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ASSESSMENTOFLANGUAGEDISORDERSINCHILDREN
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ASSESSMENTOFLANGUAGEDISORDERSINCHILDREN

RebeccaJ.McCauley
UniversityofVermont
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Copyright2001byLawrenceErlbaumAssociates,Inc.

Allrightsreserved.Nopartofthisbookmaybereproducedinanyform,byphotostat,microform,retrievalsystem,oranyothermeans,withoutthepriorwritten
permissionofthepublisher.

LawrenceErlbaumAssociates,Inc.,Publishers
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CoverdesignbyKathrynHoughtalingLacey

LibraryofCongressCataloginginPublicationData

McCauley,RebeccaJoan,1952
Assessmentoflanguagedisordersinchildren/RebeccaJ.
McCauley.
p.cm.
ISBN:0805825614(cloth:alk.paper)/0805825622(pbk.:alk.paper)
1.LanguagedisordersinchildrenDiagnosis.2.Communicative
disordersinchildrenDiagnosis.3.Learningdisabledchildren
LanguageEvaluation.I.Title.

RJ496.L35M375200100050403
618.92855075dc21CIP

PrintedintheUnitedStatesofAmerica
10987654321
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Tomyparents,
FredandPriscillaMcCauley
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Pagevii

Contents
Preface xi
WhyIWroteThisBook
HowThisBookIsOrganized
Acknowledgments
1 Introduction 1
PurposesofThisText1
WhyDoWeMakeMeasurementsintheAssessmentandManagementofChildhoodLanguageDisorders?2
WhatProblemsAccompanyMeasurement?4
AModelofClinicalDecisionMaking7
Summary11
KeyConceptsandTerms11
StudyQuestionsandQuestionstoExpandYourThinking12
RecommendedReadings12
References12
PARTI:BASICCONCEPTSINASSESSMENT
2 MeasurementofChildrensCommunicationandRelatedSkills 17
TheoreticalBuildingBlocksofMeasurement17
BasicStatisticalConcepts24
CharacterizingthePerformanceofIndividuals30
CaseExample38
Summary43
KeyConceptsandTerms44
StudyQuestionsandQuestionstoExpandYourThinking46
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RecommendedReadings47
References47
3 ValidityandReliability 49
HistoricalBackground49
Validity51
Reliability66
Summary72
KeyConceptsandTerms73
StudyQuestionsandQuestionstoExpandYourThinking75
RecommendedReadings76
References76
4 EvaluatingMeasuresofChildrensCommunicationandRelatedSkills 78
ContextualConsiderationsinAssessment:TheBiggerPictureinWhichAssessmentsTakePlace79
EvaluatingIndividualMeasures88
Summary105
KeyConceptsandTerms106
StudyQuestionsandQuestionstoExpandYourThinking106
RecommendedReadings107
References107
PARTII:ANOVERVIEWOFCHILDHOODLANGUAGEDISORDERS
5 ChildrenwithSpecificLanguageImpairment 113
DefiningtheProblem113
SuspectedCauses116
SpecialChallengesinAssessment127
ExpectedPatternsofLanguagePerformance130
RelatedProblems132
Summary137
KeyConceptsandTerms138
StudyQuestionsandQuestionstoExpandYourThinking139
RecommendedReadings140
References140
6 ChildrenwithMentalRetardation 146
DefiningtheProblem147
SuspectedCauses149
SpecialChallengesinAssessment156
ExpectedPatternofStrengthsandWeaknesses158
RelatedProblems161
Summary161
KeyConceptsandTerms162
StudyQuestionsandQuestionstoExpandYourThinking163
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RecommendedReadings164
References164
7 ChildrenwithAutisticSpectrumDisorder 168
DefiningtheProblem169
SuspectedCauses173
SpecialChallengesinAssessment174
ExpectedPatternsofLanguagePerformance176
RelatedProblems178
Summary181
KeyConceptsandTerms182
StudyQuestionsandQuestionstoExpandYourThinking183
RecommendedReadings184
References184
8 ChildrenwithHearingImpairment 187
DefiningtheProblem188
SuspectedCauses196
SpecialChallengesinAssessment198
ExpectedPatternsofOralLanguagePerformance203
RelatedProblems204
Summary205
KeyConceptsandTerms205
StudyQuestionsandQuestionstoExpandYourThinking206
RecommendedReadings207
References207
PARTIII:CLINICALQUESTIONSDRIVINGASSESSMENT
9 ScreeningandIdentification:DoesThisChildHaveaLanguageImpairment? 213
TheNatureofScreeningandIdentification214
SpecialConsiderationsWhenAskingThisClinicalQuestion216
AvailableTools236
PracticalConsiderations240
Summary242
KeyConceptsandTerms243
StudyQuestionsandQuestionstoExpandYourThinking244
RecommendedReadings244
References244
10 Description:WhatIstheNatureofThisChildsLanguage? 250
TheNatureofDescription251
SpecialConsiderationsforAskingThisClinicalQuestion252
AvailableTools 255
PracticalConsiderations280
Summary283
KeyConceptsandTerms284
StudyQuestionsandQuestionstoExpandYourThinking286
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RecommendedReadings286
References287
11 ExaminingChange:IsThisChildsLanguageChanging? 293
TheNatureofExaminingChange294
SpecialConsiderationsforAskingThisClinicalQuestion296
AvailableTools311
PracticalConsiderations317
Summary321
KeyConceptsandTerms322
StudyQuestionsandQuestionstoExpandYourThinking323
RecommendedReadings324
References324
AppendixA 328
AppendixB 334
AuthorIndex 339
SubjectIndex 353
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Preface
WhyIWroteThisBook

HowThisBookIsOrganized

Acknowledgement

WhyIWroteThisBook

Youcantkillanyonewithspeechlanguagepathology.

IcametospeechlanguagepathologybywhatwasthenanunconventionalrouteaPh.D.inanonclinicalspecialitywithinbehavioralsciences,followedby
postdoctoralstudy,clinicalpracticum,andaclinicalfellowshipyear.Thus,Iwasunschooledinthehumorouswisdomthatispassedalongwithmorestandardfareto
speechlanguagepathologydoctoralstudentsthroughtheyears.Iwasabletogleanonlyoneortwosuchaphorismsfrommycontactswithamoreconventionally
trainedandclinicallysavvycolleague.

Youcantkillanyonewithspeechlanguagepathology,shesaid.Abalmtotheanxietiesofabeginningclinicianwhoknowsthatthereissomuchshedoesnotknow.
Abitofhumortohelpyouwhileyoulearn.However,themoreclientsIworkedwith,themoreIwashauntedbythisaphorism.Certainly,killingwasexceedinglyrare
tononexistent,butloominglargewerethespectersofunfulfilledhopesandwastedtime.Thepossibilityforimprovingchildrenslivesbecameeverclearer,butsodid
thepossibilityoflessdesirableoutcomes.
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Initiallymyclientswerepreschoolerswhoseparentswerebaffledbytheirchildrensfailuretoexpressthemselvesclearly,ortheywereschoolagedchildrenwhowere
diagnosedwithbothlanguagelearningdisabilitiesandseriousemotionalproblems.Morerecently,myclientshaveincludedunintelligiblechildrenwhoseproblemswere
largelylimitedtotheirphonologyaswellaschildrenwhoseproblemsencompassednotonlythatoneaspectoflanguage,butalmostallotherareasonemightexamine.
Alloftheseclientslikethosewithwhomyoucurrentlyworkorwillsoonworkpresentuswithpuzzlestobesolvedandresponsibilitiestobemetifwearetohelp
them.

Thepuzzlepresentedbychildrenwithlanguagedisordersisthearrayofabilitiesanddifficultiesthattheybringtolanguagelearninganduse.Iusethewordpuzzle
because,likepuzzles,theirproblemsatfirstsuggestmanyalternativemodesofsolutionsomebetter,someworse,andsomeprobablyofnovalueatall.Thus,
responsibilitiesfollowfromourprofessionalobligationtohelpchildrenmaximizetheirskillsandminimizetheirproblemsintheprocessofdecipheringtheparticular
patternofintricaciestheypresent.

Inshort,thereasonIwrotethisbookwastohelpidentifybetterwaysofdealingwiththepuzzlesandresponsibilitiesthataresofrustratinglylinkedinourinteractions
withourclients.Byfindingthebestwaysofdealingwiththesepuzzlesandresponsibilitieswecanavoidtheharmimpliedbytheaphorismquotedearlierandcan
insteadenrichtheirlivesbyhelpingthemimprovetheircommunicationwithothers.

HowThisBookIsOrganized

OverallOrganizationoftheBook

Thisbookisdividedintothreemajorsections.InPartI,conceptsinmeasurementareexplainedastheyapplytochildrenscommunication.Althoughsomeofthese
conceptsarequantitativeinnature,othersrelatetothesocialcontextinwhichmeasurementsaremadeandused.Specialemphasisisplacedontheconceptsofvalidity
andreliabilitybecauseallothermeasurementcharacteristicsareultimatelyofinterestbyvirtueoftheireffectsonreliabilityand,moreimportantly,onvalidity.Thispart
ofthebookconcludeswithachapterprovidingdirectadviceregardingtheexaminationofmaterialsassociatedwithmeasurementtoolsforpurposesofdetermining
theirusefulnessforaparticularchildorgroupofchildren.

InPartII,fourmajorcategoriesofchildhoodlanguagedisordersarediscussed:specificlanguageimpairment(chap.5),languageproblemsassociatedwithmental
retardation(chap.6),autismspectrumdisorders(chap.7),andlanguageproblemsassociatedwithhearingimpairment(chap.8).Thesefourcategorieswereselected
becausetheyarethemostfrequentlyoccurringchildhoodlanguagedisorders.Althoughchildrenacrossthesedisordercategoriessharemanyproblems,eachgroupalso
presentsuniquechallengestoassessmentandmanagement.Someofthesechallengesrelatetotheheterogeneityoflanguageandotherabilitiesshownbychildreninthe
category,therelativeamountofinformationavailableduetotherarityoftheproblem,andtheoftendiversetheoreticalorientationsofresearchers.Eachofthese
chaptersprovidesabarebonesintroductiontothedisordercategory:itssuspectedcauses,
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specialchallengestolanguageassessment,expectedpatternsoflanguageperformance,andaccompanyingproblemsthatareunrelatedtolanguage.Afulldescriptionof
anyoneofthesedisorderswouldrequireseveralbooksaslongasthisone.Consequently,readersaredirectedtomorecomprehensivesourcesforfurtherlearningbut
aregivensufficientinformationtoanticipatehowlanguageassessmentwillneedtobefocusedinordertobegintorespondtothespecialneedsofeachgroupof
children.

InPartIII,threemajortypesofquestionsthatserveasthestartingpointsforassessmentareintroducedandthenpursuedindetailfromtheoreticalunderpinningsto
currentlyavailablemeasures.Themajorquestionscorrespondtostepsintheclinicalinteraction.First,theclinicianmustdeterminewhetheralanguageproblemexists
second,heorshemustdeterminethenatureoftheproblembothintermsofspecificpatternsofimpairmentacrosslanguagedomainsandmodalitiesandintermsof
specificproblemareaswithineachdomainandmodality.Finally,heorshemusttrackchange,determininghowtheclientsbehaviorsarechangingandwhether
treatmentseemstobethecauseofidentifiedimprovements.Inthecourseofaddressingeachofthesequestions,thereaderistakenthroughthestepsrequiredtomove
fromthequestiontothetoolsavailabletoansweritforanygivenclient.

OrganizationwithinChapters

Eachchaptercontainsseveralfeaturesdesignedtoassistreadersinmasteringnewcontentandinsearchingthetextforspecificinformation.Chapteroutlinesand
enumeratedsummariesofmajorpointsaidreadersinterestedinobtaininganoverviewofchaptercontent.Tohelpreaderswithneworunfamiliarvocabulary,keyterms
arehighlightedinthetext,definedwhenofparticularimportance,andlistedattheendofeachchapter.Finally,alistofstudyquestionsandrecommendedreadingsis
designedtoallowreaderstopursuetopicsfurther.

Acknowledgments

Whereastheflawsofthisbookarecertainlyofmyowndoing,itsvirtuesowemuchtothehelpIhavereceivedfromcolleaguesandfriends.Numerouscolleaguesin
Vermontandelsewherereadsectionsofthebookandcontributedgreatlytomyunderstandingofthediversegroupofchildrendescribedinitanddeservemy
considerablethanks.AmongthemareMelissaBruce,KristeenElaison,LauraEngelhart,JulieHanson,andJulieRoberts.Inaddition,Iowespecialappreciationto
BarryGuitar,whoseexperiencewithhisownbookshelpedhimprovidethemostmeaningfulencouragementandadviceonallaspectsoftheproject.Iamparticularly
gratefulforhisabilitytotemperconstructivecriticismwithegoboostingpraise.MylongtimecolleagueandfriendMarthaDemetrastookonaheroicandmosthelpful
readingofanearfinalformofthebook.ShealongwithFrancesBilleaud,BernardGrelaandElenaPlantereadsomeofthemostchallengingsectionsandtriedtohelp
keepmeontrack.AtLawrenceErlbaumAssociates,SusanMilmoe,KateGraetzer,JennyWiseman,andEileenEngelhavehelpedmecountlesstimesthroughtheir
expertiseandpatience.IreneFarrartookmygraphicsandmadethembothclearerandmoreinter
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estingandKathrynHoughtalingmadethecoverallIcouldhavehopedfor.ShedidthiswithhelpofthephotographerHollyFavroandhermostgracefulnieceSara
Faust.

Althoughnotinvolvedwiththisprojectdirectly,thereareseveralmentorswhohaveshapedmyinterestinthetopicsdiscussedhereandcontributedsubstantiallytomy
abilitytotacklethosetopicsaswellasIhave.Theyhavemyrespectandgratitudealways:RalphShelton,LindaSwisher,BettyStark,DickCurlee,andDaleTerbeek.
Finally,Iowegreatthankstomyparents,whoeachreadandcommentedonsomeportionofthebookandwhoprovidedencouragementalongtheway,notto
mentionthefoundationthatledmetowanttopursuethisproject.
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CHAPTER
1

Introduction

PurposesofThisText

WhyDoWeMakeMeasurementsintheAssessmentandManagementofChildhoodLanguageDisorders?

WhatProblemsAccompanyMeasurement?

AModelofClinicalDecisionMaking

PurposesofThisText

Thedistraughtparentsofa3yearoldwithdelayedcommunicationarriveattheofficeofaspeechlanguagepathologist,youngsterintowandanxietyemanatingalmost
palpablywitheveryword:Doesourchildhaveaseriousproblem?Whatcanbedonetocorrectit?Howeffectivewilltreatmentbe?

Althoughthechildrenandthespecificquestionschange,thesceneremainsthesame:Achildsparentsorteacherturntoaspeechlanguageclinicianforhelpthatwill
includeanswerstospecificquestionsaboutwhetheralanguageproblemexists,itsnature,andhowtointervenetominimizeorremoveitseffects.Thisbookfocuseson
basicelementsofmeasurementofchildhoodlanguagedisordersasthemeansofprovidingvalidclinicalanswerstothesequestionsbecauseonlywithvalidclinical
answerscaneffectiveclinicalactionbetaken.

Specifically,thisbookisdesignedtopreparereaderstoselect,create,andusebehavioralmeasuresastheyassess,manage,andevaluatetreatmentefficacyforchil
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drenwithlanguagedisorders.Althoughitisdesignedtoprovideguidanceforthoseworkingwithchildrenwithanylanguagedisorder,thegreatestattentionispaidto
specificlanguageimpairment,autism,andlanguagedisordersrelatedtomentalretardationandhearingimpairment.

Thisbookisintendedprimarilyforgraduateandundergraduatestudentswhoexpecttoenterthefieldofcommunicationdisorders.Itmayalsoserveasarefresherfor
professionals,suchaspracticingspeechlanguagepathologistsorteachers,whohaveneverbeenformallyintroducedtosomeofthebasicconceptsbehindthewide
rangeofmeasuresusedintheassessmentofchildhoodlanguagedisordersorwhowouldlikeanintroductiontothelatestdevelopmentsinthisarea.

Unfortunately,thetopicofmeasurementinchildhoodlanguagedisordershasthereputationofthreateningcomplexity.Indeed,measurementoflanguage,or
communicationmoregenerally,iscomplexbothbecauseofthewealthofabilitiesandbehaviorsunderlyinglanguageuseandbecauseofthevarietyofmeasurement
orientationsonwhichspeechlanguagepathologyandaudiologydraw.Althoughdirectrootsineducationalandpsychologicaltestingtraditionsareparticularlyrobust,
therearealsoconnectionstomeasurementtraditionsinlinguistics,personnelmanagement,medicine,publichealth,andevenacoustics.Theapproachtakenhere
attemptstoblendthebestofthesetraditionsandalertreaderstotheelementstheyshare.

Forallreaders,thetextisintendedtoachievethreegoals.First,readerswilllearntorecognizethebondthattiesthequalityofclinicalactionstothequalityof
measurementusedintheprocessofclinicaldecisionmakingforchildrenwithsuspectedlanguagedisorders.Second,theywilllearnhowtoframeclinicalquestionsin
measurementtermsbyconsideringtheinformationneededandthespecificmethodsavailabletoanswerthem.Third,theywilllearntorecognizethatallmeasurement
opportunitiespresentalternativesattimesalternativesofcomparablemerit,butmoreoftenalternativesthatvaryintheirabilitytoanswertheclinicalquestionathand.
Thislastgoalwillenablereaderstoactascriticalconsumersanddiscriminatingdevelopersofclinicaltoolsforlanguagemeasurement.Caseexamplesareused
frequentlyinthetexttohelpreadersapplynewconceptsandmethodstospecificproblemslikethosetheycurrentlyfaceorwillsoonencounter.

WhyDoWeMakeMeasurementsintheAssessmentandManagementofChildhoodLanguageDisorders?

Thefollowingthreecasesillustrateavarietyofoccasionsinwhichmeasurementservesasthebasisforclinicalactionsinvolvingchildrenwithvariouslanguage
difficulties.

TwoyearoldCameronhasbeenscheduledforacommunicationevaluationbecauseofparentalconcernsthatheusesonlytwowordsanddoesnotappear
tounderstandaswellashisoldersisterdidatamuchyoungerage.Additionally,hegenerallyavoidseyecontact,whichhisparentsfindparticularly
alarmingbecauseofrecentexposuretoatelevisionshowonautism.Thus,theyhavespecificquestionsaboutwhethertheirchildhasautismandwhatthey
candotoimprovehisabilitytocommunicatewithothermembersofthefamily.
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Alejandro,adiminutive9yearoldwhohardlyseemsimposingenoughforsuchadistinguishedname,movedfromMexicototheUnitedStatesayearago,
hasjustmovedintoanewschooldistrict.Althoughhehasbeendiagnosedwithalanguagedisorder,noinformationconcerningtherelationofthat
languagedisordertohisbilingualismhasaccompaniedhimtohisnewschool.Decisionsregardinghisschoolplacementandaccesstospecialserviceswill
hingeonthatinformation.

FouryearoldMaryBethhasbeenreferredbyherpediatriciantoyourprivatepracticeforacompleteevaluationofhercommunicationskills.Althoughshe
hasbeenreceivingspeechlanguagetreatmentsinceshewas2yearsofagebecauseofDownsyndrome,MaryBethhasnotmadeprogressattherate
expectedbyherregularspeechlanguagepathologistordesiredbyherparents.Infact,sheappearstohavemadealmostnoprogressinthepastyearand
maybelosingskillsinsomeareas.

Thesethreecasesillustratethevariedproblemsfacingchildrenandfamilieswhoturntospeechlanguagepathologistsforsolutions.Theyalsoillustratethespeech
languagepathologistsroleaspartofalargerteamofprofessionals.

First,Cameronsparentsarefacedwithachildwhoappearsquitedelayedinhisexpressiveandreceptivelanguageandwhomayalsoevidencedifficultiesinthe
nonverbalunderpinningsofcommunication.Addressingtheirchiefconcernwillrequireaninterdisciplinaryeffortinvolvingseveralprofessionals(includingpossiblya
psychologist,aneurologist,adevelopmentalpediatrician,andasocialworker)designedtoyieldadifferentialdiagnosis.Ifautismisdiagnosed,theneedfor
interdisciplinaryeffortswillcontinuebecauseofthearrayofproblemsoftenassociatedwithautismrangingfrommentalretardationtosleepdisorders.Thefamilys
needs,aswellasthechilds,maybeintense,withtheresultthatthespeechpathologistsfocusonthechildscommunicationmaybroadentoencompassthefamily
communicationcontextaswellasthecoordinationofeffortsaimedatthechildsoverallneeds.

Alejandropresentsthespeechlanguagepathologistwiththedifficulttaskofdeterminingtowhatextenthislanguagedifficultiesaredifferencesnotunlikethosefacing
anyonewithundevelopedskillsinanewlanguageversustowhatextenttheyreflectanunderlyingdisorderinlanguagelearningaffectingbothhisnativeandsecond
languages.Inadditiontodecisionsregardingthenatureofdirecttherapythatheshouldreceive(includingwhetheritshouldbeconductedinSpanishorEnglish),critical
decisionsregardinghisclassroomplacementsarepressing.Notonlywillthespeechlanguagepathologistneedtoworkcloselywithhisfamilyandteacherstoreach
thesedecisions,heorshemayalsoneedtoworkwithatranslatororculturalinformanttoarriveatthebestdecisionsforAlejandrosacademicandsocialfuture.

Finally,MaryBethsparentsandpediatricianareinterestedinreceivinginformationthatwillshedsomelightonherlackofprogressinspeechlanguagetreatment.Such
informationcouldhelpguidehersubsequenttreatmentbyprovidingherparents,pediatrician,andregularspeechlanguagepathologistwithabetterunderstandingofher
currentstrengthsandweaknessesand,consequently,abetterunderstandingofreasonablenextsteps.Itshouldbenoted,however,thatMaryBethsparentsmightalso
usethisinformationastheyconsidersuingthespeechlanguagepathologistresponsibleforhercare.Althoughthisprospectisremote,itisnonethelessanincreasing
possibility(Rowland,1988).

Thesethreecasesrevealthatspeechlanguagepathologistsareaskedtoobtainanduseinformationtohelpchildrenfromavarietyofculturalbackgroundsandarange
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ofcommunicationproblems.Althoughtheyobtainmuchofthatinformationdirectly,theymustoftenworkwithfamiliesandotherprofessionalstostandachanceof
gettingthefacts.Speechlanguagepathologistsusesomeofthisinformationthemselves,suchaswhentheyidentifyanddescribealanguagedisorderorplantheirrole
intreatment.Theyalsoshareinformationwithothers,includingdoctors,teachers,andotherindividualswhoworkwithpersonsexperiencingacommunicationdisorder.
Inbrief,then,speechlanguagepathologistsgenerate,use,andshareinformationhavingpotentiallyvitalmedical,educational,social,andevenlegalsignificance.

Sohowdoesmeasuremententerintothestrategiesusedtoaddresschildrensneeds?Putsimplyandintermsspecifictoitsuseincommunicationdisorders,
measurementcanbeseenasthemethodsusedtodescribeandunderstandcharacteristicsofpersonsandtheircommunicationaspartofclinicaldecisionmaking,
theprocessbywhichthecliniciandevisesaplanforclinicalaction.Thus,itistheconnectionbetweenclinicaldecisionsandclinicalactionthatmakesmeasurement
matter(Messick,1989).Cliniciansmakenumerous,almostcountlessdecisionsaboutachildinthecourseofaclinicalrelationshipfromdeterminingthata
communicationdisorderexists,toselectingageneralcourseoftreatment,toexaminingtheefficacyofaveryspecifictreatmenttask.Becausetheclinicianbasesher
actionsatleastinpartonmeasurementdataobtainedfromtheclient,thequalityoftheactionwillbecloselyrelatedtothequalityofthedatausedtoplanit.Thesection
thatfollowsconsidersseveraldecisionpointsthatofferopportunitiesforsuccessesorfailuresinclinicaldecisionmaking.

WhatProblemsAccompanyMeasurement?

Table1.1listsfivedifferentkindsofdecisionsoccurringinthecourseofaclinicalrelationshipaswellassomeofthemeasuresthatmightbeusedtoprovideinputto
eachdecision.Thislistingisintendedtoillustratethevarietyofdecisionstobemaderatherthantolistthemexhaustively.Asillustratedinthetable,decisionmaking
beginsevenpriortotheinitiationofanongoingclinicalrelationship,asthespeechlanguagepathologistscreenscommunicationskillstodeterminewhetheradditional
attentioniswarranted.Subsequently,theclinicianwillrequiremoreinformationtounderstandthenatureoftheproblempresentedandtoarriveatdecisionsabouthow
besttomanageit.Onceaprogramofmanagementisinplace,ongoingmeasurementisrequiredtorespondtotheclientschangingneedsandaccomplishments.Even
theendoftheclinicalrelationshipisbasedonthecliniciansuseofmeasurementwithdismissalfromtreatmentusuallyoccurringwhencommunicationskillsare
normalized,maximumgainshavebeeneffected,ortreatmenthasbeenfoundtobeunsuccessful.Ateachofthepointsofdecisionmaking,thepotentialforharmenters
handinhandwiththepotentialforbenefit.

AbriefreconsiderationofthecaseofMaryBethcanbeusedtoillustratethepotentialforclinicalharmaswellastointroduceamethodforevaluatingtheeffectsof
differentkindsoferrorsindecisionmaking.RecallthatMaryBethhasreceivedspeechlanguagetreatmentfor2yearsbecauseofanearlydiagnosisofDown
syndrome.Herlackofanyprogressinspeechandlanguageoverthepastyear,orworseyet,herlossof
Page5
ClinicalDecision
Screeningforalanguagedisorder
Diagnosisofalanguagedisorder
Planningformanagementoflanguagedisorder
Assessmentofchangeincommunicationovertime
Identificationofneedforadditionalinformationina
relatedarea
skills,mayrepresentapoorfitbetweentheassessmenttoolsusedtomeasureprogressandtheareasinwhichMaryBethhasinfactadvanced,oritmayrepresent
someunsatisfactoryclinicalpracticeofherregularspeechlanguagepathologist.Ontheotherhand,thislackofprogressmayreflectachangeinMaryBeths
neurologicalstatusthatrequiresmedicalattention.Therefore,oneofthemostimmediatedecisionstobemadefromaspeechlanguageperspectiveiswhethertorefer
MaryBethtoaneurologist.
Figure1.1,adecisionmatrix,illustratesamethodforthinkingaboutthepossibleoutcomesassociatedwiththisparticulardecision.Thistypeofdecisionmatrixhas
Table1.1
ClinicalDecisionsinSpeechLanguagePathology
RelatedClinicalActions
l Referforcompleteevaluation
l Counselclientandfamily
l Informandconferwithrelevantprofessionals
l Referforrelatedevaluations
l Recommendtreatment,monitoring,ornotreatment
l Counselclientandfamily
l Informandconferwithrelevantprofessionals
l Recommendtypeandfrequencyoftreatment
l Identifystrengthsandweaknessesin
communicativefunctioning
l Consultwithprofessionalsservingclientneeds
(e.g.,educators,psychologists,physicians)
l Inferdevelopmentaltrends
l Modifytreatmentplan
l Documenttreatmentefficacy
l Dismissfromtreatment
l Refertoarelatedprofessionalforadditional
information
TypesofMeasuresUsed
l Clientandfamilyinterview
l Standardizedscreeningmeasure
l Informalcliniciandesignedmeasure
l Clientandfamilyinterview
l Standardizednormreferencedtests
l Parentreportinstruments
l Standardizednormreferencedorcriterion
referencedtests
l Informalmeasuresrelatedtospecifictreatmentgoals
orusedtodescribedomainsforwhichmeasuresare
unavailableorthatrequirearealisticsetting(e.g.,
functionalperformanceintheclassroom)
l Standardizednormreferencedorcriterion
referencedtests
l Informalmeasuresrelatedtospecifictreatmentgoals
l Singlesubjectexperimentaldesigns
l Clientandfamilyinterview
l Standardizednormreferencedtests
l Informalcliniciandevisedmeasure
Page6

Fig.1.1.AdecisionmatrixforthedecisionofwhethertoreferMaryBethforneurologicevaluation.

beenusedtoassesstheimplicationsofalternativechoicesinavarietyoffields(Berk,1984Thorner&Remein,1962Turner&Nielsen,1984).Toconstructsucha
matrixasameansofconsideringrepercussionsforasinglecase,onepretendsthatonehasaccesstotheultimatetruthaboutwhatisbestforMaryBeth.Fromthat
perspective,areferraleithershouldorshouldnotbemadenodoubts.

Withsuchperfectknowledge,therefore,supposethatareferralshouldbemade.Inthatcase,theclinicianwillhavemadeacorrectjudgmentifheorshehasreferred
andanincorrectoneifheorshehasnot.Iftheclinicianerrsbynotreferring,MaryBethmaybecomeinvolvedintheexpenseandfrustrationofcontinuingspeech
languagetreatmentthatisdoomedtofailure.Furthershemaybedelayedinorpreventedfromreceivingattentionforanincipientneurologiccondition,which,inturn,
couldhaveserious,evenlifethreateningconsequences.Althoughthiserrormightbecorrectedovertime,itseffectsarelikelytoberelativelylonglastingandpotentially
costlyintermsoftimeandmoney.

Ontheotherhand,supposethatthetruthisthatareferralisnotneededandthereforeshouldnotbemade.Inthatcasetheclinicianwillhavemadeacorrect
judgmentifshehasnotreferredandanerrorifshehas.Plausibly,thistypeoferrormayresultinaneedlessexpenditureoftimeandmoneyandinundueconcernonthe
partofMaryBethsfamily.Abitmorepositively,however,theeffectsofthiserrorwouldprobablyberelativelyshortlived:Oncetheneurologicevaluationtookplace,
theconcernwouldprobablyend.

Adecisionmatrixmakesitclearthatdifferenterrorsinclinicaldecisionmakingareassociatedwithdifferenteffects.Errorsvaryintermsofthelikelihoodthatthey
Page7

willbedetected,thetimecourseforthatdetection,andthenatureofcoststheywillexactfromtheclientandclinician.Thedecisionmatrix,therefore,isaparticularly
powerfultoolbecauseitallowsonetoexamineboththefrequencyandtypeoferrorsmade.Ireturntothistypeofmatrixfrequentlybecauseofitshelpfulnessin
thinkingabouttoolsusedtoreachclinicaldecisions.

Inthenextsectionofthischapter,Iintroducemethodsusedtounderstand(andthereforepotentiallytoimprove)clinicaldecisionmaking.Theirdescriptionisfollowed
bytheintroductionofamodelthatisintendedtoserveasaframeworkinwhichtothinkaboutthestepsinvolvedinformulatingandansweringclinicalquestions.

AModelofClinicalDecisionMaking

Theprocessesbywhichindividualsmakedecisionsaboutcomplexproblemssuchasthoseinvolvedinavarietyofclinicalsettingshavebeenthefocusofseveral
linesofresearch(Shanteau&Stewart,1992Tracey&Rounds,1999).Eachdiffersfromtheotherssomewhatinintent,butallhavesomethingtoofferanyone
interestedinclinicaldecisionmaking.

First,decisionmakinghasbeenofinteresttopsychologistswhowanttounderstandhowcomplicatedproblemsaresolvedandtowhatextentthosewhoare
acknowledgedexpertproblemsolversinagivenarea(e.g.,chess,medicine,accounting)differfromnaiveproblemsolvers(Barsalou,1992).Second.skilleddecision
makinghasbeenstudiedbyresearchersfromavarietyofdisciplineswhowishtodevelopcomputerprogramscalledexpertsystems,whichseektomimicexpert
performance(Shanteau&Stewart,1992).Suchresearchershavefocusedonthecreationofcomputerprogramsyieldingoptimalclinicaljudgments.Becausethey
focusonsuccessfuldecisionmaking,theseresearchershavebeenuninterestedinunderstandingexperterrorsindecisionmaking.Finally,therehasbeenamuchsmaller
groupofresearcherswhostudythenatureandprocessofdecisionmakinginspecificfieldsforthebenefitofthefielditself.Inspeechlanguagepathologyand
audiology,suchresearchhasincreaseddramaticallyoverthelastdecade(e.g.,McCauley&Baker,1994Records&Tomblin,1994Records&Weiss,1991).
Researchersinthisthirdcategorytendtobeinterestedinbotherrorsandsuccessfulperformance,oftenasameansofimprovingprofessionaltraining.

Youmaybeasking,Howdoesresearchondecisionmakingrelatetomeasurementinspeechlanguagepathology?andmorespecifically,Howcanithelpmebea
betterprofessional?Tobeginwith,adetailedunderstandingofexpertclinicaldecisionmakingmayhelpbeginningcliniciansreachtheranksofexpertmorequickly.
Forexample,suchanunderstandingmayidentifywhichsourcesofinformationandwhichmethodsexpertsuseaswellaswhichonestheyavoid.Anotherpotential
benefitofresearchinclinicaldecisionmakingisthatitmayidentifyproblemsthatbesetevenexperiencedclinicians,therebyhelpingdecisionmakersatalllevelsbe
vigilantinavoidingthem(e.g.,Faust,1986Tracey&Rounds,1999).Arelativelybriefdescriptionoftwosuchproblemsmayhelpillustratethepotentialvalueofthis
typeofresearch.

Inareviewofresearchonhumanjudgmentinclinicalpsychologyandrelatedfields,Faust(1986)describedcliniciansoverrelianceonconfirmatorystrategies.
Essentially,theuseofaconfirmatorystrategymeansthatafterformingahypothe
Page8

sisearlyinthecourseofdecisionmaking(e.g.,regardingadiagnosis,etiology,orsomeotherclinicalquestion),theclinicianproceedstosearchoutandemphasize
informationtendingtoconfirmthehypothesis.Atthesametime,sheorhemayfailtosearchoutdiscrepantevidence.Thetendencyforveryableclinicianstoadopt
suchastrategyhasbeendemonstratedrepeatedlyinstudiesinwhichcliniciansareaskedtomakedecisionsonhypotheticalclinicaldata(Chapman&Chapman,1967,
1969Dawes,Faust,&Meehl,1993).

Foranexampleofhowaconfirmatorystrategymightoperateinacaseofdecisionmakinginspeechlanguagepathology,IreturntothecaseofAlejandro.Suppose
thatAlejandrosclinicianinitiallydevelopsthehypothesisthatAlejandrorespondsmostconsistentlywhencommunicatinginEnglish.Theclinicianwouldbeusinga
confirmatorystrategyifsheorhefailedtoevaluateAlejandrosperformanceforSpanishandinformallysoughtteachersimpressionsofhowwellAlejandrowas
respondingtotheEnglishonlyapproachshehadrecommended,butdidsoinsuchawayastoinviteonlypositivereactions.

Asecondexampleofaprobleminclinicaldecisionmakinghasbeendescribedasthefailuretorealizetheextenttowhichsamplingerrorincreasesassamplesize
decreases.(Faust,1986,p.421).TverskyandKahneman(1993)describedthispracticeasevidenceofthebeliefinthelawofsmallnumbers,bywhichthey
meanthetendencytoassumethatevenaverysmallsampleislikelytoberepresentativeofthelargerpopulationfromwhichitisdrawn.Returningtooneofthe
hypotheticalcasespresentedearlier,imaginethissortofproblemasmenacingtheclinicianwhoistoevaluateMaryBeth,theyoungsterwithDownsyndrome.Suppose
thatthatclinicianweretohaveseenonlytwoorthreechildrenwithDownsyndromeduringherclinicalcareereachofwhomhadmadeexceptionallypoorprogress.
Thedangerwouldbethattheclinicianwouldconsiderthosefewchildrenshehadseenasrepresentativeofallchildrenwiththatdiagnosis,therebycausingherto
downplaythestatedconcernsaboutMaryBethslackofprogress.

Neitheroftheseproblemsinclinicaldecisionmakinghasbeenseenasevidenceofgrossincompetence.Althoughpoorcliniciansmaysuccumbmorefrequentlytothese
practices,thepracticesthemselvesshouldbeofconsiderableconcerntoscientificallyorientedclinicianspreciselybecausetheyseemtoberelatedtotendenciesin
humanproblemsolving,andtheymustactivelybeworkedagainstforthegoodofclientsandoftheprofession.

Onceawarethatbadhabitssuchasthosedescribedabovemaycreepintoclinicaldecisionmaking,thewarycliniciancanseekremedies.Amongtheremedies
recommendedforthetendencytouseaconfirmatorystrategyistheadoptionofadisconfirmatorystrategy,inwhichevidencebothforandagainstonespethypothesis
issoughtafterandvalued.Similarly,abeliefinthelawofsmallnumberscanbeunderminedbyremindersthatwhenonehasonlylimitedexperiencewithindividuals
withaparticulartypeofcommunicationdisorder,thecharacteristicsofpeoplefromthatsamplearequitelikelytobeunrepresentativeofthatpopulationasawhole.

Althoughtheprocessbywhichspeechlanguagepathologistsandaudiologistsreachclinicaldecisionsisfarfromwellunderstoodatthispoint(Kamhi,1994Yoder&
Kent,1988),themodelshowninFig.1.2isintendedtoserveasaworkingmodelthatcanbe
Page9

Fig.1.2.Amodelillustratingthewaysinwhichmeasurementsareusedtoreachclinicaldecisionsleadingtotheinitiationormodificationofclinicalactions.

elaboratedonasunderstandingincreases.Suchagraphicmodelcanhelpemphasizethevariednatureoftheprocessesinvolvedinreachingcomplexclinicaldecisions,
includingboththosethatareverydeliberateandreadilyavailableforinspectionaswellasthosethatarealmostautomaticandlessavailableforobservation.

Theprocessofclinicaldecisionmakingisinitiatedasthespeechlanguagepathologistformulatesoneormoreclinicalquestions.Althoughsuchquestionsmayoften
coincidewiththoseactuallyexpressedbytheclient,theymaynotalwaysdoso.Thusforexample,theparentsof3yearoldMaryBethmaynothaveexpressed
interestinhavingherhearingstatusevaluated.Ontheotherhand,herspeechlanguagepathologistwouldseethatasacriticallyimportantquestion,givenboththe
susceptibilitytomiddleearinfectionwithassociatedhearinglossamongchildrenwithDownsyn
Page10

dromeandthepivotalroleofhearinginspeechlanguageacquisition.Thisexamplepointsoutthatclinicalquestionsarisebothfromclientsexpressionsofneedand
fromtheexpertknowledgepossessedbytheclinician.

Theformulationofclinicalquestionsisofcentralimportancetothequalityofclinicaldecisionmakingbecauseitdrivesallthatfollows.First,theclinicalquestion
determineswhatrangeofinformationshouldbesought.Second,itguidestheclinicianintheselectionorcreationofappropriatemeasurementtools.Infact,itiswidely
heldthatanymeasurementtoolcanonlybeevaluatedinrelationtoitsadequacyinaddressingaspecificclinicalquestion(AmericanEducationalResearchAssociation
[AERA],AmericanPsychologicalAssociation[APA],&NationalCouncilonMeasurementinEducation[NCME],1985Messick,1988).Nomeasureisintrinsically
goodorvalid.Rather,thequalityofameasurevariesdependingonthespecificquestionitisusedtoaddress.Thus,forexample,agivenlanguagetestmaybean
excellenttoolforansweringaquestionabouttheadequacyof4yearoldMaryBethsexpressivelanguageskills,yetitmaybeaperfectlyawfultoolifusedtoexamine
suchskillsfor9yearoldbilingualAlejandro.

Optimally,specificmeasurementtoolswillbeselectedsoastoaddressthefullscopeofeachclinicalquestionbeingposedusingthebestmeasuresavailable(Vetter,
1988b).Forsomequestions,however,thewealthofcommerciallyavailablestandardizedtestsandpublishedprocedureswillfailtoyieldanyacceptablemeasure,or
evenanymeasureatall.Atsuchtimes,cliniciansmaydecidetodevelopaninformalmeasureoftheirown(Vetter,1988a),ortheymaysimplyhavetoadmitthatnotall
clinicalquestionsforallclientsareanswerable(Pedhazur&Schmelkin,1991).

Theadministrationorcollectionofselectedclinicalmeasuresiscertainlythemostobviousportionoftheclinicaldecisionmakingprocess.Itsimportancecanbe
emphasizedbyreferencetothedataprocessingadagegarbagein,garbageout.Putmoredecorously,theactofskillfuladministrationiscrucialtothequalityof
informationobtained.Haphazardcompliancewithstandardadministrationguidelinesmayrendertheinformationobtainedspuriousandmisleading,therebyundermining
alllatereffortsofthecliniciantouseittoarriveatareasonableclinicaldecision.

Followingdatacollection,theclinicianexaminesinformationobtainedacrossavarietyofsourcesandintegratesthatinformationtoaddressspecificclinicalquestions.
Forexample,inordertocommentonthereasonablenessofprogressmadebyMaryBethduringthepast2years,herspeechlanguagepathologistwillneedtoperform
aHerculeantaskintegratingacrosstimeandcontentareameasuresrelatedtospeech,language,hearing,andnonverbalcognition.

ComponentsoftheclinicaldecisionmakingprocessoutlinedinFig.1.1havereceiveddifferingamountsofattentionfromspeechlanguagepathologyandaudiology
professionals.Thus,forexample,considerableattentionhasbeenpaidtotheformulationofrelevantclinicalquestionsforspecificcategoriesofcommunication
disorders(e.g.,Creaghead,Newman&Secord,1989Guitar,1998Lahey,1988).Ontheotherhand,littlehasbeenwrittenabouthowclinicianscanusesuch
informationtoarriveateffectiveclinicaldecisions(Records&Tomblin,1994Turner&Nielsen,1984).Therefore,intheremainderofthistext,bothvenerable
conceptsandemerginghypotheseswillbesharedtohelpreadersimprovethequalityoftheirclinicaldecision
Page11

makingand,consequently,oftheirclinicalactionstowardchildrenwithdevelopmentallanguagedisorders.

Summary

1.Measurementofdevelopmentallanguagedisordersdrawsonmethodsusedinawidevarietyofdisciplines.

2.Thepurposesofthistextaretohelpreaderslearntoframeeffectiveclinicalquestionsthatwillguidethedecisionmakingprocess,torecognizethatallmeasurement
opportunitiespresentalternatives,andtorecognizetheconnectionbetweenthequalityofclinicalactionsandthequalityofmeasurementusedintheclinicaldecision
makingprocess.

3.Speechlanguagepathologistsobtainanduseinformationobtainedthroughmeasurementtoarriveatdiagnosesthataffectmedical,educational,social,andevenlegal
outcomes.Theyderivethisinformationcooperativelywithothers(e.g.,familiesandotherprofessionals)andshareitwithothersasameansofachievingthechilds
greatestgood.

4.Measurementisimportantbecauseithelpsdriveclinicaldecisionmaking,whichinturnaffectsclinicalactions.

5.Measurementisusedtoaddressclinicalquestionsrelatedtoscreening,diagnosis,planningfortreatment,determiningseverity,evaluatingtreatmentefficacy,and
evaluatingchangeincommunicationovertime.

6.Thecognitiveprocessesinvolvedinclinicaldecisionmakingarenotwellunderstoodbuthavebeguntobestudiedinresearchaddressingcomplexproblemsolving,
computerexpertsystems,andspecificissueswithinavarietyoffields(e.g.,medicine,specialeducation).

7.Examplesofproblematictendenciesthathavebeenidentifiedaspossiblebarrierstoeffectiveclinicaldecisionmakingincludetheuseofconfirmatorystrategiesand
thebeliefinthelawofsmallnumbers.

KeyConceptsandTerms

beliefinthelawofsmallnumbers:thetendencytoovervalueinformationobtainedfromarelativelysmallsampleofindividuals,forexample,thosefewindividuals
withanuncommondisorderwithwhomonehashaddirectcontact.

clinicaldecisionmaking:theprocessesbywhichcliniciansposeandanswerclinicalquestionsasabasisforclinicalactionssuchasdiagnosingacommunication
disorder,developingatreatmentplan,orreferringaclientformedicalevaluation.

confirmatorystrategy:thetendencytoseekandpayspecialattentiontoinformationthatisconsistentwithaclinicalhypothesiswhilefailingtoseek,orundervaluing,
informationthatisnotconsistentwiththehypothesis.

decisionmatrix:amethodusedtoconsidertheoutcomesassociatedwithcorrectandincorrectdecisions.
Page12

differentialdiagnosis:theidentificationofaspecificdisorderwhenseveraldiagnosesarepossiblebecauseofsharedsymptoms(selfreportedproblems)andsigns
(observedproblems).

measurement:methodsusedtodescribeandunderstandcharacteristicsofaperson.

StudyQuestionsandQuestionstoExpandYourThinking

1.Takingeachofthethreecasesdescribedearlierinthechapter,useTable1.1todeterminewhattypesofclinicaldecisionsandrelatedclinicalactionsarelikelytobe
requiredforeach.

2.ForeachofthosecasesusedinQuestion1,identifyabinaryclinicaldecisionandconsidertheimplicationsofthetwokindsoferrorsthatcanresult.

3.Onthebasisofyourcurrentknowledgeofchildrenwithlanguagedisorders,developahierarchyofoutcomesthatmightresultfromclinicalerrorsinthefollowing
cases:

l screeningofhearingina4montholdinfant
l collectionoftreatmentdatainEnglishforachildwhosefirstlanguageisVietnamese
l collectionoftrialtreatmentdataforpurposesofselectingtreatmentgoalsforachildexhibitingsignificantsemanticdelays
l evaluationofalanguageskillsinachildwhoexhibitsseveredelaysinspeechdevelopment.

4.Thinkaboutdecisionsbigandsmallthatyoumayhavemadeduringthelastweek.Trytoremembertheprocessbywhichyoureachedyourdecision.Didanyof
yourdecisionmakinginvolvetheuseofaconfirmatorystrategy?Describethespecificexampleandhowyourthinkingmighthavedifferedifyouhadavoidedsucha
strategy.

RecommendedReadings

Barsalou,L.W.(1992).Cognitivepsychology:Anoverviewforcognitivescientists.Hillsdale,NJ:LawrenceErlbaumAssociates.

McCauley,R.J.(1988).Measurementasadangerousactivity.Hearsay:JournaloftheOhioSpeechandHearingAssociation,Spring1988,69.

Tracey,T.J.,&Rounds,J.(1999).Inferenceandattributionerrorsintestinterpretation.InJ.W.Lichtenberg&R.K.Goodyear(Eds.),Scientistpractitioner
perspectivesontestinterpretation(pp.113131).Boston:Allyn&Bacon.

References

AmericanEducationalResearchAssociation(AERA),AmericanPsychologicalAssociation(APA),&NationalCouncilonMeasurementinEducation(NCME)
(1985).Standardsforeducationalandpsychologicaltesting.Washington,DC:APA.

Barsalou,L.W.(1992).Thinking.Cognitivepsychology:Anoverviewforcognitivescientists.Hillsdale,NJ:LawrenceErlbaumAssociates.
Page13

Berk,R.A.(1984).Screeninganddiagnosisofchildrenwithlearningdisabilities.Springfield,IL:C.C.Thomas.

Chapman,L.J.,&Chapman,J.P.(1967).Genesisofpopularbuterroneouspsychodiagnosticobservations.JournalofAbnormalPsychology,72,193204.

Chapman,L.J.,&Chapman,J.P.(1969).Illusorycorrelationasanobstacletotheuseofvalidpsychodiagnosticsigns.JournalofAbnormalPsychology,74,271
280.

Creaghead,N.A.,Newman,P.W.,&Secord,W.A.(1989).Assessmentandremediationofarticulatoryandphonologicaldisorders.Columbus:Merrill.

Dawes,R.M.,Faust,D.,&Meehl,P.E.(1993).Statisticalpredictionversusclinicalprediction:Improvingwhatworks.InG.Keren&C.Lewis(Eds.),Ahandbook
fordataanalysisinthebehavioralsciences:Methodologicalissues(pp.351367).Hillsdale,NJ:LawrenceErlbaumAssociates.

Faust,D.(1986).Researchonhumanjudgmentanditsapplicationtoclinicalpractice.ProfessionalPsychology,17,420430.

Guitar,B.(1998).Stuttering:Anintegratedapproachtothenatureandtreatment(3rded.).Baltimore,MD:Williams&Wilkins.

Kamhi,A.G.(1994).Towardatheoryofclinicalexpertiseinspeechlanguagepathology.Language,Speech,HearingServicesinSchools,25,115118.

Lahey,M.(1988).Languagedisordersandlanguagedevelopment.NewYork:Macmillan.

McCauley,R.J.(1988,Spring).Measurementasadangerousactivity.Hearsay:JournaloftheOhioSpeechandHearingAssociation,69.

McCauley,R.J.&Baker,N.E.(1994).Clinicaldecisionmakinginspecificlanguageimpairment:Actualcases.JournaloftheNationalStudentSpeechLanguage
HearingAssociation,21,5058.

Messick,S.(1989).Validity.InR.L.Linn(Ed.),Educationalmeasurement(pp.13104).NewYork:AmericanCouncilonEducationandMacmillanPublishing.

Pedhazur,R.J.,&Schmelkin,L.P.(1991).Measurement,design,andanalysis:Anintegratedapproach.Hillsdale,NJ:LawrenceErlbaumAssociates.

Records,N.L.,&Weiss,A.(1990).Clinicaljudgment:Anoverview.JournalofChildhoodCommunicationDisorders,13,153165.

Records,N.L.,&Tomblin,J.B.(1994).Clinicaldecisionmaking:Describingthedecisionrulesofpracticingspeechlanguagepathologists,JournalofSpeechand
HearingResearch,37,144156.

Rowland,R.C.(1988).Malpracticeinaudiologyandspeechlanguagepathology.Asha,4548.

Shanteau,J.,&Stewart,T.R.(1992).Whystudyexpertdecisionmaking?Somehistoricalperspectivesandcomments.OrganizationalBehaviorandHuman
DecisionProcesses,53,95106.

Thorner,R.M.&Remein,Q.R.(1962).Principlesandproceduresintheevaluationofscreeningfordisease.PublicHealthServiceMonographNo.67,408421.

Tracey,T.J.,&Rounds,J.(1999).Inferenceandattributionerrorsintestinterpretation.InJ.W.Lichtenberg&R.K.Goodyear(Eds.),Scientistpractitioner
perspectivesontestinterpretation(pp.113131).Boston:Allyn&Bacon.

Turner,R.G.&Nielsen,D.W.(1984).Applicationofclinicaldecisionanalysistoaudiologicaltests.EarandHearing,5,125133.

Tversky,A.&Kahneman,D.(1993).Beliefinthelawofsmallnumbers.InG.Keren&C.Lewis(Eds.),Ahandbookfordataanalysisinthebehavioralsciences:
Methodologicalissues(pp.341350).Hillsdale,NJ:LawrenceErlbaumAssociates.

Vetter,D.K.(1988a).Designinginformalassessmentprocedures.InD.E.Yoder&R.D.Kent(Eds.),Decisionmakinginspeechlanguagepathology(pp.192
193).Toronto:BCDeckerInc.

Vetter,D.K.(1988b).Evaluationoftestsandassessmentprocedures.InD.E.Yoder&R.D.Kent(Eds.),Decisionmakinginspeechlanguagepathology(pp.
190191).Toronto:BCDeckerInc.

Yoder,D.E.,&Kent,R.D.(Eds.)(1988).Decisionmakinginspeechlanguagepathology.Toronto:BCDeckerInc.
Page14
Page15

PART
I

BASICCONCEPTSINASSESSMENT
Page16
Page17

CHAPTER
2

MeasurementofChildrensCommunicationandRelatedSkills

TheoreticalBuildingBlocksofMeasurement

BasicStatisticalConcepts

CharacterizingthePerformanceofIndividuals

CaseExample

TheoreticalBuildingBlocksofMeasurement

WhatIsMeasuredbyMeasurements?

Measurementsareusuallyindirect,thatis,theyinvolvethedescriptionofacharacteristictakentobecloselyrelatedtobutdifferentfromthecharacteristicofinterest.
Asanillustrationofthisnotion,PedhazurandSchmelkin(1991)consideredtemperature.Conceptually,temperatureismostcloselyrelatedtotherateofmolecular
movementwithinamaterial,yetitisalmostalwaysmeasuredusingacolumnofmercury.Inthisway,themeasurementismadeindirectlyusingtheheightofthecolumn
ofmercuryastheindicator,orindirectfocusofmeasurement.Althoughitwouldbepossibletodeterminetherateofmolecularmovementmoredirectly,thisisnot
donebecauseoftheconsiderableexpenseandeffortinvolved.

Similarly,measurementsofbehaviororothercharacteristicsofpeoplearealmostalwaysindirect.Consider,forexample,acharacteristicthatmightbeofinteresttoa
Page18

speechlanguagepathologist,suchasachildsabilitytounderstandlanguage.Clearly,asinthecaseoftemperature,onecannoteasilymeasurethischaracteristicina
directfashion.Infact,theabilitytounderstandlanguagecannoteverbedirectlymeasuredbutinsteadmustbeinferredfromavarietyofindicators.Thisisbecausethat
abilityisatheoreticalconstruct,1aconceptusedinaspecificwaywithinaparticularsystemofrelatedconcepts,ortheory.Thus,thetheoreticalconstructreferred
tohereastheabilitytounderstandlanguagerepresentsshorthandforthecarefullyweighedobservationsonehasmadeaboutpeopleastheyrespondtothe
vocalizationsofothersaswellasfortheinformationonehasreadorbeentoldaboutthisconstructbyothers.Figure2.1attemptstocapturethecomplexrelationship
betweenwhatonewantstomeasure,thetheoreticalconstruct,andtheindicatorsusedtomeasureit.

LookingatFig.2.1,youcanseethattherearemanypossibleindicatorsforasingleconstruct.Thispremiseisimportanttocliniciansandresearcherswhoneedto
recognizethatanytestormeasuretheyuserepresentsachoicefromthesetofallpossibleindicators.

Aswillbecomeclearerinlatersectionsofthisbook,thewealthofindicatorsavailableforaconstructpresentsflexibilityforthoseinterestedinmeasuringtheconstruct,
butitalsopresentspotentialproblems.Forexample,adiverserangeofindicatorsforasingleconstruct(e.g.,intelligence)canleadtoconfusionwhencliniciansor
researchersusedifferentindicatorsinrelationtothesameconstructandreachdifferentconclusionsaboutboththeconstructandhowthecharacteristicbeingstudied
functionsintheworld.Asanexample,ifoneweretouseanintelligencetestthatheavilyemphasizesknowledgeofaparticularculture,thenuseofthatmeasurewith
childrenwhocomefromadifferentculturewouldleadtoverydifferentconclusionsregardinghowintelligentthechildrenare.

Alternatively,focusingonasingleindicatorandignoringthebroaderrangeofpossibleindicatorsforagivenconstructcanleadtoitsimpoverishment.Thistypeof
problemhasrecentlyreceivedattentionintheliteratureonlearningdisabilities,whereithasbeenassertedthatintelligenceissynonymouswithperformanceonone
particulartesttheWechslerIntelligenceScaleforChildrenRevised(Wechsler,1974).Criticscomplainthattheuseofthissinglemeasuremeansthatthe
knowledgegainedbysuchresearchmaybefarmorelimitedinitsappropriateapplicationthanhasbeenappreciated.Insummary,thechoiceofwhichindicatorand
howmanyindicatorsareusedinordertogaininformationaboutaparticularconstructbeitintelligence,receptivelanguage,ornarrativeproductionhaveimportant
implicationsforthequalityofinformationtobegained.

PedhazurandSchmelkin(1991)describedtwokindsofindicators:reflectiveandformativeindicators.Reflectiveindicatorsrepresenteffectsoftheconstruct,and
formativeindicatorsrepresentcausesofit.Anexampleofareflectiveindicatorofonesabilitytounderstandalanguagewouldbetheproportionofasetofsimple
commandsinthatlanguagethatonecancorrectlyfollow.Anexampleofaformativeindicatorofonesabilitytounderstandalanguagewouldbethenumberofyears
onehas

1Withintheliteratureonpsychologicaltesting,thereisatendencytorefertosuchconstructsaslatentvariables.
Page19

Fig.2.1.Therelationshipbetweenatheoreticalconstructsinglewordcomprehensionandseveralindicatorsthatcouldbeusedtomeasureit.

beenexposedtoit.Almostallindicatorsarereflectivehowever,formativeindicatorsaresometimesused.

Bythispoint,youmaybescratchingyourhead,wonderingwhetherthetermindicatorissynonymouswiththesomewhatmorefamiliartermvariable.Infact,those
termsarequitecloselyrelatedand,attimes,maybeusedsynonymously.Iintroducedthetermindicatorfirstbecausevariableissocloselyassociatedwithresearch
thatitsapplicationtoclinicalmeasuresmighthaveseemedconfusing.Consequently,Ibelievethataninitialdiscussionofindicatorsmayhelpreadersseehowsimilar
clinicalandresearchmeasuresaretooneanotherwhileavertingtheconfusion.Forthepurposesofthisbook,indicatorandvariablewillbeusedalmost
interchangeablytorefertoameasurablecharacteristicassociatedwithatheoreticalconstruct.However,variableisfrequentlyusedinamorerestrictedwaythan
indicator,torefertoapropertythattakesonspecificvalues(Kerlinger,1973).

Onemoretermthatcommonlyfunctionsasabuildingblockformeasurementindescriptionsofhumanbehaviorandabilitiesistheoperationaldefinition.Thisterm
wasoriginallyintroducedinphysicsbyBridgman(1927)tosuggestthatinagivenapplication(e.g.,aspecificresearchdesignoraparticularclinicalmeasure)a
constructcanbeconsideredidenticaltotheproceduresusedtomeasureit.Operationaldefinitionshavebeeninfluentialincommunicationdisordersbecausetheyhave
givenrisetotheclinicaluseofbehavioralobjectives,specificstatementsdefiningdesiredoutcomesoftreatmentforclientsintermsthatexplainexactlyhowonewill
knowwhetherthedesiredoutcomehasbeenachieved.Operationaldefinitionsareprobablymostusefulasameansofencouragingustothinkcarefullyaboutthe
specificindicatorsweusetogaininformationaboutagiventheoreticalconstruct.
Page20

TESTINGANDMEASUREMENTCLOSEUP:
ALFREDBINETANDTHEPOTENTIALEVILSOFREIFICATION
Inhis1981bookTheMismeasureofMan,StephenJayGould,anotedbiologistandpopularizerofscience,describedtheworkofAlfredBinet,theFrenchman
whodevelopedoneofthefirstwellknownintelligencetests.GouldnotedthatBinetbegantodevelopthetestin1904whenhewascommissionedbytheministerof
educationtodeviseapracticaltechniqueforidentifyingthosechildrenwhoselackofsuccessinnormalclassroomssuggestedtheneedforsomeformofspecial
education(p.149).Almostassoonasthetestcameintouse,Binetexpressedhopesthatitsresultsnotbetakenasironcladpredictionsofwhatachildcould
achieve,butthattheybeusedasabasisforprovidinghelpratherthanasajustificationforlimitingopportunities.Gouldwentontodescribetheregrettabledismantling
ofBinetsfondhope.
Gouldsbookdescribestheprocessofthereificationofintelligence,aprocessinwhichanabstract,complextheoreticalconstruct(suchasintelligence)comesto
havealifeofitsown,tobeseenasrealratherthantheabstractapproximationsthatitsoriginatorsmayhavehadinmind.Toillustratethisprocess,Goulddescribed
eventsintheUnitedStatesthatoccurredwithinamere20yearsofBinetsinitialtestdevelopment.Intelligencehadbeenreifiedtothepointthatitwasusedor
rathermisusedasabasisfordecisionshavingmajoreffectsonmilitaryservice,emigrationpolicies,penalsystems,andthetreatmentofindividualssuspectedof
mentaldefectiveness:

LevelsofMeasurement

Therearenumerouswaystocategorizemeasurements,butthenotionoflevels,orscales,ofmeasurementintroducedbyS.S.Stevens(1951)isoneofthemost
influentialandcontinuestoinspirebothdefendersandattackers.Stevensslevelsdescribethemathematicalpropertiesofdifferentkindsofindicators,orvariables.The
conceptoflevelsisusuallydefinedoperationally,witheachlevelofmeasurementdescribedintermsofthemethodsusedtoassignvaluestovariablesforexample,
whetherthevaluesareassignedusingcategories(normalvs.disordered)versusnumbers(percentagecorrect).

Typically,ahierarchicalsystemoffourorderedlevelsisdiscussed,inwhichthehigherlevelspreservegreateramountsofinformationaboutthecharacteristicbeing
measured.Table2.1summarizesthedefiningpropertiesofeachlevelofmeasurementandlistsexamplesofeachthatrelatetotheassessmentofchildhoodlanguage
disorders.Theselevelsnotonlyhaveimplicationsforourinterpretationofspecificmeasures,butalsowhatstatisticswillbeappropriatefortheirfurtherinvestigation.

Thenominallevelofmeasurementreferstomeasuresinwhichmutuallyexclusivecategoriesareused.Diagnosticlabelsandcategorysystemsfordescribingerrors
arefrequentlyusedexamplesofnominalmeasures.Althoughnumeralsmaysome
Page21

Table2.1
ThreeLevelsofMeasurement,TheirDefiningCharacteristics
andExamplesFromDevelopmentalLanguageDisorders

Levelof
Measurement Characteristics Examples

l Describingachildashavingwordfindingdifficulties
Nominal l Mutuallyexclusivecategories l Labelingachildsproblemasspecificlanguageimpairment
l Describingachildsuseandnonuseforeachof14grammaticalmorphemes
l Describingtheseverityofachildsexpressivelanguagedifficultiesassevere
l Characterizingachildsintelligibilityalongaratingscale,suchasintelligible
l Mutuallyexclusivecategories
withcarefullistening,wherenoefforthasbeenmadetoassurethatthescalehas
Ordinal l Categoriesreflectarankorderingofthecharacteristicbeing
equalintervals
measured
l Describingachildslanguageinaconversationalsampleasproductiveata

particularphase(Lahey,1988)
l Mutuallyexclusivecategories l Summarizingachildsstandardizedtestperformanceusingaraworstandard
l Categoriesreflectarankorderingofthecharacteristicbeing score
Interval measured l Describingachildsspontaneoususeofpersonalpronounsusingthenumberof

l Unitsofequalsizeareusedmakingthecomparisonof correctresponses
differencesinnumbersofunitsmeaningful l Ratingintelligibilityusinganequalintervalscale

timesbeusedaslabelsfornominalcategories(e.g.,serialnumbersornumbersonbaseballjerseys),nominalmeasurementsarenotquantitativeandsimplyinvolvethe
assignmentofanindividualorbehaviortoaparticularcategory.Measurementatthislevelisquitecrudeinthatallpeopleorbehaviorsassignedtoaspecificcategory
aretreatedasiftheyareidentical.

Ideally,categoriesusedinnominallevelmeasuresaremutuallyexclusive:Eachpersonorcharacteristictobemeasuredcanbeassignedtoonlyonecategory.
Diagnosticlabelsusedinchildhoodlanguagedisorderscanideallybethoughtofasnominalhowever,theyarenotalwaysmutuallyexclusive.Forexample,achildmay
havelanguageproblemsassociatedwithbothmentalretardationandhearingimpairment.Similarly,achildwithmentalretardationmayshowapatternofgreater
difficultieswithlinguisticthannonlinguisticcognitivefunctions,leadingonetowanttoentertainadesignationofthechildasbothlanguageimpairedandmentallyretarded
(Francis,Fletcher,Shaywitz,Shaywitz,&Rourke,1996).

