LSHSS
Tutorial
Using the International Classification of
Functioning, Disability and Health in
Assessment and Intervention of School-
Aged Children With Language Impairments
Carol Westbya and Karla N. Washingtonb
Purpose: The aim of this tutorial is to support speech-
language pathologists’ (SLPs’) application of the International
Classification of Functioning, Disability and Health (ICF)
in assessment and treatment practices with children with
language impairment.
Method: This tutorial reviews the framework of the ICF,
describes the implications of the ICF for SLPs, distinguishes
between students’ capacity to perform a skill in a structured
context and the actual performance of that skill in naturalistic
contexts, and provides a case study of an elementary school
child to demonstrate how the principles of the ICF can guide
assessment and intervention.
I
n 2001, the World Health Organization (WHO) pub-
lished guidelines for the International Classification
of Functioning, Disability and Health (ICF; WHO,
2001). The intent of the ICF is to provide a common lan-
guage for describing human functioning and disability as well
as a framework for gathering data and measuring clinical
outcomes (WHO, 2013). The American Speech-Language-
Hearing Association (ASHA) adopted the ICF as the frame-
work for assessment and intervention in the Scope of Practice
(ASHA, 2001, 2016d) and in the Preferred Practice Patterns
for the Profession of Speech-Language Pathology (ASHA,
2004). The ICF classification complements WHO’s Interna-
tional Classification of Diseases, Tenth Revision (ICD; WHO,
1992; WHO, 2013), which contains information on diagno-
sis and health condition but not on functional status. Whereas
the ICD classifies disease, the ICF looks at functioning.
a
Bilingual Multicultural Services, Albuquerque, NM
b
Communication Sciences and Disorders, University of Cincinnati, OH
Correspondence to Carol Westby: mocha@unm.edu
Editor: Shelley Gray
Associate Editor: Estella Ma
Received May 1, 2016
Revision received September 27, 2016
Accepted April 13, 2017
https://doi.org/10.1044/2017_LSHSS-16-0037
Language, Speech, and Hearing Services in Schools • 1–16 • Copyright © 2017 American Speech-Language-Hearing Association
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Implications: The Scope of Practice and Preferred Practice
documents for the American Speech-Language-Hearing
Association identify the ICF as the framework for
practice in speech-language pathology. This tutorial
will facilitate clinicians’ ability to identify personal and
environmental factors that influence students’ skill
capacity and skill performance, assess students’
capacity and performance, and develop impairment-
based and socially based language goals linked to
Common Core State Standards that build students’
language capacity and their communicative performance
in naturalistic contexts.
Therefore, the use of the two together provides a more com-
prehensive picture of the health of persons, defined as “the
complete physical, mental, and social functioning of a per-
son and not merely the absence of disease” (WHO, 1948,
p. 1). Language, literacy, and academic skills are important
aspects of mental and social functioning and therefore are
part of health.
Fifty-three percent of speech-language pathologists
(SLPs) in the United States are employed in schools (ASHA,
2016c). Public schools in the United States do not use the
ICD for diagnosis nor the ICF to frame assessment and in-
tervention. Instead, schools are guided by the Individuals
with Disabilities Education Act of 2004 (IDEA) to qualify
students for special education services and the Common
Core State Standards (CCSS; National Governors Associa-
tion Center for Best Practices & Council of Chief State
School Officers, 2010) in 42 of the 50 states to set goals for
students (CCSS Initiative, 2016). Ninety percent of SLPs
working in schools serve children with diagnoses of lan-
guage disorders (ASHA, 2016a). The aim of this tutorial is
to provide SLPs guidance for applying the ICF–Children and
Youth (ICF-CY; WHO, 2007) into assessment and treat-
ment practices with school-age children with language impair-
ments. A broader approach to assessment and intervention
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
1
 supports a more complete picture of the how the impair-
ment affects everyday functioning and how remediation
of the language impairment has a synergistic effect on
other areas in the child’s life. To achieve this aim, the au-
thors will (a) describe the ICF conceptual framework, (b)
describe ways that the ICF framework can be integrated
into IDEA guidelines for assessment and intervention, (c)
explain how to use the ICF framework when designing as-
sessment (e.g., selection and use of different tools and tech-
niques) and intervention for children and adolescents with
language impairment that aligns with special education
guidelines in the IDEA and CCSS, and (d) demonstrate
how to use the ICF framework to write functional goals for
children and adolescents with language impairments. This
tutorial is useful for SLPs who work with children in a vari-
ety of different settings but would be of primary interest to
those in school settings. We begin this tutorial with a discus-
sion of the role of IDEA and CCSS for students with lan-
guage impairments in schools and an introduction to the
ICF.1 As a result of reading this tutorial, school SLPs will
be able integrate the ICF framework into the assessment
and intervention processes used in schools to (a) collaborate
with individualized education program (IEP) teams to in-
corporate into IEP goals that address students’ access and
participation in extracurricular and nonacademic activities
in addition to the general education curriculum; (b) use the
ICF to inform the types and frequencies of modifications,
accommodations, and supports students require for best
functioning; and (c) write goals that go beyond the acquisi-
tion of discrete language skills to include functional com-
munication outcomes in a variety of life situations. Our
focus will be on children with language impairments because
this is one of the largest groups of children with disorders
served by SLPs in schools.
The ICF
ICF Purpose
Traditionally, pediatric speech-language pathology
has used a medical model to guide assessment and treat-
ment practices (Cunningham et al., 2017; Washington,
2007; Westby, 2007). However, in response to the 2001
publication of the WHO’s ICF (WHO, 2001) and its sub-
sequent pediatric version, the ICF-CY (WHO, 2007), there
has been a noted shift in practice beyond that of a medi-
cal model (Cunningham & Rosenbaum, 2015). The WHO
defines “health” as the complete state of physical, mental,
and social functioning/well-being of a person and not
merely the absence of disease (WHO, 1948). In this defini-
tion, functioning in the ICF is an essential component of
1
In this article, ICF refers to the classification system, which is
applicable to the ICF and ICF-CY conceptual models (WHO, 2001,
2007). The ICF-CY represents a taxonomy derived from the ICF.
As such, the term ICF will be used for the remainder of this article
in our application to children with language disorders. The term ICF-CY
will be used only in an effort to identify the existence of the WHO
classification system that is specific to children.
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health. The ICF is not based on etiology or consequence
of disease but as a component of health. Although func-
tional status may be related to a health condition, the
health condition does not predict functional status.
The ICF is a biopsychosocial model of functioning
and disability that integrates the medical and social models
(WHO, 2001, 2007). A purely medical model views dis-
ability as a feature of the person, directly caused by dis-
ease, trauma, or other health condition. A social model of
disability sees disability as a socially created problem and
not an attribute of an individual. Disability is a complex
phenomenon that is both a problem at the level of a per-
son’s body and a complex and social phenomenon. The
impact of a disability is affected by the tasks persons must
perform and the social context in which they must perform
them.
ICF Framework
The ICF has two primary parts, Functioning and
Disability (Part 1) and Contextual Factors (Part 2),2 each
of which has two components. See Figure 1. The two com-
ponents of Functioning and Disability are Body Functions/
Structures and Activity/Participation:
1. Body Functions are defined as the physiological
functions of a body system, including psychological
functions. Body Structures are defined as the
anatomical parts of the body such as organs, limbs,
and their components (WHO, 2007, p. 9).
2. Activity represents an individual perspective and is
defined as “the execution of a task or action by an
individual” (WHO, 2007, p. 9) in a structured or
standardized environment.
3. Participation represents a societal perspective and is
defined as “involvement in a life situation” (WHO,
2007, p. 9).
There are eight domains for Body Functions and
eight domains for Body Structures, representing the major
body systems. Three Body Functions and three Body
Structures domains are most related to communication dis-
orders: Mental Functions/Structures of the nervous system;
Sensory Functions and pain/Structures of the eye, ear,
and related structures; and Voice and speech Functions/
Structures involved in voice and speech.
A problem in Body Function or Structure, such as
memory processing or a significant deviation or loss of
body parts, is termed an impairment. Impairments in body
structures are generally directly observable (or indirectly
observable with x-rays or scans). Impairments in Body
Functions may not be observable. For example, impair-
ments in most mental functions are not directly observable
but rather are manifested in delays or disorders in skills
necessary to carry out activities (McCormack, Jacobs, &
2
In this article, we use capitalization for ICF parts and components to
distinguish these terms from their use in everyday life.
 Figure 1. Interactions between the components of the International
Classification of Functioning, Disability and Health (ICF). From the
ICF (p. 17) by the World Health Organization (WHO), 2007, Geneva,
Switzerland: Author. Copyright 2007 by the WHO. Adapted with
permission.
Washington, 2012; WHO, 2013). This is true for Mental
Functions for language. One cannot directly observe the
impairments in processing that underlie the receptive and
expressive language difficulties—only their manifestation
in the use of phonology, morphology, semantics, pragmat-
ics, and discourse in activities. Impairments in the Body
Functions, mental functions for language, lead to limitations
in Activities that require comprehending or producing lan-
guage. Limitations in Activities may result in restrictions in
ability to participate in life activities. A student with diffi-
culty in comprehending and producing language may be
hesitant to participate in classroom discussions or social
groups.
The Activity and Participation components have a
single list of nine domains that cover the range of life ac-
tivities. Each domain can be coded for either Activity or
Participation or both. Three of these domains are particu-
larly applicable to communication disorders: Learning and
applying knowledge, Communication, and Interpersonal
interactions and relationships. The Activity component can
also be viewed as representing the capacity or skills needed
for participation. Having capacity or skills is essential but
not sufficient for Participation; Participation requires per-
formance of those skills in naturalistic contexts (WHO, 2007).
For example, children may exhibit age-appropriate vocabu-
lary and syntactic skills on a standardized test (demonstrat-
ing capacity) but not use these in conversation with peers
or teachers (failing to demonstrate performance). For both
capacity and performance, one considers how the person
performs with and without assistance. Assistance can be
from other persons or can be environmental or technologi-
cal supports (e.g., a quiet room, hearing aids, augmentative
and alternative communication devices).
In educational settings, Participation involves being
actively engaged in tasks, activities, and routines that are
typical for children of that age. Participation in education
includes collaborating with peers in a science experiment,
offering meaningful comments in a classroom discussion,
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playing with peers in the schoolyard, or going on a school
trip. When evaluating students’ Participation in education,
SLPs should consider how tasks or routines might be
altered to ensure overall participation in a given environ-
ment. It is not enough to simply measure the ability of the
student to carry out tasks in a predefined environment.
Contextual Factors (Part 2) “represent the complete
background of an individual’s life and living” (WHO, 2007,
p. 15) and comprise two components:
1. Environmental Factors refer to all aspects of the
external world of an individual’s life that may have
an impact on his or her functioning.
2. Personal Factors involve “features of the individual
that are not part of the health condition” (WHO,
2007, p. 15) such as gender, age, temperament, and
culture/ethnicity.
Personal Factors are not coded in the ICF because
of wide variability among cultures but are included in the
framework because they have a high likelihood of having
an impact on functioning and on the outcomes of different
interventions. The Contextual Factors interact with each
other and with the health conditions and may serve as fa-
cilitators or barriers to a person’s capacity to carry out
Activity and to Participate in academic and social events.
IDEA and the CCSS
The ICF is not typically used as part of the assess-
ment and intervention services in public schools in the
United States. Receiving services for speech and language
services in schools is guided by IDEA. IDEA lists 13 dis-
abilities that may qualify a child for special education ser-
vices. A child who has a medical diagnosis under the
ICD or an identified disability according to IDEA is not
necessarily eligible for special education services in schools.
Each state sets its own guidelines for who qualifies for ser-
vices. Eligibility for services often focuses on the degree
to which children’s disabilities affect their access to and
participation and achievement in the general education
curriculum. IDEA guidelines, however, also require that
IEP teams consider students’ access and participation in
nonacademic and noncurricular activities. Furthermore,
both academic achievement and functional performance
need to be described. IDEA does not define functional per-
formance. Schools sometimes interpret functional narrowly
to refer to self-help life skills, particularly for those with
moderate to severe disabilities, rather than more broadly
to refer to effective use of skills in naturalistic situations.
Students with language impairments not only must have
specific phonological, syntactic, semantic, and discourse
skills but they also must use these skills to function across
natural settings.
The CCSS (National Governors Association Center
for Best Practices & Council of Chief State School Officers,
2010) are designed to ensure that students graduating from
high school are prepared to take courses in 2- or 4-year
3
 college programs or enter the workforce. The intent of the
CCSS is that students leave school having the skills and
knowledge to function well enough so that they are able to
participate in life experiences. Many states require the use
of CCSS (or similar standards) for all students, including
those with disabilities. Goals in IEPs must address CCSS.
A number of states require that the CCSS goals chosen for
the IEP be at the student’s currently assigned grade level.
Yet the ASHA (2016b) website states,
Speech-language goals should NOT be taken directly
from the Common Core, especially those specified
for the grade level at which the child is currently
performing. The CCSS are general educational
standards for the grade level; therefore, their use by
SLPs implies that the clients/students do not require
special education. IEP goals should be written to
accomplish the tasks that underlie achievement of
Standards.
SLPs working in schools may, at times, experience a
conflict between what their academic programs and ASHA
recommend as best practices, such as use of the ICF frame-
work for assessment and intervention and the IDEA
guidelines and the CCSS they must follow in the schools.
The ICF is compatible with the requirements of IDEA and
CCSS. By understanding the ICF framework and the
required components of an IEP for IDEA, school-based
SLPs can integrate elements of the ICF into IEPs and
CCSS to provide more-informed, evidence-based practices
that can result in better functional outcomes for students.
By using the ICF, SLPs can gain a better understanding of
students’ knowledge, skills, and functioning (their capacity
and performance) and can then design more effective
programs to enable them to participate in academic and
social/other real-life situations.
Use of the ICF for Students
With Language Impairments
The ICF can influence the ways that children and
adolescents are made eligible for services, the types of ser-
vices provided, and the types and magnitude of modifi-
cations, accommodations, or supports provided (WHO,
2013). Rather than determining eligibility on the basis of
the diagnosis of a health condition or severity of impair-
ment alone, the ICF can be used to identify the gap be-
tween impairment in the components of Body Functions/
Structures or Activity/capacity and the component of
Participation/performance and to set functional goals. The
means to reach these goals can then be determined. Many
states rely on standardized tests and the use of a single cut
score across all tests to qualify students for services under
IDEA. Yet, such an approach for diagnosing and deter-
mining the severity of language impairments has been shown
to be inappropriate because tests vary in their sensitivity
and specificity for identifying students who have and do not
have language impairments (Spaulding, Plante, & Farinella,
2006). Furthermore, standardized tests assess capacity, not
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how students perform when they are participating in activi-
ties in and out of the classroom.
The ICF can be used either as a conceptual frame-
work for understanding disability and functioning or as a
detailed classification system to code impairments and
functioning. It is the conceptual framework of the ICF that
is more useful to SLPs than the coding classification sys-
tem. The conceptual framework presents a systematic way
of understanding the interrelationships that underlie human
functioning. Dempsey and Skarakis-Doyle (2010) sug-
gested that the ICF “may enhance understanding of the
factors that maintain functional limitations and those that
may facilitate optimal functioning, and so enable SLPs to
respond to the child in ways most likely to meet the goal of
improving functioning in everyday life” (p. 425). Table 1
shows the components of an IEP for school-age students
and the ways that use of the ICF framework might comple-
ment traditional approaches to IEP development to result
in a better individualized plan. Notice that the arrows in
the ICF graphic (see Figure 1) are bidirectional; the frame-
work is not linear. Furthermore, all components of Body
Structure, Body Function, Activity, and Participation are
influenced by the Contextual Factors. If children are re-
stricted from interacting with others, they have less exposure
to language, which can then limit their language capacity:
their vocabulary, syntactic, and discourse skills. Lack of
appropriate input and experiences can alter brain function-
ing (Fernald, 2013) and even brain structure development
(Brito & Noble, 2014). Hence, in some instances, changes
at the Body Function impairment and Activity/Capacity
levels must be addressed by making changes at the level of
Participation or Contextual Factors. Furthermore, building
skills to address deficits in Body Functions or Activities
provides no assurance that persons will use these skills to
participate in life situations.
Using the ICF Framework in Assessment
The ASHA document Preferred Practice Patterns
for the Profession of Speech-Language Pathology (ASHA,
2004) specifically addresses components of the ICF. It
states that assessment is conducted to identify and describe
“(a) effects of speech, language, cognitive-communication,
and/or swallowing impairments on the individual’s activi-
ties (capacity and performance in contexts) and participa-
tion; (b) Contextual Factors that serve as barriers to or
facilitators of successful communication and swallowing
and participation for individuals with speech, language,
cognitive-communication and/or swallowing impairments”
(ASHA, 2004, p. 26).
IDEA requires that an assessment team identify stu-
dents’ present levels of academic achievement and functional
performance. When using the ICF, this would involve doc-
umenting students’ language strengths and weaknesses in
Activities and their Participation in academic and extracur-
ricular events. Standardized and nonstandardized methods
are used in IDEA to document the present levels of perfor-
mance and in the ICF to determine the individual’s current
 Table 1. Using the International Classification of Functioning, Disability and Health (ICF) to support individualized education programs (IEPs).

