservices,itishopedthatthe
NOMSwillfacilitateadministrativeplanning(e.g.,caseloadassignments)aswellasindividualdecisionsaboutintervention.Amongparticularaspirationsarethatitwill
provideinformationaboutwheninterventionismosteffective,howmuchprogresscanbeexpectedoveranacademicyear,whatservicedeliverymodelandfrequency
ofserviceresultsinthegreatestgainsforagivenkindofcommunicationdisorder,andwhatentranceanddismissalcriteriaarereasonable.Inaddition,itishopedthat
comparativeNOMSdatamightallowindividualschoolsystemsorgroupsofschoolsystemstodemonstratetheireffectivenessandefficiencyinwaysthatwillhelpthem
negotiateinaneraofstrainededucationalresources.Thesuccessofthesysteminmeetingthesegoalswilldependgreatlyonwidespreadparticipationallowingthe
representativesamplesrequiredforspecificgeneralizationssuchasthosejustdescribed.Intermsoftheutilityofthesystemforprovidingcomparativedataacross
schoolsystemsorunits,agreatertailoringofreportsavailabletoparticipantsmaybenecessarybeforethoseaspirationscanbeactualized.
BeyondtheNOMS,Eger(1998)describednumerouswaysinwhichanoutcomesapproachcanbeincorporatedwithinschoolpractice.Theserangefromsimple
modificationsofthewaygoalsandobjectivesarewrittenforindividualizededucationalplans(IEPs)tothedevelopmentofempiricallymotivateddismissalcriteriato
moreelaborateinvestigationsofeffectivenessofspecificservicedeliverymodels(e.g.,classroombasedinterventions,selfcontainedclassroom).Thesethreeexamples
runthegamutfromthosethatcanbeimplementedbytheindividualcliniciantothoserequiringmoreextensiveresources,akintothoserequiredbytheNOMS.
IntermsofhowtheindividualspeechlanguagepathologistscanmodifytheIEPstheywrite,Eger(1998)providedanexample.Shenotedthatagoalthatmight
currentlybewrittenasThestudentwillimproveexpressivelanguageskillscouldbereplacedwithoneormoreofthefollowing:Thestudentwillapplyproblem
solvinganddecisionmakingskillsinmathandEnglishclasses,Thestudentwilluselanguagetocreatedialogueswithteachersandpeerstofacilitatelearning,or
Thestudentwillbeabletofollowwrittendirectionsonobjectivetests(Eger,1998,p.447).
Regardlessofwhetherspeechlanguagepathologistsworkingwithchildrenactivelyworktoincludeanoutcomesperspectiveintheirpractice,theoutcomesmovement
willundoubtedlydriveextensivechangesinclinicalpracticeoverthenextdecade,especiallyastheserelatetothedocumentationofchangeinchildrenscommunication.
Responsiblereactionstothesechangeswilldependonsensitivitytothemeasurementvirtues(i.e.,functionalityandthedevelopmentofcommonbestpractices)aswell
asthemeasurementperils.Manyoftheseperilsarethosesharedwithallmeasurementstrategies,suchasconcernsaboutthequalityofdatacollectionatitssourceand
thesizeofthesampleusedforanyparticulardecision.Some,however,areuniquetosuchalargeundertakingtherelinquishmentofdecisionsabouthow
interpretation
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willtakeplaceand,thus,thepossiblerelinquishmentoffeelingsofpersonalresponsibilityaswell.Still,itisanexcitingtimeformeasurementincommunicationdisorders,
oneinwhichsizeableresourcesmayfinallybefunneledtosomeofthequestionsthatmosttroublespeechlanguagepathologists.Thedesiredoutcomeofsuch
investmentsistheproliferationofinnovativemeasurementstrategiesandrefinementofexistingtoolstohelpusarriveatasophisticatedarmamentariumoftoolsfor
addressingourclinicalquestions.
Summary
1.Theassessmentofchangeunderliesbothcriticalandcommonplacedecisionsmadeinthemanagementofchildrenslanguagedisorders.Theseincludedecisions
aboutindividuals,suchaswhentobeginandendtreatmentandwhethertreatmenttacticsshouldbealteredduringthecourseoftreatment.
2.Whenquestionsoftreatmentefficacyandaccountabilityareraised,theassessmentofchangecanalsofueldecisionsabouttherelativemeritofvarioustreatment
approachesortherelativeproductivityofgroupsofclinicians.
3.Threetypesofoutcomesobservedinclinicalsettingsincludeultimateoutcomes,intermediateoutcomes,andinstrumentaloutcomes.Whereasultimateoutcomes
relatetodecisionsabouttreatmenttermination,intermediateandinstrumentaloutcomesrelatetoclinicaldecisionsmadeduringthecourseoftreatment.
4.Measurementerrorpresentsanespeciallydifficultchallengetointerpretationwhenmeasuresareexaminedatmultiplepointsintime,suchaswhenpastchangeis
examinedorfuturechangeispredicted.
5.Clinicallysignificantchangemustnotonlybereliable,itmustalsorepresentanimportantchangetothelifeofthechild.Threemethodsusedtoaddresswhetheran
observedchangeislikelytobeimportantinvolveconsiderationsofeffectsize,socialvalidation,andtheuseofmultiplemeasures.
6.Determiningthatpositivechangesinachildslanguagearecausedbytreatmentismadeextraordinarilydifficultbythethankfullyunavoidablebutnonetheless
confoundinginfluencesofgrowthanddevelopment.Increasedunderstandingofthoseinfluenceswithinandacrosschildrenareneededtohelpaddressthisverythorny
measurementproblem.
7.Singlesubjectexperimentaldesignsoffercliniciansthebestcurrentlyavailablemeansfordemonstratingthattreatmentisresponsibleforobservedchanges,buthave
thusfarbeenusedprimarilybyresearchers.
8.Measurementelementsstrengtheningargumentsthattreatmentisthecauseofobservedchangesincludethepresenceofpretreatmentbaselinesandtheuseof
treatment,generalization,andcontrolprobes.
9.Treatmentefficacyresearchisconcernedwithdocumentingwhethertreatmentiseffective,efficient,andwhethertheeffectsoftreatmentextendtoanumberof
significantbehaviors.
10.
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Treatmentoutcomesresearchisdesignedtodemonstratebenefitsassociatedwithtreatmentasitisconductedineverydaycontexts.Cooperationfromallmembersof
theprofessionisneededtocollectsomekindsofparticularlypersuasivetreatmentoutcomesdata,suchasthosebeingcollectedintheNOMSdatabasebyASHA.
KeyConceptsandTerms
clinicallysignificantchange:achangethatmakesanimmediateimpactonthecommunicativelifeofachildorthatrepresentssignificantprogresstowardthe
acquisitionofcriticalaspectsoflanguage.
effectsize:themagnitudeofthedifferencebetweentwoscoresorsetsofscores,orofthecorrelationbetweentwosetsofvariables.
FunctionalCommunicationMeasures(FCMs):oneofseveralratingscalesdesignedbyASHAforuseintrackingfunctionalcommunicationgainsmadebyclients.
gainscores:thedifferencebetweenscoresobtainedbyanindividualattwopointsintimewhenthatdifferencerepresentsapositivechangeinperformancealsocalled
differencescores.
instrumentaloutcomes:individualbehaviorsacquiredduringtreatmentthatsuggestthelikelihoodofadditionalchangegeneralizationprobedatafunctionas
instrumentaloutcomes.
intermediateoutcomes:individualbehaviorsthatmustbeacquiredforprogressintreatmenttohaveoccurredtreatmentprobedatacanfunctionasintermediate
outcomes.
NationalOutcomesMeasurementSystem(NOMS):anoutcomesdatabaseforspeechlanguagepathologyandaudiologythatisbeingdevelopedtoaddressthe
professionsneedforlargescaleoutcomesdata.
outcomemeasurement:theuseofmeasuresdesignedtodescribetheeffectsoftreatmentconductedundertypical,ratherthancontrolledconditions.
ProportionalChangeIndex(PCI):amethodforexaminingtherateofchangeobservedinagivenbehaviorduringtreatmentrelativetothatobservedpriorto
treatment.
singlesubjectexperimentaldesigns:agroupofrelatedresearchdesignsthatpermittheusertosupportclaimsofcausalrelationshipbetweenvariables,suchasthe
effectoftreatmentonatargetedbehavior.
socialcomparison:asocialvalidationmethodthatinvolvestheuseofacomparisonbetweenlanguagebehaviorsofagivenchildorgroupofchildrenandthoseofa
smallgroupofpeers.
socialvalidation:methodsusedtoindicatethesocialimportanceofchangesoccurringintreatment.
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subjectiveevaluation:asocialvalidationmethodinwhichproceduresareusedtodeterminewhetherindividualswhointeractfrequentlywithachildwhoisreceiving
treatmentseeperceivedchangesasimportant.
treatmenteffectiveness:thedemonstrationthatatreatment,ratherthanothervariables,isresponsibleforchangesinbehavior(Kreb&Wolf,1997Olswang,
1990).
treatmenteffects:changesinmultiplebehaviorsthatappeartoresultfromagiventreatment(Olswang,1990).
treatmentefficacyresearch:researchdesignedtodemonstratethecomplexpropertyofatreatmentthatincludesitseffectiveness,efficiency,andeffects(Olswang,
1990,1998).
treatmentefficiency:theeffectivenessofatreatmentrelativetoanalternativeamoreefficienttreatmentisoneinwhichgoalsareaccomplishedmorerapidly,
completely,ormorecosteffectivelythanalessefficienttreatment(Olswang,1990).
ultimateoutcomes:individualbehaviorsthatsignalsuccessfultreatment,eitherbecauseageappropriateorfunctionallyadequatelevelsofperformancehadbeen
achievedorbecausefurthertreatmentwouldbeunlikelytoyieldsignificantadditionalgains.
StudyQuestionsandQuestionstoExpandYourThinking
1.Arrangetoseeaclinicalcasefileforachildwhoisreceivingtreatmentforalanguagedisorder.Listthewaysinwhichchangeiscurrentlydocumented.Consider
waysinwhichthatdocumentationmightbestrengthenedincludinghoweffortsmightbemadetoaddresschangesineducationalorsocialfunctionaswellasinthe
natureofimpairment.
2.Discusstheadvantagesanddisadvantagesofusingastandardbatteryofnormreferencedteststolookatachildsoveralllanguagefunctioningovertime.Ifyou
weretodevisesuchabattery,whatwouldyoulookforinitscomponents?Wouldthatbatterydifferonthebasisoftheetiologyofthedisorder?Ifso,how?
3.Withregardtothedifferenttoolsthatmightbeusedtoexaminechange,discusshowyoumightexplainthatmethodtoachildsparents.
4.VisitthewebsitefortheNOCMSathttp://www.asha.org/nctecd/treatment_outcomes.htm.DeterminewhatbarriersmightexisttoparticipatingintheNOMS.On
thebasisoftheinformationyouobtainedinthischapterandthroughthatwebsite,whatargumentsmightbemadetojustifyeffortstoovercomethesebarriers?
5.LookatthetreatmentefficacystudiesforchildlanguagedisorderscollectedattheNOMSwebsiteundertheEfficacyBibliographieslink.Onthebasisofthe
informationyoucangleanfromreadingthetitlesofarticleslistedthere,whatkindsofaspectsoftreatmentefficacyseemtohavegottenthegreatestattention?
6.Onthebasisofwhatyouknowaboutclinicaldecisionsregardingchange,discussspecificchangesthatmightwarranttheuseofamethodsuchasasinglesubject
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designorsocialvalidationtechniques.Althoughthesemethodsaremorecomplexthansomeothermethods,theyhavetherespectiveadvantagesofdemonstratingthe
cliniciansresponsibilityforchangeorthesocialimpactofchange.
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Schwartz,I.S.,&Olswang,L.B.(1996).Evaluatingchildbehaviorchangeinnaturalsettings:Exploringalternativestrategiesfordatacollection.TopicsinEarly
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APPENDIXA
Page329
NormReferencedTestsDesignedfortheAssessmentofLanguageinChildren,
ExcludingThoseDesignedPrimarilyforPhonology(AppendixB)
Oral
Language Written
Modalities Language ReviewedinMMY?
Test Ages andDomains Included? CompleteReference (x=ComputerForm)
AssessingSemantic Barrett,M.,Zachman,L.,&Huisingh,R.(1988).Assessing
SkillsThrough 3to9years RandESem no SemanticSkillsThroughEverydayThemes.EastMoline,IL: no
EverydayThemes LinguiSystems.
3yearsto6 ESem,
BanksonLanguage Bankson,N.W.(1990).BanksonLanguageTest2.San
years,11 Morph,Syn, no x
Test2 Antonio,TX:ProEd.
months Prag
Boehm,A.E.(1986).BoehmTestofBasicConcepts
BoehmTestofBasic
3to5years RSem no PreschoolVersion.SanAntonio,TX:Psychological x
ConceptsPreschool
Corporation.
BoehmTestofBasic Kindergarten Boehm,A.E.(1986).BoehmTestofBasicConceptsRevised.
RSem no x
ConceptsRevised toGrade2 SanAntonio,TX:PsychologicalCorporation.
BrackenBasic
Bracken,B.A.(1986).BrackenBasicConceptScale.San
ConceptScale 2to8years RSem no x
Antonio,TX:PsychologicalCorporation.