Theordinallevelofmeasurementreferstomeasuresusingmutuallyexclusivecategoriesinwhichthecategoriesreflectanunderlyingrankingofthecharacteristic
Page22

tobemeasured.Putdifferently,atthislevel,categoriesbearanorderedrelationshiptooneanothersothatobjectsorpersonsplacedinonecategoryhavelessormore
ofthecharacteristicbeingmeasuredthanthoseassignedtoanothercategory.Despitethegreaterinformationprovidedatthislevelofmeasurementcomparedwiththe
nominallevel,itlackstheassumptionthatcategoriesdifferfromoneanotherbyequalamounts.Severityratingsareprobablythemostcommonlyusedordinalmeasures
inchildhoodlanguagedisorders.

Althoughordinalmeasuresreflectrelativeamountsofacharacteristic,theyarestillnotquantitativeinthesenseofreflectingprecisenumericalrelationshipsbetween
categories.Forexample,althoughaprofoundexpressivelanguageimpairmentmayberegardedasrepresentingmoreofanimpairmentthanasevereexpressive
languageimpairment,itisnotclearhowmuchmoreoftheimpairmentispresent.

Oneresultoftheabsenceofequaldistancesbetweencategories(alsocalledequalintervals)inanordinalmeasureisthatwhenrankingsarebasedonanindividual
judgment,theyarelikelytobequiteinconsistentacrossindividuals.Imaginethecaseofaclinicianwhoonlyserveschildrenwithdevastatinglyseverelanguage
impairments.Whenthatclinicianusesthelabelmildtodescribeachildsproblems,itmaymeansomethingverydifferentfromthelevelofimpairmentmeanttobe
conveyedbythesamelabelwhenitisusedbycliniciansservingalessinvolvedpopulation.Becauseofthis,ithasbeenrecommendedthatordinalmeasuresbeused
whentheratingsmadebyasingleindividualwillbecomparedwithoneanother,butnotwhenratingsofseveralpeoplewillbecompared(Allen&Yen,1979
Pedhazur&Schmelkin,1991).

Theintervallevelofmeasurementreferstomeasuresusingmutuallyexclusivecategories,orderedrankingsofcategories,andunitsofequalsize.Itisthehighest
levelofmeasurementusuallyencounteredinmeasurementsofhumanabilitiesandbehavior.Unlikemeasurementsatthefirsttwolevels,measurementsatthislevelcan
beconsideredquantitativebecausenumericaldifferencesbetweenscoresaremeaningful,aswasnotthecasefornumeralsusedatthenominalorordinallevels.Test
scoresareusuallyidentifiedasthemostfrequentexamplesofthislevelofmeasurementinchildhoodlanguagedisorders.

Theuseofequalsizeunitsinintervallevelmeasurementsallowsmoreprecisecomparisonsofmeasuredcharacteristicstotakeplace.Forexample,someonewho
receivesascoreof100onavocabularytestcanbesaidtohavereceived10morepointsthansomeonewhoreceivedascoreof90,andthesamecanbesaidforthe
personwhoscored40pointswhencomparedwithsomeonewhoscored30onthesametest.Whatcannotbesaid,however,isthatsomeonewhoreceivedascoreof
80knewtwiceasmuchassomeonewhoreceivedascoreof40thatcomparisonentailsaratio(80:40),andtheabilitytodescriberatiospreciselyisnotreacheduntil
thefinallevelofmeasurement.However,formostmeasurementpurposes,theintervallevelofmeasurementallowssufficientprecision.

Theratiolevelofmeasurementreferstomeasuresusingmutuallyexclusivecategories,orderedrankingsofcategories,equalsizeunits,andarealzero.Achievement
ofthislevelofmeasurementisconsideredrareinthebehavioralsciences,butoccurswhenameasuredemonstratesallofthetraitsassociatedwithintervalmeasures
along
Page23

withasensitivitytotheabsenceofthecharacteristicbeingmeasuredtherealzeromentionedabove.Thetermratioisusedtodescribesuchmeasuresbecauseratio
comparisonsoftwodifferentmeasurementsalongthisscaleholdtrueregardlessoftheunitofmeasurementthatisused.Itshouldalsobenotedthatwhenratiosare
formedfromothermeasures,theyachievethislevelofmeasurement.Forexample,theratioofapersonsheighttoweightfallsattheratiolevelofmeasurement.
Measuresinvolvingtime(suchasageorduration)areprobablythemostcommonoftherelativelyfewmeasuresinchildhoodlanguagedisordersthatreachtheratio
level.

Atthispoint,readersmaywonderwhyscoredataarenotdescribedasfallingattheratiolevelofmeasurementgiventhatascoreof0onatestorotherscoredclinical
measuresisanunpleasantbutrealpossibility.Forscoredata,however,thezeropointisconsideredanarbitraryzeroratherthanarealzerobecauseascoreof0does
notreflectarealabsenceofthecharacteristicbeingstudied(Pedhazur&Schmelkin,1991).Thus,forexample,ascoreofzeroona15itemtaskconcerning
phonologicalawarenessisnotconsideredindicativeofacompleteabsenceofphonologicalawarenessonthepartofthepersontakingthetest.Inordertodemonstrate
thatapersonhasnophonologicalawareness,thetestwouldneedtoincludeitemsaddressingallpossibledemonstrationsofphonologicalawarenessandwould
thereforebetoolongtoadminister(ordevise,forthatmatter).

Informationconcerninglevelsofmeasurementmaybeareviewtomanyreaderswhorememberitfrompaststatisticsorresearchmethodscourses.Levelsof
measurementareintroducedinthosecontextsbecauseeachlevelisassociatedwithspecificmathematicaltransformationsthatcanbeappliedtomeasurementsatthat
levelwithoutchangingtherelationshipbetweenthecharacteristictobemeasuredandthevalueorcategoryassignedtoit.Thosemathematicalproperties,inturn,
determinethetypesofstatisticsconsideredappropriatetothemeasure.Ingeneral,thelowerthelevelofmeasurement,thelessinformationcontainedinthemeasure
andthelessflexibilityonewillhaveinitsstatisticaltreatment.

Recallthatagivenconstructmaybeassociatedwithindicatorsatvariouslevelsofmeasurement.Consequently,thelevelofmeasurementofanindicatormaybeone
considerationwhenchoosingaparticularmeasure.Thus,forexample,imaginethatyouareinterestedincharacterizingachildsskillatstructuringanoralnarrative.At
thecrudestlevel,onemightchoosetolabelachildsperformanceintheproductionofsuchanarrativeasimpairedornotimpairedmeasuringitatanominallevel.For
greaterprecision,however,aspontaneousnarrativeproducedbythechildmightberatedusinga5pointscale,with1indicatingaverypoorlyorganizednarrative
and5anarrativewithadultlikestructure.Yetprobablythemostsatisfactorytypeofmeasurefordescribingthischildsdifficultiesisoneattheintervallevelof
measurement.AnexampleofsuchameasurefornarrativeproductionisonedevisedbyCulatta,Page,andEllis(1983),inwhichthechildreceivesascoreforthe
numberofpropositionscorrectlyrecalledinastoryretellingtask.Withsuchameasure(asopposedtomeasuresatthenominalorordinallevels),youcanobtain
greaterinsightintothenatureofthedifficultiesfacingthechildandcanmorereadilymakecomparisonstotheseverityofotherchildrenwithproblemsinnarrative
production.
Page24

BasicStatisticalConcepts

Asabranchofappliedmathematics,thefieldofstatisticshastwogeneraluses:describinggroupsofmeasurementsmadetogaininformationaboutoneormore
variablesandtestinghypothesesabouttherelationshipsofvariablestooneanother.Formanystudentsinanelementarystatisticsclass,eachoftheseusesrepresentsa
vast,aweinspiring,andsometimesfearprovokinglandscape.Inthissectionofthechapter,onlythehighestpeaksandlowestvalleysoftheselandscapeswillbe
surveyed.Specifically,selectedstatisticalconceptsareintroducedintermsoftheirmeaningandthepracticalusestowhichtheyareappliedbythoseofusinterestedin
measuringchildrensbehaviorsandabilities.Althoughstatisticalcalculationsaredescribed,onlyrarelyarespecificformulasgivensothattheconnectionbetween
meaningandapplicationcanremainparticularlyclose.MoreelaborateandmathematicallyspecificdiscussionscanbefoundinsourcessuchasPedhazurandSchmelkin
(1991).

StatisticalConceptsUsedtoDescribeGroupsofMeasurements

Oneofthemostcommonusesofstatisticsistosummarizegroupsofmeasurements,typicallyreferredtoasdistributions.Distributionscanconsistofasetof
measurementsbasedonactualobservations(oftencalledasample)orasetofvalueshypothesizedforasetofpossibleobservations(oftencalledapopulation).An
exampleofadistributionbasedonasamplewouldbeallofthetestscoresobtainedbychildreninasinglepreschoolclassonascreeningtestoflanguage.Incontrast,
anexampleofadistributionbasedonapopulationwouldbeallofthescoresonthatsametestobtainedbyanychildwhohasevertakenit.Exceptwhenpopulation
distributionsarediscussedfromapurelymathematicalpointofview,theyarealmostalwaysinferredfromaspecificsampledistributionbecauseoftheimpracticalityor
evenimpossibilityofmeasuringthepopulation.

Twotypesofstatisticsusedtosummarizedistributionsofmeasurementsaremeasuresofcentraltendencyandvariability.Measuresofcentraltendencyaredesigned
toconveyatypicalorrepresentativevalue,whereasmeasuresofvariabilityareusedtoconveythedegreeofvariationfromthecentraltendency.

Measuresofcentraltendencyhavebeendescribedasindicatinghowscorestendtoclusterinaparticulardistribution(Williams,1979,p.30).Thethreemost
commonmeasuresofcentraltendencyare(inorderofdecreasinguse)themean,median,andmode.Themeanisthemostcommonmeasureofcentraltendency.Itis
usedtorefertothevalueinadistributionthatisthearithmeticaverage,thatis,theresultwhenthesumofallscoresinadistributionisdividedbythenumberofscoresin
thedistribution.Unlikethetwoothermeasuresofcentraltendency,themeanisappropriateonlyformeasurementsthatfallatintervalorratiolevels.Althoughitis
consideredtherichestmeasureofcentraltendency,themeanhasthenegativefeatureofbeingparticularlysensitivetooutliersextremescoresthatdiffergreatlyfrom
mostscoresinthedistribution.Becauseofthis,themeanwillsometimesnotbeusedevenifthelevelofmeasurementallowsitinstead,themedian,whichisthenext
mostsensitivemeasureofcentraltendencywillbeused.
Page25

Themedianisthescoreorcategorythatliesatthemidpointofadistribution.Itisthemiddlescoreinthecaseofungroupeddistributionsofintervalorratiodataand
themiddlecategoryinthecaseofordinaldata.Themedianisconsideredanappropriatemeasureofcentraltendencyforeitherordinalorintervalmeasuresandiseven
superiortothemeanintermsofitsrelativestabilityinthefaceofoutliers.Ontheotherhand,itisconsideredinappropriatefornominalmeasuresbecausethecategories
usedatthatlevelofmeasurementcannot,bydefinition,beorderedlogically.Becauseofthislackoforderinnominaldata,findingamiddlescoreorcategoryis
nonsensical.

Thethirdandfinalmeasureofcentraltendency,themode,hasrelativelyfewuses.Themodesimplyreferstothemostfrequentlyoccurringscore(forintervalorratio
data)orcategory(fornominaldata).Becauseofthewaythemodeisdefined,itispossiblefortheretobemorethanonemodeinagivendistribution,inwhichcasethe
distributionfromwhichitcomescanbereferredtoasbimodal,trimodal,andsoforth.Fornominalleveldata,themodeistheonlysuitablemeasureofcentraltendency.

Becausemeasurementswithinadistributionvary,ameasureofvariabilityisalsorequiredtocharacterizeiteffectively.Threemeasuresofvariability,twoofwhichare
verycloselyrelated,aremostfrequentlyusedindescriptionsofchildrensabilitiesandbehaviors.Aswasdoneinthedescriptionofmeasuresofcentraltendency,these
measureswillbedescribedinorderofdecreasinguse.

Althoughconsideredsomewhatdauntingbybeginningstatisticsstudentsbecauseofitsrelativelyinvolvedcalculations,themostfrequentlyusedmeasureofvariabilityis
thestandarddeviation.Thestandarddeviationwasdevelopedforintervalandratiomeasuresasanimprovementontheseeminglygoodideaofdescribingthe
average(ormean)difference(ordeviation)fromthemean.Theproblemwithanaveragedeviationwasthatbecauseofthewaythemeanisdefined,allofthe
deviationsabovethemeanarepositiveinsignandwouldthereforebalanceallofthenegativedeviationsfallingbelowthemean,leadingtoanaveragedeviationofzero
foralldistributionsregardlessofobviousdifferencesinvariabilityfromonedistributiontoanother.Inordertoavoidthisproblem,thestandarddeviationiscalculated
inamannerthatmakesalldeviationspositive.Nonetheless,theintentbehindthestandarddeviationistoconveythesizeofthetypicaldifferencefromthemeanscore.
AsIexpandoninanupcomingsectionofthischapter,thestandarddeviationhasspecialsignificancebecauseofitsrelationshiptothenormalcurve.Specifically,
standarddeviationunitsbecomecriticaltocomparisonsofonepersonsscoreagainstadistributionofscores,suchasoccurswhentestnormsareused.

Theconceptofvarianceiscloselyrelatedtothestandarddeviation.Infact,thestandarddeviationofadistributionisthesquarerootofitsvariance.Despitethisvery
closerelationshiptostandarddeviation,varianceislessfrequentlyusedbecause,unlikethestandarddeviation,itcannotbeexpressedinthesameunitsasthemeasure
itisbeingusedtocharacterize.Forexample,youcandescribetheageofagroupofchildreninmonthsbysayingthatthemeanageforthegroupis36months,andthe
standarddeviationis3months.Thisresultsinamuchclearerdescriptionthansayingthatthemeanageforthegroupis36months,andthevarianceis9.No,not9
monthssimply9.Becauseofthisunitlessness,varianceisrarelyusedwhenthe
Page26

intentissimplytodescribethecharacteristicsofagroup.Itdoesplayaroleinsomestatisticaloperations,however,andsoisanimportantstatistictobeawareof.

Theleastcomplicatedmeasureofvariability,therange,isalsotheleastfrequentlyusedofthethreemeasures.Itrepresentsthedifferencebetweenthehighestand
lowestscoresinadistribution.Theutilityoftherangeliesinitseaseofcalculationanditsapplicabilitytodistributionsatanylevelofmeasurementotherthanthenominal
level.Forintervalorratiodata,itiscalculatedbysubtractingthelowestfromthehighestscoreandadding1.Thusforexample,ifthehighestandlowestscoresina
distributionoftestscoreswere85and25,respectively,therangewouldbe61.Attheordinallevel,therangeisusuallyreportedbyindicatingthelowesttohighest
valueused.Forexample,onemightreportthatlistenerratingsofachildsintelligibilityinconversationrangedfromusuallyunintelligibletointelligiblewithcareful
listening,orfrom2to4ifa5pointnumericscalewereused.Becausetherangeisbasedononlytwonumbers(ortwolevelsinthecaseofanordinalmeasure),its
weaknessisthelackofsensitivityandsusceptibilitytotheeffectsofoutliers.

Insummary,measuresofcentraltendencyandvariabilityareusefulfordescribinggroupsofmeasurementsrelatedtoasinglevariableandareselectedonthebasisof
thevariableslevelofmeasurement.

StatisticalConceptsUsedtoDescribeRelationshipsbetweenVariables

Anumberofstatisticalconceptsareavailabletodescriberelationshipsbetweenandamongtwoormoregroupsofmeasurementsandtotesthypothesesaboutthe
natureofthoserelationships.Becausetheintenthereistofocusonlyonthoseconceptsmostbasictounderstandingmeasurementapplicationsindevelopmental
languagedisorders,onlyoneofthoseconceptswillbediscussedinsomedetailthecorrelation.

Thecorrelationbetweentwovariablesdescribesthedegreeofrelationshipexistingbetweenthemaswellasinformationaboutthedirectionofthatrelationshipandits
strength.Correlationcoefficientstypicallyrangeindegreefrom0(indicatingnorelationship)topositiveornegative1(indicatingaperfectrelationshipinwhichknowing
onemeasureforanindividualwouldallowyoutopredictthatpersonsperformanceonthesecondmeasurewithperfectaccuracy).Thesignofthecorrelationrefersto
itsdirection:Apositivecorrelationindicatesthatasonemeasureincreases,thesecondmeasureincreasesaswell.Relationshipsassociatedwithapositivecorrelation
aresaidtobedirect.Avividexampleofadirectrelationshipwouldbetherelationshipsomeseebetweenmoneyandhappiness.Incontrast,anegativecorrelation
indicatesthatasonemeasureincreases,thesecondmeasuredecreases.Relationshipsassociatedwithanegativecorrelationaresaidtobeinverse.Avividexampleof
aninverserelationshipwouldbetherelationshipbetweenunpaidbillsandpeaceofmind.

Figure2.2containsexamplesofgraphicrepresentationsofcorrelationsthatdifferinmagnitudeanddirection.Noticethattwoofthecorrelationsaredescribedasbeing
associatedwithacorrelationcoefficientof0.Thesecondofthosedemonstratesacurvilinearrelationship,whichcannotbecapturedbythesimplemethodsdescribed
here.
Page27

Fig.2.2.Illustrationsshowingthevarietyofrelationshipsthatcanexistbetweenvariablesandcanpotentiallybedescribedusingcorrelationcoefficients.Theseinclude
norelationship(i.e.,thevalueofonevariableisindependentofthevalueoftheother),acurvilinearrelationship(i.e.,inwhichthenatureoftherelationshipbetween
variableschangesinacurvilinearfashiondependingonthevalueofoneofthevariables),andlinearrelationshipsoflowerandgreatermagnitudes.

Asamoredetailed(andrelevant)exampleinvolvingcorrelation,letsconsidertwohypotheticalsetsoftestscoresobtainedforaclassofthirdgradersoneonreading
comprehensionandtheotheronphonologicalawareness(explicitknowledgeofthesoundstructureofwords).Ifthisgroupofchildrenwerelikemanyothers,thenone
wouldexpecttheirperformancesonthesetwomeasurestobepositivelycorrelated(e.g.,Badian,1993Bradley&Bryant,1983)thatis,onewouldexpectthat
childrenwhoreceivehigherscoresonthereadingcomprehensiontestwouldreceivehigherscoresonthephonologicalawarenesstest.However,becausemanyfactors
affecteachoftheabilitiestargetedbythemeasures,itwouldbeunlikelythatthemagnitudeofthecorrelation,whichreflectsthestrengthoftheassociation,wouldbe
verylarge.In
Page28

fact,alowcorrelationmightbeexpectedinthiscontext.Table2.2containslabelsthatarefrequentlyusedtodescribecorrelationsofvariousmagnitudes(Williams,
1979).

ThecorrelationcoefficientmostfrequentlyusedindescribinghumanbehavioristhePearsonproductmomentcorrelationcoefficient(r),thespecifictypeofcorrelation
thatwouldhavebeenappropriatefortheexamplegivenabove.Unfortunately,thatcorrelationcoefficientisonlyconsideredappropriateformeasurementsatthe
intervalorratiolevelofmeasurement.Formeasurementsattheordinallevel,Spearmansrankordercorrelationcoefficient()canbecalculated.Atthenominallevel,
thecontingencycoefficient(C)isusedtodescribetherelationshipbetweenthefrequenciesofpairsofnominalcategories.

Inadditiontothesecorrelationcoefficients,however,thereareseveralothercorrelationcoefficients(e.g.,phi,pointbiserial,biserial,terachoic)thatareusedduringthe
developmentofstandardizedtests.Thechoiceoftheselessfamiliarcorrelationcoefficientsisdictatedbythecharacteristicsofthemeasurementstobecorrelated,such
aswhethereitherorbothofthemeasurementsaredichotomous(e.g.,yesno,correctincorrect),multivalued(e.g.,numbercorrect),orcontinuous(e.g.,response
times).

Itiseasytobeintimidatedbyanunfamiliarcorrelationcoefficient.However,thisdangercanbecounteredwiththeknowledgethattheconceptofcorrelationremains
thesame,regardlessofhowexoticthenameofthespecificcoefficient.Thus,whetheroneisusingphiorPearsonsproductmomentcorrelation,acorrelation
coefficientalwaysisintendedtodescribetheextenttowhichtwomeasurestendtovarywithoneanother.Infact,evenwhenoneexaminestherelationshipsbetween
thedistributionsofmorethantwovariablesusingmultiplecorrelations,theinterpretationofcorrelationsremainsessentiallyunchanged.

Correlationcoefficientsareusuallyreportedalongwithastatementofstatisticalsignificance,whichdescribestheextenttowhichthecorrelationcoefficientislikely
todifferfromzerobychance,giventhesizeofthesampleonwhichitisbased.Ingeneral,statementsofstatisticalsignificancealwayscarrytheimplicationthatalthough
aparticularsampleofbehaviorwasobserved,itisbeingusedtodrawconclusionsforthelargerpopulation.Statementsofstatisticalsignificanceareusedtotest
hypothesesconjecturalstatementsaboutarelationbetweentwoormorevariables(Pedhazur&Schmelkin,1991).Inthiscase,thehypothesisisthattheobtained
correlationcoefficientdiffersfromzero.Statisticalsignificanceindicatesthattheobtainedvaluewasunlikelytohaveoccurredbychance.

Table2.2
DescriptiveLabelsAppliedtoCorrelationsofVaryingMagnitudes

Correlation Label DegreeofRelationship

<.20 Slightcorrelation Almostnegligiblerelationship

.20.40 Lowcorrelation Definite,butsmallrelationship
0.40.70 Moderatecorrelation Substantialrelationship
0.70.90 Highcorrelation Markedrelationship
>.90 Veryhighcorrelation Verydependablerelationship
Page29

Unfortunately,acorrelationsstatisticalsignificanceissometimesmistakenlytakenasthemostimportantindicationofitsimportance.However,averylowcorrelation
coefficientisunlikelytobeimportantevenifitisstatisticallysignificantbecauseitdoesnotexplainmuchofthevariabilityofthecorrelatedmeasures.Inaddition,the
largerthesamplesize,theeasieritisforacorrelationcoefficienttoattainstatisticalsignificance.Therefore,althoughastatisticallysignificantcorrelationcoefficientis
alwaysdesirable,themagnitudeaswellasthesignificanceofthecorrelationmustbeconsidered.

Anadditionalconcernsurroundingtheinterpretationofcorrelationcoefficients,suchasthePearsonproductmomentcorrelationcoefficient,isthatitsmagnitudedoes
notitselfreflecttheextenttowhichtwovariablesexplainoneanother.Instead,thatinformationisprovidedbyacloselyrelatedstatistic,thecoefficientofdetermination,
whichcanalsobereferredtoasvarianceaccountedfor,orr2,forthePearsonproductmomentcorrelation.Itiscalculatedbysquaringthecorrelationcoefficient
andmultiplyingittimes100.Asanexample,assumethatthecorrelationbetweentwosetsoftestscoreswas.60(amoderatecorrelationaccordingtoTable2.2).The
correspondingcoefficientofdeterminationwouldbe36%,meaningthat36%ofthevariationobservedinthetwosetsoftestscoreswasaccountedforbytheir
relationshipleavingasubstantial64%unexplained.Awarenessofthisconceptbecomesimportantinevaluatingcorrelationalevidenceprovidedbytestdevelopersto
supportthequalityoftheirtest.

Intheirbookonphonologicdisorders,BernthalandBankson(1998)madeageneralpointconcerningthelimitationsofstatisticalsignificanceasanindicationofthe
importancearesearchfinding.Althoughtheywerenottalkingspecificallyaboutcorrelationaldata,theywarnedcliniciansagainsttheassumptionthatanystatistically
significantfindingreportedintheresearchliteraturewasworthyofimpactonclinicalpractice.Theyusethetermclinicalsignificancetosuggestthatonlyrelatively
largeeffects(i.e.,thosethatwouldbeassociatedwitharelativelylargeproportionofvarianceaccountedfor)wouldlikelybeofimportanceintheclinicalenvironment.
Theyencouragedreaderstolookforevidenceofthesizeofrelationshipsintheformofvariationaccountedfor,whichisreportedasomegasquaredformany
analyses(Young,1993).Forthepurposesofthisbook,BernthalandBanksonscautionshouldbeconsideredasitappliestobothcorrelationcoefficientsandany
statisticalfindingthatmightbeusedindiscussionsofchildrenslanguageabilities.

Afinalcautionarystatementconcerningtheinterpretationofcorrelationsisthefundamentalideathattheexistenceofacorrelationbetweentwomeasuresdoesnot
constituteevidenceofacausalrelationshipbetweenthem.Thus,returningtotheexampleinitiallyusedtointroducetheconceptofcorrelation,rememberthatchildrens
scoresontwotests,oneofreadingcomprehensionandoneofphonologicalawareness,werefoundtobecorrelated.Althoughitwouldbeverytemptingtoconclude
thatchildrensphonologicalawarenesscausedtheircomprehensionperformance,thatwouldbeanincomplete,evenincorrectinterpretationofthecorrelation.
Theoreticallysuchaninterpretationwouldbequiteinvitingbecauseitwouldbeeasytoimaginethatagreaterfamiliaritywiththesoundstructureofawrittenlanguage
wouldmakeitsprocessingeasier,thusresultinginimprovedcomprehension.Infact,however,itisequallyplausiblethatchildrenscomprehensioncausedtheir
performanceonthephonologicaltasks.Thatis,theirlevelofcomprehensionmayhaveallowedthemtoprocessthe
Page30

soundinformationofthelanguagetoagreaterdegreebecausetheywerenotasoverwhelmedwiththeothermemoryandprocessingdemandsassociatedwith
understandingtext.Thus,theywouldperformbetteronthephonologicalawarenesstestbecauseoftheircomprehensionskills.Finally,itwouldalsobeplausibleto
imaginethatchildrensperformancesonbothtaskswereinfactcausedbysomethirdvariableorbymultiplevariables.Theoftrepeatedwarningnottoconfuse
correlationwithcausationisprobablyoneofthemostimportantlessonsinthisoranybookbecauseofitsimpactoncriticalthinkinginnonscientificaswellasscientific
realms.

Inadditiontosimplecorrelations,awiderangeofotherstatisticsareavailableforexamininghypothesesabouttherelationshipbetweenvariables.Frequently,
hypothesesrelatetotherelationshipofoneormoreclassificationvariables(e.g.,ageandgender)toanoutcomeorresponsevariable(e.g.,performanceonaparticular
test).Alternatively,statisticsareusedtodeterminewhetheroneormorevariableshaveacausaleffectonaresponsevariable.Whenthatisthecase,variables
hypothesizedtobecausesaretermedindependentvariablesandthosehypothesizedtobeeffectsaretermeddependentvariables.Selectionofspecificstatistical
techniquesfortestingahypothesisdependsquiteheavilyonthelevelofmeasurementoftheoutcomeordependentvariable.

Variablesmeasuredattheintervalorratiolevelofmeasurementaregenerallystudiedusingparametricstatistics(e.g.,ttests,analysesofvariance,orANOVAs)
whereasvariablesmeasuredatnominalorordinallevelsareexaminedusingnonparametricstatistics(e.g.,chisquareanalysesandCochransQ).Nonparametric
statisticsarealsousedwhenthedependentvariableseemstobedistributedinamannerthateitherdepartssignificantlyfromanormaldistributionorseemslikelyto
violateassumptionsunderlyingtheuseofnormaldistributions.Aconciseintroductiontothedecisionmakingbehindtheselectionofanappropriatestatisticaltechnique
canbefoundinChial(1988).LongerdiscussionscanbefoundinFreedman,Pisani&Purves(1998)orMcClave(1995)forparametricstatistics,andConover
(1998)orGibbons(1993)fornonparametricstatistics.

Statisticaltechniquesfortestinghypothesesarenotexploredfurtherherebecauseoftheirrelativelylimiteduseinassessingchildrenslanguagedisorders.Theyprimarily
comeintoplayinthedocumentationprovidedbytestdeveloperstosupportthevalueofstandardizedmeasures,andtheywillbediscussedfurtherinthatcontextinthe
nextchapter.

CharacterizingthePerformanceofIndividuals

Methodsforsummarizinganindividualsperformancevarydependingonthenatureofthemeasurementbeingmade.Numerousschemesforcategorizingmeasurements
ofhumanbehaviorhavebeenproposed.Thesecategorizationsoftenassumethatthemeasurementsofinterestareformaltestsbecausetestsarethemoststudiedform
ofmeasurementrelatedtohumanabilitiesandbehaviors.Onefrequentlydiscussedcategorizationseparatesachievementtestingfromabilitytestingtheformer
seekstomeasureactuallearning,andthelatterseekstomeasurelearningpotential.Withinachievementtesting,distinctionsaremadebetweenplacementtesting,which
takesplacepriortoinstructionformativeanddiagnostictesting,whichtakeplaceduring
Page31

instructionandsummativetesting,whichtakesplaceattheendofinstruction(Gronlund,1982).Formativetestingisdesignedtomeasurethelearnersprogressas
learningisunderway,whereasdiagnostictestingidentifiesthesourceofdifficultiesimpedingthelearnersprogress.Summativetestingisdesignedtoevaluatelearning
progressatsomeendingpoint,forexample,attheendofaschoolterm.

Othercategoriesappliedtotestshaveincludedpaperandpenciltests,themoststudiedmediumfortestexecutionperformancetests,whichtypicallyinvolvethe
testtakersmanipulationofobjectsorperformanceofsomeactivitythatusuallydoesnotinvolvetheuseofpaperandpencilandcomputerizedtests,whichinvolve
theuseofcomputerdisplaysorbothcomputerdisplayandkeyboardedresponses.Althoughperformancetestspredominateasamethodoftestingindevelopmental
languagedisorders,paperandpenciltestsaretypicallyusedincaseswhenwrittenlanguageskillsareassessed.Computerizedtestingisagrowingtopicofinterest
(e.g.,Wiig,Jones,&Wiig,1996)becauseofthepossibilitiesitpresentsforprovidingmoreinteresting,evenanimatedstimuliandforgreatertailoringoftestitemstoa
clientsneedsbychoosinglateritemsbasedonearlierperformance(Bunderson,Inouye,&Olsen,1989).Eachofthesetypesoftestsaltersaspectsofthetest
administrationandscoringprocessandthusindirectlyaffectstheinterpretationofindividualscores.

Althoughtestsandothermeasurescanbecategorizedalongmanydifferentdimensions,thecategorizationofmeasuresasnormreferencedversuscriterionreferenced
hasthegreatestimpactonhowindividualperformancesareinterpreted.Infact,attimes,thesetwocategoriesarereferredtoasmodesofscoreinterpretationrather
thantypesoftests(e.g.,APA,AERA,&NCME,1985).

NormReferencedversusCriterionReferencedMeasures

Overall,normreferencedmeasuresarethoseforwhichanindividualsperformanceisinterpretedinrelationtotheperformanceofothers,andcriterion
referencedmeasuresarethoseforwhichanindividualsperformanceisinterpretedinrelationtoanestablishedbehavioralcriterion.Table2.3listssomenorm
referencedandcriterionreferencedmeasureswithwhichreadersmayhavehadpersonalexperienceaswellassomethatarecommonlyusedindevelopmental
languagedisorders.Althoughnoteveryauthorwouldagreethatsomeofthemoreinformalofthesemeasuresshouldbecategorizedasnormorcriterionreferenced,
eachofthemeasuresfitswithinthedefinitionsappearingatthebeginningofthisparagraph.

ThedependenceofthiscategorizationonthemethodusedtointerpretanindividualsscorecanbeillustratedusingthebriefexampleinTable2.4,whichIcallthe
AmazingUniversityofVermontTest.ImaginefirstthatthiswouldbetestistobegiventodeterminewhichincomingstudentstotheUniversitywillreceiveascholarship
beinggrantedbytheUniversitysAlumniAssociation.Ifthatwerethetestspurpose,appropriatescoreinterpretationwouldinvolvecomparingalloftheincomingfirst
yearstudentstoseewhichoneshadthemostknowledgeandthuswouldreceivethescholarship.Thatmethodofscoreinterpretation,therefore,woulddependnotonly
onknowledgeofasingletesttakersscore,butalsoonknowledgeoftheperformanceoftheentiregroupagainstwhichtheindividualsperformancewastobe
compared.
Page32

Table2.3
ExamplesofCriterionandNormReferencedMeasuresAssociatedWithReaders
PersonalExperiencesandClinicalPracticeinDevelopmentalLanguageDisorders

Normreferenced Criterionreferenced

Personalexperience Developmentallanguagedisorders Personalexperience Developmentallanguagedisorders

l IQtests
l Driverstest
l GREs l Mostarticulationorphonologytests
l IQtests l Eyeexamination
l SATs l Treatmentprobesinwhichaset
l Mostlanguagetests l Classroomexamination(without
l Classroomtests(withgradingonthe criterion(e.g.,80%)isused
gradingonthecurve)
curve)

Note.GRE=GraduateRecordExaminationSAT=ScholasticAptitudeTest.
Table2.4
TheAmazingUniversityofVermontTest

1.TheUniversityofVermontislocatedin
2.TheofficialacronymfortheUniversityis
3.ThenumberofstudentsattendingtheUniversityis
4.Theschoolcolorsare
5.ThemascotoftheUniversityis
6.ThemostpopularspectatorsportattheUniversityis
7.ThemostfamousphilosophergraduatingfromUVMwas
8.TranslatedfromtheLatin,theschoolmottomeans
(a)Burlington,Vermont(b)Montpelier,Vermont
(c)Manchester,NewHampshire(d)St.Albans,Vermont
(e)EnosburgFalls,Vermont
(a)UofV(b)VU(c)UVM(d)MUV
(e)noneoftheabove
(a)5001500(b)15003000(c)30004500
(d)45006000(e)>10,000
(a)greyandwhite(b)greenandwhite
(c)greyandgreen(d)greenandgold(e)greyandgold
(a)snowyowl(b)raccoon(c)barnowl(d)catamount
(e)Jerseycow
(a)cowtipping(b)icehockey(c)football
(d)downhillskiing(e)snowboarding
(a)EthanAllen(b)IraAllen(c)WoodyAllen
(d)WoodyJackson(e)JohnDewey
(a)Scholarshipandhardwork(b)Staywarm
(c)LivefreeandstayoutofNewHampshire
(d)Suspectflatlanders(e)Independenceanddignity

Suchacomparisongroupiscalledanormativegroup,hence,thedesignationnormreferencedtorefertothemethodofscoreinterpretationandsometimestorefer
tothespecifictypeofmeasurebeingused.

Norms,then,refertothespecificinformationaboutthedistributionofscoresassociatedwiththenormativegroup.Twotypesofnormsmeritspecialattention:national
normsandlocalnorms.Nationalnormsaredataconcerningagroupthathasbeenrecruitedsoastoberepresentativeofanationalcrosssectionofindividualswho
mightbetested.Normsfortestsinvolvingchildrenaretypicallyorganizedsothatinformation
Page33

basedonsubgroupsofchildrenarereportedbyage(usuallyin26monthintervals),bygrade,orboth.Itisoftenrecommendedthatwhennormsarecollected,the
normativegroupsbematchedagainstnationaldata(usuallycensusdata)forsocioeconomicstatus,race,ethnicity,education,andgeographicregion(Salvia&
Ysseldyke,1995).Nationalnormsarecollectedalmostsolelyforstandardizedmeasuresthatwillbeusedwithverylargenumbersofindividualseachyear.For
example,intelligencetests,educationaltests,andmanylanguageteststypicallyprovidenationalnorms.

Localnormsarepreparedwhennationalnormsforameasureareunavailableorinappropriatetoagroupoftesttakers.Theyrepresentnormative,datacollectedona
groupoftesttakerslikethoseonwhomthemeasurewillbeused.Localnormsareespeciallyusefulwhennationalnormsarelikelytobeinappropriateforagroupof
testtakerswhoselanguageisunlikethatinwhichthetestiswritten.Mostfrequently,thiswouldinvolveindividualswhospeakoneofmanyregionalorsocialdialects
thataresignificantlydifferentfromtheidealizedstandardAmericanEnglishdialect,forexample,speakersofBlackAmericanEnglishorSpanishinfluencedEnglish.
Alternatively,aclinicianmaywanttocollectlocalnormsforspecificclientpopulationsforwhomnormativedataarelacking(e.g.,individualswithhearingimpairment,
mentalretardation,orcerebralpalsy).

RatherthanusingtheAmazingUniversityofVermontTesttocompareperformancesofanumberoftesttakers,youmightusetheAmazingUniversityofVermontTest
todeterminewhetheragroupofincomingstudentshasadequatelylearnedtheinformationincludedintheirorientationmaterials.Inthatcase,theoutcomeofthetest
couldleadtoastudentsbecomingexemptfromanadditionalorientationsessionorbeingrequiredtocompleteit.

Forthattestingpurpose,scoreswouldbeinterpretedinrelationtoabehavioralcriterion,forexample,6of10correct.Wheninterpretedinthatway,thetestcouldbe
describedasacriterionreferencedmeasure.Thelevelofperformancewouldthenbeconsideredacutoff,or,lessfrequently,acuttingscore.Oftenthetermmaster
isusedtorefertoatesttakerwhosescoreexceedsthecutoffscore,andnonmasterisusedtorefertoatesttakerwhosescorefallsbelowthecutoff.Brieflythen,in
contrasttoanormreferencedinterpretation,scoreinterpretationforacriterionreferencedmeasurehingesonknowledgeofthepersonsrawscoreandthecutoff
score.Informationaboutareferenceornormativegroupisnotnecessary.Itisoftenuseful,however,fordevelopersofcriterionreferencedmeasurestostudygroup
performancesasameansofdeterminingareasonablecutoffscoreonethatisempiricallyderivedratherthanbasedonanarbitrarycutoff,forexampleat80%
correct.

Inadditiontodifferencesinthemechanicsofscoreinterpretation,normreferencedversuscriterionreferencedmeasurestendtodifferinthescopeofknowledgebeing
assessedandthespecificmethodusedtochooseitems.Specifically,normreferencedmeasurestendtoaddressalargecontentareawhichissampledbroadly
whereascriterionreferencedmeasurestendtoaddressaquitenarrowlydefinedconceptthatissampledinasexhaustiveamanneraspossible.Fornormreferenced
measures,itemsareselectedsothatthegreatestamountofvariabilityintestscoresisachievedamongtesttakerswhereasforcriterionreferencedmeasures,itemsare
selectedprimarilybecauseofhowwelltheyaddressthetargetedconstruct.Figure2.3showsthestepsinvolvedinthedevelopmentofstandardizednormreferenced
andcriterionreferencedinstruments.
Page34

Atthebeginningofthissection,onlyasinglemeasure,theAmazingUniversityofVermontTest,wasusedtointroducetheconceptsofcriterionandnormreferencing.
Thiswasdoneinordertoemphasizethatmethodofinterpretationisthemostcrucialfeaturedistinguishingnormfromcriterionreferencedmeasures.Practically,
however,becauseofdifferencesinhowitemsareselectedforeachtypeofmeasure,itisverydifficulttodevelopasinglemeasurethatcanequallysupportthesetwo
differentapproachestoscoreinterpretation.

TypesofScores

NormReferencedMeasures

Fornormreferencedmeasures,avarietyoftestscoresisuseful.Becauseofthecentralityofthecomparisonbetweenthetesttakersandthenormativegroups
performances,however,therawscoreisoflittlevalue

Fig.2.3.Stepsinvolvedinthedevelopmentofnormreferencedandcriterionreferencedstandardizedmeasures.
Page35

exceptasthestartingpointforotherscores.Theseotherscoresaretermedderivedscoresbecauseoftheirdependentrelationshiptotherawscore.Threetypesof
derivedscoresdeserveattention:developmentalscores,percentileranks,andstandardscores.Thesearelistedinincreasingorderofboththeirvalueasameansof
representingatesttakersperformanceandtheircomplexityofcalculation.

DevelopmentalscoresaretheleastvaluablederivedscoresbutarestillubiquitousinclinicalandresearchcontextsaparadoxthatIwilladdressshortly.Thetwo
mostcommonlyuseddevelopmentalscoresareageequivalentscoresandgradeequivalentscores.Atesttakersageequivalentscoreisderivedbyidentifying
theagegroupthathasameanscoreclosesttothescorereceivedbytheindividualtesttaker.Forexampleifatesttakersrawscoreof85correspondingthemeanraw
scoreofagroupof3yearolds,theageequivalentscoreassignedtothetesttakerwouldbe3years.Ifthereisnoagegroupthatexactlymatchesthescoreofatest
taker,thenanestimationismadeofhowmanymonthsshouldbeaddedtotheagegroupwhosemeanfallsjustbelowthatofthetesttaker,resultingingradeequivalent
scores,suchas2years,6monthsor5years,11months.Typically,testusersdonothavetoexaminethegroupdatadirectly,butaregiventableslistingrawscoresand
theagescorestowhichtheycorrespond.

Gradeequivalentscoresaresimilarinmanyrespectstoageequivalentscoresbutare,asonewouldguessfromtheirname,derivedfromdataconcerningthemean
performanceofgroupsoftesttakersindifferentgrades.Whenestimationisrequired,gradeequivalentscoresarereportedintenthsofagrade.Thus,fora12yearold
whoachievesascorejustslightlyabovethatofagroupof4thgraders,agradeequivalentof4.1or4.2mightbeassigned.

Inpsychometriccircles,almostneverisakindwordspokenaboutscoresofthistype.Long,derogatorylistsoftheproblemswithdevelopmentalscoresabound(e.g.,
McCauley&Swisher,1984Salvia&Ysseldyke,1995),butthelistsinvariablycenteraroundconcernsthatsuchscoresareeasilymisunderstoodandlikelytobe
unreliable.Table2.5providesanelaborateversionoftheselistsaswellasapointedcommentaryondevelopmentalscores.

Theappealofdevelopmentalscoresistwofold.First,theapparentuniformityofmeaningofsuchscoresacrossdifferenttestsmakesitseemthattheyallowfora
comparisonofskillsindifferentareasandpermitasensitivequantificationofdegreeofimpairment.Thus,whena9yearoldchildissaidtohaveskillsfallingatthe7
yearlevelinmathandthe8yearlevelinreceptivelanguage,itcanbemisinterpretedasindicatingsignificantproblemsinbothareas,withamoresevereimpairmentin
mathematics.Althoughmanyindividualsarequiteawareofthelowesteeminwhichdevelopmentalscoresareheld,theynonethelessfallintomisinterpretationslikethis.
Giventhatageequivalentscoresonlycrudelycomparetwoscoresastheirmeansofnormreferencing,neitherindividualdevelopmentalscoresnorcomparisons
betweenthemnecessarilyconveydegreesofimpairment.Dependingonthetestsused,forexample,itmaybethatagreatmanyverynormallydevelopingchildren
wouldexhibitthesameimpairedscores.

Thesecondappealofdevelopmentalscoresliesoutsidetheinterestsofindividualtestusers.Numerousstateandinsuranceregulationsdemandthatdevelopmental
scoresbeusedtodescribetestperformances,presumablyonthebasisofthemisconceptionscitedearlierthatmeaningfulcomparisonsbetweenskillareascanbe
based
Page36

Table2.5
FiveDrawbackstoDevelopmentalScores,SuchasAgeEquivalent
andGradeEquivalentScores(Anastasi,1982Salvia&Ysseldyke,1995)

Developmentalscoresleadtofrequentmisunderstandingsconcerningthemeaningofscoresfallingbelowachildsageorgrade.Forexample,aparentmay
interpretanageequivalentof5years,10monthsasevidenceofadelayina6yearold.Infact,bydefinition,halfofthosechildreninagivenagegroup(orgrade
1.
level)wouldreceiveageequivalentscoresbelowthechildsage.Thisproblemarisesbecausedevelopmentalscorescontainnoinformationaboutnormalgroup
variability.
Thereisatendencytointerpretdevelopmentalscoresasindicatingthatperformancewassimilartothatofanindividualofcorrespondingageforexample,thata
2. scoreof3years,6monthswouldbeassociatedwithperformancethatwasqualitativelylikethatofa3yearold.Infact,however,itisunlikelythatthenature
andconsistencyoferrorswouldbesimilarfortwoindividualswithsimilardevelopmentalscoresbutdifferingagesorgradelevels.
3. Developmentalscorespromotecomparisonsofchildrenwithotherchildrenofdifferentagesorgradesratherthanwiththeirsameagepeers.
Developmentalscorestendtobeordinalintheirlevelofmeasurement.Therefore,theylackflexibilityinhowtheymaybetreatedmathematicallyandareproneto
4. beingmisunderstood.Forexample,adelayof1yearinafifthgraderwhoreceivesagradeequivalentscoreof4isnotnecessarilycomparabletoadelayof1
yearinaninthgraderwhoreceivesagradeequivalentscoreof8.
5. Developmentalscoresarelessreliablethanothertypesofscores.

onthem.AsIdiscussinthenextsectionofthischapter,suchregulationoftestusersprovidesavividexampleofthenumerouscasesinwhichassessmentmustrespond
toavarietyofforcesoutsideofthedirectclinicalinteractionbetweenclinicianandclient.Typically,testusersfacedwiththedilemmaofhavingtoreportdevelopmental
scoresareadvisedbypsychometricianstoreportthemalongwithmoreusefulderivedscoresinamannerthatminimizesthelikelihoodofmisunderstanding.

Percentileranksareactuallyonevarietyofaclassofderivedscoresthatincludesquartilesanddeciles.Percentileranksrepresentthepercentageofpeoplereceiving
scoresatorbelowagivenrawscore.Thus,apercentilerankof98,or98thpercentile,indicatesthatatesttakerreceivedascorebetterorequaltothoseof98%of
personstakingthetest(usuallythenormativesample).Thistypeofscorehasthedistinctadvantageofbeingreadilyunderstoodbyawiderangeofpersons,including
parentsandsomeolderchildren.

Percentilerankshavetwodisadvantages.Thefirstisthattheyaresometimesmisunderstoodasmeaningpercentageofcorrectresponsesonthetest.Readerscanavoid
thisfalsestepiftheyrememberthatonaverydifficulttest,onecouldperformbetterthanalmostanyone(andthereforehaveahighpercentilerank),butinfacthave
obtainedalowpercentagecorrect.Theseconddisadvantageofpercentileranksisthat,likedevelopmentalscores,theyrepresentanordinalmeasureandthuscannot
becombinedoraveraged.

Standardscoresrepresentthepinnacleofscoringapproachesusedinnormreferencedtesting.Theypreserveinformationaboutthecomparisonbetweenanindividual
andappropriateagegroupandinformationaboutthevariabilityofthenormativegroup.
Page37

Inaddition,theyareattheintervallevelofmeasurementandthuscanbecombinedandaveragedinwaysnotpossiblewiththeothertypesofscoresdiscussedearlier.

Standardscoresarestandardbecausetheoriginaldistributionofrawscoresonwhichtheyarebasedhasbeentransformedtoproduceastandarddistributionhaving
aspecificmeanandstandarddeviation.Becausestandardscoresarenormallydistributed,theycanbeinterpretedintermsofknownpropertiesofthenormal
distribution,especiallyexpectationsconcerninghowexpectedorunexpectedaparticularscoreis.Thismakesstandardscoresafavoredmethodofcommunicatingtest
resultsamongprofessionals.Figure2.4illustratestherelationshipbetweenthenormalcurveandseveralofthemostfrequentlyusedscores:thezscore,deviationIQ
score,andTscores.

Themostbasicstandardscoreisthezscore,whichhasameanof0andastandarddeviationof1.Itiscalculatedbytakingthedifferenceofaparticularrawscore
fromthemeanforthedistributionanddividingtheresultbythestandarddeviationofthedistribution.Eachscoreisrepresentedbythenumberofstandarddeviationsit
fallsfromthemean,withpositivevaluesrepresentingscoresthatwereabovethemeanandnegativevalues,representingthosebelowthemean.Becauseofthe
relationshipbetweenthistypeofscoreandthenormalcurve,itispossibletoknowthatazscore

Fig.2.4.Therelationshipbetweenthenormalcurveandseveralofthemostfrequentlyusedstandardscores,includingthezscore,deviationIQscore,andTscores.
FromAssessmentofchildren(p.17),byJ.M.Sattler,1988,SanDiego,CA:Author.Copyright1988byJ.M.Sattler.Reprintedwithpermission.
Page38

of2falls2standarddeviationsbelowthemeanandthatfewerthan3%ofthenormativepopulationhadascorethatloworlower.

OtherwidelyusedstandardscoresindevelopmentallanguagedisordersarethedeviationIQandtheTscore.Thesescoressharethevirtueofzscoresintheirknown
relationshipstothenormalcurve:ThedeviationIQhasameanof100andastandarddeviationof15.Asanadditionalbenefit,suchscoresaresomewhatlessopento
theconfusionassociatedwithnegativenumbersusedinzscores.However,theirinterpretationremainsquitechallengingforpeoplewhoareunfamiliarwiththeuseof
thenormalcurveinscoreinterpretation.Still,becauseoftheirstrengths,standardscoressuchasthesearefrequentlyusedamongprofessionals,withpercentiles
favoredforusewithotheraudiences.

CriterionReferencedMeasures

Forcriterionreferencedmeasures,rawscoresarethemajortypeofscorebecausebydefinitionsuchmeasuresinvolvethecomparisonofarawscoreagainstagiven
criterionorcuttingscore.Asmentionedpreviously,itispossibleforthecutoffscoretobebasedonempiricalstudyorforittobearbitrarilyestablishedonthebasisof
hypothesesaboutthelevelofperformance,orperformancestandard,requiredforsatisfactoryadvancementtolaterlevelsofskillacquisition(McCauley,1996).

CaseExample

Case2.1illustratesmostoftheconceptsdiscussedinthischapterastheyrelatetoAustin,a5yearoldboywithspecificlanguageimpairment.Thishypotheticalreport
isannotatedtohighlightinstanceswhereameasurementhasbeenmadebytheclinician.Specifically,bothformalandinformalmeasuresareboldedinthiscase.

Case2.1
SpeechLanguageHearingCenter
353LuseStreet
Burlington,VT054050010
Clientsname:AustinG.
Address:(childshomewithmotherandstepfather) DateofEvaluation:2/12/97
284WillowCreekRoad Parentsnames:LeslieG.(mother)
Burlington,VT05401 WarrenG.(stepfather)
GeorgeC.(father)
33ElmStreet
DateofBirth:1/8/92 Savannah,GA31411
EducationStatus:Kindergarten h:(912)9999393
School:WoodwardElementarySchool ReferralSource:Dr.A.B.Park
2StationStreet Studentclinician:E.Miller,B.A.
Burlington,VT05401 Supervisor:R.J.Turner,M.S.,CCCSLP
Dateofreport:2/14/97
Page39

BACKGROUNDINFORMATION
Austin,a5year,1montholdboy,wasseentodayforaspeechandlanguageevaluationfollowingreferralbyhisprimarycarephysician.Dr.A.B.Park.Background
informationwasobtainedusingacasehistoryform,anindepthparentinterviewconductedwithMr.andMrs.G.,whoaccompaniedAustintoday,andaphone
conversationwithMr.C.,Austinsbiologicalfather.
ThereasonsgivenbyMr.andMrs.GfortodaysevaluationweregrowingconcernsregardingAustinsarticulation,overallintelligibility,andexpressivelanguage
skills.Mr.andMrs.GreportthatstrangersandevenotherchildreninAustinsclassfindhimdifficulttounderstandandfrequentlyaskhimtorepeatwhathehassaid.
Heisalsobecomingincreasinglyfrustratedwithfamilymemberswhentheyfailtounderstandhim,resultinginincreasinglyfrequentandescalatingargumentswithhis
oldersister.Elizabeth(age10).Incontrast,theyreportthatheunderstandseverythingthatissaidtohimandisrecognizedasaverybrightchildevenbyadultswho
failtounderstandhim.
AustinandhissisterElizabethlivewithMr.andMrs.Gandseetheirbiologicalfather,Mr.C,onlyatholidaysandfor6weeksinthesummer.Theparentsdivorced
whenAustinwas1yearold,andhecallshisstepfatheraswellashisbiologicalfatherDaddy.AustincurrentlyattendsakindergartenclassintheWoodward
ElementarySchoolBurlington,wherehehasthreeorfourespeciallyclosefriends.AccordingtohisteacherMrs.Smithsreportstohisparents,Austinisahappy
childWhoispopularatleastinpartbecauseofhisenthusiasticmannerandskillatplaygroundathletics.Becauseheissmallforhisage(inthe5thpercentileforheight
andweight)andbecauseofhisimmaturesoundingspeech,heissometimesteasedbychildrenfromolderclassesaboutbeingababy,butisreadilydefendedbyhis
classmatesandappearsunaffectedbysuchtaunts,accordingtoMrs.Smith.ShereferredAustinforaspeechlanguageevaluationbytheschoolspeechlanguage
pathologistinJanuarybecauseofconcernsabouthislanguageproductionandarticulation,butotherwiseshestatesthatheisperformingwellinthekindergarten
classroom.Becausecircumstancespreventedthatevaluationfromtakingplace,Mr.andMrs.GhaddecidedtoseekanevaluationattheLuseCenter.
Austinsbirthandearlyhealthanddevelopmentalhistoryareunremarkableexceptfordelaysintheonsetofspeech,withonlyabout10wordsbyage2andnoword
combinationsuntilage3.Althoughhehadshownadramaticincreaseinthelengthofhisutterancesoverthepast2years,hisparentsreportedthathestillspeaksin
incomplete.sentencesandproducesmanywordsincorrectly.Bothbiologicalparentsreportedasignificanthistoryoffamilymemberswithspeechandlanguage
problems,includingMr.C.,whoreceivedspeechtherapyuntil5thgradeforwhatappearedtohavebeenlanguagerelatedconcerns,twoofAustinspaternaluncles,
onematernalauntintheprecedinggeneration,andtwomaternalcousins.
Page40

LISTOFASSESSMENTTOOLS
Theassessmentproceduresthatwereconductedduringthisevaluationarelistedandreportedintheparagraphsthatfollow.
Hearingscreeningtest
TestofLanguageDevelopment2Primary(Newcomer&Hammill,1991).
ExpressiveOneWordPictureVocabularyTest(Gardner,1990)
PeabodyPictureVocabularyTest3(Dunn&Dunn,1997)
BanksonandBanksonTestofPhonology(Bankson&Bernthal,1990)
OralStructuralMechanismExaminationRevised(St.Louis&Ruscello,1987).

Inaddition,informalprocedureswereusedtoscreenpragmatics,voice,andfluency.Overallresultsofthesetestsandproceduresaredescribedinthefollowing
sections,withmoredetailedinformationaboutsubtestperformanceandspecificerrorsavailableonsummarytestforms(seefile).
Hearing
Austinshearingwasscreenedusingpuretonesthatwerepresentedunderheadphonesat20dBbilaterallyat500,100,2000,and4000Hz.Hepassedthescreening
inbothears.
ReceptiveLanguage
AustinsabilitytounderstandwhatissaidtohimwasassessedusingreceptiveportionoftheTestofLanguageDevelopment2Primary(TOLDP:2)andthe
PeabodyPictureVocabularyTest3(PPVT2).OnthereceptivelanguagesubtestsoftheTOLDP:2,Austinreceivedalisteningquotientof96,which
approximatesapercentilerankof50.OnthePPVT2,hisperformancewasevenbetter.Therawscoreheobtainedwas78,whichcorrespondstoapercentilerank
of75andastandardscoreof110.
ExpressiveLanguage
AustinsabilitytoexpresshimselfwasassessedusingtheTOLDP:2expressiveportionsandtheExpressiveOneWordPictureVocabularyTestRevised,
aswellasinformalmeasuresobtainedfromatranscriptionofaconversationalsampletakenasAustinplayedwithhismother.Austinsformaltestscoreswere
considerablyloweronthesemeasures,inpartbecauseofthedifficultiesassociatedwithhisspeechintelligibility.OnEOWPVTR,Austinreceivedarawscore
Page41

of20,whichcorrespondstothe5thpercentileandastandardscoreof76.Ofhis10errorsonthattest,approximately4wereunambiguouswithrespecttothe
possibleimpactofhisspeechproductiondifficultiesforexample,theyinvolvedtheuseofamoregeneralorassociatedwordthanthetarget,ortheyconsistedof
instanceswhenAustinsaidthathedidnotknowthename.OntheTOLDP:2expressivesubtests,Austinreceivedanoverallspeakingquotientof61,whichfalls
belowthefirstpercentile.Anexaminationofhisutterancesduringaconversationwithhismotherrevealedfrequentomissionofgrammaticalmorphemes,an
absenceofcomplexsentences,andatendencytooverusethewordthingytorefertonumerouselementsofaLegoconstructionthattheybuiltcooperatively.
PhonologyandOralMotorPerformance
TheOralSpeechMechanismExaminationRevised(OSMER)wasusedtoexaminetheadequacyofAustinsoralstructuresforspeechproduction.His
performanceonthatmeasurewaswellwithinthenormalrange,withnosignsofincoordinationorweaknessandnoobservableabnormalitiesofthestructuresusedin
speech.Errorsnotedintheproductionofrepeatedsyllablesmirroredthoseinhisconversationalspeech.
OntheBanksonBernthalTestofPhonology,Austinreceivedawordinventoryscore,whichreflectsthenumberofwordsproducedcorrectly,of39,which
correspondstoaStandardScoreof71andapercentilerankof3.Errorsoccurredprimarilyonmedialorfinalconsonants.Patternsoferrorsthatoccurredmost
frequentlywerefinalconsonantdeletion(omissionofthefinalconsonantintheworde.g.,batbecomesba),clustersimplification(replacementorlessofoneor
moreelementsofaconsonantclustere.g.,clownbecomesclo),andfronting(replacementofavelarconsonantbyamoreforwardconsonante.g.,gun
becomesdun).Effortstoelicitcorrectproductionoftwoconsonantsthathadnotbeenproducedcorrectlyuptothatpoint(viz.,k,g)wereundertakenusinga
phoneticplacementinstructionsandtouchcuesresultedinvelarfricativeapproximations.Othersoundsconsistentlyinerrorwere[s,z,r]and[l].
Whenthelanguagesamplediscussedintheprevioussectionwasexaminedwithregardtospeecherrorsandintelligibility,very,similarerrorpatternswereobserved
andthepercentageofunderstandablewordsoutofallwordsspokenwasdeterminedtobe70%.
ScreeningforOtherLanguageandSpeechProblems
TheconversationalsamplebetweenAustinandhismotherwasalsoexaminedtoscreenforproblemsinpragmatics,voice,andfluency.Austinsuseoflanguage
andhisabilitytodescribetheplotofamoviehehadrecentlyseenwith
Page42

outhismotherappearedappropriateforhisage.Hisvoicequalityandpitchwerenormal.Fluencyalsoappearednormal,althoughfrequentrepetitionsandrewordings
ofsentencesoccurredinresponsetohismothersverbalandnonverblindicationsofhavingdifficultyinunderstandingsomeofhisutterances.AlthoughAustins
awarenessofhiscommunicationdifficultiesisquitesophisticatedinachildofhisage,hisfacialexpressionandmovementsattimessuggestedsignificantfrustration.
Summary
Austinappearstobeabrightandsensitive5yearoldwithnosignificantmedicalhistory,butafamilyhistoryofcommunicationdifficulties.Todaysevaluationreveals
normalhearingandlanguagecomprehension,aswellasgoodconversationalskillsandnormalvoiceandfluency.Austinsdifficultiesinbeingunderstoodaremoderate
tosevereatthistimeandappeartoreflecthisdifficultiesinusingsoundsasexpectedforhisageandinselectingandcombiningwordstocreategrammatically
acceptablesentences.Hisstrongskillsinotherareas,supportbyfamilyandschoolpersonnel,andclearmotivationtoimprovehiscommunicationeffortssuggesta
verypositiveprognosisforchange.
Recommendations
Austinislikelytobenefitfromspeechlanguageinterventionconductedinindividualandgroupsettingathisschool,includinginclassworkconductedbyhisteacherin
consultationwiththeschoolspeechlanguagepathologist.Areastobetargetedincludephonology,expressivevocabulary,andsyntax.Specificgoalsshouldaddress
(a)thephonologicalprocessesoffinalconsonantdeletionandfronting,(b)expressivevocabularyrelatedtoschoolactivities,(c)theuseofgrammaticalmorphemes
thatarenotcurrentlyusedbutshouldbepronounceablegivenhiscurrentphonologicalsystem,and(d)thedevelopmentofstrategiesfordealinginamorerelaxedway
withlistenersdifficultiesinunderstandingAustinsspeech.
ItwasapleasuretomeetAustinandhisfamilytodayandtohavetalkedpreviouslytoothersinvolvedinhiseducationandupbringing.Weurgeyoutocallwithany
questionsyoumighthaveaboutthisreportorAustinsongoingdevelopment.
Sincerely,

E.Miller,B.A.R.J.Turner,M.S.,CCCSLP
StudentclinicianSupervisor

Page43

Summary

1.Measurementisusuallyindirect,meaningthatitinvolvesthemeasurementofcharacteristics,sometimescalledindicators,thatarecloselyrelatedtobutdifferentfrom
thecharacteristicbeingdescribedbytheprocessofmeasurement.

2.Theuseoftheoreticalconstructs,whichareexaminedusingvariousindicators,underliesclinicalaswellasresearchmeasurement.

3.Fourlevelsofmeasurement,firstproposedbyS.S.Stevens(1951),arenominal,ordinal,interval,andratio.Theselevelscorrespondtodifferentmethodsof
assigningmeasurementstocharacteristics,whichhaveimplicationsforthemeasurementsappropriateinterpretationandstatisticalstudy.

4.Measuresatthenominallevel,suchasdiagnosticlabelsorlabelsoferrortype,involvetheassignmentofmeasuredindividualperformancesorbehaviorstomutually
exclusivecategories.Measurementsattheordinallevels,suchasseveritylabels,alsousemutuallyexclusivecategories,butonesthatcanbeorderedasdemonstrating
moreorlessofthemeasuredcharacteristic.

5.Measuresattheintervallevel,suchastestscoresreportedinraworstandardscores,involvetheassignmentofnumberedvaluestocharacteristics.Thisisthehighest
levelofmeasurementusuallyattainedinthebehavioralsciences.

6.Oftenatheoreticalconstructcanbemeasuredusingindicatorsfallingatvariouslevelsofmeasurement.

7.Statisticsareusefulforgainingandsummarizinginformationaboutgroupsofmeasurements,calleddistributions,aswellasfortestinghypothesesaboutthe
relationshipsbetweendistributionsorbetweenanindividualscoreandadistribution.

8.Twotypesofstatisticsusedinsummarizingdistributionsofmeasurementsaremeasuresofcentraltendency(e.g.,mean,median,mode)andmeasuresofvariability
(e.g.,standarddeviation,variance,range).Centraltendencyreferstothemosttypicalvaluesinadistribution,whereasvariabilityreferstothetendencyofvaluesinthe
distributiontodifferfromoneanother.

9.Inthemeasurementliterature,correlationcoefficientsaretheonesmostusedtodescribetherelationshipbetweengroupsofmeasures,withthePearsonproduct
momentcorrelationcoefficientachievingthegreatestuse.Correlationreferstothetendencyforvaluesofonedistributiontobesystematicallyrelatedtovaluesof
anotherdistribution.

10.Causalinferencescannotbemadedirectlyfromobservationsofcorrelations:IfvariablesAandBarerelated,itmaybecauseAcausedB,BcausedA,orthatboth
arecausedbyathirdvariableorsetofvariables.