IEP component IDEA IEP requirements Integrating the ICF with IDEA

Current skill levels
Annual goals
Alternative assessments
Measuring progress
Description of services
Program modifications,
accommodation, or
supports for school
personnel
A statement of the child’s present levels of
academic achievement and functional
performance (IDEA does not define functional)
Must ensure that children with disabilities can
participate in extracurricular activities and
other nonacademic activities
A statement of measurable annual goals,
including academic and functional goals
designed to meet the child’s needs that result
from the child’s disability to enable the child
to be involved in and make progress in the
general education curriculum and to meet
each of the child’s other educational needs
that result from the child’s disability; other
educational needs are not defined
For children with disabilities who take alternate
assessments aligned to alternate achievement
standards, a description of benchmarks or
short-term objectives
A description of how the child’s progress toward
meeting the annual goals will be measured
A statement of the special education and related
services and supplementary aids and services
to be provided to the child
A statement of any individual-appropriate
accommodations, modifications, and
supports that are necessary for the student
to participate and be successful in school
The ICF defines current levels at both capacity (skill)
level and Participation (performance) level and
considers Personal and Environmental Factors that
serve as facilitators or barriers to current levels
The ICF provides a framework to identify educational
needs/goals not only in academic activities but
also in general task demands/daily routines,
interpersonal relationships, daily life activities
(self-help, domestic life, work/employment), and
community, social, and civic life (play, sports,
religious life); goals can be developed at both
capacity and performance levels
The ICF can serve as a bridge between assessments
focusing on health, development, curriculum, and
social dynamics. It provides a neutral framework
that can be linked with norm-referenced or
criterion-referenced measurements (WHO,
2013)
According to the ICF, ultimate goals should include
functional goals that focus on Participation/
performance in addition to goals that focus on
skills or capacity; progress is measured in more
than academic achievement
With the ICF, description of services distinguishes
between services to promote capacity (impairment-
based goals) and services to promote performance
(social-based goals) and the types of assistance
provided (personal assistance or an assistance
device); services can address more than academic
achievement
Contextual Factors act as facilitators or barriers
to functioning; as a consequence, information
about contextual factors can provide insight into
the types and frequency of accommodations,
modifications, and supports that should be
included in the IEP. Considerations can be given
to how contextual factors influence the differences
between a student’s capacities and performance
in different domains