Revised
3yearsto7
CarrowElicited CarrowWoolfolk,E.(1974).CarrowElicitedLanguage
years,11 EMorph,Syn no x
LanguageInventory Inventory.Austin,TX:LearningConcepts.
months
ClinicalEvaluationof RandESem, Semel,E.,Wiig,E.H.,&Secord,W.A.(1996).Clinical
Language 6to21years Syn,Rapid no EvaluationofLanguageFundamentals3.SanAntonio,TX: x
Fundamentals3 Naming PsychologicalCorporation.
ClinicalEvaluationof
Wiig,E.H.,Secord,W.,&Semel,E.(1992).Clinical
Language 3to6years, RandESem,
no EvaluationofLanguageFundamentalsPreschool.San x
Fundamentals 11months Syn
Antonio,TX:PsychologicalCorporation.
Preschool
(Continued)
Page330
AppendixA(Continued)
Oral
Language Written
Modalities Language ReviewedinMMY?
Test Ages andDomains Included? CompleteReference (x=ComputerForm)
Communication
RandESem, Johnston,E.B.,&Johnston,A.V.(1990).Communication
AbilitiesDiagnostic 3to9years no x
Syn,Prag AbilitiesDiagnosticTest.Chicago:Riverside.
Test
Comprehensive RandESem, CarrowWoolfolk,E.(1999).ComprehensiveAssessmentof
AssessmentofSpoken 3to21years Morph, no SpokenLanguage.CirclePines,MN:AmericanGuidance no
Language Syntax,Prag Service.
Comprehensive
Wallace,G.,&Hammill,D.D.(1994).Comprehensive
Receptiveand 4to17years,
RandESem no ReceptiveandExpressiveVocabularyTest.SanAntonio,TX: x
ExpressiveVocabulary 11months
PsychologicalCorporation.
Test
EvaluatingAcquired
RandESem, Riley,A.M.(1991).EvaluatingAcquiredSkillsin
Skillsin 3monthsto8
Morph, no CommunicationRevised.SanAntonio,TX:Psychological x
Communication years
Syntax,Prag Corporation.
Revised
ExpressiveOneWord
Gardner,M.F.(1990).ExpressiveOneWordPicture
PictureVocabulary 2to12years ESem no x
VocabularyTestRevised.Austin,TX:ProEd.
TestRevised
ExpressiveVocabulary Williams,K.T.(1997).ExpressiveVocabularyTest.Circle
2to90years E no no
Test Pines,MN:AmericanGuidanceService.
FullertonLanguage 11yearsto RandESem, Thorum,A.R.(1986).FullertonLanguageTestfor
no x
TestforAdolescents adult Morph,Syntax Adolescents(2nded.).SanAntonio,TX:ProEd.
LanguageProcessing 5to11years, Richard,G.J.,&Hanner,M.A.(1985).LanguageProcessing
ESem no x
TestRevised 11months TestRevised.EastMoline,IL:LinguiSystems.
OralandWritten
LanguageScales: CarrowWoolfolk,E.(1995)OralandWrittenLanguage
3to21years
Listening RandE no Scales:ListeningComprehensionandOralExpression.Circle x
fororal
Comprehensionand Pines,MN:AmericanGuidanceService.
OralExpression
Page331
OralandWritten CarrowWoolfolk,E.(1996).OralandWrittenLanguage
Writing
LanguageScales: 5to21years E Scales:WrittenExpression.CirclePines,MN:American x
Morph,Syn
WrittenExpression GuidanceService.
PatternedElicitation
Young,E.C.,&Perachio,J.J.(1993).ThePatterned
SyntaxTestWith ESem,
3to7years no ElicitationSyntaxTestwithMorphophonemicAnalysis. x
Morphophonemic Morph,Syn
Tucson,AZ:CommunicationSkillBuilders.
Analysis
PeabodyPicture 2to90+ Dunn,L.,&Dunn,L.(1997).PeabodyPictureVocabulary
RSem no no
VocabularyTestIII years TestIII.CirclePines,MN:AmericanGuidanceService.
PorchIndexof
Porch,B.E.(1979).PorchIndexofCommunicativeAbilityin
CommunicativeAbility 4to12years RandE no x
Children.Chicago:Riverside.
inChildren
Birthto6 Zimmerman,I.L.,Steiner,V.,&Pond,R.(1992).Preschool
PreschoolLanguage RandESem,
years,11 no LanguageScale3.SanAntonio,TX:Psychological no
Scale3 Morph,Syntax
months Corporation.
ReceptiveOneWord 12yearsto15 Brownell,R.(1987).ReceptiveOneWordPictureVocabulary
PictureVocabulary years,11 RSem no TestUpperExtension.Novato,CA:AcademicTherapy x
TestUpperExtension months Publications.
ReceptiveOneWord 2years,11
Gardner,M.F.(1985).ReceptiveOneWordPicture
PictureVocabulary monthsto12 RSem no x
VocabularyTest.Novato,CA:AcademicTherapyPublications.
Test years
ReynellDevelopmental 1yearto6 Reynell,J.,&Gruber,C.P.(1990).ReynellDevelopmental
LanguageScalesU.S. years,11 RandE no LanguageScale.US.Edition.Windsor,Ontario,Canada: x
Edition months NFERNelson.
StructuredPhoto
4to9years,5 Werner,E.,&Kresheck,J.D.(1983).StructuredPhotographic
graphicExpressive EMorph,Syn no MMY9a
months ExpressiveLanguageTestII.Sandwich,IL:Janelle.
LanguageTestII
TestforExamining 3yearsto7 Shipley,K.G.,Stone,T.A.,&Sue,M.B.(1983).Testfor
Expressive years,11 ESyn no ExaminingExpressiveMorphology.Tucson,AZ: MMY10b
Morphology months CommunicationSkillBuilders.
(Continued)
Page332
AppendixA(Continued)
Oral
Language Written
Modalities Language ReviewedinMMY?
Test Ages andDomains Included? CompleteReference (x=ComputerForm)
Hammill,D.D.,Brown,V.L.,Larsen,S.C.,&Wiederholt,J.
TestofAdolescentand RandESem, Writing:Sem,
12to21years L.(1994).TestofAdolescentandAdultLanguage3.Austin, x
AdultLanguage3 Morph,Syn Syn
TX:ProEd.
TestofAdolescent/ German,D.J.(1990).TestofAdolescent/AdultWordFinding.
12to80years EWF no x
AdultWordFinding SanAntonio,TX:PsychologicalCorporation.
TestofAuditory 3yearsto9
RSem, CarrowWoolfolk,E.(1999).TestofAuditoryComprehension
Comprehensionof years,11 no no
Morph,Syn ofLanguage3.Austin,TX:ProEd.
Language3 months
5yearsto8
TestofChildrens Reading, Barenbaum,E.,&Newcomer,P.(1996).TestofChildrens
years,11 E x
Language writing Language.SanAntonio,TX:ProEd.
months
3yearsto7
TestofEarlyLanguage RandESem, Hresko,W.P.,Reid,K.,&Hammill,D.D.(1991).Testof
years,11 no x
Development Syn EarlyLanguageDevelopment(2nded.).Austin,TX:Proed.
months
TestofLanguage Wiig,E.H.,&Secord,W.(1989).TestofLanguage
5to18years, RandESem,
Competence no CompetenceExpandedEdition.SanAntonio:Psychological x
11months Syn,Prag
Expanded Corporation.
TestofLanguage 8yearsto12 Hammill,D.D.,&Newcomer,P.L.(1997).TestofLanguage
RandESem,
Development years,11 no DevelopmentIntermediate:3.CirclePines,MN:American x
Syn
Intermediate:3 months GuidanceService.
TestofLanguage 4yearsto8 RandE
Newcomer,P.,&Hammill,D.(1997).TestofLanguage
Development years,11 Phon,Sem, no x
DevelopmentPrimary:3.Austin,TX:ProEd.
Primary:3 months Syn
PhelpsTerasaki,D.,&PhelpsGunn,T.(1992).Testof
TestofPragmatic 5to13years,
RandE no PragmaticLanguage.SanAntonio,TX:Psychological x
Language 11months
Corporation
TestofPragmaticSkills RandESem, Shulman,B.B.(1986).TestofPragmaticSkills(Revised).
3to8years no no
(Revised) Prag Tucson,AZ:CommunicationSkillBuilders.
Page333
3yearsto7
TestofRelational Edmonston,N.,&Thane,N.L.(1988).TestofRelational
years,11 RSem no x
Concepts Concepts.Austin,TX:ProEd.
months
6to12
German,D.J.(1989).TestofWordFinding.SanAntonio,TX:
TestofWordFinding years,11 EWF no x
PsychologicalCorporation.
months
6to12
TestofWordFinding German,D.J.(1991).TestofWordFindinginDiscourse.
years,11 EWF no x
inDiscourse Chicago:RiversidePublishing.
months
TestofWord Wiig,E.H.,&Secord,W.(1992).TestofWordKnowledge.
5to17 RandESem no x
Knowledge SanAntonio,TX:PsychologicalCorporation.
6yearsto14
TestofWritten McGhee,R.,Bryant,B.R.,Larsen,S.C.,&Rivera,D.M.
years,11 Writing x
Expression (1995).TestofWrittenExpression.SanAntonio:ProEd.
months
TestofWritten 17years,11 Hammill,D.D.,&Larsen,S.C.(1988).TestofWritten
E Writing x
Language2 months Language2.SanAntonio,TX:PsychologicalCorporation.
12yearsto17 Bowers,L.,Huisingh,R.,Orman,J.,Barrett,M.,&LoGiudice,
TheWordTest
years,11 ESem no C.(1989).TheWordTestAdolescent.EastMoline,IL: no
Adolescent
months LinguiSystems.
Bowers,L.,Huisingh,R.,Barrett,M.,&LoGiudice,C.,&
TheWordTest
7to11years ESem no Orman,J.(1990).TheWordTestRevisedElementary.East no
RevisedElementary
Moline,IL:LinguiSystems.
TokenTestfor DiSimoni,F.(1978).TokenTestforChildren.Chicago:
3to12years RSem,Syn no MMY9
Children Riverside.
3yearsto10
UtahTestofLanguage Mecham,M.J.(1989).UtahTestofLanguageDevelopment
years,11 RandESyn no x
Development3 3.Austin,TX:ProEd.
months
WoodcockLanguage
RandESem, Woodcock,R.W.(1991).WoodcockLanguageProficiency
ProficiencyBattery 2to95years reading,writing x
Syn Revised.Chicago:Riverside.
Revised
Note.Modalitiesanddomainsareabbreviatedasfollows:Receptive(R),Expressive(E),Semantics(Sem),Morphology(Morph),Syntax(Syn),Pragmatics(Prag),
Phonology(Phon),andWordFinding(WF).ThepresenceofareviewintheMentalMeasurementsYearbook(MMY)databaseorprintseriesisnotedinthefinal
column,withxindicatingacomputerizedversionandnumeralsrepresentingthespecificprintvolumecontainingthereview.
aMitchell,J.V.(Ed.).(1985).Theninthmentalmeasurementsyearbook.Lincoln,NE:BurosInstituteofMentalMeasurement.
bConoley,J.C.,&Kramer,J.J.(Eds.).(1989).Thetenthmentalmeasurementsyearbook.Lincoln,NE:BurosInstituteofMentalMeasurement.
Page334
APPENDIXB
Page335
NormReferencedandCriterionReferencedTestsDesignedPrimarilyfortheAssessmentofPhonologyinChildren
Criterion
referenced
(CR)and/or Reviewedin
Norm MMY?(x=
referenced computer
TestwithReferenceInformation (NR) Ages Stimuli,Processes,andOtherFeatures form)
AssessmentLinkBetweenPhonologyand
Sentenceorsinglewordselicitedusingdelayedimitation
Articulation:ALPHA(Reviseded.)(Lowe,1995). NR/CR 30to811 no
andpictures15processesexamined
Mifflinville,PA:SpeechandLanguageResources.
Singlewordselicitedusingobjects30processes
AssessmentofPhonologicalProcessesRevised Preschoolto
CR including10basicprocessesthatareusedincalculating x
(Hodson,1986).Danville,IL:InterstatePress. age10
overallscorethatallowsclarificationofseverity
Singlewordsandstimuliforelicitedconnectedspeech
ArizonaArticulationProficiencyScale,2nded.
consonants,consonantclusters,vowels,anddiphthongs
(Fudala&Reynolds,1994).LosAngeles:Western NR/CR 16to1311 x
areassessedomission,substitution,anddistortionerror
PsychologicalServices.
analysisalsoallowscalculationofseverity
BanksonBernthalTestofPhonology(Bankson& Singlewords10mostfrequentlyoccurringprocessesin
NR/CR 30to911 x
Bernthal,1990).Chicago:RiversidePress. standardizationsamples
Singlewordandsentenceformsincludingconsonants,
FisherLogemannTestofArticulatoryCompetence 2to3years
CR consonantclusters,vowels,anddiphthongsareassessed ?