11.Normreferencedmeasuresareinterpretedthroughthecomparisonofapersonsperformancetothoseofarelevantnormativegroupusuallyusingaderived
scorethatincorporatesinformationrelevanttothecomparison.Criterionreferencedmeasuresareinterpretedthroughthecomparisonofapersonsperformancetoa
performancestandardusuallyusingarawscore.
Page44

12.Derivedscoresconsistofdevelopmentalscores(ageandgradeequivalentscores),percentileranks,andstandardscores(e.g.,zscores,Tscores,deviationIQ
scores).Percentileranksareprobablythemostwidelyusedamonglaypersons,whereasstandardscoresarepreferredbymostprofessionals.Althoughwidelyused,
developmentalscoresaretheleastrespectedtypeofscoreamongprofessionalsbecausetheyencouragemisunderstandingandarelessreliablethanotherderived
scores.

KeyConceptsandTerms

abilitytesting:asystematicprocedureforexploringlearningpotential.

achievementtesting:asystematicprocedureforexaminingpastlearning.

ageequivalentscore:aderivedscorecorrespondingtotheagegroupwiththemeanscorethatisclosesttotherawscorereceivedbytheindividualtesttaker.

behavioralobjectives:adescriptionoftreatmentgoalsintermsofclientbehaviors.

clinicalsignificance:thelikelyvalueofaparticularresearchfindingonthebasisofthereliabilityofthefinding(i.e.,itsstatisticalsignificance)anditsmagnitude.

computerizedtests:teststhatinvolvetheuseofcomputerdisplay,keyboardedresponses,orboth.

correlation:thedegreeofrelationshipexistingbetweentwoormorevariables.

criterionreferencedmeasure:ameasureinwhichscoresareinterpretedinrelationtoaparticularbehavioralcriterioncontrastswithnormreferencedmeasure.

developmentalscores:atypeofderivedscoreinwhichdevelopmentistakenintoaccount,forexample,ageequivalentandgradeequivalentscores.

distribution:agroupofscores,eithertheoreticalorobserved.

formativeindicators:indicatorsthatareassociatedwithacauseofaconstructthatisofinterest.

gradeequivalentscores:aderivedscorecorrespondingtothegradespecifiedgroupwiththemeanscorethatisclosesttotherawscorereceivedbytheindividual
testtaker.

indicator:anindirectobjectofmeasurementsomethingonemeasuresinplaceofthecharacteristiconeisreallyinterestedinbecauseitisbothrelatedtotheactual
focusofinterestandismoreaccessibletomeasurement.

intervallevelofmeasurement:alevelofmeasurementusingmutuallyexclusivecategoriesinwhichscoresreflectarankorderingofthecharacteristicbeingmeasured
andthedifferencebetweenadjacentscoresisequalinsizeforexample,scoresonabehavioralprobe.

localnorms:summariesoftheperformanceofarelevantgroupofindividualsthatareobtained,oftenwhennationalnormsareunavailable,forpurposesofmakinga
specificcomparisonbetweenanindividualtesttakersperformanceandthoseofthatgroup.
Page45

mean:adistributionsarithmeticaverage.

median:themiddlescoreofadistribution.

mode:themostfrequentlyoccurringscore(s)ofadistribution.

nationalnorms:summariesofthetestperformancesofalargegroupofindividualsagainstwhichapersonsperformancecanbecomparedusuallyconsistingof
individualswithknowndemographiccharacteristics.

nominallevelofmeasurement:alevelofmeasurementinwhichcharacteristicsofanindividualareassignedtomutuallyexclusivecategories(e.g.,boysandgirls).

nonparametricstatistics:statisticsthatdonotrequireassumptionsaboutthenatureoftheunderlyingdistributionfromwhichobservationsaredrawn.

normaldistribution:atheoreticaldistributionofscoresorsetofscoreswithknownmathematicalproperties.

normativegroup:agroupwhoseperformanceisusedinthecomparisonandinterpretationofanindividualsscoreinnormreferencedscoreinterpretation.

normreferencedmeasure:ameasureinwhichscoresareinterpretedinrelationtotheperformanceofanormativegroupcontrastswithcriterionreferenced.

norms:dataconcerningthedistributionofscoresachievedbyanormativegroup.

operationaldefinition:definingavariablethroughtheoperationsusedtomeasureit.

ordinallevelofmeasurement:alevelofmeasurementusingmutuallyexclusivecategoriesthatreflectarankorderingofthecharacteristicbeingmeasured.

paperandpenciltests:conventionaltestinginwhichprintedtestmaterialsarecompletedindependentlybyliteratetesttakers.

parametricstatistics:statisticsthatrequirecertainassumptionsaboutthenatureoftheunderlyingdistributionfromwhichobservationsaredrawn.

percentileranks(percentiles):derivedscoresrepresentingthepercentageofindividualsperformingatorbelowagivenrawscore.

performancestandard:acriterionagainstwhichanindividualsperformancecanbecomparedincriterionreferencedscoreinterpretation.

performancetests:teststoassessskillsinvolvingthemanipulationofobjectsorthatotherwisearedifficultorimpossibletoassessusingpaperandpenciltests.

range:onemethodofdescribingthevariabilityofadistributionthedifferencebetweenthehighestandlowestscoresinthedistribution.

ratiolevelofmeasurement:alevelofmeasurementusingmutuallyexclusivecategories(scores)inwhichthescoresreflectarankorderingofthecharacteristicbeing
measured,thedifferencebetweenadjacentscoresisequalinsize,andthereisarealzeroalongthescaleforexample,thetimeelapsingbetweenpresentationofa
pictureandnameproduction.

reflectiveindicators:indicatorsthatareassociatedwiththeeffectsofaconstructthatisofinterest.
Page46

standarddeviation:amethodofdescribingthevariabilityofadistributionofscoresthesquarerootofthevariance.

standardscores:derivedscoresinwhichatransformationhasbeenusedtoassureapredeterminedmeanandstandarddeviation,forexample,ameanof100and
standarddeviationof15.

statisticalsignificance:statisticalevidencethatanobtainedvaluewasunlikelytohaveoccurredbychance.

theoreticalconstruct:aconceptusedinaspecificwaywithinaparticularsystemofrelatedconcepts.

theory:asystemofrelatedconcepts,usuallyusedtoexplainavarietyofrelateddataconcerningaphenomenonofinterest.

variables:measurablecharacteristicsthatdifferunderdifferentcircumstances.

variance:amethodofdescribingthevariabilityofadistributionitconsistsofthemeanofthesquareddistancesofscoresfromthedistributionmean

StudyQuestionsandQuestionstoExpandYourThinking

1.Imaginethatyouareinterestedinmeasuringtheabilityofachildtounderstandthenamesofcolorsusuallyknownbychildrenofhisorherage.Thinkoffourdifferent
indicatorsfortheconstructofcolornamecomprehensiontwothatarereflectiveandtwothatareformative.

2.Proposeanindicatorofspellingproficiencyfallingateachofthefirstthreelevelsofmeasurement:nominal,ordinal,andinterval.

3.SupposethatameasurementtooloffersyoutwodifferentnormativegroupsagainstwhichtocomparetheperformanceofachildwhospeaksKoreanasafirst
languageandEnglishasasecondonegroupconsistingofchildrenofsimilarageswithsimilarlanguagehistoriestothechildtobetestedandoneofchildrenofsimilar
ageswithEnglishastheironlylanguage.Whatwouldeachcomparisontellyouaboutthechild?

4.Foreachofthefollowingmeasurementpurposes,explainwhichtypeofscoreinterpretationwouldbemostsuitablenormorcriterionreferencing:

a. identifyingthepoorestperformanceonaclassroomtest
b. competencytestingforgraduationfromhighschool
c. testingforlicensureinaprofession,suchasspeechlanguagepathology
d. nationaltestingforscholasticaptitude(e.g.,SATsorGREs)
e. determiningsuccessoftreatmentaimedatimprovingastudentscorrectuseofselectedverbforms

5.Findanewspaperarticleinwhichabehavioralmeasureisdescribed.Whatconstructappearstobemeasured?Atwhatlevelisthatmeasurementconducted?What
measuresofcentraltendencyandvariabilitywouldbeappropriateforthismeasure?
Page47

6.Findanewspaperarticleinwhichtherelationshipbetweentwovariablesisdescribed.Isacausalrelationshipbetweenthesevariablesimplied?Doesthat
interpretationseemwarrantedorcanyouimagineadifferentcausalrelationshipbetweenthevariables?Describeit.

7.Onthebasisofyourpersonalobservation,describetwovariablesyoubelievehaveapositivecorrelationwithoneanother,thentwothathaveanegativecorrelation.

8.A3yearoldchildreceivesatestscoreonanormreferencedtestthatfallsatthe35thpercentileandyieldsanageequivalentscoreof2years,8months.Explain
themeaningofthosescoresasifyouweretalkingtoaveryworriedparent.

9.Theparentofahighachieving10yearoldgirltellsyouthatherdaughterhasbeentestedbyaneighborwhoisstudyingpsychologyandachievedastandardscore
of100onanintelligencetest.Shewondersifthatdoesntmeanthatherchildsperfectscoresuggeststhatsheisageniuswhoshouldskipseveralgrades.Whatwould
youtellheraboutherchildsperformance?(Thisistricky.Considerboththefactthatyoudidntobtainthisinformationdirectlyaswellasthemeaningofstandard
scores.)

10.Pretendthatyouhavedevisedatesttodeterminestudentsmasteryofthecontentcoveredinthischapter.Howmightyoudetermineanappropriatecuttingscore?
(No,theanswertothisisnotinthebookuptothispoint.Thinkcreatively).

RecommendedReadings

Gould,S.J.(1981).Themismeasureofman.NewYork:Norton.

Sattler,J.M.(1988).Assessmentofchildren(3rded.).SanDiego:Author.

References

Allen,M.J.,&Yen,W.M.(1979).Introductiontomeasurementtheory.Monterey,CA:Brooks/ColePublishing.

AmericanPsychologicalAssociation,AmericanEducationalResearchAssociation,&NationalCouncilonMeasurementinEducation.(1985).Standardsfor
educationalandpsychologicaltesting.Washington,DC:AmericanPsychologicalAssociation.

Anatasi,A.(1982).Psychologicaltesting(5thed.).NewYork:Macmillan.

Badian,N.(1993).Phonemicawareness,namingandvisualsymbolprocessingandreading.ReadingandWriting,5,87100.

Bankson,N.W.,&Bernthal,J.E.(1990).BanksonBernthalTestofPhonology.Chicago:Riverside.

Bernthal,J.E.,&Bankson,N.W.(1998).Articulationandphonologicaldisorders(4thed.).EnglewoodCliffs,NJ:PrenticeHall.

Bradley,L.,&Bryant,P.(1983).Categorizingsoundsandlearningtoread:Acausalconnection.Nature,301,419421.

Bridgman,P.W.(1927).Thelogicofmodernphysics.NewYork:Macmillan.

Bunderson,C.V.,Inouye,D.K.&Olsen,J.B.(1989).Thefourgenerationsofcomputerizededucationalmeasurement.InR.L.Linn(Ed.),Educational
measurement(3rded.,pp.409429).NewYork:NationalCouncilonMeasurementinEducationandAmericanCouncilonEducation.

Chial,M.R.(1988).Utilityinferentialstatistics.InD.Yoder&R.D.Kent(Eds.),Decisionmakinginspeechlanguagepathology(pp.198201).Toronto:B.C.
Decker.

Conover,W.M.(1998).Practicalnonparametricstatistics(3rded.).NewYork:Wiley.
Page48

Culatta,B.,Page.,J.L.,&Ellis,J.(1983).Storyretellingasacommunicativeperformancescreeningtool.Language,Speech,andHearingServicesinSchools,14,
6674.

Francis,D.J.,Fletcher,J.M.,Shaywitz,B.A.,Shaywitz,S.E.,&Rourke,B.P.(1996).Defininglearningandlanguagedisabilities:Conceptualandpsychometric
issueswiththeuseofIQtests.Language,Speech,andHearingServicesinSchools,27,132143.

Freedman,D.,Pisani,R.,&Purves,R.(1998).Statistics(3rded).NewYork:Norton.

Gardner,M.F.(1990).ExpressiveOneWordPictureVocabularyTestRevised.Novato,CA:AcademicTherapy.

Gibbons,J.D.(1993).Nonparametricstatistics:Anintroduction.NewburyPark,CA:Sage.

Gould,S.J.(1981).Themismeasureofman.NewYork:Norton.

Gronlund,N.(1982).Constructingachievementtests(3rded.).EnglewoodCliffs,NJ:PrenticeHall.

Kerlinger,F.N.(1973).Foundationsofbehavioralresearch.(2nded.)NewYork:Holt,Rinehart&Winston.

Lahey,M.(1988).Languagedisordersandlanguagedevelopment.NewYork:Macmillan.

McCauley,R.J.(1996).Familiarstrangers:Criterionreferencedmeasuresincommunicationdisorders.Language,Speech,andHearingServicesinSchools,27,
122131.

McCauley,R.J.,&Swisher,L.(1984).Useandmisuseofnormreferencedtestsinclinicalassessment:Ahypotheticalcase.JournalofSpeechandHearing
Disorders,49,338348.

McClave,J.T.(1995).Afirstcourseinstatistics(5thed.).EnglewoodCliffs,NJ:PrenticeHall.

Newcomer,P.L.,&Hammill,D.D.(1991).TestofLangugeDeveloment2Primary.Austin,TX:ProEd.

Pedhazur,R.J.,&Schmelkin,L.P.(1991).Measurement,design,andanalysis:Anintegratedapproach.Hillsdale,NJ:LawrenceErlbaumAssociates.

Salvia,J.,&Ysseldyke,J.E.(1995).Assessment(6thed.).Boston:HoughtonMifflin.

Sattler,J.M.(1988).Assessmentofchildren(3rded.).SanDiego,CA:Author.

St.Louis,K.O.&Ruscello,D.(1987).OralSpeechMechanismScreeningExaminationRevised.Baltimore:UniversityParkPress.

Stevens,S.S.(1951).Mathematics,measurement,andpsychophysics.InS.S.Stevens(Ed.),Handbookofexperimentalpsychology(pp.149).NewYork:
Wiley.

Wechsler,D.(1974).ManualfortheWechslerIntelligenceScaleforChildrenRevised.SanAntonio:ThePsychologicalCorporation.

Wiig,E.S.,Jones,S.S.,&Wiig,E.D.(1996).Computerbasedassessmentofwordknowledgeinteenswithlearningdisabilities.Language,Speech,andHearing
ServicesinSchools,27,2128.

Williams,F.(1979).Reasoningwithstatistics(2nded.).NewYork:Holt,Rinehart&Winston.

Young,M.A.(1993).Supplementingtestsofstatisticalsignificance:Variationaccountedfor.JournalofSpeechandHearingResearch,36,644656.
Page49

CHAPTER
3

ValidityandReliability

HistoricalBackground

Validity

Reliability

HistoricalBackground

ThehistoricrootsofbehavioralmeasurementcanbetracedtotestsusedinthethirdcenturyB.C.bytheChinesemilitaryforthepurposeofidentifyingofficersworthy
ofpromotion(Nitko,1983).Despitesuchearlybeginnings,however,widespreadinterestinmeasurementforpurposessuchashelpingchildrenhasfarmorerecent
origins,beginningatthecloseofthe19thcentury.Notsurprisingly,therefore,therearemanythreadsofthoughtleadingtothediversityofinstrumentsandprocedures
nowbeingusedtodescribeandmakedecisionsaboutpeople.

Duringthe20thcentury,perspectivesonhowtodevelopandusemeasuressuchasthoseusedtohelpchildrenwithdevelopmentallanguagedisordershavecomefrom
education,psychology,andmostrecentlyspeechlanguagepathology.Overthisrelativelybriefperiodoftime,professionalandacademicorganizationsinthese
fieldshavetakenontheresponsibilityofdevelopingstandardsoftestdevelopmentanduse.Theseeffortshaveprimarilyfocusedontests,wheretestisdefinedasa
behavioralmeasureinwhichastructuredsampleofbehaviorisobtainedunderconditionsinwhichthetestedindividualisexpected(oratleasthasbeeninstructed)to
dohisor
Page50

herbest1(APA,AERA,&NCME,1985).Despiteafocusontestsinthisnarrowsense,suchstandardshavealwaysbeenmeanttoapplytoallbehavioral
measuresalthoughtheyapplytoagreaterorlesserextentdependingonthespecificcharacteristicsofthemeasure.

MostnotableamongeffortstoprovideguidancetotestdevelopersandusershavebeenthoseoftheAPA,AERA,andNCME.In1966,aftertwoearliersetsof
testingstandards(APA,1954NationalEducationAssociation,1955),thethreeorganizationsworkedtogethertocreateasingledocument,Standardsfor
EducationalandPsychologicalTestsandManuals,whichhasgonethroughtworevisions.ThemostrecentrevisionwasrenamedStandardsforEducationaland
PsychologicalTesting(AERA,APA,&NCME,1985).

Thefrequentrevisionofthesestandardsreflectsthebriskpaceofresearchandongoingdiscussionaboutbehavioralmeasurement.Oneparticularlyimportanttransition
occurringwithinthepasttwodecadesisreflectedinthechangeoftitlefromStandardsforTeststoStandardsforTesting.Thischangeemphasizesthecentrality
ofthetestuserinmeasurementquality.Earliereditionsfocusedonwaysinwhichtestdeveloperscoulddemonstratethequalityoftheirinstruments.Farlessattention
waspaidtoissuesrelatedtoactualtestadministrationandinterpretation.Infact,whereas75%ofthe1974versionrelatedtoteststandards,only25%ofitrelatedto
standardsoftestuse.Inthemostrecentversion,therehasbeenalmostareversalinthosepercentages:about60%relatestotestuseversus40%toteststandards.
Thisshiftisconsistentwiththemostinfluentialworkconductedinthelastdecadeinwhichtestusersareaskedtoconsidernotsimplythetechnicaladequacyof
methodsusedtoderivespecifictestscores,butalsotheimpacttheirdecisionswillhave(Messick,1989).Notsurprisingly,thetermethicshascroppedupfrequentlyin
thecourseofthesediscussions.Itwillsurfacefrequentlyinthistextaswell.

Beginningwiththischapter,IhopethatreaderswilladoptaperspectivesimilartothatsetbytheAPA,AERA,andNCME(1985).Specifically,Ihopethatyouwill
considermeasurementqualityindevelopmentallanguagedisordersasaarenainwhichmanyelementscomeintoplay,butinwhichyouaretheliontamer,theperson
whoremainsexpertlyinchargeofapotentiallydangeroussituation.Inthischapterandtheonethatfollowsit,Ifocusonhowbesttoselectappropriatemeasuresonce
youhaveafairlyspecificapplicationinmind.ChaptersinPartIIfocusonthosespecificapplicationscommonlyfacedbyclinicianswhoworkwithchildrenwhohave
developmentallanguagedisorders.Thosechapterswillfigureprominentlyinhelpingyoulearntotailoryourmeasurementstothespecificpurposesyouhaveinminda
keylessonforthoseinterestedinprovidingtheirclientswiththebestpossiblecare.

Theremainderofthischapterisintendedtointroduceyoutovalidityandreliability,twoconceptsthatinvariablydominatediscussionsofmeasurementquality.Validity
isbyfarthemostcentralofthetwoterms.Itevenmightbesaidthatanydiscussionofmeasurementqualityisautomaticallyadiscussionofvalidity.Reliabilityisof

1Thisassumptionisprobablynotwellfoundedformanychildrenwithlanguagedisorders,whomaybeunabletounderstandwhatitmeanstodoonesbestorwho
maybeunwillingtodoit.Ireturntothisissueatnumerouspointsthroughoutthisbook.
Page51

lesserimportancebutisstillvital.Itssecondaryplacederivesfromitsroleasprerequisitefor,butnotsoledeterminantof,validity.

Validity

Validitycanbedefinedastheextenttowhichameasuremeasureswhatitisbeingusedtomeasure.So,youmightask,whatsallofthefussabout?Despiteits
seemingsimplicity,however,theconceptofvalidityhasanumberofsubtlenuancesthatcanbedifficulttograspforeventhemostseasonedusersofbehavioral
measures.Severalmisconceptionsareevidentwhenatestuserordevelopersayssweepinglythatagiventestisavalidtest.First,thiskindofstatementabouta
measuresuggeststhatitsomehowpossessesvalidity,independentofitsuseforaparticularpurpose.Second,itsuggeststhatvalidityisanallornothingproposition.
Bothofthosesuggestionsareuntrue,however.Whatcansafelybesaidaboutagivenmeasureisthatitseemstohaveacertainlevelofvaliditytoansweraspecific
questionregardingaspecificindividual.However,evenreachingthatlessthandefinitivesoundingconclusionrequiresconsiderableworkonthepartoftheclinician.

Toexplorethegeneralconceptofvalidityalittlemorefully,consideraspecific,widelyusedmeasurethePeabodyPictureVocabularyTestIII(Dunn&Dunn,
1997).Thatmeasurewasdevelopedforthepurposeofexaminingreceptivevocabularyinawidevarietyofindividualsusingataskinwhichasinglewordisspokenby
thetestgiverandthetesttakerpointstoonepicture(fromasetoffour)towhichthewordcorresponds.Despitetheexceptionallydetaileddevelopmentundergoneby
thePPVTIII,itisnonethelessquiteeasytoimaginesituationsinwhichitsusecouldleadtohighlyinvalidconclusionsand,thus,forwhichitsvaliditycouldbe
questioned.Forexample,usingthePPVTIIItoreachconclusionsaboutatesttakersartistictalentoraboutthevocabularyofsomeonewhodoesnotspeakEnglish
representgrossexamplesofhowmisapplicationunderminesvalidity.

OnecanalsoimagineorsimplyobservelessobviousyetsimilarlyproblematicapplicationsofthePPVTIII.Forexample,thePPVTIIImightbeusedtodraw
conclusionsaboutoverallreceptivelanguage,ratherthanreceptivevocabularyonly.Itmightalsobeusedtoexaminethereceptivevocabularyskillsofanindividualor
grouplackingmuchpreviousexposuretomanyvocabularyitemspicturedintheexam.Ineachofthesecases,thevalidityofthetestsusewouldbeadverselyaffected,
althoughprobablynottothedegreeofthefirst,extremeexamples.Thus,theselatterexamplesillustratethecontinuousnatureofvaliditybyshowingthatameasurecan
belessvalidthanifitwereusedappropriately,butmorevalidthanifwildlymisused.Theselasttwoexamplesarealsopoignantbecausetheyarentjusthypothetical
examples,butactualonesthatreadilyoccurifaclinicianiscarelessornaiveabouttheconceptofvalidity.

Asanotherwayofthinkingabouttheseproblemsinvalidity,considertwoquestions:(a)Issomethingotherthantheintendedconstructactuallybeingmeasuredbythe
indicator(thetest)?and(b)Doestheindicatorreflectitstargetconstructinsuchalimitedwaythatmuchofthemeaningoftheconstructislost?Affirmativeanswersto
eitherorbothofthosequestionschipawayatthevalueoftheindicatorasameans
Page52

ofmeasuringtheintendedconstructand,bydefinition,chipawayatthemeasuresvalidity.Thus,whenthePPVTIIIisusedasameasureofreceptivelanguageasa
whole,theconstructofreceptivelanguageisgreatlyimpoverished,henceonecanconcludethatreducedvalidityisastrongrisk.Ontheotherhand,itmaybeusedto
measurevocabularyskillsinindividualswhohavenothadmuchexposuretothevocabulary.Thenitmaybecomeameasureofexposuretothevocabularyrather
learningofthevocabulary,thusreducingthemeasuresvaliditybecausethetestwouldnotbemeasuringwhatitwassupposedtomeasure.

Giventhecontinuousnatureofvalidityandtheconsiderablespecificitywithwhichitmustbedemonstrated,howdoesoneascertainthatameasureisvalidenoughto
warrantuseforaparticularpurpose?InthenextsectionIoutlinemethodsthatareusedbytestdevelopersandotherresearcherstoprovidesupportofageneral
naturethatis,suggestingbroadparametersassociatedwithitsusefulapplication.Methodsusedbytestuserstoevaluatethatsupportintermsofaspecificapplication
aredescribedinthenextchapter.

WaysofExaminingValidity

Themethodsusedtodemonstratethatameasureislikelytoprovevalidforageneralpurpose(suchasidentifyingaproblemareaormonitoringlearning)havegrownin
numberandsophisticationovertheyears.Althoughthemethodsarehighlyinterrelated,theyarenonethelesscharacterizedasfallingintothreecategories:construct
validation,contentvalidation,andcriterionrelatedvalidation.Thesethreecategoriesareorderedbeginningwiththemostimportant.

ConstructValidation

Constructvalidationreferstotheaccumulationofevidenceshowingthatameasurerelatesinpredictedwaystotheconstructitisbeingusedtomeasurethatis,to
showthatitisaneffectiveindicatorofthatconstruct.Awidevarietyofevidencefallsintothiscategory,includingevidencethatisdescribedascontentorcriterion
relatedinthesectionsthatfollow.Ifthatseemsconfusingtoyouatfirst,youarenotalonethetheoreticalcentralityofconstructvalidityhasonlyrecentlybeen
recognized.Untilthattime,validitywasusuallyconveyedascomposedofthreepartsratherthanasaunity.

Figure3.1portraystherelationshipbetweenthethreetypesofvalidityevidence.Italsoconveysthetwomeaningsofconstructvalidity(a)asacovertermforall
typesofvalidityevidenceand(b)asatermusedtorefertoseveralmethodsofvalidationthatarenotseenasfittingundereithercontentorcriterionrelatedvalidation
techniques.

Theunderlyingsimilarityofmethodsuniquelydefinedasdemonstratingconstructvaliditycanperhapsbestbeseenthroughadiscussionoftheearlieststagesin
measurementdevelopment.Whenapproachingthedevelopmentofabehavioralmeasure,thedeveloperconsidershowtheconstructtobemeasured(suchasreceptive
vocabulary)isrelatedtootherbehavioralconstructsandeventsintheworld(suchasage,gender,otherabilities).Alsoconsideredatthisstagearepossibleindicators
(suchaspointingatnamedpicturesoractingoutnamedactions)thatmightreasonablybeused
Page53

Fig.3.1.Agraphicanalogyillustratingthedifferentkindsofevidenceofvalidity.

toobtaininformationabouttheconstructandtherebyserveasthebasisforthemeasure.

Forexample,inthecaseofreceptivevocabularyasapossibleconstruct,thetestdeveloperbeginswithascientificknowledgebasethatsupportsexpectationsabout
howreceptivevocabularyisaffectedbyphenomenasuchageandgender.Thatknowledgebasealsogeneratesexpectationsabouthowtheconstructisrelatedtoother
behavioralconstructssuchasexpressivelanguagedevelopmentandhearingability.Fromthisknowledgebase,thedeveloperformulatespredictionsabouthowavalid
indicator,ormeasure,willbeaffectedbysuchphenomenaandhowsuchavalidindicatorwillberelatedtootherconstructs.Evidencesuggestingthatthemeasureacts
aspredictedsupportsclaimsofconstructvalidity.Fourspecificmethodsofconstructvalidationarediscussedinupcomingparagraphsdevelopmentalstudies,
contrastinggroupstudies,factoranalyticstudies,andconvergentdiscriminantvalidationstudies.

Formanymeasuresusedwithchildren,twokindsofstudiesarefrequentlyusedtoprovideevidenceofconstructvaliditydevelopmentalstudies(sometimescalledage
differentiationstudies)andstudiesinwhichgroupswhoarebelievedtodifferinrelationtotheconstructarecontrastedwithoneanother(sometimescalledgroup
differentiationstudies).Table3.1providesanexampleofthedescriptionprovidedforeachofthesetypesofstudy.Thespecificexamplesusedherearenotconsidered
tobethemostthoroughnorthemostsophisticatedpossibleexamples.Insteadtheyaremeanttohelpyouanticipatethewaysuchstudiesaredescribedintestmanuals.

Thedevelopmentalmethodofconstructvalidationisbasedonthegeneralexpectationthatlanguageandmanyrelatedskillsofinterestincreasewithage.The
Page54

Table3.1
ExamplesofTestManualDescriptionsofTwoTypesofConstructValidationStudies

Typeofstudy Description

CorrelationalmethodswereusedtodetermineifperformanceontheTWF[TestofWordFinding]changeswithage.UsingthePearson
productmomentcorrelationprocedure,TWFaccuracyscores(scalescoresgeneratedfromtheRaschanalyses)werecorrelatedwiththe
chronologicalageofthe1,200normalsubjectsinthestandardizationsample.Allcoefficientswerestatisticallysignificantandofasufficient
magnitudetosupporttheconstructvalidityoftheTWFasameasureofexpressivelanguageforbothboysandgirlsandofchildrenof
Developmentalstudies
differentethnicandracialbackground.
Comparisonofaccuracyscoresateachgradelevelalsoreflecteddevelopmentaltrendsastheaccuracyscoresofthenormalsubjectsinthe
standardizationsampleincreasedacrossgrades.Thesefindings,whichsupportgradedifferentiationbytheTWFforallbutonegrade,are
afurtherindicationofdevelopmentaltrendsintestperformancesontheTWF.(German,1986,p.5)
InordertotestthecapacityoftheTELD[TestofEarlyLanguageDevelopment]todistinguishbetweengroupsknowntodifferin
communicationability,weadministeredtheTELDtoseventeenchildrenwhowerediagnosedascommunicationdisorderedcases.No
childrenwithapparenthearinglosseswereincludedinthegroup.Eightypercentofthechildrenwerewhitemalestheyrangedinagefrom
threetosixandahalf.Insocioeconomicstatus,sixtyfourpercentweremiddleclassorabove.AllofthechildrenattendedschoolinDallas,
Contrastinggroup
Texas.
studies
ThemeanLanguageQuotient(LQ)derivedfromtheTELDforthisgroupwas76.SincetheTELDisbuilttoconformtoadistributionthat
hasameanof100andastandarddeviationof15,itisapparentthattheobserved76LQrepresentsaconsiderabledeparturefrom
expectancy.Itisadiscrepancythatapproachestwostandarddeviationsfromnormal.Thesefindingsweretakenasevidencesupportingthe
TELDsconstructvalidity.(Hresko,Reid,&Hammill,1981,p.15)

hypothesistestedinthistypeofvalidationstudyisthatperformanceonthemeasurebeingstudiedwillimprovewithage.Asyouprobablyrecallfrompreviouscourse
work,developmentalstudiesofthiskindcantakeacoupleofdifferentformsone(calledalongitudinalstudy)comparestheperformancesofasinglegroupof
childrenacrosstime,andasecond(calledacrosssectionaldesign)comparestheperformancesofseveralgroupsofchildren,eachgroupfallingatadifferentage.
Crosssectionalstudiesareparticularlypopularamongtestdevelopers,undoubtedlybecausethedataneededtotestthehypothesisarethesameasthoseneededto
providenorms.

Asecondmajortypeofconstructvalidationstudy,whichcanbecalledthecontrastinggroupsmethodofconstructvalidation,teststhehypothesisthattwoor
moregroupsofchildrenwilldiffersignificantlyintheirperformanceonthetargetedmeasure.Again,considerreceptivevocabularyastheexample.Obviously
developingatestofreceptivevocabularyforusewithchildrenonlymakessenseifyoubelievethattherearesomechildrenwhoseperformancefallssofarbelowthatof
peersasto
Page55

havesignificantnegativeconsequences.Forthistypeofmeasure,onemightevaluateconstructvaliditybyfindinggroupsofchildrenwhoarethoughttodifferintheir
receptivevocabularyknowledge(e.g.,childrenwithadevelopmentallanguagedisordervs.childrenwithoutsuchadisorder).Inthistypeofstudy,ifthemeasureisa
validreflectionoftheconstruct,childrenwhohavebeenidentifiedasdifferinginrelationtotheconstructshouldalsodifferintheirperformanceonthemeasure.See
Table3.1foranexampleofavalidationstudyofthistype.

Athirdcategoryofconstructvaliditystudyisidentifiedthroughtheuseofaspecificstatisticaltechniquefactoranalysis.Factoranalysisislessfrequentlyusedin
speechlanguagepathologythanitisinsomeotherdisciplines.Forexample,ithasbeenusedmostextensivelytostudyintelligencetests.Besidesitsvalueasameansof
studyinganalreadydevelopedmeasure,factoranalysisisfrequentlyusedinearlystagesoftestdevelopmentasanaidinselectingitemsfromapoolofpossibleitems.

Thetermfactoranalysisdescribesanumberoftechniquesusedtoexaminetheinterrelationshipsofasetofvariablesandtoexplainthoseinterrelationshipsthrougha
smallernumberoffactors(Allen&Yen,1979).Factoranalysisassistsresearchersintheverydifficultprocessofmakingsenseofalargenumberofcorrelations,the
mostbasicmethodfordescribinginterrelationships(asdescribedinchap.2).

Infactoranalyticstudies,theoriginalsetofvariablestobestudiedtypicallyconsistsofagroupsperformanceonthetargetmeasureaswellasasetofother
measuressomeofwhichtapasimilarconstructasthetargetmeasure.Althoughtheconceptofthefactordoesnotexactlyrelatetoaspecificunderlyingconstruct,all
measuresrelatedtoasingleconstructareexpectedtobeassociatedwithasinglefactor.Therefore,constructvaliditywouldbedemonstratedinthistypeofstudywhen
thetargetmeasureshares,orloadson,thesamefactorasmeasuresforwhichvaliditywithrespecttoaparticularconstructhasalreadybeendemonstrated(Pedhazur
&Schmelkin,1991).

Aparticularlysophisticatedmethodproposedforstudyingconstructvalidityexistsinprinciple,isappliedtomeasuresdevelopedforavarietyofbehavioralconstructs,
butisrarelyappliedinspeechandlanguagemeasures.Thatisthemethodknownasconvergentanddiscriminantvalidation(Campbell&Fiske,1959),whichis
associatedwithatypeofexperimentaldesigntheycalledamultitraitmultimethodmatrix.Becauseoftherelativerarityofthisapproachformeasuresusedwithchildren
whohavelanguagedisorders,Idonotdiscussitindetail.However,becausethismethodissometimesusedformeasuresyouwillbeinterestedin,itisimportantto
knowthatconvergentvalidiationreferstodemonstrationsthatameasurecorrelatessignificantlyandhighlywithmeasuresaimedatthesameconstruct,butusing
differentmethodsdiscriminantvalidationreferstodemonstrationsthatitdoesnotcorrelatesignificantlyandhighlywithmeasurestargetingdifferentconstructs
(Pedhazur&Schmelkin,1991).

AnexamplefromAnastasi(1988)mayhelpmaketheideasbehindconvergentanddiscriminantvalidationclearer:

Correlationofaquantitativereasoningtestwithsubsequentgradesinamathcoursewouldbeanexampleofconvergentvalidation.Forthesametest,discriminant
validitywouldbeevidencedbyalowandinsignificantcorrelationwithscoresonareadingcomprehensiontest,sincereadingabilityisanirrelevantvariableinatest
designedtomeasurequantitativereasoning.(p.156)
Page56

Inshort,validityissupportedinthisapproachthroughevidencethatthemeasureunderstudyismeasuringwhatitissupposedtomeasureinamanneruncontaminated
byitsrelationshiptosomethingelsethatitwasnotsupposedtomeasure.

Inthecontextoftheirdiscussionofconvergentanddiscriminantvalidation,PedhazurandSchmelkin(1991)discussedapairoffallaciesthatthreatenresearchers
understandingoftheevidencetheyobtainusingthismeasure,butequallyapplytothoughtsabouttestselection.Cleverly,theyhavebeentermedthejingleandjangle
fallacies.Jinglefallaciesarisewhenoneassumesthatmeasureswithsimilarnamesmusttapsimilarconstructswhereasjanglefallaciesarisewhenoneassumesthat
measureswithdissimilarnamesmusttapdissimilarconstructs.Obviously,closeexaminationofactualcontentcanhelpwardoffthedeludingeffectsofsuchthinking.

AlthoughIonlydiscussedfourmethodsofconstructvalidation,manymoremethodsareactuallyused,includingthosethathaveconventionallybeenidentifiedin
associationwithcontentandcriterionrelatedvalidation.Methodsfittingundercontentandcriterionrelatedvalidationtechniquesarediscussednext.Theseare
typicallyviewedasmoreeasilyunderstoodthanconstructvalidation.

ContentValidation

Contentvalidationinvolvesthedemonstrationthatameasurescontentisconsistentwiththeconstructorconstructsitisbeingusedtomeasure.Aswithconstruct
validity,thedeveloperaddressesconcernsaboutcontentvalidityfromtheearlieststagesofthemeasuresdevelopment.Suchconcernsnecessitatetheuseofaplanto
guidetheconstructionofthecomponentsofthemeasure(testitems,inthecaseofstandardizedtests).Theplanensuresthatthecomponentsofthemeasurewill
providesufficientcoverageofvariousaspectsofaconstruct(oftencalledcontentcoverage)whileavoidingextraneouscontentunrelatedtotheconstruct(thusassuring
contentrelevance).Later,contentvalidityisevaluateddirectly,usuallythroughtheuseofapanelofexpertswhoevaluatetheoriginalplanandtheextenttowhichit
waseffectivelyexecuted.Table3.2liststhebasicstepsinvolvedinthedevelopmentofstandardizedmeasures.

Despiteunderlyingsimilarities,thespecificwaysinwhichconcernsregardingcontentvalidityaffectthedevelopmentprocessdifferfornormreferencedandcriterion
referencedmeasures.Beforeattemptingacomparisonofthesedifferences,recall

Table3.2
StepsInvolvedintheDevelopmentofaStandardizedMeasure
(Allen&Yen,1979Berk,1984)

Step TestDevelopmentActivity

1 Planthetest
2 Writepossibleitems
3 Conductanitemtryout
4 Conductanitemanalysis
5 Developinterpretivebase(normsorperformancestandards)
6 Collectadditionalvalidityandreliabilitydata
Page57

thesetwoideasfromchapter2:(a)contenttendstobebroadlysampledfornormreferencedmeasuresandextensively,almostexhaustively,sampledforcriterion
referencedmeasuresand(b)apersonsperformanceisinterpretedinrelationtotheperformanceofanormativegroupfornormreferencedmeasuresandtoaspecific
performancelevelforcriterionreferencedmeasures.Inthefollowingsections,Idescribetheeffectofthesedifferencesoncontentvalidationwithinthecontextofan
explanationofproceduresusedinthedevelopmentofnormreferencedaswellascriterionreferencedmeasures.

TheDevelopmentofNormReferencedMeasuresandContentValidity.Fornormreferencedtests,thedevelopmentoftheplaninvolvesdecisionsaboutthe
numberandcomplexityofconstructstobeexaminedaswellasthenumbersandkindsofitemstobeused.Sometestsattempttotakeononlyoneconstruct(e.g.,the
PPVTIIIDunn&Dunn,1997),whereasothersaddressmanyorcomplexconstructsandconsequentlyarecomposedofnumeroussubtests(e.g.,theTestof
LanguageDevelopmentIntermediate3[Hammill&Newcomer,1997]),inwhichthecomplexconstructoflanguageisviewedascomposedofnumeroussimpler
constructsinvolvingvariousaspectsofreceptiveandexpressivelanguage).

Next,asmanyas1.5to3timesasmanyitemsarewrittenasareexpectedtobeusedinthefinalversionofthetest(Allen&Yen,1979).Itemsarewrittenwiththe
goalofsamplingevenlyacrosstherangeofallpossibleitemsandprovidingalargeenoughpoolofitemsthattheireffectivenesscanbestudiedinthenextstepsofthe
testsdevelopment:itemtryoutanditemanalysis.

Anitemtryoutisconductedusingalargesampleofindividualschosentobeassimilaraspossibletothoseforwhomthetestwillultimatelybeused.Afterthetestis
giventothesample,theperformanceofeachitemisstudiedusingitemanalysis.Thisanalysistendstorelymostheavilyoninformationabouttheitemsdifficultyand
discriminationbutcaninvolveavarietyoftechniques(includingfactoranalysis)intendedtohelpthetestdeveloperarriveatasubsetofthemostvaliditemsbythrowing
outormodifyingunsatisfactoryitems.

Itemdifficulty(p)isthenumberofpersonsansweringtheitemcorrectlydividedbythenumberofpersonswhotooktheitem.Itcanbeusedtogaugewhetheranitem
isappropriatetotherangeofabilitiescharacteristicofthetargetpopulation.Obviously,ifatestispassedbyeveryone(p=1.0)orisfailedbyeveryone(p=.0),itwill
nothelpyourankindividualsrelativetooneanotherthegoalofanormreferencedmeasure.Infact,itisgenerallyheldthatanitemhasthemaximumabilityto
discriminateamongtesttakerswhenithasapvalueof.50.Normreferencedtestdevelopersareoftenencouragedtostriveforitemswithdifficultiesfalling
between.30and.70asanacceptablerangearound.50(Allen&Yen,1979Carver,1974).Itemsthatfalloutsideofthisrangearediscardedorrewritten(becausea
difficultitemmayonlybedifficultbecauseitswordingisconfusing).

Itemdiscriminationcanbemeasuredinseveraldifferentways,withitemdiscriminationindexesanditemtotaltestscorepointbiserialcorrelationsasthemostpopular
methods.Itemdiscriminationreflectstheextenttowhichpeopletendtoperformsimilarlyontheitemastheydoonthetestasawhole(Allen&Yen,1979).Itisgen
Page58

erallythoughtthatbetteritemswillbethoseforwhichthereisatendencyformorepositiveperformancesontheitemtobeassociatedwithmorepositiveperformance
onthetestaswhole.Again,itemsthatfailtoperforminadesirablefashionarecandidatesforrewritingorexclusion.

Onceitemsarerewrittenandasubsequentitemanalysisdemonstratesasatisfactoryreportonthefinalbodyofitems,thelaststepofthetestconstructionprocess
involvesthecollectionofinitialinformationabouttheinstrumentsoverallvalidityandreliabilityandthepreparationofdocumentationconcerningtheinstrument.Content
validitycomesinatthispointintwoways.First,byreportingonthespecificmethodsusedinthestepsIdescribed,thetestauthorisprovidingapotentialtestuserwith
someevidencethattheinitialintendedcontentofthetesthasbeenwelltranslatedintothefinalmeasure.Second,onetypeofdatacollectedduringthefinalstepoftest
constructionconsistsofexpertevaluationofthedevelopmentprocessandofthefinalfitbetweenintendedandactualcontentofthetest.Table3.3providestwo
examples,showinghowdifferenttestmanualsdescribethisinformation.

TheDevelopmentofCriterionReferencedMeasuresandContentValidity.Criterionreferencedmeasuresareconstructedusingstepssimilartothose
previouslydescribed.However,numerousdifferencesinmethodsandrationalesdistinguishthedevelopmentofsuchmeasuresfromthedevelopmentofnorm
referencedmeasures.

Tobeginwith,theinitialplanusedforacriterionreferencedmeasuretendstobemoreelaborateanddetailedthanthatusedinnormreferencedmeasureconstruction
(Glaser,1963Glaser&Klaus,1962).Also,behavioralobjectives,oftenhierarchicallyarranged,maybeusedaspartoftheplan,particularlywhenthemeasureis
beingdevelopedtoexamineprogressintheacquisitionofaparticularbodyofinformationoraparticularskill(Allen&Yen,1979).Nitko(1983)offeredadetailed
accountingofthesometimesveryintricateplansusedforcriterionreferencedmeasures.

TheTestingandMeasurementCloseUpinthischapterprovidesaverypersonalexamplefromthelifeofoneoftheauthorsquotedmostfrequentlyonthetopicof
validity,AnneAnastasi,whichremindsusofthedifferenceinnormreferencedandcriterionreferencedtests.

Oncetheplanhasbeenfinalized,itemsarewrittensothattheyaddressallaspectsoftheintendedcontent.Althoughexhaustiveistoostrongaword(anexhaustive
testofanyconstructworthknowingaboutwouldundoubtedlyrequireseverallifetimes),theextensivenessofitemcoverageisdefinitelyinthedirectionofexhaustive
whencomparedwiththatofnormreferencedmeasures.

Itemtryoutsandanalysesofferanotherpointatwhichmajordifferencesseparatenormreferencedfromcriterionreferencedinstruments.Fornormreferenced
measures,itemsareselectedfortheirabilitytodiscriminateacrossarangeofabilitiesforcriterionreferencedmeasures,however,itemsareselectedfortheirabilityto
discriminatebetweenperformancelevels.Mostcommonly,dichotomousperformancelevelsareused,suchthatitemsareselectedfortheirabilitytodiscriminate
betweenperformanceshowingmasteryofaparticularcontentversusthatshowingnonmastery.Forthatpurpose,anidealitemsdifficultywouldapproximatezerofor
nonmastersand1formasters.Onemethodusedtotentativelyidentifymastersandnonmasters
Page59

Table3.3
ExamplesofTwoTypesofCriterionRelatedValidityStudies

Concurrentvalidity
l TestofPhonologicalAwareness(TOPA):WhentheTOPA(TestofPhonologicalAwareness)wasgiventoasampleof100
childrenattheendofkindergarten,itwasfoundtobesignificantlycorrelatedwithtwoother,relativelydifferentmeasuresof
phonologicalawareness.TheTOPAKindergartenscoreswerecorrelatedwithscoresfromameasurecalledsoundisolation(a15
itemtestrequiringpronunciationofthefirstphonemeinwords)at.66andwithasegmentationtask(requiringchildrentoproduceall
thephonemesinathreetofivephonemeword)at.47.Bothoftheseothermeasuresassessedanalyticalphonologicalawareness,
althoughtheyrequiredamoreexplicitlevelofawarenessthandidtheTOPA.(Torgesen&Bryant,1994,p.24)
l PreschoolLanguageScale3(PLS3):AstudyoftherelationshipbetweenPLS3andCELFR[ClinicalEvaluationof

LanguageFunctionRevised(Semel,Wiig,&Secord,1987)]wasconductedwith58children.Thesampleconsistedof25males
and33femalesranginginagefrom5yearsto6years,11months(mean=6years,0months).Thetwotestswereadministeredin
counterbalancedorder.Thebetweentestintervalrangedfromtwodaystotwoweeks,withanaverageof4.5days.Bothtestswere
administeredbythesameexaminer.Reportedcorrelationswereasfollows:PLS3AuditoryComprehensionwithCELFR
ReceptiveComposite(r=.69)PLS3ExpressiveCommunicationwithCELFRExpressiveComposite(r=.75)PLS3Total
LanguagescorewithCELFRtotalScore(r=.82).(Zimmerman,Steiner,&Pond,1992,p.95)
l TestofPhonologicalAwareness(TOPA):WhentheTOPAKindergartenwasgivento90kindergartenchildrensampledfrom
twoelementaryschoolsservingprimarilylowsocioeconomicstatusandracialminoritychildren,itscorrelationwithameasureof
alphabeticreadingskill(theWordAnalysissubtestfromtheWoodcockReadingMasteryTest)attheendoffirstgradewas.62.
Thus,between30%to40%ofthevarianceinwordlevelreadingskillsinfirstgradewasaccountedforbytheTOPAadministered
inkindergarten.(Torgesen&Bryant,1994,p.24)
Predictivevalidity
l ReceptiveExpressiveEmergentLanguageScale(REEL2):Inthefirststudyinvestigatingpredictivevalidity,researchersatthe
UniversityofFloridasEmergentLanguagelaboratoryconductedalongitudinalstudyof50normalinfantsfromlinguistically
enrichedenvironments.Afterrepeatedmonthlytestingovera2to3yearperiod,allinfantswerefoundtoachievemeanaverage
scoresforReceptiveLanguageAge(RLA)andExpressiveLanguageAge(ELA),andCombinedLanguageAge(CLA)atorabout
theirchronologicalages.(Bzoch&League,1992,p.10)

hasbeentoexamineperformancesofanitemtryoutsamplebeforeandafterinstructiondesignedtoproducemastery(Allen&Yen,1979).Inthatcontext,betteritems
arethoseinwhichpvaluesshowthegreatestupwardchange.

Aswasthecasewithnormreferencedmeasures,thelaststepofthetestconstructionforacriterionreferencedmeasureinvolvesthecollectionofinitialinformation
abouttheinstrumentsoverallvalidityandreliabilityandthepreparationofdocu
Page60

mentationconcerningtheinstrument.Here,theeffectsoncontentvalidityareachievedusingmeanssimilartothoseusedfornormreferencedmeasures.Inadditionto
providingdescriptiveevidenceoftheproceduresusedtodevelopthetestscontent,testauthorslooktotheresultsofexpertevaluationsofconstructionmethodsand
finaltestcontentasafurthersourceofcontentvalidation.

TESTINGANDMEASUREMENTCLOSEUP
AnneAnastasihasbeencalledoneofpsychologysleadingwomen.Shewasoneofonlyfivewomen(ofatotalof96psychologists)tobeconsideredduringthe
firsteightdecadesofthiscenturyinaprominentseriesofbooksrecordingthehistoryofpsychologythroughautobiography(Stevens&Gardner,1982).Although
Anastasihasmadecontributionsinavarietyofareasinpsychology,thereasonthatsheisincludedhereisbecauseofherauthorshipofaclassictextonpsychological
testing(Anastasi,1954).Thattexthasgonethroughseveneditions,withthelatesteditionpublishedin1997.Ithasundoubtedlyservedasthesourceofmore
informationontestingforpsychologistsandothersthanperhapsanyotherwork,andinitslatestedition,Anastasi(1997)againprovidedoneoftheclearestsources
foressentialinformationonvalidityandreliability.
Intheearly1980s,attheUniversityofArizona,IhadthepleasureofhearingAnneAnastasipresentalecture,whenshewasinher70s.Herblackpatentleather
pocketbookwasproppedupinfrontofheronthepodiumasshespoke,itsstiffhandlealmostobscuringtheaudiencesviewofherwhitehair,thickhornrimmed
glasses,andthebrighteyesthatlaybehindthem.Idonotactuallyremembermuchaboutthedetailsofherpresentation,exceptthatherspeechwasasclearasher
writingandwaspresentedwithoutasinglenote.Shewasasimpressiveinpersonasshehadbeenonthepage.
Thefollowingpassagefromherautobiographybreatheslifeintotwoverydifferentideasfromthischapter.First,itshowsthepossiblytraumatizingeffectthatthe
processofassessmentcanhaveevenonachildwhosebiggestproblemappearstohavebeenherexceptionalintelligence.Seconditrevisitsthedistinctionbetween
normreferencedandcriterionreferenced(orasshecallsithere,contentreferenced)scoreinterpretation.
Throughoutmyschooling,Iretainedadeeprootednotionthatanygradeshortof100percentwasunsatisfactory.AtonetimeIactuallybelievedthatasingleerror
meantafailingscore.Irecallaspellingtestin4B,inwhichwewrotetenwordsfromdictation.Iwasunabletohearoneofthewordsproperly,becausethesubway
hadjustroaredpastthewindow(itwaselevatedinthatarea).Thewordwasfriend,butIhearditasbrand.Asaresult,theitemwasmarkedwrongandmy
gradewasonly90%.ThateveningwhenItoldmymotheraboutit,sheconsoledmeandadvisedmetoraisemyhandatthetimeandtelltheteacher,ifanythinglike
thatshouldhappenagain.Butshedidnotdisabusemeofthenotionthatanythingshortofaperfectscorewasafailure.Ieventual
Page61

lydiscoveredformyselfthatonecouldpassdespiteafewerrorsbutIalwaysfeltpersonallyuncomfortablewiththeidea.Thereseemedtobesomelogicalfallacyin
callingaperformancesatisfactorywhenitcontainederrors.Iwasapparentlyfollowingacontentreferencedratherthananormreferencedapproachtoperformance
evaluation.(Anastasi,1980,p.78).

FaceValidity.Onefurthertopicregardingcontentvaliditythatdemandsattentionisnotreallyamatteroftruevalidityatall,despiteitsbeingtermedfacevalidity.
Facevalidityisthesuperficialappearanceofvaliditytoacasualobserver.Facevalidityisconsideredapotentiallydangerousnotionifatestusermistakenlyassumes
thatacursoryevaluationofameasureforitsfacevalidityconstitutessufficientevidencetowarrantitsadoption.Nonetheless,facevaliditycanplayaroleinatests
actualvalidityforexample,poorfacevaliditymaycauseatesttakertodiscounttheimportanceofameasureandtherebyundermineitsabilitytofunctionasintended.

Insummary,thekindofevidenceprovidedfornormreferencedversuscriterionreferencedmeasuresdiffers.However,contentvalidationforbothtypesofmeasuresis
achievedthroughtheauthorscarefulplanning,execution,andreportingofthemeasuresdevelopmentandthroughthepositiveevaluationofthisprocessbyexpertsin
thecontentbeingaddressed.

CriterionRelatedValidation

Criterionrelatedvalidationreferstotheaccumulationofevidencethatthemeasurebeingvalidatedisrelatedtoanothermeasureacriterionwherethecriterionis
assumedtohavebeenshowntobeavalidindicatorofthetargetedconstruct.Puttingthisinprimitiveterms,criterionrelatedvalidationinvolveslookingtoseeifyour
duckactslikeaduck.Thisexplanationderivesfromfamousstreetwiselogicinwhichanythingthatlookslikeaduck,walkslikeaduck,andquackslikeaduckis
determinedtobeaduck.Thus,asyousetouttovalidateyourmeasure(Duck1),yousearcharoundforaduck(Duck2,a.k.a.CriterionDuck)thateveryone
acknowledgesisindeedatrueduck(i.e.,avalidindicatoroftheunderlyingconstruct).Thenyouputyourducksthroughtheirpacestoseetowhatextenttheyact
similarly.Thegreatertheirsimilarities,thebettertheevidencethattheyshareacommonduckness.Andthen,voil:Youhaveevidenceofcriterionrelatedvalidity!

IncaseIlostyouthere,thewaythatcriterionrelatedvalidationworksforabehavioralmeasureisthatoneobtainsevidencebyfindingastrong,usuallypositive
correlationbetweenthetargetmeasureandacriterion.Thechoiceofthecriterioniscrucialbecauseoftheassumptionthatthecriterionhashighvalidityitself.Itcan
alsobeproblematicbecauseformanyconstructsitmaybedifficulttofindacriterionthatcanclaimsuchanexaltedstatus.

Twotypesofcriterionrelatedvaliditystudiesaretypicallydescribed:concurrentandpredictive.Predictivevalidityismostrelevantwhenthemeasureunderstudywill
beusedtopredictfutureperformanceinsomearea.Forexample,thePredictive
Page62

ScreeningTestofArticulation(PSTAVanRiper&Erickson,1969)wasintendedtopredictwhetherachildtestedatthebeginningoffirstgradewouldstillbe
consideredimpairedinphonologicperformance2yearslater.Consequently,thistypeofevidencewasimportantindemonstratingthatthetestwouldmeasurewhatit
wassupposedtomeasure.Inthatparticularcase,thetestdevelopersusedasthecriterionmeasuretheresearchersjudgmentsofnormalarticulationversuscontinued
articulatoryerrorsbasedonasimplephoneticinventoryandonsamplesofspontaneousconnectedspeechobtained2yearsafterinitialtestingwiththePSTA.

Astudyofconcurrentvalidityisperformedwhenthecriterionandtargetmeasuresarestudiedsimultaneouslyinagroupofindividualslikethoseforwhomthetestwill
generallybeused.Itisbyfarthemorecommontypeofcriterionrelatedvaliditystudy.SeeTable3.3foranexampleofthistypeofvaliditystudy.

Forbothpredictiveandconcurrentstudiesofcriterionrelatedvalidity,theresultingcorrelationcoefficientisoftentermedavaliditycoefficient,ormorespecifically,asa
predictiveorconcurrentvaliditycoefficient,respectively.Interpretationofsuchcoefficientsisessentiallythesameasthatdescribedforcorrelationsinchapter2.
However,onefactorintheinterpretationofvaliditycoefficientsthatwasnotaddressedpreviouslyconcernshowhighacorrelationhastobeforonetoconsiderit
crediblesupportofameasuresvaliduseforaparticularpurpose.TheStandardsforEducationalandPsychologicalTesting(APA,AERA,&NCME,1985)
doesnotprovidedirectguidanceonthisquestion.However,severalexpertsrecommendthatwhenameasureisgoingtobeusedtomakedecisionsaboutanindividual
(ratherthanasawaytosummarizeagroupsperformance),astandardof.90shouldbeused.Asanadditionalproviso,thecorrelationcoefficientshouldalsobefound
tobestatisticallysignificant(Anastasi,1988).

FactorsAffectingValidity

Anythingthatcausesameasuretobesensitivetofactorsotherthanthetargetedconstructwilldiminishthemeasuresvalidity.Forexample,abathroomscalethat
becomessensitivetoroomtemperatureorhumidityislikelytobelessvalidasanindicatorofhowmuchdamageonehasdoneafteraseriesofholidaymeals.Inthis
sectionofchapter,Iconsiderfactorsaffectingthevalidityofbehavioralmeasuressuchasthoseusedwithchildrenfirstconsideringtwofactorsoverwhichthe
clinicianhasconsiderabledirectcontrol,thentwofactorsoverwhichtheclinicianscontrolisfarlessdirect.

SelectionofanAppropriateMeasure

Asmentionedatthebeginningofthischapter,probablythebiggestfactoraffectingthevalidityofdecisionsmadeusingaparticularmeasureisthesuitabilityofthematch
betweenthespecifictestingpurposeandthedemonstratedqualitiesofthemeasuretobeused.Themajorityofinformationdescribedthusfarrelatestoactivities
performedbythedeveloperofastandardizedmeasure.Stilltobediscussedishowtestusersmakeuseofthatinformationtodotheirratherlargepartinassuringthe
validityoftheirowntestuse.Forthemoment,itissufficientthatyoubeawarethatyourroleiscriticalinassuringtestingvalidityandthatitbeginswithathorough
evaluationofinformationprovidedbythe
Page63

testdeveloper,testreviewers,andtheclinicalliteratureinlightofyourclientsneeds.Specificstepsleadingtosuchanevaluationaredescribedinthenextchapter.

AdministrationoftheMeasure

Aftersuccessfulselectionofameasure,theclinicianplaysacriticalroleinassuringvaliditythroughitsskilledandaccurateadministration.Unlessameasureis
administeredinamannerconsistentwiththemethodsusedindevelopingthemeasuresnormsandtestingitsreliabilityandvalidity,anycomparisonoftheresulting
performanceagainsteithernormsorperformancestandardsbecomesdistorted,evennonsensical.Thusforexample,thedirectionssupplied,withatestmayindicate
thatorallypresenteditemsaretobereadaloudonlyonce.Inthatcase,thedifficultyofthattestwillprobablybelessenedifthetestuserdecidesthatitsonlyfairto
thechildtogiveasecondchancetoheartheinformationincludedintheitem.Inreality,however,itisdecidedlyunfairtothechildifthetestisbeingusedtoprovide
informationabouthowthatchildsperformancecompareswithastandardthatwasdeterminedunderdifferentconditions.

Skilledadministrationofstandardizedmeasures,however,goeswellbeyondthepreservationofidealizedconditions.Italsofacilitatesacrucialbutsometimes
overlookedfunctionofatestingsituationthatis,theestablishmentofatrusting,potentiallyhelpfulrelationshipbetweentheclinicianandthechildbeingtested.Iftest
administrationgoeswell,thechildcomesawayfromtheexperiencewithasensethatthetestgiverlikesthechildandisarewardingpersonwithwhomtointeract.Ifit
doesnot,notonlywillthetestdatabecompromised,butthechildmaydevelopexpectationsofthetestgiverthatwillbedifficulttoovercome.Indeed,some
researchers(Maynard&Marlaire,1999Stillman,Snow,&Warren,1999)whoexaminethetestingprocessindetailnotethatfartoolittleattentionispaidtothe
collaborativenatureoftesting,inwhichtheexaminerisnotapassiveconduitofitemsbutanintegralparticipantinthetestingoutcome.Table3.4listssomesuggestions
gleanedfromseveralyearsofclinicalexperience(myownandothers)concerninghowtofacilitatetesting.

ClientFactors

Clientfactorsaresuchakeyfeaturetovalidtestingofchildrenthatitseemsworthdiscussingthemunderaseparateheading.Ofparticularinterestaremotivationand
whatSalviaandYsseldyke(1995)calledenablingbehaviorsandknowledge.

Motivationaffectstheperformanceofadultsandchildreninoftendramaticways.Althoughthetopicofmotivationhasbeentheimpetusforextensiveresearchin
severaldisciplines,youcanquicklyappreciatethedevastatingimpactoflowmotivationbylookingbackoveryourownexperiencesandrememberinganoccasion
whenaclassroomquizortestfellatatimewhenyouwerepreoccupiedbyotherthingshappeninginyourlife,orperhapsatimewhenyoupsychedyourselfout,
therebyseeminglynecessitatingthefulfillmentofaprophecyoffailure.Forme,theexperiencethatcomestomindisamidtermexaminationItookincollege.Ihad
foundanunconsciousbutstillbreathingmockingbirdonmywaytotheexam.Consequently,duringtheexamination,Ispentmuchmoreofmytimewonderingwhether
thebirdwouldstill
Page64

Table3.4
TestingRecommendations

ThingstoConsiderWhenTestingChildren

Rememberthatchildrenrarelyhavemuchsophisticationintesttakingskills.Theyexpectyourrelationshipwiththemtobebasedonthesamerulesthatapplyto
1.
interactionsinothersituations.Thereforeitisyourresponsibilitytohonortheirexpectationsandfindwaystoachieveyourgoalswithinthatcontext.
Childrenseffortstoachievetheirbestforyouwillbebuiltontheexpectationthatyouandtheyareouttopleaseeachotherintheinteraction.Youwanttobe
2.
acceptedbythechildasarewarding,appreciativeadultwhoisgenerallyfuntobewith.
Forolderchildren,youneedtostriveforabalanceinwhichyouareincontrolasmuchasyouneedtobetohaveyourquestionsansweredandthechildisin
controlasmuchaspossibleotherwise.Forexample,itisimportantthatyoumaintaincontroloveryourtestmaterials,arerelativelyfirmwhenyoumakearequest
3.
thatisanecessarypartofthetestingprocess,andonlyofferchoiceswheretheyaretrulyavailable(e.g.,avoidaskingquestionssuchasthefollowingiftheyare
nottrueoffers:Doyouwanttolookatsomepictureswithmenow?).
Helpchildrencooperatebyinformingthemaboutthecontent,order,andtimeframesassociatedwithvariousassessmenttasks.Towardthisend,considerdoing
thefollowing:(a)Wheneverpossible,allowthechildtomakechoicesinorderingactivities,and(b)deviseamethodtoletchildrenknowhowmuchmoreis
4.
requiredofthem.Forolderchildren,youcanusealistwhereeachcompleteditemischeckedofforrewardedwithasticker.Foryoungerorlesssophisticated
children,youcanusetokensequalingthenumberofactivities,whichareremovedfromsightormovedtoadifferentlocationaseachactivityisfinished.

bealivewhenIfinisheditandwhereIcouldgethelpforitifitwerestillalive,thanIspentactivelyfocusedontheoutcomeoftheexamination.Withpredictableresults.
(Sadly,thebirdfarednobetterthanmyexamgrade.)

Motivationisparticularlycriticalformeasuresthatareintendedtoelicitonesbesteffort.Onevarietyofsuchmeasuresarethoseinwhichclientsareassumedtobe
doingtheirbestunderconditionsstressingaccuracy,speedofexecution,orboth.Thesearesometimescalledmaximalperformancemeasures.Commonexamplesof
maximalperformancemeasuresinchildhoodlanguagedisordersincludemeasurementoflanguagefunctionsinwhichresponsesaretimedaswellasavarietyofspeech
productionmeasures,includingdiadochokineticrate.Inadiscussionofsuchmeasuresusedtostudyspeechproduction,Kent,KentandRosenbek(1987)cautioned
thatextremecareshouldbetakenbeforeconcludingthatatesttakerisfullyawareandmotivatedandthereforelikelytoproduceaperformancethatcanreasonablybe
comparedwithnormsorbehavioralstandards.TheneedforcautionisparticularlygreatforyoungerchildrenandforchildrenwitheitherDownsyndromeorautism,but
itshouldalwaysbeaconcernforanychild.Whereasthelevelofconcernshouldbegreatestformaximalperformancetesting,anytestingofachildwillbesubjectto
reducedvalidityifthechildisuninterestedoroverlyanxious.