Note. IDEA = Individuals with Disabilities Education Act; WHO = World Health Organization.

status including Body Structures/Functions, Activities/
Participation, and Contextual Factors affecting communi-
cation. Using the ICF framework, the team examines
Contextual Factors that influence the individual’s relative
success or difficulty in educational, social, and vocational
activities. IDEA makes no reference to the concept of Con-
textual Factors, but one component of the IEP is identifica-
tion of modifications, accommodations, or supports that a
student may require for access to the curriculum or extra-
curricular activities. Contextual Factors can influence stu-
dents’ present levels of performance and could influence the
types and intensity of accommodations, modifications, and
supports a student requires (WHO, 2013).
involved. Assessments at the Body Structure level for lan-
guage impairments may be medical evaluations, x-rays/
computed tomography scans, magnetic resonance imaging,
audiometric assessments, or observations (e.g., noting ear
atresia). Language impairment falls primarily under the
Body Function of Mental Functions. Generally, the impair-
ments in Body Functions that give rise to language impair-
ment are not observable or easily measureable. Impairments
of mental functions affecting language are manifested in
delays or disorders in skills necessary to carry out activities
(WHO, 2007, 2013). Hence, a person’s ability to carry out
language tasks at the Activity level is a reflection of their
Body Functions/Mental Functions.

Body Structures and Functions Activity/Participation

The brain is the primary body structure contributing Standardized tests and many observational tools are
to language impairment; structures of the ear may also be typically used for assessment at the Activity/capacity level