(Fisher&Logemann,1971).Boston:HoughtonMifflin. andup
place/manner/voicinganalysisonly
(Continued)
Page336
AppendixB(Continued)
Criterion
referenced
(CR)and/or Reviewedin
Norm MMY?(x=
referenced computer
TestwithReferenceInformation (NR) Ages Stimuli,Processes,andOtherFeatures form)
44singlewordsand2setsofpicturesforconnected
GoldmanFristoeTestofArticulation2(Goldman& speechelicitationerroranalysisdoesnotinclude
NR/CR 2to21years x
Fristoe,2000).Austin,TX:ProEd. features,buttheKhanLewisisdesignedforusewiththe
earlierversionofthistest
Limitednormativedataassessproductionsat4levels:
KaufmanSpeechPraxisTestforChildren(Kaufmann, 2yearsto6 oralmovement,simplephonemic/syllabic,complex
NR/CR no
1995).Detroit:WayneStateUniversityPress. years phonemic/syllabic,andspontaneouslengthand
complexity
StimulusmaterialsarethoseoftheGoldmanFristoe
KhanLewisPhonologicalAnalysis(Khan&Lewis, TestofArticulationRevised15phonological
NR/CR 2to6years x
1986).CirclePines,MN:AmericanGuidanceService. processesoneofthefewtestswithnormativedatafor
processes
NaturalProcessAnalysis(Shriberg&Kwiatkowski, Analysismethodforcontinuousspeechsample8natural
CR anyage no
1980).NewYork:JohnWiley&Sons. processes
PhonologicalProcessAnalysis(Weiner,1979). preschool
CR Singlewordsorsentences16phonologicalprocesses no
Baltimore:UniversityParkPress,1979. children
Page337
Singlewordandstimulitoelicitedconnectedspeech
PhotoArticulationTest(Pendergast,Dickey,Selmar& includingconsonants,consonantclusters,and
NR/CR 3to12years MMY9a
Soder,1984).Austin,TX:ProEd. diphthongsomissions,substitutions,anddistortionsare
scored
Scoresgivenforexpressivelanguagediscrepancy,
vowelsanddiphthongs,oralmotormovement,verbal
ScreeningTestforDevelopmentalApraxiaofSpeech
NR/CR 4to12years sequencing,articulation,motoricallycomplexwords, x
(Blakely,1980).Austin,TX:ProEd.
transpositions,prosody,andtotalbasedonasmall
population
Twotestcomponents(1)ContextualProbesof
ArticulationCompetence(CPAC)probesfor
SCAT.SecordConsistencyofArticulationTests
productionofindividualsoundsandprocessesinwords,
(Secord,1997).Sedona,AZ:RedRockEducational CR allages no
clustersandsentence,(2)SPACStorytellingProbes
Publications.
ofArticulationCompetence(SPAC)probesfor
productioninanarrativetask
SmitHandArticulationandPhonologyEvaluation
Singlewordselicitedthroughpicturesordelayed
(SHAPESmit&Hand,1997).LosAngeles:Western NR/CR 3to9years no
imitation11processesexamined
PsychologicalServices.
Singlewordsseveralsubtests,includingscreening,Iowa
TemplinDarleyTestsofArticulation(Templin&
Pressureconsonantstest(thoseaffectedby
Darley,1969).IowaCity,IA:BureauofEducational NR/CR 3to8years MMY7b
velopharyngealinsufficiency),vowels,anddiphthongs
ResearchandService,UniversityofIowa.
omissions,substitutions,anddistortionsarescored
Note.ThepresenceofareviewinMentalMeasurementsYearbook(MMY),withxindicatingacomputerizedversionandnumeralsrepresentingthespecificprint
volumecontainingthereview.
aMitchell,J.V.(Ed.).(1985).Theninthmentalmeasurementsyearbook.Lincoln,NE:BurosInstituteofMentalMeasurement.
bBuros,O.K.(Ed.).(1992).Theseventhmentalmeasurementsyearbook.HighlandPark,NJ:GryphonPress.
Page338
Page339
AUTHORINDEX
Entriesinitalicsappearinreferencelists.
Abbeduto,L.,149,155,166
Abkarian,G.,160,164
Aboitiz,F.,119,141
Agerton,E.P.,273,287
Aitken,K.,169,186
Alcock,K.,118,145
Alfonso,V.C.,264,280,291,306,326
Allen,D.,114,130,143,171,172,173,178,186,233
Allen,J.,175,184
Allen,M.J.,22,47,55,56,57,58,59,66,68,76
Allen,S.,231,245
Allison,D.B.,264,280,291,306,307,308,315,317,325,326
Ambrose,W.R.,222,246
AmericanCollegeofMedicalGenetics,153,164
AmericanEducationalResearchAssociation(AERA),10,12,31,47,50,62,72,75,76,89,96,105,107,252,287
AmericanPsychiatricAssociation,111,114,115,130,134,140,148,149,150,161,164,169,170,171,172,173,178,180,181,182,183,184
AmericanPsychologicalAssociation(APA),10,12,31,47,50,62,72,75,76,89,96,105,107,217,228,244,252,287
AmericanSpeechLanguageHearingAssociation(ASHA),82,84,85,104,107,196,207,264,287
Anastasi,A.,36,47,55,60,61,62,76,96,107,296,324
Andrellos,P.J.,237,246
Andrews,J.F.,197,198,210
Angell,R.,181,184
Annahatak,B.,231,245
Apel,K.,241,242,245
Aram,D.M.,116,117,118,119,128,130,140,143,170,184,231,240,245,270,287
Archer,P.,213,246
Arensberg,K.,229,249
Arndt,S.,171,185
Arndt,W.B.,259,288,294,324
Aspedon,M.,238,248
Augustine,L.E.,82,108,229,230,245
Bachelet,J.F.,270,291
Bachman,L.F.,103,107
Baddeley,A.,125,141
Badian,N.,27,47
Baer,D.M.,308,326
Bailey,D.,237,245
Page340
Bain,B.A.,230,248,251,252,255,256,276,277,278,279,286,287,291,294,295,296,297,298,299,300,302,303,304,305,307,308,309,310,311,
314,315,316,324,326
Baker,K.A.,239,247
Baker,L.,133,140
Baker,N.E.,7,13
BakervandenGoorbergh,L.,269,287
Ball,E.W.,137,140
Balla,D.,163,166,215,249
Baltaxe,C.A.M.,176,184
Bangert,J.,259,288,294,302,324
Bankson,N.W.,29,40,47,298,324,329,335
Barenbaum,E.,332
BaronCohen,S.,175,184
Barrett,M.,329,333
Barrow,J.D.,252,287
Barsalou,L.W.,7,12
Barthelemy,C.,181,185
Bashir,A.,135,140,241,245
Bates,E.,237,245,246,268,287
Batshaw,M.L.,149,164
Battaglia,F.,153,154,155,160,166
Baumeister,A.A.,147,149,152,154,156,158,164
Baumgartner,J.M.,120,142
Beasley,T.M.,308,325
Beck,A.R.,266,283,287
Becker,J.,170,185
Bedi,G.,125,126,144
Bedor,L.,125,142
Beitchman,J.H,130,140
Bejar,I.I.,66,77
Bell,J.J.,158,165
Bellenir,K.,151,152,159,164
Bellugi,U.,158,166,188,198,207,208
Benavidez,D.A.,178,181,185
Berg,B.L.,279,280,287
Bergstrom,L.,197,207
Beringer,M.,232
Berk,R.A.,6,13,56,76,158,163,165,256,287
Berkley,R.K.,251,289
Berlin,L.J.,258
Bernthal,J.E.,29,40,47,215,246,298,324,335
Berns,S.B.,304,325
Bess,F.H.,189,192,203,207
Bettelheim,B.,173,184
Biederman,J.,161,165
Bihrle,A.,158,166
Biklen,S.K.,279,280,287
Bishop,D.V.M.,114,118,119,124,130,140,141,144,269,287
Bjork,R.A.,251,292,309,326
Blackmon,R.,283,292
Blake,J.,270,287
Blakeley,R.W.,337
Blank,M.,258
Bliss,L.S.,103,107,233
Bloodstein,O.,159,165
Boehm,A.E.,329
Bogdan,R.C.,279,280,287,292
Bondurant,J.,121,141
Botting,N.,238,245
Boucher,J.,181,185
Bow,S.,121,122,141
Bowers,L.,333
Bracken,B.A.,215,245,329
Brackett,D.,191,192,194,195,200,203,207,209
Bradley,L.,27,47
BradleyJohnson,S.,188,189,200,201,204,207
Braukmann,C.J.,304,325,326
Bredart,S.,270,291
Breecher,S.V.A.,238,248
Brennan,R.L.,102,108
Bretherton,I.,237,245
Bridgman,P.W.,19,47
Brinton,B.,133,141,241,245,262,287
Broks,P.,173,185
Bronfenbrenner,U.,79,107
Brown,A.L.,226,245,272,277,287
Brown,J.,226,245
Brown,R.,266,287
Brown,S.,230,246,255,278,289
Brown,V.L.,332
Brownell,R.,331
Brownlie,E.B.,133,140
Bruneau,N.,181,185
Bryant,B.R.,59,77,333
Bryant,P.,27,47
Brzustowicz,L.,117,141
Buckwalter,P.,114,118,145
Bunderson,C.V.,31,47
Buros,O.,337
Burroughs,E.I.,262,287
Butkovsky,L.,122,143
Butler,K.G.,132,145,255,287
Byma,G.,125,144
Bzoch,K.R.,59,76,103,107,237,245,258
Cacace,A.T.,192,207
Cairns,H.S.,259,290
Page341
Calhoon,J.M.,281,287
Camarata,M.,122,143
Camarata,S.,115,122,141,143,192,209
Camaioni,L.,237,245
Campbell,D.,55,76,306,324
Campbell,M.,184
Campbell,R.,120,141
Campbell,T.,223,230,245,262,264,265,268,274,275,287,288,294,295,296,304,305,307,309,311,324
Campione,J.,277,287
Cantekin,E.I.,191,208
Cantwell,D.,133,140
Carney,A.E.,189,194,196,203,207
Carpentieri,S.,171,185
Carr,E.G.,317,326
Carr,L.,124,142
CarrowWoolfolk,E.,232,329,330,331,332
Carver,R.,57,76,312,313,324
Casby,M.,128,141
Caspi,A.,313,324
Castelli,M.C.,237,245
Chabon,S.S.,295,310,317,324
Channell,R.W.,269,290
Chapman,A.,238,248
Chapman,J.P.,8,13
Chapman,L.J.,8,13
Chapman,R.,158,166,268,272,287,290
Cheng,L.L.,231,245
Chial,M.R.,30,47
Chipchase,B.B.,130,144
Chomsky,N.,123,141
Chung,M.C.,174,175,184
Cibis,G.,161,166
Cicchetti,D.,163,166,215,249
Cirrin,F.M.,241,245,255,273,288
Clahsen,H.,124,141
Clark,M.,118,121,122,135,141,143
Cleave,P.L.,116,124,128,141,144,231,246
Clegg,M.,133,140
Cochran,P.S.,269,270,288
Coe,D.,178,181,185
Cohen,I.L.,153,165,173,178,184
Cohen,M.,120,141,149,164,165
Cohen,N.J.,134,141
Cohrs,M.,215,246
Compton,A.J.,232
Compton,C.,104,108,232,245
Conant,S.,270,288
Conboy,B.,230,246,255,278,289
Connell,P.J.,317,324
Connor,M.,152,161,165
Conoley,J.C.,103,104,108,333
Conover,W.M.,30,47
ContiRamsden,G.,238,245
Cook,T.D.,306,324
Cooke,A.,158,165
Cooley,W.C.,151,152,165
Cooper,J.,126,144
Cordes,A.K.,66,68,76
Corker,M.,195,207
Coryell,J.,195,196,207
Coster,W.J.,237,246
Courchesne,E.,173,184,185
Crago,M.,118,124,135,141,142,231,245
Craig,H.K.,133,141,268
Crais,E.R.,79,81,108,236,245,281,288
Creaghead,N.A.,10,13,282,288
Creswell,J.W.,279,288
Crittenden,J.B.,196,207
Cromer,R.,149,165
Cronbach,L.J.,66,76
Crutchley,A.,238,245
Crystal,D.,268,269,288
Cueva,J.E.,184
Culatta,B.,23,48
Culbertson,J.L.,189,192,203,207,208
Cunningham,C.,121,122,141
Curtiss,S.,117,118,144
Cushman,B.B.,295,310,317,324
Dale,P.,237,246
Damasio,A.R.,181,184
Damico,J.S.,82,108,229,230,241,245,251,252,253,255,257,274,275,283,284,285,286,288
DAngiola,N.,176,184
Daniel,B.,271,291
Darley,F.,251,290,337
Davidson,R.,270,291
Davies,C.,238,249
Davine,M.,134,141
Davis,B.,128,145
Dawes,R.M.,8,13
Day,K.,271,291
deVilliers,J.,262,291
deVilliers,P.,262,291
DeBose,C.E.,229,231,249
DellaPietra,L.,235,245
Demers,S.T.,84,85,108
Denzin,N.K.,279,288
Derogatis,L.R.,235,245
Page342
Deyo,D.A.,196,209
Dickey,S.,337
Diedrich,W.M.,259,288,294,302,324
DiLavore,P.,174,175,184
Dirckx,J.H.,197,208
DiSimoni,F.,333
Dobrich,W.,135,144
Dodds,J.,213,215,246
Doehring,D.G.,231,245
Dollaghan,C.,223,230,245,251,262,264,265,268,274,275,287,288,296,297,298,299,300,302,303,304,305,307,308,309,315,316,324
DonahueKilburg,G.,82,83,108,203,208
Donaldson,M.D.C.,158,165
Dowdy,C.A.,134,141
Downey,J.,158,165
Downs,M.P.,188,189,190,191,193,194,197,207,209
Dub,R.V.,196,208
Dublinske,S.,241,245
Duchan,J.,253,259,262,263,279,289,290
Dunn,Leota,40,51,57,71,76,232,245,331
Dunn,Lloyd,40,51,57,71,76,232,245,331
Dunn,M.,171,172,186,240,245