EnablingbehaviorsandknowledgearedefinedbySalviaandYsseldyke(1995)asskillsandfactsthatapersonmustrelyontodemonstrateatargetbehavioror
knowledge.Ifanassumedenablingbehaviorisabsentordiminished,performanceonthe
Page65

measuremaynolongerbeassociatedwiththebehaviorunderstudyhenceitsvalidityisthreateneddramatically.Enablingbehaviorsthatarefrequentlyassumedin
childrenslanguagetestsincludeadequatevision,hearing,motorskill,andunderstandingofthedialectinwhichthetestisconstructed.Infact,althoughIdiscussedit
earlierasaseparatecategory,positivemotivationtoparticipateinassessmentisafrequentlyassumedenablingbehavior.

Reliability

Reliability,orconsistencyinmeasurement,isinvariablylistedasamajorfactoraffectingvaliditybecauseitisanecessaryconditionforvalidity,meaningthatameasure
canonlybevalidifitisalsoreliable.Reliabilitydoesnotassurevalidity,however.Figure3.2illustratesthisrelationshipbetweenreliabilityandvalidityusingarcheryas
ananalogy.Targetnumber1demonstratesthehandiworkofanarcherwhoseaimisbothreliableandvalidnumber2,anarcherwhoseaimisreliable,butnotvalid
andnumber3,anarcherwhoseaimisneitherreliablenorvalid.Inbehavioralmeasurement,theuseofmeasureswithdegreesofreliabilityandvaliditysimilartothat
shownintargets2and3willhavesimilarlynegativeoutcomes,althoughunfortunatelytheoutcomesmaynotbeasobviousand,therefore,willbehardertodetect
and,possibly,torectify.

Fig.3.2.Agraphicanalogyillustratingtherelationshipbetweenreliabilityandvalidity.
Page66

Onepoint(nopunintended)madebyFig.3.2isthatreliabilitylimitshowvalidameasurecanbeanylossofreliabilityrepresentsalossofvalidity.Thus,information
aboutreliabilitycanprovideveryimportantinsightintothequalityofameasure.Toillustratethisprobleminamorelivelyway,imaginetheproblemsassociatedwithan
elasticandthereforeunreliableruler.Overrepeatedmeasurementsofasinglepieceofwoodwithsucharuler,itsuseroneachattemptmighttrydesperately,even
comically,toapplyexactlythesameoutwardpressurestotheruleralmostcertainlyinvain,withmeasurementsof5inchesonetime,6inchesthenext,andsoon.
Withsuchimmediatefeedback,theuserofthemeasurewouldsurelyrecognizethehopelesslackofvalidityinthesemeasurementsandwouldundoubtedlygolooking
forabetterruler.Unfortunately,whenhumanbehaviorisbeingmeasured,evenmeasureswithreliabilityequivalenttothatofanelasticrulerwouldnotbesoeasily
recognized.Thus,becauseoftheimportanceofreliability,thenextsectionofthischapterisdevotedtoamoredetailedexplanationofreliabilitywhatitisandhowitis
studied.

Reliability

Reliabilitycanbedefinedastheconsistencyofameasureacrossvariousconditionssuchasconditionsassociatedwithchangesintime,intheindividualadministering
orscoringthemeasure,andevenchangesinthespecificitemsitcontains.Ifameasureisshowntobeconsistentinitsresultsacrosstheseconditions,thenitsusercan
makeinferencesfromperformanceunderobservedconditionstobehaviorsandskillsshowninother,unobservedconditions.Inshort,acceptablereliabilityallowsfor
generalizationoffindingsobtainedintheassessmentsituationtoabroaderarrayofreallifesituationsthoseinwhichtestusersarereallymoreinterested.

Whenthereliabilityofameasureisexaminedduringthecourseofitsconstruction,thatinformationisfrequentlyrepresentedusinganothertypeofcorrelationcoefficient
calledareliabilitycoefficient.Alternatively,moresophisticatedstatisticalmethodshavebeendevelopedtoexaminethereliabilityofmeasuresonthebasisofan
influentialperspectivecalledGeneralizabilitytheory(Cronbach,Gleser,Nanda,&Rajaratnam,1972),whichattemptstoexamineseveralsourcesofinconsistency
simultaneously.Thesemethods,however,arerelativelyrecentandonlyinfrequentlyappliedinspeechandlanguagemeasures(Cordes,1994).

Anotherwayforthinkingaboutreliabilityisintermsofhowitaffectsanindividualscore.Themostpopularframeworkguidingthisperspectiveonreliabilityis
sometimesdescribedastheclassicalpsychometrictheoryortheclassicaltruescoretheory.Althoughrecentdevelopments,includingGeneralizabilitytheory,have
eclipsedclassicaltheoryasthecuttingedgeofpsychometrics(Fredericksen,Mislevy,&Bejar,1993),classicaltheorynonethelesspervadesmuchofthepractical
methodsusedbytestdevelopersandhencetestusers.Further,itscontinuingutilityispraisedevenbythoseactivelyworkingalongotherlines(e.g.,Mislevy,1993).

Themostimportantassumptionassociatedwithclassicaltruescoretheory(Allen&Yen,1979)isthatanobservedscore(ascoresomeoneactuallyobtains)isthe
sumofthetesttakerstruescoreplussomenonsystematicerror.Thus,thetruescoreisan
Page67

idealization.Ithasalternativelybeendescribedasthescoreyouwouldfindifyouhadaccesstoacrystalballorasthemeanscoreatesttakerwouldachieveiftested
infinitely.Noticethaterrorandreliabilityarecorrelatedinthisperspective.Specificallytheyareinverselyrelated:Thelargerthereliability,thesmallertheerror.

Besidesitshistoricalvalue,thisperspectiveonreliabilityisusefulbecauseitforeshadowsourabilitytoapplyreliabilityinformationobtainedonagrouptopossibleerror
intheobservedscoreofanindividualtesttaker,suchasourclient.Whenthereliabilityofameasureisexpressedinrelationtoindividualscores,thatinformationis
representedusingameasureknownasthestandarderrorofmeasurement(SEM).Itsmentionhereismeanttowhetyourappetiteforfurtherinformation,whichis
providedlaterundertheheadingInternalConsistency.

WaysofExaminingReliability

Threetypesofreliabilityareofmostfrequentinteresttestretestreliability,internalconsistencyreliability,andinterexaminerreliability.Afourthtypeofreliability,
alternateformsreliability,isrelativelyinfrequentlyused.Themethodsusedtodemonstratesuchreliabilitywithaparticulargroupoftesttakersdependtosomeextent
onwhetheritwillbeinterpretedusingacriterionreferencedornormreferencedapproach.Whereasthereiswidespreadagreementconcerningthemethodstobeused
tostudythereliabilityofnormreferencedmeasures,debatecontinuesconcerningthebestmethodstobeusedwithcriterionreferencedmeasuresandwhethermethods
traditionallydevelopedfornormreferencedmeasurescanalsobeusedwithcriterionreferencedmeasures(Gronlund,1993Nitko,1983).Idiscussreliabilityprimarily
fromthetraditional,ornormreferenced,perspective,butnotethosepointsatwhichmethodsrecommendedforcriterionreferencedmeasuresdepartfromthat
perspective.

TestRetestReliability

Testretestreliabilityisstudiedinordertoaddressconcernsaboutameasuresconsistencyovertime.Itisparticularlyimportantwherethecharacteristicbeing
measuredisthoughttoremainrelativelyconstantforatleastshorterperiodsoftime(suchas2weekstoamonth).Sometimesadistinctionismadebetween
examinationsofreliabilityoverperiodsoftimeunder2monthsandthoseofreliabilityoverlongerperiodsoftime,whichisthentermedstability(e.g.,Watson,1983).
However,morecommonisatendencyforthetermstestretestreliabilityandstabilitytobeusedinterchangeably.

Fornormreferencedmeasuresusedwithchildrenwithlanguageimpairments,testretestreliabilityistypicallystudiedbytestingagroupofchildrensimilartothosefor
whomthemeasureisintendedontwooccasions,usuallynomorethanamonthapart.Acorrelationcoefficient,calledatestretestreliabilitycoefficient,iscalculated
todescribetherelationshipbetweenthetwosetsofscoresandisinterpretedinamanneridenticaltothatusedforpreviouscorrelationcoefficients,withincreasing
correlationsizeshowingagreaterdegreeofrelatednessbetweenthetwosetsofscores.

Formeasuresusedwithchildren,thetestretestintervalisparticularlycrucialbecauserapiddevelopmentalchangesarelikelytoaffectwhatevercharacteristicisbeing
meas
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uredifthetestretestintervalistoolarge.Thusitisimperativethattestdevelopersreportthesizeofthatintervaloverwhichtestretestreliabilityiscalculated.Only
rarelywillameasurebeexaminedfortestretestreliabilityoveranintervallongerthanamonth.

Onelimitationoftestretestreliabilitycoefficientsistheirsusceptibilitytocarryovereffectswherethefirsttestingaffectsthesecond.Dependingonthenatureofthe
carryover,theapparentreliabilityofameasureforuseinaonetimetestingsituation(themosttypicalapplication)mightbeeitherinflatedordeflated(Allen&Yen,
1979).Forexample,practiceeffectsmightmakethetesteasieronthesecondtesting,causinganswerstochangefromthefirsttosecondtestingthatwouldresultina
reliabilitycoefficientthatissmallerthanitwouldbeifcarryoverhadnotoccurred.Ontheotherhand,testtakersmayremembertheiranswersfromthefirsttestingand
simplyrepeatthemonthesecond,resultinginareliabilitycoefficientthatislargerthanitwouldbeifcarryoverhadnotoccurred.Becauseofthis,testdeveloperswill
sometimesadoptmethodsotherthanthestraightforwardtestretestmethod,choosingtousealternateformsretestingmethodstosupplementorsometimeseven
replacetestretestdata.

Manymeasuresofconsiderableutilitytospeechlanguagepathologistsworkingwithchildrenwhohavelanguageimpairmentsarenotstandardizedtestsforwhich
reliabilitydataareprovided.Instead,theyareinformalmeasuresdevisedforalimitedpurpose.Forinformalmeasuresitismorecommontodiscusstheconceptof
consistencyundertheheadingofagreement.Thus,forexample,itispossibletocalculatetestretestagreementforaninformalmeasureusedbyasingleclinician.

Figure3.3providesanexampleofaninformalprobemeasureforwhichanagreementmeasureiscalculated.Althoughthisexampleusestwojudges,analogous
methodscanbeusedtoexamineconsistencyforasinglejudgeovertime.Inthisexample,theimportanceofagreementmeasuresingivingyouasenseofthe
consistencyofmeasurementishighlightedwhenyounoticethatthetwojudgesarrivedatexactlythesamepercentagecorrectcalculationfortheclient.However,they
didsowhileagreeingaboutwhichwordswerecorrectlyproducedatapercentagealmostequaltothatpredictediftheirjudgementswereduetochance(50%)!A
particularlypopularalternativetothesimpleprocedureIdescribedistheKappacoefficient(Fleiss,1981Hsu&Hsu,1996),whichaddressesthisproblemofchance
agreement.McReynoldsandKearns(1983)areanespeciallyhelpfulresourceforthoseinterestedinamorethoroughdescriptionofagreementmeasures.Yetanother
resourceforthoseinterestedinadetaileddiscussionofthemeaningandrelativemeritofsuchmeasurescanbefoundinCordes(1994).

InternalConsistency

Internalconsistencyisstudiedinordertoaddressconcernsaboutameasuresconsistencyofcontent.Itisprimarilyofinterestincaseswhereatestorsubtesthas
itemsthatareassumedtofunctionsimilarly.Obtaininginformationaboutinternalconsistencyfornormreferencedmeasurespresentsfewpracticaldifficulties:Thesame
informationusedtoprovidenormsisusedtostudyinternalconsistency.Thus,informationaboutinternalconsistencyisoftenprovided,eveniflittleelseis.

Themostbasicmethodforexamininginternalconsistencyinvolvesthecalculationofasplithalfreliabilitycoefficient,whereperformancesofagroupoftesttakerslike
Page69

Fig.3.3.Anexampleshowinghowtocalculateapointtopointmeasureofagreement.

thoseforwhomthemeasureisdesignedarecomparedfortwohalvesofthemeasure.Althoughthemeasuremaybesplitinhalfusingavarietyofstrategies,mostoften
evenitemsarecomparedwithodditemsthroughthecalculationofacorrelationcoefficient.Highercorrelationsaretakenasevidenceofinternalconsistency.

Amajorproblemwiththesplithalfmethodisthatbecauseyoucompareonlyonehalfofthetestitemswiththeotherhalf,theamountofdatausedinthecorrelation
coefficientishalfwhatitshouldbe.Thishastheeffectofmakingthecorrelationcoefficientsmallerthanitwouldotherwisebe.Alternativemethodshavebeen
developedtocopewiththislimitation.

ThetwomostimportantalternativemeasuresofinternalconsistencyencounteredintestsforchildrenaretheKuderRichardsonformula(KR20)andCoefficientalpha
().KR20(which,incaseyourecuriousaboutthename,wasthetwentiethformulausedbyKuder&Richardsoninafamous1937articleKuder&Richardson,
1937)isusedonlyfordichotomouslyscoreditems(e.g.,thosescoredas1=rightand2=wrongonly).Itcannotbeusedforitemsthatarenotscoreddichotomously
(e.g.,thoseusingaratingsystemfrom1to4).Thislimitationledtothedevelopmentof.CoefficientalphaisamoregeneralformulathanKR20andcanhandleboth
dichotomouslyandnondichotomouslyscoredmeasures.KR20andarethoughttobemoresensitivethansplithalfmethodstohomogeneityofitemcontent,meaning
theextenttowhichitemsareaimedatthesamespecificconstruct.Thustheyaresometimesdescribedasmeasuresoftesthomogeneity.
Page70

NearthebeginningofthissectiononreliabilityIintroducedtheideathatreliabilitycanbeconsideredintermsofitsimpactonagivenscoreusingastatisticcalledthe
SEM.TheSEMisdiscussedingreaterdetailatthispointbecauseitisusuallybasedonameasureofinternalconsistency(possiblybecauseoftheeasyavailabilityof
thistypeofreliabilitydata,ratherthanfortheoreticalreasons).TheformulafortheSEMisrelativelyeasytounderstandanduse.Itiscalculatedbymultiplyingthe
standarddeviationofthetestbythesquarerootof1minusthereliabilitycoefficient.Itrepresentsthedegreeoferroraffectinganindividualscore.

Recallthatasreliabilityincreases,thesizeoftheSEMdecreases:Themorereliableameasure,thesmallertheerroraffectingindividualscoresandthemoreprecisethe
measurement.Thus,onecanusetheSEMdirectlyasameansofdeterminingwhichoftwocompetingmeasuresismoreprecise.Forexample,fora4yearoldchild
youmaywanttocomparetheSEMfortwotestsdesignedtoaddressreceptivevocabularyskillsusingverysimilartasks.Althoughthereareadditionalgroundson
whichyoumaywanttocomparethetwotests,precisionwouldbeoneimportantfeaturetoconsiderinmakingachoicebetweenthem.Searchingintheirtestmanuals,
youfindthattheSEMforthefirsttestis7(forwhichthemeanstandardscoreis100,SD=15)andforthesecondtestis4(forwhichthemeanandstandardscoreis
100,SD=15).Thus,thesecondisthemorepreciseofthetwomeasures.(Althoughitispossibletomakeessentiallythesamecomparisonusingthereliability
coefficientsforthesemeasures,phrasingthatcomparisonintermsoftheSEMallowsyoutoseemuchmorevividlytheimpactonanindividualscore.)

TheSEMcanalsobeused,alongwithinformationaboutthenormalcurve,toobtainaconfidenceintervalaroundanobtainedscoreaconceptIdiscussmorefullyin
chapter9aspartofalargerdiscussionoftestscoresandidentificationdecisions.

InterexaminerReliability

Interexaminerreliabilityisstudiedinordertoaddressconcernsaboutameasuresconsistencyacrossexaminers.Essentially,thisformofreliabilitystudyaddressesthe
question,Aredifferentexaminerslikelytoaffectperformanceonthemeasure?Dependingonthespecificfocus,itcanbecalledbyavarietyofnames:interscorer
reliability,interobserverreliability,interjudgereliability,amongothers.Thenatureofthestudydependsonwhichaspectsofthesequenceofactivitiesinvolvedin
administering,scoring,andinterpretingthemeasureareexpectedtobemostvulnerabletoinconsistency.Forexample,ifameasureinvolvesasophisticatedperceptual
judgmentonthepartoftheexaminer(suchastheapplicationofa5pointratingscale),thataspectofthetestsusewouldbetheprimaryfocusofareliabilitystudy.
Alternatively,ifthecalculationofameasurestotalscoredependedonthecalculationandcorrectrecordingofnumeroussums,thenthataspectofthetestsusewould
beamoreimportantfocusofstudy.

Wherepossibleduringreliabilitystudies,twotestersareaskedtoperformthesamefunction(e.g.,scoring),eitherfromtape(audioorvideo)orlive,forasinglegroup
oftesttakers.Thentheresultingscoresareexaminedusingareliabilitycoefficient.Whentheactualadministrationofitemsseemstoprovideasourceoferror,thesame
Page71

groupoftesttakersmaybetestedbytwotesters.Theresultswillbelessclearcutinthatcase,however,becausedifferencesinthetwotestingtimescouldbedueto
differenceseitherintestersorintestingtimes(testretestreliability).

Forinformalmeasures,consistencyacrossusersofthemeasureismorecommonlydiscussedintermsofagreement.Forexample,itispossibletocalculateagreement
fortwoexaminersusingabehavioralprobetoexamineperformancewithinaspecifictreatmenttask.ThemethodsareidenticaltothosedescribedinFig.3.3.

AlternateFormsReliability

Alternateformsreliabilityisstudiedtoaddressconcernsaboutconsistencyacrossvaryingformsofthetest.Multipleversionsofatest,termedalternateorparallel
forms,tendtobecreatedwhenatestwillprobablybeusedonmorethanoneoccasionwithanindividual,thusmakingrepeattestingsubjecttopossiblecarryover
effects.Alternateformsarecreatedbyselectingitemsforeachformfromacommonpoolofpossibleitems.Alternateformsreliabilityisstudiedbyadministeringone
version,thenanother(balancedsothathalfofthetesttakerswilltakeoneversionfirstandtheotherhalfwilltaketheotherversionfirst),andthencalculatinga
correlationcoefficientfortheresultingtwosetsofscores.Oftentheintervalbetweentestingsisveryshort,andthecorrelationcoefficientisthoughttoreflectonly
differencesintheformused.Iftheintervalislonger,however,theresultingcorrelationcoefficientcanbeexpectedtoreflectnotonlydifferencesincontentbetweenthe
twoforms,butalsochangesduetotime.Therefore,informationabouttheintervalbetweentestingsshouldbereportedaspartofthetestdevelopersdescriptionofthe
study.

Alternate,orparallel,formsarerarelyprovidedfortestsusedwithchildrenwhohavedevelopmentallanguageproblems.Theyaretypicallyreservedforteststhatare
usedwithgreaterfrequency,suchassomeeducationalandintelligencetests.Nonetheless,thereareasmallnumberoftests(e.g.,thePPVTIII,Dunn&Dunn,1997)
thatdoprovidethisinformation,whichiswhyitisconsideredhere.

FactorsAffectingReliability

Anyfactorthatincreasesthelikelihoodthatnonsystematicerrorwillenterintothetestingsituationwill,bydefinition,decreaseameasuresmeasuredreliability.
Consequently,anylackofsimilaritybetweentestingconditionsduringastudyoftestretestreliabilityorinterexaminerreliability,forexample,arelikelytoresultinlower
reliabilitycoefficients.Inaddition,thereareacoupleoffactorsthatmaynotbesoobviousthatwilldistortthemagnitudeofreliabilitycoefficients.Thesearediscussed
furtherinavarietyofsources,includingNitko(1983)andGronlund(1993).

First,thelengthofthemeasureusedwillaffectthesizeofthereliabilitycoefficient.Ingeneral,thelongerameasure,thegreateritsreliability.Thisfactorpresentsa
significantchallengetothosewishingtodeveloptestsfortesttakerswithshorterattentionspans(e.g.,children!).

Second,thespecificgrouponwhichreliabilityisstudiedmayaffectthesizeoftheobtainedreliabilitycoefficient.Onereasonforthisisaphenomenonknownasrestric
Page72

tionofrange.Whatthatmeansisthatwhenthereislittlevariabilityinperformanceinadistributionofscores(therestrictedrange),thesizeofthecorrelationcoefficient
willbesmallerthanifthesamepatternofvariationwereextendedoveralargerrangeofscores.

Anotherreasonforthepossibilityofspecificgroupsaffectingthesizeofreliabilitycoefficientsisthatcharacteristicsofonegroupmaymakeitsusceptibletoerrorthat
doesnotaffectadifferentgroup.TaketheperformanceonanIQtestofonegroupwithandonegroupwithoutanidentifiedlearningdisability.Theabilityofthosetwo
groupstoperformconsistentlyunderthesameconditionsmaynotbethesame,leadingtodifferingresultsifreliabilitycoefficientsweretobecalculatedforeachgroup.
Thedangerwouldbe,however,thatratherthanlookingforevidenceforeachgroupseparately,onewouldconsiderevidenceaboutthegroupwithoutanidentified
learningdisabilityassufficientforbothgroups.Here,ashasbeenstressedbefore,theadequacyofevidenceconcerningreliability(andvalidity)needstobeconsidered
inlightofthespecificcircumstances(whoisbeingmeasuredandforwhatpurpose)motivatingtheclinicianssearchforanappropriatemeasure.Inthenextchapter,
proceduresarepresentedthataredesignedtohelpyoulearnhowtoevaluateindividualmeasureswithinaclientorientedframework.

Summary

1.Althoughbehavioralmeasurementhasrelativelyancientroots,clinicalandeducationaltestingbeganonlyattheendofthe19thcentury.

2.ThemostinfluentialstandardsdevelopedforeducationalandpsychologicaltestinghavebeenthoseofAPA,AERA,andNCME(1985).Thesestandardsapplyto
allbehavioralmeasures,butapplymoststrictlytostandardizedtests.

3.Thetestuserisresponsibleforassuringthataspecificmeasureislikelytoprovidetheinformationbeingsought(i.e.,thatthemeasureisavalidmeasureforthe
purposetowhichitwillbeput).

4.Becauseallevidenceofvaliditydependsondemonstrationsthatthemeasurecapturesthetheoreticalconstructitwasintendedtoassess,constructvaliditycanbe
seenastheoverarchingframeworkofvalidation.Asaresultofhistoricalfactors,however,threetypesofevidencearetypicallydiscussed:constructvalidity,content
validity,andcriterionrelatedvalidity.

5.Fourspecificmethodsofconstructvalidationincludethedevelopmentalmethod,thecontrastinggroupsmethod,factoranalyticstudies,andstudiesofconvergent
anddiscriminantvalidity.

6.Contentvalidationactivitiesoccuraspartofthedevelopmentprocess(e.g.,documentationofthetestplan,itemanalyses)and,followingdevelopment,aspartof
validationactivities.

7.Standardizedmeasuresdesignedforcriterionreferencedinterpretationandfornormreferencedinterpretationaredevelopedusingsimilarsteps,butdifferinthe
methodsusedtomakedecisionsateachstep.
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8.Facevalidity,orpublicrelationsvalidityasitissometimescalled,involvesameasuresappearanceofvalidityratherthanthedegreeofvalidityitwillbeshownto
haveoncloser,systematicscrutiny.

9.Criterionrelatedvalidityinvolvesthecollectionofevidencesuggestingthatthetargetmeasureperformsinamannersimilartothatofanalreadyvalidatedcriterion
measure.Concurrentvalidityreferstocriterionreferencedvalidationstudiesinwhichthecriterionandthetargetmeasureareadministeredtotheparticipantatthesame
pointintime,whereaspredictivevalidityreferstostudiesinwhichthetargetmeasureisobtainedfirstandthecriterionatalatertime.

10.Validityisaffectedbyappropriatemeasureselection,testadministrationconditions,reliability,andclientfactorssuchasmotivationandenablingbehaviors.

11.Reliability(consistencyofmeasurement)placesanupperlimitonpossiblevalidity,butevenperfectreliabilitydoesnotensurevalidity.Reliabilityisthereforesaidto
beanecessary,butnotsufficientconditionforvalidity.

12.Studiesofreliabilityusuallytargetconsistencyacrosstestingoccasions(testretestreliability),acrosssubsetsoftestitems(internalconsistencyreliability),and
acrosstesters(interexaminerreliability).Forspeechlanguagepathologyandaudiologymeasures,consistencyacrosstestversions(alternateformreliability)ismuch
lessfrequentlyexamined.

13.Whenreliabilityinformationisreportedforaparticularmeasure,reliabilitycorrelationcoefficientsareusedmostfrequently.Whensuchinformationisreportedin
relationtoaspecificscoreobtainedbyanindividual,SEMisused.

14.Wheninformationaboutconsistencyissoughtforinformalmeasures,agreementmeasuresareusuallycalculated.Themostcommonmeasuresofagreementare
interexaminerandinterexamineragreement.

15.Classicaltruetestscoretheoryholdsthatthescoreactuallyreceivedbyanindividual(theobtainedscore)iscomposedoferrorandthetheoreticalscorethe
individualshouldreceive(thetruescore).

16.SEMcanbeusedtoconstructaconfidenceintervalwithinwhichonecandetermineahighprobabilityoffindingtheindividualstruescore.

17.Reliabilityisaffectedbytestlength(withfeweritemsresultinginlowerreliability)andbytherangeofabilitiesrepresentedinthereliabilitysubjects(withasmaller
rangeofabilitiesresultinginlowerreliability).

KeyConceptsandTerms

constructvalidation:theaccumulationofevidenceshowingthatameasurerelatesinpredictedwaystotheconstructitisbeingusedtomeasure.

contentvalidation:theaccumulationofevidencesuggestingthatthecontentincludedinameasureisrelevantandrepresentativeoftherangeofbehaviorsfittingwithin
theconstructbeingmeasured.
Page74

contrastinggroupsmethodofconstructvalidation:theaccumulationofevidencesuggestingthatgroupsknowntodifferintheextenttowhichthetestedconstruct
appliestothemalsodifferintheirperformanceonthetargetmeasure.

convergentanddiscriminantvalidation:theaccumulationofevidencesuggestingthatameasurecorrelatessignificantlyandhighlywithmeasuresaimedatthesame
construct(convergentvalidation)aswellasevidencethatthemeasuredoesnotcorrelatesignificantlyandhighlywithmeasurestargetingdifferentconstructs
(discriminantvalidation).

criterionrelatedvalidation:theaccumulationofevidencesuggestingthatthemeasureperformsinamannersimilartoanothermeasure(thecriterion)thatisbelieved
tobeavalidindicatoroftheconstructunderstudy,eitherwherebothcriterionandmeasureareadministeredatonepointintime(concurrentvalidation)orwiththe
criterionmeasuredatalaterpointintimethanthetargetmeasure(predictivevalidation).

developmentalmethodofconstructvalidation:theaccumulationofevidencesuggestingthatperformanceonameasurechangeswithage(usuallyimproves),when
themeasureismeanttotargetaconstructthatisthoughttochangewithage.

enablingbehaviorsandknowledge:behaviorsnotrelatedtotheconstructunderstudythatarenonethelessrequiredforsuccessfultestperformance(e.g.,visionfor
tasksusingvisualstimuli,previousexposuretovocabularybeingused).

facevalidity:theappearanceofvalidityofameasure,whichisnotnecessarilyreflectiveofitsactualvalidity.

factoranalysis:anumberofstatisticalproceduresusedduringtestdevelopmentandconstructvalidationtodescribeandconfirmtherelationshipsofanumberof
variables.

informalmeasure:ameasuredevelopedforalimitedmeasurementpurposeforwhichastandardizedmeasurewasinappropriateorunavailableforexample,probes
designedbyspeechlanguagepathologiststoassesslearningwithinatreatmentsessionareusuallyinformalmeasures.

interexamineragreement:theextenttowhichresultsofameasureagreewhenitisadministered,scored,orinterpretedbytwoormoreexaminers.

interexaminerreliability:theconsistencyofameasureacrosstwoormoreexaminers,alsotermedinterjudgereliability,interobserverreliability,andintertester
reliability.

internalconsistency:theconsistencyofameasureacrosssubdivisionsofitscontent,usuallymeasuredusingsplithalfreliability,KR20,orcoefficient.

itemanalysis:avarietyofproceduresappliedtothepoolofitemsbeingconsideredforinclusioninameasurethatexamineitspossiblecontributionstotheoverall
measure.

observedscore:thescoreactuallyachievedbyagiventesttakerusuallycontrastedwithtruescoreinclassicaltruescoretheory.
Page75

reliability:consistencyofameasureacrosschangesintime(testretest),intheindividualadministeringorscoringit(interexaminer),andinthespecificitemsitcontains
(internalconsistency).

standarderrorofmeasurement(SEM):ameasureofreliabilitythatisexpressedintermsoftheoriginalunitsofmeasurement(e.g.,numberofitems).

testretestreliability:theconsistencyofameasurethatisadministeredattwopointsintime.

test:abehavioralmeasureinwhichastructuredsampleofbehaviorisobtainedunderconditionsinwhichthetestedindividualisassumedtoperformathisorher
best(APA,AERA,&NCME,1985).

truescore:atheoreticalvaluethathypotheticallywouldbeobtainedbyatesttakerifthemeasurebeingusedwereperfectlyreliable,thatis,wereunaffectedbyerror

validity:theextenttowhichameasureactuallymeasureswhatitclaimstomeasure.

StudyQuestionsandQuestionstoExpandYourThinking

1.Definevalidity.

2.Chooseaspecifictestdealingwithchildlanguage.Comparesourcesofinformationaboutitscontent:(a)contentimpliedbythetitle,(b)itsapparentcontentonthe
basisoftheauthorsoverviewstatementsconcerningtheintendedpurposeofthetestanditsintendedcontent,and(c)individualitems.Howmightanaivetestuserbe
misledifheorsheonlyconsidersthetitle?

3.Describethethreemajorkindsofvalidityevidenceandtheirrelationshipswithoneanother.

4.Translatethefollowingsentenceintoaformthatsomeoneunfamiliarwithtestingwouldbeabletounderstand:Reliabilityisanecessarybutnotsufficientconditionfor
validity.

5.Listthestepsrequiredinthedevelopmentofastandardizedmeasure.Compareandcontrastthesestepsastheyapplytocriterionversusnormreferenced
measures.

6.Imaginethatyouvesetupataskwith20itemsthatyoubelievemaybedifficultforyoutorateconsistentlyascorrectorincorrect.Whatprocedurewouldyouuse
toobtainameasureofyourconsistencyinratingtheseitems.

7.Listthreefactorsknowntoaffectvalidity.

8.Listthreefactorsknowtoaffectreliability.

9.Explainhowtheamountofvariabilityintestscoresaffectsthemagnitudeofcorrelationcoefficients.Whatimplicationsdoesthiseffecthavefortestdevelopers?

10.Whatismeantbytheconvergentdiscriminantapproachtoconstructvalidity?

11.Howdoesreliabilityrelatetoclassicaltruescoretheory?
Page76

12.Whyisinternalconsistencyassociatedwiththreemeasures:splithalfreliability,KR20,andcoefficient?

13.Listfiveenablingbehaviorsrequiredfortheperformanceofapicturevocabularytestinwhichthetesttakerisrequiredtolistentothenameofanactionandpick
outapicture(fromagroupof4)thatcorrespondstotheaction.

14.Reflectonsituationsinwhichateacher,coach,orparenthashelpedyoudosomethingthatyoufoundparticularlydifficult.Whatdidtheydothathelpedyoufeel
motivatedtotrythatdifficultsomething?Howmightyouapplythesameapproachtothetestingofareluctantchild?

RecommendedReadings

AmericanEducationalResearchAssociation,AmericanPsychologicalAssociation,andNationalCouncilonMeasurementinEducation.(1985).Standardsfor
educationalandpsychologicaltesting.Washington,DC:AmericanPsychologicalAssociation.

Gronlund,N.E.(1993).Howtomakeachievementtestsandassessments.(5thed.).Boston:Allyn&Bacon.

Lyman,H.B.(1963).Testscoresandwhattheymean.EnglewoodCliffs,NJ:PrenticeHall.

McReynolds,L.,&Kearns,K.(1983).Singlesubjectexperimentaldesignsincommunicativedisorders.Baltimore:UniversityParkPress.

Messick,S.(1989).Validity.InR.L.Linn(Ed.),Educationalmeasurement(3rded.,pp.13103).NewYork:AmericanCouncilonEducationandMacmillan.

Sattler,J.(1988).Assessmentofchildren(3rded.).SanDiego,CA:Author.

References

Allen,M.J.,&Yen,W.M.(1979).Introductiontomeasurementtheory.Monterey,CA:Brooks/Cole.

AmericanPsychologicalAssociation.(1954).Technicalrecommendationsforpsychologicaltestsanddiagnostictechniques.Washington,DC:Author.

AmericanPsychologicalAssociation,AmericanEducationalResearchAssociation,andNationalCouncilonMeasurementinEducation.(1985).Standardsfor
educationalandpsychologicaltesting.Washington,DC:AmericanPsychologicalAssociation.

Anastasi,A.(1954).Psychologicaltesting.NewYork:Macmillan.

Anastasi,A.(1980).AnneAnastasi.InG.Lindzey(Ed.),Ahistoryofpsychologyinautobiography(pp.137).SanFrancisco:W.H.FreemanandCompany.

Anastasi,A.(1988).Psychologicaltesting(6thed.).UpperSaddleRiver,NJ:PrenticeHall.

Berk,R.A.(1984).Screeningandidentificationoflearningdisabilities.Springfield,IL:CCThomas.

Bzoch,K.R.,&League,R.(1991).ReceptiveExpressiveEmergentLanguageTest(REEL2).Austin,TX:ProEd.

Campbell,D.P.,&Fiske,D.W.(1959).Convergentanddiscriminantvalidationbythemultitraitmultimethodmatrix.PsychologicalBulletin,56,81105.

Carver,R.P(1974).Twodimensionsoftests:Edumetricandpsychometric.AmericanPsychologist,29,512518.

Cordes,A.K.(1994).Thereliabilityofobservationaldata:I.Theoriesandmethodsforspeechlanguagepathology.JournalofSpeechandHearingResearch,37,
264278.

Cronbach,L.J.,Gleser,G.D.,Nanda,H.,&Rajaratnam,N.(1972).Thedependabilityofbehavioralmeasurements:Theoryofgeneralizabilityforscoresand
profiles.NewYork:Wiley.

Dunn,L.,&Dunn,L.(1997).PeabodyPictureVocabularyTestIII.CirclePines,MN:AmericanGuidanceServices.
Page77

Fleiss,J.L.(1981).Statisticalmethodsforratesandproportions.NewYork:Wiley.

Fredericksen,N.,Mislevy,R.J.,&Bejar,I.I.(Eds.)(1993).Testtheoryforanewgenerationoftests.Hillsdale,NJ:LawrenceErlbaumAssociates.

German,D.J.(1986).TestofWordFinding.Allen,TX:DLMTeachingResources.

Glaser,R.(1963).Instructionaltechnologyandthemeasurementoflearningoutcomes.AmericanPsychologist,18,519521.

Glaser,R.,&Klaus,D.J.(1962).Proficiencymeasurement:Assessinghumanperformance.InR.Gagne(Ed.),Psychologicalprinciplesinsystemsdevelopment
(pp.419476).NewYork:Holt,Rinehart&Winston.

Gronlund,N.(1993).Howtomakeachievementtestsandassessments.(5thed.).Boston:Allyn&Bacon.

Hammill,D.D.,&Newcomer,P.L.(1997).TestofLanguageDevelopmentIntermediate3.CirclePines,MN:AmericanGuidanceService.

Hresko,W.,Reid,D.,&Hammill,D.D.(1981).TestofEarlyLanguageDevelopment.LosAngeles:WesternPsychologicalAssociates.

Hsu,J.R.,&Hsu,L.M.(1996).Issuesindesignresearchandevaluatingdatapertainingtochildrenssyntacticknowledge.InD.McDaniel,C.McKee,&H.S.
Cairns(Eds.),Methodsforassessingchildrenssyntax(pp.303341).Cambridge,MA:MITPress.

Kent,R.D.,Kent,J.F,&Rosenbek,J.C.(1987).Maximumperformancetestsofspeechproduction.JournalofSpeechandHearingDisorders,52,367387.

Kuder,G.F.,&Richardson,M.W.(1937).Thetheoryofestimationoftestreliability.Psychometrika,2,151160.

Maynard,D.W.,&Marlaire,C.L.(1999).Goodreasonsforbadtestingperformance:Theinteractionalsubstrateofeducationaltesting.InD.Kovarsky,J.Duchan,
&M.Maxwell(Eds.),Constructing(in)competence(pp.171196).Mahwah,NJ:LawrenceErlbaumAssociates.

McReynolds,L.V.&Kearns,K.P.(1983).Singlesubjectexperimentaldesignsincommunicativedisorders.Baltimore:UniversityParkPress.

Messick,S.(1989).Validity.InR.L.Linn(Ed.),Educationalmeasurement(3rded.,pp.13103).NewYork:AmericanCouncilonEducationandMacmillan.

Mislevy,R.J.(1993).Foundationsofanewtesttheory.InN.Fredericksen,R.J.Mislevy,&I.I.Bejar(Eds.),Testtheoryforanewgenerationoftests(pp.19
40).Hillsdale,NJ:LawrenceErlbaumAssociates.

NationalEducationAssociation.(1955).Technicalrecommendationsforachievementtests.Washington,DC:Author.

Nitko,A.J.(1983).Educationaltestsandmeasurement:Anintroduction.NewYork:HarcourtBraceJovanovich.

Pedhazur,R.J.,&Schmelkin,L.P.(1991).Measurement,design,andanalysis:Anintegratedapproach.Hillsdale,NJ:LawrenceErlbaumAssociates.

Salvia,J.,&Ysseldyke,J.E.(1995).Assessment(6thed.).Boston:HoughtonMifflin.

Semel,E.,Wiig,E.H.,&Secord,W.(1987).ClinicalEvaluationofLanguageFundamentalsRevised.SanAntonio:ThePsychologicalCorporation.

Stillman,R.,Snow,R.,&Warren,K.(1999).Iusedtobegoodwithkids.EncountersbetweenspeechlanguagepathologystudentsandchildrenwithPervasive
DevelopmentalDisorders(PDD).InD.Kovarsky,J.Duchan,&M.Maxwell(Eds.),Constructing(in)competence(pp.2948).Mahwah,NJ:LawrenceErlbaum
Associates.

Stevens,G.,&Gardner,S.(1982).Thewomenofpsychology.Cambridge,MA:Schenkman.

Torgesen,J.K.,&Bryant,B.R.(1994).TestofPhonologicalAwareness(TOPA).Austin,TX:ProEd.

VanRiper,C.,&Erickson,R.(1969).Apredictivescreeningtestofarticulation.JournalofSpeechandHearingDisorders,34,214219.

Zimmerman,I.L.,Steiner,V.G.,&Pond,R.E.(1992).PreschoolLanguageScale3.SanAntonio,TX:PsychologicalCorporation.
Page78

CHAPTER
4

EvaluatingMeasuresofChildrensCommunicationandRelatedSkills

ContextualConsiderationsinAssessment:TheBiggerPictureinwhichAssessmentsTakePlace

EvaluatingIndividualMeasures

Inthelastchapter,youwereintroducedtothemostimportanttestrelatedconsiderationsforevaluatingindividualmeasures:validityandreliability.Inthischapter,you
willlearnaboutfactorstoconsiderinevaluatingmeasuresandabouthowtoperformsuchanevaluationaprocessthatmakesthemostsensewhenthefocusisshifted
awayfromthetestitselfandtowardthereasonforitsuse:thechildinquestionandthelargerworldinwhichheorshemoves.

Speechlanguagepathologistsusemeasurementinformationtoachievegoalsaffectingchildrenshealth,development,familylife,education,andsocialwellbeing.They
obtainthisinformationcooperatively(workingprimarilywithfamiliesandotherprofessionals)andshareitwithothersasameansofachievingthechildsgreatestgood.
Thiscooperativepursuitonbehalfofthechildisnotsimplyapracticalmatter,althoughitcertainlyaffectsthelogisticsofmeasurementinverypracticalways.Rather,a
richunderstandingofthewayinwhichchildrensinteractionswiththeworldaremediatedbytheirfamilyandcultureiscriticaltoframingquestionsthatwillresultin
validresponsestothechildsneeds.Alsoneeded,however,isanappreciationthattheclinicianbringshisorherownhistory,culture,andworkplaceconstraintstothe
questionaskingsituation
Page79

allofwhichwillalsobearonwhichquestionsareaskedandhowtheyareanswered.Inthefirsthalfofthischapter,Idiscussthelargercontextofmeasurement,
focusingfirstonfactorsaffectingthechildandthenonfactors,thatmoredirectlyimpingeontheclinician.Figure4.1illustratesavisualmodelforthinkingaboutthis
largercontext.

ContextualConsiderationsinAssessment:TheBiggerPictureinWhichAssessmentsTakePlace

In1974,UrieBronfenbrennerwasresponsibleforanevaluationofthedevelopmentalresearchofthaterawhichcanstillchilltheheartofresearchersandclinicianswho
studychildreninhighlystructuredcontexts.Specifically,hedescribedthatresearchasthestudyofthestrangebehaviorofchildreninstrangesituationsforthebriefest
possibleperiodoftime(Bronfenbrenner,1974).Thisquotationbringsintosharpfocusadeepconcernthatresearcherswerefailingtocapturetheessentialfactors
affectingthechildbyfailingtostudythemandtheirmostinfluentialcompanions(usuallyparents)inthenaturalsituationsinwhichdevelopmentoccurs.Shiftingspecies
forasecond,onecouldsaythatessentiallyBronfenbrennerpointedoutthatdrawingconclusionsaboutchildreninreallifefromexistingresearchparadigmswasakinto
concludingthatoneknewaboutlionsinthewildbyobservinglionsmovingaroundtheartificialrocks,caves,andpondsoftheirenclosureinazoo.Anyonewhohas
seenawildeyed,noncompliant,andvirtuallynonverbalchildleaveaclinicroomtobeginafastpaced,detailedlitanyofhisordealscanunderstandBronfenbrenners
pointaswellastherelevanceofthelionanalogy.

AvastresearchliteraturewasspawnedbyBronfenbrennerscriticismandbytheprogramofresearchheandothersundertooktounderstanddevelopmentthrough
observationsofchildrenandtheircaretakersinreallifesettings.Theresultingliteratureisassociatedwithanevolvingtheoryofdevelopment(Bronfenbrenner,1986
Bronfenbrenner&Morris,1998)thatcanprovideuswithavaluablestartingpointforthinkingaboutthelargercontextofassessment.

Arecentarticulationofthismodel(Bronfenbrenner&Morris,1998)wasdescribedbyitsauthorsasabioecologicalmodelofdevelopmentbecauseitemphasizes
boththechildscharacteristicsandthecontextinwhichdevelopmentoccursascontributorstotheprocessofdevelopment.Amongthemostobviousmodifications
representedinthisversionofthemodelaretheplacingofgreateremphasisbothonbiologicalfactorsaffectingthechildandthosearoundhimorherandonthechilds
roleinaffectinghisorherenvironmentaswellasbeingaffectedbyit.Theenduringcentralcomponentofthemodel,however,andthecomponentthatwasmost
neededandchampionedinspeechlanguagepathology,isitscelebrationoftheimportanceofthechildsenvironmenttodevelopmentalprocesses,especiallythesocial
environment(Crais,1995Muma,1998).InthefollowingpagesIbrieflydiscusshowcurrentthoughtsonthecontextsoffamily,language,culture,andsocietyasa
wholecontinuetoshapeandreshapeviewsofvalidlanguageevaluationandhowaspectsoftheclinicianscontextalsoaffecttheevaluationofchildrenslanguage.
Page80

Fig.4.1.Amodeloffactorsaffectingthechildandtheclinicianintheassessmentprocess.FromAssessingandscreeningpreschoolers:Psychologicaland
educationaldimensions(p.6),byVasquezNuttall,Romero,andKalesnik,Boston:Allyn&Bacon.Copyright1999byAllyn&Bacon.Adaptedbypermission.
Page81

FamilialContexts

Whyshouldfamiliesbeseenasthecentralforumforlanguagedevelopmentand,thus,languageassessment?Fromthetimethechildisborn,thefamilyconstitutesthe
mostbasicandenduringofcontextsinwhichchildrenspendtheirtimeandtheirenergies.Further,thefoundationofcommunicationandlanguageisestablishedwiththe
giveandtakeofearlyfeedingandproceedsonwardtoallattainedlevelsoflinguisticachievement.

Althoughthesetruthshaveprobablyalwaysbeenrecognizedbyprofessionalsatsomelevel,theyhavetendedtobeoverlookedinmeasurementpracticesuntilthe
diffusionoftheoriessuchasthatproposedbyBronfenbrennerledtopoliticalaction.Specifically,theEducationoftheHandicappedActAmendmentsof1986required
IndividualEducationalPlans(IEPs)forchildrenages3to5andIndividualizedFamilyServicePlans(IFSPs)forchildrenyoungerthan3.Throughtheserequirements,
thelawembodiedtheperspectivethatbecauseoftheintertwinedandinterdependentnatureofchildandfamilyneeds,effectiveevaluationandinterventionforchildren
requiresinclusionofthefamilyascollaboratorsthatis,asactiveagentsinthelifeandaffairsofthechildratherthanaspassiverecipientsofprofessionalactivities.
Particularlyforchildrenbelowtheageofthree,thisperspectivewasseenascrucial,hencetherequirementoftheIFSPforthatagegroup.

WithintheIFSPprovisions,assessmentsincludeinformationaboutfamilystrengths,needs,andvariablesrelatedtoprogramservices,aswellasaboutthechilds
currentleveloffunctioning(Radziewicz,1995).Radziewicznotedthateffectivefamilyassessmentisconductedinamannerthatispositiveforthefamily,respectfulof
thefamilysvalues,inclusiveofkeyfamilymembers,nonintrusive,andaimedattargetingfamilyneedsandresources(Radziewicz,1995).Newtypesoftoolshavebeen
developedtoaddressclinicalquestionsconcerningthenatureofthefamilyandofparentchildinteractions.Radziewicz(1995)andCrais(1992,1995)provided
excellentdiscussionsofthese.

Inadditiontoservingasafocusofattentionofprofessionals,however,parentsandfamilieshavebecomemoreactivelyinvolvedinavarietyofclinicalactivities,
includingscreening,providingdescriptionsandotherdata,validatingevaluationfindings,andevenadministeringsometests.Althoughtheseactivitiesaredescribedin
laterchapters,theyarementionedheretohelpyoubecomeawarethatyourconsiderationofaninstrumentsvaliditywilloftenincludethinkingaboutthesuitabilityofits
usewithandbyparents.Notsurprisingly,thisneedisgreatestforyoungerchildrenandinfantsandforchildrenwhoaremoreaffectedbytheirdifficulties.

CulturalLinguisticContextsforAssessment

Justasthechildisembeddedwithinhisorherfamily,sotooisthefamilyembeddedwithinaspecificcultureandlinguisticcontext.Thus,effectiveinteractionwith
familiesdependsnotsimplyontheclinicianschoosingtoincludethemintheprocess,butalsoonherorhisknowledgeofeachfamilysculturalandlinguistic
expectations.Thevarietyofculturalandlinguisticdifferencesaffectingacliniciansinteractionwith
Page82

parentsisquiteawesome.Amongjustafewofthedifferencesdiscussedinagrowingliterature(Damico,Smith,&Augustine,1996DonahueKilburg,1992van
Kleeck,1994)arethefollowing:

1. differencesinchildrearingpractices(e.g.,theappropriatenessofaskingchildrentoengageinquestionaskingortoreciteinformationalreadyknownby
listeners)
2. differencesinpatternsofdecisionmakingwithinfamilies(e.g.,whichfiguresareseenasprimarydecisionmakers)
3. differencesinfamilychoicesconcerninglanguageanddialectuse(e.g.,whetherchildrenareexpectedtousethelanguageofthehome)
4. anddifferencesinhowdifficultiesincommunicationareviewed(e.g.,howtheyareviewedasaffectingthefamilyandchild).

Differencessuchasthesecanaffectthenatureandextentofcommunicationsoccurringbetweencliniciansandparents,howtheyareincludedintheirchildscare,the
natureofintervention,andmostimportantlyforthepurposesofthisbookhowlanguageevaluationsareplanned,executed,andactedon.Also,becauseevaluations
arepromptedbyheightenedparentalconcernorcanacttopromoteparentsfocusontheirchild,evaluationsthatsuccessfullyinvolveparentscanalsoenlistparents
continuingengagementinwaysthatarecriticaltothechildssuccess.Table4.1summarizesreportedtrendsintheattitudesofAsianAmericans,AfricanAmericans,
andHispanicAmericanstowardchildren,family,andchildrearing.Ofcourse,thesetrendsrepresentprejudices,thatis,prejudgments,ofatype:Thereissimplyno
substituteforfindingouthowaspecificfamilyfunctionsandwhatitsattitudesare,regardlessofitsculture.

Thateachchildisalsoamaturinguserofambientlanguage(s)anddialect(s)willaffectassessmentdramatically.Mostobviously,cliniciansareawareofthiswhenthey
areaskedtoassessthecommunicationskillsofachildwhosefirstlanguageisnotthesameastheirown,andtheymustdecidewhetherandhowtheycanbeinvolved
withthechild.Cliniciansarealsoawareofthiswhentheyservechildrenwhodifferinsocialorregionaldialectfromthemselves.Inbothcases,theclinicianmustoften
determinewhetherthedifferencesfromthemainstream,dominant,orschoollanguageareduetolanguagedisorderortodifficultiesspecifictosecondlanguageor
dialectacquisition(e.g.,inadequateexposure,transferenceeffectsfromthefirstlanguageordialect,motivationaldifferencesbetweenfirstandsecondlanguage
acquisitionDamicoetal.,1996).

Issuesrelatedtothepresenceofculturallyandlinguisticallydiverseclientswasonceseenasamatterofsporadicsignificance.Onceitwasconsideredmoreimportant
inbiggercitieswithlargerimmigrantpopulationsandingeographicregionswithgreatercultural,ethnic,anddialectaldiversity.Now,howeverithasbeenestimatedthat
oneineverythreeAmericansisAfricanAmerican,Hispanic,AsianAmerican,orAmericanIndian(AmericanSpeechLanguageHearingAssociation[ASHA],1999).
Althoughnationallyandglobally,diversityinlanguageandcultureistheruleratherthantheexception,thatfactisnotrepresentedinthedemographicsoftheprofessions
of
Page83

Table4.1
TrendsinAttitudesTowardChildren,Family,andChildRearing

AsianAmericans
l Strictgenderandageroles
l Fatherthefamilyleader,headoffamily
l Motherthenurturer,caregiver
l Oldermalessuperiortoyoungermales
l Femalessubmissivetomales
l Close,extendedfamilies
l Multigenerationalfamilies
l Olderchildrenstrictlycontrolled,restricted,protected
l Physicalpunishmentused
l Parentsactivelypromotelearningactivitiesathomemaynotparticipateinschoolfunctions
l Childrenaretreasured
l Infant/toddlerneedsmetimmediatelyoranticipated
l Closephysicalcontactbetweenmotherandchild
l Touchratherthanvocal/verbalisprimaryvehicleofearlymotherinfantinteraction
l Harmonyofsocietymoreimportantthanindividual
l Infantseenasindependentandneedingtodevelopdependenceonfamilyandsociety
AfricanAmericans
l Mothersandgrandmothersmaybegreatestinfluences
l Strongextendedfamilytiesareencouraged
l Independenceandassertivenessencouraged
l Infantsmaybefocusoffamilyattention
l Affectionatetreatmentofbabies,butfearofspoiling
l Strongbeliefindiscipline,oftenphysical
l Caregivingofoldertoddlermaybedonebyanolderchild
HispanicAmericans
l Strongidentificationwithextendedfamily
l Familiestendtobepatriarchalwithmalesmakingmostdecisions
l Infantstendtobeindulgedtoddlersareexpectedtolearnacceptablebehavior
l Emphasisplacedoncooperativenessandharmonyinfamilyandsociety
l Independenceandabilitytodefendselfencouraged
l Oldersiblingsoftenparticipateinchildcare

Note.FromFamilyCenteredEarlyInterventionforCommunicationDisorders:PreventionandTreatment(p.21),byG.DonahueKilburg,1992,
Gaithersburg,MD:Aspen.Copyright1992byAspen.Reprintedwithpermission.

speechlanguagepathologyandaudiology.Thus,cliniciansareincreasinglyfacedwiththespecialchallengeofenlargingtheirunderstandingofotherculturesand
linguisticcommunitiesandtheskillsrequiredtoimplementthatunderstandingintheirwork.

Theprocessofrespectingdiversityinchildrenandintheirfamiliespervadesallphasesofclinicalinteraction.Becauseitiscriticaltovalidscreening,identification,
description,andassessmentsofchange,diversityarisesasacontinuingpointofdiscussionthroughouttheremainderofthistext.Ihighlightitherebecauseofits
particularrelevancetothetestreviewprocessdiscussedlaterinthischapter.
Page84

SocietalandLegalContexts

Justasthechildwhoselanguagedevelopmentisindoubtexistsasamemberofalargercommunity,sotooisthespeechlanguagepathologistwhoservesthechild.He
orsheisalsoaparticipantinthelargersocialcontextsofagivenprofessionandworkplacewithinaparticulartimeandplaceagivenerawithinagivenschooldistrict
orinstitution,state,andcountry.Eachofthesecontextualfactorscanaffectdecisionsaboutassessment.Arecentdiscussionoftherolesandresponsibilitiesofschool
speechlanguagepathologists,containedwithinanextensiveASHAdocumentavailableontheirwebsite,emphasizedthisfact(ASHA,1999).Table4.2includesjusta
smallnumberofthemanyfactorsASHAdescribedasaffectingclinicalpracticewithchildren.Inthisbriefsection,twoparticularlycompellingsourcesofeffectson
measurementpracticeareaddressed:nationallegislationandchangingglobalperspectivesondisablement.

NationalLegislation

Asmentionedbrieflyintermsofregulationsregardingfamilyinvolvement,legalinfluencesonhowchildrenareevaluatedforlanguageproblemsrepresentsomeofthe
mostpowerfulinfluencesinclinicalpractice.Inparticular,federallegislationestablishingthewaysinwhichpublicschoolsaddresstheneedsofchildrenhashad
profoundeffectsonhowchildrensproblemsarescreened,identifiedandaddressed(ASHA,1999Demers&Fiorello,1999).Thus,asdescribedearlier,itwas
throughEducationoftheHandicappedActAmendmentsof1986thatideasabouttheneedforgreaterattentiontofamiliesbecameapotentfactorinshapingactual
practice.Inthissection,Ipointouttheevenbroadereffectsthathaveresultedfromanumberofotherlegislativeinitiatives,payingparticularattentiontothe
IndividualswithDisabilitiesEducationAct(IDEA),whichwaspassedin1990.

TheIDEAbuiltonandmodifiedearlierlegislation,includingtwolandmarkfederallaws:theEducationforAllHandicappedChildrenActof1975(P.L.94142),which
establishedmanynowstandardfeaturesofeducationalattentiontochildrenwithspecialneedsandEducationoftheHandicappedActAmendments(1986),which
mandatedservicesforthosechildrenfrombirthtoage21,inadditiontoitsroleinpressingforgreaterinclusionoffamiliesineducationalevaluations.Since1990,the
IDEAhasbeenamended(IDEAAmendmentsof1997)andhashadregulationsdevelopedforitsimplementation.

Table4.2
ABriefListofSomeoftheContextualFactorsAffectingSpeechLanguagePathologyPracticeAmongSchoolBasedClinicians(ASHA,1999)

l Specificfederallegislativeactions(e.g.,theIndividualswithDisabilitiesEducationActof1990)
l Stateregulationsandguidelines
l Localpoliciesandprocedures
l Staffingneeds
l Caseloadcompositionandseverity
l Cutbacksineducationbudgets
l Personnelshortages
l Expandingroles
Page85

TheIDEAandthe1997amendmentstoitmaintainednumerouselementsoftheearlierlegislation.Amongthemostimportantofthesemaintainedfeaturesisamandate
fornondiscriminatoryassessment.Insuchassessments,itisrequiredthatmeasuresbeadministeredinthechildsnativelanguagebytrainedpersonnelfollowingthe
proceduresoutlinedinthetestmanual.Inaddition,thesemorerecentlawsdictatethatvalidityinformationforatestbespecifictothepurposeforwhichthetestisused.
Further,thislegislationrequiresthatevaluationsofchildrenbecomprehensive,multifactored,andconductedbyaninterdisciplinaryteam.Althougheachofthese
componentswasviewedasthebestpracticeatthetimeoflegislation,legislationandthepotentialforlitigationwherelegislationisnotfollowedgiverisetotheactual
implementationofprofessionalandacademicrecommendations.However,itsimportanttorecognizethatlegislationisnotalwaysinaccordwithbestpractices,asI
discussinlatersections.

NewprovisionsoftheIDEA,itsamendments,andthemorerecentdevelopmentofregulationsimplementingitincludesomechangesinnomenclature,suchas
abandonmentofthetermhandicappedforthetermdisabledasthedesignationgiventochildrencoveredbythelaw.Inaddition,theselegalactionshaveadded
severalnewseparatedisabilitycategories,withautismbeingthemostrelevanttodiscussionsoflanguagedisorders.Othernewelementsconsistofdemandsfor
increasedaccountabilitywithresultingincreasesindocumentationrequirementsandinsistencethatchildrensIEPscontaininformationconnectingthechildsdisabilityto
itsimpactonthegeneraleducationcurriculum(ASHA,1999Demers&Fiorello,1999).

Becauseofthelegislationdescribedabove,speechlanguagepathologistswhoworkwithchildreninschoolsareinvolvedinabroaderrangeofresponsibilitiesand
potentialroles(ASHA,1999).Thechildrentheyevaluatearemorediverseinage,language,andculture,andthecollaborativenatureoftheirworkhasincreased
dramatically.Also,cliniciansaremademoreaccountableforthevalidityoftheinstrumentstheyuseandthemethodstheyfollowinevaluatingclients.

Toagreatextent,theeffectsofnationallegislationaresupportiveofgoodmeasurementpractices.Atthesametime,however,legislationintroducescomplexityfor
clinicians,whofaceincreasingresponsibilities,increasingdemandsfordocumentation,andthepushtoreviseordevelopstrategiestodealwiththespecificwaysin
whichindividualstatesandschooldistrictsimplementfederallaw.SomeofthecomplicationstoclinicalpracticeintroducedbystateDepartmentsofEducationare
discussedastheyrelatetospecificmeasurementquestionsinlaterchapters.

WorldHealthOrganizationDefinitions

Ataninternationallevel,changesbroughtaboutbytheWorldHealthOrganization(WHO)oftheUnitedNationshaveaffectedassessmentpractices(WHO,1980).
Aspartofitschargetodevelopaglobalcommonlanguageinthefieldofhealth,WHOproposedguidelinesreflectingchangingviewsabouthealthanddepartures
fromhealththatwouldaffectawidearrayofsectors,includinghealthcare,research,planningandpolicyformation,andeducation.Specifically,in1980,WHO
developedtheInternationalClassificationofImpairments,Disabilities,andHandicaps(ICIDH),inwhichvarioustypesofoutcomesassociatedwithhealth
conditionswereconsidered.
Page86

The1980ICIDHclassificationrecognizedfourlevelsofeffects.Theselevelsaresummarizedherewithexamplestakenfromapplicationstolanguagedisorders.First,
thereisdiseaseordisorder,thephysicalpresenceofahealthcondition,forwhichalanguagedisordercanserveastheexample.Next,thereisimpairment,an
alterationofstructureorfunctioncausingtheindividualwiththeconditiontobecomeawareofit.Forchildrenwithlanguagedisorders,anexampleofapossible
impairmentwouldbeinappropriateuseofgrammaticalmorphemes.Thethirdlevelofeffectsisdescribedasdisability,analterationinfunctionalability.Forchildren
withlanguagedisorders,thedisabilityassociatedwiththeirdifficultiescouldbeadecreasedabilitytocommunicate.ThelastlevelrecognizedintheICIDHisthatof
handicap,whichisasocialoutcome.Thus,negativeattitudesonthepartofplaymatesorteacherstowardaffectedchildrenconstitutesapossiblehandicapassociated
withlanguagedisorder.

Althoughchangesinthesetermsandthereasonsforthosechangesarediscussedinamoment,Ifirstdiscusstwoimportantimplicationsofthisnewclassificationsystem
thathaveprovenmostsignificant.First,althoughthereisatendencyforthesefourtypesofeffectstoberelatedtooneanother(e.g.,formoreseveredisorderstobe
associatedwithgreaterhandicaps),thisisnotalwaysthecase.Forexample,itispossibleforahandicaptoexistapartfromthepresenceofadiseaseordisorder,as
mightbethecaseifsocietalprejudiceagainstanindividualoccurredintheabsenceofactualimpairment.Aspecificexamplemightbeifachildweretobeexcludedby
agroupofpeersbecauseofacleftlip,anobservablebutfunctionallyinsignificantdifference.

Similarly,itispossibleforamoresevereimpairmenttobeassociatedwithonlyamilddisabilityandminimalhandicapbecauseofsuccessfulcompensatorystrategieson
thepartoftheindividual,effectiveinterventionsonthepartofprofessionals,orboth.Imagineachildwithamoderatehearinglossacquiredafterinitialstagesof
languageacquisitionarecompletewhoexperienceshighoverallintelligence,strongmotivation,asupportivehomeenvironment,andeffectiveauditorymanagement.
Suchachildcouldbeexpectedtoexperiencelessereffectsoncommunicationeffectivenessandonsocialrolesthanwouldbeexpectedonthebasisoftheseverityof
hearinglossalone.Thisclassificationcausesonetoconsidertheroleofnotonlythechild,butalsoofhisorhersurroundingsindeterminingthenatureofnegativeeffects
experiencedbecauseofadisorder.

Asecondmajorimplicationofthe1980classificationisthateachofthefourlevelsofeffectsisunderstoodtobeassociatedwithdifferentmeasurementgoalsforboth
researchandclinicalpurposes.Forexample,measurementfocusedatthelevelofhandicaprequiresinformationabouthowachildssocialandeducationalrolesare
affectedbyhisorhercondition.Thiscontrastswithmeasuresfocusedatthelevelofimpairment,whichrequireinformationaboutthechildsuseofparticularlanguage
structures.Thegreaterattentionpaidtothelargerramificationsofhealthconditionscoincideswithanurgentpushinbothclinicalandeducationalsettingsformeasuring
andevaluatingtheeffectivenessofinterventionsintermsthesehigherordereffects.

Despitethewidespreadinfluenceofthe1980classificationsystem,dissatisfactionexistedwithitsterminologyandwiththewaysinwhichthesocialcontributionstothe
effectsofhealthconditionswashandled.Amongspecificcriticismswasthatterminologywassometimesconfusingandincludedtheuseofpotentiallyoffensiveterms
Page87

suchashandicap(Frattali,1998).Themodelunderlyingtheclassificationwasalsocriticizedforfailingtorepresenttheinfluenceofcontextualfactors.