Westby & Washington: ICF in Child Language Assessment and Intervention 5

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 (McCormack et al., 2012; McLeod, McCartney, &
McCormack, 2012). The ICF states that a person’s opti-
mal ability or capacity is determined in a standardized
or uniform environment (WHO, 2007). Because the im-
pairments in mental functions that give rise to language
impairments are manifested in deficits in language com-
prehension and production, assessment at this level may
be termed impairment-based assessment (McLeod & Bleile,
2004). Schools and health insurances nearly always require
the use of standardized tests as the primary assessment
tool to qualify students for services (Paul & Norbury,
2012). Such assessments evaluate the child’s capacity to
perform a task under controlled conditions. In schools,
SLPs are seldom required to evaluate a child’s Participa-
tion in naturalistic contexts (Izaryk, Skarakis-Doyle,
Campbell, & Kertoy, 2015). Showing that the child’s lan-
guage impairment influences academic performance is usu-
ally accomplished by measuring children’s capacity on
standardized reading and writing tasks, not on their Par-
ticipation in the classroom. Children’s functional perfor-
mance of oral and written language skills for meaningful
purposes in naturalistic contexts is seldom evaluated.
Nearly all the language assessment tools used by
SLPs assess capacity at the Activity level. The majority of
these assessments evaluate primarily language skills in vo-
cabulary and morpho-syntax (e.g., the Clinical Evaluation
of Language Fundamentals–Fifth Edition [CELF-5], Wiig,
Semel, & Secord, 2013; Oral and Written Language Scales–
Second Edition, Carrow-Woolfolk, 2011; the Comprehen-
sive Assessment of Spoken Language–Second Edition,
Carrow-Woolfolk, 2017; Peabody Picture Vocabulary Test–
Fourth Edition, Dunn & Dunn, 2007). Some standardized
tests are available to evaluate children’s pragmatic capacity
(e.g., Social Language Development Test Elementary, Bowers,
Husingh, & LaGiudice, 2008; Test of Pragmatic Language,
Phelps-Terasaki, & Phelps-Gunn, 2007) and observational
tools (e.g., Targeted Observation of Pragmatics in Chil-
dren’s Conversation, Adams, Gaile, Freed, & Lockton,
2010; Yale in vivo Pragmatic Protocol, Simmons, Paul, &
Volkmar, 2014; and CELF-5 Pragmatics Activities Check-
list, Wiig et al., 2013). Relatively little attention has been
given to assessment at the Participation level (Cunningham
et al., 2017). Because many tools are available for assess-
ment at the Activity/capacity level, this section will address
assessment strategies for the Participation/performance level.
Assessments for the ICF Participation component com-
prise systematic observations, questionnaires, rating scales,
and interviews. The Focus on the Outcomes of Children Un-
der Six (FOCUS; Thomas-Stonell, Oddson, Robertson, &
Rosenbaum, 2010) for children 12 months to 6 years is a
parent/clinician questionnaire reflective of the ICF structure
(available for free download at www.focusoutcomemeasurement.
ca). Parents or clinicians rate children on 7-point Likert
scales. The FOCUS provides assessment at two ICF-CY
levels: Body Function/Capacity and Performance. (Note:
Capacity is associated with Activity, and performance is
associated with Participation). Following are some items in
these two areas:
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1. Body Function/Capacity: My child speaks slowly
when not understood. My child’s speech is clear. My
child uses correct grammar when speaking. My child
takes turns. My child can string words together.
2. Performance: My child can communicate independently
with adults who do not know my child well. My
child is understood the first time when she or he is
talking with other children. My child is understood
the first time when talking with adults who do not
know my child well. My child can tell adults who do
not know my child well about past events.
The FOCUS is not normed but is a valid and reliable
measure of participation-level communication in children
(Washington, Thomas-Stonell, Oddson, McLeod, Warr-
Leeper, & Rosenbaum, 2013; Washington, Thomas-Stonell,
Oddson, Roberston, & Rosenbaum, 2013). It captures
changes in a child’s capacity and performance as these re-
late to communication skills and is intended to document
change in children who are receiving speech and language
therapy (Thomas-Stonell et al., 2013).
For school-age children, several observation scales
capture aspects of communicative participation. For exam-
ple, the Pragmatic Language Observation Scale (PLOS;
Newcomer & Hammill, 2009), a valid and reliable norm-
references scale, uses teachers’ ratings to assess students’
everyday classroom oral language behaviors. This assess-
ment has 30 items that evaluate students on a variety of
communication skills in Participation contexts. The major-
ity measure pragmatic skills (e.g., shares information,
sticks to the topic when speaking), but items also assess
students’ use of phonological (has intelligible speech), se-
mantic (e.g., retrieves words quickly), and syntactic skills
(uses acceptable grammar) in the classroom. The standard
score obtained on the PLOS can be compared with scores
on tests that assess skills at the Activity/capacity level to
evaluate the relationship between students’ capacity and
performance.
The CELF-5 Pragmatics Profile (Wiig et al., 2013)
is similar to the PLOS. Parents or teachers judge students’
use of language in naturalistic contexts. A scaled score
on this subtest can be compared with the student’s scaled
scores on other subtests. The Pragmatics Observational
Measure (POM; Cordier, Munroc, Wilkes-Gillan, Speyer,
& Pearce, 2014) has been shown to be a reliable and valid
measure of pragmatic language skills of children aged 5 to
11 years within the naturalistic contexts of peer–peer play.
Hence, it is a measure of a child’s language performance
rather than capacity. It has demonstrated clinical utility
in identifying children with pragmatic language difficulties.
The POM was designed to map five elements of pragmatic
language: (a) introducing communication and being re-
sponsive to social interactions with peers, (b) interpreting
and using nonverbal communication, (c) understanding
and using emotional reactions and intentions of peers,
(d) using higher-level thinking to promote interaction with
peers, and (e) using appropriate negotiation techniques when
interacting with peers. None of these measures, however,
 makes reference to the types of supports a student may or
may not receive in the contexts, so the SLP cannot qualify
the student’s capacity or performance.
Contextual Factors
By considering both performance and capacity in an
assessment, SLPs can gain an understanding of the influ-
ences of the Contextual Factors on a student and consider
ways to effect changes in the Contextual Factors to enhance
the student’s function. “The gap between capacity and per-
formance reflects the difference between the impacts of
current and uniform environments, and thus provides a use-
ful guide as to what can be done to the environment of the
individual to improve performance” (WHO, 2007, p. 14).
By further evaluating capacity with assistance and perfor-
mance without assistance, SLPs may gain better ideas of
how to modify the Contextual Factors by, for example,
using technology, personal support, or policies related to
equitable access (WHO, 2013). Assessment of Contextual
Factors is typically done by observation or by using ethno-
graphic interviewing of the students and significant persons
in their environment. The ICF does not provide a list of
Personal Factors. SLPs can address factors they feel are
relevant for a particular child. Personal Factors could in-
clude the child’s age, gender, ethnicity/culture, languages
spoken, temperament, intellectual level, family socioeco-
nomic level, and living situation. SLPs will want to specifi-
cally note Personal Factors that could be barriers to a child’s
communication development (e.g., a feisty or shy/fearful
temperament) or facilitators of communication development
(e.g., a flexible temperament).
Environmental Factors are of five types: (a) products/
technology, (b) natural environment and human changes
to environment, (c) support and relationships, (d) attitudes
(of friends, family, service providers), and (e) services, sys-
tems, and policies. Not all of these are relevant for every
child. As with Personal Factors, SLPs should consider what
might serve as barriers or facilitators for a particular child.
For example, environmental barriers might be no funding
for hearing aids (products/technology), poor classroom
acoustics (natural environment and human changes), or a
policy that permits services for children only when they fall
below two standard deviations on an approved standard-
ized test (educational policies). Environmental supports
might be involved grandparents (support and relationships),
parent support groups (services, systems), or comfortable,
child-sized furniture (human changes to environment).
Using the ICF Framework in Intervention
The ASHA document Preferred Practice Patterns for
the Profession of Speech-Language Pathology (ASHA, 2004)
also specifically addresses the components of the ICF
when stating that intervention is designed to (a) capitalize
on strengths and address weaknesses related to underlying
structures and functions that affect spoken and written lan-
guage development and use; (b) facilitate the individual’s
social, educational, and vocational activities and participation
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by assisting the person to acquire new spoken and written
language skills and communication strategies (verbal and
nonverbal); and (c) modify contextual factors to reduce bar-
riers and enhance facilitators of successful spoken and
written communication and participation and to provide
appropriate accommodations and other supports, as well as
training in how to use them.
Body Structures and Functions
Some interventions treat communication impairments
at the level of Body Structure (e.g., cochlear implants or
surgery for oral-facial anomalies). Interventions that at-
tempt to directly modify nonword repetition, working
memory, rapid automatic naming, central auditory pro-
cessing, or attention are focusing on the Body Functions
level. Evidence for these types of interventions is limited,
and their effectiveness is questionable (ASHA, 1996; Chacko
et al., 2014; Melby-Lervåg & Hulme, 2013). Interventions
at the Activity/Participation levels can effect changes at the
Body Function level (Gillam et al., 2008).
Activity/Participation
SLPs have typically focused interventions for chil-
dren with language impairments on remediating the im-
pairments at the Activity/capacity level. However, children
and adolescents with language learning impairments usu-
ally require intervention at both the Activity/capacity and
Participation/performance levels. They must be helped to
develop vocabulary, syntactic patterns, and discourse
structures at the capacity level, and they must then be sup-
ported to perform these skills as they participate in com-