Durkin,M.S.,147,148,165
Dykens,E.M.,149,152,153,158,159,161,164,165
Eaton,L.F.,161,165
Eaves,L.C.,171,184
Edelson,S.M.,181,185
Edmonston,A.,333
Edwards,E.B.,241,245
Edwards,J.,118,124,141,142
Edwards,S.,159,160,164,166
Eger,D.,295,306,310,317,318,320,324
Ehlers,S.,171,174,175,180,184,185
Ehrhardt,A.A.,158,165
Eichler,J.A.,191,208
Eisele,J.A.,119,140
Ekelman,B.,130,140
Elbert,M.,259,288,294,324
Elcholtz,G.,283,292
EllisWeismer,S.,124,125,141,237,249
Ellis,J.,23,48
Embretson,S.E.,279,288
Emerick,L.L.,215,248
Engen,E.,202,208
Engen,T.,202,208
Erickson,J.G.,62,77
Evans,A.W.,104,109,238,239,249,296,312,326
Evans,J.,125,141,266,267,268,288
Evans,L.D.,188,189,200,201,204,207
Eyer,J.,125,142
Fandal,A.,215,246
Farmer,M.,133,141
Faust,D.,7,8,13
Fay,W.,176,184
Feeney,J.,215,246
Fein,D.,171,172,173,178,186
Feinstein,C.,171,172,173,178,186
Feldt,L.S.,102,108
Fenson,L.,237,246
Ferguson,B.,133,140
FergusonSmith,M.,152,161,165
Fergusson,D.M.,313,324
Feuerstein,R.,276,278,288
Fey,M.,116,128,141,221,231,246,269,290,309,325
Finnerty,J.,269,288
Fiorello,C.,84,85,108
Fisher,H.B.,335
Fiske,D.W.,55,76
Fixsen,D.L.,304,325,326
Flax,J.,240,247
Fleiss,J.L.,68,77
Fletcher,J.M.,21,48
Fletcher,P.,118,145,269,288
Flexer,C.,188,195,199,208
Fluharty,N.,239,246
Flynn,S.,260,290
Foley,C.,260,290
Folstein,S.,173,184
Foster,R.,258
Foster,S.L.,298,304,325
Fowler,A.E.,159,165
Fox,R.,157,165
Francis,D.J.,21,48
Frankenburg,W.K.,213,215,246
Franklin,R.D.,307,308,315,317,325
Fraser,G.R.,197,208
Frattali,C.,87,108,251,288,295,303,306,318,319,325
Fredericksen,N.,66,77
Freedman,D.,30,48
Freese,P.,130,133,135,143,145
Freiberg,C.,266,290
Page343
Fria,T.J.,191,208
Fristoe,M.,336
Frith,U.,173,178,181,184
Fudala,J.,335
Fujiki,M.,133,141,262,287
Fukkink,R.,314,325
Funk,S.G.,104,109,238,239,249,296,312,326
Gabreels,F.,147,166
Gaines,R.,161,166
Galaburda,A.,119,141
Gardiner,P.,157,167
Gardner,M.F.,40,48,60,77,100,108,233,330,331
Garman,M.L.,269,288
Garreau,B.,181,185
Gathercole,S.,125,141
Gauger,L.,119,121,141
Gavin,W.J.,266,271,289
Geers,A.E.,201,202,208,209
Geirut,J.,251,262,289,303,325
Gerken,L.,261,289
German,D.J.,54,77,332,333
Gertner,B.L.,133,141
Geschwind,N.,119,120,141,142
GeschwintRabin,J.,154,166
Ghiotto,M.,270,291
Gibbons,J.D.,30,47
Giddan,J.J.,258
Gilbert,L.E.,189,203,208
Giles,L.,271,289
Gilger,J.W.,117,118,140,142
Gillam,R.,126,128,140,142,145
Gillberg,C.,171,174,175,180,184,185
Girolametto,L.,237,246
Glaser,R.,58,77
Gleser,G.D.,66,76
Glesne,C.,279,303,325
Goldenberg,D.,215,247
Goldfield,B.A.,302
Goldman,R.,336
Goldman,S.,134,142
Goldsmith,L.,204,208,237,248
Goldstein,H.,251,262,289,303,325
Golin,S.,273,292
Golinkoff,R.M.,261,289
Good,R.,234,248
Goodluck,H.,261,289
Gopnik,M.,118,124,135,141,142
GordonBrannan,M.,241,242,245
Gorman,B.S.,307,308,315,317,325
Gottlieb,M.L.,165
Gottsleben,R.,269,292
Gould,S.J.,20,47,48
Graham,J.M.,151,152,165
Grandin,T.,178,184
Green,A.,161,166
Green,J.A.,239,249
Greene,S.A.,158,165
Grela,B.,125,142
Grievink,E.H.,205,209
Grimes,A.M.,241,245
Gronlund,N.,31,48,67,71,76,77
Grossman,H.J.,149,165
Gruber,C.P.,331
Gruen,R.,158,165
Gruner,J.,120,144
Guerin,P.,181,185
Guidubaldi,J.,201,209
Guitar,B.,10,13,238,249,264,292
GutierrezClellen,V.F.,230,237,246,255,278,289
Haas,R.H.,173,185
Haber,J.S.,239,246
Hadley,P.,121,133,141,142,237,246
Haley,S.M.,237,246
Hall,N.E.,116,128,135,140,142,170,184,231,245,270,287
Hall,P.,259,290
Hall,R.,283,292
Hallin,A.,184
Haltiwanger,J.T.,237,246
Hammer,A.L.,96,100,108
Hammill,D.D.,40,48,54,57,77,103,109,233,240,247,330,332,333
Hand,L.,337
Hanna,C.,233
Hanner,M.A.,330
Hansen,J.C.,224,244,246
Harper,T.M.,171,185,304,325
Harris,J.L.,229,231,246
Harris,J.,195,208
Harrison,M.,194,208
Harryman,E.,215,248
Hartley,J.,268,289
Hartung,J.,237,246
Haynes,W.O.,215,248
Hecaen,H.,120,144
Page344
Hedrick,D.,233,236,237,246
Heller,J.H.,104,109,238,239,249,296,312,326
Hemenway,W.G.,197,207
Hersen,M.,164,165
Hesketh,L.J.,125,141
Hesselink,J.,121,142
Hicks,P.L.,317,318,325
Hirshoren,A.,222,246
HirshPasek,K.,261,289
Hixson,P.K.,269,289
Ho,H.H.,171,184
Hodapp,R.M.,149,152,153,158,159,161,164,165
Hodson,B.,241,242,245,335
Hoffman,M.,276,278,288
Hoffman,P.,276,291
Holcomb,T.K.,195,196,207
Holmes,D.W.,199,208
Hopkins,J.,104,108,217,238,246
Horodezky,N.,134,141
Horwood,L.J.,313,324
Howard,S.,268,289
Howe,C.,153,154,155,160,166
Howlin,P.,133,144
Hresko,W.,54,77,103,109,233,332
Hsu,J.R.,68,77
Hsu,L.M.,68,77
Huang,R.,104,108,217,238,246
Huisingh,R.,329,333
Hummel,T.J.,235,246
Hurford,J.R.,132,140,142
Hutchinson,T.A.,96,107,108,222,246,248
Hux,K.,238,248
Iglesias,A.,278,291
Impara,J.C.,103,104,108
Ingham,J.,304,325
Inglis,A.,133,140
Ingram,D.,124,142
Inouye,D.K.,31,47
Isaacson,L.,134,141
Jackson,D.W.,121,142,194,200,204,209
JacksonMaldonado,D.,237,246
Jacobson,J.W.,148,165,304,325
Janesick,V.J.,280,289
Janosky,J.,230,245
Jauhiainen,T.,204,210
Jenkins,W.,125,126,143,144
Jensen,M.,276,288
Jernigan,T.,121,142
Johansson,M.,171,180,185
Johnson,G.A.,277,291
Johnson,G.,230,248
Johnston,A.V.,330
Johnston,E.G.,330
Johnston,J.R.,115,142
Johnston,P.,126,143
Jones,S.S.,31,48
Juarez,M.J.,222,248
Kahneman,D.,8,13
Kalesnik,J.O,215,216,235,236,238,248
Kallman,C.,125,144
Kamhi,A.,8,13,115,116,128,142,216,229,231,241,245,246
Kanner,L.,181,185
Kaplan,C.A.,130,144
Kapur,Y.P.,194,197,198,208
Karchmer,M.A.,204,208
Kaufman,A.S.,215,246
Kaufman,N.L.,215,246,336
Kayser,H.,229,231,246,247
Kazdin,A.E.,297,304,305,324,325
Kazuk,E.,215,246
Kearns,K.P.,68,76,77,274,275,286,290,307,308,309,314,315,317,325,326
Kelley,D.L.,279,289
Kelly,D.J.,217,247
Kemp,K.,266,267,270,289
Kent,J.F.,64,77
Kent,R.D.,8,13,64,77
Kerlinger,F.N.,19,48
Keyser,D.J.,104,108
Khan,L.M.,336
King,J.M.,161,166
Kingsley,J.,156,166
Klaus,D.J.,58,77
Klee,T.,189,192,203,207,266,267,270,289,290
Klein,S.K.,203,208
Kline,M.,232
Koegel,L.K.,304,325
Koegel,R.,304,325
Koller,H.,156,161,166
Page345
Kovarsky,D.,253,279,286,289
Kozak,V.J.,201,202,209
Kramer,J.J.,333
Krassowski,E.,127,142,231,247
Kratochwill,T.R.,307,315,317,325
Kreb,R.A.,319,323,324,325
Kretschmer,R.,121,141
Kresheck,J.,215,232,248,331
Kuder,G.F.,69,77
Kuehn,D.P.,120,142
Kulig,S.G.,239,247
Kunze,L.,239,249
Kwiatkowski,J.,336
Lahey,M.,10,13,48,118,124,128,141,142,223,231,247,269,289,303,325
Lancee,W.,133,140
Lancy,D.,279,289
Landa,R.M.,273,289
Larsen,S.C.,332,333
Larson,L.,199,210
Layton,T.L.,104,109,199,208,238,239,249,296,312,326
LeCouteur,A.,175,185
League,R.,59,76,103,107,237,246,258
Leap,W.L.,231,247
Leckman,J.F.,149,152,153,159,164,165
Lee,L.,218,247
Lehman,I.,296,326
Lehr,C.A.,215,247
Lehrke,R.G.,152,166
Lemme,M.L.,120,142
Leonard,C.,119,121,141
Leonard,L.,114,117,118,119,121,122,123,124,125,126,128,130,131,132,137,140,142,221,223,230,240,247,251,270,289,317,327
Leverman,D.,233
Levin,J.R.,307,315,317,325
Levitsky,W.,120,142
Levitz,M.,156,166
Levy,D.,125,143
Lewis,N.P.,336
Lidz,C.S.,255,276,278,289
LilloMartin,D.,188,198,207,208
Lincoln,A.J.,173,185
Lincoln,Y.S.,279,288
Linder,T.W.,281,289
Ling,D.,195,208
Linkola,H.,204,210
Lipsett,L.,134,141
Locke,J.,125,143
Loeb,D.,124,143
Logemann,J.A.,335
Logue,B.,271,291
LoGuidice,C.,333
Lombardino,L.,119,121,141
Loncke,F.,192,209
Long,S.H.,116,128,141,231,246,266,269,270,278,289,290,310,314,325
Longobardi,E.,237,245
LonsburyMartin,B.L.,206,208
Lord,C.,174,175,184,185
Love,S.R.,178,181,185
Lowe,R.,335
Lubetsky,M.J.,147,161,166
Lucas,C.R.,259,290
Luckasson,R.,148,166
Ludlow,L.H.,237,246
Lugo,D.E.,232,245
Lund,N.J.,253,259,262,263,290
Lust,B.,260,290
Lyman,H.B.,76
Machon,M.W.,104,109,238,239,249,296,312,326
Macmillan,D.L.,148,149,166
MacWhinney,B.,268,269,287,290
Maino,D.M.,161,166
Maloney,D.M.,304,325
Malvy,J.,181,185
Marchman,V.,237,246
MardellCzudnoswki,C.,215,247
Marks,S.,158,166
Marlaire,C.L.,63,77,236,244,247
Martin,G.K.,206,208
Mash,E.J.,298,304,325
Masterson,J.J.,269,270,288,290
Matese,M.J.,178,181,185
Matkin,N.D.,189,203,209
Matson,J.L.,178,181,185
Matthews,R.,133,145
Mauk,G.W.,194,208
Maurer,R.G.,181,184
Mawhood,L.,133,144
Maxon,A.,191,192,194,200,209
Maxwell,L.A.,154,166,199,200,208
Maxwell,M.M.,253,279,289
Page346
Maynard,D.W.,63,77,236,244,247
McCarthy,D.A.,215,249
McCauley,R.J.,7,12,13,35,38,48,102,104,108,217,220,225,231,234,238,247,249,251,252,253,256,264,290,292,296,299,312,313,326
McClave,J.T.,30,48
McDaniel,D.,259,290
McGhee,R.,333
McGlinchey,J.B.,304,325
McKee,C.,259,290
McFarland,D.J.,192,207
McReynolds,L.V.,68,76,77,274,275,286,290,307,308,309,314,315,317,326
Mecham,M.J.,333
Meehl,P.E.,8,13,223,247
Mehrens,W.,296,326
Mellits,D.,125,144
Membrino,I.,266,289
Menolascino,F.J.,161,165
Menyuk,P.,130,143
Merrell,A.M.,104,108,217,242,247
Mervis,C.B.,158,166
Merzenich,M.,125,126,143,144
Messick,S.,4,13,76,77,252,290
Mient,M.G.,295,310,317,324
Miller,J.F.,158,166,230,235,236,249,252,253,262,258,263,266,268,269,270,271,273,284,288,290,292
Miller,R.,276,288
Miller,S.,125,126,143,144
Miller,T.L.,217,248
Milone,M.N.,204,208
Minifie,F.,251,290
Minkin,B.L.,304,326
Minkin,N.,304,326
Mislevy,R.J.,66,77
Mitchell,J.V.,333,337
Moeller,M.P.,189,194,196,200,203,207,208
MoellmanLanda,R.,273,290
Moffitt,T.E.,313,324
Mogford,K.,195,208
MogfordBevan,K.,188,203,208
Moldonado,A.,233
Montgomery,A.A.,104,109
Montgomery,J.K.,241,242,248
Moog,J.S.,201,202,208,209
Moores,D.F.,196,209
Morales,A.,271,291
Moran,M.J.,273,287
Mordecai,D.R.,269,290
Morgan,S.B.,171,184
Morishima,A.,158,165
Morisset,C.,237,245
Morris,P.,79,107
Morris,R.,116,128,140,171,172,173,178,186,231,245,252,270,287,290
Morriss,D.,271,291
Mowrer,D.,294,317,326
Mulick,J.A.,148,165
Muller,D.,268,289
Muma,J.,79,108,217,247,253,271,290,291
Murphy,L.L.,104,108
Musket,C.H.,199,209
Myles,B.S.,170,185
Nagarajan,S.,125,126,144
Nair,R.,133,140
Nanda,H.,66,76
Nation,J.,130,140
NationalCouncilonMeasurementinEducation(NCME),10,12,31,47,50,62,72,75,76,89,96,105,107,252,287
Needleman,H.,230,245
Neils,J.,117,118,143