Becauseofconcernsaboutthe1980classificationsystem,adraftrevisionwasputforwardin1997forcommentandfieldtesting,withanexpectedfinalapprovaldate
forafinalversionin2000(WHO,1998).TheproposedclassificationsystemiscalledtheICIDH2:InternationalClassificationofImpairments,Activities,and
Participation(WHO,1998),reflectingsignificantchangestothetheoreticalorientationfromtheearlierclassificationofImpairments,Disabilities,andHandicaps.
Thedetailsofthefinalrevisionremainindefiniteatthemoment.Nonetheless,thecurrentdraftwarrantsdiscussionbecauseofitsvalueasanindicatorofemerging
trendsandbecauseitfitssnuglywiththeviewofchildrenadvanceduptothispointinthechapterthatis,asdeeplyaffectingandaffectedbytheirenvironment.

Asitsmostimportantchange,the1997classificationisdesignedtoembraceamodelinwhichhumanfunctioninganddisablementresultfromaninteractionofthe
individualsconditionandhisorhersocialandphysicalenvironment.Inthissystem,therefore,thefollowingdefinitionsareusedtodescribelevelsoffunctioning(or
wheredecreasedfunctioningisnoted,disablement)inthecontextofahealthcondition:

1.Impairmentisalossorabnormalityofbodystructureorphysiologicalorpsychologicalfunction,e.g.,lossofalimb,lossofvision(WHO,1998,p.8).Notice
thatthislevelcorrespondstothecurrentICIDHlevelofimpairmentandthusmightrefertoachildsabnormalordelayedlanguagecharacteristics.

2.AnActivityisthenatureandextentoffunctioningattheleveloftheperson.Activitiesmaybelimitedinnature,duration,andquality,e.g.,takingcareofoneself,
maintainingajob(WHO,1998,p.8).NoticethatthislevelreplacesthecurrentICIDHlevelofdisabilityandthusmightrefertoachildsreducedabilityto
communicate.

3.ParticipationisthenatureandextentofapersonsinvolvementinlifesituationsinrelationtoImpairment,Activities,HealthConditionsandContextualfactors.
Participationmayberestrictedinnature,durationandquality,e.g.,participationincommunityactivities,obtainingadrivinglicense(WHO,1998,p.8).This
finallevelcorrespondstotheolderlevelofhandicapandthusmightrefertonegativesocialoutcomesofachildslanguageproblems.

Onthebasisofthesenewformulations,onecanseecontinuitiesbetweentheproposedandexistingsystemsyetalsonoticeasignificantchangeinorientationthatis
bothmorepositiveintoneandmorerecognizingofcontextualinfluences.Inthenewclassificationsystem,apersonsenvironmental(socialandphysical)andpersonal
contextsaresaidtoinfluencehowdisablementateachoftheselevelsisexperienced.Inparticular,twotypesofcontextualfactorsaredeemedmostimportant:(a)
environmentalandphysicalfactors(suchassocialattitudes,physicalbarriersposedbyspecificsettings,climate,andpublicpolicy)and(b)personalfactors(e.g.,
education,copingstyle,gender,age,andotherhealthconditionsWHO,1998,p.8).

Fromthisoverview,itisevidentthatthethrustoftheICIDH2willbesupportformanyoftheprincipleschampionedbyBronfenbrenner,byrecentfederallegislation,
Page88

andbyadvocatesforanintegratedviewofvalidityinwhichtheeffectsofadecisionmadeusingameasuremustbeconsideredwhenoneevaluatesameasuresvalidity.
Overall,aunifyingprincipleisthatdecisionmakingonbehalfofchildrenrequiresattentionnotsimplytopropertiesofthechildbuttothecontextinwhichthedecisionis
beingmadeandactedon.

Inthelasthalfofthischapter,practicalstepsinvolvedintheprocessofevaluatingmeasuresforpossibleuseindecisionmakingaredescribed.AlthoughIhave
renderedthelargercontextinwhichthisprocessmusttakeplaceinonlythegrossestdetail,Ihopethatyoucansensethesheerintricacyofthetaskathand.Onthe
onehand,confrontingtheverysignificantintellectualchallengeentailedintheselection,use,andinterpretationofappropriatemeasuresmakesmenearlyturntailand
run.Ontheotherhand,however,therewardsofsuccessfulclinicaldecisionmakingandactionwouldbelesssweetiftheywereeasilywon.

EvaluatingIndividualMeasures

Evaluatingindividualmeasuresislikesolvingamystery,wherethemysteryishowtoviewameasureforusewithaparticularclientorgroupofclients.Afterageneral
planisdevelopedintheearlystagesofthereviewprocess,cluesarecollectedandweighed.Mostcluescomefromthecliniciansknowledgeofindividualclientsand
theirneedsandfromthemanualfortheparticularmeasure.Additionalsourcesofinformation,suchastestreviewsandpertinentresearcharticles,canalsohelpinthe
process.Thischapterisarrangedsothat,followingabriefoverviewoftwomodesofreviewing,youareintroducedtothetestmanualandthentoothersourcesof
informationtohelpyoureachafinaldecisiontocrackthecase,ifwefollowthedetectiveanalogy.

ClientversusPopulationOrientedReviewsofMeasures

Ihavesaidthatthevalidityofameasuredependsonitsabilitytoansweraparticularclinicalquestionforaparticularchild.Consequently,theappropriatenessofa
measureisdeterminedwithintherealmoftheparticularsideally,withinafirmappreciationoffactorsimportanttoanindividualchild,suchascoexistinghandicapping
conditions,languagebackground,gender,andageasonereviewsthetestmanualandothersourcesofinformationforthemeasure.Suchareviewmightbesaidto
beaclientorientedreviewofthemeasure.

Clientorientedreviewofmeasuresisanidealthatisoftenunattainable.Giventhepaceofmostclinicalenvironments,cliniciansarerarelyabletorevieweachpotential
measurethoroughlyandcompareitwithcompetingmeasuresimmediatelypriortoeachmeasurementtheymake.Infact,cliniciansmorecommonlyusewhatIwould
callapopulationorientedevaluation.

Inapopulationorientedreviewofameasure,theclinicianreviewsthemeasuresdocumentationinreferencetoaparticulargrouporgroupsusuallythosesubgroups
ofchildrentheyservemostfrequently.Forexample,aspeechlanguagepathologistinaruralVermontschoolwouldpayspecialattentiontoatestslikelyvaluefora
subgroupofchil
Page89

drenwithfewsignificantproblemsinotherareasofdevelopment,whocomefromhomesinwhichEnglishistheonlylanguagespoken,andsocioeconomicstatusis
middletolow.Incontrast,averydifferentpopulationorientedassessmentmightbeconductedbyaspeechlanguagepathologistinaBostonschooldistrictwitha
caseloadconsistingsolelyofchildrenfromFrenchspeakingHaitianfamilieslivinginpoverty.Althoughevaluatingameasureforthesetwopopulationswouldinvolve
manyofthesamequestions,eachwouldrequiredifferentanswersreflectingsensitivitytotherelevantpopulation.

Populationorientedreviewsaremostfrequentlyconductedwhenanewmeasureisconsideredforpurchase,whenameasureisexaminedatapublishersdisplayata
convention,orwhenaspeechlanguagepathologistentersanewpositionandinventoriesavailablemeasures.Incontrast,clientorientedreviewsofmeasuresoften
arisewhenanuncommonclinicalquestionemergesorwhenachildsparticularpatternofproblems(e.g.,mentalretardationandaseverehearingloss)makethechilds
needsinatestingsituationtoounlikethoseforwhichtheclinicianhasconductedapopulationorientedevaluation.

HowtoUseTestManuals

Regardlessofthetypeofreviewyouundertake,theoutcomeofyourevaluationwillneversimplybeabuydontbuyorusedontusedecision.Athoroughreview
providespotentialuserswithanappreciationofthemeasureslimitationsforanswerstospecificclinicalquestions.

Thetestmanualisthedefinitivesourceofinformationonastandardizedmeasure.Infact,manyoftherecommendationsmadeintheStandardsforPsychologicaland
EducationalTesting(APA,AERA,&NCME,1985)relatedirectlytomaterialthatshouldbeprovidedintestmanuals.Despitetheirimportance,however,test
manualsrangewidelyintheirsophisticationandvalue.Attheirbest,testmanualsprovidenotonlythebasicinformationrequiredtoevaluatethemeasures
appropriatenessforgivenuseswithspecificpopulations,butalsoinsightfultutorialinformationthatcanreinforceandextendonesunderstandingoftestconstruction
anduse.Attheirworst,testmanualsappeartobelittlemorethansalesbrochuresdesignedtoobscureatestsweaknessesandimplythatitcanbeusedforallclients
andtestingpurposes.Evenmeasuresthatarevaluableadditionstoacliniciansarsenalmayimplypossibleusesthatreallyarenotsupportable.Consequently,a
cliniciansdetectivetalentsarecalledontoferretoutthetruth!

ThereviewingguidereproducedinFig.4.2isaworksheetforevaluatingbehavioralmeasures.Itisblanksothatyoucanreadilyduplicateanduseit.Anannotated
versionoftheguide,whichappearsasFig.4.3,summarizesthemostimportantkindsofinformationorcluesyouwillbelookingforasyouconductameasure
review.Theannotatedguideisdesignedtofunctionlikethereadyreferencecardsavailableformanysoftwareapplications.

Thereviewingguideandannotatedguideareincludedtomakereviewingamoreefficientprocess,buttheirinclusionisnotwithouthazards.Thedangerofsuch
worksheetsandsummariesisthatsomeindividualsmayconsiderthemalloneneedstoknowinordertoconductacrediblereview.Thisisabigmistake!Theseguides
areafirststepthatshouldalwaysbeaccompaniedbyawillingnesseveneagernessto
Page90

(continued)
Page91

(continued)
Page92

Fig.4.2.Annotatedreviewform.
Page93

(continued)
Page94

(continued)
Page95

Fig.4.3.Reviewform.
Page96

lookbackattrustedresourcesonmeasurement,especiallytheStandardsforEducationalandPsychologicalTesting(APA,AERA,&NCME,1985).Afterall,
evenSherlockHolmesdependedonhislearnedfriendDr.Watson!

Numerousauthorswritingaboutpsychometricissuesproposereviewproceduresthatareverysimilartothosedescribedhere(e.g.,Anastasi,1988,1997Hammer,
1992Hutchinson,1996Salvia&Ysseldyke,1998Vetter,1988b).Appendix5inSalviaandYsseldyke(1998,pp.763766),HowtoReviewaTest,isa
particularlyinformativeandamusingdescriptionofthereviewprocess.

IntheremainderofthissectionIleadyouthroughtheannotatedguide,explainingwhyitisimportanttolookforcertainkindsofinformation.Thesesectionsareless
sketchyversionsofthebriefsummariesgiveninFig.4.3.Someoftheircontentshouldsoundquitefamiliarbecauseitisbasedontheconceptsdiscussedatlengthin
chapter3.Thissectionendswithareviewguidecompletedaspartofahypotheticalclientorientedreview(Fig.4.4).

1.ReviewerThisinformationwillprobablybeunnecessaryforreviewerswhofunctionaloneintheirtestselectionandevaluation.Ontheotherhand,itcanbehelpful
incaseswheremultipletestuserssharereviewingresponsibilities,atleastforpreliminary,populationorientedreviews.Useofastandardguidefacilitatessuchsharing
byreducingdifferencesbetweenreviewersandofferinglaterreviewersapossiblestartingpointforclientorientedreviews.

2.IdentifyingInformationBesidesinformationthatcanhelpyoulocateorreplaceaninstrument,thissectionprovidespreliminarycluestothescopeandnatureof
themeasure.Testnamesvarygreatlyinjusthowmuchtheydiscloseaboutthenatureofthetest(e.g.,whetheritiscomprehensiveoraimedatonlyonemodalityorone
domainoflanguage),sotheyshouldbeapproachedwithcaution.Testingtime,whichusersmaywanttobreakdownintermsofprojectedadministrationandscoring
times,isofpracticalimportancewhenschedulingtesting.

Informationaboutbasiccharacteristicsofthemeasuresuchaswhetheritisstandardizedversusinformal,criterionreferencedversusnormreferenced,isusedto
determinethemeasuressuitabilityforcertainclinicalquestionsandguidesexpectationsforothersectionsofthereviewguide.AlthoughallmajorsectionsoftheGuide
arerelevanttoallmeasures,thekindsandamountsofinformationprovidedvarydependingonthemeasurestype.Manualsforstandardized,normreferenced
measuresprobablyprovidethegreatestamountsofinformation.Ontheotherhand,moreinformal,criterionreferencedmeasures,whichhaveoftenbeencreatedbyan
individualclinicianforaspecificpurpose,havefarlessinformationavailable.(AlthoughseeVetter,1988a,forrecommendationsaboutthekindofinformationthat
shouldbekeptforanyprocedurethatmightprofitablybeusedonrepeatedoccasions).

3.TestingPurposeHere,yousummarizeyourknowledgeoftheintendedclientorpopulation.Relevantinformationincludestheclientsage,otherproblems(e.g.,
visual,motor,orcognitiveimpairments),andimportantlanguagecharacteristics(e.g.,bilingualhome,regionalorsocialdialectuse).
Page97

(continued)
Page98

(continued)
Page99

Fig.4.4.Sampleofacompletedreviewform.
Page100

Themainclinicalquestionsleadingtothesearchforanappropriatemeasureshouldalsorecordedhere:Isthemeasuregoingtobeusedforscreening,identifyinga
problemordifference,treatmentplanning,orassessingchange?Also,whatlanguagemodalitiesandskillareasareofinterest?Asmentionedinchapter1,eachofthese
clinicalquestionsrequiresdifferentmeasurementsolutions.Therefore,thereviewershouldconductallreviewswiththeassessmentpurposevividlyinmind.Chapters9
12addressinconsiderabledetailthedemandsassociatedwithdifferentclinicalquestions.

4.TestContentThissectionreturnsthereviewersattentiontothetestmanual.Gainingaclearunderstandingofatestscontentusuallyrequiresthatyouexamineat
leasttheearlysectionsofthetestmanualandthetestformitself.Homogeneousmeasures,inwhichallitemsareaimedatasinglemodalityandlanguagedomain,are
relativelyeasytospecifyintermsoftheircontent.Forexample,theExpressiveOneWordPictureVocabularyTestRevised(Gardner,1990)fitsintothiscategoryits
contentcanbespecifiedasexpressivevocabularyorexpressivesemantics.Usually,however,measuresaddressmorethanonecontentarea,whichareindicated
throughtheuseofsubtestsorsubscores.Forthissectionofthereviewguide,aswellasforthesectionsthatfollowit,recordingpagenumbersalongwithyourfindings
isanexcellentwaytoencouragecheckingagainstthemanualduringlateruseofthecompletedguide.

Asyourecordinformationabouttestcontent,youwanttoseehowwellthecontentareascoveredbythemeasurematchthoseofinterestforyourclient.Eventhe
natureofitems(e.g.,forcedchoicevs.openendedresponses)willbeimportantinhelpingyoudeterminewhetherthebehaviorsorabilitiesofinterestwillbethelargest
contributortoyourclientsperformance.Recallthatonethreattovalidityintroducedinchapter3wasthatofenablingbehaviors,behaviorsthatenableatesttakerto
takethetestvalidly.Forexample,supposethatyouwereinterestedinassessingthereceptivelanguageskillsofachildwithcerebralpalsywhofatiguedeasilyifasked
toshoworactoutresponses.Themotoricdemandsofmeasuresbecomeenablingbehaviorsthatwillnegativelyinfluencethechildsperformanceeventhoughtheyare
independentofthetargetedconstructofreceptivelanguage.

Inadditiontoprovidingatangibleremindernottooverlookpossiblyproblematicenablingbehaviors,thissectionofthereviewformshouldalsostimulatecluegathering
aroundwhatisactuallybeingtested(Hammer,1992Sabers,1996).Recallthatasthetestdevelopermovesfromanidealformulationofthemeasuresunderlying
constructtothedownanddirtytaskofwritingsetsofitems,certainbehaviorsorskillsnecessarilytagalongtoyieldafleshedoutconstructthatmayormaynotmatch
yourown(oreventheauthors)intendedformulations.

Asanexampleofhowconstructscanbemodifiedasatesttakesshape,imagineatestdeveloperwhodecidestodeviseameasuretoassessuseofcomplexsentences
usingmethodsthatplaceaheavydemandonworkingmemorycapabilities.Forexample,thetestdevelopercouldprovidethetesttakerwithasetofsevenwords,
includingthewordbecausethataretobeusedtocreateasinglesentence.Althoughthefinalforminwhichtheconstructisrealizedmaybeacceptabletosometest
users,itmay
Page101

notbetoothers,dependingontheirunderstandingofthetargetedconstruct.Itisprimarilythroughcarefulattentiontothisstepinthereviewprocessthatyouwill
becomeawareofcorrespondencesordisjunctionsbetweenthetestdevelopersandyourviewofwhatisbeingtested.Armedwiththisknowledge,youcanmake
aninformeddecisionastowhethertheconstructbeingmeasurediscloseenoughtoyourreasonfortestingforyoutoconsiderusingit.

5.StandardizationSample/NormsAtfirstglance,thissectionmayseemtobeprimarilyofinterestwhenyouarelookingforanormreferencedinstrument,thatis,
oneinwhichscoresareinterpretedprimarilyonthebasisofhowthetesttakersperformancecomparesinaquantitativewaywiththatofapeergroup.Infact,
however,thenatureofthestandardizationsamplehasimportantimplicationsforallmeasures.Itcandeterminetheextenttowhichsummarystatistics(inthecaseof
normreferencedmeasures)orsummarydescriptionsofbehaviors(inthecaseofcriterionreferencedmeasures)arelikelytoreflectcharacteristicsofmostchildren
ratherthanthoseofasmall,potentiallynonrepresentativegroup(e.g.,childrenofaffluent,highlyeducatedparents).Nonetheless,therearesomedifferencesinhowthe
informationprovidedinthissectionwillbeweighedonthebasisofthenatureoftheinstrument.

Whenanormreferencedmeasureisbeingevaluated,youlookforacleardescriptionofthenormativesamplethatwasused:howmanychildrenwerestudied,whether
andwhyanychildrenwereexcluded,andhowrepresentativethesampleiscomparedwiththepopulationyourclient(orsubgroupofclients)fitsinto.Ideally,atleast
50childrenwhoarewithinarelativelysmallrangeinagefromthatofyourclient(usuallynomorethan6monthsolderoryounger)willhavebeentested.Also,you
wantthesechildrentobesimilarinrace,languagebackground,andsocioeconomicstatustothechildorchildrenyouhaveinmind.

Whentherearesignificantdifferencesbetweenthenormativesampleandyourclient(s),youneedtodrawonyourknowledgeoftheappropriateresearchbaseaswell
asyourownknowledgeofculturaldifferencestodeterminetowhatextentthevalidityofthismeasureislikelytobeundermined.Ifameasuresvalidityisseriously
underminedandalternativemeasuresareunavailable,avarietyofapproaches,includingdynamicassessmentandthedevelopmentofaninformalmeasure,represent
possiblestrategies(seechap.10forfurtherdiscussionofthisissue.)

Foranormreferencedinstrument,youalsowanttoexaminethetypesofscoresthetestusestodescribethetesttakersperformance.Intermsofdesirability,standard
scoresrankfirst,percentilescoresarenext,anddevelopmentalscores(suchasageequivalentorgradeequivalentscores)earnasorrylastplace.Inthissectionofthe
reviewform,youmayalsowanttorecordtheavailabilityoftablesthatrecordthestandarderrorofmeasurement(whichwillbediscussedatgreaterlengthbelowunder
reliability).Recordingthatinformationhereisagoodideabecauseitindicatestheamountoferrorassociatedwithatesttakersstandardscore.

Whenacriterionreferencedmeasureisevaluated,thecompositionofgroupsusedtodeterminecutoffscoreswillbethefocusofyourscrutinyatthispointinthe
reviewform.Iamnotawareofrecommendationsconcerningsamplesizeandcompositionthatareasspecificasthosegivenabovefornormreferencedmeasures.
However,you
Page102

wanttobesurethatthegroupforwhomthecutoffscoresareprovidedaresimilartoyourclientorclientsandthatthegroupislargeenoughsothatthecutoffislikely
tobestable(McCauley,1996).

6.ReliabilityInthissection,youwillsummarizerelevantinformationaboutthetestsreliability,whichisalmostalwayscontainedinaseparate,clearlymarkedsection
ofthetestmanual.Theoperativewordhereisrelevant.Themanualmayreport6,10,even20studiesinwhichthereliabilityofthemeasurewasexamined.
Nonetheless,therelevantonesarethose(a)usingparticipantswhoareassimilaraspossibletoyourclient(s)and(b)focusingonthetypeofreliabilitythatiseithermost
atriskbecauseofthenatureoftheinstrumentormostimportanttoyourclinicalquestion.Recallthatchapter3discussesthedifferentkindsofreliabilitydatathatare
typicallyofinterest.

Onceyouhavedecidedwhatformsofreliabilityareofgreatestimportance,howdoyouknowwhethertheevidenceisadequate?Fornormreferencedtests,the
evidencewillalmostalwaystaketheformofreliabilitycoefficients.Traditionally,ithasbeensuggestedthatonedemandcorrelationcoefficientsthatarestatistically
significantandatleast.80inmagnitudeforscreeningpurposesandatleast.90whenmakingmoreimportantdecisionsaboutindividuals(Salvia&Ysseldyke,1998).
However,amorecircumspectrecommendationmightbethatyouwantthebestreliabilityavailableonthemarket.BythisImeanthatwhentheidealof.90isnot
available,andadecisionmustbemade,youwillwantthebestthatyoucanfindaswellasmultiple,independentsourcesofinformation.

Forcriterionreferencedmeasures,evidenceforreliabilitycantakeagreatmanyformsfromcorrelationcoefficientstoagreementindices(Feldt&Brennan,1989).
Suchevidenceforcriterionreferencedmeasuresusuallyaddressesthequestionofhowconsistentlythecutoffcanbeusedtoreachaparticulardecision.Asyouwould
dofornormreferencedmeasures,focusontheresultsofthosestudiesthatinvolveresearchquestionsmostlikeyourclinicalquestionandparticipantsmostlikeyour
client(s).Informationabouttherelationshipbetweentypesofreliabilityandclinicalquestionsisdiscussedinchapters9to11.

7.ValidityAlthoughtheentirereviewformisaimedatyourcrackingthecaseofameasuresvalidityforaparticularuse,inthissectionofthereviewform,youwill
summarizethemostimportantoftheinformationprovidedbythetestdeveloperforthepurposeofevaluatingvalidity.Althoughmostoftheinformationofinterestwill
probablybefoundinclearlylabeledsectionsofthemanual,informationrelevanttoconsiderationsofcontentandconstructvalidityisalsofrequentlyfoundinsections
dealingwiththemeasuresinitialdevelopmentandsubsequentrevisions(ifany).Recallthatsomeofthespecificmethodsusedtoprovideevidenceofvalidity(e.g.,
developmentalstudies,contrastinggroupstudies)arediscussedatsomelengthinthepreviouschapter.

Thestatisticalmethodsthatareusedtodocumentvalidityvaryfromcorrelationcoefficientstoanalysesofvariancetofactoranalysis.Consequently,adiscussionof
whatconstitutesacceptabledatamustremainfairlygeneralhere.Overall,onelooks
Page103

toseethatthemeasureisshowntofunctionasitispredictedtofunctionifvalid.Aswithreliabilityevidence,thenatureoftheparticipantsinthestudywillaffectthe
extenttowhichitisrelevantforyourclientandpurposes.Asyoucompletethissectionofthereviewform,everyskepticalboneinyourbodyshouldberecruitedfor
service.Claimingvaliditydoesntmakeameasurevalid,althoughattimestestdevelopersseemtoforgetthis.

8.OverallImpressionsofValidityforTestingPurposeandPopulationAtthispointinthereviewguide,youputthecluestogethertosumupthecase.Your
studyoftheprosandconsshouldbesummarized,withholesintheevidencenotedanddiscussedintermsoftheirimplicationsforinterpretingresults.Thisiswhereyou
determinewhetheryoubelievetheinstrumentcanbesafelyusedand,ifused,whatcautionsshouldbekeptinmindwhenitisadministeredandinterpreted.Clearly,this
isthemostdemandingpointinthereviewprocessakintoafinalexamortheconcludingparagraphofalargepaper.Althoughpracticeisperhapsthebestwayof
honingtherequisiteanalyticskills,examinationofotherreviewsoftheinstrument(whentheyreavailable)canhelpyoumakesureyouhavenotoverlookedanymajor
cluesandcanalsohelpyouseehowothershaveapproachedthetask.Evenexaminingreviewsonothermeasurescanprovehelpfulforgettingasenseofhow
seasoneddetectivessumuptheircases.(e.g.,SeereviewsinConoley&Impara,1995,oftheReceptiveExpressiveEmergentLanguageTest2[Bzoch&
League,1994],writtenbyBachman[1995]andBliss[1995]andoftheTestofEarlyReadingAbilityDeaforHardofHearing[Reid,Hresko,Hammill,&
Wiltshire,1991],writtenbyRothlisberg[1995]andToubanos[1995]).

Becauseexamplescanprovesohelpfulindevelopingonesunderstandingofanewprocess,IincludedFig.4.3,whichillustrateshowIwouldcompletethereviewing
guidefortheExpressiveVocabularyTest(Williams,1997)asIconsideritsvalidityforusewithahypotheticalchild,Melissa.Melissaisa9year,2montholdgirl
whohaspreviouslybeenreceivingtreatmentforaspecificlanguageimpairment.Sheisbeingtestedaspartofaperiodicreevaluation,whichwillbeusedbyan
educationalteamtodeterminewhethershewillcontinuetoreceiveservicesinherschool.Melissasunilateralhearinglossandproblemswithattentionwillrequire
specialattentionduringthereviewoftheExpressiveVocabularyTest(Williams,1997)forpossibleuse.

HowtoAccessOtherSourcesofInformation

Inadditiontotestmanuals,independenttestreviewsareavailabletohelpinthetestreviewprocessinthreedifferentforms:reviewsappearinginstandardreference
volumesonbehavioralmeasures,journalarticlesreviewingoneormoretestsinaparticulararea,andcomputerdatabasesoftestreviews.

Standardreferencesandjournalarticlesthatincludereviewsoftestsusedfrequentlyintheassessmentofchildrenwithdevelopmentallanguagedisordersorthat
providespecificinformationrelevanttoanunderstandingofindividualtestsarelistedinTable4.3.
Page104

Table4.3
BooksandJournalArticlesProvidingInformationAboutSpecificTestsUsedWithChildren

Books
AmericanSpeechLanguageHearingAssociation.(1995).Directoryofspeechlanguagepathologyassessmentinstruments.Rockville,MD:Author.
Compton,C.(1996).Aguideto100testsforspecialeducation.UpperSaddleRiver,NJ:GlobeFearonEducational.
Impara,J.C.,&Plake,B.S.(Eds.).(1998).Thirteenthmentalmeasurementsyearbook.Lincoln,NE:BurosInstituteofMentalMeasurements.
Keyser,D.J.,&Sweetland,R.C.(1994).(Eds.).Testcritiques(Vol.X).Austin,TX:ProEd.
Murphy,L.L.,Conoley,J.C.,&Impara,J.C.(Eds.).(1994).TestsinprintIV:Anindextotests,testreviews,andtheliteratureonspecifictests.Lincoln,
NE:BurosInstituteofMentalMeasurements.

JournalArticles
Huang,R.,Hopkins,J.,&Nippold,M.A.(1997).Satisfactionwithstandardizedlanguagetesting:Asurveyofspeechlanguagepathologists.Language,Speech,
andHearingServicesinSchools,28,1223.
McCauley,R.J.,&Swisher,L.(1984).Psychometricreviewoflanguageandarticulationtestsforpreschoolchildren.JournalofSpeechandHearingDisorders,
49,342.
Merrell,A.W.,&Plante,E.(1997).Normreferencedtestinterpretationinthediagnosticprocess.Language,Speech,HearingServicesinSchools,28,5058.
Plante,E.,&Vance,R.(1994).Selectionofpreschoollanguagetests:Adatabasedapproach.AmericanJournalofSpeechLanguagePathology,4,7076.
Plante,E.,&Vance,R.(1995).Diagnosticaccuracyoftwotestsofpreschoollanguage.AmericanJournalofSpeechLanguagePathology,4,7076.
Stephens,M.I.,&Montgomery,A.A.(1985).Acriticalreviewofrecentrelevantstandardizedtests.TopicsinLanguageDisorders,5(3),2145.
Sturner,R.A.,Layton,T.L.,Evans,A.W.,Heller,J.H.,Funk,S.G.,&Machon,M.W.(1994).Preschoolspeechandlanguagescreening:Areviewofcurrently
availabletests.AmericanJournalofSpeechLanguagePathology,3,2536.

EachnewvolumeintheMentalmeasurementsyearbookseriescontainsreviewsofcommerciallyavailabletestsandteststhathavejustbeenpublishedorwere
revisedsincetheirreviewinaprecedingvolume.Entriesarealphabeticallyorganizedbythenameofthetest,withtworeviewspreparedindependentlybyindividuals
withexpertiseintesting,inthecontentareatested,orboth.Anewvolumeofthisseriesappearsabouteverythreeyears.Inaddition,reviewspublishedsince1989are
availableontheInternettoallowforonlinesearchesthatcanhelpconsumersfindreviewsaswellasspecifickindsofmeasuresbecauseofsearchingcapabilities.

SeveralrecentjournalarticlesreviewingtestsinaparticularcontentareaorforaparticulargroupofchildrenwithlanguageimpairmentsarealsolistedinTable4.3.

Computerdatabasesrepresentamorerecentpossiblesourceofinformationonstandardizedmeasures.ReviewsfromtheMentalmeasurementsyearbookseriesare
Page105

availableonlinethroughcolleges,universities,andpubliclibraries.Reviewsincludedinthisonlinedatabaseareidenticalincontenttothoseincludedinthebound
volumesoftheMentalmeasurementsyearbook.Further,thesereviewsaremoretimelythanthoseappearingintheprintedvolumesbecausereviewsthatwill
eventuallybeincorporatedinalaterboundvolumeareaddedeverymonth.

TheHealthandPsychosocialInstruments(HaPI)databaseisalsoavailableatmanylibrariesandcanbesearchedonline.Itallowsonetosearchforinformationabout
aspecifictest,tofindthepublishinginformationaboutatestthroughitsname,acronym,orauthorship,andtosearchforinstrumentsfocusingbycontentoragegroup.
TheHaPIpublishesabstractsanddoesnotcontaincompletereviewsofinstruments.However,itdoesindicatewhetherinformationisreportedforsevencritical
characteristics:internalconsistencyreliability,testretestreliability,parallelformsreliability,interraterreliability,contentvalidity,constructvalidity,andcriterionrelated
validity.

Summary

1.Effectiveevaluationofmeasuresofchildrenscommunicationandrelatedskillsmustbeconductedwithappreciationforthecontextualvariablesaffectingboth
childrenandclinicians.

2.ThebioecologicaltheoryofBronfenbrennerandhiscolleaguesemphasizestheinterplayofthechildscharacteristicswiththoseofhisorherenvironment,beginning
withthefamilyandextendingtothebroaderphysical,social,andhistoricalenvironmentaswell.Therelevanceofthistheorytotheevaluationofmeasuresand
measurementstrategiesforchildrenliesintheconnectionbetweenvalidityandattentiontothesecontextualvariables.

3.Amongthecontextualvariablesaffectingcliniciansastheyinteractwithchildrenandevaluatetheirlanguagearenotonlypersonalvariables(e.g.,theirownlanguage
andculture),butalsolegalvariablesandothervariablesaffectingtheirprofessionalpractice.

4.Evaluationofindividualmeasuresrequiresthepotentialtestusertogathercluessuggestingthestrengthsandweaknessesofthemeasureforansweringaparticular
clinicalquestionforaparticularclient.Clientorientedreviewsareconductedtorefineinformationobtainedfromapopulationorientedrevieworinresponsetothe
exceptionalneedsofaparticularclient.

5.Testmanualsorothermaterialsprovidedbythedeveloperofameasureserveastheprimarysourceofinformationtobeconsideredinevaluatingitsusefulnessfora
givenclient.

6.Thetestreviewerneedstoapproachthereviewprocessarmedwithaskepticalattitudetowardunprovenclaimsandanarsenalofinformationregardingacceptable
psychometricstandards.

7.TheStandardsforeducationalandpsychologicaltesting(AERA,APA,&NCME,1985)isthemostwidelyacceptedsourceforsuchinformationonstandards.
Page106

8.Additionalinformationforuseinthereviewingprocessisavailableintheformofreviewspublishedinstandardreferencebooks,relevantjournalarticles,and
computerdatabases.

9.Inspiteofexistingidealsforevidenceofreliabilityandvalidity,theclinicianmaynonethelessdecidetouseaparticularmeasureevenwhenitdoesnotreachanideal,
whenitisthebestavailableforaparticularclient,andaclinicaldecisionmustbemade.

KeyConceptsandTerms

clientorientedmeasurereview:evaluationofameasuresappropriatenessforuseinansweringaspecificclinicalquestionforasingleclient.

IndividualswithDisabilitiesEducationAct(IDEA):federallegislationaddressingtheeducationneedsofindividualswithdisabilities,includingchildrenwith
communicationdisorders.

InternationalClassificationofImpairments,Disabilities,andHandicaps(ICIDH):aclassificationdesignedbytheWHOforglobalusebyhealthprofessionals,
educators,legislators,andothergroupsconcernedwithhealthrelatedissuestoserveasacommonlanguage.

Mentalmeasurementyearbooks:awellregardedsourceoftestreviews.

nondiscriminatoryassessment:theuseofmeasuresandproceduresforadministeringandinterpretingdatathatwillnotconfoundachildslanguageordialect
backgroundwiththetargetoftesting.

populationorientedmeasurereview:apreliminaryevaluationofameasureslikelyappropriatenessforuseinansweringoneormoreclinicalquestionsfora
populationofclientswhoshareimportantsimilarcharacteristics.Populationorientedreviewsofmeasuresareoftenconductedforsubgroupsofclientswhoare
frequentlyseenbyagivenclinician.

StudyQuestionsandQuestionstoExpandYourThinking

1.Consideryourownsocialecology.Thinkaboutaspecifickindofdecisionyouhavemadeorwillmake(e.g.,concerningschooloremployment).Whatinstitutions
andpeopleaffectyourdecision?

2.Talktotheparentofayoungchildaboutthecontextsinwhichthatchildfunctionsdaycare,timespentwithextendedfamily,andsoforth.Determinehowmany
hoursthechildspendsineachsettingandwhothemaininteractionpartnersforthechildare.Howmightthesesettingsinfluencethecommunicationexperiencesofthis
child?

3.Listfivedomainsoflanguage.

4.Doestimetakentoconductatesthaveanyobviouspotentialrelationshiptothevalidityoftesting?Ifso,whenorforwhatgroupsofchildren?
Page107

5.Discusstheimportanceofconductingaclientorientedreviewratherthansimplyapopulationorientedreviewofameasureyouwillusewithaspecificclient.

6.GotothelibraryandexamineseveralvolumesoftheMentalmeasurementsyearbookseries.Describetheprocessbywhichtestsareselectedtobereviewed,and
examinetworeviewsforasinglespeechlanguagemeasure.

7.Chooseatestthatyouhaveheardreferredtoinacourseyouhavetaken.SeeifyoucanfindareviewforitintheMentalmeasurementsyearbookseriesor
elsewhere.Also,considertheextenttowhichtheinteractionimplicitinthetestingproceduresmatchesthekindsofexperiencesachildmighthaveonaneverydaybasis.

8.Completeareviewformforanormreferencedspeechlanguagetest.

9.Completeareviewformforacriterionreferencedspeechlanguagemeasure.

RecommendedReadings

Hutchinson,T.A.(1996).Whattolookforinthetechnicalmanual:Twentyquestionsforusers.Language,Speech,HearingServicesinSchools,27,109121.

Sabers,D.L.(1996).Bytheirtestswewillknowthem.Language,Speech,HearingServicesinSchools,27,102108.

Salvia,J.,&Ysseldyke,J.(1998).Appendix5.InJ.Salvia&J.Ysseldyke(Eds.),Assessment(5thed.,pp.763766).Boston:HoughtonMifflin.

References

AmericanPsychologicalAssociation,AmericanEducationalResearchAssociation,NationalCouncilonMeasurementinEducation.(1985).Standardsfor
educationalandpsychologicaltesting.Washington,DC:AmericanPsychologicalAssociation.

AmericanSpeechLanguageHearingAssociation.(1995).Directoryofspeechlanguagepathologyassessmentinstruments.Rockville,MD:Author.

AmericanSpeechLanguageHearingAssociation.(1999).Guidelinesforrolesandresponsibilitiesoftheschoolbasedspeechlanguagepathologist[Online].
Available:http:/www.asha.org/professionals/library/slpschool_i.htm#purpose.

Anastasi,A.(1988).Psychologicaltesting(6thed.).NewYork:Macmillan.

Anastasi,A.(1997).Psychologicaltesting(7thed.).UpperSaddleRiver,NJ:PrenticeHall.

Bachman,L.F.(1995).ReviewoftheReceptiveExpressiveEmergentLanguageTest(2nded.).InJ.C.Conoley&J.C.Impara(Eds.),Thetwelfthmental
measurementsyearbook.(pp.843845).Lincoln,NE:BurosInstituteofMentalMeasurements.

Bliss,L.S.(1995).ReviewoftheReceptiveExpressiveEmergentLanguageTest(2nded.).InJ.C.Conoley&J.C.Impara(Eds.),Thetwelfthmental
measurementsyearbook(p.846).Lincoln,NE:BurosInstituteofMentalMeasurements.

Bronfenbrenner,U.(1974).Developmentalresearch,publicpolicy,andtheecologyofchildhood.ChildDevelopment,45,15.

Bronfenbrenner,U.(1986).Recentadvancesinresearchontheecologyofhumandevelopment.InR.K.Silbereisen,E.Eyferth,&G.Rudinger(Eds.),Development
asactionincontext:Problembehaviorandnormalyouthdevelopment(pp.286309).NewYork:SpringerVerlag.

Bronfenbrenner,U.,&Morris,P.(1998).Theecologyofdevelopmentalprocesses.InW.Damon&R.M.Lerner(Eds.),Handbookofchildpsychology:
Theoreticalmodelsofhumandevelopment(5thed.,Vol.1,pp.9931028).NewYork:Wiley.

Bzoch,K.R.,&League,R.(1994).ReceptiveExpressiveEmergentLanguageTest2.Austin,TX:ProEd.
Page108

Compton,C.(1996).Aguideto100testsforspecialeducation.UpperSaddleRiver,NJ:GlobeFearonEducational.

Conoley,J.C.,&Impara,J.C.(Eds.).(1995).Thetwelfthmentalmeasurementsyearbook.Lincoln,NE:BurosInstituteofMentalMeasurements.

Crais,E.R.(1992).Bestpracticeswithpreschoolers:Assessingwithinthecontextofafamilycenteredapproach.InW.Secord(Ed.),Bestpracticesinschool
speechlanguagepathology:Descriptive/nonstandardizedlanguageassessment(pp.3342).SanAntonio,TX:PsychologicalCorporation.

Crais,E.R.(1995).Expandingtherepertoireoftoolsandtechniquesforassessingthecommunicationskillsofinfantsandtoddlers.AmericanJournalofSpeech
LanguagePathology,4,4759.

Damico,J.S.,Smith,M.,&Augustine,L.E.(1996).InM.D.Smith&J.S.Damico(Eds.),Childhoodlanguagedisorders(pp.272299).NewYork:Thieme.

Demers,S.T.,&Fiorello,C.(1999).Legalandethicalissuesinpreschoolassessmentandscreening.InE.V.Nuttall,I.Romero,&J.Kalesnik(Eds.),Assessing
andscreeningpreschoolers:Psychologicalandeducationaldimensions(2nded.,pp.5058).NeedhamHeights,MA:Allyn&Bacon.

DonahueKilburg,G.(1992).Familycenteredearlyinterventionforcommunicationdisorders:Preventionandtreatment.Gaithersburg,MD:Aspen.

EducationforAllHandicappedChildrenActof1975.Pub.L.No.94142,89Stat.773(1975).

EducationoftheHandicappedActAmendmentsof1986.Pub.L.No.99457,100Stat.1145(1986).

Feldt,L.S.,&Brennan,R.L.(1989).Reliability.InR.L.Linn(Ed.),Educationalmeasurement(3rded.,pp.105146).NewYork:AmericanCouncilon
EducationandMacmillan.

Frattali,C.(1998).Outcomemeasurement:Definitions,dimensions,andperspectives.InC.Frattali(Ed.),Measuringoutcomesinspeechlanguagepathology(pp.
127).NewYork:Thieme.

Gardner,M.F.(1990).ExpressiveOneWordPictureVocabularyTestRevised.Novato,CA:AcademicTherapy.

Hammer,A.L.(1992).Testevaluationandquality.InM.Zeidner&R.Most(Eds.),Psychologicaltesting:Aninsideview.PaloAlto,CA:ConsultingPsychologists
Press.

Hammill,D.D.,&Newcomer,P.L.(1988).TestofLanguageDevelopment2Intermediate.Austin,TX:ProEd.

Huang,R.,Hopkins,J.,&Nippold,M.A.(1997).Satisfactionwithstandardizedlanguagetesting:Asurveyofspeechlanguagepathologists.Language,Speech,and
HearingServicesinSchools,28,1223.

Hutchinson,T.A.(1996).Whattolookforinthetechnicalmanual:Twentyquestionsforusers.Language,Speech,HearingServicesinSchools,27,109121.

Impara,J.C.,&Plake,B.S.(Eds.).(1998).Thethirteenthmentalmeasurementsyearbook(pp.10501052).Lincoln,NE:BurosInstituteofMental
Measurements.

IndividualswithDisabilitiesEducationAct(IDEA).Pub.L.No.101476,104Stat.1103(1990).

IndividualswithDisabilitiesEducationActAmendmentsof1997.Pub.L.No.10517,111Stat.37(1997).

Keyser,D.J.,&Sweetland,R.C.(1994).(Eds.).Testcritiques(Vol.X).Austin,TX:ProEd.

McCauley,R.J.(1996).Familiarstrangers:Criterionreferencedmeasuresincommunicationdisorders.Language,Speech,andHearingServicesinSchools,27,
122131.

McCauley,R.J.,&Swisher,L.(1984).Psychometricreviewoflanguageandarticulationtestsforpreschoolchildren.JournalofSpeechandHearingDisorders,
49,3442.

Merrell,A.W.,&Plante,E.(1997).Normreferencedtestinterpretationinthediagnosticprocess.Language,Speech,HearingServicesinSchools,28,5058.

Murphy,L.L.,Conoley,J.C.,&Impara,J.C.(Eds.).(1994).TestsinprintIV:Anindextotests,testreviews,andtheliteratureonspecifictests.Lincoln,NE:
BurosInstituteofMentalMeasurements.

Muma,J.(1998).Effectivespeechlanguagepathology:Acognitivesocializationapproach.Mahwah,NJ:LawrenceErlbaumAssociates.

Plante,E.,&Vance,R.(1994).Selectionofpreschoollanguagetests:Adatabasedapproach.Language,Speech,andHearingServicesinSchools,25,1524.

Plante,E.,&Vance,R.(1995).Diagnosticaccuracyoftwotestsofpreschoollanguage.AmericanJournalofSpeechLanguagePathology,4,7076.
Page109

Radziewicz,C.(1995).InE.TiegermanFarber,Languageandcommunicationinterventioninpreschoolchildren(pp.95128).Boston:Allyn&Bacon.

Reid,D.K.,Hresko,W.P.,Hammill,D.D.,&Wiltshire,S.(1991).TestofEarlyReadingAbilityDeaforhardofhearing.Austin,TX:ProEd.

Rothlisberg,B.A.(1995).ReviewoftheTestofEarlyReadingAbilityDeaforHardofHearing.InJ.C.Conoley&J.C.Impara(Eds.),Thetwelfthmental
measurementsyearbook(pp.10491051).Lincoln,NE:BurosInstituteofMentalMeasurements.

Sabers,D.L.(1996).Bytheirtestswewillknowthem.Language,Speech,andHearingServicesinSchools,27,102108.

Salvia,J.,&Ysseldyke,J.E.(1995).Assessment(7thed.).Boston:HoughtonMifflin.

Stephens,M.I.,&Montgomery,A.A.(1985).Acriticalreviewofrecentrelevantstandardizedtests.TopicsinLanguageDisorders,5(3),2145.

Sturner,R.A.,Layton,T.L.,Evans,A.W.,Heller,J.H.,Funk,S.G.,&Machon,M.W.(1994).Preschoolspeechandlanguagescreening:Areviewofcurrently
availabletests.AmericanJournalofSpeechLanguagePathology,3,2536.

Toubanos,E.S.(1995).ReviewoftheTestofEarlyReadingAbilityDeaforHardofHearing.InJ.C.Conoley&J.C.Impara(Eds.),Thetwelfthmental
measurementsyearbook(pp.10511053).Lincoln,NE:BurosInstituteofMentalMeasurements.

vanKleeck,A.(1994).Potentialculturalbiasintrainingparentsasconversationalpartnerswiththeirchildrenwhohavedelaysinlanguagedevelopment.American
JournalofSpeechLanguagePathology,3,6778.

Vetter,D.K.(1988a).Designinginformalassessmentprocedures.InD.E.Yoder&R.D.Kent(Eds.),Decisionmakinginspeechlanguagepathology(pp.192
193).Philadelphia:B.C.Decker.

Vetter,D.K.(1988b).Evaluationoftestsandassessmentprocedures.InD.E.Yoder&R.D.Kent(Eds.),Decisionmakinginspeechlanguagepathology(pp.
190191).Philadelphia:B.C.Decker.

Williams,K.T.(1997).ExpressiveVocabularyTest.CirclePines,MN:AmericanGuidanceService.

WorldHealthOrganization.(1980).ICIDH:Theinternationalclassificationofimpairments,disabilities,andhandicaps.Geneva:Author.

WorldHealthOrganization.(1998).Towardsacommonlanguageforfunctioninganddisablement:ICIDH2:TheInternationalClassificationofImpairments,
ActivitiesandParticipation.Geneva:Author.
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Page111

PART
II

ANOVERVIEWOFCHILDHOODLANGUAGEDISORDERS
PartIIintroducesthefourmostfrequentlyoccurringcategoriesofchildhoodlanguagedisorders:specificlanguageimpairment(chap.5)andlanguageproblems
associatedwithmentalretardation(chap.6),autismspectrumdisorders(chap.7),andhearingimpairment(chap.8).Eachchapterisdesignedtoprovideanoverview
ofthenatureandspecialtestingproblemsassociatedwithonecategory.

Withineachchapter,disordercategoriesaredefined,wherepossible,accordingtocriteriaoutlinestheDiagnosticandstatisticalmanualofmentaldisorders(4th
ed.DSMIV)oftheAmericanPsychiatricAssociation(1994)andinsomechaptersaccordingtootherinfluentialdefinitions.Eachdisordercategoryisthenfurther
introducedintermsofitssuspectedcauses,thespecialchallengestolanguageassessmentaffordedbychildrenwiththespecificproblem,theirexpectedpatternsof
languageperformance,andaccompanyingproblemsthatmayfurthercomplicatethesechildrenslivesandcommunicationfunctioning.Eachchapteralsocontainsa
shortpassagewrittenfromtheperspectiveofsomeonediagnosedwiththeconditionaddressedinthechapter.
Page112
Page113

CHAPTER
5

ChildrenwithSpecificLanguageImpairment

DefiningtheProblem

SuspectedCauses

SpecialChallengesinAssessment

ExpectedPatternsofLanguagePerformance

RelatedProblems

DefiningtheProblem

Sandyisacompact6yearoldwhowaslateintalkingandconsideredunintelligiblebyallbutafewfamilymembersuntilaboutage5.Sheisstilloften
mistakenforayoungerchildbecauseofhersize,limitedvocabulary,andfrequenterrorsingrammar.Havingrecentlytransferredtoanewschool,Sandyis
havingtroubleadjustingandhasbecomeveryquietexceptforoccasionalinteractionswithfriendsfromherpreviousschool.

Joshua,a9yearoldwithahistoryofdelayedspeechandlanguage,continuestouseshort,simplesentencesthatareoftenineffectiveingettinghismessage
across.Despitesignificantgainsinhisoralcommunication,hehasmadelittleprogressinearlyreadingskills.Thus,despitetwoyearsofinstructionand
specialsupportinbothoralandwrittenlanguage,henameslettersofthealphabetinconsistentlyandhasa
Page114

sightvocabularylimitedtoabout30words.Joshuaalsoappearstohavedifficultyunderstandingmanyoftheinstructionsgivenintheclassroom.

Wilsonisa4yearoldwhirlwindwhoaugmentshislimitedspeechproductionswithanimatedgesturesand,sometimes,trulygifteddoodles.Becauseofhis
activitylevelandawkward,sometimesoverwhelmingstyleofinteracting,heisavoidedbyhispeersandhasformedfierceattachmentstothepreschool
teacherandhisspeechlanguagepathologist.Wilsonsparentsandeducatorsarebeginningtoquestionwhetherhisactivitylevelfallswithinthenormal
rangeandwillbediscussingthepossibilityofhavinghimevaluatedforattentiondeficitdisorderwithhyperactivityattheirnextmeeting.Wilsonsabilityto
understandthecommunicationsofothershasneverbeenquestioned.

AlthoughSandy,Joshua,andWilsonarevariedintheirpatternsofcommunicationdifficulties,eachcanbedescribedasdemonstratingspecificlanguageimpairment
(SLI),adisorderestimatedtoaffectbetween1.5and7%ofchildren(Leonard,1998).Arecentlyproposedfigureof7%for5yearoldsmaybethebestcurrent
estimateofprevalence:Theresearchonwhichitwasbasedwasrigorousandincludedtheuseofacarefullyselectedsampleof7,218children(Tomblinetal.,1997).
Althoughestimatesdifferconsiderablyfromstudytostudy,ithasgenerallybeenfoundthatboysareaffectedmoreoftenthangirls,withsomestudiessuggestingthat
boysareattwicetheriskofgirls(Tomblin,1996b).

SLIcanbedefinedasdelayedacquisitionoflanguageskills,occurringinconjunctionwithnormalfunctioninginintellectual,socialemotional,andauditory
domains(Watkins,1994,p.1).Thus,SLIisfrequentlydescribedasadisorderofexclusion.Assuch,itcanseemlikeadefinitionofleftovers,encompassingthose
instanceswherelanguageimpairmentexistsbutcannotreadilybeattributedtofactorsthatclearlylimitachildsaccesstoinformationaboutlanguageortotheabilities
requiredtoundertakethecreativetaskoflanguageacquisition.Ontheotherhand,specificlanguageimpairmentcanberegardedasapureformofdevelopmental
languagedisorder,oneinwhichlanguagealoneisaffected(Bishop,1992b).

Hopesofdefiningthenatureofspecificlanguageimpairmenthaveinstigatedawealthofresearchinchildlanguagedisordersoverthepast50years.Initiallytermed
congenitalaphasiaordevelopmentaldysphasia,SLIseemedtooffertheopportunitytolookatapure,orspecific,varietyofcommunicationdisorder(Rapin,
1996Rapin&Allen,1983).Historically,eachofthecategoriesofdevelopmentallanguagedisordersexaminedinotherchaptersinthissectionofferedostensibly
obviousexplanationsfortheirexistence.Incontrast,childrenwithSLIofferednoapparentexplanationsyetpromisedanopportunitytolookattheuniqueeffectsof
impairedlanguageondevelopment.Orsoitfirstappeared.IntheRelatedProblemssectionofthischapter,youwillreadaboutthesubtledifferencesincognitionand
otherattributesthathavebeenidentifiedinchildrenwithSLIandthatthusthreatennarrowconceptionsofspecificimpairment.

TheDSMIV(AmericanPsychiatricAssociation,1994)doesnotusethetermspecificlanguageimpairment,butincludestwodisordersthattogethercovermuchof
thesameterrain:ExpressiveLanguageDisorderandMixedExpressiveReceptiveLanguageDisorder.Table5.1liststhediagnosticcriteriaforthesetwo
communication
Page115

Table5.1
SummaryofCriteriaforTwoDisordersCorrespondingtoSpecificLanguageImpairmentFromtheDiagnosticandStatisticalManual(4thed.)oftheAmerican
PsychiatricAssociation(1994)

ExpressiveLanguageDisorder(AmericanPsychiatricAssociation,1994,p.58)
Thescoresobtainedfromstandardized,individuallyadministeredmeasuresofexpressivelanguagedevelopmentaresubstantiallybelowthoseobtainedfrom
standardizedmeasuresofbothnonverbalintellectualcapacityandreceptivelanguagedevelopment.Thedisturbancemaybemanifestclinicallybysymptomsthat
A.
includehavingamarkedlylimitedvocabulary,makingerrorsintense,orhavingdifficultyrecallingwordsorproducingsentenceswithdevelopmentally
appropriatelengthorcomplexity.
B. Thedifficultieswithexpressivelanguageinterferewithacademicoroccupationalachievementorwithsocialcommunication.
C. CriteriaarenotmetforMixedReceptiveExpressiveLanguageDisorderorPervasiveDevelopmentalDisorder.
IfMentalRetardation,aspeechmotororsensorydeficit,orenvironmentaldeprivationispresent,thelanguagedifficultiesareinexcessofthoseusually
D.
associatedwiththeseproblems.
MixedReceptiveExpressiveLanguageDisorder(AmericanPsychiatricAssociation,1994,pp.6061).
Thescoresobtainedfromabatteryofstandardizedindividuallyadministeredmeasuresofbothreceptiveandexpressivelanguagedevelopmentaresubstantially
A. belowthoseobtainedfromstandardizedmeasuresofnonverbalintellectualcapacity.SymptomsincludethoseforExpressiveLanguageDisorderaswellas
difficultyunderstandingwords,sentences,orspecifictypesofwords,suchasspatialterms.
B. Thedifficultieswithreceptiveandexpressivelanguagesignificantlyinterferewithacademicoroccupationalachievementorwithsocialcommunication.
C. CriteriaarenotmetforPervasiveDevelopmentalDisorder.
IfMentalRetardation,aspeechmotororsensorydeficit,orenvironmentaldeprivationispresent,thelanguagedifficultiesareinexcessofthoseusually
D.
associatedwiththeseproblems.

disorders.ThedivisionofSLIintothesetwocategoriesreflectsarecurringimpulseamongresearchersandclinicianstoidentifysubgroupswithinthelarger
populationinthiscaseandmostoftenaccordingtowhetherreceptivelanguageissignificantlyaffected.

TheDSMIVcriteriaincludeavariationontheexclusionaryelementsoftheSLIdefinitiondescribeduptothispoint.Specifically,inCriterionDforbothdisorders,the
clinicianisdirectedtolookforlanguageimpairmentswhoseseverityisunexplainedbytheobviousthreatstolanguagedevelopmentincludedinotherexclusionary
definitions(e.g.,thepresenceofhearingimpairmentormentalretardation).TheDSMIVdefinitionsallowbothfortheidentificationofalanguageimpairmentwhenno
obviousthreatsexistsaswellasforcaseswherethepresenceofthesethreatsdoesnotseemsufficienttoaccountforthedegreeofproblempresented.

MostresearchersoverthepastthreedecadeshaveuseddefinitionslargelylikethosediscussedandhaveparticularlyreliedontheoperationalizationofSLIproposed
byStarkandTallal(1981,1988).Thedetailsofsuchdefinitions,however,haveprovenquitecontroversial(Camarata&Swisher,1990Johnston,1992,1993
Kamhi,
Page116

1993Plante,1998).Movingfromthelaboratorytoclinicalpracticeinschools,thecontroversyisintensifiedbecausestatepoliciesarevigorousparticipantsinthe
decisionmakingprocess.Inparticular,theuseofdifferenceordiscrepancyscoresisoftenmandatedbuthasfacedincreasingcriticism(e.g.,Aram,Morris,&Hall,
1993Fey,Long,&Cleave,1994Kamhi,1998).AlthoughmethodsusedinidentificationofSLIarediscussedatsomelengthintheSpecialChallengesin
Assessmentsectionofthischapter,theyarementionedherebecausetheyaffectunderstandingofthenatureoftheproblemandthereforeaffectresearchintendedto
obtaininformationaboutsuspectedcauses,patternsoflanguageperformance,andrelatedproblems.

ItseemsimportanttorecognizethatSLIisatermthatisoftenabsentfromthedaytodayfunctioningofspeechlanguagepathologistsinmanyclinicalandeducation
settings.Instead,theyfrequentlyusethetermslanguagedelaysorlanguageimpairments,therebyremainingsilentonthespecificityofagivenchildsproblems
(Kamhi,1998).Nonetheless,thefoundationofresearchonthispopulationandclinicalwritingsprovidesanimportantcontextforscientificallyorientedclinicalpractice.
Inthesamewaythatfieldgeologistsneedtoknowaboutbasicchemistrydespitefewencountersinthewildwithpureironorotherelements,speechlanguage
pathologistscanlearnfromattemptstoidentifyandunderstandSLIsandtorecognizethemwhentheyencounterthemintheirpractice.Theverylengthofthischapter
comparedwiththeothersaddressinginformationaboutsubgroupsofchildrenwithlanguagedisorderstestifiestothefertilityoftheresultingexplorations.

SuspectedCauses

Thequestionofwhatcausesisolatedlanguageimpairmenthasbeenapproachedfromseveralperspectivesfromgenetictolinguistic,physiologicaltosocial.Itremains
aquestionor,moreaccurately,aseriesofrelatedquestionsthattantalizesresearchers,clinicians,andparentsalike.Itisbestviewedasasetofrelatedquestions
becauseonecanconceiveofcausesonseveraldifferentlevels(e.g.,physicalaswellassocial).Inaddition,itcanbeviewedthatwaybecauseeffectsarefrequentlythe
resultofaconvergenceofcausesratherthanasinglecause.Thustwoormorefactorsmayneedtocomeintoplaybeforeimpairedlanguageoccurs.Understanding
causationisfurthercloudedbythefactthatresearchersarefrequentlyonlyinthepositionofidentifyingriskfactorsthatis,factorsthattendtocooccurwiththe
presenceofSLI,butthatcanonlybethoughtofaspotentialcausesuntilthenatureoftheassociationcanbeworkedoutthroughfurtherresearch.

Inthissection,areviewofsuspectedcausesencompassesnotonlydifferencesinbrainstructureandfunction,genetics,andselectedenvironmentalfactors,butalso
moreabstractlinguisticandcognitivediscussionsoftheoriginsofspecificlanguagedisorderinchildren.Althoughthereisconsiderableturmoilinthecommunityofchild
languageresearchersconcerningthemoreabstractaccountsprovidedinlinguisticandcognitiveexplanations,theirroleinassessmentandplanningfortreatmenthasthe
potentialforbeingmoreimmediateandinfluentialthanthatofaccountsrelatedtogeneticsandphysiology.
Page117

Genetics

GeneticoriginsforSLIhaveprobablybeensuspectedforsomeyearsbyanyonewhohasencounteredfamiliesinwhichlanguageproblemsseemmorecommonplace
thanonemightexpectgiventherelativeexceptionalityoflanguageimpairment.Nonetheless,seriousstudyofgeneticcontributionstoSLIhavebeenundertakenonlyin
thelastcoupleofdecades(Leonard,1998Pembrey,1992Rice,1996).Largely,theincreaseinsuchstudieshasoccurredbecauseofadvancesinthestudyof
behavioralgenetics(Rice,1996).Inaddition,however,thedelayedinterestinthegeneticsoflanguageimpairmenthasresultedfromtheneedforagreementona
phenotype,thatis,thebehaviororsetofbehaviorsthatconstitutecriticalcharacteristicsofthedisorder(Gilger,1995Rice,1996).

Severaldifferenttypesofgeneticstudiesareregularlyusedtolinkspecificdiseasesorbehavioraldifferenceswithgeneticunderpinnings(Brzustowiz,1996).Among
thosethathavebeenusedtothegreatestextentsofarinstudyingSLIarefamilystudies,twinstudies,andpedigreestudies.Infamilystudies,thefamilymembersofa
proband(i.e.,anaffectedpersonwhoisthefocusofstudy)areexaminedtodeterminewhethertheyshowevidenceofthecharacteristicordisorderunderstudyat
ratesthatarehigherthanwouldbeexpectedinthegeneralpopulation.Iftheydo,thecharacteristicordisorderisconsideredfamilialastateofaffairsthatcouldbe
duetogeneticoriginsortocommonexposuretootherinfluences.Thus,forexample,afondnessforchocolatemightbefoundtobefamilial,but,withoutfurtherstudy,
couldjustaseasilybeduetolongexposuretoakitchenfullofchocolatedelicaciesastoageneticbasis.

Intwinstudies,comparisonsofthefrequencyofacharacteristicordisorderaremadebetweenidenticalandfraternaltwins.Becauseidenticaltwinssharethesame
geneticmakeup,theyshouldshowhigherconcordanceforthecharacteristicifithasageneticbasisthatis,thereshouldbeastrongtendencyforbothidenticaltwins
toeitherhaveornothavethecharacteristic.Incontrast,iftheirratesofconcordancearerelativelyhigh,butsimilartothoseofthefraternaltwins(whoarenomore
geneticallyrelatedthananypairofsiblingsandthusonaverageshare50%oftheirgeneticmakeup),thecharacteristicmightstillbeconsideredfamilial.However,in
thatcase,itwouldbemorelikelytheresultofenvironmentalratherthangeneticinfluences.(SeeTomblin,1996b,foradiscussionofsomeofthecomplexitiesofthis
typeofdesign.)

Inpedigreestudies,asmanymembersas,possibleofasingleprobandslarge,multigenerationalfamilyareexaminedinordertogetinsightintopatternsofinheritance
associatedwiththetargetedcharacteristicordisorder.Closelyrelatedtopedigreestudiesaresegregationstudiesinwhichmultiplefamilieswithaffectedmembersare
examinedtocompareobservedpatternsofinheritancewithpatternsthathavebeenobservedforothergeneticallytransmitteddiseases.

DespitethedifficultiesassociatedwithdefiningadisorderascomplexasSLI(Brzustowicz,1996),considerableprogresshasbeenmadeoverthepast15yearsin
understandinggeneticcontributionstothedisorder.Familialstudies(e.g.,Neils&Aram,1986Tallal,Ross,&Curtiss,1989Tomblin,1989)haveconsistently
demonstratedhigherriskamongfamiliesselectedbecauseofanindividualmemberwithSLIthanfamiliesselectedbecauseofanunaffectedmemberwhoisservingasa
control
Page118

participant.Complicatingthesefindings,however,havebeenobservationsthatmanychildrenwithSLIcomefromfamilieswheretheyaretheonlyaffectedmember
(Tomblin&Buckwalter,1994).Further,familyhistoriesofSLImaybemorecommonamongchildrenwithexpressiveproblemsonlythanamongthosewithboth
receptiveandexpressiveproblems(Lahey&Edwards,1995).

Whereassomefamilialstudies(e.g.,Neils&Aram,1986Tallaletal.,1989Tomblin,1989)haveusedquestionnairestoexaminethelanguageskillsofotheroften
olderfamilymembers,othershaveuseddirectassessmentoflanguageskills(e.g.,Plante,Shenkman,&Clark,1996Tomblin&Buckwalter,1994).Thelatterstudies
areconsideredmoredesirable(Leonard,1998)becausetheyrelyneitheronparticipantsmemoriesofchildhooddifficultiesnoronpotentiallyincompleteand
inaccurateschoolorclinicalrecords.Further,theyseemtobemoresensitivetomanifestationsofSLIinadults,therebycapturingagreaternumberofaffected
individualsforexaminationofinheritancepatterns(Planteetal.,1996).Mostimportantly,however,bothtypesofstudiescandemonstratefamilialpatternsofSLI,
whicharethefirststeptowardprovingitsgeneticunderpinningsforinleastsomeaffectedindividuals.