municative interactions in natural contexts. Interventions
must address both capacity (with impairment-based goals
addressing skills) and performance (with socially based
goals addressing functioning in natural contexts). Because
training at the capacity level does not automatically result
in transfer of skills to the performance level, and training
at the performance level does not necessarily result in im-
proved capacity skills (Milman, 2016), both need to be
considered.
Contextual Factors
Contextual Factors are integral to the ways persons
function and, consequently, should be an essential com-
ponent of therapy. There are several reasons why SLPs
should focus on Environmental Factors in therapy (Howe,
2008). First, their ultimate goal is to improve students’
communication in everyday environments, not just in the
therapy session. If SLPs fail to address contextual cues in
interventions, they can only hope that communications
skills taught in therapy sessions will transfer to real-life situ-
ations. Second, communication requires partners. The
attitudes of and support or lack of support from these part-
ners are Environmental Factors that can serve as barriers
or facilitators to the students’ communication. Who are the
people students must communicate with outside of therapy
sessions? How might these persons facilitate or inhibit the
students’ communication? What information do they need
7
 to facilitate the students’ communication? And third, SLPs
have the knowledge about communication and communi-
cation disorders that can be used to address the Environ-
mental Factors that influence children and adolescents with
language impairments. For example, an SLP may note the
poor acoustics in a room that make it difficult for students
to hear the teacher and one another and advocate for a
sound system. Or SLPs can identify communication strate-
gies of others that function as either barriers or facilitators
for students and demonstrate how others in the students’
environments can use more facilitating communication strat-
egies. What might serve as an environmental facilitator for
one student can be a barrier for another. For example, car-
ing siblings may facilitate a brother’s communication by
cueing him with ideas to talk about or they might serve as
barriers by talking for him; or a mother may provide support
for a child in one area of life but also prevent the develop-
ment of his or her autonomy in interpersonal relations.
Personal Factors can be divided into potentially
changeable or unchangeable factors (Howe, 2008). Factors
that are unchangeable or difficult to change are demo-
graphic factors (e.g., ethnicity, age, gender, socioeconomic
level, past experiences). By considering unchangeable fac-
tors, clinicians can better understand their clients and adapt
services to meet their clients’ needs (Threats, 2007). Poten-
tially changeable factors include other health conditions,
current experiences, and personality traits (e.g., attitudes,
coping styles). Children with language impairments are
somewhat more likely than typically developing children
to exhibit withdrawn behaviors (Fujiki, Brinton, Isaacson,
& Summers, 2001), more negative dispositions, poorer
persistence/self-regulation, and greater temperamental diffi-
culties (Prior, Bavin, Cini, Eadie, & Reilly, 2011). Students
with language impairments may have attitudes that are
barriers to responding to services. Older students, particu-
larly, may see no reason for services or do not want to be
seen as needing services. Impairments in Body Functions
and Structures and limitations in Activities cannot be treated
independently from these Personal Factors. Further, the
identification of potentially changeable Personal Factors
such as coping styles and other health conditions can help
SLPs advocate for other services their clients may require
(Threats, 2003).
A Clinical Example
We present a case study of Mateo, a Spanish-English
bilingual child with a primary or specific language impair-
ment (PLI). We present Mateo’s history upon entry in
kindergarten, then use the ICF framework for assessment
strategies and intervention objectives for kindergarten and
fifth grade. Language impairment is one of the most com-
mon childhood learning disabilities, affecting approximately
7% to 8% of children in kindergarten (National Institute
on Deafness and Other Communication Disorders, 2016).
Several long-term studies have shown that children and
adolescents with language impairments rarely “outgrow”
their language/literacy learning difficulties (Conti-Ramsden,
8 Language, Speech, and Hearing Services in Schools • 1–16
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St. Clair, Pickles, & Durkin, 2012; Snowling, Bishop, Stothard,
Chipchase, & Kaplan, 2006). At times, they appear to catch
up with their peers, but as language demands increase, they
again fall behind (Bashir & Scavuzzo, 1995). We use the
same child at two grade levels to demonstrate the chang-
ing nature of language impairment during the elementary
school years.
Background
Figure 2 displays information about Mateo in the
ICF framework. Mateo was enrolled in a bilingual kinder-
garten at age 5;2 (years;months; Environmental Factor:
services). His teacher reported that he had some difficulty
playing with and socializing with his peers (Participation).
He did better when the teaching assistant joined him in
play with other children (Participation with assistance).
The teacher stated that Mateo spoke in short agrammatical
sentences and had a limited vocabulary in both English and
Spanish (Activity/capacity). He needed considerable assis-
tance when trying to relate experiences or retell a story
(Activity/capacity with assistance). He was not making
the expected progress in emergent literacy skills, learning
the letter names and associated sounds (Activity/capacity).
Kindergarten
Assessment
Although at age 5 years Mateo was speaking English
in school, Spanish was the home language. With a child
like Mateo, who is bilingual, it is important to differentiate
a PLI from a language difference. The Primary Test of
Nonverbal Intelligence (Ehrler & McGhee, 2008) was ad-
ministered to determine Mateo’s cognitive capacity. His
score of 95 was in the average range. To determine if Mateo
had a PLI and was eligible for services under IDEA, his
language skills, at the Body Functions/Activity or capacity
level, were assessed with the Bilingual English Spanish As-
sessment (BESA; Peña, Gutierrez-Clellen, Iglesias, Goldstein,
& Bedore, 2014). The questionnaires completed by Mateo’s
teacher and mother indicated that he should be assessed
for a language impairment and he should be assessed in
both English and Spanish. The BESA assesses the child’s
phonology, morphosyntactic, and semantics skills. The
English and Spanish test items are different from one an-
other and are designed to assess the linguistic skills in both
languages that are most associated with language impair-
ment. For bilingual children, a single score based on re-
sponses on both the English and Spanish versions is used
to determine if a child has a language impairment. Mateo
obtained a standard score of 73 on the BESA, indicating
that he is highly likely to have a language impairment and
highly unlikely to have typically developing language.
Some members of the IEP team suggested that
Mateo’s BESA scores were low because he is learning two
languages. The SLP used a nonword repetition task and a
fast-mapping task with Mateo to determine if his low BESA
score was related to specific difficulty learning language.
 Figure 2. Matteo’s data illustrated within the International Classification of Functioning, Disability and Health (ICF) framework. From the ICF
(p. 17) by the World Health Organization (WHO), 2007, Geneva, Switzerland: Author. Copyright 2007 by the WHO. Adapted with permission.

(Nonword repetition and fast-mapping tasks are closer to
measuring phonological short-term memory mechanisms
underlying language learning and therefore are more closely
associated with assessing Body Functions than other lan-
guage tasks.) In a nonword repetition task, children repeat
nonsense words with an increasing number of syllables; in
a fast-mapping task, the child has minimal exposure to a
word (one to three exposures) for an object and then is
asked to identify the object and give its name. These tasks
are not norm referenced, but a number of research studies
have shown that compared with typically developing chil-
dren Mateo’s age, children with PLIs exhibit noticeable dif-
ficulty repeating three-syllable and four-syllable words (e.g.,
Ebert, Kalanek, Cordero, & Kohnert, 2008; Gray, 2003).
Furthermore, on fast-mapping tasks, typically developing
children will learn to comprehend the words and will some-
times learn to say the words after one to three exposures;
children will PLI exhibit more obvious difficulties in learning
to comprehend and use the words (e.g., Dollaghan, 1987).
Because bilingual children may respond differently to non-
sense words that follow the phonotactic rules of each lan-
guage, the SLP used a Spanish-like and an English-like
nonword list (Summers, Bohman, Gillam, Peña, & Bedore,
2010). Mateo exhibited marked difficulty on both the
Spanish and English lists. He easily repeated one- and two-
syllable words but had some difficulty with three-syllable
words and marked difficulty with four-syllable words. On
a fast-mapping word task (Hwa-Froelick & Matsuo, 2005),
he identified a new word in about half the instances but
never used the new word to name an object. Mateo’s per-
formance indicated he had difficulty with language learning.
Children with histories of speech and language
impairments in the preschool years are at high risk for
experiencing difficulty with literacy (Botting, Simkin, &
Conti-Ramsden, 2006). Mateo’s emergent literacy skills
were evaluated with the Dynamic Indicators of Basic Early
Literacy Skills (DIBELS; Dynamic Measurement Group,
2012) in English and with the Indicadores Dinámicos del
Éxito en la Lectura (IDEL; Dynamic Measurement Group,
2006) in Spanish. (Free downloads of the DIBELS and IDEL
are available at https://dibels.uoregon.edu/.) The DIBELS
and IDEL are parallel assessments but not translations.
Each assesses the children’s knowledge of letters and sound/
grapheme relationships in each language, the ability to seg-
ment words into sounds and to read nonsense words. On
both the DIBELS and IDEL, Mateo’s scores placed him in
the moderately at risk category in letter naming, identifying
a word or picture that began with a particular sound, and
segmenting words into phonemes and in the high-risk cate-
gory for reading vowel–consonant and consonant–vowel–
consonant nonsense words.
Narrative skills in kindergarten are highly predictive
of students’ later academic achievement (Griffin, Hemphill,
Camp, & Wolf, 2004), and narrative skills are critical for
self-regulation (Fivush, 2007) and participation in social
interactions (Schank, 1990). Because sharing of personal
and fictional stories is essential for participation in academic
and social contexts, Mateo’s capacity to produce narratives