Nelson,K.E.,122,143,192,209
Nelson,N.W.,235,247,282,291
Newborg,J.,201,209
Newcomer,P.L.,40,48,57,77,103,108,240,247,332
Newcorn,J.H.,161,165
Newhoff,M.,121,143
Newman,P.W.,10,13
Newport,E.,198,209
Nicolosi,L.,215,248
Nielsen,D.W.,6,10,13
Nippold,M.A.,104,108,134,143,217,238,246,248
Nitko,A.J.,49,58,67,71,77
Nordin,V.,171,174,175,184,185
Norris,J.,276,291
Norris,M.K.,222,248
Norris,M.L.,239,246
Northern,J.L.,188,189,190,191,193,194,207,209
Nunnally,J.,225,248
Nuttall,E.V.,215,216,235,236,238,248
Nyden,A.,171,180,185
Nye,C.,241,242,248
OBrien,M.,114,145
OGrady,L.,188,207
Page347
Olsen,J.B.,31,47
Olswang,L.B.,128,129,143,223,230,248,249,251,252,255,256,273,276,277,278,279,280,286,287,289,290,291,292,294,295,296,297,298,
302,303,304,305,307,310,311,314,317,318,319,323,324,325,326
Onorati,S.,270,287
Orman,J.,333
Ort,S.I.,149,165
Owens,R.E.,221,248
Oyler,A.L.,189,203,209
Oyler,R.F.,189,203,209
Padilla,E.R.,232,245
Page,J.L.,23,48,181,185
Palin,M.W.,269,290
Palmer,P.,171,185,269,290
Pan,B.A.,174,185
Panagos,J.,268,291
Pang,V.O.,231,248
Papoudi,D.,169,186
Parsonson,B.S.,308,326
Passingham,R.,118,145
Patell,P.G.,133,140
Patton,J.R.,134,141
Paul,P.V.,194,196,200,204,207,209
Paul,R.,128,143,174,176,177,185,203,209,221,222,223,248,253,262,263,268,290,291
Payne,K.T.,228,229,249
Pedhazur,R.J.,10,13,17,18,22,23,24,28,48,55,56,76,264,280,291,297,298,303,306,326
Pembrey,M.,117,143
Pea,E.,230,248,255,276,278,289
Pendergast,K.,337
Penner,S.G.,255,273,288
Perachio,J.J.,331
Perkins,M.N.,222,248
Perozzi,J.A.,251,289
Perret,Y.M.,149,164
Peshkin,A.,279,303,325
Peters,S.A.F.,205,209
Pethick,S.,237,246
PhelpsGunn,T.,332
PhelpsTerasaki,D.,332
Phillips,E.L.,304,325,326
Piercy,M.,125,144
Pindzola,R.H.,215,248
Pisani,R.,30,48
Piven,J.,171,185
Plake,B.S.,104,108
Plante,E.,104,108,116,118,120,121,127,135,141,142,143,217,218,220,222,231,242,247,299,326
Plapinger,D.,199,209
Poizner,H.,198,208
Pollock,K.E.,229,231,246
Polloway,E.A.,134,141
Pond,R.E.,59,77,233,331
Porch,B.E.,274,331
Prather,E.M.,233,236,237,238,246,248
Prelock,P.A.,241,245,268,282,289,291
Primavera,L.H.,264,280,291,306,326
Prinz,P.,196,198,209
Prizant,B.M.,171,174,185,214,248
Proctor,E.K.,294,326
Prutting,C.A.,251,289
Purves,R.,30,48
Pye,C.,269,291
Quartaro,G.,270,287
Quigley,S.P.,207
Quinn,M.,230,235,236,249,252,284,292
Quinn,R.,278,291
Radziewicz,C.,81,109
Rajaratnam,N.,66,76
Ramberg,C.,171,180,185
Rand,Y.,276,278,288
Rapcsak,S.,120,143
Rapin,I.,114,130,143,171,172,173,174,178,179,180,181,185,186,191,203,208,209
Raver,S.A.,281,291
Records,N.L.,7,10,13,114,130,133,135,143,145
Rees,N.S.,192,209
Reeves,M.,266,290
Reichler,R.J.,175,185
Reid,D.,54,77,103,109,233,332
Reilly,J.,237,246
Remein,Q.R.,6,13,214,249
Renner,B.R.,175,185
Reschly,D.J.,148,149,166
Rescorla,L.,128,143,237,248
Resnick,T.J.,191,209
Reveron,W.W.,229,248
Reynell,J.,331
Reynolds,W.M.,335
Page348
Reznick,S.,237,246
Rice,M.L.,117,119,121,124,133,141,142,143,144,217,237,247,249
Richard,G.J.,330
Richardson,M.W.,69,77
Richardson,S.A.,156,161,166
Ries,P.W.,188,209
Riley,A.M.,330
Rimland,B.,173,181,185
Risucci,D.,130,145
Rivera,D.M.,333
Robarts,J.,169,186
Roberts,J.E.,237,245
Roberts,L.J.,304,325
RobinsonZaartu,C.,230,231,248,255,278,289
Roby,C.,136,144
Rodriguez,B.,128,129,143,241,245
Roeleveld,N.,147,166
Roeper,T.,262,291
Rolland,M.B.266,290
Romeo,D.,121,141
Romero,I.,215,216,235,236,238,248
Rondal,J.A.,159,160,161,164,166,270,291
Rosa,M.,229,249
Rose,S.A.,258
Rosen,A.,294,326
Rosen,G.,119,141
Rosenbek,J.C.,64,77
Rosenberg,L.R.,233
Rosenberg,S.,149,155,166
Rosenzweig,P.,233
Rosetti,L.,237,248,281
Ross,M.,189,191,192,194,200,209
Ross,R.,117,118,144
Roth,F.,267,291
Rothlisberg,B.A.,103,109
Rounds,J.,7,13
Rourke,B.,21,48
Roush,J.,194,203,208,209
Roussel,N.,232,248
Roux,S.,181,185
Rowland,R.C.,3,13
Ruscello,D.,40,48
Rutter,M.,133,144,169,173,174,175,184,185
Sabatino,A.D.,217,248
Sabers,D.L.,100,107,109,222,248
Sabo,H.,158,166
Salvia,J.,33,35,36,48,63,64,77,96,102,107,109,225,231,233,248,252,264,291,296,326
Sanders,D.A.,192,195,209
Sandgrund,A.,161,166
Sanger,D.,238,248
Sattler,J.M.,37,47,48,76,158,166,225,226,249
Sauvage,D.,181,185
Scarborough,H.,135,144,269,270,291
Schachter,D.C.,133,137,140,144
Scheetz,N.A.,191,207,209
Schiavetti,N.,262,265,292
Schilder,A.G.M.,205,209
Schlange,D.,161,166
Schloss,P.J.,204,208
Schmelkin,L.P.,10,13,17,18,22,23,24,28,48,55,56,76,264,280,291,297,298,303,306,326
Schmidt,R.A.,251,292,309,326
Schopler,E.,169,175,184,185
Schraeder,T.,230,235,236,249,252,284,292
Schreibman,L.,173,185,317,326
Schreiner,C.,125,126,143,144
Schupf,N.,152,167
Schwartz,I.S.,223,249,255,279,280,292,296,297,304,305,307,324,326
ScientificLearningCorporation,126,144
Secord,W.A.,10,13,59,77,230,233,238,245,249,251,252,253,255,257,259,264,274,283,284,285,286,288,292,305,326,329,332,333,337
Selmar,J.,337
Semel,E.,59,77,233,238,249,264,292,305,326,329
Sevin,J.A.,178,181,185
Shady,M.,261,289
Shanteau,J.,7,13
Shaywitz,B.,21,48
Shaywitz,S.E.,21,48
Shelton,R.L.,259,288,294,324
Shenkman,K.,118,135,143
Shepard,L.A.,235,249
Sherman,D.,251,290
Sherman,G.,119,141
Shewan,C.,283,292
Shields,J.,173,185
Shine,R.E.,259,292
Shipley,K.G.,331
Short,R.J.,148,166
Shriberg,L.,268,291,336
Shu,C.E.,158,165
Page349
Shulman,B.,241,242,245,332
Siegel,L.,121,122,141
Silliman,E.R.,279,282,292
Silva,P.A.,313,324
Silverman,W.,152,167
Simeonsson,R.J.,148,166
Simon,C.,262,263,292
Simpson,A.,173,185
Simpson,R.L.,170,185
Slater,S.,283,292
Sliwinski,M.,240,247
Smedley,T.,199,209
Smit,A.,222,249,337
Smith,A.R.,238,249,264,292
Smith,B.,174,175,184
Smith,E.,114,145
Smith,M.,82,108,229,230,245
Smith,S.,271,291
Smith,T.E.C.,134,141
Snyder,L.,237,245
Snow,C.E.,123,144,174,185
Snow,R.,63,77
Snowling,M.J.,130,144
Soder,A.L.,337
Sowell,E.,121,142
Sparks,S.N.,155,166
Sparrow,S.S.,149,163,165,166,215,249
Spekman,N.,266,290
Spencer,L.,192,196,209
Sponheim,E.,174,185
Sprich,S.,161,165
St.Louis,K.O.,40,48
Stafford,M.L.,238,248
Stagg,V.,157,166
Stark,J.,258
Stark,R.E.,115,125,137,144
Stein,Z.A.,147,148,165
Steiner,V.,59,77,233,331
Stelmachowicz,P.,199,210
Stephens,M.I.,104,109,239,249
Stephenson,J.B.,158,165
Stevens,G.,60,77
Stevens,S.S.,20,43,48,265,292
Stevenson,J.,133,144
Stewart,T.R.,7,13
Stillman,R.,63,77
Stock,J.R.,201,209
Stockman,I.J.,230,235,236,249,252,284,292
Stokes,S.,238,249
Stone,T.A.,331
Stothard,S.E.,130,144
Stout,G.G.,195,209
Strain,P.S.,184,185
Stratton,K.,153,154,155,160,166
StrayGunderson,K.,151,164,166
Striffler,N.,239,249
Strominger,A.,135,140
Stromswold,K.,266,292
Strong,M.,196,198,209
Sturner,R.A.,104,109,238,239,249,296,312,326
Sue,M.B.,331
Supalla,S.,198,209
Supalla,T.,198,209
Svinicki,J.,201,209
Sweetland,R.C.,104,108
Swisher,L.,35,48,104,108,115,120,141,143,217,220,225,231,234,247,252,256,290,296,299,312,313,326
Tackett,A.,271,291
TagerFlusberg,H.,126,144
Taitz,L.S.,161,166
Tallal,P.,115,117,118,121,125,126,137,142,143,144,145
Taylor,O.L.,228,229,249
Taylor,S.J.,279,292
Templin,M.C.,266,292,337
Terrell,F.,229,249,273,292
Terrell,S.L.,229,249,273,292
Teszner,D.,120,144
Thal,D.,237,246
Thane,N.L.,333
Thompson,C.K.,315,317,324,326
Thordardottir,E.T.,237,249
Thorner,R.M.,6,13,214,249
Thorton,R.,260,292
Thorum,A.R.,330
Thurlow,M.L.,215,247
Tibbits,D.F.,241,245
Timbers,B.J.,304,326
Timbers,G.D.,304,326
Timler,G.,128,145,146
Tobin,A.,233,236,237,246
Tomblin,J.B.,7,10,13,114,117,118,121,122,130,133,135,142,143,144,145,262,265,287
Tomlin,R.,265,288
Torgesen,J.K.,59,77
Toronto,A.S.,233
Toubanos,E.S.,103,109
Page350
Townsend,J.,173,185
Tracey,T.J.,7,12,13
Trauner,D.,121,145
Trevarthen,C.,169,186
Tsang,C.,232,233
Turner,R.G.,6,10,13,222,249,256,292
Tversky,A.,8,13
Tyack,D.,269,292
TyeMurray,N.,192,209
Tynan,T.,157,167
Tzavares,A.,120,144
Udwin,O.,160,166
vanBon,W.H.J.,205,209
VandenBercken,J.H.L.,205,209
vanderLely,H.,124,145
vanderSpuy,H.,121,122,141
VanHasselt,V.B.,164,165
vanHoek,K.,188,207
VanKeulen,J.E.,229,231,249
vanKleeck,A.,82,109,128,145
VanRiper,C.,62,77
VanVoy,K.,304,325
Vance,H.B.,217,248
Vance,R.,104,108,120,143,218,220,222,247,299,326
VarghaKadeem,F.,118,145
VaughnCooke,F.B.,223,229,230,249
Veale,T.K.,126,145
Veltkamp,L.J.,161,167
Vernon,M.,197,198,210
Vetter,D.K.,10,13,96,109,253,292
Volterra,V.,237,245
Vostanis,P.,174,175,184
Voutilainen,R.,204,210
Vygotsky,L.S.,276,292,310,327
Wallace,E.M.,238,248
Wallace,G.,330
Wallach,G.P.,132,145
Walters,H.,133,140
Wang,X.,125,126,144
Warren,K.,63,77
Washington,J.A.,229,230,249
Wasson,P.,157,167
Waterhouse,L.,169,171,172,173,178,186
Watkins,K.,118,145
Watkins,R.V.,114,121,130,145
Wechsler,D.,18,48
Weddington,G.T.,229,231,249
Weiner,F.F.,269,292,336
Weiner,P.,135,145
Weiss,A.,7,13,230,247,259,290
Welsh,J.,122,143
Wender,E.,134,145,181,186
Werner,E.O.,232,331
Wesson,M.,161,166
Westby,C.,241,245,279,292
Wetherby,A.M.,171,174,185,214,248
Wexler,K.,124,144
White,K.R.,194,208
Whitehead,M.L.,206,208
Whitworth,A.,238,249
Wiederholt,J.L.,332
Wiig,E.D.,31,48
Wiig,E.H.,59,77,230,233,238,245,249,251,252,253,255,257,258,264,274,283,284,285,286,288,292,305,326,329,332,333
Wiig,E.S.,31,48
Willis,S.,239,249
Wilcox,M.J.,317,327
Wild,J.,133,140
Wilkinson,L.C.,279,282,292
Williams,D.,176,186
Williams,F.,24,28,48
Williams,K.T.,97,103,109,330
Wilson,A.,158,165
Wilson,B.,130,133,140,145
Wilson,K.,283,292
Wiltshire,S.,103,109
Windle,J.,195,209
Wing,L.,171,172,173,178,180,186
Wise,P.S.,157,165
Wnek,L.,201,209
Wolery,M.,299,300,327
Wolf,M.M.,304,305,319,323,324,325,326
Wolfram,W.,231,249
WolfSchein,E.G.,169,173,175,186
Wolk,S.,204,208
Woodcock,R.W,333
WoodleyZanthos,P.,152,154,164
Woodworth,G.G.,192,198,209
WorldHealthOrganization,85,87,109,169,186,253,280,282,292
Page351
Worthington,D.W.,199,210
Wulfeck,B.,121,145
Wyckoff,J.,270,291
Yaghmai,F.,120,141
Yen,W.M.,22,47,55,56,57,58,59,68,76
YeungCourchesne,R.,173,185
Ying,E.,199,200,210
Yoder,D.E.,8,13,258
Yonce,L.J.,223,245
YoshinagoItano,C.,200,203,210
Young,E.C.,331