Twinstudies(e.g.,Bishop,1992aTomblin,1996b)havedemonstratedhigherconcordanceforSLIamongidenticalthanfraternaltwins,thusprovidingevidenceof
somedegreeofgeneticinfluence.However,evenamongidenticaltwins,concordanceisnotperfect,despitetheiridenticalgeneticmakeup.Consequentlyithasbeen
suggestedthateithertheaffectedgeneassociatedwithSLIdoesnotalwaysproducethesameoutcome(duetoincompletepenetrance)oritdoesnotoperatealoneto
produceSLI(Tomblin&Buckwalter,1994Leonard,1998).Intheformercase,incompletepenetrancereferstocasesinwhichageneassociatedwithadisorder
failstoactinanallornothingfashion,withsomepeoplewhocarryageneshowingnoilleffects(Gilger,1995).ThelatterprospectmeansthatSLImaybecausedby
morethanonegeneorthatageneorgroupofgenesmustoperateincombinationwithenvironmentalfactors.

CurrentresearchonthegeneticsofSLIisweighingthesealternativescenarios.Amongthekindsofstudiesneededarepedigreeandsegregationstudiesinwhich
groupsoffamiliesorasinglefamilyisstudiedacrossgenerations.Onefamily,referredtoastheKEfamily,hasbeenunderstudyforsometime(e.g.,Crago&Gopnik,
1994Gopnik&Crago,1991VarghaKadeem,Watkins,Alcock,Fletcher,&Passingham,1995).Thisfamilycontinuestobeexaminedtodeterminewhethera
hypothesizedautosomaldominanttransmissionmodeisatwork.Briefly,autosomaldominanttransmissionmeansthatthedisorderistransmittedthroughapairof
autosomalchromosomes(i.e.,oneofthe22chromosomepairsthatarenotsexlinked)andwilloccurevenifonlyoneofthetwochromosomesinapairisaffected.

TheKEfamilyhasmanyaffectedmembers,aswouldbeexpectedgivenanautosomaldominantmodeoftransmission,asopposedtomodesinvolvingthesex
chromosomes(asinglepair)orarecessivemodeoftransmissioninwhichbothmembersofapairwouldbeaffectedtoresultinthedisorder.Infact,mostmembersof
theKEfamilydemonstratebothseverelyimpairedspeechandlanguage,andseveralshowcognitiveimpairmentorpsychiatricdisordersaswell.Thus,additionalwork
isneededtoexamineotherfamilieswhomightbemorerepresentativeofgreaternumbersofchildrenwithSLI.
Page119

Continuingpursuitofinformationaboutgeneticbasesisthoughttobeusefulbecauseitmaybepossibletodeterminewhataspectsoflanguageimpairmentaremore
biologicallydeterminedand,therefore,perhapslessamenabletotreatment.Oncethosedeterminationsaremade,clinicianscouldfocusonthefosteringof
compensatorystrategiesorontheameliorationofremainingaspectsofthelanguageimpairmentthatmaybemoremodifiablethroughtreatment(Rice,1996).

DifferencesinBrainStructureandFunction

TheprospectofdifferencesinbrainstructureandfunctionbetweenchildrenwithSLIandthosewithouthasbeckonedasapotentialexplanationsinceresearchersfirst
beganruminatingaboutthisdisorder.Thisisillustratedbytheuseofthetermchildhoodaphasiainthe1930sandseveraldecadesthereafter.Amongthepossibilities
thathavebeenexaminedarethoseofearlydamagetobothcerebralhemispheres,ofdamagetothelefthemisphereonly(Aram&Eisele,1994Bishop,1992a),as
wellasthepossibilitythatdifferencesarenottheresultofdamageperse,butratheraretheexpressionofnaturalgeneticvariation(Leonard,1998).

Currently,casesoffrankneurologicdamageforexamplethosefollowingastrokeorheadinjuryareexcludedfromdefinitionsofSLI.Somewhatmoredifficultto
classifyaretheproblemsofchildrenwithLandauKleffnersyndrome,alsocalledacquiredepilepticaphasia.Thesechildrenfailtoshowsignsoffocaldamageexcept
forelectroencephalographicabnormalities,yettheyexperienceaprofoundlossoflanguageskills(Bishop,1993).Althoughincludedinearlyformulationsofchildhood
aphasia,thissyndromehasrecentlybeenfoundtofitwithincasesthataretypicallyexcludedfromSLI.

DespitetheexclusionofknownbraindamagefromstrictdefinitionsofSLI,arelativelylargenumberofstudiesusingtechniquessuchasmagneticresonanceimaging
(MRI)and,lessfrequently,autopsyexaminationhavebeenundertakentodeterminewhethersubtledifferencesinbrainstructureandfunctioncanaccountforthe
difficultiesfacingchildrenwithSLI.Oftenthesedifferenceshavebeenstructuralanomaliesthatseemtodepartfromthoseconsideredoptimalforalefthemisphere
dominanceforspeechleadingtoeitherrighthemispheredominanceoralackofdominancebyeitherhemisphere(Gauger,Lombardino,&Leonard,1997).
Increasingly,itisthoughtthatsuchdifferencesmayreflectvariationsinstructurethatmakelanguagedevelopmentlessefficient(e.g.,Leonard,1998).

Twoareasofthecerebralhemispheresinwhichsuchvariationshavebeenidentifiedaretheplanatemporaleandtheperisylvianareas,illustratedinFig.5.1.Thesetwo
areasoverlap,withthesmallerplanumtemporalelyingwithinthelargerperisylvianregionofeachhemispherebothoftheareasliewithinanareathathasconsistently
beenshowntobeassociatedwithlanguagefunction.

ExaminationsoftheplanatemporaleinindividualswithSLIweresparkedbya1985autopsystudy(Galaburda,Sherman,Rosen,Aboitiz,&Geschwind)ofadultswho
hadhadwrittenlanguagedeficits.Detailedexaminationoftheseindividualsbrainsafterdeathshowedanatypicalsymmetrybetweentheplanumtemporaleontheleft
andtheoneontheright.Thispatterncontrastedwiththemoretypicalasymmet
Page120

Fig.5.1.Theleftcerebralhemispherewiththeplanumtemporalehighlighted.FromNeuralbasesofspeech,hearing,andlanguage(Figure92),byD.P.Kuehn,
M.L.Lemme,&J.M.Baumgartner,1989,SanAntonio,TX:ProEd.Copyright1989byProEd.Adaptedwithpermission.

ricarrangementinwhichtheplanumtemporaleontheleftisbiggerthanthatontheright,withthelargersizethoughttoreflectgreaterinvolvementinlanguage
processing.Theatypicalsymmetryresultsfromatypicallysizedleftplanumtemporaleandalargerthanusualrightplanumtemporale.Intheonlyautopsystudy
conductedtodateforasinglechildwithSLI,thissameatypicalsymmetrywasobserved(Cohen,Campbell,&Yaghmai,1989).

Similarasymmetries,withleftlargerthanrighthemisphereperisylvianareas,havealsobeenidentifiedinautopsystudiesperformedonindividualswhodidnothave
SLIduringtheirlifetimes(e.g.,Geschwind&Levitsky,1968Teszner,Tzavares,Gruner,&Hecaen,1972).Theperisylvianareas,ratherthanthesmallerplana
temporale,becamethefocusofaseriesofstudiesconductedbyPlanteandhercolleagues(Plante,1991Plante,Swisher,&Vance,1989Plante,Swisher,Vance,&
Rapcsak,1991).Inthosestudies,Planteandhercolleaguescomparedtherelativesizeoftheseareasbetweenhemispheresandbetweenfamilymemberswhowere
affectedorunaffectedbySLI.TheresearchersfocusedontheperisylvianareasratherthantheplanatemporalebecauseoflimitationsintheuseofMRI(Plante,
1996)atechniquethatwasnonethelesshighlydesirablebecauseitcouldbeusedevenonveryyoung,liveparticipants.

TheresearchersfoundthatchildrenwithSLIandtheirfamiliesdemonstratedperisylvianareasthatwerelargerontherightthanthosetypicallyseeninstudiesof
individualswithoutSLIoraknownfamilyhistoryofSLI(Plante,1991Planteetal.,1989,1991).Theselargerrightperisylvianareassometimesassociatedwith
symmetryacrosshemispheresandsometimeswithasymmetriesfavoringtherighthemisphere.Nonetheless,becausesomeindividualswithatypicalconfigurationsdid
notshowlanguageimpairment,andotherswithnormalconfigurationsdidshowsuchimpairment,thisstructuraldifferencecannotbeseenasasinglecauseoflanguage
impairment.Ina1996reviewofthisliterature,PlantenotedthattheabsenceofabnormalfindingsforsomeindividualsmaysimplybeduetotheinsensitivityofMRI
techniquestosubtledifferencesinbrainstructure.Nonetheless,herargumentdoesnotreallyexplaintheinstancesinwhichidentifiedatypicalstructuresareassociated
withnormallanguageperform
Page121

ance.Furthermore,Plante,aswellasotherresearchersinthefield(Leonard,1998Rice,1996Watkins,1994),believethatanumberoffactorsprobablyneedtobe
inplaceforstructuralbraindifferencestoculminateinlanguageimpairment.

MorerecentstudieshavelookednotonlyattheperisylvianareasbutalsoatotherbrainstructuresfordifferencesthatmayhelpresearchersbetterunderstandSLI
(e.g.,Clark&Plante,1998Gaugeretal.,1997Jackson&Plante,1996).Whereasmanyofthesehavebeenregionsinorclosetotheperisylvianregion(e.g.,Clark
&Plante,1998Jackson&Plante,1996),othershavelookedatmuchlargerareasofthecerebrum(Jernigan,Hesselink,Sowell&Tallal,1991),attheextensivetract
ofnervefibersconnectingthetwocerebralhemispheres(Cowell,Jernigan,Denenberg&Tallal,1994,citedinLeonard,1998),andatareasincludingtheventricles
(Trauner,Wulfeck,Tallal,&Hesselink,1995).Allofthesestudiesfoundatleastsomedifferences(Cowelletal.,1994).

Inarecentreviewofthesestudiesandothersusingbehavioralandneurophysiologicaldata,Leonard(1998)summarizedtheevidenceasindicatingthehighpercentage
ofatypicalneurobehavioralfindingsforchildrenwithspecificlanguageimpairmentimplicatesaconstitutionalbasisthatmaycontributetothepresenceoflanguage
impairment.Theoriginsofthesesuspecteddifferencesinbrainstructureleadtootherkindsofquestionsaboutcauses,suchasenvironmentalfactors.

EnvironmentalVariables

Environmentalvariablescanencompassphysical,social,emotional,orotheraspectsofthedevelopingchildssurroundingsfromconceptiononward.Twotypesof
environmentalvariables,however,havereceivedthegreatestamountofattentionforSLI(a)variablesconstitutingthesocialandlinguisticenvironmentinwhich
childrenwithSLIareacquiringtheirlanguage(Leonard,1998)and(b)demographicvariables,suchasparentaleducation,birthorder,andfamilysocioeconomicstatus
(SES),thataffectthatenvironmentinlessdirectways(Tomblin,1996b).

AparticularlyengagingandclearaccountoftheliteratureexaminingconversationalenvironmentofchildrenwithSLIcanbefoundinLeonard(1998,chap.8).Inthe
literatureexaminingthistypeofenvironmentalinfluence(e.g.,Bondurant,Romeo&Kretschmer,1983Cunningham,Siegel,vanderSpuy,Clark,&Bow,1985),most
studieshavefocusedonthenatureandlinguisticcontentofconversationsoccurringbetweenchildrenwithSLIandtheirparents.Usually,comparisonsaremadeto
conversationsbetweenparentsandtheirnormallydevelopingchildren(agematchedorlanguagematched,dependingonthestudy).Inaddition,inordertoclarify
chickenortheeggspeculationaboutthedirectionofcausation(i.e.,Aredifferencesinconversationcausingchildrensproblemsorresultingfromthem?),studies
havealsoexaminedconversationsbetweenchildrenwithSLIandunrelatedadults(Newhoff,1977)andevenwithotherchildren(e.g.,Hadley&Rice,1991).

Despitetheimpedimentsofferedbyabundantmethodologicalvariationsandchallengingpatternsofempiricaldisagreements,Leonard(1998)venturedafew
generalizationsaboutthislineofinvestigation.First,mostoftheevidenceinwhichchildrenwithSLIarecomparedwithcontrolchildrenwhoaresimilarinagesuggests
thattheir
Page122

conversationpartners(parents,otheradults,andpeersalike)makeallowancesfortheirdiminishedlanguageskillsandarethusreactingto,ratherthancausing,the
childrensproblems.Forexample,Cunninghametal.(1985)foundthatmothersofchildrenwithSLIinteractedsimilarlytomothersofcontrolchildrenofthesimilar
agesinconditionsoffreeplay,butaskedfewerquestionsduringastructuredtask.Inaddition,forthosechildrenwithSLIwhosecomprehensionandproductionwere
bothaffected,mothersreducedtheirlengthofutterance,somethingthatwasnotdonebymotherswhosechildrenwereeithernormallydevelopingorhadSLIinwhich
onlyexpressivelanguagewasaffected.

Second,Leonard(1998)contendedthatinstudieswherechildrenwithSLIarecomparedwithyoungerchildrenwhoaresimilarinlanguagecharacteristics,findingsare
lessconsistentinshowingdifferences.Nonetheless,themostreliabledifferenceinhoweachgroupisspokentobytheirparentsinvolvesthefrequencywithwhich
recastsareused.Arecastisarestatementofachildsproductionusinggrammaticallycorrectstructures,oftenincorporatingmorphosyntacticformsthathadbeen
omittedorproducedinerrorbythechild(Leonard,1998).Recentresearchhassuggestedthatthisconversationalstrategyisusedfrequentlybyparentsofnormally
developingchildrenatearlierstages,butisthenfadedovertime.Ithasalsobeenshowntobeausefultherapeuticstrategy(Nelson,Camarata,Welsh,Butkovsky,&
Camarata,1996).Interestingly,LeonardnotedthatratherthanincreasingtheiruseofthiskindofstatementwithchildrenwithSLIasmightbeexpectedin
compensation,parentsofchildrenwithSLIuseitlessfrequentlythanthoseofchildrenwithoutSLI.Despitethepossiblevalueofadditionalresearchinclarifyingwhy
thisdifferenceisseen,allinall,thislineofresearchhasnotprovenasproductivetotheunderstandingofthegenesisofSLIaswasoncehoped(Leonard,1998).

Turningtopossiblecluesintheformofdemographicvariables,Tomblin(1996b)searchedforriskfactorsindemographicdataobtainedfromthepreliminaryresults
(consistingof32childrenwithSLIand114controls)ofalargerepidemiologicalstudy(plannedtoinclude200childrenwithSLIand800controls).Specifically,he
lookedforassociationsbetweendemographicandbiologicaldataandthepresenceofSLI.Amongthevariablesheexaminedrelativetothehomeenvironmentwere
parenteducation,familyincome,andbirthorderofthechildinthefamily.AlthoughthereweretrendsinthedirectionofchildrenwithSLIbeinglaterbornandhaving
parentswithfeweryearsofeducationthanunaffectedchildren,neitherofthesetrendswassignificant.Tomblinspeculatedthatthetwotrendsmayhavebeenduetothe
extentthatlowerincomesareassociatedwithlargerfamilies.

AlsoavailabletoTomblin(1996b)weredataconcerningexposuretobiologicalriskfactorsincludingmaternalinfectionorillness,medication,useofalcohol,anduseof
tobaccoduringpregnancy,aswellastheevidenceofpotentialtraumaatbirthandtheparticipantsbirthweights.Inthesepreliminarydataatleast,Tomblinfoundno
differencesbetweenthegroupsrelativetomaternalinfectionandillnessduringpregnancy,andactuallyfoundlower,butnonsignificantratesofexposuretoalcoholand
medication.Birthhistoriesandbirthweightsalsodidnotdiffersignificantly.OnlymaternalsmokingshowedatrendtowardshigherlevelsamongthechildrenwithSLI.
Althoughattributingthelackofsignificantfindingstotherelativelysmallsamplesizesused,
Page123

Tomblinalsosuggestedthatthelargernumbersassociatedwiththecompletedstudywouldbeunlikelytorevealeffectsizesofanymajorsignificance,whereeffect
sizesrelatetothemagnitudeofthedifferencebetweengroups.

Clearly,findingsacrossseverallinesofresearchsuggesttheneedforthecontinuationandcoordinationofeffortstounderstandthecomplexityofvariablesthatput
childrenatriskforSLI.Althoughneurologicandgeneticresearchfindingshavebeenparticularlyexcitingoverthepasttwodecades,thesevariablesarenotsufficientby
themselvestoexplainSLI.Biologicalandenvironmentalfactorsrepresentimportantfrontiersforamorecompleteunderstandingoflanguageimpairment(Snow,1996).
Atadifferentlevelofexplanation,linguisticandcognitiveaccountsattempttoprovidemoreimmediateexplanationsforthespecificpatternsoflanguagebehaviorsseen
inSLIandtheirvariabilityacrosschildrenandovervaryingages.

LinguisticandCognitiveAccounts

AlargenumberoflinguisticaccountsofSLIaswellascognitiveaccountshavebeenadvancedoverthepastseveraldecades.Atpresent,morethanadozen
warrantseriousconsideration(Leonard,1998).Asagroup,theseaccountsdeservesomeattentionherebecauseoftheirpotentialimpactonassessmentandtreatment
ofchildrenforwhomSLIissuspectedorconfirmed.

Asdiscussedinpreviouschapters,thevalidityoftheassessmenttoolchieflyturnsontheextenttowhichitcapturestheconstructbeingmeasured.Consequently,
differentmodelsofSLIimplytheneedfordifferentmeasures.Inpractice,however,thelinkbetweentheoreticalunderstandingsofacomplexbehaviorandreadily
availableassessmentproceduresisusuallyfarfromdirect.Thisisparticularlytruewhentherearealargenumberofcompetingaccountsbutnoclearfrontrunnersthe
currentcaseforSLI.Inaddition,thetermaccounts,usedhereandusedbyLeonard,specificallyimpliesacknowledgementthattheseformulationsfailtotietogether
thebreadthofdatathataretypicallyassociatedwithuseofthetermtheories.Despitetheselimitations,somefamiliaritywiththesecompetingaccountscanhelpreaders
anticipatefuturetrendsinboththeoreticaleffortsandinrecommendedassessmentpractice.

Leonard(1998)reviewedawidefieldoflinguisticandcognitiveexplanationsofSLI,dividingthemintothreecategories.Specifically,heconsideredsixexplanationsof
SLIfocusingondeficitsinlinguisticknowledge:threeonlimitationsingeneralprocessingcapacityandthreeonspecificprocessingdeficits.Becauseofspacelimitations,
eachofthesetwelveaccountscannotbediscussedindetailhere.Instead,asmallsubsetwillbeusedtointroducereaderstothiscomplexdebateandillustratethe
challengesawaitingresearchersandclinicianswhoseektotranslatetheseaccountsintoassessmentpractice.

LanguageKnowledgeDeficitAccounts

Leonard(1998)arguedthatChomskys(1986)principlesandparametersframeworktolanguageacquisitioncanbeseenasafoundationforthemajoraccountsin
whichdeficitsinlinguisticknowledgearepostulatedascentraltoSLI.Stemming
Page124

fromtransformationalgrammarofthe1960sand1970s,principlesrepresentuniversalsofnaturallanguages,andparametersthedimensionsalongwhichindividual
languagesdiffer.Childrenarepresumedtoworkwithintheconstraintsassociatedwithuniversalprinciplestoacquirethespecificknowledgeoftheparametersettings
associatedwiththeirambientlanguage.Chiefamongthedifficultiesfacingchildreninthisprocessistheapparentneedtounderstandmorethanjustthesurfacerelations
existingbetweenwordsinsentencesastheyareheard.Rather,theymustalsounderstandtheunderlying,orinferred,relationshipsbetweenlexicalcategories(e.g.,
noun,verb,adjective)andfunctionalcategoriesthatexplainrelationshipsbetweenwordswithinsentences(e.g.,complementizer,inflection,determiner).

DifferencesintheaccountsthatLeonard(1998)placedwithinthiscategorylieprimarilyinwhichareaoflinguisticknowledgeisabsentor,moreoften,incompletein
childrenwithSLI.Leonardhimselfandseveralcolleaguesareassociatedwithaccountsinwhichknowledgeoffunctionalcategoriesoverallisdeemedincomplete
(Leob&Leonard,1991Leonard,1995).Alternatively,Rice,Wexler,andCleave(1995)areassociatedwiththeextendedoptionalinfinitiveaccount,inwhich
childrenwithSLIarethoughttoremaintoolonginadevelopmentalphaseinwhichtenseistreatedasoptional.OtheraccountsseechildrenwithSLIasunableto
developimplicitgrammaticalrules(Gopnik,1990),asdevelopingrulesthataretoonarrowintheirapplication(e.g.,Ingram&Carr,1994),oraslackingtheabilityto
understanddifferentagreementordependentrelationshipsexistingbetweenfunctionalcategories(e.g.,Clahsen,1989vanderLely,1996).

Amongthesignificantchallengesfacingtheseaccountsistheirneedtoprovidemorecompleteexplanationsofthevariabilityindevelopmentalpatternsshownby
childrenwithSLIandofcrosslinguisticdifferencesintheerrorpatternsanddevelopmentofchildrenwithSLI.Inaddition,despiteemergingeffortstotielinguistic
accountstogenetic,biological,andenvironmentalaccounts(e.g.,Gopnik&Crago,1991),furtherstepsinthatdirectionareneeded.

AccountsPositingGeneralProcessingDeficits

GeneralprocessingdeficitaccountsofSLIplacegeneraldeficitsincognitiveprocessingatthecoreofSLI,withthemostambitiousofthemholdingthesedeficits
responsibleforboththelinguisticandnonlinguisticdifferencesseeninchildrenwithSLI(Leonard,1998).Ratherthanassumethatspecificcognitivemechanismsare
affectedasisdoneinthethirdandfinalcategoryofaccountstheseaccountspostulateamorewidespreaddeficiencyofferingasimpler,moreelegantexplanationof
thepatternsofdeficitsseeninchildrenwithSLI.Typically,suchaccountstendtodescribecentralcognitivedeficitsintermsofreductionsinprocessingcapacityor
speed.

Suchaccountsareparticularlycompellingforexplanationsofdifficultiesinwordrecallandretrievalandcomprehensionaswellasnonlinguisticcognitivedeficits,but
mustalsoexplainthespecialdifficultiesassociatedwithmorphosyntaxinmostEnglishspeakingchildrenwithSLI.AmongthenumerousresearcherscitedbyLeonard
(1998)asworkingonaccountsofthistypeareEllisWeismer(1985),Bishop(1994),EdwardsandLahey(1996Lahey&Edwards,1996)aswellasLeonard
himself.
Page125

Leonardssurfacehypothesis(e.g.,Leonard,1989Leonard,Eyer,Bedor,&Grela,1997)representsoneofthemostthoroughlyprobedofthegeneralprocessing
deficitaccountsand,consequently,serveshereasanimportantexemplarofsuchaccounts.Thesurfacehypothesissuggeststhatdifferencesinthepatternofdeficits
observedcrosslinguisticallyinchildrenwithSLImaybeduetodifferencesinlanguagestructureacrosslanguages.Suchdifferencesarethoughttoleadtodifferencesin
processingdemandsratherthantotheimpairedgralnmaticalsystemspositedbylinguisticaccounts.Thisaccountemphasizestheimportanceofsurfacefeaturesof
languages,suchasthephysicalpropertiesofEnglishgraummaticalmorphology,thatmayrepresentspecialchallengestochildren,particularlytothosewithreduced
processingcapabilities.

Accordingtothesurfacehypothesis,childrenwithSLIwilltakelongertoacquirethemoredifficultaspectsoftheirlanguageandmayfocustheirprocessingeffortsin
someareasattheexpenseofothers(e.g.,onwordorderattheexpenseofmorphology).Amongthosefeaturesofalanguagethatareconsideredparticularly
vulnerablearethosethatarerelativelybrief,uncommoninlanguagesoftheworld,orlessregularwithinthelanguage(e.g.,numerousgrammaticalmorphemesin
English).Leonard(1998)providesathoroughdescriptionofthesuccessesandfailuresofthisaccountinexplaininganeverexpandingbodyofempiricaldatafrom
severallanguagegroups.Furtherheshowsitsbasiccompatibilitywiththesurfacehypothesisandotherprocessinglimitationaccountsthatemphasizereducedspeedof
processing.

Aswiththegrammaticalknowledgeaccounts,accountsthatpositgeneralprocessingdeficitshaveawiderangeofcrosslinguisticdatatoaddress,includingpatternsof
errorsandofacquisitionpatternsinchildrenwithSLI.Further,theappealofsuchaccountsintermsofsimplicityisenhancediftheycanalsoaddresssimilardatafor
childrenwithoutimpairedlanguage.AddtothatthedesirabilityofaddressingemergingdataonthegeneticandbiologicfactorsassociatedwithSLIanditbecomesonly
asmallwonderthatconsensusleadingtoaunifiedtheoryofSLIeludestheresearchcommunityatthistime.ThelastofthethreetypesofaccountsLeonarddescribes
withinthiscommunitywrestleswiththissamelistofempiricalchallengesbutproposescognitivelimitationsthataremorespecificinnature.

SpecificProcessingDeficitAccountsofSLI

AccordingtoLeonard(1998),threeaccountshavefocusedonspecificdeficitsasresponsibleforfarreachingconsequencesforlanguagefunction.Respectively,these
accountshypothesizedeficitsinphonologicalmemory(EllisWeismer,Evans,&Hesketh,1999Gathercole&Baddeley,1990),intemporalprocessing(Tallal,1976,
Tallal&Piercy,1973Tallal,Stark,Kallman,&Mellits,1981),andinthemechanismsusedforgrammaticalanalysis(Locke,1994).Theseaccountsarelesswell
developedthanthelinguisticandgeneralcognitivedeficitaccountsintermsofthebreadthofdatatheyencompass.

Oftheseaccounts,theaccountsassociatedwithtemporalprocessing(viz.,Stark&Tallal,1988Tallaletal.,1996)havehadthegreatestrecentimpact,including
considerableattentioninthepopularpress(e.g.,inaUSATodayarticle[Levy,1996]).
Page126

ThisattentionhaslargelybeentheresultofthepopularizationofaspecifictrainingprogramcalledFastForWord(ScientificLearningCorporation,1998).

AfteralonghistoryofworkonSLI,TallaljoinedwithMichaelMerzenichandotherstoconductaseriesofremarkabletreatmentstudies(Merzenichetal.,1996Tallal
etal.,1996).InthosestudiesuseofFastForWord,acomputertrainingprogramdesignedtoaddresshypothesizedprocessingdifficulties,resultedinsignificantgainsin
languageperformanceandauditoryprocessing.DevelopmentofthatprogramwasbasedonevidencethatchildrenwithSLIhavedifficultyprocessingbriefstimulior
stimulithatfollowoneanotherinrapidsuccessiondifficultiesthatmightsignificantlyaffectachildsabilitytoprocessspeech.Further,theprogramisbasedonthe
hypothesisthatthedeficitcanbeamelioratedbyexposingchildrenwithSLItostimulithatareinitiallyrecognizablebutacousticallyalteredthroughthelengtheningof
formanttransitions.Duringtreatment,childrenparticipateinalargenumberofvideogameliketrialsinwhichtheyarerequiredtomakejudgementsaboutthealtered
stimuli.Acrosstrials,thestimuluscharacteristicsarealteredinthedirectionofnaturalspeech.

Readersareencouragedtotakenoteofthedebatesurroundingthisaccountandthecommercializationithasfostered(e.g.,Gillam,1999Veale,1999).Ironically,the
authorsoftheotheraccountsdiscussedinthissectionofthechapterhaveappearedtotakegreaterpainstotietogetherahugenumberofempiricalcluesaboutthe
natureofSLI.However,itisraretofindthepublicsoawareofanaccountoratleastthetreatmentprogramassociatedwithitandtoclamorforitsusewith
childrenpresentingwithawiderangeofcommunicationrelateddisorders(includingreadingdisabilitiesandautism).Thesepublicresponsesalonemakeitafascinating
areaofadditionalinvestigationforcliniciansandresearchersinterestedinchildrenslanguagedisorders.Independentvalidationofthistreatmentanditstheoretical
underpinningshasyettobeprovided(Gillam,1999).

WhatsAheadforAccountsofSLI?

Inthissection,Ihavetriedmybesttopointoutthemostimportantlandmarksofthisvastandchangingterrain(helpedconsiderablybytheworkofLeonard,1998,and
theurgingsofBernardGrelatoaddressthesecomplexissues).However,IamcertainthatIhavemissedsomeimportantvantagepointsandcriticalroadways.
Nonetheless,Ihopethatthisbriefoverviewprovidesyouwiththesenseofthecomplexitiesfacingtheseresearchers.

Theresearchersworkingonthistopichaveimmenseamountsofdatatoaddressiftheyaretosettleonatrulycomprehensivetheory,ratherthanfragmentedaccounts
ofisolatedaspectsofSLI.NotonlymusttheydealwithinformationabouthowchildrenofSLIperformonarangeoflanguageandnonlanguagetasks,theymustdoso
forthewiderangeofspokenlanguagesandacrossthelifespan.Furthertheymusttiethesetogetherwiththeburgeoningfindingsaboutthegenetics,brainstructures,
andsocialcontextsofchildrenwithSLI.

OtherchallengesfacingresearchersinterestedinSLIhavebeensummarizedbyTagerFlusberg&Cooper(1999),whoreviewedthefindingsofarecentNational
InstitutesofHealthworkshopfocusedonstepsneededtoproducecleardefinitionsofSLI
Page127

forgeneticstudy.Despitethenarrowfocusofthatconference,therecommendationsthatcameoutofitappeargermanetothoughtsabouttherelationoftheoryto
assessmentpractices.AmongtherecommendationssummarizedbyTagerFlusbergandCooperarethatresearchersabandonexclusionarydefinitionsofSLI,broaden
thelanguagedomainsandinformationprocessingskillstheyassess,anddevelopastandardapproachtodefiningSLI,notonlyinpreschoolersbutalsoinolderschool
agechildren,adolescents,andadults.Thesesamerecommendationsareclinicallyrelevantinsofarascombiningclinicalandresearcheffortsmayresultinthegreatest
gainsinbotharenas.

SpecialChallengesinAssessment

InadditiontothetheoreticalchallengestotheassessmentofchildrenwithSLI,thesechildrenalsocomewitharangeofpersonalreactionstotestingthatareatleast
partiallydeterminedbytheamountofsuccesstheyexpect.Anyofuswhohasdifficultyincertainareas,suchassinging,drawing,orplayingsportsknowshow
uncomfortablewefeelwhenourperformanceinthoseareasisevaluated.Consequently,Iurgeyoutoreferbacktochapter3forsomeofthegeneralguidelines
addressedinthatchapter,whichwillserveasausefulexerciseinpreparingforworkingwithchildrenwithSLI.

Beyondthepersonaldynamicsthatshouldalwaysbeaspecialconsiderationinassessment,childrenwithSLIpresentseveralproblemsrelatedtohowtheyare
identifiedasneedinghelp.Plante(1998)pointedoutatleastthreeproblemswithhowsuchchildrenhavebeenidentifiedbyresearchers.SomeofPlantesconcerns
abouttheliteraturealsofaceclinicians.Eventhosethatdonot,deserveattentionbyknowledgeableconsumersofthisresearchliterature.

First,Plante(1998)argued,researchershavetendedtousecriteriafornonverbalIQ(oftennonverbalIQof85orgreater)thatexcludenotonlychildrenwithmental
retardationbutlargenumbersofotherswhoselowerintelligencemakesthemnolessrelevanttoourunderstandingofSLI.Second,Plantenotedthatintheidentification
process,researchershavetendedtousetestsandcutoffscoresonthoseteststhathavenotbeenshowntosuccessfullyidentifychildrenwiththedisorder.Specifically,
shequestionedtwoparticularaspectsofthevalidityofthosetestsandcutoffs:theirsensitivity(theextenttowhichindividualswithdisordersareactuallyidentifiedas
havingthedisorder)andspecificity(theextenttowhichindividualswithoutdisordersaresuccessfullyidentifiedassuch).(Seechap.9formorecompleteexplanations
oftheseconcepts).

Third,Plante(1998)questionedtheuseofdiscrepancyordifferencescoresinthepracticeoftenreferredtoascognitivereferencing.Cognitivereferencingoccurs
whentheidentificationofSLIhingesonthedemonstrationofaspecificdifferencebetweenexpectedlanguagefunction(basedonnonverbalIQ)andlanguage
performance.Planteattackedthispracticeontwogrounds:(a)becauseofatendencyforsuchcomparisonstobebasedonageequivalentscores,whicharethe
targetsofalonghistoryofcriticismfrompsychometricperspectives(e.g.,seechap.2)and(b)becausethereisnogoodevidencetosupporttheuseofnonverbalIQ
asanindicatoroflanguagepotential.Asjustoneexampleofthislackofevidence,KrassowskiandPlante(1997)reportedalackofstabilityintheperformanceIQ
scoresof75childrenwithSLIovera3yeartimeframethatwouldbeinconsistentwiththeiruseasaconstant
Page128

measureoflanguagepotential.Planteandhercolleaguesarejoinedbylargenumbersofthecommunityoflanguageresearchersinfindingseriousmanywouldsay
fatalflawswithcognitivereferencing(e.g.,Arametal.,1993Feyetal.,1994Kamhi,1998Lahey,1988).Alongwiththeinstabilityofcategorizationsobtained
throughcognitivereferencing,othershavenotedthatsimilaramountsofimprovementinspecifictreatmentsaremadebychildrenwhowouldfallonbothsidesof
conventionalcognitivecriteria(e.g.,Feyetal.,1994).

Evenreaderswhohavesimplyskimmedearlierchaptersontheirwaytothisonewillrecognizecertaincommondilemmasfacingcliniciansaswellasresearchers
regardingcognitivereferencing.Thus,forexample,bothgroupsneedtobeascarefulaspossibletoselectmeasuresthathavebeenstudiedverycarefullyforthe
purposetowhichtheyarebeingused.Thatis,evidenceofcriterionrelatedvalidityforhowandwithwhommeasuresareusedissomethinginwhichbothcliniciansand
researchershaveaprodigiousstake.Inaddition,bothgroupsshouldavoidtherelativelyunreliableandmisleadingnatureofageequivalentscoresinsofarastheyare
abletodoso.Thewiggleroomleftbythatlastclausestemsfromthefactthatcliniciansmayfindthemselvescompelledtouseageequivalentscoresbythesettingsin
whichtheywork,particularlyforyoungerchildren.Withregardtocognitivereferencing,Casby(1992)notedthatin31states,eligibilityforservicesbasedonSLI
demanditsuseinsomeform.Insuchsituations,anethicalandsensiblerecommendationwouldbetoprovidetherequireddocumentation(i.e.,togoaheadandreport
thecognitivereferencedinformation,ageequivalentscores,orboth),butaccompanyitwithappropriatewarningsaboutthelimitationsofeachandrecommendations
fromamorescientificallysupportableperspective.

InadiscussionofproblemsofdifferentialdiagnosisinSLI,Leonard(1998)calledattentiontoafurtherdifficultyassociatedwiththeassessmentofchildrenconsidered
atriskforthedisorder.Specifically,hecalledattentiontothedifficultyindistinguishinglatetalkers,whowillultimatelyprovetobesimplylateindevelopinglanguage,
fromthosechildrenwhoselatetalkingforetellspersistingproblemsinlanguageacquisition.MostchildrenwithSLIhaveahistoryoflatetalking(whichisusuallydefined
intermsoflateuseofwords).However,onlyonequartertoonehalfoflatetalkerswillgoontobediagnosedwithalanguagedisorder.Developingaccurate
predictionsofwhichchildrenareshowingearlysignsofSLIhasspurredtheeffortsofanumberofresearcherswhohopethatearlyidentificationwillleadtoeffective
andefficientearlyintervention(e.g.,Paul,1996Rescorla,1991).

Unfortunately,thedramaticvariabilityinchildrensnormallanguagedevelopmentisprovingaconsiderableobstacle.Thus,reliablesignsyieldingreasonablyaccurate
predictionshaveevadedresearchers,leadingLeonard(1998)torecommendwithholdingdiagnosesuntilatleastage3andPaul(1996)toadviseawatchandsee
policy.AdifferinginterpretationofthedataonwhichPaulsrecommendationsarebasedthatincludesapleaformoreaggressiveinterventioncanbefoundinvan
Kleeck,Gillam,andDavis(1997).

Alsourgingmoreaggressiveresponsestolatetalkingchildren,Olswang,Rodriguez,andTimler(1998)representasomewhatmoreoptimisticreadingoftheresearch
evidence.Specificallytheyoutlinedspeechandlanguagedifferencesandotherriskfactorsthattheyproposeshouldpromptdecisionstointervene.Table5.2
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Table5.2
PredictorsandRiskFactorsUsefulinHelpingCliniciansDecideWhethertoEnrollToddlersWhoAreLateTalkersforIntervention

Predictors

Speech Nonspeech RiskFactors

Languageproduction
l Smallvocabularyforage

l Fewverbs
Play
l Preponderanceofgeneralallpurposeverbs OtitismediaProlongedperiodsofuntreatedotitis
l Primarilymanipulatingandgrouping
(e.g.,want,go,get,do,put,look,make,got) media
l Littlecombinatorialand/orsymbolicplay
l Moretransitiveverbs(e.g.,Johnhittheball)

l Fewintransitiveandditransitiveverbforms(e.g.,

hesleep,doggierun)
Languagecomprehension
l Presenceof6monthcomprehensiongap
l Largecomprehensionproductiongapwith
comprehensiondeficit
Phonology
l Fewprelinguisticvocalizations
l Limitednumberofconsonants
l Limitedvarietyinbabblingstructure
l Lessthan50%consonantscorrect(substitutionof
glottalconsonantsandbacksoundsforfront)
l Restrictedsyllablestructure
GesturesFewcommunicativegestures,symbolic HeritabilityFamilymemberwithpersistentlanguage
gesturalsequences,orsupplementarygestures andlearningproblems
Socialskills
Parentneeds
l Behaviorproblems
l Parentcharacteristics:LowSESdirectivemorethan
l Fewconversationalinitiations
responseinteractionstyle
l Interactionswithadultsmorethanpeers
l Extremeparentconcern
l Difficultygainingaccesstoactivities

l Vowelerrors

Imitation
l Fewspontaneousimitations

l Relianceondirectmodelandpromptingin

imitationstasksofemerginglanguageforms

Note.FromRecommendingInterventionforToddlersWithSpecificLanguageLearningDifficulties:WeMayNotHaveAlltheAnswers,butWeKnowaLot,by
L.Olswang,B.Rodriguez,&G.Timler,1998.AmericanJournalofSpeechLanguagePalhology,7,p.29.Copyright1998byAmericanSpeechLanguage
HearingAssociation.AmericanSpeechLanguageHearingAssociation.Reprintedwithpermission.
Page130

summarizestheirlist.Theyrecommendedthatlargernumbersofriskfactorsbeviewedascauseforgreaterconcern.

ExpectedPatternsofLanguagePerformance

ThelanguageperformanceofchildrenwithSLIhasundergonegreaterscrutinythanthatofanyothergroupofchildrenwithlanguagedifficulties.Thediversityanddepth
ofthisresearchoverseveraldecadesleadstosomeclearexpectationsofareasinwhichdifficultiescanbeexpectedbutalsotoubquitousexpectationsthateachchild
willbedifferent.

Therefore,beforeIdelveintoexpectedpatternsofdifficulties,Ishouldmentionagainthatgeneralexpectationsleadtohypothesesaboutwhatmightbeexpectedina
givenchildnotinfalliblecertainties.GeneralizationsalsofailtorendereitherthevariationsfoundinstudiesidentifyingdistinctsubtypesofSLI(e.g.,Aram&Nation,
1975Rapin&Allen,1988Wilson&Risucci,1986)orinstudiesrevealingchangesinpatternsofimpairmentthatoccurwithage(e.g.,Aram,Ekelman,&Nation,
1984Stothard,Snowling,Bishop,Chipchase,&Kaplan,1998Tomblin,Freese,&Records,1992).Further,thesegeneralizationshavebeenidentifiedforchildren
acquiringEnglishapotentiallyseriouslimitationforcliniciansworkingwithchildrenacquiringotherlessstudiedlanguages(Leonard,1998).Thus,theexpected
patternsdiscussedherearedescribedonlybrieflyandaremeanttopromptconsiderationoflikelyareasofdifficulty,nottobecometheonlyonesgivenattention.

AmongthemorerobustfindingsfromstudiesexamininglanguageskillsinEnglishspeakingchildrenwithSLIhavebeenthefindingsthat(a)expressiveandreceptive
languageareoftendifferentiallyimpaired,and(b)degreeofinvolvementcanvaryfromquitemildtoquitesevere.Also,expressivelanguagetendstobemorefrequently
andseverelyaffectedanobservationthatisborneoutinmuchoftheliteratureandisalsoreflectedintheDSMIV(AmericanPsychiatricAssociation,1994)
definitionsharedatthebeginningofthechapter.Recentresearch,however,suggeststhatthisdisparitymaynotbeaslargeashassometimesbeenthought.Amongthe
childrenwhowerefoundtohaveimpairedlanguageinareportdealingwithalargeepidemiologicalstudy,Tomblin(1996a)identified35%ofchildrenwithexpressive
problems,28%withreceptiveproblems,and35%withbothexpressiveandreceptiveproblems(givenacutoffof1.25standarddeviationsbelowthemean).

InTable5.3,specificareasofdifficultyrelativetonormallydevelopingpeersaresummarizedonthebasisofanextensivereviewofliteratureappearinginLeonard
(1998cf.Menyuk,1993Watkins,1994).InTable5.3,thedensityofcommentsfallingunderlanguageproductionreflectsnotonlythetendencyforthismodalityto
beaffectedbymoreobviousandoftenmoreseveredeficitsthancomprehension,butalsobyatendencyforittohavereceivedmuchgreaterresearchattention.A
relatedtable,Table5.4,listsspecificgrammaticalmorphemesthathavebeenidentifiedasparticularlyproblematic.

AsyouexamineTable5.3,noticethatmanyalthoughnotallofthedifferencesshownbychildrenwithSLIresemblepatternsseeninyoungerchildrenandare
thereforecharacterizedasdelays.Thisobservationmayhaveimplicationsrelatedtothenatureofthisdisorder.Inaddition,itsupportsthereasonablenessof
approaching
Page131

Table5.3
PatternsofOralLanguageImpairmentbyModalityandDomainReportedinChildrenWithSpecificLanguageImpairment(SLI)(Leonard,1998)

Domain Production Comprehension

Semantics
l Delaysinacquiringfirstwordsandwordcombinations

Delaysinverbacquisition,withoveruseofsomecommon
Lexicalabilitiesandearlyword l l Deficientinlearningtounderstandnewwords,particularly
verbs(e.g.,do,go,get,put,want)
combinations thoseinvolvingactions
l Wordfindingdifficulties,aespeciallynotedinschoolage

children
l Increasedtendencytoomitobligatoryarguments(e.g.,
omissionofobjectfortransitiveverb)oreventheverbitself
l Increasedtendencytoomitoptionalbutsemanticallyimportant l Increaseddifficultyinacquiringargumentstructureinformation
Argumentstructure
information(e.g.,adverbialsprovidinginformationregardingtime, fromsyntacticinformationfornewverbs
location,ormannerofaction)anduseofaninfinitivalcomplement
(e.g.,Hewantstodothis)
l Grammaticalmorphologyconstitutesarelativeandsometimes
enduringweaknessinchildrenwithSLI(seeTable5.4foralistof l Limitedresearchsuggestspoorercomprehensionof
grammaticalmorphemesthathavereceivedparticularattention) grammaticalmorphemes,especiallyforthoseofshorterduration,
Grammaticalmorphologyb
l Grammaticalmorphologyrelatedtoverbsisespeciallyaffected andpooreridentificationoferrorsinvolvinggrammatical

l Errorsmostoftenconsistofomissionsratherthan morphemes
inappropriateuse,butarelikelytobeinconsistentineithercase
l Althoughoccasionallyoccurringalone,phonologicaldeficits
arealmostalwaysaccompaniedbyotherlanguagedeficits,and
viceversa
l Delaysaremostfrequentlyseenwithmosterrorsresembling
Phonology thoseofyoungernormallydevelopingchildren.
l Unusualerrorsinproductioncoccurrarely,butprobablymore

oftenthaninnormallydevelopingchildren
l GreatervariabilityinproductionthanchildrenwithoutSLIat
similarstagesofphonologicaldevelopment

(Continued)
Page132

Table5.3(Continued)

Domain Production Comprehension

l Someevidenceofpragmaticdifficulties
l Althoughthesedifficultieslargelyseemduetocommunication
l Limitedresearchsuggeststhatunderstandingofthespeech
problemsposedbyotherlanguagedeficits,independent
actsofothersmaybeaffected
Pragmatics pragmaticdeficitsmayoccuraswell
l Comprehensionoffigurativelanguage(e.g.,metaphors,
l Participationincommunicationisnegativelyaffectedwhen
idioms)canbeaffected
communicationinvolvesadultsormultiplecommunication
partners
l Cohesionofnarrativescanbeaffected,andsometimes l Comprehensionofnarrativescanbeaffectedwheninferences
Narratives
expectedstorycomponentsareabsent needtobedrawnfromtheliteralnarrativecontent

aEvidencedbyunusuallylongpausesinspeech,frequentcircumlocution,orfrequentuseofnonspecificwordssuchasitandstuff.
bGrammaticalmorphologycanbedefinedastheclosedclassmorphemesoflanguage,boththemorphemesseenininflectionalmorphology(e.g.,plays,played)
andderivationalmorphology(e.g.,fool,foolish),andfunctionwordssuchasarticlesandauxiliaryverbs(Leonard,1998,p.55).
cAmongtheunusualerrorsreportedforthispopulationarelaterdevelopingsoundsbeingusedinplaceofearlierdevelopingsounds,asoundsegmentaddition,and
useofsoundsnotheardinthechildsambientlanguage.

treatmentgoalsfromadevelopmentalperspective(Leonard,1998).Also,noticetheexpanseofunmappedcountryrevealedhere.Despiteseveraldecadesofwork,
muchremainsunknownabouttheabilitiesofchildrenwithSLIandhowtheyarerelatedtooneanother.Consequently,thepotentialforvaluableoutcomesfrom
experimentalexplorationisimmense!

Finally,onaverydifferentnote,readersofthistablemayfindthattheirknowledgeofsometerminologyrelatedtolinguisticdescriptionsofthesechildrensdifficultiesis
outdatedorincomplete.TheyarereferredtoHurford(1994)asareferenceguidetothemorebasicgrammaticalterms.

RelatedProblems

Whencomparedwithchildrendescribedinothersectionsofthisbook,childrenwithSLIhavefarfewerrelatedproblems.Despitethemorerestrictednatureoftheir
difficulties,however,childrenwithSLIareatincreasedriskforanumberofsignificant,ongoingproblemsinadditiontoalengtheninglistofsubtleperceptualand
cognitivedeficienciesthatweredescribedbrieflyearlier.Amongtheseareincreasedriskforemotional,behavioral,andsocialdifficulties.Inaddition,thereisincreased
riskforongoingacademicdifficultiesoftenassociatedwithdiagnosesoflearningdisabilities(Wallach&Butler,1994).
Page133

Table5.4
ExamplesofGrammaticalMorphemes,anAreaofSpecialDifficultyforChildrenWithSpecificLanguageImpairment(SLI)

Inflectionalmorphemes
Pasttense,regulared:slept,walked,irregular:flew,hid
Thirdpersonsingulars:sits,runs
Progressiveing:isrunning,isseeing
Plurals:coats,flowers
Possessives(alsocalledgenitives):Sams,dogs
Othergrammaticalmorphemes
Copulabe:heisaboytheyarehappy
Auxiliarybe:sheishunting,hewascooking
Auxiliarydo:IdonthateyouDoyourememberthatman?
Articles:themanacat
Pronouns:anything,herself,I,he,they,them,her

Emotional,Behavioral,andSocialDifficulties

Thepossibilitythatchildrenwithspecificlanguagedisordersmaybeatriskfordifficultiesinpersonaladjustmenthasbeenexaminedatseverallevelsofseverity.These
levelsofseverityhaverangedfromstudiesexaminingtheprevalenceofidentifiablepsychiatricdiagnoses(e.g.,Baker&Cantwell,1987a,bBeitchman,Nair,Clegg,&
Patell,1986Beitchman,Brownlie,etal.,1996Beitchman,Wilson,etal.,1996)tostudiesexaminingspecificaspectsofpeerrelationshipsorsocialmaturation(e.g.,
Craig,1993Farmer,1997Fujiki&Brinton,1994Gertner,Rice,&Hadley,1994Records,Tomblin,&Freese,1992Rutter,Mawhood,&Howlin,1992).

Studieslookingatthisissuedifferinalargenumberofmethodologicalvariables(e.g.,agesstudied,methodsusedtodefinelanguageimpairmentandotherproblem
areas).Nonetheless,aserviceableoverviewoftheirfindingsisthatchildrenwithSLIareatincreasedriskfordifficultiesinvolvingtheiremotional,behavioral,andsocial
status.Further,thisgeneralizationholdsforbothchildrenandolderindividualswithahistoryofSLIevenwhentheyappeartohaveoutgrownpersistinglanguage
impairment(throughtreatmentormaturationalprocessesalonee.g.,Rutter,Mawhood,&Howlin,1992).Thereisevidencethatchildrenwithreceptiveproblemsor
thosewithbothexpressiveandreceptivelanguageproblemsareatgreaterriskthanthosewithexpressiveproblemsalone(e.g.,Beitchman,Wilson,etal.,1996
Stevenson,1996).Thecausalmechanismsinvolvedinthecooccurrenceofcommunicationproblemsanddifficultiesinemotional,behavioral,andsocialrealmsare
difficulttodiscernandarefarfrombeingunderstood(Stevenson,1996).Still,theimplicationsofthecooccurrencealonearenonethelessimportantforthosewhohelp
childrenwithSLI.

AmongthespecificproblemsassociatedwithSLIthatcanbecategorizedaspsychiatricproblemsareattentiondeficitdisorder(ADD),conductdisorder,andanxiety
disorders(Baker&Cantwell,1987b).Ofthesethreedisorders,perhapsthemostfamiliartomanypeopleisattentiondeficithyperactivitydisorder(ADHD).
With
Page134

anestimatedprevalenceof4to6%ofallelementaryschoolagedchildren,ithasbeendescribedasthemostcommonsignificantbehavioralsyndromein
children(Wender,1995,p.185).RecallthatinthedescriptionofWilsonatthebeginningofthechapter,itwassuspectedasacontributortosomeofhisdifficultiesin
fittingintotheclassroomandinteractingwithpeers.

ADHDistypicallydiagnosedinchildrenwhoshowpatternsofinattention,overactivityimpulsivity,orboth,thatseeminappropriateforageanddetrimentalto
functioning(AmericanPsychiatricAssociation,1994).Althoughsymptomsofthedisordermaybemorecommoninsomesituationsthanothers,theyoccuracross
settings.ExcellentpracticalrecommendationsfordealingwiththesymptomsofthisdisorderintheclassroomareavailableinDowdy,Patton,Smith,andPolloway
(1998,AppendixA).

Conductdisorderisdiagnosedinchildrenwhodemonstratearepeatedandconsistentpatternofbehaviorthatisinappropriateforageandviolatessocialorevenlegal
norms(AmericanPsychiatricAssociation,1994Goldman,1995).Behaviorsthatareassociatedwiththisdiagnosiscanincludeaggressiontopeopleandanimals,
destructionofproperty,deceitfulness,theft,truancy,andrunningaway.

Anxietydisorderisdiagnosedinchildrenwhoworryexcessively,usuallyabouttheirperformance,withresultingnegativeeffectsontheirfunctioning(American
PsychiatricAssociation,1994).Althoughtheareaofconcernmayshiftfromtimetotime,theintensity,duration,andfrequencyoftheanxietyandworryareseenasout
ofproportionwiththeiractuallikelihoodorimpact.Childrenwiththisdisordermaybeoverlyconcernedaboutapprovalandrequireexcessivereassuranceaboutthe
adequacyoftheirperformanceorotherfocusofconcern.

Althoughthediagnosesofattentiondeficitdisorder,conductdisorderandanxietydisordersarerelativelyrareamongchildrenwithlanguageimpairment,anotherview
oftheassociationbetweenpsychiatricdiagnosesandlanguageskillshasbeentakenbyresearcherswhoexaminethelanguageskillsofgroupsofchildrenseenas
psychiatricoutpatients.Inonerelativelyrecentstudy,researchersfoundthatonethirdofthe399suchchildrenwhoselanguagewasscreenedwereidentifiedashaving
anunsuspectedlanguageimpairment(Cohen,Davine,Horodezky,Lipsett,&Isaacson,1993).Thus,awarenessofthispossibleassociationcanhelpspeechlanguage
pathologistscontributetothedevelopmentofchildrenwhoseemotionalandbehavioralissueshavepreviouslyovershadowedveryreallanguagedifficulties,aswellas
thosechildrenforwhomalanguagediagnosishasalreadybeenmade.

AcademicDifficulties

Theconnectionbetweenlanguagedifficultiesandacademicdifficultiesisapowerfulone.Intheearlygrades,academicskillsbuildonlanguageskillsusedineveryday
experience.Later,academicdemands,especiallyforwrittenlanguageacquisitionbutalsofortheunderstandinganduseoffigurativelanguage,narrativeconstruction
andtheuseoflanguageinreasoning(Nippold,1998),helpfueladditionalgainsinlanguagedevelopment.Atleastthatisthewaythingsarethoughttoworkfor
normallydevelopingchildren.
Page135

Increasingly,itappearsthattheorallanguagedifficultiesofchildrenwithSLImaycontributetoandbeexacerbatedbytheunsuccessfullanguageexperiencesthey
encounterinschool.BashirandStrominger(1996)describedtheinterweavingoforalandwrittenlanguageproblemsasfollows:

Itisreasonabletoarguethatthecontinuedacademicvulnerabilityinchildrenwithlanguagedisordersinthemiddlegradesreflectsboththepersistenceoflanguage
problemsandrestrictionsonlaterlanguagedevelopmentresultingfromreducedreadingaswellasrestrictedexposuretodifferenttextsandtextbasedinformation.(p.
134)

Thus,notonlymaylanguageimpairmentsleadtoacademicdifficulties,butdifficultieswiththelanguageoftheacademicsettingmaycontributetochildrenfallingfurther
behindtheirpeersinlanguagedevelopment.

ArecentstudybyStothardetal.isquiterepresentativeoftheliteratureonlaterlanguageandacademicoutcomes(e.g,Hall&Tomblin,1978Tomblinetal.,1992
Weiner,1974)andcorroboratessomeofitsmorerobustfindings.Thestudyreportsondatafromthesamechildrenseenatages4,5,and15years.Experimental
measuresincludedmeasuresoforallanguage(receptivevocabulary,expressivevocabulary,generalcomprehension,grammaticalunderstanding,naming),shortterm
memoryandphonologicalskills(sentencerepetition,nonwordrepetition,andspoonerisms),andwrittenlanguage(consistingofonetestthatassessessingleword
reading,singlewordspelling,andreadingcomprehension).Inaddition,informationaboutchildrensspecialeducationstatuswasexamined.

ResultsindicatedthatchildrenwhowereseenashavingpersistingSLIatage5demonstratedlongstandingimpairment,withperformancesatage15fallingbelow
agematchedpeersonallorallanguagemeasures.Inparticular,47%ofthesechildrenobtainedverbalcompositescoresmorethan1standarddeviationbelowthe
mean,and20%obtainedscoresmorethan2standarddeviationsbelowthemean.Inaddition,theyshowedpersistingproblemsinreadingandspellingthathadresulted
inahighpercentagereceivingspecialeducationassistanceofsomekind.

Evenchildrenwhoseemedtohaverecoveredatage5,performedsignificantlylesswellthanagematchedpeersatage15onteststappingshorttermmemoryand
phonologicalskills.Further,almostathirdofthesechildren,31%(8outof26),demonstratedperformancesconsistentwiththepersistingSLIcategory,thatis,they
couldagainbeconsideredlanguageimpaired.Thisisconsistentwithapatterntermedillusoryrecovery,whichreferstotheapparentreemergenceofproblemsasthe
complexityofdemandsplacedonchildrenincreaseswithgradelevel(Scarborough&Dobrich,1990).

ThefewstudiesexploringthelanguageskillsandacademicaccomplishmentsofadultswithahistoryofSLI(Gopnik&Crago,1991Hall&Tomblin,1978Planteet
al.,1996Tomblinetal.,1992)confirmthatmanychildrenwithSLIwillcontinuetobeplaguedbysignificantdifferencesinlanguageperformancethatimpactother
areasoffunctioning,includingschooladvancement.

ThePersonalPerspectiveforthischapterillustratesthepossibilityoflongtermacademiceffectsofSLI.
Page136

PERSONALPERSPECTIVE
ThisperspectivewasprovidedbyMichele,whotoldherstorytoCynthiaRoby,theauthorofWhenlearningistough:Kidstalkabouttheirlearningdisabilities
(1994).AlthoughMicheleprimarilydiscussedherlearningdisabilityanditsimpactonherschoolexperiences,itseemslikelythatshehadlanguageproblemsasa
learningproblem.
Myapartmentisaboveavideostoreinthecity.Icangorightdownstairsandrentamovie.Idonthaveanybrothersorsisters.MymotherisKorean.Sheworksat
acafeteria.MydadworksattheairporthesChinese.WeeatlotsofKoreanandChinesefood.Ilikericeandnoodles.Ilovepizza,too.
IthinkmyparentsfoundoutIhadalearningproblemwhenIwastwo.Ihadaproblemwhenpeoplewouldreadtome.IwouldjustdrawonthebooksbecauseI
couldntunderstandthestories.Itwashardformetounderstandthewords.
Ihatedmyoldschool,Ifeltalittlebitmadabouthavingalearningproblem.Icouldntreadthewordsandtheotherkidscould.IhadtobesenttoaquietroomsoI
couldread.Somebodywouldhelpmethere.ItmademefeelhappywhenIfinallygotextrahelp.Itdidntmakemefeelbadtogotothespecialclassroom.
Thenafewyearsago,myparentsdecidedtosendmetoaspecialschoolforkidswithlearningdisabilities.Ilikeitthere,andtheteachershelpme.Theytreatme
nicelyandhelpmewithmyreading.Evenso,recessisstillthemostfun.Irunaroundtheplaygroundwiththegirls.
Myparentshelpmewithschoolwork.Mydadusedtoshowmeflashcards.Hestillhelpsmewithmymath,myreading,andmyspelling.Hemadealistofallthe
mathfactsIhavetolearnitstapednexttomybed.Myparentsaregoodtome.TheydontgetangryatmebecauseIhavelearningproblems.
Ithinkmycousinmayhavelearningproblems,too.Heisjustlittle.Hegoestoschool,andwhentheteacherreadsabookhewontlisten.Heislikemeatthatage.
Imgoodatart.Iliketodoselfportraitsandpaintanddoprojects.Iwouldratherpaintalldayinsteadofdoingmathorreading.Ilikeclassicalmusic.AndlastyearI
learnedtoplayCanCanonthekeyboard.Ipracticedeveryday.SometimesIwouldmessupalittle.ThenIwoulddoitoveragain,andIwoulddoitright.
Ithinkhighschoolwillbehard,veryhard.Iamgoingtostudybiologyincollegeitsallabouthumanbeingsandthebodyparts.IllbeateacherwhenIgrowup.I
willtellkidsnottofightorpinch.Iwanttoteachlittlekids.Theyrecute!
Michelestip:Iwouldtellotherkidswithlearningproblemstogetbooksandkeeptryingtoreadthem.
Page137

Althoughitistheexceptionalchildwithwrittenlanguagedifficultieswhoiswithoutahistoryofspokenlanguagedifficulties(Stark&Tallal,1988),notallchildrenwith
SLIgoontobeidentifiedwithdifficultiesinwrittenlanguage.Factorsthatappeartopredictlaterproblemsinliteracyincludedifficultieswithreceptivelanguage,
phonologicalawareness,andrapidnaming(Leonard,1998).Phonologicalawarenessisexplicitknowledgeaboutthesoundstructureofthelanguageforinstance,
thatwordsaremadeupofsyllablesandsyllablesofindividualsounds(Ball,1993).Othercomplicationstobedealtwithinunderstandingtherelationshipbetween
languageimpairmentandlateracademicdifficultiesareatendencyforlowerintelligenceandlowerSEStoencroachaspotentialconfoundingvariables(Schachter,
1996).

Summary

1.Specificlanguageimpairment(SLI)isaresearchconstructdesignedtohelpidentifyapurelanguagedisorderandisusuallydefinedintermsofexclusionaryaswell
asinclusionarycharacteristics,althoughsuchdefinitionsareincreasinglycontroversial.

2.AmongfactorsthataresuspectedinthecausationofSLIaregenetics,differencesinbrainstructureandfunction,andotherbiologicalfactors.Environmentalfactors,
especiallyaspectsofthechildssocialenvironment,havebeenexamined,butappearlessimportantatthistime.

3.Inaddition,linguisticandcognitiveaccountsofcausationinSLIhavereceivedextensiveattentionfromresearchers.AccordingtoLeonard(1998),thethreemajor
categoriesintowhichtheseaccountsfitarethosefocusedonlinguisticknowledgedeficits,generalprocessingdeficits,andspecificprocessingdeficits.

4.AlthoughtheoreticalunderstandingofSLIcanultimatelybeexpectedtoengendermajorshiftsinassessment]methods,littletranslationfromexperimentalassessment
toolstothoseavailabletopracticingclinicianshasyetoccurred.Moreimmediateimpactmayderivefromcallsforresearchers(andclinicians)toassesslanguageand
otherperformancedomainsmorebroadlyandtoseekconsensusondiagnosticmethods.

5.SpecialchallengestoassessmentincludeproblemswiththefrequentexclusionofchildrenwithmentalretardationfromdefinitionsofSLI,theuseofcognitive
referencinginresearch,bureaucraticallydictatedprotocols,andtheoveruseofmeasuresinidentificationwithoutsufficientstudyoftheirvalidityforthatpurpose.

6.Asanadditionalchallenge,theproblemofdifferentiatingyounglatetalkersfromchildrenwhowillhaveapersistentimpairmentinlanguageposesspecialdifficulties.

7.Patternsoflanguageimpairmentcanrangefrommildtoquitesevereandcanaffectbothreceptiveandexpressivelanguage.Domainsoflanguagethatareparticularly
problematicforyoungchildrenlearningEnglishappeartoincludemorphology,syntax,andphonology.