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 was assessed. His narrative skills capacity in English and
Spanish was assessed with the Multilingual Assessment
Instrument for Narratives (MAIN; Gagarina et al., 2015;
materials can be downloaded at http://www.zas.gwz-berlin.
de/zaspil5410.html). The MAIN was developed by the
European Union to assess narrative production and com-
prehension abilities of bilingual children from 3 to 9 years
old (Gagarina et al., 2015). Children are shown four sets
of six-sequenced pictures. They retell two of the stories (one
in each of their languages), and then they generate stories
in each of their languages to the other two sets of pictures.
The stories are scored in terms of story macrostructure ele-
ments including character goals and attempts and references
to thoughts and feeling of the story characters. The assess-
ment is not normed, but the evaluator can compare chil-
dren’s stories in their two languages. The content of Mateo’s
stories was similar in both English and Spanish. His per-
formance was somewhat better on the story retells. On the
retells, he was more likely to mention a character’s emo-
tional response in response to an event. On the generated
narratives, he reported only the actions he saw in the pic-
tures. He did not appear to recognize that the six pictures
told one story. He did not report character emotions or
goals. As a kindergarten child, Mateo should have included
more sequential and some causal information in his stories.
Mateo’s mother and teacher rated him on the FOCUS
to evaluate his participation with others. When playing
with other children, Mateo tended to stand off to the side;
the teacher had to assist him in joining the play by suggest-
ing a role he could play and giving him some scripts to
say. Both Mateo’s mother and teacher rated him higher on
the FOCUS items for Body Function/capacity than on the
items for performance, indicating that his language capacity
or skills in structured situations were better than his use of
these skills in naturalistic contexts. Mateo’s performance
in naturalistic contexts was compromised when the environ-
ment was noisy, when there were more than four children
in a group, and when children in the group were aggressive.
His performance was enhanced by adults who used self-talk
and parallel talk to model language and who gave him
strategies for entering the playgroups and when he entered
the group with a familiar peer.
Intervention
Table 2 shows the interventions to build Mateo’s ca-
pacity and performance in kindergarten. We have termed
the goals that address Body Function impairments/Activity
capacity as impairment-based goals and goals that address
Participation performance as socially based goals (McLeod
& Bleile, 2004). We have organized the goals under domains
in the Activity/Performance component of the ICF. It is not
necessary for school SLPs to use the ICF Activity/Performance
domains; however, the domains do address areas that
school SLPs typically consider. The interventions also ad-
dress the kindergarten CCSS for reading foundational skills
and reading literature (CCSS; National Governors Associa-
tion Center for Best Practices & Council of Chief State
School Officers, 2010).
10 Language, Speech, and Hearing Services in Schools • 1–16
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The programs Systematic Engaging Early Literacy
(SEEL) and its Spanish variant Aleer (Culatta, Hall-Kenyon,
& Black, 2013), which address the CCSS, were used to build
Mateo’s capacity and performance in emergent literacy
skills. These programs use playful strategies to teach capac-
ity skills for phonological awareness skills, letters, and
sound/grapheme relations for children between the ages of
4 and 6 years in functional activities. Most literacy pro-
grams focus on developing skills at the capacity level. The
listening, reading, and writing activities in SEEL and Aleer
do teach the explicit skills necessary for reading and com-
prehending text (capacity skills), but all of the lessons in-
volve children interacting with one another and using the
sounds, words, and sentences in functional playful contexts.
Hence, the orientation of SEEL and Aleer address both
activity and participation levels. (See videos of activities
and lesson plans at http://education.byu.edu/seel/.)
Mateo’s narrative comprehension, retells, and gener-
ation were below kindergarten expectations. Kindergarten
narrative skills predict reading comprehension as late as
seventh grade (Griffin et al., 2004). Because narrative skills
are part of the CCSS for kindergarten and because they
are so critical to later academic success and social inter-
actions, goals were developed to improve Mateo’s narra-
tive skills at the capacity and performance levels. The initial
focus was on developing Mateo’s ability to produce a per-
sonal narrative about a recent event. With support of pho-
tographs and picture cues, Mateo was taught to name the
people, where the event occurred, what the people were
doing, and how they felt about what they were doing. These
skills were then transferred to fictional narratives: identify-
ing the story characters, story setting, characters’ actions,
and how characters felt (Westby & Culatta, 2016). As Mateo
developed these capacity-level skills, goals at the Participation/
performance level were established in which Mateo was
supported in relating personal experiences to his teacher
and peers and in participating in discussion of fictional
stories in his classroom.
The IEP team incorporated several modifications,
adaptations, and supports in Mateo’s IEP. They addressed
the poor classroom acoustics (Environmental Factor bar-
rier) by providing the teacher with a sound-field amplifica-
tion system and a large rug for the part of the classroom
where the literacy activities were held (Environmental Fac-
tor: natural environment and human changes to the envi-
ronment). Noting Mateo’s cautious temperament (Personal
Factor barrier), the IEP team suggested that the teacher
and assistant let Mateo know when changes in activities
were coming; they place him in work groups with other
children who are most accepting of him, and the assistant
or teacher provide support to assist Mateo taking his turn
in group activities.
Fifth Grade
Children who exhibit language impairments in the
preschool-kindergarten years are very likely to continue to
exhibit language/learning difficulties as they move through
 Table 2. Interventions to build capacity and performance in kindergarten.

Impairment-based goals/build capacity Socially based goals/build performance for participation

d1 Learning and applying knowledge d1 Learning and applying knowledge

Identify words beginning with same sound
Read Spanish CV syllables and CVCV words
(mi, me, ma) or English CVC words (hat, mat)
Identify and spell common Spanish and English
grammatical morphemes
Identify components of fictional stories
d3 Communicating – producing
With picture support, relate past experience
including who, where, what happened
d7 and d9 Interactions and social life
Describe the rules for popular kindergarten games
Play with saying Spanish sentences with CVCV ( papa, nada) words about
activities students are engaged in (or English CVC [ hat, net, top] words)
Read/write Spanish CVCV passages (or English CVC passages) about
activities students are engaged in
d3 Communicating – producing
Share a past experience in a classroom sharing time using correct plural and
past-tense markers and comparative morphemes
Based on Common Core State Standards
With prompting and support, retell familiar stories, including key details
Participate in collaborative conversations with diverse partners about
kindergarten topics and texts with peers and adults in small and
larger groups
Follow agreed-upon rules for discussions (e.g., listening to others, taking turns)
Continue a conversation through multiple exchanges
Confirm understanding of a text read aloud or information presented orally or
through other media by asking and answering questions about key details
and requesting clarification if something is not understood

Note. Codes represent International Classification of Functioning, Disability and Health (World Health Organization, 2007) codes used to
identify different domains. C = consonant; V = vowel.

school (Beitchman et al., 2001). Early phonological
awareness/decoding and grammar deficits frequently resolve,
and scores on some tests that measure capacity at morpho-
syntactic and vocabulary levels may be within the average
range (Conti-Ramsden & Botting, 1999). Yet many of
these students with PLIs will exhibit deficits at the discourse
level (Wetherell, Botting, & Conti-Ramsden, 2007). These
deficits can influence not only their comprehension and pro-
duction of written texts but also their ability to engage in
classroom discussions with peers.
Assessment
By fifth grade, many students with a history of lan-
guage impairments have acquired basic morpho-syntax
as measured on standardized tests (Stothard, Snowling,
Bishop, Chipchase, & Kaplan, 1998). Their syntactic defi-
cits may not be manifested in conversation but are likely
to become more obvious and problematic in academic
discourse that requires a variety of participial phrases and
dependent clauses. The complexity of narratives has in-
creased, and much of the academic work is now presented in
expository format. For this reason, assessment of Activity/
capacity should assess comprehension and production of
narrative and expository discourse. The Test of Narrative
Language (Gillam & Pearson, 2004) provided a standard-
ized score for Mateo’s narrative skills. His score of 68 indi-
cated he had significant difficulty comprehending and
producing narrative. To assess both capacity for complex
syntactic patterns and overall text organization, Mateo
was asked to produce a story in response to a single picture
of a gorilla on a snow-covered mountaintop at night. Tell-
ing a story from a set of sequenced pictures, as Mateo did
in kindergarten, would not tap the narrative demands in
fifth grade. Telling the story from a picture sequence requires
that the student recognize the temporal and causal relation-
ships portrayed in the pictures and generate sentences to
describe or interpret the pictures, but unlike a novel story
from a single picture, it does not require metacognitive
knowledge of what comprises a good story and executive
functions and working memory to organize temporal and
causal information coherently without visual supports.
The story was analyzed using the Monitoring Indica-
tors of Scholarly Language (MISL; Gillam, Gillam, Fargo,
Olszewski, & Segura, 2016; short form in article, long form
available at https://www.pdffiller.com/247021337-MISLpdf-
Monitoring-Indicators-of-Scholarly-Language-MISL-Utah-
State-Various-Fillable-Forms). The MISL was designed
to measure changes in macrostructure and microstructure
features that have been documented to contribute to nar-
rative proficiency and that are aligned with CCSS. Mateo
produced a minimally complete narrative but did not
receive full credit for any component. He provided a
general reference to a setting (mountain), characters
(monster, they), a vague initiating event (monster bug-
ging people), what the people were doing and why (climb-
ing mountain to tell monster to go), an attempt (telling
monster he could stay if it did not eat them), and out-
come (the monster stays on the mountain). Mateo did
not explain what the monster was doing that bugged the
people. He did not mention the characters’ emotions or
internal thoughts. He correctly used two sentences with
adverbial dependent clauses (And the monster didn’t want
to go cause he liked the mountain; then they told him, “If
you don’t try to eat us, we’ll let you stay”), but most of his
sentences were simple sentences connected by and or then.
To evaluate expository discourse skills, Mateo was
also asked to give procedural explanations. After making
chocolate chip cookies, he was asked to explain how he
did so. He exhibited obvious word-finding difficulties
during the task and had difficulty clearly sequencing all
components. His word-finding and discourse-organizing
difficulties were also obvious when he explained how