Young,M.A.,29,48,297,298,327
Ysseldyke,J.E.,33,35,36,48,64,77,96,102,107,109,215,225,231,234,247,248,252,264,291,296,326
Yule,W.,160,166
Zachman,L.,329
Zelinsky,D.G.,149,165
Zhang,X.,114,145
Zielhuis,G.A.,147,166
Zigler,E.,149,165
Zigman,A.,152,167
Zigman,W.B.,152,167
Zimmerman,I.L.,59,77,233,331
Page352
Page353
SUBJECTINDEX
Pagenumbersfollowedbyatindicatetablesandthosefollowedbyanfindicatefigures.
14morphemecount,240
Abilitytesting,30,44
Accountability,295,306309,315,317
Achievementtesting,30,44
Acquiredepilepticaphasia,seeLandauKleffnersyndrome
Actingouttasks,261
Activity,ICIDH2proposeddefinitionof,87
AfricanAmericanculture,
BlackEnglish,236
familyattitudes,83
Agedifferentiationstudiesofconstructvalidity,seeConstructvalidity,developmentalstudiesof
Ageequivalentscores,3536t,44
Agreementmeasures,6869f
Akinesia,181182
Alternateformsreliability,6768,71
AmazingUniversityofVermontTest,32
AmericanSignLanguage(ASL),196
AmericanSpeechLanguageHearingAssociation,317,319320
Anastasi,Anne,autobiographicalstatement,6061
Anxietydisorder,134,138
Arenaassessment,281,284
ArizonaArticulationProficiencyScale,2nded.,335t
Asianculture,83
Aspergersdisorder,169,171172t,180t,182
Aspergersyndrome,seeAspergersdisorder
AspergerSyndromeScreeningQuestionnaire(ASSQ),175
AssessingSemanticSkillsThroughEverydayThemes,329t
AssessmentLinkBetweenPhonologyandArticulation:ALPHA(Reviseded.),335t
Assessmentofchange,
importanceof,294,317321
outcomemeasurementand,294295,317,322
predictionoffuturechange,310311
recommendedreadings,324
specialconsiderations,296311
typesofmethodsused,
dynamicassessment,310311,314
informalcriterionreferencedmeasures,313314
normreferencedtests,312313
singlesubjectexperimentaldesigns,314317,316f
standardizedcriterionreferencedmeasures,258t,313
AssessmentofChildrensLanguageComprehension,258t
AssessmentofPhonologicalProcessesRevised,335t
Page354
AssigningStructuralStage,269t
Attentiondeficithyperactivitydisorder(ADHD),133134,138
definition,134
specificlanguageimpairmentand,133134
Atypicalautism,seePervasivedevelopmentaldisordernototherwisespecified(PDDNOS)
Auditoryintegrationtraining,181
Auditorytraining,190
AustinSpanishArticulationTest,232t
Authenticassessment,236,252,284
Authenticity,252,284
Autism,seeAutisticspectrumdisorder
Autisticdisorder,
definition,170t,182
highfunctioning,174,176,179t
lowfunctioning,180t
othertermsfor,169
symptomsof,169
Autisticspectrumdisorder,
behavioralchecklistsandinterviews,174175t
classificationofsubgroups,169,178
DSMIVdiagnosticcategories,169
dyspraxiaand,181
fragileXsyndromeand,153,173
mentalretardationand,169,171
motorabnormalities,179t180t,181
personalperspective,176177
playand,170,174,178
pragmaticdeficits,169170t,172,174,179t,180t
prevalence,169
recommendedreadings,184
sensorydifferences,181
sleepdisordersand,181
stereotypicalbehaviors,170t,178
suspectedcauses,173174
genetic,173
infectiousdisease,173
neurologic,173
suspectedneurologicabnormalities,173
theoryofmindand,181
writtenlanguageand,179
AutismDiagnosticInverviewRevised(ADIR),175t
BanksonBernthalTestofPhonology,335t
BanksonLanguageTest2,329t
Baselinemeasures,307,315317,316f
BatelleDevelopmentalInventory,201t
Behavioralobjectives,19,44
Beliefinthelawofsmallnumbers,8,11
Bellugisnegationtest,263
BerSilSpanishTest,232t
BilingualSyntaxMeasureChinese,232t
BilingualSyntaxMeasureTagalog,232t
Bioecologicalmodelofdevelopment,79
Blindmeasurementprocedures,definitionof,314
BoehmTestofBasicConceptsPreschool,329t
BoehmTestofBasicConceptsRevised,329t
BrackenBasicConceptScaleRevised,329t
Bradykinesia,181,182
Bronfenbrenner,influenceindevelopmentalresearch,79
CarolinaPictureVocabularyTest,199
CarrowElicitedLanguageInventory,329t
Caseexamples,1,2,3,3842,113114,168169,187188,213214,228t,250251,293294
Caseloadsandassessmentpractices,283
Causation,
confusionwithcorrelation,2930,43
singlesubjectdesignandstudyof,307
Centralauditoryprocessingdisorders,191
Chaptersummary,11,4647,7576,106107,137,161162,181182,205,242243,283284,323324
ChecklistforAutisminToddlers(CHAT),175t
ChildhoodAutismRatingScale(CARS),175t
Childhooddisintegrativedisorder,169,172t,182
Chinese,232t
Chromosomes,162
Classicalpsychometrictheory,6667
Classicaltruescoretheory,seeClassicalpsychometrictheory
Clinicaldecisionmaking,
definition,4,11
disconfirmatorystrategyin,8
ethicsand,50,72
fallaciesin,7,8
measurementand,252
modelof,7,9f
typesof,5t
ClinicalEvaluationofLanguageFundamentals3,264,329t
ClinicalEvaluationofLanguageFundamentals3SpanishEdition,233t
ClinicalEvaluationofLanguageFundamentalsPreschool,329t
ClinicalProbesofArticulation(CPAC),259
Clinicallysignificantchange,321322
Clinicalsignificance,29,44,297306,321
Cochlearimplants,192,205
Coefficientalpha,69
Page355
Coefficientofdetermination,29
Cognitivereferencing,seealsoDiscrepancytesting
definition,127,138,
problemswith,127128,231235
Collaborativeassessmentapproaches,280282
typesof,281
foryoungerchildren,236237
CommunicationAbilitiesDiagnosticTest,330t
CommunicationAnalyzer,269t
CommunicationScreen,239t
ComptonSpeechandLanguageScreeningEvaluationSpanish,232t
ComprehensiveAssessmentofSpokenLanguage,330t
ComprehensiveReceptiveandExpressiveVocabularyTest,330t
ComputerizedLanguageAnalysis(CLAN),268
ComputerizedLanguageErrorAnalysisReport(CLEAR),269t
ComputerizedProfilingVersion6.2and1.0,269t
Computersandlanguageassessmentandtreatment,31,44,126
Concurrentvalidity,59t,6162
Conductdisorder,134,138
Confidenceinterval,70,73,224226,225f
Confirmatorystrategyindecisionmaking,78,11
Congenitalaphasia,seeSpecificlanguageimpairment
Constructvalidity,
centralityof,53,72
contrastinggroupsevidence,5355,54t,74
convergentanddiscriminantvalidation,5556,74
definition,52,73
developmentalstudiesof,5354,54t,74
factoranalysisand,55
Content,FormandUseAnalysis,269
Contentrelatedvalidity,seeContentvalidity
Contentvalidity,seealsoItemanalysis,
Contentcoverage,56
Contentrelevance,56
Definition,73
Expertevaluationof,56
Testdesignand,56
Contexts,
affectingchildrenandfamilies,7983,80f,83t,87
affectingclinicians,7980f,84t,8488,240242,283,317321
Coordinatedassessmentstrategies,280282,284
Correlation,2628,27f
Correlationcoefficients,interpretationofmagnitude,28t
Correlationcoefficients,typesof,28
Criterionreferencedmeasures
constructionof,3334f,58,253255,254f
definitionof,31,44
examplesof,32t
interpretationof,31,43,60
scoresfor,38,101102
useinscreeningandidentification,217,230,236
Criterionrelatedvalidity,6162,74
concurrentvalidity,59t
criterionselection,61
predictivevalidity,59t,6162,310
Culturalvalidity,seeClinicalsignificance
Curricula,typesof,282
Curriculumbasedassessment,280,282,284
Cutoffscore
confidenceintervalsand,224226
definition,33,243
determininglocalcutoffs,222
empiricalselectionof,222
recommendedlevelsforidentificationoflanguageimpairment,221224
Cuttingscore,seeCutoffscore
Deafculture,195196
Deafness,seeHearingimpairment,deafness
Decisionmatrix,56f,11,219f
DelRioLanguageScreeningTest,233
DenverDevelopmentalScreeningTestRevised,215
Derivedscores,3537,44
Descriptionoflanguage,seeDescriptivemeasures
Descriptivemeasures,seealsoCriterionreferencedmeasuresInformalmeasures
characteristicsof,252253,283
criterionreferencedtestsas,257
normreferencedtestsas,255256
purposes,230
recommendedreadings,286
typesof
criterionreferenced,257,258t
dynamicassessment,276279,277t,310311
onlineobservations,274275
normreferenced,255256
probes,seealsoInformalmeasures,257,259261,260t261t,263t,285,308310,316f
qualitativemeasures,279280
ratingscales,262266
useinexaminingtreatmenteffectiveness,251
useintreatmentplanning,251
validityand,250255,280,283
Developmentaldysphasia,seeSpecificlanguageimpairment
Page356
DevelopmentalIndicatorsforAssessmentofLearningRevised,215
Developmentalscores,seeAgeequivalentscoresGradeequivalentscores
DevelopmentalSentenceScoring(DSS),267,269t
DeviationIQ,38
Diadochokinesis,64
Diagnosis,seeIdentification
DiagnosticandStatisticalManualofMentalDisordersIV,
diagnosticcategoriesrelatedtoautisticdisorder,170t
diagnosticcategoriesrelatedtospecificlanguageimpairment,114115t
Dichotomousscoring,69
Differencescores,116,296
Differentialdiagnosis,3,12
Directmagnitudeestimation,263,284
Disability,
ICIDHdefinitionof,86
Discrepancyanalysis,seeDiscrepancytesting
Discrepancytesting,seealsoCognitivereferencing
criticismsof,116,231235
mentalretardationand,158,162
specificlanguageimpairmentand,116
stateregulationsand,241242
useindescription,255257
Discriminantanalysis,222
Distributions,statistical,24,37f,4344
Downsyndrome,
definition,162
dementiaand,5,152
healthproblemsand,151152
patternofstrengthsandweaknesses,159t
personalperspective,156
prevalence,150152,151f,152f
Dynamicassessment,276279
definition,276,
samplehierarchyofcues,277t
useinidentification,278
useinplanningtreatment,276278
usewithchildrenfromdiversecultures,230,278
usewithchildrenwithmentalretardation,278
validation,278279
Dyskinesia,181182
Dyspraxia,181182
Echolalia,176,179,182
Ecologicalvalidity,seeClinicalsignificance
Eduationalrelevance,seeClinicalsignificance
Effectsize,123,138,297303,322323,seealsoClinicalsignificance
Elicitationstrategies,
imitation,260t
production,260t
syntax,260t261t
Eligibilityforspecialeducationservices,241242
Emotional/Behavioralproblems
hearingimpairmentand,204
mentalretardationand,161
specificlanguageimpairmentand,133134
Enablingbehaviors,6365,74,100
EnglishasaSecondLanguage(ESL),227
Epilepsyandlanguagedisorders,119,161,181,183
Error,seeMeasurementerror
EvaluatingAcquiredSkillsinCommunicationRevised,330t
Eventrecording,275,285
Expertsystems,7
Expressivelanguagedisorder,114115t
ExpressiveOneWordPictureVocabularyTestRevised,330t
ExpressiveOneWordPictureVocabularyTestSpanish,233t
ExpressiveVocabularyTest,97f99f,103,109,330t
ExtendedoptionalinfinitiveaccountofSLI,124
Facevalidity,61,74
Factoranalysis,74
Fallaciesindecisionmaking,78
Familyassessment,81