8.Relatedproblemsforthesechildrenincludesomewhatincreasedriskforemotional,behavioral,andsocialdifficulties,aswellasgreaterriskforpersistentacademic
difficulties.
Page138

KeyConceptsandTerms

anxietydisorder:anemotionaldisorderinchildreninwhichtheirexcessiveanxietyandworrying,usuallyaboutperformance,adverselyaffectstheirperformancein
schoolandathome.

attentiondeficitdisorder(withorwithouthyperactivity):apsychologicaldisorderinwhichindividualsdemonstrateexcessiveinattentionanddistractibility,
implusivityandhyperactivity,orbothwhencomparedwithotherindividualsthesameage.

cognitivereferencing:theuseofameasureofintelligence(usuallynonverbalIQ)asareferenceagainstwhichtodefineimpairedlanguageitisbasedonthe
assumptionthatnonverbalcognitionrepresentsanupperboundforlanguagefunction.

concordance:agreementinthepresenceorabsenceofadisorderbetweentwoindividualsinanaturalpair(e.g.,apairofidenticalorfraternaltwins).

conductdisorder:apsychologicaldisorderinwhichthereisapersistentpatternofviolatingsocialrights,othersrights,orsocietalnormsthroughbehaviorssuchas
aggressiontowardpeopleoranimals,destructionofproperty,theft,ordeceitfulness.

effectsize:Ameasurereflectingthemagnitudeofdifferencebetweengroupsinanexperimentalstudy.Whereasstatisticalsignificanceaddressesthereliabilityofa
researchfinding,effectsizeprovidesimportantinformationforjudgingtheimportanceofastatisticallysignificanteffect.

FastForWord:AcomputerizedtreatmentdevelopedbyPaulaTallal,MichaelMerzenich,andtheircolleagues,basedonthepremisethatSLIiscausedbydifficulties
intemporalprocessing.

generalallpurposeverbs:Verbs,suchasdoandget,thatoccurwithrelativelyhighfrequencyinthespeechofnormallydevelopingchildren,butthatalsotendtobe
overusedinthespeechofchildrenwhoarelatetalkers.

generalprocessingdeficitaccountsofSLI:explanationsofSLIinwhichprocessingdeficitsarepresumedtoaccountforbothverbalandnonverbaldifficulties
documentedinchildrenwithSLI.Thesurfacehypothesisisonesuchaccount.

incompletepenetrance:thefailureofagenetohavethesameeffectonallindividualswhocarryit,forexample,whenagenethatisusuallyassociatedwithaspecific
diseasedoesnotproducethatdiseaseinsomeindividualswhocarryit.

latetalkers:ChildrenwhoshowdelaysinlanguageproductionthatmayrepresentearlysignsofSLIorsimplyadelayinlanguagedevelopmentthatisovercomeas
thechildmatures.

linguisticaccountsofSLI:AccountsinwhichdeficitsinlinguisticknowledgeareconsideredthecoredeficitsinchildrenwithSLI.Rice,WexlerandCleaves
extendedoptionalinfinitiveisanexampleofthistypeofaccount.
Page139

magneticresonanceimaging(MRI):arelativelynoninvasiveradiographictechniqueusedtostudybrainstructureinlivingindividuals.

phenotype:thebehavioraloutcomeforwhichageneticexplanationissought(Rice,1996).

phonologicalawareness:explicitknowledgeaboutthesoundstructureofthelanguage,forexample,knowingthatwordsaremadeofsyllables,andsyllablesof
individualsounds.

proband:theaffectedindividualinageneticstudy,whoseidentifieddisorderordifficultyleadstoresearchersincludingthemandmembersoftheirfamilyingenetic
research.

recast:arestatementofachildsproductionusinggrammaticallycorrectstructures,oftenincorporatingmorphosyntacticformsthathadbeenomittedorproducedin
errorbythechild.

riskfactors:factorsthatareassociatedwithincreasedlikelihoodthatadisorderwilloccurthesefactorsmayormaynotrepresentcauses.

specificlanguageimpairment(SLI):delayedacquisitionoflanguageskills,usuallydefinedasoccurringintheabsenceofimpairmentsinotherareasoffunctioning,
suchasnonverbalcognitionandhearing.

specificprocessingdeficitaccountsofSLI:explanationsofSLIinwhichspecificprocessingdeficits(e.g.,inauditoryprocessingorphonologicworkingmemory)
arethoughttoaccountforthelanguageandotherdifficultiesassociatedwithSLI.Tallalsaccountbasedontemporalprocessingdeficitsisoneexample.

StudyQuestionsandQuestionstoExpandYourThinking

1.HowmightknowledgethatSLIissometimescausedbydifferencesinbrainstructureaffectdiagnosis?Howmightitaffecttreatment?

2.Rememberingthatcooccurrencedoesnotmeancausation,considerthesignificanceofaphysicalmarker,suchasaspecificneurologicalanomaly,forSLI.What
othermechanismsmightexplainitspresencebesidesitshavingaroleincausingtheappearanceoflanguagelearningdifficulties?

3.IfyouweretheparentofachildwithSLI,whatmightyouwanttoknowaboutthegeneticsofthiscondition?Howmightyou,asaclinician,explainthisinformation,
andwherecouldyousuggestthatbothyouandtheparentobtainadditionalinformation?

4.DescribethreepossiblecooccurringproblemsthatmayaffectthecommunicationandtesttakingbehaviorsofachildwithSLI.

5.Onthebasisofyourreading,whatdomainsoflanguageandcommunicationhavebeenconsideredimportantbyresearchers?Canyoufindstandardizedteststhat
correspondtotheseareas?
Page140

6.Whatresearchquestionsdoyouthinkaremostimportantforfurtheringourunderstandingofthiscondition?

RecommendedReadings

Gilger,J.W.(1995).Behavioralgenetics:Conceptsforresearchandpracticeinlanguagedevelopmentanddisorders.JournalofSpeechandHearingResearch,38,
11261142.

Gillam,R.(1999).ComputerassistedlanguageinterventionusingFastForward:Theoreticalandempiricalconsiderationsforclinicaldecisionmaking.Language,
Speech,andHearingServicesinSchools,30,363370.

Hurford,J.R.(1994).Grammar:Astudentsguide.Cambridge,England:CambridgeUniversityPress.

Leonard,L.(1998).Childrenwithspecificlanguageimpairment.Cambridge,MA:MITPress.

References

AmericanPsychiatricAssociation.(1994).Diagnosticandstatisticalmanualofmentaldisorders(4thed.).Washington,DC:Author.

Aram,D.M.,&Eisele,J.A.(1994).Limitstoalefthemisphereexplanationforspecificlanguageimpairment.JournalofSpeechandHearingResearch,37,824
830.

Aram,D.M.,Morris,R.,&Hall,N.E.(1993).Clinicalandresearchcongruenceinidentifyingchildrenwithspecificlanguageimpairment.JournalofSpeechand
HearingResearch,36,580591.

Aram,D.M.,&Nation.J.(1975).Patternsoflanguagebehaviorinchildrenwithdevelopmentallanguagedisorders.JournalofSpeechandHearingResearch,18,
229241.

Aram,D.M.,Ekelman,B.,&Nation,J.(1984).Preschoolerswithlanguagedisorders:10yearslater.JournalofSpeechandHearingResearch,27,232244.

Baker,L.,&Cantwell,D.(1987a).Comparisonofwell,emotionallydisorderedandbehaviorallydisorderedchildrenwithlinguisticproblems.Journalofthe
AmericanAcademyofChildandAdolescentPsychiatry,26,193196.

Baker,L.,&Cantwell,D.(1987b).Aprospectivepsychiatricfollowupofchildrenwithspeech/languagedisorders.JournaloftheAmericanAcademyofChildand
AdolescentPsychiatry,26,546553.

Ball,E.W.(1993).Assessingphonemeawareness.Language,Speech,andHearingServicesinSchools,24,130139.

Bashir,A.,&Strominger,A.(1996).Childrenwithdevelopmentallanguagedisorders:Outcomes,persistence,andchange.InM.D.Smith&J.S.Damico(Eds.),
Childhoodlanguagedisorders(pp.119140).NewYork:Thieme.

Beitchman,J.H.,Nair,R.,Clegg,M.,&Patell,P.G.(1986).Prevalenceofpsychiatricdisordersinchildrenwithspeechandlanguagedisorders.Journalofthe
AmericanAcademyofChildandAdolescentPsychiatry,25,528535.

Beitchman,J.H.,Brownlie,E.B.,Inglis,A.,Wild,J.,Ferguson,B.,Schachter,D.,Lancee,W.,Wilson,B.,&Mathews,R.(1996).Sevenyearfollowupof
speech/languageimpairedandcontrolchildren:Psychiatricoutcome.JournalofChildPsychologyandPsychiatry,37,961970.

Beitchman,J.H.,Wilson,B.,Brownlie,E.B.,Walters,H.,Inglis,A.,&Lancee,W.(1996).Longtermconsistencyinspeech/languageprofiles:II.Behavioral,
emotional,andsocialoutcomes.JournaloftheAmericanAcademyofChildandAdolescentPsychiatry,35,815825.

Bishop,D.V.M.(1992a).Thebiologicalbasisofspecificlanguageimpairment.InP.Fletcher&D.Hall(Eds.),Specificspeechandlanguagedisordersinchildren
(pp.217).SanDiego,CA:SingularPress.

Bishop,D.V.M.(1992b).Theunderlyingnatureofspecificlanguageimpairment.JournalofChildPsychologyandPsychiatry,33,366.

Bishop,D.V.M.(1993).Languagedevelopmentafterfocalbraindamage.InD.Bishop&K.Mogford(Eds.),Languagedevelopmentinexceptional
circumstances(pp.203219).Hove,UK:LawrenceErlbaumAssociates.
Page141

Bishop,D.V.M.(1994).Grammaticalerrorsinspecificlanguageimpairment:Competenceorperformancelimitations?AppliedPsycholinguistics,15,507550.

Bishop,D.V.M.,&Edmundson,A.(1987).Languageimpaired4yearolds:Distinguishingtransientfrompersistentimpairment.JournalofSpeechandHearing
Disorders,52,156173.

Bondurant,J.,Romeo,D.,&Kretschmer,R.(1983).Languagebehaviorsofmothersofchildrenwithnormalanddelayedlanguage.Language,Speech,andHearing
ServicesinSchools,14,233242.

Brzustowicz,L.(1996).Lookingforlanguagegenes:Lessonsfromcomplexdisorderstudies.InM.Rice(Ed.),Towardsageneticsoflanguage(pp.325).
Mahwah,NJ:LawrenceErlbaumAssociates.

Camarata,S.,&Swisher,L.(1990).Anoteonintelligenceassessmentwithinstudiesofspecificlanguageimpairment.JournalofSpeechandHearingResearch,33,
205207.

Casby,M.(1992).Thecognitivehypothesisanditsinfluenceonspeechlanguageservicesinschools.Language,Speech,andHearingServicesinSchool,23,198
202.

Chomsky,N.(1986).Barriers.Cambridge,MA:MITPress.

Clahsen,H.(1989).Thegrammaticalcharacterizationofdevelopmentaldysphasia.Linguistics,27,897920.

Clark,M.,&Plante,E.(1998).Morphologyoftheinferiorfrontalgyrusindevelopmentallylanguagedisorderedadults.BrainandLanguage,61(2),288303.

Cohen,M.,Campbell,R.,&Yaghmai,F.(1989).Neuropathologicalabnormalitiesindevelopmentaldysphasia.AnnalsofNeurology,25,567570.

Cohen,N.J.,Davine,M.,Horodezky,N.,Lipsett,L.,&Isaacson,L.(1993).Unsuspectedlanguageimpairmentinpsychiatricallydisturbedchildren:prevalenceand
languageandbehavioralcharacteristics.JournaloftheAmericanAcademyofChildandAdolescentPsychiatry,32,595603.

Crago,M.,&Gopnik,M.(1994).Fromfamiliestophenotypes.InR.Watkins&M.Rice(Eds.),Specificlanguageimpairmentsinchildren(pp.3551).
Baltimore:PaulH.Brookes.

Craig,H.K.(1993).Socialskillsofchildrenwithspecificlanguageimpairment:Peerrelationships.Language,Speech,andHearingServicesinSchools,24,206
215.

Cunningham,C.,Siegel,L.,vanderSpuy,H.,Clark,M.,&Bow,S.(1985).Thebehavioralandlinguisticinteractionsofspecificallylanguagedelayedandnormal
boyswiththeirmothers.ChildDevelopment,56,13891403.

Dowdy,C.A.,Patton,J.R.,Smith,T.E.C.,&PollowayE.A.(1998).Attentiondeficit/hyperactivitydisorderintheclassroom:Apracticalguidefor
teachers.Austin,TX:ProEd.

Edwards,J.,&Lahey,M.(1996).Auditorylexicaldecisionsofchildrenwithspecificlanguageimpairment.JournalofSpeechandHearingResearch,39,1263
1273.

EllisWeismer,S.(1985).Constructivecomprehensionabilitiesexhibitedbylanguagedisorderedchildren.JournalofSpeechandHearingResearch,28,175184.

EllisWeismer,S.,Evans,J.,&Hesketh,L.J.(1999).Anexaminationofverbalworkingmemorycapacityinchildrenwithspecificlanguageimpairment.Journalof
Speech,Language,andHearingResearch,42,12491260.

Farmer,M.(1997).Exploringthelinksbetweencommunicationskillsandsocialcompetence.EducationalandChildPsychology,14(3),3844.

Fey,M.,Long,S.H.,&Cleave,P.L.(1994)ReconsiderationofIQcriteriainthedefinitionofspecificlanguageimpairment.InR.Watkins&M.Rice(Eds.),
Specificlanguageimpairmentsinchildren(pp.161178).Baltimore:PaulH.Brookes.

Fujiki,M.,&Brinton,B.(1994).Socialcompetenceandlanguageimpairmentinchildren.InR.V.Watkins&M.L.Rice(Eds.),Specificlanguageimpairmentsin
children(pp.123143).Baltimore:PaulH.Brookes.

Galaburda,A.,Sherman,G.,Rosen,G.,Aboitiz,F.,&Geschwind,N.(1985).Developmentaldyslexia:Fourconsecutivepatientswithcorticalanomalies.Annalsof
Neurology,18,222233.

Gathercole,S.,&Baddeley,A.(1990).Phonologicalmemorydeficitsinlanguagedisorderedchildren:Isthereacausalconnection?JournalofMemoryand
Language,29,336360.

Gauger,L.,Lombardino,L.,&Leonard,C.(1997).Brainmorphologyinchildrenwithspecificlanguageimpairment.JournalofSpeech,Language,andHearing
Research,40,12721284.

Gertner,B.L.,Rice,M.L.,&Hadley,P.A.(1994).Influenceofcommunicativecompetenceonpeerpreferencesinapreschoolclassroom.JournalofSpeechand
HearingResearch,37,913923.
Page142

Geschwind,N.,&Levitsky,W.(1968).Humanbrain:Asymmetriesinthetemporalspeechregion.Science,161,186187.

Gilger,J.W.(1995).Behavioralgenetics:Conceptsforresearchandpracticeinlanguagedevelopmentanddisorders.JournalofSpeechandHearingResearch,38,
11261142.

Gillam,R.(1999).ComputerassistedlanguageinterventionusingFastForWord:Theoreticalandempiricalconsiderationsforclinicaldecisionmaking.Language,
Speech,andHearingServicesinSchools,30,363370.

Goldman,S.(1995).Disruptivebehavior,lying,stealing,andaggression.InS.Parker&B.Zuckerman(Eds.),Behavioralanddevelopmentalpediatrics(pp.110
115).Boston:Little,Brown.

Gopnik,M.(1990).Featureblindgrammaranddysphasia.Nature,344,715.

Gopnik,M.,&Crago,M.(1991).Familialaggregationofadevelopmentallanguagedisorder.Cognition,39,150.

Hadley,P.,&Rice,M.L.(1991).Conversationalresponsivenessofspeechandlanguageimpairedpreschoolers.JournalofSpeechandHearingResearch,34,
13081317.

Hall,P.,&Tomblin,B.(1978).Afollowupstudyofchildrenwitharticulationandlanguagedisorders.JournalofSpeechandHearingDisorders,43,227241.

Hurford,J.R.(1994).Grammar:Astudentsguide.Cambridge,England:CambridgeUniversityPress.

Ingram,D.,&Carr,L.(1994,November).Whenmorphologyabilityexceedssyntacticability:Acasestudy.PaperpresentedattheConventionoftheAmerican
SpeechLanguageHearingAssociation,NewOrleans,LA.

Jackson,T.,&Plante,E.(1996).Gyralmorphologyintheposteriorsylvianregioninfamiliesaffectedbydevelopmentallanguagedisorder.NeuropsychologyReview,
6(2),8194.

Jernigan,T.,Hesselink,J.,Sowell,E.,&Tallal,P.(1991).Cerebralstructureonmagneticresonanceimaginginlanguageandlearningimpairedchildren.Archivesof
Neurology,48,539545.

Johnston,J.R.(1992).Cognitiveabilitiesoflanguageimpairedchildren.InP.Fletcher&D.Hall(Eds.),Specificspeechandlanguagedisordersinchildren(pp.
105116).SanDiego,CA:SingularPress.

Johnston,J.R.(1993).Definitionanddiagnosisoflanguagedevelopmentdisorders.InG.Blanken,J.Dittman,H.Grimm,J.C.Marshall,C.W.Wallesch(Eds.),
Linguisticdisordersandpathologies:Aninternationalhandbook(pp.574585).Berlin,Germany:deGruyter.

Kamhi,A.(1993).Childrenwithspecificlanguageimpairment(developmentaldysphasia):Perceptualandcognitiveaspects.InG.Blanken,J.Dittman,H.Grimm,J.
C.Marshall,C.W.Wallesch(Eds.),Linguisticdisordersandpathologies:Aninternationalhandbook(pp.574585).Berlin,Germany:deGruyter.

Kamhi,A.(1998).Tryingtomakesenseofdevelopmentallanguagedisorders.Language,Speech,andHearingServicesinSchools,29,3544.

Krassowski,E.,&Plante,E.(1997).IQvariabilityinchildrenwithSLI:ImplicationsforuseofcognitivereferencingindeterminingSLI.JournalofCommunication
Disorders,30,19.

Kuehn,D.P.,Lemme,M.L.,&Baumgartner,J.M.(1989).Neuralbasesofspeech,hearing,andlanguage.SanAntonio,TX:ProEd.

Lahey,M.(1988).Languagedisordersandlanguagedevelopment.NewYork:Macmillan.

Lahey,M.,&Edwards,J.(1995).Specificlanguageimpairment:Preliminaryinvestigationoffactorsassociatedwithfamilyhistoryandwithpatternsoflanguage
performance.JournalofSpeechandHearingResearch,38,643657.

Lahey,M.,&Edwards,J.(1996).Whydochildrenwithspecificlanguageimpairmentnamepicturesmoreslowlythantheirpeers?JournalofSpeechandHearing
Research,39,10811098.

Leonard,L.(1989).Languagelearnabilityandspecificlanguageimpairmentinchildren.AppliedPsycholinguistics,10,179202.

Leonard,L.(1995).Functionalcategoriesinthegrammarsofchildrenwithspecificlanguageimpairment.JournalofSpeechandHearingResearch,38,12701283.

Leonard,L.(1998).Childrenwithspecificlanguageimpairment.Cambridge,MA:MITPress.

Leonard,L.,Eyer,J.,Bedore,L.,&Grela,B.(1997).ThreeaccountsofthegrammaticalmorphemedifficultiesofEnglishspeakingchildrenwithspecificlanguage
impairment.JournalofSpeechandHearingResearch,40,741753.
Page143

Levy,D.(1996,January5).Soundgameshelpteachimpairedkids.USAToday,p.1A.

Locke,J.(1994).Gradualemergenceofdevelopmentallanguagedisorders.JournalofSpeechandHearingDisorders,37,608616.

Loeb,D.,&Leonard,L.(1991).Subjectcasemarkingandverbmorphologyinnormallydevelopingandspecificallylanguageimpairedchildren.JournalofSpeech
andHearingResearch,34,340346.

Menyuk,P.(1993).Childrenwithspecificlanguageimpairment(Developmentaldysphasia):Linguisticaspects.InG.Blanken,J.Dittman,H.Grimm,J.C.Marshall,C.
W.Wallesch(Eds.),Linguisticdisordersandpathologies.Aninternationalhandbook(pp.606625).Berlin,Germany:deGruyter.

Merzenich,M.,Jenkins,W.,Johnston,P.,Schreiner,C.,Miller,S.,&Tallal,P.(1996,January).Temporalprocessingdeficitsoflanguagelearningimpairedchildren
amelioratedbytraining.Science,271,7781.

Neils,J.,&Aram.D.(1986).Familyhistoryofchildrenwithdevelopmentallanguagedisorders.PerceptualandMotorSkills,63,655658.

Nelson,K.E.,Camarata,S.,Welsh,J.,Butkovsky,L.,&Camarata,M.(1996).Effectsofimitativeandconversationalrecastingtreatmentontheacquisitionof
grammarinchildrenwithspecificlanguageimpairmentandyoungerlanguagenormalchildren.JournalofSpeechandHearingResearch,39,850859.

Newhoff,M.(1977).Maternallinguisticbehaviorinrelationtothelinguisticanddevelopmentalagesofchildren.Unpublisheddoctoraldissertation,MemphisState
University,Tennessee.

Nippold,M.A.(1998).Laterlanguagedevelopment:Theschoolageandadolescentyears.(2nded.).Austin,TX:ProEd.

Olswang,L.,Rodriguez,B.,&Timlet,G.(1998).Recommendinginterventionfortoddlerswithspecificlanguagelearningdifficulties:Wemaynothavealltheanswers,
butweknowalot.AmericanJournalofSpeechLanguagePathology,7,2332.

Paul,R.(1996).Clinicalimplicationsofthenaturalhistoryofslowexpressivelanguagedevelopment.AmericanJournalofSpeechLanguagePathology,5,521.

Pembrey,M.(1992).Geneticsandlanguagedisorder.InP.Fletcher&D.Hall(Eds.),Specificspeechandlanguagedisordersinchildren(pp.5162).SanDiego,
CA:SingularPress.

Plante,E.(1991).MRIfindingsintheparentsandsiblingsofspecificallylanguageimpairedboys.BrainandLanguage,41,6780.

Plante,E.(1996).Phenotypicvariabilityinbrainbehaviorstudiesofspecificlanguageimpairment.InM.Rice(Ed.),Towardageneticsoflanguage(pp.317335).
Mahwah,NJ:LawrenceErlbaumAssociates.

Plante,E.(1998).CriteriaforSLI:TheStarkandTallallegacyandbeyond.JournalofSpeech,Language,andHearingResearch,41,951957.

Plante,E.,Shenkman,K.,&Clark,M.(1996).Classificationofadultsforfamilystudiesofdevelopmentallanguagedisorders.JournalofSpeechandHearing
Research,39,661667.

Plante,E.,Swisher,L.,&Vance,R.(1989).Anatomicalcorrelatesofnormalandimpairedlanguageinasetofdizygotictwins.BrainandLanguage,37,643655.

Plante,E.,Swisher,L.,Vance,R.,&Rapcsak,S.(1991).MRIfindingsinboyswithspecificlanguageimpairment.BrainandLanguage,41,5266.

Rapin,I.(1996).Practitionerreview:Developmentallanguagedisorders:Aclinicalupdate.JournalofChildPsychologyandPsychiatry,37,643655.

Rapin,I.,&Allen,D.(1983).Developmentallanguagedisorders:Nosologicconsiderations.InU.Kirk(Ed.),Neurospychologyoflanguage,reading,andspelling
(pp.155184).NewYork:AcademicPress.

Rapin,I.,&Allen,D.(1988).Syndromesindevelopmentaldysphasiaandadultaphasia.InF.Plum(Ed.),Language,communication,andthebrain(pp.5775).
NewYork:RavenPress.

Records,N.L.,Tomblin,J.B.,&Freese,P.(1992).Thequalityoflifeofyoungadultswithhistoriesofspeechlanguageimpairment.AmericanJournalofSpeech
LanguagePathology,1,4453.

Rescorla,L.(1991).Identifyingexpressivelanguagedelayatage2.TopicsinLanguageDisorders,11(4),1420.

Rice,M.L.(1996).Oflanguage,phenotypes,andgenetics:Buildingacrossdisciplinaryplatformforinquiry.InM.Rice(Ed.),Towardsageneticsoflanguage(pp.
xixxv),Mahwah,NJ:LawrenceErlbaumAssociates.
Page144

Rice,M.L.,Wexler,K.andCleave,P.(1995).Specificlanguageimpairmentasaperiodofextendedoptionalinfinitive.JournalofSpeechandHearingResearch,
38,850863.

Roby,C.(1994).Whenlearningistough:Kidstalkabouttheirlearningdisabilities.MortonGrove,IL:AlbertWhitman&Company.

Rutter,M.,Mawhood,L.,&Howlin,P.(1992).Languagedelayandsocialdevelopment.InP.Fletcher&D.Hall(Eds.),Specificspeechandlanguagedisorders
inchildren(pp.6378).SanDiego,CA:SingularPress.

Scarborough,H.,&Dobrich,W.(1990).Developmentofchildrenwithearlylanguagedelay.JournalofSpeechandHearingResearch,33,7083.

Schachter,D.C.(1996).Academicperformanceinchildrenwithspeechandlanguageimpairment:Areviewoffollowupresearch.InJ.H.Beitchman,N.J.Cohen,
M.M.Konstantaras,&R.Tannock(Eds.),Language,learning,andbehaviordisorders:Developmental,biological,andclinicalperspectives(pp.515529).
Cambridge,England:CambridgeUniversityPress.

ScientificLearningCorporation.(1998).FastForWord[Computersoftware].Berkeley,CA:Author.

Snow,C.E.(1996).Towardarationalempiricism:Whyinteractionismisnotbehavioranymorethanbiologyisgenetics.InM.L.Rice(Ed.),Towardageneticsof
language(pp.377396).Mahwah,NJ:LawrenceErlbaumAssociates.

Stark,R.E.,&Tallal,P.(1981).Selectionofchildrenwithspecificlanguagedeficits.JournalofSpeechandHearingDisorders,46,114122.

Stark,R.E.,&Tallal,P.(1988).R.J.McCauley(Ed.),Language,speech,andreadingdisordersinchildren:Neuropsychologicalstudies.Boston:Little,
Brown/CollegeHill.

Stevenson,J.(1996).Developmentalchangesinthemechanismslinkinglanguagedisabilitiesandbehaviordisorders.InJ.H.Beitchman,N.J.Cohen,M.M.
Konstantaras,&R.Tannock(Eds.),Language,learning,andbehaviordisorders:Developmental,biological,andclinicalperspectives(pp.7899).Cambridge,
England:CambridgeUniversityPress.

Stothard,S.E.,Snowling,M.J.,Bishop,D.V.M.,Chipchase,B.B.,&Kaplan,C.A.(1998).Languageimpairedpreschoolers:Afollowupintoadolescence.
JournalofSpeechLanguageHearingResearch,41,407418.

TagerFlusberg,H.,&Cooper,J.(1999).Presentandfuturepossibilitiesfordefiningaphenotypeforspecificlanguageimpairment.JournalofSpeech,Language,
andHearingResearch,42,12731278.

Tallal,P.(1976).Rapidauditoryprocessinginnormalanddisorderedlanguagedevelopment.JournalofSpeechandHearingResearch,19,561571.

Tallal,P.,&Piercy,M.(1973).Developmentalaphasia:Impairedrateofnonverbalprocessingasafunctionofsensorymodality.Neuropsychologia,11,389398.

Tallal,P.,Ross,R.,&Curtiss,S.(1989).Familialaggregationinspecificlanguageimpairment.JournalofSpeech&HearingDisorders,54,167173.

Tallal,P.,Stark,R.E.,Kallman,C.,&Mellits,D.(1980).Developmentalaphasia:Therelationbetweenacousticprocessingdeficitsandverbalprocessing.
Neuropsychologia,18,273284.

Tallal,P.,Miller,S.,Bedi,G.,Byma,G.,Wang,X.,Nagarajan,S.,Schreiner,C.,Jenkins,W.,&Merzenich,M.(1996,January).Languagecomprehensionin
languagelearningimpairedchildrenwithacousticallymodifiedspeech,Science,271,8184.

Teszner,D.,Tzavares,A.,Grunder,J.,&Hecaen,H.(1972).Lasymetriedroitegaucheduplanumtemporale:Aproposdeletudeanatomiquede100cerveau
[Rightleftasymmetryoftheplanumtemporaleaproposoftheanatomicalstudyof100brains].NeurologicalReview,146,444449.

Tomblin,J.B.(1989).Familialconcentrationofdevelopmentallanguageimpairment.JournalofSpeechandHearingDisorders,54,287295.

Tomblin,J.B.(1996a,June).ThebigpictureofSLI:ResultsofanepidemiologicstudyofSLIamongkindergartenchildren.PaperpresentedattheSymposium
forResearchinChildLanguageDisorders,Madison,WI.

Tomblin,J.B.(1996b).Geneticandenvironmentalcontributionstotheriskforspecificlanguageimpairment.InM.Rice(Ed.),Towardageneticsoflanguage(pp.
191210).Hillsdale,NJ:LawrenceErlbaumAssociates.
Page145

Tomblin,J.B.,&Buckwalter,P.(1994).Studiesofgeneticsofspecificlanguageimpairment.InR.Watkins&M.Rice(Eds.),Specificlanguageimpairmentsin
children(pp.1735).Baltimore:PaulH.Brookes.

Tomblin,J.B.,Freese,P.,&Records,N.(1992).Diagnosingspecificlanguageimpairmentinadultsforthepurposeofpedigreeanalysis.JournalofSpeechand
HearingResearch,35,832843.

Tomblin,J.B.,Records,N.L.,Buckwalter,P.,Zhang,X.,Smith,E.,&OBrien,M.(1997).Prevalenceofspecificlanguageimpairmentinkindergartenchildren.
JournalofSpeech,Language,andHearingResearch,40,12451260.

Trauner,D.,Wulfeck,B.,Tallal,P.,&Hesselink,J.(1995).NeurologicandMRIprofilesoflanguageimpairedchildren.TechnicalReportCND9513.Center
forResearchinLanguage,UniversityofCaliforniaatSanDiego.

vanderLely,H.(1996).Specificallylanguageimpairedandnormallydevelopingchildren:Verbalpassivevs.adjectivalpassiveinterpretation.Lingua,98,243272.

vanKleeck,A.,Gillam,R.B.,&Davis,B.(1997).Wheniswatchandseewarranted?AresponsetoPauls1996articleClinicalimplicationsofthenaturalhistory
ofslowexpressivelanguagedevelopment.AmericanJournalofSpeechLanguagePathology,6,3439.

VarghaKadeem,F.,Watkins,K.,Alcock,K.,Fletcher,P.,&Passingham,R.(1995).Praxicandnonverbalcognitivedeficitsinalargefamilywithagenetically
transmittedspeechandlanguagedisorder.ProceedingsoftheNationalAcademyofSciences,92,930933.

Veale,T.K.(1999).TargetingtemporalprocessingdeficitsthroughFastForWord:Languagetherapywithanewtwist.Language,Speech,andHearingServicesin
Schools,30,353362.

Wallach,G.P.,&Butler,K.G.(1994).Languagelearningdisabilitiesinschoolagechildrenandadolescents:Someprinciplesandapplications.NewYork:
Macmillan.

Watkins,R.V.(1994).Specificlanguageimpairmentsinchildren:Anintroduction.InR.V.Watkins&M.L.Rice(Eds.),Specificlanguageimpairmentsin
children(pp.115).Baltimore:PaulH.Brookes.

Wender,E.(1995).Hyperactivity.InS.Parker&B.Zuckerman(Eds.),Behavioralanddevelopmentalpediatrics(pp.185194).Boston:Little,Brown.

Weiner,P.(1974).Alanguagedelayedchildatadolescence.JournalofSpeechandHearingDisorders,39,202212.

Wilson,B.,&Risucci,D.(1986).Amodelforclinicalquantitativeclassification.GenerationI:Applicationtolanguagedisorderedpreschoolchildren.Brain&
Language,27,281309.
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CHAPTER
6

ChildrenwithMentalRetardation

DefiningtheProblem

SuspectedCauses

SpecialChallengesinAssessment

ExpectedPatternofStrengthsandWeaknesses

RelatedProblems

Tracy,a10yearoldwithDownsyndrome,attendsaregularclassroom,wherehervoiceoftenringsoutassheexpressesexuberantenthusiasmforallthe
funthingsthathappen.Tracyspeaksinshortsentencesthatarefrequentlydifficulttounderstand.Althoughshesometimesshowsconsiderablefrustration
withothersnotunderstandingher,mostofthetimeTracyappearsoblivioustotheirlackofunderstanding.Aspeechlanguagepathologistworkswithher
ongoalsrelatedtosyntaxandintelligibility,usuallywithintheclassroom.

Seth,a4yearoldwithcerebralpalsyandepilepsyaswellasmentalretardation,attendsaspecialpreschoolclassroomirregularlybecauseofhisfrequent
illnesses.Intheclassroom,hespendsmuchofhistimeinawheelchairoradaptiveseat,whichwasdesignedtoprovidehimwiththeposturalsupportneeded
forhimtocontrolhisheadmovements.Inadditiontoworkingwithhimintheclassroom,aspeechlanguagepathologistvisitshishomeonceaweekto
workwithSethandhismother.Sethvocalizesinfrequentlyandoftenseemsunawareofothersinhisenvironment.Goalsforhim
Page147

includeestablishingnonverbalturntakingskillsandincreasingthefrequencyofhisvocalizations.

Jakeisa12yearoldboywithmildmentalretardationassociatedwithFetalalcoholsyndrome.Althoughhiscomprehensionskillstestwithinthenormal
range,andheisgenerallyunderstandableinhislanguageproduction,Jakehasconsiderabledifficultyinfollowingdirectionsinschool.Hehasbeen
diagnosedwithADDandrequiresfrequentredirectingtostayinvolvedinclassroomactivities.Althoughheiseagertoestablishfriendshipswithhis
classmates,hisabilitytousesocialcuestoguidehiscommunicationsappearsinconsistent.InterventionforJakeincludesindividual,attentionwithinthe
classroomandparticipationinasocialskillsgroupwiththespeechlanguagepathologistonetimeperweek.

DefiningtheProblem

Tracy,Seth,andJakearerepresentativeoftheapproximately3%ofschoolagechildrenintheUnitedStateswhoexhibitproblemsassociatedwithmentalretardation
(Roeleveld,Zielhuis,&Gabreels,1997),wherementalretardationcanbedefinedasreducedintelligenceaccompaniedbyreducedadaptivefunctioning,thatis,
reducedabilitytofunctionineverydaysituationsinamannerconsideredculturallyanddevelopmentallyappropriate.Becausecommunicationisaparticularlyimportant
adaptivefunctionaffectedbymentalretardation,speechlanguagepathologistsoftenworkwithaffectedchildrenandtheirfamilies.

About85%ofchildrenwithmentalretardationexperiencemildproblems(Lubetsky,1990)andmaynotbeidentifiedasmentallyretardeduntiltheyreachschoolage.
Childrenwithmoresignificantdegreesofimpairmentareoftenidentifiedatanearlierpointbecausetheirdelaysinachievingdevelopmentalmilestonesaremore
pronouncedandbecausetheyoftenhaveadditionalmedicaldifficulties,suchascerebralpalsyorepilepsy(Durkin&Stein,1996).Althoughmentalretardationis
usuallypresentfrombirth,itcanalsobediagnosedforconditionsthatcanoccurupto18yearsofage,includingexposuretoenvironmentaltoxinssuchasleadoverthe
firstfewyearsoflife.

Despitethebriefdefinitionofferedearlier,formulatingamorecomplete,usabledefinitionofmentalretardationthatisequallyacceptabletofamilies,advocates,
scientists,clinicians,andpoliticianshasprovedcontroversialanddifficultsomewouldsayimpossibleparticularlywheremilderformsofretardationareconcerned
(Baumeister,1997Roeleveldetal.,1997).Table6.1providestwoofthemostinfluentialdefinitionscurrentlybeingusedthoseproposedbytheAmerican
AssociationforMentalRetardation(AAMR)andtheAmericanPsychiatricAssociation.

TheAAMRandAmericanPsychiatricAssociationdefinitionsbothspecifyimpairmentinadaptiveskillsasacriticalelementintheidentificationprocess.Traditionally,
IQscorealone,withlessattentiontoadaptiveskills,wascentraltotheidentificationprocess.Thesetwonewerdefinitionsaddressessentiallythesameadaptiveskills
(viz.,communication,selfcare,homeliving,socialskills,communityuse,selfdirection,healthandsafety,functionalacademics,leisure,andwork).Despitethis
uniformity,however,thesedefinitionsarestillquitecontroversialbecauseofsignificantconcerns
Page148

Table6.1
TwoInfluentialDefinitionsofMentalRetardation

AmericanAssociationonMentalRetardation(Luckasson,1992)
Mentalretardationreferstosubstantiallimitationsinpresentfunctioning.Itischaracterizedbysignificantlysubaverageintellectualfunctioning,existingconcurrently
withrelatedlimitationsintwoormoreofthefollowingapplicableadaptiveskillareas:communication,selfcare,homeliving,socialskills,communityuse,self
direction,healthandsafety,functionalacademics,leisure,andwork.Mentalretardationmanifestsbeforeage18.
AmericanPsychiatricAssociation(1994)
Diagnosticcriteria:
Significantlysubaverageintellectualfunctioning:anIQofapproximately70orbelowonanindividuallyadministeredIQtest(forinfants,aclinicaljudgmentof
A.
significantlysubaverageintellectualfunctioning)
Concurrentdeficitsorimpairmentsinpresentadaptivefunctioning(i.e.,thepersonseffectivenessinmeetingthestandardsexpectedforhisorheragebyhisor
B. herculturalgroup)inatleasttwoofthefollowingareas:communication,selfcare,homeliving,socialandinterpersonalskills,useofcommunityresources,self
direction,functionalacademicskllswork,leisure,health,andsafety
C. Theonsetisbeforeage18years.

aboutthelackofvalidmeasuresformanyadaptiveskillareas(e.g.,Jacobson&Mulick,1996Macmillan&Reschly,1997)andbecauseofdebatesaboutthenumber
ofdimensionsneededtocaptureadaptivefunctioning(Simeonsson&Short,1996).

AlthoughnotevidentinTable6.1,thecompleteAAMRandAmericanPsychiatricAssociationdefinitionsdiffersharplyintheirhandlingofseverity.Whereasthe
AmericanPsychiatricAssociationdefinitionmaintainsatraditionaltreatmentofseverityusingasystemwithfivelevels(seeTable6.2),theAAMRsystem(Luckasson,
1992)replacesthosewiththedescriptionoflevelsofsupportneededbytheindividual(intermittent,limited,extensive,andpervasive)forintellectualabilityandforeach
adaptiveskillseparately.Becausetreatmentrecommendationsareoftenformulatedonthebasisofseverity(Durkin&Stein,1996),thischangeintheAAMRdefinition
representsamajordeparturefromlongstandingpractice.

Table6.2
DegreesofSeverityofMentalRetardationUsed
bytheAmericanPsychiatricAssociation(DSMIV,1994)

Degree IQLevel

Mildmentalretardation 5055toapproximately70
Moderateretardation 3540to4055
Severementalretardation 2025to3540
Profoundmentalretardation Below20or25
Usedwhenthereisastrongpresumptionofmentalretardationbuttheindividual
Mentalretardation,severityunspecified
cannotbetestedusingstandardizedinstruments
Page149

Radicalchangesindefinitionssuchasthosejustdescribedcanaffectthewaysinwhichgovernmentalandotheragenciesdeterminewhichchildrenareeligiblefor
assistance.Theyalsoaffectresearcherswhomustidentifythegroupofindividualstowhomtheirresearchcanbegeneralizedandcliniciansastheyworkwithinthe
bureaucracytohelpaffectedchildrenandtheirfamilies(Macmillan&Reschly,1997).Therefore,althoughwranglesoverdefinitionscanseemirrelevanttoabasic
understandingoflanguageimpairmentanditsassessmentinchildrenwithmentalretardation,theyarepowerfulindetermininghowsuchchildrencanbehelped.For
example,dependingonwhichofthetwodefinitionsdescribedinthissectionisusedandexactlyhowitisimplemented,Jake,thethirdchilddescribedatthebeginning
ofthechapter,mightnotbeidentifiedasachildrequiringspecialattentionintheschoolsetting.

SuspectedCauses

Untilthepastdecade,onlyabout25%ofcasesofmentalretardationwereassociatedwithknownorganiccauses(e.g.,Downsyndrome,perinataltraumaGrossman,
1983).Recentadvances,however,bringthatfigureuptoabout50%(AmericanPsychiatricAssociation,1994Baumeister,1997),withawiderangeoforganic
causesnowidentified.Suchcausesareoftenassociatedwithmoreseverecasesofmentalretardation(Rosenberg&Abbeduto,1993).

OrganicCauses

Classificationofthemanypre,peri,andpostnatalorganiccausesofmentalretardationrevealshumanvulnerabilitytoamyriadoffactorsthatcanalterlaterneurologic
developmentandfunction.Table6.3presentsalengthybutfarfromcompletelistofpredisposingfactors.Knowledgeofcausationcanhelpineffortstoprevent
retardationinsomeindividuals,tocounselfamiliesregardingitslikelihoodofrecurringinlaterchildren,andtodeveloptreatmentsthatcanpreventoramelioratelong
termnegativeconsequences.

ThreeimportantknowncausesofmentalretardationareDownsyndrome,fragileXsyndrome,andfetalalcoholsyndrome.Eachoftheseconditionsisdescribedasa
syndromebecauseitisassociatedwithacommonsetofphysicaltraitsormalformationssharingasimilarprognosis(Batshaw&Perret,1981).Twoofthese
syndromeshavegeneticcausesthethird,fetalalcoholsyndrome,hasapreventablecausenamely,intrauterineexposuretoalcohol,apowerfultoxintothedeveloping
brain.Considerationofthesesyndromesdemonstratestheintimateconnectionsbetweenthecauseofmentalretardationandthenatureofcommunicationandother
difficultiesconfrontingaffectedchildren(Cromer,1981Hodapp&Dykens,1994Hodapp,Leckman,Dykens,Sparrow,Zelinsky,&Ort,1992cf.Hodapp&
Zigler,1990).

DownsyndromeandfragileXsyndromearethemostcommongeneticbirthdefectsassociatedwithmentalretardation.Beginningtounderstandthesetwoconditions,
therefore,dependsonatleastabarebonesgraspofhumangenetics,whichwillbeofferedhere.MorelengthytreatmentscanbefoundinresourcessuchasM.M.
Cohen(1997).
Page150

Table6.3
CategoriesofOrganicPredisposingFactorsAssociatedWithMentalRetardation
(AmericanPsychiatricAssociation,1994,p.43)

Percentageofcasesofmental
retardationassociatedwith
Category thisfactor Specificconditions

5 l Inbornerrorsofmetabolism(e.g.,TaySachsdisease)
l Singlegeneabnormalities(e.g.,tuberoussclerosis)
Heredity
l Chromosomalaberrations(e.g.,fragileXsyndrome,asmallnumberofcasesofDown
syndrome)
Earlyalterations 30
ofembryonic l Chromosomalchanges(mostcasesofDownsyndromethoseduetotrisomy21)
development l Prenataldamageduetotoxins(e.g.,maternalalchoholconsumption,infections)
Pregnancyand
perinatal l Fetalmalnutrition,prematurity,hypoxia(oxygendeficiency),viralandotherinfections,and
problems 10 trauma
Generalmedical
conditions
acquiredin
infancyor
childhood 5 l Infections,traumas,andpoisoning(e.g.,duetolead)

Probablythemostbasicfactsingeneticsincludetheinformationthatallcellsinthehumanbodyexceptforthereproductivecells(sperminmenandovainwomen)
contain23pairsofchromosomes.These23chromosomepairsconsistof22pairsofnumberedautosomesand1pairofsexchromosomes,whichareidentifiedas
XXforwomenandXYformen.Thesechromosomes,whichholdmanyindividualgenes,actastheblueprintsforcellfunctionandthusdetermineanindividuals
physicalmakeup.

Unlikeotherhumancells,ovaandspermcellshavehalftheusualnumberofchromosomes23nonpairedchromosomesandonesexchromosome.Duringthe
reproductiveprocess,thisfeatureofreproductivecellsallowseachparenttocontributeonehalfofeachoffspringsgeneticmaterialasthegeneticmaterialsofboth
reproductivecellsarecombinedduringfertilization.Becausechromosomescontainnumerousgenes,defectstoeitherthelargerchromosomesortoindividualgenescan
resultinimpairedcellularfunctionduringembryonicdevelopmentandlaterlife.

Downsyndromeisanexampleofanautosomalgeneticdisorderinwhichextrageneticmaterialisfoundatchromosomepair21.Thisconditionarisesaboutoncein
every800livebirths,makingitthemostcommongeneticdisorderassociatedwithmentalretardation.About95%ofthetime,Downsyndromeoccursbecausean
entire
Page151

Fig.6.1.GraphicrepresentationofthegenetictestusedtoidentifythepresenceofTrisomy21.FromBabiesWithDownSyndrome:ANewParentsGuide(p.8),
byK.StrayGunderson(Ed.),1986,Kensington,MD:WoodbineHouse.Copyright1986byWoodbineHouse.Reproducedwithpermission.

extrachromosomeispresent,resultingintheindividualspossessingthreechromosomesofchromosome21knownastrisomy21,insteadofthenormalpairingof
chromosomes(Bellenir,1996).Figure6.1illustratesthecompletesetofchromosomesassociatedwithagirlwhohasDownsyndrome.

Lessfrequently,Downsyndromeisassociatedwithonlyaportionofanextrachromosomeoccurringatchromosome21orwiththeoccurrenceofanentireextra
chromosome21,butonlyinsomecellswithinthebody(termedmosaicDownsyndrome).Usuallythechromosomaldefectoccursduringthedevelopmentofan
individualovum,butitcanoccurbecauseofaspermdefectoradefectoccurringaftertheunitingofthespermandovuminfertilization.Becauseofthistimingofthe
changeinthegeneticmaterial,Downsyndromeisdescribedasageneticdisorder,butnotaninheritedone,inwhichbothparentandchildareaffected.

Downsyndromeisassociatedwithacharacteristicphysicalappearance,involvingslantedeyes,smallskinfoldsontheinnercorneroftheeyes(epicanthalfolds),
slightlyprotrudinglips,smallears,anoverlylargetongue(macroglossia),andshorthands,feet,andtrunk(Bellenir,1996).Figure6.2showstwoyoungchildrenwith
thissyndrome.

OthermoreseriousphysicalanomaliesfoundamongchildrenwithDownsyndromeaffectthecervicalspine,bowel,thyroid,eyes,andheart(Cooley&Graham,
1991).ChildrenwithDownsyndromearemoresusceptibletoinfection,includingotitismedia
Page152

Fig.6.2.TwochildrenwithDownsyndrome.

(Cooley&Graham,1991),andare20timesmorelikelythanotherchildrentodevelopanddiefromleukemia.Becauseoftheseabnormalities,asagrouptheirlife
expectancyissomewhatshortened,despiterecentadvancesinthecorrectionofcongenitalheartdefects,improvedcontrolofinfections,andavoidanceof
institutionalization.Roughly80%ofthesechildrenwilllivetotheageof30andbeyond(Cooley&Graham,1991).AdultswithDownsyndromehavealsobeenshown
tobeatincreasedriskfortheonsetofAlzheimerslikedementia,ordeclineinintellectualfunction(Connor&FergusonSmith,1997Zigman,Schupf,Zigman,&
Silverman,1993)

FragileXsyndromeiscurrentlythoughttobethesinglemostcommoninheritedcauseofmentalretardation(Baumeister&WoodleyZanthos,1996).Althoughit
occurslessfrequentlythanDownsyndromethemostfrequentgeneticcauseofmentalretardationfragileXismorefrequentlyinheritedthanDownsyndrome
becauseDownsyndromeisalmostneverpassedfromonegenerationtothenext.

FragileXoccursaboutonceinevery1250to2500menandabouthalfthatofteninwomen(Bellenir,1996).AlthoughfragileXcanoccurineithergender,itismore
oftenassociatedwithmentalretardationinaffectedmen.Whenmentalretardationoccurs,itcanrangefrommildtoprofoundlevels,withgenerallymilderimpairmentsin
affectedwomen(Dykens,Hodapp,&Leckman,1994).Becauseitspatternsofinheritancearemorecomplexthanthoseseeninotherpreviouslyidentifiedgenetic
disorders,fragileXwasonlyidentifiedinthe1970s(Lehrke,1972).

FragileXsyndromeinvolvesthesinglegeneFMR1,presentontheXchromosome,whichcanbedefectiveorabsent.Apartiallydefectivegeneisreferredtoasapre
Page153

mutationandmaybeassociatedwithverymildorevennoobviousproblemsintheaffectedperson.Whenthedefectisgreater,orthegeneFMR1isabsent,more
seriousproblems,includingseveretoprofoundmentalretardation,arethelikelyoutcome.

FragileXsyndromeisinheritedthroughanXlinkedmodeoftransmission(similartohemophilia)inwhichsomeindividualsarecarriers(usuallywomen)andothers
areaffectedindividuals(usuallymen).FathershaveonlyoneXandoneYchromosome.Consequently,theycanonlytransmitadefectiveXchromosometoa
daughter,whowillhavereceivedasecondXfromhermother(whohastwoXandnoYchromosomes).BecauseonlyoneofthetwoXchromosomesinagirlislikely
tobeactive,itispossiblefordaughterstoappearunaffected,buttobecarriersofthedefectivechromosome.Theycanalsobeaffected,however,iftheypossesstwo
defectiveXchromosomesorifthedefectiveXchromosomeforsomereasonistheactiveone.Aboutonethirdofthosegirlswiththedefectivegenewillbeofnormal
intelligence,onethirdwillhaveborderlineintelligence,andonethirdwillhavegreaterdegreesofmentalretardation(AmericanCollegeofMedicalGenetics,1997).
About50%ofthemaleoffspringofcarrierwomenwilldemonstratefragileXsyndrome(Dykensetal.,1994),andmostofthesechildrenwillhavementalretardation.

BoyswithfragileXandmentalretardationoftensharethefollowingphysicaltraits:along,narrowfacelong,thick,prominentearsandoverlylargetesticles(Dykenset
al.,1994).Figure6.3showstwoyoungsterswiththiscondition.Beyondthephysicaltraitsnotedthroughoutlife,childrenareatriskforobesityduringadolescence.On
thebasisofasmallernumberofstudiesthanthoseundertakenformaleswithfragileX,itappearsthatfemaleswithfragileXshowsomesimilartraitstothoseofmales,
althoughtoalesserextent.ConditionsthattendtoaccompanymentalretardationinchildrenwithfragileXareADDandADHD,anxietyandmooddifficulties,aswell
asauditoryandvisualproblems(Dykensetal.,1994).ConsiderablecontroversyhassurroundedtherelationshipbetweenfragileXandautisticdisorder(chap.7,this
volumeI.L.Cohen,1995).Therehasbeensomespeculationthattherateofcooccurrencemaybeduetothelevelofmentalretardationratherthantoetiology
(Dykensetal.,1994).However,workbyI.L.Cohen(1995)suggeststhatboyswithbothautismandfragileXaremoresignificantlyimpairedthanwouldbeexpected
iftheeffectsofeachconditionweresimplyadditive.

Fetalalcoholsyndrome(FAS)referstotheconstellationofphysicalabnormalities,deficientgrowthpatterns,andcognitiveandbehavioralproblemsfoundinchildren
whosemothersdrankheavilyduringpregnancy.Fetalalcoholeffect(FAE)isacloselyrelateddiagnosisinwhichonlysomeportionoftheconstellationof
abnormalitiesdescribedforFASisseenintheaffectedchild(Stratton,Howe,&Battaglia,1996).

Althoughapossibleconnectionbetweenalcoholconsumptionbymothersduringpregnancyandsubsequentbirthdefectshasbeenknownthroughouthistory,onlyin
thelate1960sandearly1970swasFASformallydescribed(Strattonetal.,1996).Despiteitshavingreceivedconsiderableattentiononlyrecently,FAShasbeen
proposedasthemostcommonknownnongeneticcauseofmentalretardation(Strattonetal.,1996,p.7),withestimatesofincidencerangingfrom0.5to3birthsper
1000livebirths(Strattonetal.,1996).ThehigheroftheseincidencefiguresmakesFASamorefrequentcauseofmentalretardationthaneitherDownsyndromeor
fragileXsyndrome.
Page154

Fig.6.3.TwoyoungboyswithFragileXsyndrome.

Inaddition,itisthoughttobewidelyunderdiagnosed(Maxwell&GeschwintRabin,1996).

Alcoholisoneofmanydifferentsubstanceswellknowntobetoxictothedevelopingcentralnervoussystem.However,thespecificmechanismbywhichalcohol
consumptionleadstothevarietyofdifficultiesseeninFASorFAEispoorlyunderstood(Baumeister&WoodleyZanthos,1996).Ingeneral,themagnitudeandnature
ofatoxinseffectsonprenataldevelopmentarethoughttobecloselyrelatedtotheamountofthetoxin,thetimingofexposure,andthegeneticmakeupofthemother
andchild(Strattonetal.,1996).Currently,however,littleisknownabouthowthosevariablesinteracttoproducethebroadrangeofeffectsseeninchildrenwithfull
FASorwithFAE.Particularlypuzzlingareobservationsthatsomewomenwhodrinkveryheavilythroughouttheirpregnancycangivebirthtounaffectedchildren,
whereasotherwomenwhodrinkfarlesscangivebirthtochildrenwithseveresymptoms.Thisuncertaintyabouthowdamageiscausedhasresultedinstrong
prohibitionsagainstdrinkingduringpregnancyuntilmoreisknownaboutwhat,ifany,degreeofexposureissafe.

Asagroup,childrenwithfullFAStendtohavemildmentalretardation,butforindividualchildren,cognitivelevelscanrangefromsevereretardationtonormalfunc
Page155

tion.Inadditiontomentalretardation,cardiacandskeletalabnormalitiesandvisionproblemshavealsobeennoted.Facialabnormalitiesapparentduringearly
childhoodincludethepresenceofepicanthalfolds(suchasthoseseeninDownsyndrome),eyelidsthatareoverlynarrowfrominnertooutercorner,aflatmidface,
smoothorlongphiltrum(areaabovetheupperlip),andthinupperlip(Sparks,1993).Thesefacialfeaturesaresometimeslesspronouncedininfancyandafter
childhood,sotheyarenotasusefulasindicatorsofthisproblemforsomeagegroupsasforothers.Congenitalhearinglossisanotherareaofincreasedrisk(Strattonet
al.,1996).Figure6.4showstwoyoungstersaffectedbyFAS.

NonorganicSuspectedCauses

Despitethegrowingfrequencywithwhichbiologicalcausesofmentalretardationareidentified,abouthalfofallcasesofmentalretardationdonothavesuchwell
definedexplanations.Insuchcases,thedegreeofretardationtendstobemilder,andtheretardationtendstobeassociatedwithafamilyhistoryofmentalretardation
andlowSES(Rosenberg&Abbeduto,1993).Historically,suchcaseswereclassifiedasnonorganicorfamilialmentalretardation.

Fig.6.4.Twoyoungsterswithfetalalcoholsyndrome.FromFetalAlcoholSyndrome:Diagnosis,Epidemiology,Prevention,andTreatment(Figure11,p.18),
byK.Stratton,C.Howe,&F.Battaglia(Eds.),1996,Washington,DC:NationalAcademyPress.Copyright1996byNationalAcademyPress.Reproducedwith
permission.
Page156

Despitetheimplicationsthatthesecasesinvolvesocialorexperientialbases,thereisconsiderablespeculationthatnonorganiccasesofmentalretardationmayactually
reflectourcurrentlackofknowledgeratherthantrulynonorganiccauses(Baumeister,1997Richardson&Koller,1994).Manycasesnowidentifiedasnonorganic
mayberecategorizedastherelationshipoflowSESandfamilyhistorytoexposuretoenvironmentaltoxins(e.g.,lead),poornutrition,andotherultimatelyorganic
causesareuncovered.Theonemajor,trulynonorganicfactorassociatedwithmentalretardationisseveresocialdeprivation,asaresultofeitherinadequateinstitutional
conditionsorlimitationsofachildsprincipalcaregiver(Richardson&Koller,1994).Yeteventhatmechanismmayactbydeprivingtheinfantsmaturingnervous
systemoftheproperinputstopromotespecificphysiologicalstatesrequiredforbraindevelopment.

SpecialChallengesinAssessment

Oneofthemostimportantthingstokeepinmindwhentryingtounderstandanychildishisorheruniquenesstheuniquenessofcurrentstrengthsandweaknesses,
history,andfamilysituation.Mostimportant,thereistheneedtorememberthatuniquenessthatmakesthemTracyorSethorJake,ratherthanjustthechildwith
aparticularsyndromeandpatternofdeficits.Assessingchildrenwithmentalretardationtemptssomeindividualstoequatethemwiththeirlevelofretardationorits
etiologyandtemptssomepeopletopayattentiontowhattheycannotdoratherthantowhattheyaredoingintheircommunications.PersonalPerspective6hintsatthe
negativeeffectsofsuchamistake.

PERSONALPERSPECTIVE
ThefollowingpassageistakenfromabookwrittenbyapairofyoungadultfriendswhohaveeachbeendiagnosedwithDownsyndrome.Thetitleoftheirbookis
CountUsin:GrowingupWithDownSyndrome(Kingsley&Levitz,1994,p.35).
August90
Mitchell:IwishIdidnthaveDownsyndromebecauseIwouldbearegularperson,aregularmainstreamnormalperson.BecauseIdidntknowIhadDown
syndromesincealongtimeago,butIfeelveryspecialinmanyways.Ifeelthatbeingwith,havingDownsyndrome,theresmoretoitthanIexpected.Itwasvery
difficultbutIwasabletohandleitverywell.
Jason:ImgladtohaveDownsyndrome.Ithinkitsagoodthingtohaveforallpeoplethatarebornwithit.Idontthinkitsahandicap.Itsadisabilityforwhat
yourelearningbecauseyourelearningslowly.Itsnotthatbad.(p.35)

Howdoyouavoidthesetemptations?First,planassessmentsusinginitialhypothesesaboutdevelopmentallevelsandpatternsofimpairment(whichwillbedescribedin
thenextsection)andoninformationobtainedfromcaregiversorotherswhoknow
Page157

thechildwell.Framingtheassessmentquestionswithspecialclaritycanhelpyouanticipatetheparticularchallengesindividualchildrenmightposetothevalidityof
conventionalinstruments.

Second,preparetoalteryourplanasneededtokeepthechildengagedandinteracting.Notonlydoesthismeanthatyoumayneedtoturnawayfromastandardized
instrumentmidstream(e.g.,ifitisdevelopmentallyinappropriate)infavorofamoreinformalordynamicassessmentmethod(seechap.10),youmayalsowantto
considertheuseofadaptations.

Testadaptationsarechangesmadeintheteststimuli,responserequiredofthechild,ortestingprocedures(Stagg,1988Wasson,Tynan,&Gardiner,1982).Onthe
onehand,theuseoftestadaptationsthreatensthevalidityofnormreferencedcomparisonsthatmaybemadeusingtheinstrument.Therefore,ifaclinicalquestionthat
reallyrequiresthatkindofcomparisonisatstake(e.g.,aninitialevaluationinwhichadifferencefromnormsmustbedemonstratedtohelpachildreceiveservices),the
clinicianwillavoidadaptationsifpossible.Ontheotherhand,whensomeaspectofthestandardadministrationotherthanthebasicskillorknowledgebeingtested
interfereswithachildsabilitytorevealhisorheractualskillorknowledge,onecanarguethatthevalidityofthecomparisonhasalreadybeenseverelycompromised.
Table6.4listssomeofthemostcommonadaptationsused.Regardlessofwhichadaptationsareused,theyshouldbedescribedinreportsoftestresultsandthe
clinicianshouldcom

Table6.4
ExamplesofTestingAdaptationsUsedFrequently
WithChildrenWithMentalRetardationandFrequentCoexistingProblems(Stagg,1988)

Reasonfor
Adaptation RecommendedAdaptations

l Increaseduseofsocial,tangible,andactivityreinforcers(Fox&Wise,1981)
l Breakingupadministrationintosmallerperiodsoftimetomaximizeattention
Attentionandmotivation
l Useofauditorycommandsorvisualcueing(e.g.,withalightpen)todirectattentionpriortoeachitem(Wasson,Tynan,

&Gardiner,1982)
l Replacementoftabletopadministrationtopositionachildtoachieveoptimalmotorperformance
l Useofalternativeresponsemodes(e.g.,gazel.,headpointers,oralinsteadofpointingWasson,Tynan,&Gardiner,
Motorskills 1982)
l Removalofresponsetimerestrictions

l Breakingupadministrationintosmallerperiodsoftimetoaddressfatigue

l Substitutionofsignfororalpresentation
Hearing l Additionofgestureorsigntooralpresentation(Wasson,Tynan,&Gardiner,1982)
l Positioningtoenhancechildsaccesstovisualinformationandtooptimizeresidualhearing
l Substitutionofstandardvisualstimulibyhighcontraststimuliorlargerstimuli
Vision
l Placementofallstimuliwithinthechildsvisualfield(asdeterminedpriortotesting)
Page158

mentontheextenttowhichtheseadaptationsarelikelytointerferewiththevaliduseofnorms.

RelatedtotheuseofadaptationsisamethodthatSattler(1988)hasproposedasafollowuptostandardizedtestadministrationtestingoflimits.Atestoflimits
involves(a)providingadditionalcues,(b)changingtestmodality(e.g.,fromwrittentooral),(c)establishingmethodsusedbythetestedchild,(d)eliminatingtimelimits,
and(e)askingprobingquestionsdesignedtoclarifyachildsthinkingleadingtoaresponse.Itismeanttohelpthecliniciangainanappreciationofhowachildhas
approachedthetaskandwhataspectsofitinterferedwithsuccess.Itiscloselyrelatedtodynamicassessmentapproaches,whichIdescribeingreaterdetailinchapter
10.

SpecialissuesintestingthatIdiscussinlaterchaptersofthebookareoutofleveltestinganddiscrepancytesting.Exceptforbriefdefinitions,thesetopicsarenot
addressedherebecausetheyarealsorelevanttosomeoftheothergroupsofchildrendiscussedinthenextfewchapters.Outofleveltesting(Berk,1984)refersto
theuseofaninstrumentdevelopedforchildrenofadifferentagegroupfromthatofthechildtobetested.Inthecontextofchildrenwithmentalretardation,thisisdone
inordertousecontentthatisdevelopmentallyappropriate.Thispracticeisdiscussedagaininchapter10.

Discrepancytestingreferstothecomparisonofperformancesintwodifferentbehavioralorskillareas(e.g.,betweenabilityandachievement)todeterminewhethera
discrepancyexists.Thiskindoftestingisimportantforchildrenwithmentalretardationbecauseitwilloftenberequiredaspartoftheproceduresdictatedwithinan
educationalsystemtojustifytheprovisionofspecifickindsofassistance.Thistopicisdiscussedrepeatedlythroughoutthisbook,butespeciallyinchapters9and10,
becauseitrepresentsoneofthegreatestcontemporarychallengestoassessment.

ExpectedPatternofStrengthsandWeaknesses

Inpsychologyandspecialeducation,levelofmentalretardationhasplayedamuchgreaterrolethanetiologyintheidentificationofparticipantsforresearchstudiesand
thedevelopmentoftreatmentapproaches(Baumeister,1997Hodapp&Dykens,1994).However,thereisagrowingsensitivitythatbothetiology(e.g.,Down
syndrome,fragileXsyndrome)andlevelofmentalretardation(viz.,mild,moderate,severe,profound)provideusefulbasesforsometentativepredictionsregarding
likelypatternsofbehavioralstrengthsandweaknesses(Miller&Chapman,1984).SyndromesforwhichcommunicationskillshavebeenextensivelystudiedareDown
syndromeand,toalesserextent,fragileXsyndrome.Severalothersyndromes,suchasWilliamsSyndrome(Bellugi,Marks,Bihrle,&Sabo,1993Mervis,1998),
PraderWilli(Donaldson,Shu,Cooke,Wilson,Greene,&Stephenson,1994),andTurnerSyndrome(Downey,Ehrhardt,Gruen,Bell,&Morishima,1989)have
beguntobestudied.