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to play his favorite game, soccer (Heilmann & Malone,
2014; guidelines for eliciting and scoring an expository
text on how to play a favorite game are available for free
download at http://saltsoftware.com/media/wysiwyg/
codeaids/ESS_Scoring_Guide.pdf).
The Test of Integrated Language & Literacy (TILLS;
Nelson, Plante, Helm-Esterbrooks, & Hotz, 2016), normed
on students ages 6 to 18 years, has parallel oral and writ-
ten subtests (e.g., nonword repetition and nonword reading,
and listening and reading comprehension). The listening
and reading comprehension and story-retelling subtests tar-
get the narrative language capacity skills essential for par-
ticipating in classroom discussions. The written expression
subtest targets capacity with spelling/grammar and syntactic
structure of written texts. The written stories are scored for
number of story ideas or concepts included, number of word
errors, and syntactic complexity (number of concepts divided
by number of T-units, which are independent clauses with
any dependent clauses attached to them). Mateo’s score on
the TILLS was below the cut score for his age, indicating
that he did have a language/literacy impairment. On the
CELF-5 Pragmatics Profile, Mateo’s teacher reported defi-
cits primarily in the participation category. He did not
easily interact with his peers in structured or unstructured
group activities. He had difficulty getting into discussions
or holding his own when peers interrupted him as well as
asking for help from others or offering help.
Intervention
Table 3 shows the interventions to build Mateo’s capac-
ity and performance in fifth grade. The interventions address
the fifth-grade CCSS for reading literature and informa-
tional texts (National Governors Association Center for Best
Practices & Council of Chief State School Officers, 2010).
Impairment-based interventions to build capacity
focused on developing Mateo’s ability to identify the com-
ponent structures of narrative and expository texts, to pro-
duce a variety of relative and adverbial dependent clauses
to explain temporal and causal relationships within texts,
and to identify rules and nonverbal behaviors for social sit-
uations. Socially based goals to build performance for Par-
ticipation involved interactions in the classroom and social
situations in which Mateo uses the skills he developed in
the capacity-building activities. To build capacity for com-
prehension of relationships between emotions, thoughts,
and events in narratives and the complex syntax needed to
express these relationships, Mateo was provided with a
frame to express relationships between events (when), feel-
ings, and reasons (why). For example, the students read
the book, Wonder (Palacio, 2012), about Auggie, a fifth-grade
boy with a severe facial deformity and his interactions with
his peers, and during discussion, they produced sentences
such as, “When Jack says he only hangs out with Auggie
because he was asked to, Auggie feels devastated and
betrayed because he thought Jack was his best friend.” A
syntactic frame was also provided expressing characters’
goals in fiction narratives and nonfiction historical narratives
(Somebody + Wanted/because + But + So). For example,
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Table 3. Interventions to build capacity and performance in fifth
grade.
Impairment-based goals/build capacity
d1 Learning and applying knowledge
Produce sentences with relative and adverbial clauses using a
variety of conjunctions (e.g., because, so, when)
Identify structural components of narrative and expository texts
Use graphic organizers to produce narrative and expository texts
d7 and d9 Interactions and social life
Identify appropriate social rules and codes of conduct for
various social situations opportunities
Identify various nonverbal social communication behaviors
(i.e., tone of voice, personal space, vocal volume, body
orientation, facial expressions)
Explain how to play games and sports peers play
Socially based goals/build performance for participation
d3 Communication (based on Common Core)
Engage effectively in collaborative discussions by building on
others’ ideas and expressing their own clearly
Follow agreed-upon rules for discussions and assigned roles
Pose and respond to specific questions by making comments
that contribute to the discussion and elaborate on the
remarks of others
Tell a story or give an explanation sequencing ideas, logically
giving details to support main ideas or themes
d1 Learning and applying knowledge
Orally explain a science activity; write an organized science
report
Participate in classroom science discussion using the
organizational structure for a science lab report and
sentences with dependent clauses that signal temporal
and causal relationship
Explain characters’ goals/behaviors in stories using adverbial
and adjectival dependent clauses
d7 and d9 Interactions and social life
Join sports activity, play by rules, negotiate conflicts
Share personal stories in conversations with peers
Note. Codes represent International Classification of Functioning,
Disability and Health (World Health Organization, 2007) codes used
to identify different domains.
as part of a civil rights unit, students read Sixteen Years in
Sixteen Seconds (Yoo, 2010), the story of Sammy Lee, a
Korean-American who won a gold medal for diving at the
1948 Olympics. Using the syntactic frame, Mateo produced
the sentence, “Sammy wanted to learn to dive because he
wanted to be an Olympic champion, but because he was
Asian American he could only use the public pool one day
a week to practice, so he practiced by diving into a sandpit.”
Mateo’s teacher incorporated classroom activities
that required students to use syntactically complex sen-
tences. For example, in a science lesson, students learned
about blood types. They were told that Dracula was get-
ting sick when he took blood from certain victims. The
students were given beakers with clear (type O blood), red
(type A blood), blue (type B blood), and purple (type AB
blood) water and a number of test tubes to mix the differ-
ent bloods. After completing the experiment, the students
used the evidence to draw inferences or logical conclusions.
To do so, they had to use complex syntactic patterns (sen-
tences with a variety of dependent clauses, e.g., Dracula
can take blood from everyone, so (therefore) he is type
 AB or Dracula is type O because he gets sick when he takes
blood from type A, type B, and type AB donors). Next, stu-
dents wrote a lab report using a graphic organizer, stating
the purpose of the experiment, describing the procedures,
describing the results, and explaining their conclusions.
Conclusions
Value of an ICF Approach to Assessment
and Intervention
As reflected in Table 1, the ICF is compatible with
IDEA and provides the structure for meeting the intent of
IDEA, which is “to ensure that all children with disabilities
have available to them a free appropriate public education
that emphasizes special education and related services
designed to meet their unique needs and prepare them for
further education, employment and independent living”
(IDEA, 2004). IEPs are to include information on how stu-
dents will be involved in and make progress in the general
education curriculum and how they will participate in ex-
tracurricular and other nonacademic activities. All public
school systems in the United States use IDEA guidelines
when qualifying students for special education services in-
cluding speech and language therapy. Yet how children
and adolescents are assessed for speech and language im-
pairments in schools and made eligible for services varies
considerably across states and school districts. IDEA guide-
lines do not suggest any specific formal or informal assess-
ment tools; they do not require standardized tests, nor do
they mandate specific scores to qualify for services. Nearly
all states, however, require that students fall below a pre-
determined level on a standardized test battery, and some
states list the standardized tests that are acceptable for the
assessment process. In practice, school districts may con-
sider only a student’s standardized scores and academic
achievement when determining eligibility for services, yet
IDEA guidelines state that functional performance also be
considered. IDEA does not define functional or nonacademic,
so there is considerable variation in how these terms are
interpreted.
Without careful selection of the assessment tools
used and observation of Mateo’s language learning (non-
word repetitions and fast mapping), it might have been as-
sumed that his test scores (reflecting his language capacity)
were a result of his bilingualism (Personal Contextual
Factor). Unlike Virginia educational guidelines, which
mandate that statements of functional strengths and needs
be included in IEPs in the areas of (a) social competence,
(b) communication, (c) behavior, (d) personal management,
and (e) self-determination (Virginia Department of Educa-
tion, 2015), regulations in Mateo’s state provide no explana-
tion of functional behaviors. Mateo’s shy temperament
(Personal Contextual Factor) contributed to some of these
functional deficits that resulted in a marked gap between his
capacity and performance. His performance deficits had the
potential to result in even greater long-term academic and
social difficulties and restrictions. By understanding IDEA
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requirements and using the ICF framework, Mateo’s SLPs
were able to justify his eligibility for services and develop
intervention plans that addressed both his academic and
functional skills and his capacity and performance commu-
nication needs in academic, nonacademic, and extracurricu-
lar activities.
Recommendations
School SLPs frequently experience situations in which
children are qualified or discharged from therapeutic ser-
vices on the basis of scores from standardized tests. Such
tools rarely consider how well the students are participating
in social and academic contexts. The purpose of IDEA is
to prepare students for further education, employment, and
independent living, whereas the purpose of the CCSS is to
ensure that all students are prepared for college or careers
at the end of high school. Being prepared requires not only
having the necessary skills but also using these skills effi-
ciently and effectively in life experiences. The ICF frame-
work provides SLPs with a rationale and justification for
looking beyond scores on standardized tests for qualifying
students for services and setting functional goals for aca-
demic and nonacademic settings.
SLPs can use the ICF framework to judge the fit be-
tween Contextual Factors (Environmental and Personal)
and the functioning of the child or adolescent to decide
whether goals should be stated to target capacity or perfor-
mance problems, to adapt the environment, or both. The
ICF framework can also be used to differentiate between
and balance different goals—goals to alter an impairment
(e.g., wearing a hearing aid), compensatory goals (e.g., using
an augmentative device), building language skills goals
(e.g., developing vocabulary, syntactic, disorder organiza-
tion), social language performance goals (e.g., be able to
communicate adequately in different social settings), or cur-
ricular goals (e.g., literacy skills). Different professionals,
the parents, and the child may hold different opinions as to
the most important goals and the best ways to achieve those
goals. SLPs can integrate the ICF into the IDEA-IEP pro-
cess in the following ways:
• When reporting students’ present levels of performance
on an IEP, report their levels for both Activity/
capacity and Participation/performance tasks and
situations.
• Interview all stakeholders (e.g., family members,
teachers) to determine desired goals.
• For IEP goals, consider including those for academic,
nonacademic, and extracurricular settings. Consider
the student’s need for impairment-based activity/
capacity goals and socially based Participation/
performance goals.
• Through interviews and observations, determine
Personal and Environmental contextual factors that
may serve as barriers or facilitators for students’
capacity on Activities/tasks and performance in
situations requiring Participation.
13
 • Contextual Factor information can determine types
and frequency of modifications, accommodations,
and supports that facilitate the students’ capacity and
performance.
The ICF can be a complement to the IDEA-IEP pro-
cess and result in an IEP that establishes functional goals
and supports that will better enable students to move to-
ward and meet CCSS.
References
Adams, C., Gaile, J., Freed, J., & Lockton, E. (2010). Targeted
Observation of Pragmatics in Children’s Conversation
(TOPICC). Retrieved from https://www.escholar.manchester.
ac.uk/uk-ac-man-scw:83594
American Speech-Language-Hearing Association. (1996). Central
auditory processing: Current status of research and implications
for clinical practice [Technical Report]. Retrieved from http://
www.asha.org/policy
American Speech-Language-Hearing Association. (2001). Scope of
practice in speech-language pathology. Retrieved from http://
www.asha.org/policy
American Speech-Language-Hearing Association. (2004). Preferred
practice patterns for the profession of speech-language pathology
[Preferred Practice Patterns]. Retrieved from http://www.asha.
org/policy
American Speech-Language-Hearing Association. (2016a). 2016
schools survey: SLP caseload characteristics. Retrieved from
http://www.asha.org/uploadedFiles/2016-Schools-Survey-SLP-
Caseload-Characteristics.pdf
American Speech-Language-Hearing Association. (2016b). Fre-
quently asked questions: Common core state standards.
Retrieved from http://www.asha.org/SLP/schools/Frequently-
Asked-Questions/
American Speech-Language-Hearing Association. (2016c). High-
lights and trends: Member and affiliate counts, year‐end 2015.
Retrieved from http://www.asha.org/uploadedFiles/2015-
Member-Counts.pdf
American Speech-Language-Hearing Association. (2016d). Scope
of practice in speech-language pathology [Scope of Practice].
Retrieved from http://www.asha.org/policy
Bashir, A., & Scavuzzo, A. (1995). Children with language disor-
ders natural history and academic success. Journal of Learning
Disabilities, 25, 53–65.
Beitchman, J. H., Wilson, B., Johnson, C. J., Atkinson, L., Young,