Familymembersaspartnersinassessment,78,81,236237,281
FastForWord,126,138
Fetalalcoholeffect(FAE),153,163
Fetalalcoholsyndrome,153155t,163
FisherLogemannTestofArticulatoryCompetence,335t
FluhartyPreschoolSpeechandLanguageScreeningTest,239t
FMradiosystems,206
Formativetesting,30,31
FragileXsyndrome
attentiondeficitandhyperactivitydisorder,153
autismand,153,173
definition,163
genderand,152
prevalenceand,152
sensoryproblems,153
FullertonLanguageTestforAdolescents,330t
Page357
FunctionalCommunicationMeasures(FCMs),319320,322
FunctionalStatusMeasures(EducationalSettings)ofthePediatricTreatmentOutcomesForm,264
Functionality,252,285
Gainscores,296,322,seealsoDifferencescores
Generalallpurposeverbs,129t,138
GeneralprocessingdeficitaccountsofSLI,124125,138
Generalizabilitytheory,66
Generalization,295,311,315
Genetics,
basicconcepts,150,162163
chromosomaldisorders,150
concordance,117,138
Downsyndromeand,150151f
familystudiesofspecificlanguageimpairment,117118
fragileXsyndromeand,152153,154f
geneticdisordersversusinheriteddisorders,151
hearingimpairmentand,197
incompletepenetrance,118,138
pedigreestudiesofspecificlanguageimpairment,117
premutation,152153,
specificlanguageimpairmentand,117119
transmissionmodes
autosomalversusXlinked,118,162
dominantversusrecessive,118
twinstudiesofspecificlanguageimpairment,117
GoldmanFristoeTestofArticulationRevised,336t
Goldstandard,218,243
Gradeequivalentscores,35,36t,44
Grammar,recommendedtutorialtext,132
GrammaticalAnalysisofElicitedLanguageComplexSentenceLevels(GAELC),201t
GrammaticalAnalysisofElicitedLanguagePresentenceLevel(GAELP),201t
GrammaticalAnalysisofElicitedLanguageSimpleSentenceLevel(GAELS),201t
Grammaticalcomplexity,seeLinguisticcomplexity
Grammaticalmorphemes,
inflectionalmorphemes,133
specificlanguageimpairmentand,131,133
Handicap,
ICIDHdefinitionof,86
objectionstouseofthisterm,8687
Hardofhearing,definition,191,206
HealthandPsychosocialInstruments(HaPI)database,105
Hearingaids,195
Hearingimpairment,
academicdifficulties,189,203
ageatidentification,194
assessmentofAmericansignlanguage(ASL),198199
bilingualmodeloflanguagedevelopmentforDeafchildren,196
causes
genetic,197
infectiousdisease,197
ototoxicagents,197,206
prematurity,197198,206
rhincompatibility,197,206
configurationof,192193f,206
deafness
culturalconsiderations,195,196,seealsoDeafculture
definition,188,205
differencesfromotherlevelsofhearingimpairment
effectsonorallanguageacquisition,203204
emotional/behavioraldisordersand,204
implicationsfororallanguageassessment,
norms,200
procedures,199201t
interventions
formildandmoderatehearingimpairment,190t,195t
forprofoundhearingimpairment,190t
lateralityof,192
magnitudeof,189190t
personalperspective,189
prelingual,194
prevalence,188
recommendedreadings,207
signlanguage,188,195196
specialconsiderationsinassessmentplanning,198200,203
syndromesassociatedwith,197
totalcommunicationand,195196
typesof,
centralauditoryprocessingdisorders,191192
conductive,191,205
mixed,191,206
sensorineural,191,206
Hispanicculture,83t
Homogeneityofitemcontent,69
Page358
ICIDH:InternationalClassificationofImpairments,Disabilities,andHandicaps,8587,282
ICIDH2:InternationalClassificationofImpairments,Activities,andParticipationoftheWorldHealthOrganization,87
IDEA,seeLegislation,IndividualswithDisabilitiesEducationActof1990(IDEA)
Identificationoflanguageimpairment,
cognitivereferencingand,231235
definition,215
diagnosisversus,215
disorderversusdifferencequestion,227231
federallegislationand,seeLegislation
importanceof,216
localregulationsand,128
recommendedcutoffs,221224
recommendedlevelsofsensitivityandspecificity,220,222
recommendedreadings,244
specialchallengesin,217236
useofcriterionreferencedmeasuresin,238240
useofnormreferencedmeasuresin,217240
useofstandardizedmeasuresin,217
IllinoisTestofPsycholinguisticAbilities,267
IndexofProductiveSyntax(IPSyn),269t
Imitation,260t
Impairment,
ICIDHdefinitionof,86
ICIDH2proposeddefinitionof,87
Indicators
definition,17,19f,43,44
formative,18,19,44
reflective,18,45
valueofmultipleindicators,305306
IndividualEducationalPlans(IEPs),81,320
IndividualizedFamilyServicePlans(IFSPs),81
IndividualswithDisabilitiesEducationAct(IDEA),84,106,108
Informalmeasures,seealsoCriterionreferencedmeasuresDescriptivemeasures
developmentof,254f
relationshiptocriterionreferencedmeasures,251
relationshiptoexperimentalmeasures,251
reliability,6869t
Informativeness,265
Instrumentaloutcomes,295,311322
Intelligencetesting,20,seealsoCognitivereferencing
Interdisciplinaryteams,281
forchildrenwithautisticspectrumdisorder,3
forchildrenwithhearingimpairment,203
requirementfornondiscriminatoryassessment,85
Interexamineragreement,69t,74
Interexaminerreliability,70,74
Intermediateoutcomes,294,322
Internalconsistency,seeReliability,typesof
Intervallevelofmeasurement,21t22,4344
Intervalrecording,275,285
Intervalscaling,262,285
Itemanalysis,5759,74
Itemdifficulty,57
Itemdiscrimination,57
Itemformats,100
Itemtryout,57
Janglefallacy,56
Jinglefallacy,56
KaufmanAssessmentBatteryforChildren,215
KaufmanSpeechPraxisTestforChildren,336t
KEfamily,118
Keyconceptsandterms,1112,4446,7375,106,138139,162163,182183,205206,243,284286,322323
KhanLewisPhonologicalAnalysis,336t
KuderRichardsonformula20(KR20),69
Labeling
negativeeffectsof,216
purposesof,216
LandauKleffnersyndrome,119
LanguageAssessment,Remediation,andScreeningProcedure(LARSP),269t
Language
development,
asaguidetotreatmentplanning,130
regressioninchildhooddisintegrativedisorder,172t
regressioninRettsdisorder,172t
regressioninLandauKleffnersyndrome,119
variabilityin,128129
domains,90
modalities,90
LanguageDevelopmentSurvey,237t
Languagedifference,228,243
Page359
Languagediversity,
currentlevelsofdiversity,82,227
implicationsforscreeningandidentification,3,33,81,227231,243
norms,33,229230
recommendedreadings,231
Languageimpairmentversuslanguagedelay,130,132,216
LanguageknowledgedeficitaccountsofSLI,123124
LanguageProcessingTestRevised,330t
Languagesampleanalysis,266274
analysismethods,267271
computerizedprograms,266,269t270
elicitationprocedures,269t,273274
factorsaffectingresults,271,273274
historyofuse,266271,283
innovationsin,266
useinassessingchange,266
useinexamininginteractionsinlanguageperformance,268
useinidentification,240
useintreatmentplanning,266
usewithdiversepopulations,230
LanguageSampling,Analysis&Training(LSAT),267,269t
Languagetests,
criterionreferencedmeasures,32t
forchildrenunderage3,237t
forchildrenwithhearingimpairment,201t202t
forlanguagesotherthansignlanguagesorEnglish,232t233t
normreferencedmeasures,329t337t
processingdependentmeasures,230
signlanguages,198199
writtenlanguage,329t337t
Latentvariables,18
Latetalkers,128130,129t,138
Learningdisabilitiesandmeasurementissues,18
Learningreadiness,seeAssessmentofchange,predictionoffuturechange
Legislation
EducationforAllHandicappedChildrenActof1975(PL94142),84,108
EducationoftheHandicappedActAmendmentsof1986,81,108
IndividualswithDisabilitiesEducationActof1990(IDEA),84,85,106,108,281282
IndividualswithDisabilitiesEducationActAmendmentsof1997,84,85,108,318
NewbornandInfantHearingScreeningandInterventionActof1999,194
LimitedEnglishproficiency(LEP),227,243
Lingquest,269
Linguisticcomplexity,259,266
Linguisticuniversals,267
Lipreading,seeSpeechreading
Localnorms,33,44,222223
MacArthurCommunicativeDevelopmentInventories,237t
Magneticresonanceimaging(MRI),119120,139
Manualcommunication,seeSignlanguages
Mastery,33
Maximalperformancemeasures,64
McCarthyScalesofChildrensAbilities,215
Mean,24,45
Meanlengthofutterance(MLU),240,267,270271
calculationof,272t
Measurementofbehavior
definition,4,12,252
historyof,20,49
levelsof,2023
relationshiptoselectionofappropriatestatisticalmethods,23
Measurementerror,224226f
assessmentofchangeand,296
baseratesand,235
referralratesand,235
relationshiptoreliability,67,224
types,6
falsenegatives,219f
falsepositives,219f
Measurementscales,seeMeasurementofbehavior,levelsof
Median,25,45
Mentalmeasurementsyearbookseries,104105,106,240
Mentalretardation
adaptivefunctioningand,147,162
ageatidentification,147,161162
alcoholand,153154
attentiondeficitandhyperactivitydisorder,153,159t161,160t,
autismand,153,171
causes
nonorganic,155156
organic,149155
toxins,153154,156
cerebralpalsyand,147
communicationstrengthsandweaknesses,159t160t
definitionsof,147,148t,163
Page360
Mentalretardation(Continued)
dementiaand,152,162
emotional/behavioraldisorders,153,159t161,160t
familial,155
fetalalcoholsyndromeand,153155f
fluencydisorder,159t
fragileXsyndromeand,149,152153,154f
hearingimpairmentand,151,155,159t,160t
longtermoutcomes,171
maltreatmentand,161
personalperspective,156
prevalence,147,161
recommendedreadings,164
sensorydifferences,151,153,155,159t160t
severity,147,148
MillerYoderLanguageComprehensionTest,258t
Mixedexpressivereceptivelanguagedisorder,114115,115t
Mode,25,45
MosaicDownsyndrome,151,163
Multidisciplinaryassessment,281,285
Multiplemeasures,223,305306,seealsoMultipleoperationalism
Multipleoperationalism,306
Nationalnorms,32,45
NationalOutcomesMeasurementSystem(NOMS),294,319320,322323
NativeAmericanculturefamilyattitudes,83t
NaturalProcessAnalysis,336t
Nominallevelofmeasurement,2021t,43,45
Nondiscriminatoryassessment
definitionof,85,106
methodsforachieving,229231,278
Nonparametricstatistics,30,45
Nonreciprocallanguage,seeStereotypiclanguage
Normalcurve,seeNormaldistribution
Normaldistribution,30,37f
Normativegroup,32,45,101,234
Normreferencedmeasures
constructionof,3334f,5758
definitionof,31,45
examplesof,32t
interpretationof,31,43,60,218227,234
scores,3435,101
useindescription,255256
useinscreeningandidentification,217
Norms
definition,32,45
local,33,44
national,32,45
ObservationalRatingScales,305
Observedscore,66,74
Omegasquared,29
Operationaldefinitions,19,45
OralandWrittenLanguageScales:ListeningComprehensionandOralExpression,330t
