Dx is a problem solving skill: therefore the scientific method should be used in

Steps.
1. Constituent Analysis: Definition and delimitation of the problem:
understanding the subject matter
2. Clinical hypothesis: derivation of cause-effect relationships
3. Clinical design: development of the measurement plan.
4. Clinical testing: collection of the data
5. Clinical data analysis
6. Clinical interpretation (Support or reject the hypothesis)
7. Conclusions: patient management

1. Constituent Analysis: defining and delimitation of the problem. It is

dependent on 2 sources of info.
1- the patient information he has available to him from any source
(referral source, case history forms, medical records etc.) and
2. his/her own organized funds of knowledge about normal and
disordered speech and L.
Reads the constituents and then categorizes and examines each of them in light of
his funds of knowledge to determine if they are significant and relevant for asking
questions. It's on the basis of Step. 1 that the dx'ican determines what his specific
job will be. This analysis integrates 2 imp. ingreds: what the dx’ican knows
about the patient and what the d'ican knows about normal and disordered
speech and L.
2. Makes (formulates) a (working clinical) hypothesis expressing cause-effect
relationships. The dx'ian can pursue cause and effect separately or simultaneously.
Need to be cautious at this stage due to incomplete state of knowledge regarding
causal factors of speech and L disorders.
 might not be shown together on the cause and effect model b/c of this reason but
for the remainder they converge, try to bring them tog. for the rest of the process.
Cause - effect statements are the dx'ians best statements/questions about the causal
factors and presented S&L disorders of the patients he sees.
Can be reformulated or revised as get more info. during dx process. The Hypoth. is
the dx's tentative solution to the patient's problem.
3. Planning the Dx session - in order to test his Hyp. He designs it with this in
mind: gain th emost info. selects and develops needed tools to fit his design, and
plans test strategy to optimize data collection.
• Countless tools include: interview (major source of info.) (decides what he
wants to learn and how he'll learn it), unstructured situations in which to
observe spontaneous behavior, array of commercial or experimental tools
available.
• Various ways to view the purposes of clinical design - 1. assessment implies
the use of standardized tools, which allow for norm comparisons to be made.
Others, (Muma) being a major proponent, would say that clinical
assessment is a process of discovering and describing how an individual
functions in natural contexts.
• Whatever the specific tools chosen, the dx'ian evaluates their usefulness to
him/her for gathering info. About the cause-effect relationships he has
hypothesized. Evaluate each tool in relationship to all other tools and
procedures considered. How imp. will the info gained from each tool be for
understanding the clinical problem?
• Also, the dx'ian must plan his testing strategy to optimize his data collection.
how will he frame his questions.
4. Clinical testing: collection of the data- start of face to face contact with patient
and family. gain interview info. and administer the tools he has chosen to test his
clinical hypoth. Collects his data. Major concern here is: control over the stimuli,
responses, and reinforcements. Also, appropriateness of the tools, need to adapt the
format to fit the patient? Are all the procedures needed? Never works out exactly
like think it will. Also, need to relate to patient, cultural stuff, flexible with
children.
Also, recording the data as it occurs in a way that he can reflect on at a later time,
some way to make it permanent. Some procedures have scoring forms, others
don't.

5. Clinical data analysis - objectifies and analyzes data. Scores, categorizes and
orders all inform. obtained in the intereview and testing sessions. Determine how
well/poorly the patient performed in reference to some standard criteria. could be
normative data or intragroup (other patients with similar problems). when scoring
spontaneous behavior, the norms are derived from the dx'ians's background info.
on normal speech and L behaviors.
After objectifying the data, categorize it in relation to the cause -effect hyp. Order
the data that provides information about S&L probls. Here she considers the
validity, reliability and completeness of the obtained data. NOT AN
INTERPRETIVE STEP.
6. Clinical interpretation - vital b/c it sets the course for future mgmt. of the
patient. Uses all the info. now available, from all sources, to determine its meaning
and significance. He wants to know if the data confirms or denies the original
hypotheses or if it suggests other interpretations.
Determine the significance of the results. What does the data mean in rel. to the
cause -effect hypothesis, to general purposes of dx, to refrral request and to the
statement of the problem as seen by the patient.
However tentative they may be, the dx'ian must arrive at some conclusion. States
succinctly what the disorder may be and to implicate probably causal factors;
formulate, state, and support the dx. Dx'ian puts the pieces all together, attempt to
understand the whole. Use his reasoning abilities to present the most logica
interpretation of the avaiable data. Be aware of missing info. Highest degree of
professionalism. Use his knowledge and problem-solving skills to arrive at best
answers to the clinical problems presented.

7. Conclusions: patient management - a. Conclusions are drawn about what must

be done and how it's to be done (re: the patient). He formulates a mgmt. proposal.
Must decide if the dis. constitutes a problem that needs attn. if so, what cna be
done about it. He must know appropriate management alternatives for the disorder
and its contributing causal factors. Best alternatives for his age, family concerns,
probable prognosis.
b. communicate the dx and plan to patient and family using a two way approach.
Be open to patient’s family, use interpersonal comm. skills here. Comm. to other
professionals as well. Report findings to the original referral source and make dx
findings available to others concerned with the therapy plan of the patient.
The dxi'ian must also follow up on the dx decisions that have been made. make
sure they're being implemented: may incl. referrals, scheduling for thpy ...
Action plan for the patient. Payoff for the family and patient