A., Adlaf, E., . . . Douglas, L. (2001). Fourteen year follow-up
of speech/language impaired children and control children:
Psychiatric outcome. Journal of the American Academy of
Child and Adolescent Psychiatry, 40, 75–82.
Botting, N., Simkin, Z. & Conti-Ramsden, G. (2006). Associated
reading skills in children with a history of specific language
impairment (SLI). Reading and Writing, 19, 77–98.
Bowers, L., Husingh, R., & LaGiudice, C. (2008). Social Language
Development Test–Elementary. East Moline, IL: Linguisystems.
Brito, N. H., & Noble, K. G. (2014). Socioeconomic status and
structural brain development. Frontiers in Neuroscience, 8,
1–12.
Carrow-Woolfolk, E. (2011). Oral and Written Language Scales–
Second Edition. Torrance, CA: Western Psychological Services.
Carrow-Woolfolk, E. (2017). The Comprehensive Assessment
of Spoken Language–Second Edition. San Antonio, TX:
Pearson.
14 Language, Speech, and Hearing Services in Schools • 1–16
Downloaded From: http://lshss.pubs.asha.org/pdfaccess.ashx?url=/data/journals/lshss/0/ by a Texas State University User on 06/22/2017
Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
Chacko, A., Bedard, A. C., Marks, D. J., Feirsen, N., Uderman,
J. Z., Chimiklis, A., . . . Ramon, M. (2014). A randomized clin-
ical trial of Cogmed working memory training in school-age
children with ADHD: A replication in a diverse sample using
a control condition. Journal of Child Psychology and Psychia-
try, 55, 247–255.
Common Core State Standards Initiative. (2016). Standards in your
state. Retrieved from http://www.corestandards.org/standards-
in-your-state/
Conti-Ramsden, G., & Botting, N. (1999). Classification of chil-
dren with specific language impairment: Longitudinal consid-
erations. Journal of Speech, Language, and Hearing Research,
42, 1195–1204.
Conti-Ramsden, G., St. Clair, M. C., Pickles, A., & Durkin, K.
(2012). Developmental trajectories of verbal and nonverbal
skills in individuals with a history of specific language impair-
ment: From childhood to adolescence. Journal of Speech,
Language, and Hearing Research, 55, 1716–1735.
Cordier, R., Munroc, N., Wilkes-Gillan, S., Speyer, R., & Pearce,
W. M. (2014). Reliability and validity of the Pragmatics Ob-
servational Measure (POM): A new observational measure of
pragmatic language for children. Research in Developmental
Disabilities, 35, 1588–1598.
Culatta, B., Hall-Kenyon, K. M., & Black, S. (Eds.). (2013). Sys-
tematic and engaging early literacy. San Diego, CA: Plural.
Cunningham, B. J., & Rosenbaum, P. L. (2015). A bioecological
framework to evaluate communicative participation outcomes
for preschoolers receiving speech-language therapy interven-
tions in Ontario, Canada. International Journal of Language
and Communication Disorders, 50, 405–415.
Cunningham, B., Washington, K. N., Binns, A., Rolfe, K., Robertson,
B., & Rosenbaum, P. (2017). Current methods of evaluating
speech-language outcomes for pre-schoolers with communica-
tion disorders: A scoping review using the ICF-CY. Journal of
Speech, Language, and Hearing Research, 60, 447–464.
Dempsey, L., & Skarakis-Doyle, E. (2010). Developmental lan-
guage impairment through the lens of the ICF: An integrated
account of children’s functioning. Journal of Communication
Disorders, 43, 424–437.
Dollaghan, C. A. (1987). Fast mapping in normal and language-
impaired children. Journal of Speech and Hearing Disorders,
52, 218–222.
Dunn, L. M., & Dunn, D. M. (2007). Peabody Picture Vocabulary
Test–Fourth Edition. Bloomington, MN: Pearson Education.
Dynamic Measurement Group. (2006). Indicadores Dinámicos del
Éxito en la Lectura. Eugene, OR: Author. Retrieved from:
http://dibels.org/pubs.html
Dynamic Measurement Group. (2012). DIBELS Next. Eugene,
OR: Author. Retrieved from: http://dibels.org/pubs.html
Ebert, K. D., Kalanek, J., Cordero, K. N., & Kohnert, K. (2008).
Spanish nonword repetition: Stimuli development and pre-
liminary results. Communication Disorders Quarterly, 29,
67–74.
Ehrler, D. J., & McGhee, R. L. (2008). Primary Test of Nonverbal
Intelligence (PTONI). Austin, TX: Pro-Ed.
Fernald, A. (2013). SES differences in language processing skill
and vocabulary development are evident at 18 months. Devel-
opmental Science, 16, 234–248.
Fivush, R. (2007). Maternal reminiscing style and children’s devel-
oping understanding of self and emotion. Clinical Social Work
Journal, 35, 37–46.
Fujiki, M., Brinton, B., Isaacson, T., & Summers, C. (2001). Social
behaviors of children with language impairment on the play-
ground: A pilot study. Language, Speech, and Hearing Services
in Schools, 32, 101–113.
 Gagarina, N., Klop, D., Kumari, S., Tantele, K., Valimaa, T.,
Balciunien, I., . . . Walters, J. (2015). Assessment of narrative
abilities in bilingual children. In S. Armon-Lotem, J. de Jong,
& N. Meir (Eds.), Assessing multilingual children: Disentan-
gling bilingualism from language (pp. 243–269). Buffalo, NY:
Multilingual Matters.
Gillam, R. B., Loeb, D. F., Hoffman, L. M., Bohman, T.,
Champlin, C. A., Thibodeau, L., . . . Friel-Patti, S. (2008).
The efficacy of fast ForWord language intervention in school-
age children with language impairment: A randomized con-
trolled trial. Journal of Speech, Language, and Hearing Research,
51, 97–119.
Gillam, R. B., & Pearson, N. A. (2004). Test of Narrative Language.
Austin, TX: Pro-Ed.
Gillam, S. L., Gillam, R. B., Fargo, J. D., Olszewski, A., &
Segura, H. (2016). Monitoring indicators of scholarly lan-
guage: A progress-monitoring instrument for measuring
narrative discourse skills. Communication Disorders Quarterly,
38, 96–106.
Gray, S. (2003). Diagnostic accuracy and test-retest reliability of
nonword repetition and digit span tasks administered to pre-
school children with specific language impairment. Journal of
Communication Disorders, 36, 129–151.
Griffin, T. M., Hemphill, L., Camp, L., & Wolf, D. P. (2004).
Oral discourse in the preschool years and later literacy skills.
First Language, 24, 123–147.
Heilmann, J., & Malone, T. O. (2014). The rules of the game:
Properties of a database of expository language samples.
Language, Speech, and Hearing Services in Schools, 45,
277–290.
Howe, T. J. (2008). The ICF contextual factors related to speech-
language pathology. International Journal of Speech-Language
Pathology, 10, 27–37.
Hwa-Froelick, D., & Matsuo, H. (2005). Vietnamese children and
language-based processing tasks. Language, Speech, and Hear-
ing Services in Schools, 36, 230–243.
Individuals with Disabilities Education Act, 20 U.S.C. § 300.1
(2004).
Izaryk, K., Skarakis-Doyle, E., Campbell, W., & Kertoy, M. (2015).
Social communication functioning: An appraisal of current as-
sessment tools through the lens of the International Classifica-
tion of Functioning, Disability and Health–Child & Youth
Version. Journal of Communication Disorders, Deaf Studies &
Hearing Aids, 3(3), 1–9.
McCormack, J., Jacobs, D., & Washington, K. (2012). Specific
mental functions: Language (B167). In A. Majnemer (Ed.),
Measures for children with developmental disabilities: An ICF
approach (pp. 129–153). Hoboken, NJ: Wiley.
McLeod, S., & Bleile, K. (2004). The ICF: A framework for set-
ting goals for children with speech impairments. Child Lan-
guage Teaching and Therapy, 20, 199–219.
McLeod, S., McCartney, E., & McCormack, J. (2012). Commu-
nication (D310-D369). In A. Majnemer (Ed.), Measures for
children with developmental disabilities: An ICF approach
(pp. 312–325). Hoboken, NJ: Wiley.
Melby-Lervåg, M., & Hulme, C. (2013). Is working memory train-
ing effective? A meta-analytic review. Developmental Psychol-
ogy, 49, 270–291.
Milman, L. (2016). An integrated approach to teaching discourse
in aphasia. Topic in Language Disorders, 36, 80–96.
National Governors Association Center for Best Practices & Council
of Chief State School Officers. (2010). Common Core State
Standards for English language arts and literacy in history/
social studies, science, and technical subjects. Washington,
DC: Authors.
Westby & Washington: ICF in Child Language Assessment and Intervention
Downloaded From: http://lshss.pubs.asha.org/pdfaccess.ashx?url=/data/journals/lshss/0/ by a Texas State University User on 06/22/2017
Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
National Institute for Deafness and Other Communication Disorders.
(2016). Specific language impairment. Retrieved from https://
www.nidcd.nih.gov/health/specific-language-impairment
Nelson, N. W., Plante, E., Helm-Esterbrooks, N., & Hotz, G. (2016).
Test of integrated language and literacy skills. Baltimore, MD:
Brookes.
Newcomer, P. L., & Hammill, D. D. (2009). Pragmatic language
observation scale. Austin, TX: Hammill Institute.
Palacio, R. J. (2012). Wonder. New York, NY: Knopf.
Paul, R., & Norbury, C. F. (2012). Language disorders from in-
fancy through adolescence: Listening, speaking, reading, writ-
ing, and communicating. St. Louis, MO: Mosby.
Peña, E. D., Gutierrez-Clellen, V. F., Iglesias, A., Goldstein, B. A.,
& Bedore, L. M. (2014). Bilingual English Spanish Assessment.
San Rafael, CA: AR-Clinical Publications.
Phelps-Terasaki, D., & Phelps-Gunn, T. (2007). Test of pragmatic
language (2nd ed.). Austin, TX: Pro-Ed.
Prior, M., Bavin, E., Cini, E., Eadie, P., & Reilly, S. (2011). Rela-
tionships between language impairment, temperament, be-
havioural adjustment and maternal factors in a community
sample of preschool children. International Journal of Language
and Communication Disorders, 46, 489–494.
Schank, R. C. (1990). Tell me a story: Narrative and intelligence.
Evanston, IL: Northwestern University Press.
Simmons, E. S., Paul, R., & Volkmar, F. (2014). Assessing prag-
matic language in autism spectrum disorder: The Yale in vivo
pragmatic protocol. Journal of Speech, Language, and Hearing
Research, 57, 2164–2173.
Snowling, M. J., Bishop, D. V. M., Stothard, S. E., Chipchase, B.,
& Kaplan, C. (2006). Psychosocial outcomes at 15 years of
children with a preschool history of speech-language im-
pairment. Journal of Child Psychology and Psychiatry, 47,
759–765.
Spaulding, T. J., Plante, E., & Farinella, K. A. (2006). Eligibility
criteria for language impairment: Is the low end of normal
always appropriate? Language, Speech, and Hearing Services
in Schools, 37, 61–72.
Stothard, S. E., Snowling, M. J., Bishop, D. V. M., Chipchase,
B. B., & Kaplan, C. A. (1998). Language-impaired preschoolers:
A follow-up into adolescence. Journal of Speech, Language,
Hearing Research, 41, 407–418.
Summers, C., Bohman, T. M., Gillam, R. B., Peña, E. D., & Bedore,
L. M. (2010). Bilingual performance on nonword repetition in
Spanish and English. International Journal of Language and
Communication Disorders, 45, 480–493.
Thomas-Stonell, N., Oddson, B., Robertson, B., & Rosenbaum, P.
(2010) Development of the FOCUS (FOCUS on the Outcomes
of Communication Under Six), a communication outcome
measure for preschool children. Developmental Medicine and
Child Neurology, 52, 47–53.
Thomas-Stonell, N., Washington, K., Oddson, B., Robertson, B., &
Rosenbaum, P. (2013). Measuring communicative participa-
tion using the FOCUS: Focus on the Outcomes of Communi-
cation Under Six. Child: Care, Health, and Development, 39,
474–480.
Threats, T. T. (2003). The conceptual framework of ASHA’s
new scope of practice for speech-language pathology. Speech
Pathology Online. Retrieved May 10, 2007, from http://www.
speechpathology.com
Threats, T. T. (2007). Access for persons with neurogenic commu-
nication disorders: Influence of Personal and Environmental
Factors of the ICF. Aphasiology, 21, 67–80.
Virginia Department of Education. (2015). Sample IEP form. Re-
trieved from http://www.doe.virginia.gov/special_ed/iep_instruct_
svcs/iep/
15
 Washington, K. N. (2007). Using the ICF within speech-language
pathology: Application to developmental language impair-
ment. International Journal of Speech-Language Pathology, 9,
242–255.
Washington, K. N., Thomas-Stonell, N., Oddson, B., McLeod, S.,
Warr-Leeper, G., & Rosenbaum, P. (2013). Construct validity
of the FOCUS (Focus on the Outcomes of Communication
Under Six): A functional communication outcome measure for
preschool children. Child: Care, Health, and Development, 39,
481–489.
Washington, K. N., Thomas-Stonell, N., Oddson, B., Robertson,
B., & Rosenbaum, P. (2013). Reliability of the Focus on the
Outcomes of Communication Under Six (FOCUS). Journal
of Clinical Practice in Speech-Language Pathology, 15,
25–31.
Westby, C. (2007). Application of the ICF in children with lan-
guage impairments. Seminars in Speech and Language, 28,
265–272.
Westby, C. E., & Culatta, B. (2016). Telling tales: Personal event
narratives and life stories. Language Speech and Hearing
Services is Schools, 47, 260–282.
Wetherell, D., Botting, N. & Conti-Ramsden, G. (2007). Narrative
in adolescent specific language impairment: A comparison
with peers across two different narrative genres. International
Journal of Language & Communication Disorders, 42, 583–605.
16 Language, Speech, and Hearing Services in Schools • 1–16
Downloaded From: http://lshss.pubs.asha.org/pdfaccess.ashx?url=/data/journals/lshss/0/ by a Texas State University User on 06/22/2017
Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
Wiig, E., Semel, E., & Secord, W. (2013). Clinical Evaluation of
Language Fundamentals–Fifth Edition. San Antonio, TX:
Pearson.
World Health Organization. (1948). Preamble to the constitu-
tion of the World Health Organization as adopted by the
international health conference. New York, June 19–22, 1946;
signed on July 22, 1946, by the representatives of 61 states
(Official Records of the World Health Organization, No. 2,
p. 100), and entered into force on April 7, 1948.
World Health Organization. (1992). ICD-10 classifications of men-
tal and behavioural disorder: Clinical descriptions and diagnostic
guidelines. Geneva, Switzerland: Author.
World Health Organization. (2001). International Classification of
Functioning, Disability and Health (ICF). Geneva, Switzerland:
Author.
World Health Organization (WHO Workgroup for development of
version of ICF for Children & Youth). (2007). Classification of
Functioning, Disability and Health–Children and Youth Version
(ICF-CY). Geneva, Switzerland: Author.
World Health Organization. (2013). How to use the ICF: A practi-
cal manual for using the International Classification of Function-
ing, Disability and Health (ICF). Exposure draft for comment.
Geneva, Switzerland: Author.
Yoo, P. (2010). Sixteen years in sixteen seconds: The Sammy Lee
story. New York, NY: Lee & Lowe Books.