OralandWrittenLanguageScales:WrittenExpression,331t
Ordinallevelofmeasurement,21t22,43,45
Otitismedia,129,151,191,199,203,205206
Otoacousticemissionsandearlyidentificationofhearingimpairment,194,206
Outliers,24
Outofleveltesting,158,163,256
Overshadowing,204
Paperandpenciltests,31,45
Parallelformsreliability,seeAlternateformsreliability
Parametricstatistics,30
Parentinvolvementinassessment,236,304
Parentquestionnaires,236238
ParrotEarlyLanguageSampleAnalysis(PELSA),269
Participation,ICIDH2proposeddefinitionof,87
PatternedElicitationSyntaxTestwithMorphophonemicAnalysis,331t
PeabodyPictureVocabularyTest,267
PeabodyPictureVocabularyTestIII,5152,57,71,331t
PearsonProductMomentcorrelationcoefficient,28,43
Percentileranks,36
Performancestandard,38
Performancetesting,31,45
Perisylvianareas,119120
Personfirstnomenclature,216,243
Pervasivedevelopmentaldisorder(PDD),169,172t,183
Pervasivedevelopmentaldisordernototherwisespecified(PDDNOS),169,172t,183
Phenotype,117,139
Phonologicalawareness,137,139
Phonologicalmemorydeficitaccountofspecificlanguageimpairment,125
PhonologicalProcessAnalysis,336t
Phonologytests,335t337t
PhotoArticulationTest,337t
PhysiciansDevelopmentalQuickScreen,239t
Pictureselectiontask,261
Page361
Placementtesting,30
Playbasedassessment,281,284
PorchIndexofCommunicativeAbilityinChildren,274,331t
PraderWillisyndrome,158
Predictivevalidity,seeCriterionrelatedvalidity,predictivevalidity
Preferentiallooking,261t
Preferentialseating,190t,195
Prelingualhearingloss,206
PreLinguisticAutismDiagnosticObservationSchedule(PLADOS),175
PreschoolLanguageAssessmentInstrument(PLAI),258t
PreschoolLanguageScale3(PLS3),331t
PreschoolLanguageScale3Spanishedition,233t
PreubadelDesarrolloInicialdelLenguaje,233t
Principlesandparametersframework(Chomsky),123124
Proband,117,139
Probes,seealsoCriterionreferencedmeasuresDescriptivemeasuresInformalmeasures
controlprobes,308,315
generalizationprobes,251,308309,315
phonology,259
pragmatics,259,260
sourcesforfinding,259,260t261t
syntax,260t261t
treatmentprobes,308309,315
Profileanalysis,seeDiscrepancytesting
ProfileinSemanticsGrammar(PRISMG),269t
ProfileinSemanticsLexicon(PRISML),269t
Pronominalreversals,176,183
ProportionalChangeIndex(PCI),299303,322
Psychiatricdiagnosesandlanguageimpairment,134
Publicrelationsvalidity,73,seealsoFacevalidity
PyeAnalysisofLanguage(PAL),269t
Qualitativechange,seeClinicalsignificance
Qualitativemeasures,279280
Qualitativeresearch,280,285
Range,26,45
Ratingscales,262266
haloeffects,264
leniencyeffects,264
metatheticcontinuum,265,285
protheticcontinuum,265,285
Ratiolevelofmeasurement,21t23,43,45
Rawscores,3435
Recasts,122,139
ReceptiveExpressiveEmergentLanguageTest2,103,237t,258t
ReceptiveOneWordPictureVocabularyTestUpperExtension,331t
ReceptiveOneWordPictureVocabularyTest,331t
Regionaldialect,82,227231
Reificationandintelligencetests,20
Reliability
coefficients,66
definition,6566,75
differencesinmethodsforcriterionversusnormreferencedmeasures,67,102
factorsaffecting,71,72
recommendationregardinglevels,102
relationshiptoagreement,6869f
relationshiptovalidity,51,65f66,73
typesof,73
alternateformsreliability,6768,71
internalconsistency,6870
testretestreliability,6768,75
Restrictionofrange,effectonreliability,71
Rettsdisorder,169,172t,183
ReynellDevelopmentalLanguageScalesU.S.Edition,331t
RhodeIslandTestofLanguageStructure,202
Richnessofdescription,253,285
Riskfactors
definitionof,116,139
forlanguageimpairment,116127
RosettiInfantToddlerLanguageScale,237t
ScalesofEarlyCommunicationSkills(SECS),202
Schoollanguage,82
Scores,typesof
ageequivalent,3536t,44
criterionreferenced,38
gradeequivalent,3536t,44
normreferenced,3438
percentileranks,36
standardscores,3637,46
Screening,seealsoIdentification
baseratesand,235236
characteristicsof,214,242,
comprehensiveteststhatincludecommunication,215
federalandlocallegislation,240242
indirectmethods,214
languagemeasuresfor,236239t
Page362
Screening,(Continued)
reasonsfor,214215
referralrates,235236,243
ScreeningTestforDevelopmentalApraxiaofSpeech,337t
SecordConsistencyofArticulationTests(SCAT),259,337t
Segregationstudies,seeGenetics,pedigreestudiesofspecificlanguageimpairment
SEM,seeStandarderrorofmeasurement(SEM)
Sensitivity
definitionof,218,243
languagetestsand,220221
SentenceRepetitionScreeningTest,239t
SequencedInventoryofCommunicationDevelopment(SICD),236237t
SequencedInventoryofCommunicationDevelopment(SICD)Spanishtranslation,233t
Severityratings,43,
Sexchromosomes,163
Signlanguages,
testsof,198199
varietiesof,196
SignedEnglish,196
SigningEssentialEnglish(SEE1),196
SigningExactEnglish(SEE2),196
Simultaneouscommunication,seeHearingimpairment,totalcommunicationand
Singlesubjectexperimentaldesigns,
clinicaluseof,307310,314
definition,322
interpretationof,307308,315317
recommendedreadings,317
statisticalversusvisualanalysis,308
withdrawal,315
SmitHandArticulationandPhonologyEvaluation,337t
Socialcomparisonasamethodofsocialvalidation,304,322
Socialdeprivation,effectsondevelopment,156
Socialdialect,82,227231
Socialvalidation,297,303,322
Socialvalidity,seeClinicalsignificance
SoundProductionTask(SPT),259
Spanish,231233t,237
SpanishStructuredPhotographicExpressiveLanguageTest,232t
Specificlanguageimpairment(SLI)
academicdifficultiesand,132,134135
alternativetermsfor,114116,119
argumentstructureand,131t
braindifferences,119121
affectingdominance,119
perisylvianareas,119121
planumtemporale,119120f
versusdamage,119
definitionof,114115,137,139
demographicvariablesand,121122
emotional/behavioraldisordersand,133
environmentalvariablesand,121123
figurativelanguageand,132t,134
genderdifferencesand,114
geneticfactors,117119
illusoryrecovery,135
languagepatterns,130133t,137
longtermoutcomes,135
morphologicaldeficitsand,131t
narrativeskillsand,132
natureof,223224
personalperspective,136
phonologyand,131t,135,137
pragmaticsand,132t
prevalence,114
recommendedreadings,140
subgroupidentification,115,130
suspectedcauses,116127
syntacticdeficitsand,131t
theoreticalaccounts(afterLeonard),123127
crosslinguisticdataand,123125,
linguisticknowledgedeficitaccounts,123124,138
generalizedprocessingdeficitaccounts,124125
specificprocessingdeficitaccounts,125126,139
writtenlanguageand,135,137
Specificity,
definition,218,243
languagetestsand,218221,222
Speechreading,188,190t
Splithalfreliability,6869
Stability,67
Standarddeviation,25,46
Standarderrorofmeasurement(SEM),67,70,75,101,224
Standardscores,3637,46
StandardsforEducationalandPsychologicalTesting,50,62,89,96,105,107
Statisticalmeasures
ofcentraltendency,2425,43
ofvariability,2426,43
Statisticalsignificance,2829,46,297
StephensOralLanguageScreeningTest,239t
Stereotypiclanguage,177
Stereotypy,182183
Page363
Stimulabilitytesting,relationshiptodynamicassessment,276
Strabismus,161,163
StructuredPhotographicExpressiveLanguageTestII,331t
Subjectiveevaluationasamethodofsocialvalidation,304305,323
Summativetesting,31
SurfacehypothesisaccountofSLI,125
Syndrome,definitionof,149
SystematicAnalysisofLanguageTranscripts(SALT),268,269t,271t
Tagalog,233
TalkingTask(TT),259
TeacherAssessmentofStudentCommunicativeCompetence(TASCC),264
TeacherAssessmentofGrammaticalStructures(TAGS),202
Teacherquestionnaires,237238
TemplinDarleyTestsofArticulation,336t
Temporalprocessingaccountofspecificlanguageimpairment,125126
Terminationoftreatment,4,310311
Test,
definition,49,75
effectoflengthonreliability,71
Testadministration,
adaptations,63,157158,200,203,229t
importanceof,10,63
motivation,63
suggestionsfor,64t
TestdeVocabularioenImagenesPeabody,232t
TestforExaminingExpressiveMorphology,331t
Testmanuals,howtouse,88103
TestofAdolescentandAdultLanguage,332t
TestofAdolescent/AdultWordFinding,332t
TestofAuditoryComprehensionofLanguage3,332t
TestofChildrensLanguage,332t
TestofEarlyLanguageDevelopment,332t
TestofEarlyReadingAbilityDeaforHardofHearing,103,109
TestofLanguageCompetenceExpanded,332t
TestofLanguageDevelopmentIntermediate:3,57,332t
TestofLanguageDevelopmentPrimary:3,240,332t
TestofPragmaticLanguage,332t
TestofPragmaticSkills(Revised),332t
TestofRelationalConcepts,333t
TestofWordFinding,333t
TestofWordFindinginDiscourse,333t
TestofWordKnowledge,333t
TestofWrittenExpression,333t
TestofWrittenLanguage2,333t
Testreviewguide,
annotated,90f92f
basicform,93f95f
completedexample,97f99f
Testreviews
clientoriented,8889,106
computerizedsourcesof,1045
populationoriented,8889,106
stepsin,88103
sourcesofpublishedreviews,103105,104t
Testingoflimits,158
TexasPreschoolScreening,239t
Theoreticalconstruct,1819f,43,46,51,57,306
Theory,18,46
Theoryofmind,181,183
Timesampling,275,285
TokenTestforChildren,333t
Transdisciplinaryassessment,281,285
Treatment
effectiveness,319,323
effects,319,323
efficacyresearch,295,318,321
efficiency,319,323
outcomes,294295
outcomesresearch,318
Trialscoring,274,286
Triangulationofqualitativedata,280,286
Trisomy21,151,163
Truescore,66,75
Tscore,38
TurnerSyndrome,158
Typetokenratio,240
Ultimateoutcomes,294,311,323
UtahTestofLanguageDevelopment3,333t
Validity
centralitytodiscussionsofmeasurementquality,50
definition,51,75
factorsaffecting,10,61,6266,235236
typesof,seeValidation,strategiesofevidencegathering
Page364
Validation
differencesforcriterionversusnormreferencedmeasures,5660
strategiesofevidencegathering,5262
contentvalidity,52,56t60
criterionrelatedvalidity,52,6162,310
constructvalidity,5256,53f
Variable,19,46
Variance,25,46
Varianceaccountedfor,29
Verbalauditoryagnosia,191
VinelandAdaptiveBehaviorScales,163,215
Visuospatiallanguages,seeSignlanguages
Watchandseepolicytowardlatetalkers,128
WechslerIntelligenceScaleforChildrenRevised,18
WiigCriterionReferencedInventoryofLanguage,258t
Williamssyndrome,158,160t,163
WoodcockLanguageProficiencyBatteryRevised,333t
WordTestAdolescent,333t
WordTestRevised,333t
WorldHealthOrganization,85
Writtenlanguage,241
Zoneofproximaldevelopment(ZPD),276,286
Zscores,37