Table6.5summarizestentativepatternsofstrengthsandweaknessesastheyhavebeensuggestedforchildrenwithDownsyndrome,fragileX,FAS,andWilliams
syndrome,acongenitalmetabolicdiseaseusuallyassociatedwithmoderatetoseverelearningdifficulties.(Williamssyndromewasnotdiscussedpreviouslyinthis
chapter
Page159

Table6.5
PatternsofStrengthsandWeaknessesAmongChildrenWithMentalRetardationAssociated
WithDownSyndrome,FragileXSyndrome,FetalAlcoholSyndrome,andWilliamsSyndrome

Syndrome RelativeStrengthsinCommunication RelativeWeaknessesinCommunication OtherStrengthsandWeaknesses

Morphology(Fowler,1990Rondal,1996)
l Strengths:
Syntax(Fowler,1990Rondal,1996)
l l Adaptivebehavior(Hodapp,1996)

l Phonology(Rondal,1996) l Pleasantpersonality(Hodapp,1996)

l Expressiveskillsrelativetoreceptiveskills Weaknesses:
l Semantics(Rondal,1996) (Dykens,Hodapp,&Leckman,1994) l Lowtaskpersistence(Hodapp,1996)

l Pragmatics(e.g.,turntaking, l Plateauingofdevelopmentinaboveareas l Mathematics(Hodapp,1996)

Downsyndrome diversityofspeechactsRondal,1996) fromlatechildhoodon(Rondal,1996) l Inadequatemotororganization(Hodapp,

l Nonverbalsocialinteractionskills l Auditoryprocessing(Hodapp,1996) 1996)

(Hodapp,1996) l Nonverbalrequestingbehavior(Hodapp, l Visuallydirectedreaching(Hodapp,1996)

1996) l Visualmonitoring

l Increasedriskofhearingloss(Bellenir,1996) l Hypotonia(Hodapp,1996)

l Increasedriskoffluencydisorder l Sloworientingtoauditoryinformation

(Bloodstein,1995) (Hodapp,1996)
l Fluencyabnormalities(e.g.,perseverativeand Strengths:
l Expressivevocabularyskills(Rondal staccatospeech,rateofspeech,cluttering l Adaptiveskills(especiallyinpersonaland

&Edwards,1997) Rondal&Edwards,1997). domesticskillsDykens,Hodapp,&Leckman,

l Possiblysyntax(althoughsometimes
FragileXsyndromea grammarhasbeenidentifiedasa
weaknessDykens,Hodapp,&
Leckman,1994Rondal&Edwards,
1997)
l Pragmatics,especiallypooreyecontactand 1994)
otherautisticlikebehaviors(Rondal& Weaknesses:
Edwards,1997) l Attentiondeficitsandhyperactivity(Dykens,
l Phonology,difficultyinsequencingsyllables Hodapp,&Leckman,1994)
(Dykens,Hodapp,&Leckman,1994Rondal l Socialavoidanceandshyness(Dykens,
&Edwards,1997) Hodapp,&Leckman,1994)

(Continued)
Page160

Table6.5(Continued)

Syndrome RelativeStrengthsinCommunication RelativeWeaknessesinCommunication OtherStrengthsandWeaknesses

Strengths:
l Cognitivedelays,whenpresent,areusually

mild
Weaknesses:
l Comprehension
Fetalalcoholsyndrome l Mostareasoflanguagerelatively l Attentionalproblemsorhyperactivity
l Pragmatics(e.g.,frequentlytangential
andfetalalcoholeffect unaffected (Stratton,Howe,&Battaglia,1996)
responsesAbkarian,1992)
l Increasedriskforvisualandhearingproblems

(Stratton,Howe,&Battaglia,1996)
l Increasedriskforbehaviorproblems

(Stratton,Howe,&Battaglia,1996)
l Expressivelanguage(Rondal&
Edwards,1997)
l Morphologyandsyntax(Rondal&

Edwards,1997)
Strengths:
l Lexicalknowledge(Rondal&
l Facialrecognition(Rondal&Edwards,1997)
Edwards,1997) l Receptivelanguage(Udwin&Yule,1990).
Weaknesses:
l Metalinguisticknowledge(Rondal& l Pragmaticsskills(sociallyinappropriate
Williamssyndromeb l Severevisuospatialdeficits(Rondal&
Edwards,1997) content,pooreyecontactRondal&Edwards,
Edwards,1997)
l Fluency,prosody(Rondal& 1997)
l Hyperacusis(negativelysensitivetonoise),
Edwards,1997)
especiallyyoungerchildren
l Narrativeskills(Rondal&Edwards,
1997)
l Phonologicalskills(Rondal&
Edwards,1997)

aPatternsrelatealmostentirelytoaffectedmalesbecauseofthepaucityofdataonaffectedfemales.
bPatternsbasedonaverylimiteddatabase.
Page161

becauseofitsrarity.)BecausethefourgroupsofchildrendescribedinTable6.4haveexperiencedverydifferentlevelsofscrutiny,theydifferinthecertaintywithwhich
thesestrengthsandweaknessesareknown(Hodapp&Dykens,1994).Specifically,childrenwithDownsyndromehavereceivedmuchmoreattentionthanthosewith
fragileX,whohave,inturn,receivedconsiderablymoreattentionthanthosewithWilliamsorFAS.Interestingly,therehasevenbeensomeworksuggestingthatthe
specifictypeofchromosomalabnormalityresultinginDownsyndromeresultsindifferentprognosesforcommunicationoutcomes,withbettercommunicationskills
predictedforthosechildrenwithmosaicDownsyndromethanwiththemorecommontrisomy21(Rondal,1996).

RelatedProblems

Childrenwithmentalretardationareatriskforavarietyofadditionalhealthrelatedandsocialproblems,particularlyiftheretardationismoresevere(American
PsychiatricAssociation,1994).Forexample,twomedicalconditionsthatoccurfrequentlyamongchildrenwithsevereorprofoundmentalretardationareepilepsyand
cerebralpalsy,whichhaveexpectedpercentageofoccurrenceratesof1936%forepilepsyand2040%forcerebralpalsy(Richardson&Koller,1994).

Overall,childrenwithmentalretardation,regardlessofetiology,appeartobeatfourtimesthenormalrisklevelforADHD,althoughthereissomequestionasto
whethertheirattentionproblemsarereallymanifestationsofmentalretardationratherthananindependentadditionalproblem(Biederman,Newcorn,&Sprich,1997).
Otherbehavioralandemotionalproblemsarealsoobservedmorefrequentlyamongindividualswithmentalretardationthanamongothers,includingconductdisorder,
anxietydisorders,psychozoidaldisorder,anddepression(Eaton&Menolascino,1982).

Often,theetiologyofmentalretardationiscloselyassociatedwithrisklevelsforparticularproblems.Forexample,differentkindsofvisualproblemsarefoundin
childrenwithDownsyndromethaninchildrenwithfragileXsyndrome.WhereaschildrenwithDownsyndromewillfrequentlyexperiencenearsightednessand
cataracts(Connor&FergusonSmith,1997Lubetsky,1990),childrenwithfragileXsyndromewillmorecommonlyhavestrabismus,aprobleminthecoordination
ofeyemovements(Maino,Wesson,Schlange,Cibis,&Maino,1991).

Childrenwithdevelopmentalandspeechdelayshavealsobeenfoundtobeatincreasedriskformaltreatment,includingphysicalabuse,sexualabuse,andneglect
(Sandgrund,Gaines,&Green,1974Taitz&King,1988).Giventheclosecontactthatspeechlanguagepathologistsfrequentlyhavewiththeirclients,thisincreased
incidenceofmaltreatmentmakesitparticularlyimportantforthemtobeawareofsignsofmaltreatment(Veltkamp,1994).

Summary

1.Mentalretardation,whichaffectsabout3%ofchildrenintheUnitedStates,involvesreducedintelligenceandreducedadaptivefunctioning.

2.Moreseverelevelsofmentalretardation(i.e.,moderate,severe,andprofound)areoftendiagnosedrelativelyearly,butarerelativelyuncommon,affectingonly15%
Page162

ofthosechildrendiagnosedwithmentalretardation.Mildmentalretardationaffectsabout85%ofchildrenwithmentalretardationbuttendstobediagnosedlater
sometimesnotuntilschoolage.

3.DefinitionsofmentalretardationproposedbytheAAMRandtheAmericanPsychiatricAssociationdifferprimarilyintheircharacterizationofseverity,withthe
AAMRdefinitionproposinglevelsofsupportneededfornumerousintellectualandadaptivefunctionsinplaceoflevelsofimpairment.

4.Increasingly,organicfactors,asopposedtofamilialornonorganicfactors,arebeingidentifiedasreasonableexplanationsforcasesofmentalretardation.Thethree
mostcommonorganiccausesofmentalretardationareDownsyndrome,fragileXsyndrome,andFAE.

5.DownsyndromeandfragileXsyndromearethemostfrequentgeneticsourcesofmentalretardation.Downsyndromeisalmostalwaysassociatedwitha
chromosomalabnormality,whereasfragileXsyndromeisassociatedwithanerrorinvolvingasinglegeneontheXchromosome.

6.FAS,whichisusuallyassociatedwithmildmentalretardation,isconsideredthemostfrequentpreventablecauseofmentalretardation.

7.Assessmentchallengesincludetheneedforparticularlycarefulselectionofdevelopmentallyappropriateinstruments,increasedneedforlessformalmeasures
becauseofalackofappropriatestandardizedmeasure,andtheneedtoadaptteststohelpinsurethataspectsofthechildsdifficultiesthatareunrelatedtotheconcept
beingtestedarenotpreventingsuccessfulperformance.

8.Expectedpatternsofcommunicationperformancearerelatedtolevelofmentalretardationandtoetiology.

KeyConceptsandTerms

adaptivefunctioning:reducedabilitytofunctionineverydaysituationsinamannerconsideredculturallyanddevelopmentallyadequate.

autosomes:themostcommontypeofchromosomewithinthehumancell.Theyareusuallycontrastedwiththesexchromosomes,whichtypicallyconsistofasingle
pair(XXforwomenandXYformen).

chromosomes:structureswithinhumancellsthatcarrythegenesthatactasblueprintsforcellfunction.

dementia:asignificantdeclineinintellectualfunction,usuallyafteraperiodofnormalintellectualfunction.

discrepancytesting:thecomparisonofperformancesintwodifferentbehavioralorskillareas(e.g.,betweenabilityandachievement)todeterminewhethera
discrepancyexistsoftenusedasarequirementforservicesineducationsystems.

Downsyndrome:anautosomalgeneticdisorderthatisconsideredthemostcommongeneticabnormalityresultinginmentalretardation.Itisassociatedwithmildto
severementalretardationandparticularlymarkeddifficultieswithsyntaxandphonology.
Page163

fetalalcoholeffect(FAE):adiagnosisrelatedtoFAS,inwhichsomebutnotalloftheabnormalitiesrequiredforadiagnosisofFASareobserved.

Fetalalcoholsyndrome(FAS):theconstellationofphysicalabnormalities,deficientgrowthpatterns,andcognitiveandbehavioralproblemsfoundinchildrenwitha
significantprenatalexposuretoalcohol.

fragileXsyndrome:themostcommoninheritedcauseofmentalretardationitisrelatedtoanXchromosomeabnormalitythatmaybepassedthroughseveral
generationsbeforebecomingsevereenoughtoresultinmentalretardation.Thesyndromemorecommonlyaffectsmenthanwomen.

mentalretardation:reducedintelligenceaccompaniedbyreducedadaptivefunctioning.

mosaicDownsyndrome:anuncommonformofDownsyndromeoccurringinlessthan5%ofcases,whentrisomy21affectsonlysomeratherthanallcellsinthe
body.

outofleveltesting:theuseofaninstrumentdevelopedforchildrenwhoseagediffersfromthatofthechildtobetested(Berk,1984).

premutation:agenethatissomewhatdefectivebutnotassociatedwithsignificantabnormalities,ascanhappeninfamilieswherefragileXsyndromeissubsequently
identified.

sexchromosomes:genebearingchromosomesassociatedwithgenderrelatedcharacteristicsthesearerelatedtonumerousbirthdefectsinwhichpatternsof
transmissionappeartobeaffectedbygender.

strabismus:aproblemineyemovementcoordination,sometimesreferredtoascrossedeyes.

trisomy21:themosttypicalchromosomalabnormalityinDownsyndrome,consistingofathirdchromosome21.

Williamssyndrome:acongenitalmetabolicdiseaseusuallyassociatedwithmoderatetoseverelearningdifficulties.

StudyQuestionsandQuestionstoExpandYourThinking

1.Whatarethemajorcommoncomponentsofthedefinitionsofmentalretardationprovidedinthischapter?

2.Describethreepossiblecooccurringproblemsthatmayaffectthecommunicationandtesttakingbehaviorsofachildwithmentalretardation.

3.Whatisthemostcommoninheritedcauseofmentalretardation?Whatisthemostcommonpreventablecause?

4.Determinethedefinitionformentalretardationusedinaschoolsystemnearyou.HowdoesthatdefinitioncomparetothoseoftheAAMRandtheAmerican
PsychiatricAssociation?

5.OnetestofadaptiveskillsthatisfrequentlyusedistheVinelandAdaptiveBehaviorScales(Sparrow,Balla,&Cicchetti,1984).Examinethatmeasureinterms
Page164

ofitemsrelatedtocommunication.Whatlanguagedomains(e.g.,semantics,syntax,morphology,pragmatics)andwhatlanguagemodalities(speaking,listening,writing,
reading)areemphasized?

6.UsingaformatlikethatusedinTable6.5,identifyasyndromenotdescribedinthischapter(e.g.,PraderWillisyndrome,criduchat)andprepareabrieflistof
expectedpatternsoflanguageandcommunication.

7.Examinethetestmanualofalanguagetesttodetermine(a)what,ifanything,issaidabouttheappropriatenessofthemeasureforachildwithmentalretardation,and
(b)whataspectsofoneormoretasksincludedinthetestmightbeincompatiblewiththecharacteristicsofthefollowingchildren:

l achildwithseverecerebralpalsyandmoderateretardationwhoseonlyreliableresponsemodeisaslow,effortfulpointingresponse
l achildwithmildretardationbutsevereattentionandmotivationalproblemsand
l achildwithDownsyndromewhohasmoderateretardationandaseverevisualimpairment.

RecommendedReadings

Cohen,M.M.(1997).Thechildwithmultiplebirthdefects.(2nded.)NewYork:OxfordUniversityPress.

Dykens,E.M.,Hodapp,R.M.&Leckman,J.F.(1994).BehavioranddevelopmentinfragileXSyndrome.ThousandOaks,CA:Sage.

Hersen,M.,&VanHasselt,V.(Eds.).(1990).Psychologicalaspectsofdevelopmentalandphysicaldisabilities:Acasebook.NewburyPark,CA:Sage.

Rondal,J.A.,&Edwards,S.(1997).Languageinmentalretardation.SanDiego,CA:Singular.

StrayGunderson,K.(Ed.).(1986).BabieswithDownsyndrome:Anewparentsguide.Kensington,MD:WoodbinePress.

References

Abkarian,G.(1992).Communicationeffectsofprenatalalcoholexposure.JournalofCommunicationDisorders,25(4),221240.

AmericanCollegeofMedicalGenetics.(1997).PolicystatementonfragileXsyndrome:Diagnosticandcarriertesting[Online].Available:
http://www.faseb.org/genetics/acmg/pol16.htm.

AmericanPsychiatricAssociation.(1994).Diagnosticandstatisticalmanualofmentaldisorders(4thed.).Washington,DC:Author.

Batshaw,M.L.,&Perret,Y.M.(1981).Childrenwithhandicaps:Amedicalprimer.Baltimore:BrookesPublishingCompany.

Baumeister,A.A.(1997).Behavioralresearch:Boomorbust?InW.E.MacLean,Jr.(Ed.),Ellishandbookofmentaldeficiency,psychologicaltheoryand
research(3rded.,pp.345).Mahwah,NJ:LawrenceErlbaumAssociates.

Baumeister,A.A.,&WoodleyZanthos,P.(1996).Prevention:Biologicalfactors.InJ.W.Jacobson&J.A.Mulick(Eds.),Manualofdiagnosisandprofessional
practiceinmentalretardation(pp.229242).Washington,DC:APA.

Bellenir,K.(1996).FactsaboutDownsyndrome.Geneticdisordershandbook.(pp.314).Detroit,MI:Omnigraphics.

Bellugi,U.,Marks,S.,Bihrle,A.,&Sabo,H.(1993).DissociationbetweenlanguageandcognitivefunctionsinWilliamssyndrome.InD.Bishop&K.Mogford
(Eds.),Languagedevelopmentinexceptionalcircumstances(pp.177189).Mahwah,NJ:LawrenceErlbaumAssociates.
Page165

Berk,R.A.(1984).Screeninganddiagnosisofchildrenwithlearningdisabilities.Springfield,IL:Thomas.

Biederman,J.,Newcorn,J.H.,&Sprich,S.(1997).Comorbidityofattentiondeficit/hyperactivitydisorder.InT.A.Widiger,A.J.Frances,H.A.Pincus,R.Ross,
M.B.First,&W.Davis(Eds.),DSMIVsourcebook.Washington,DC:AmericanPsychiatricAssociation.

Bloodstein,O.(1995).Ahandbookonstuttering(5thed.).SanDiego,CA:Singular.

Cohen,I.L.(1995).BehavioralprofilesofautisticandnonautisticFragileXmales.DevelopmentalBrainDysfunction,8,252269.

Cohen,M.M.(1997).Thechildwithmultiplebirthdefects(2nded.).NewYork:OxfordUniversityPress.

Connor,M.,&FergusonSmith,M.(1997).Essentialmedicalgenetics(5thed.).Oxford,England:Blackwell.

Cooley,W.C.&Graham,J.M.(1991).Commonsyndromeandmanagementissuesforprimarycarephysicians:DownsyndromeAnupdateandreviewforthe
primarypediatrician.ClinicalPediatrics,30(4),233253.

Cromer,R.(1981).Reconceptualizinglanguageacquisitionandcognitivedevelopment.InR.L.Schiefelbusch&D.D.Bricker(Eds.),Earlylanguage:Acquisition
andintervention.Baltimore:UniversityParkPress.

Donaldson,M.D.C.,Shu,C.E.,Cooke,A.,Wilson,A.,Greene,S.A.,&Stephenson,J.B.(1994).ThePraderWillisyndrome.ArchivesofDiseasesof
Children,70,5863.

Downey,J.,Ehrhardt,A.A.,Gruen,R.,Bell,J.J.,&Morishima,A.(1989).PsychopathologyandsocialfunctioninginwomenwithTurnersyndrome.Journalof
NervousandMentalDisorders,177,191201.

Durkin,M.S.,&Stein,Z.A.(1996).Classificationofmentalretardation.InJ.W.Jacobson&J.A.Mulick,(Eds.),Manualofdiagnosisandprofessionalpractice
inmentalretardation(pp.6773).Washington,DC:APA.

Dykens,E.M.,Hodapp,R.M.,&Leckman,J.F.(1994).BehavioranddevelopmentinfragileXsyndrome.ThousandOaks,CA:Sage.

Eaton,L.F.,&Menolascino,F.J.(1982).Psychiatricdisorderinthementallyretarded:Types,problems,andchallenges.AmericanJournalofPsychiatry,139,
12971303.

Fowler,A.E.(1990).LanguageabilitiesinchildrenwithDownsyndrome:evidenceforaspecificsyntacticdelay.InD.Cicchetti&M.Beeghley(Eds.),Childrenwith
Downsyndrome(pp.302328).Cambridge,England:CambridgeUniversityPress.

Fox,R.,&Wise,P.S.(1981).Infantandpreschoolreinforcementsurvey.PsychologyintheSchools,18,8792.

Gottlieb,M.L.(1987).Majorvariationsinintelligence.InM.I.Gottlieb&J.E.Williams(Eds.),Textbookofdevelopmentalpediatrics(pp.127150).NewYork:
Plenum.

Grossman,H.J.(Ed.).(1983).Classificationinmentalretardation.Washington,DC:AmericanAssociationonMentalDeficiency.

Hersen,M.,&VanHasselt,V.B.(Eds.).(1990).Psychologicalaspectsofdevelopmentalandphysicaldisabilities:Acasebook.NewburyPark,CA:Sage
Publications.

Hodapp,R.M.(1996).CrossdomainrelationsinDownssyndrome.InJ.A.Rondal,J.Porera,L.Nadel,&A.Comblain(Eds.),Downssyndrome:
Psychological,psychological,andsocioeducationalperspectives(pp.6579).SanDiego,CA:Singular.

Hodapp,R.M.,&Dykens,E.M.(1994).Mentalretardationstwoculturesofbehavioralresearch.AmericanJournalonMentalRetardation,98,675687.

Hodapp,R.M.,&Zigler,E.(1997).Newissuesinthedevelopmentalapproachtomentalretardation.InW.E.MacLean,Jr.(Ed.),Ellishandbookofmental
deficiency,psychologicaltheoryandresearch(3rded.,pp.128).Mahwah,NJ:LawrenceErlbaumAssociates.

Hodapp,R.M.,Leckman,J.F,Dykens,E.M.,Sparrow,S.S.,Zelinsky,D.G.,&Ort,S.I.(1992).KABCprofilesofchildrenwithfragileXsyndrome,Down
syndrome,andnonspecificmentalretardation.AmericanJournalonMentalRetardation,97,3946.

Jacobson,J.W.,&Mulick,J.A.(Eds.)(1996).Manualofdiagnosisandprofessionalpracticeinmentalretardation.Washington,DC:APA.
Page166

Kingsley,J.,&Levitz,M.(1994).Countusin:GrowingupwithDownsyndrome.NewYork:HarcourtBrace.

Lehrke,R.G.(1972).AtheoryofXlinkageofmajorintellectualtraits.AmericanJournalofMentalDeficiency,76,611619.

Lubetsky,M.J.(1990).Diagnosticandmedicalconsiderations.InM.Hersen&V.B.VanHasselt(Eds.),Psychologicalaspectsofdevelopmentalandphysical
disabilities:Acasebook(pp.2553).NewburyPark,CA:SagePublications.

Luckasson,R.(1992).Mentalretardation:Definition,classification,andsystemsofsupport.Washington,DC:AmericanAssociationonMentalRetardation.

Macmillan,D.L.,&Reschly,D.J.(1997).Issuesofdefinitionandclassification.InW.E.MacLean,Jr.(Ed.),Ellishandbookofmentaldeficiency,psychological
theoryandresearch(3rded.,pp.4771).Mahwah,NJ:LawrenceErlbaumAssociates.

Maino,D.M.,Wesson,M.,Schlange,D.,Cibis,G.,&Maino,J.H.(1991).OptometricfindingsinthefragileX.OptometryandVisionScience,68,634640.

Maxwell,L.A.,&GeschwintRabin,J.(1996).Substanceabuseriskfactorsandchildhoodlanguagedisorders.InM.D.Smith&J.S.Damico(Eds.),Childhood
languagedisorders(pp.235271).NewYork:Thieme.

Mervis,C.B.(1998).TheWilliamssyndromecognitiveprofile:Strengths,weaknesses,andinterrelationsamongauditoryshorttermmemory,language,and
visuospatialconstructivecognition.InE.Winograd,R.Fivush,&W.Hirst(Eds.),Ecologicalapproachestocognition.Mahwah,NJ:LawrenceErlbaumAssociates.

Miller,J.F,&Chapman,R.(1984).Disordersofcommunication:Investigatingthedevelopmentoflanguageofmentallyretardedchildren.AmericanJournalof
MentalDeficiency,88,536545.

Richardson,S.A.,&Koller,H.(1994).Mentalretardation.InI.B.Pless(Ed.),Theepidemiologyofchildhooddisorders(pp.277303).NewYork:Oxford
UniversityPress.

Roeleveld,N.,Zielhuis,G.A.,&Gabreels,F.(1997).Theprevalenceofmentalretardation:Acriticalreviewoftheliterature.DevelopmentalMedicineandChild
Neurology,39,125132.

Rondal,J.A.(1996).OrallanguageinDownssyndrome.InJ.A.Rondal,J.Porera,L.Nadel,&A.Comblain(Eds.),Downssyndrome:Psychological,
psychobiological,andsocioeducationalperspectives(pp.99117).SanDiego,CA:Singular.

Rondal,J.A.,&Edwards,S.(1997).Languageinmentalretardation.SanDiego,SingularPublishingGroup.

Rosenberg,S.,&Abbeduto,L.(1993).Languageandcommunicationinmentalretardation:development,processes,andprevention.Hillsdale,NJ:Lawrence
ErlbaumAssociates.

Sandgrund,A.,Gaines,R.,&Green,A.(1974).Childabuseandmentalretardation:Aproblemofcauseandeffect.AmericanJournalofMentalDeficiency,79,
327330.

Sattler,J.M.(1988).Assessmentofchildren(3rded.).SanDiego,CA:Author.

Simeonsson,R.J.,&Short,R.J.(1996).Adaptivedevelopment,survivalroles,andqualityoflife.InJ.W.Jacobson&J.A.Mulick(Eds.),Manualofdiagnosis
andprofessionalpracticeinmentalretardation(pp.137146).Washington,DC:APA.

Sparks,S.N.(1993).Childrenofprenatalsubstanceabuse.SanDiego,CA:Singular.

Sparrow,S.,Balla,D.,&Cicchetti,D.(1984).VinelandAdaptiveBehaviorScales.CirclePines,MN:AmericanGuidanceService.

Stagg,V.(1988).Clinicalconsiderationsintheassessmentofyounghandicappedchildren.InT.D.Wachs&R.Sheehan(Eds.),Assessmentofyoung
developmentallydisabledchildren(pp.6173).NewYork:Plenum.

Stratton,K.,Howe,C.,&Battaglia,E(1996).Fetalalcoholsyndrome:Diagnosis,epidemiology,prevention,andtreatment.Washington,DC:National
AcademyPress.

StrayGunderson,K.(Ed.).(1986).BabieswithDownsyndrome:Anewparentsguide.Kensington,MD:WoodbinePress.

Taitz,L.S.,&King,J.M.(1988).Aprofileofabuse.ArchivesofDiseaseinChildhood,63,10261031.

Udwin,O.,&Yule,W.(1990).ExpressivelanguageofchildrenwithWilliamssyndrome.AmericanJournalofMedicalGeneticsSupplement6,108114.
Page167

Veltkamp,L.J.(1994).Clinicalhandbookofchildabuseandneglect.Madison,CT:InternationalUniversitiesPress.

Wasson,P.,Tynan,T.,&Gardiner,P.(1982).Testadaptationsforthehandicapped.SanAntonio,TX:EducationServiceCenter,Region20.

Zigman,W.B.,Schupf,N.,Zigman,A.,&Silverman,W.(1993).AgingandAlzheimersdiseaseinpeoplewithmentalretardation.InN.W.Bray(Ed.),
Internationalreviewofresearchinmentalretardation(Vol.19,pp.4170)NewYork:AcademicPress.
Page168

CHAPTER
7

ChildrenwithAutisticSpectrumDisorder

DefiningtheProblem

SuspectedCauses

SpecialChallengesinAssessment

ExpectedPatternsofLanguagePerformance

RelatedProblems

Andrewisa4yearoldwhorarelyspeaksorvocalizes.Healsofailstorespondormakeeyecontactwhenothersspeaktohim.Hehassomeactivitieshewill
engageinincessantly,suchasspinningpartsofatoytruckortwirlinghisfingersinfrontofhiseyes.Andrewhasepilepticseizuresalmostdaily,isnotyet
toilettrained,risesearlyinthemorningandawakensonceortwiceeachnightproblemsthatprovideadditionalstresstohiscaring,beleagueredparents.
HewasinitiallyidentifiedashavingseveretoprofoundmentalretardationandhasmorerecentlybeenidentifiedashavingAutisticDisorder

Peterisa12yearoldwhospeaksinfrequentlyandoftenappearstoignoreremarksdirectedtohimbyothers.Heoccasionallyrepeatsthefulltextofa
televisioncommercialcontainingwordsheneitherusesnorappearstounderstandinothercontexts.Petersexpressiveandreceptivelanguage,asmeasured
throughstandardizedtests,appeardelayed,hisvocalintonationsoundsunmodulatedinpitchandherarely
Page169

seemsabletopracticethegiveandtakerequiredforconversation.AlthoughPeterwasinitiallyidentifiedashavingautism,hehasrecentlybeendiagnosed
ashavingpervasivedevelopmentaldelaynototherwisespecified.

Ameliaisa10yearoldgirlwhowasconsiderednormalinherdevelopmentoflanguageuntilherextremedifficultyinusinglanguageforcommunication
wasnoticedwhensheenteredpreschool.Despitehavingnearnormallanguageabilitiesonstandardizedmeasures,herneedforsamenessandherdifficulty
inengaginginsocialinteractionmakeheraverysolitarychild.Sheperformsbestinschoolsubjectssuchasmathematicsandgeography,whichappearto
interesthergreatly.HerproblemshavebeententativelyidentifiedasassociatedwithAspergersDisorder.

DefiningtheProblem

Autisticspectrumdisorder,thediagnosticcategorythatencompassesmanyoftheproblemsofAndrew,Peter,andAmelia,isfoundin0.02to0.05%ofthe
population,orinabout2to5ofevery10,000people(AmericanPsychiatricAssociation,1994).Recently,somewhathigherestimateshavesuggestedasmanyas10
to14ofevery10,000individuals(Trevarthen,Aitken,Papoudi,&Robarts,1996).Evenwiththesehigherestimates,autismspectrumdisorderisrelativelyrare.The
magnitudeofitsimpactonaffectedchildrenandtheirfamilies,however,hascausedittobethefocusofconsiderableresearchandclinicalwriting.Itsimpactstemsfrom
theseverityofsymptoms,whichincludedelayedordeviantlanguageandsocialcommunicationandabnormalwaysofrespondingtopeople,places,andobjects.There
isalsosomeevidencetosuggestthatitisbecomingmoreprevalent(WolfSchein,1996cf.Trevarthenetal.,1996).

About75%ofchildrenwithautismarediagnosedwithmentalretardationaswell(Rutter&Schopler,1987),withabout50%reportedlyhavingIQslessthan50and
fewerthan33%havingIQsgreaterthan70(Waterhouse,1996).Thereisgreatuncertaintyassociatedwiththesefigures,however,becausethediagnosisofmental
retardationisoftenquestionablegiventhedifficultythesechildrenhaveinparticipatinginformalassessmentprocedures(WolfSchein,1996).

IntheinfluentialDSMIVsystemofnomenclature(AmericanPsychiatricAssociation,1994),autisticspectrumdisorderisreferredtoasPervasiveDevelopmental
Disorder(PDD),acategorythatincludesautisticdisorder,Rettsdisorder,childhooddisintegrativedisorder,Aspergersdisorder,andpervasive
developmentaldisordernototherwisespecified(PDDNOS)(Waterhouse,1996).Readersshouldbeawarethatanalternativeandsomewhatmorecomplicated
setofdiagnosesrelatedtoautismhasbeenformulatedbytheWorldHealthOrganization(WHO)intheInternationalClassificationofDiseases(ICDWHO,1992,
1993),althoughitisnotdiscussedhere.

AutisticdisorderissometimesreferredtoasKannersautismorinfantileautismandisthemostcommonofspectrumdisorders.Itssymptomsaresimilartotheother
disorderswithinthePDDcategory,includingseveredelaysinreciprocalsocialinteractionskills,communicationskills,andthepresenceofstereotypedbehavior,
interestsandactivities(AmericanPsychiatricAssociation,1994,p.65).Althoughchil
Page170

drenwithautisticdisordersharemanycharacteristicswithchildrenwithotherPDDdisorders,theprimaryfocusofthischapterischildrenwithautisticdisorderandtheir
surprisingdegreeofheterogeneity,withregardtolevelsofcognitivefunction,languageoutcomes,andspecificsymptoms(Hall&Aram,1996Myles,Simpson,&
Becker,1995).Theconsiderabledifferenceswithinthissingledisorderareillustratedbytherangeofdifficultiesdescribedattheoutsetofthechapterinrelationto
PeterandAndrew.

TheAmericanPsychiatricAssociation(1994)definitionforAutisticDisorderispresentedinTable7.1.Besidescallingattentiontothesechildrensverymarked
problemsinsocialinteractionandlanguage,thisdefinitionemphasizestheabnormaland

Table7.1
ADefinitionofAutisticDisorder(AmericanPsychiatricAssociation,1994)

A. Atotalofsix(ormore)itemsfrom(1),(2),and(3),withatleasttwofrom(1)andoneeachfrom(2)and(3):
(1) Qualitativeimpairmentinsocialinteraction,asmanifestedbyatleasttwoofthefollowing:
markedimpairmentintheuseofmultiplenonverbalbehaviorssuchaseyetoeyegaze,facialexpression,bodypostures,andgesturestoregulatesocial
(a)
interaction
(b) failuretodeveloppeerrelationshipsappropriatetodevelopmentallevel
alackofspontaneousseekingtoshareenjoyment,interests,orachievementswithotherpeople(e.g.,byalackofshowing,bringing,orpointingout
(c)
objectsofinterest)
(d) lackofsocialoremotionalreciprocity.
(2) Qualitativeimpairmentsincommunicationasmanifestedbyatleastoneofthefollowing:
delayin,ortotallackof,thedevelopmentofspokenlanguage(notaccompaniedbyanattempttocompensatethroughalternativemodesof
(a)
communicationsuchasgesturesormime)
(b) inindividualswithadequatespeech,markedimpairmentintheabilitytoinitiateorsustainaconversationwithothers
(c) stereotypedandrepetitiveuseoflanguageoridiosyncraticlanguage
(d) lackofvaried,spontaneousmakebelieveplayorsocialimitativeplayappropriatetodevelopmentallevel.
(3) Restrictedrepetitiveandstereotypedpatternsofbehavior,interests,andactivities,asmanifestedbyatleastoneofthefollowing:
(a) encompassingpreoccupationwithoneormorestereotypedandrestrictedpatternsofinterestthatisabnormaleitherinintensityorfocus
(b) apparentlyinflexibleadherencetospecific,nonfunctionalroutinesorrituals
(c) stereotypedandrepetitivemotormannerisms(e.g.,handorfingerflappingortwisting,orcomplexwholebodymovements)
(d) persistentpreoccupationwithpartsofobjects.
Delaysorabnormalfunctioninginatleastoneofthefollowingareas,withonsetpriortoage3years:(1)socialinteraction,(2)languageasusedinsocial
B.
communication,or(3)symbolicorimaginativeplay.
C. ThedisturbanceisnotbetteraccountedforbyRettssyndromeorChildhoodDisintegrativeDisorder.

Note.FromDiagnosticandStatisticalManualofMentalDisorders(4thed.,pp.7071)bytheAmericanPsychiatricAssociation,1994,Washington,DC:Author.
Copyright1994bytheAmericanPsychiatricAssociation.Adaptedwithpermission.
Page171

oftenrigidpatternofinteractionwithobjectsandotheraspectsoftheirenvironmentthatischaracteristicofchildrenwithautism.Inthisdefinition,theonsetisspecified
asbeingpriortoage3becauseofthevarietyofagesatwhichmarkedchangesindevelopmentarereported:Althoughmanychildrenaredescribedbytheirparentsas
havingalwaysbeendistantandunresponsive,othersaredescribedashavingrespondedtosocialinteractionnormallyuntilage1or2(AmericanPsychiatric
Association,1994Prizant&Wetherby,1993).

Difficultiesindefiningautisticdisorderarisefromtheremarkableheterogeneityofchildrenwiththedisorderandfromtheextenttowhichtheirproblemsoverlapwith
thoseassociatedwithotherdevelopmentaldisordersandwithmentalretardation(Carpentieri&Morgan,1996Nordin&Gillberg,1996Waterhouseetal.,1996).
Table7.2liststheotherdisordersincludedwithinPDDandthecharacteristicsthatarethoughttodistinguishautisticdisorderfromthem.

Anumberofresearchers(e.g.,Rapin,1996Waterhouse,1996Wing,1991)haveexploredcommonfeaturesacrossspecificdisordersincludedwithinPDDand
havesuggestedthatfrequentchangesinterminologyandclinicalcategoriesarelikelytocontinueasmoreislearnedaboutthesechildren(Waterhouse,1996).In
particular,considerableresearchhasrecentlybeendevotedtothedefiningboundariesbetweenAspergerssyndromeandautisticdisorderinindividualswithhigher
measuredIQs(Ramberg,Ehlers,Nyden,Johansson&Gillberg,1996Wing,1991).

Theoverlapbetweenmentalretardationandautisticspectrumdisorderalsopresentsmajorchallengestoresearchersandclinicians.Asmentionedearlier,about75%of
childrenwithautisticspectrumdisorderarediagnosedwithmentalretardation.Inaddition,theseverityofmentalretardationappearstoberelatedtothefrequencyof
autisticsymptoms.Forexample,inonerecentSwedishstudy(Nordin&Gillberg,1996a),autisticspectrumdisorderwasidentifiedinabout12%ofchildrenwithmild
retardation,whereasitwasidentifiedin29.5%ofthosewithsevereretardation.Thefactthatnotallchildrenwithmentalretardationshowautisticsymptoms,however,
suggeststhatmuchmoreneedstobedonetounderstandtherelationshipofthesetwoconditions.Increasedunderstandingofthenatureoftherelationshipbetween
mentalretardationandthespecificcognitivedeficitsassociatedwithautisticspectrumdisordershouldhelpimprovethequalityofcaredirectedtochildrenwiththese
combineddifficulties.

Additionaldifficultiesindiagnosisareduetothechangingnatureofsymptomsassociatedwithautisticdisorderwithage,althoughcurrentlythereisconsiderable
disagreementoverthenatureanddirectionofthosechanges(i.e.,improvementvs.declinee.g.,seeEaves&Ho,1996Piven,Harper,Palmer,&Arndt,1996).
Despitepossiblechangesovertime,however,itisrareforindividualsdiagnosedasautisticinchildhoodtoenteradulthoodwithoutsignificantresidualproblems(e.g.,
seePivenetal.,1996).ApersonalexperiencewithanacquaintanceingraduateschoolwhoinretrospectwouldprobablyhavebeenidentifiedashavingAspergers
disorderandwhomIwillcallMatthewMetzcapturesthisgeneralityforme:AlthoughMatthewwouldeventuallycompleteaPh.D.inhistory,heinvariablygreeted
membersofourgraduatehousehesawoncampuswithanintroductionHi,youmaynotrememberme,butmynameisMatthewMetz.Thisgreetingpersisted
despitemonthsofhaving
Page172

Table7.2
DifferentiatingAutisticDisorderFromOtherDisordersWithintheAutisticSpectrumDisorder
(CalledPervasiveDevelopmentalDisorders,PDD,bytheAmericanPsychiatricAssociation,1994)

Disorder MajorCharacteristics BasisforDifferentiationFromAutisticDisorder

l Differencesinsexratios(femaleonlyversuspredominately
l Anautosomaldisorderaffectingonlywomen(probablynomen maleinautism)
areidentifiedbecauseoffetalmortality) l HeadgrowthslowsdownafterinfancyonlyinRetts

l Normalpatternofearlyphysical,motordevelopmentwithlater
lossofskillsanddecelerationinheadgrowth
Rettsdisorder
l Associatedwithsevereorprofoundmentalretardationand
limitedlanguageskills
l Characteristichandmovements(wringingorwashingof
Autisticdisordermayactuallybeassociatedwithanabnormally
largeheadcircumference(Waterhouseetal.,1996)
l Socialinteractiondifficultiesaremorepersistentintolate
childhoodinautismthaninRettsdisorder
l Differentiationfromautismdependsongoodevidenceof

hands) normaldevelopmentduringfirsttwoyearsotherwise,the
autismcategorizationispreferred
l Markedregressionafteratleast2yearsofseeminglynormal
development
Childhooddisintegrative l Social,communication,andbehavioralcharacteristicssimilarto

disorder autism
l Usuallyassociatedwithseverementalretardation

l Veryraredisorder,possiblymorecommoninmenthanwomen

l Preservedlanguagefunctioninthepresenceofsevereand
sustainedimpairmentinsocialinteraction(p.75)
Aspergersdisorder
l Restricted,repetitivepatternsofbehavior,interests,and
activities(e.g.,pronouncedinterestintrainschedules)
l Absenceofsignificantlanguageandcognitivedeficitsin
Aspergersdisorder,butverysignificantdelaysinautism
l Exceptforsocialcommunicationdeficits,adaptiveskillsare
developmentallyappropriateinAspergers,butnotinautism
l AspergersDisorderistypicallydiagnosedlaterthanautism,

oftenatschoolage,possiblyduetolateronsetthanautism
l Severeandpervasiveimpairmentinsocialinteractionand/or
verbalandnonverbalcommunicationand/orpresenceofrestricted,
PervasiveDevelopmental l Onsetorsymptomsfailingtoconformtocriteriaforother
repetitivepatternsofbehavior,interests,andactivities
DisorderNotOtherwise PDD,includingautism
l FailuretomeetspecificcriteriarequiredforotherPDD
Specified(PDDNOS) l Sometimesreferredtoasatypicalautism
categoriesdescribedabovewithregardtoseverityofsymptomsor
ageofonset
Page173

shareddinnersatacommontablewiththeacquaintancesheaddressed.Asyoumayexpect,Matthewhadaveryrestrictedsocialspherethatwaslargelyconfinedto
fellowstudentsinhisgraduateprogram.WhenIlastheardofhim,hewaslivingwithhiselderlyparentsandearnedalimitedincomebywritingentriesonhistorical
subjectsforpublishersofanencyclopedia.Thus,eveninthepresenceoftheintellectualabilitiesrequiredforcompletionofagraduatedegree,significantchallengesfor
Matthewpersistedwellintoadulthood.

SuspectedCauses

Todate,discussionsofetiologyforautisticspectrumdisorderhavefocusedonsocioenvironmental,behavioral,andpurelyorganicpossibilities(Haas,Townsend,
Courchesne,Lincoln,Schreibman,&YeungCourchesne,1996Waterhouse,1996WolfSchein,1996).Thesocioenvironmentalperspectivehadstrongproponents
inthe1960s,especiallyamongpsychoanalystswhoheldthatpoorparentingwasthesourceofthesechildrensdifficulties(e.g.,Bettelheim,1967).Morerecently,
however,suchtheorieshavelostfavorwithalmostallresearchersandclinicians.Currently,thedominantperspectiveonautismisthatithasoneormoreorganicbases
intheformofunderlyingneurologicalabnormalities.

Thenatureofneurologicabnormalitiesunderlyingautismhasnotyetbeenwelldocumentedandconstitutesamajorareaofresearch(Rapin,1996).Proposedsitesof
suspectedneurologicabnormalitiesarethefrontallobe(Frith,1993),thereticularformationofthebrainstem(Rimland,1964),andthecerebellum(Courchesne,
1995)justtonameafew(cf.Cohen,1995WolfShein,1996).Inaddition,therolethattherighthemisphereofthebrainplaysinautisticsymptomshasreceived
someattention(e.g.,Shields,Varley,Broks,&Simpson,1996).Althoughlocalizedfunctionalabnormalitieshavebeensought,ithasfrequentlybeensuggestedthatthe
underlyingabnormalitiesareinfactlikelytobediffuse(Rapin,1996).

Asamoredistalcausalfactorleadingtothebrainabnormalitiesthatarethenbelievedtocauseautisticsymptomsmoredirectly,geneticfactorsareimplicatedforsome
casesofautism.Evidencesupportingthisreasoningincludes(a)thepreponderanceofmalesinallcategorieswithPDDexceptRettsdisorder(AmericanPsychiatric
Association,1994Waterhouseetal.,1996),1(b)thetendencyforPDDtooccurmuchmorefrequentlyinsomefamiliesthaninothers(Folstein&Rutter,1977),and
(c)thetendencyforPDDtooccurfrequentlyamongindividualswithfragileX,wheregeneticabnormalitiesarewelldocumented(Cohen,1995).

Manycasesofautism,however,haveyettobelinkedtogeneticabnormalities.Nonetheless,itissuspectedthatthesecasesarestillduetoorganicfactorsarising
beforeratherthanduringorafterthechildsbirth(Rapin,1996).Othersuspectedsourcesofthepresumedneurologicabnormalitiesincludemetabolicdisordersand
infectiousdisorders(e.g.,congenitalrubella,encephalitis,ormeningitisRapin,1996WolfSchein,1995).Insomecases,nolikelycausalfactorissuggestedleading
tocasesthataretermed

1ThereasoningisthatmalepreponderancemayexistbecausemalessingleXchromosomemakesthematspecialriskforXchromosomedefects.
Page174

idiopathic,thatis,withoutaknowncause.Effortstoidentifytherealnatureofsuchidiopathiccasesandtoidentifythespecificmechanismsbywhichknowncausesact
tocreateautisticsymptomsrepresentsomeofthemostneededareasforresearchonPDD.

SpecialChallengesinAssessment

Childrenwithautisticspectrumdisorderpresentthegreatestimaginablechallengestothecliniciancontemplatingformaltestingasameansofcollectinginformation.
Frequently,thesechildrensessentialsocialinteractiondeficitsdramaticallylimittheirparticipationintheusualgiveandtakerequiredbymoststandardizedlanguage
instruments.Consequently,informalmeasures,especiallyparentquestionnairesandbehavioralchecklists,areusedveryfrequentlyforpurposesofscreening,diagnosis,
anddescriptionoflanguageamongchildrenandadultswithautisticspectrumdisorder(Chung,Smith,&Vostanis,1995DiLavore,Lord,&Rutter,1995Gillberg,
Nordin,&Ehlers,1996Nordin,&Gillberg,1996Prizant&Wetherby,1993Sponheim,1996).

Alternativestostandardizedtestsareparticularlyvaluableforthosechildrenwhosecommunicationrepertoireisverylimited,agroupthatincludesasmanyas50%of
allchildrenwithautism(Paul,1987).Wherethepurposeofanevaluationistoaidindiagnosisofthedisorder,ithasbeenarguedthatparentinterviewsmaybe
considerablybetterthanobservationalmethodsthatmaybeappliedbyclinicians(Rapin,1996).Table7.3listssomeofthemostcommonquestionnaires,interview
schedules,checklists,andotherinstrumentsusedinscreeninganddiagnosingautisticspectrumdisorders.Althoughmanyofthesefocusontheentirerangeofdifficulties
oftenseenaspartofautism,somefocusonselectedskillareas,suchascommunicationorplay.

Despitethefrequentneedfornontraditional,observationaltechniques,moretraditional,standardizedspeechandlanguagetestscanplayausefulroleinlanguage
assessmentsofsomechildrenwithautism.Inparticular,childrenwithmoreelaboratelanguageandcommunicationskillschildrenwhoareoftendescribedashigh
functioningmaybeamenabletostandardizedtestingwhenappropriateattentionispaidtomotivationandotherenablingfactors.Informationobtainedfromfamily
membersandotherindividualswhoareveryfamiliarwiththechildcanhelppinpointthereinforcersthatwillprovemosthelpfulinfacilitatingachildsparticipationand
warnagainstspecificstimuli(e.g.,typesofenvironmentalnoisesuchastrafficnoiseorthesoundofsomeelectricaldevices)thatarelikelytobedistractingordisturbing
totheindividualchild.

Forhigherfunctioningchildren,standardizedspeechandlanguagetestingmaynotonlybefeasible,butquitevitaltoathoroughunderstandingoftheirstrengthsand
weaknessesparticularlyforreceptiveskillsthat,unlikeexpressiveskills,cannotbeasreadilyobservableinspontaneousproductions.

Evenwhenexpressivelanguagetestingisfeasible,analysisofspontaneousproductionswillalmostalwaysconstituteaparticularlydesirabletoolforexpressivelanguage
assessment.Notonlydoesanalysisofspontaneouslanguageallowonetosimultaneouslyexaminevariablesrelatedtonumerousexpressivelanguagedomains(Snow&
Pan,1993),onecanarguethatthevalidityofsuchmeasureswillbeparticularlysuperiorforchildrenwhoaresoreactivetostandardizedtestingprocedures.In
Page175
RecentBehavioralChecklistsandInterviewforScreeningandDescriptionofAutisticSpectrumDisorder
(Chung,Smith,&Vostanis,1995Gillberg,Nordin,&Ehlers,1996WolfSchein,1996)
Purpose Instrument
ChecklistforAutisminToddlers(CHAT
Screening
BaronCohen,Allen,&Gillberg,1992)
PreLinguisticAutismDiagnosticObservation
Schedule(PLADOS)(DiLavore,Lord,&
Rutter,1995)
AspergerSyndromeScreeningQuestionnaire
(ASSQEhlers&Gillberg,1993)
Diagnosisand AutismDiagnosticInterviewRevised(ADIR
Description Lord,Rutter,&LeCouteur,1994)
ChildhoodAutismRatingScale(CARS)
(Schopler,Reichler,&Renner,1986)
Table7.3
AgeGroup Description
Uses14itemsthatarerespondedtobyparent(n=9)andby
Childrenfrom18to30 clinician(n=5items)foundtohavealowrateoffalsepositives
months andreportedtohavegoodreliability(Gillberg,Nordin&Ehlers,
1996)
Uses12playbasedactiviteswith17associatedratings,with
Childrenunder6years itemsadministeredbytheexaminerorthroughoneofthechilds
ofage caregiversdesignedtorelatedirectlytotheDSMIVorICD10
criteria
Ateacherquestionnairecontaining27itemsitappearsto
consistentlyidentifyAspergersdisorder,butitmayoveridentify
7to16years
incasesofothersocialabnormalitiesoneofthefewmeasures
developedtobesensitivetoAspergersdisorder.
UsesinterviewofparentsorcaregiversofIndividualswith
Childrenfrom18
suspectedautisticdisorder.Designedtorelatedirectlytothe
monthstoadults
DSMIVorICD10criteria.
Usesdirectobservationofchildrenwithsuspectedautistic
Children disorder.Designedtobeusedindiagnosisanddescriptionof
severity.
Page176

chapter10,theuseofspontaneouslanguagesampleanalysesisdiscussedatsomelength.

ExpectedPatternsofLanguagePerformance

Certainspecificlanguagebehaviorsarefrequentlyassociatedwithautism,althoughtheymayalsooccurinfrequentlyinnormallanguagedevelopmentandinother
languagedisturbances.Amongthesebehaviorsareecholalia,pronominalreversals,andstereotypicornonreciprocallanguage(Fay,1993Paul,1995).

Echolaliaconsistsoftheimmediateordelayedrepetitionofspeech,oftenwithoutevidentcommunicativeintent.Echolalicproductionscanoftenbequitecomplexin
theirlanguagestructurerelativetothelevelofthechildsspontaneouscommunicationsandmaysimplyrepresentmemorizedroutinesratherthancreativelygenerated
language.Thepresenceofecholalicproductionsoftenappearstoindicateachildsattempttostayengagedinthesocialinteractiondespitefailingtounderstandwhat
hasjustbeensaidorbeingunabletoproduceamoresuitableresponse.Suchproductions,consequently,maybecommunicativeinintentandthereforeprovide
informationaboutthenatureofthechildspragmaticskills(Paul,1995).

Pronominalreversalsinvolvesanapparentconfusioninpronounchoiceinwhichfirstandsecondpersonpronounsaresubstitutedforoneanother.Thus,forexample,
achildmightsayyougowhenapparentlyreferringtohimorherself.Althoughatonepointintimetheseerrorswerethoughttoreflectthechildsfailuretodistinguish
himorherselffromtheenvironment,theyarecurrentlytakentoreflectthechildsinflexibleuseoflanguageforms.Inshort,thechildtreatspronouns,whichare
sometimesreferredtoasdeicticshifters,asunchanginglabels,therebyfailingtorecognizetheshiftthatallowsItorefertoseveraldifferentspeakersinturnsimply
byvirtueoftheirroleasspeaker,andyoubyvirtueoftheirroleaslistener.Althoughonceconsideredahallmarkofthedisorder,pronominalreversalsarenot
necessarilyusedfrequently(Baltaxe&DAngiola,1996).ThePersonalPerspectiveincludedinthischaptercontainsthereflectionsofDonnaWilliams,anadultwith
autism,whoarguespersuasivelyfortherelativeunimportanceofpronounuseasatargetfortherapy,givenallofthewordsoneneedstolearn.

PERSONALPERSPECTIVE
Thefollowingpassagecomesfromabookwrittenbyayoungwomanwhodescribesherselfashavingautismassociatedwithhighfunctioning(Williams,1996,pp.
16061).Inthispassage,shediscusseswhichwordsareimportantandwhichareunimportanttolearn:
Wordstodowiththenamesofobjectsareprobablythemostimportantonestoconnectwithasitishardtoaskforhelpifyouhaventgotthese.Ifsomeonecan
onlysaybook,atleastyoucanworkoutwhattheymightwantdonewith
Page177

it.iftheyjustsaylookbuthaventconnectedwithbook,youhaveawholehousefullofthingsthatcanbelooked(atorfor).
Wordstodowithwhatthingsarecontainedin(box,bottle,bag,packet),madeof(wood,metal,cloth,leather,glass,plastic,powder,goo)orwhatisdonewith
them(eating,drinking,closing,warming,sleeping)arealsoreallyimportanttolearn.Muchlater,lesstangible,lessdirectlyobservablewordssuchasthosetodowith
feelings(hadenough,hurt,good,angry)orbodysensations(tired,full,cold,thirsty)arereallyimportanttoconnectwith.
Wordstodowithpronouns,suchasI,you,he,she,weorthey,arentsoimportant.Toomanypeoplemakearidiculousbighoohaaboutthesethings,
becausetheywanttoeradicatethissymptomofautism,orforthesakeofmannersorimpressiveness.Pronounsarerelativetowhoisbeingreferredto,where
youareandwheretheyareinspaceandwhoyouaretellingallthisto.Thatsalotofconnectionsandfarmorethaneverhavetobemadetocorrectlyaccess,use
andinterpretmostotherwords.Pronounsare,inmyexperience,thehardestwordstoconnectwithexperienceablemeaningbecausetheyarealwayschanging,
becausetheyaresorelative.Inmyexperience,theyrequirefarmoreconnections,monitoringandfeedbackthaninthelearningofsomanyotherwords.
Toooftensomuchenergyisputintoteachingpronounsandthepersonbeingdrilledexperiencessolittleconsistentsuccessinusingthemthatitcanreallystrongly
detractfromanyinterestinlearningallthewordsthatcanbeeasilyconnectedwith.Igotthroughmostofmylifeusinggeneraltermslikeapersonandone,calling
peoplebynameorbygenderwithtermslikethewomanorthemanorbyagewithtermsliketheboy.Itdidntmakeagreatdealofdifferencetomyabilitytobe
comprehendedwhetherIreferredtothesepeoplesrelationshiptomeorinspaceornot.Thesethingsmighthavetheirtimeandplacebuttherearealotofmore
importantthingstolearnwhichcomeeasierandcanbuildasenseofachievementbeforebuildingtoogreatasenseoffailure.

Stereotypicornonreciprocallanguagereferstoidiosyncraticuseofwordsorevenwholesentences(Paul,1995).Oftentheparticularwordorphraseseemstobeused
becauseitwasfirstheardinaparticularsituationorinconjunctionwithaspecificeventorobjects.Thereafter,itisusedtostandfortheassociatedsituation,event,or
object,despiteitslackofmeaningtoanyoneexceptaveryperceptiveindividualpresentatthetimetheassociationwasformed.TempleGrandin,acollegeprofessor
whohasrecentlypublishedseveralbooksaboutherexperiencesassomeonewithautism,describesapersonalexampleofnonreciprocallanguage:

Teacherswhoworkwithautisticchildrenneedtounderstandassociativethoughtpatterns.Anautisticchildwilloftenuseawordinaninappropriatemanner.Sometimes
theseuseshavealogicalassociatedmeaningandothertimestheydont.Forexample,anautisticchildmightsaytheworddogwhenhewantstogooutside.The
worddogisassociatedwithgoingoutside.Inmy
Page178

owncase,Icanrememberbothlogicalandillogicaluseofinappropriatewords.WhenIwassix,Ilearnedtosayprosecution.Ihadabsolutelynoideawhatitmeant,
butitsoundednicewhenIsaidit,soIuseditasanexclamationeverytimemykitehittheground.Imusthavebaffledmorethanafewpeoplewhoheardmeexclaim
Prosecution!tomydownwardspiralingkite.(Grandin,1995,p.32)

Inadditiontocharacteristickindsofatypicallanguageuse,patternsoflanguagestrengthsandweaknessesamongchildrenwithautisticdisorderandAspergers
disorderhavereceivedextensiveattentionbyresearchers.Table7.4summarizesthelanguagecharacteristicsdescribedforthreediagnosesinthespectrum:twoforms
ofautisticdisorderandAspergersdisorder.Thetwodescriptionsprovidedunderautisticdisorderareincludedbecauseoftherelativelyrichresearchbasethathas
identifiedverydifferentskillsseeninindividualswhocanbedescribedashighversuslowfunctioningintermsofseverityaswellasintermsofnonverbalintelligence
scores.AstudyperformedbyalargegroupofresearchersheadedbyIsabelleRapin(1996)providesthemostcomprehensivestudyofthelargestnumberofchildren
withautismtodateitmadeuseofnormalcontrolsandtwoothercontrolgroups(a)agroupoflanguageimpairedchildrentoactascontrolsforthehighfunctioning
childrenwithautismand(b)agroupofchildrenwithoutautismbutwithlownonverbalIQstoactasacontrolgroupforthelowfunctioningchildrenwithautism.That
multiyear,multisitestudyprovidedmuchoftheinformationincludedinTable7.4.Despitemyuseofthesubcategorieshighandlowfunctioning,itshouldbenotedthat
researchershaveidentifiedseveralsubgroupingsofautisticspectrumdisorderbeyondthosediscussedinthischapter,includingaloof,passive,andactivebutodde.g.,
Frith,1991Sevinetal.,1995Waterhouse,1996Waterhouseetal.,1996).

RelatedProblems

AutisticDisorder,andindeedmostofthedisordersontheautisticspectrum,arecharacterizedbyanumberofbehavioralproblemsinadditiontothosealready
discussedintermsofcommunicationandlanguage.Twooftheserestrictedrepetitiveandstereotypedpatternsofbehavior,interests,andactivitiesandlackof
varied,spontaneousmakebelieveplayorsocialimitativeplayappropriatetodevelopmentallevelareconsideredcentralenoughtothenatureofthedisordertobe
listedintheDSMIVdefinition(AmericanPsychiatricAssociation,1994).Theyarecloselyrelated.

Restrictedandstereotypedpatternsofbehavior,interests,andactivitiescanincludebehaviorssuchasthechildsrocking,flappingoneorbothhandsinfrontofhisor
herowneyes,repeatedlymanipulatingpartsofobjects(suchasspinningthewheelonatoyorrepeatedlyopeningandclosingahallwaydoor),or,morealarmingly,
repeatedlybitingorstrikingothersorhimorherself.Someoftheserepetitivebehaviorscanbeinterpretedasselfstimulatoryoraseffortsbythechildtodealwith
anxietyandavoidoverstimulation(e.g.,Cohen,1995)othersaremoredifficulttointerpret.Stereotyped,repetitivebehaviors(sometimesreferredtoasstereotypies)
willoftenneedtobeaddressedinordertofreethechildtoattendtoimportantinteractions(suchasassessmentorestablishingrelationshipswithpeers).Howthey
shouldbeaddressed
Page179

Table7.4
PatternsofStrengthsandWeaknessesAmongChildrenWithAutisticDisorderHighFunctioning,
AutisticDisorderLowFunctioning,andAspergersDisorder

Disorder RelativeStrengthsinCommunication RelativeWeaknessesinCommunication OtherStrengthsandWeaknesses

l Receptivelanguagemoreaffectedthan
expressivelanguage(Rapin,1996) Strengths:
l Expressivevocabulary(Rapin,1996) l Functionaluseofexpressivelanguagebelow l Preservedfunctiononvisuospatialandvisual

l Writtenlanguagesuperiortooral performanceonmosttestsofexpressive perceptualskills(Rapin,1996)

languageandsuperiortowritten language(Rapin,1996) Weaknesses:
Autisticdisorderhigh languageskillsofchildrenwithdelayed l Pragmaticskills l Markeddelayinonsetofabilitytoengagein

functioning(ADHF) languageskills,butnormalintelligence l Rapidnamingwithinacategory(Rapin,1996) symbolicplay(Rapin,1996)

(Rapin,1996) l Formulatedoutputofconnectedspeech l Possibledeficitsinmemory(Rapin,1996)

l Relativelylessuseofecholaliathanin (Rapin,1996) l Subtlemotordeficits,especiallyaffecting

ADLF l Verbalreasoning(Rapin,1996) grossmotorskills(Rapin,1996)thataremore

l Delayeddevelopmentofquestionaskingas consistentwithlanguageskillsthannonverbalIQ
pronouncedinADLF(Rapin,1996)

(Continued)
Page180
Disorder RelativeStrengthsinCommunication
l Expressivevocabularyisarelative
strengthandisgenerallybetterthan
receptivevocabulary
Autisticdisorderlow
l Patternsofstrengthandweaknesses
functioning(ADLF)
maybeespeciallydifficulttodetermine
becauseofflooreffectsonmany
measures(Rapin,1996)
l Generallypreservedlanguageskills
(AmericanPsychiatricAssociation,
AspergersDisorder 1994)
(AD) l Phonology,exceptpossiblyinthe
areasofprosody
l Syntax
Note.AspergersDisorderisconsideredequivalenttoAutisticDisorderHighFunctioningbysomeauthors(e.g.,Rapin,1996).
Table7.4(Continued)
RelativeWeaknessesinCommunication OtherStrengthsandWeaknesses
l Verbalcommunicationmaybeabsentin
abouthalfofthesechildren(Rapin,1996)
Strengths:
l Whenpresent,mostareasoflanguageare
l Nonverbalperformancesupperiortoverbal
severelyaffected(Rapin,1996)
performance(Rapin,1996)
l Reportedtemporaryregressionoflanguage
skillsinearlydevelopment(Rapin,1996)
Strengths:
l Pragmaticskills(Ramberg,Ehlers,Nyden,
l Normalnonverbalintelligence
Johansson,&Gillberg,1996Wing,1991)
Weaknesses:
l Atypicalprosodyandvocalcharacteristics
l Motorclumsiness(Rambergetal.,1996
(Rambergetal.,1996)
Wing,1991)
Page181

mustbedeterminedinrelationtotheirpotentiallyadaptiverolefromthechildsperspective.Teamapproachesusingbehavioralinterventionsand,attimes,drug
interventionaresometimesuseful.

Thehighfrequencyofthesestereotypedpatternsofinteractioniscombinedwithalackofthespontaneous,imaginativeplayconsideredsocharacteristicofchildhood.
AlthoughthisdeficiencyhasbeennotedsinceautismwasfirstdescribedbyKannerin1943,ithasrecentlybeenseenasrelatedtothesechildrensapparentinabilityto
assumealternativeperspectivesanabilitythatalsosupportssocialinteraction.Ithasbeensaidthatoneofthechiefcognitivedeficitsinchildrenwithautisticdisorder
maybetheirlackofatheoryofmind,theabilitytothinkaboutemotions,thoughts,motiveseitherinthemselvesorothers(Frith,1993).

Sometimes,pronouncedsensoryabnormalitieshavebeeninferredinmanyautisticchildrenonthebasisoftheirapparentavoidanceofandnegativereactionstomany
auditory,visual,andtactilestimuli.Inparticular,hypersensitivityandhyposensitivityhavebeenassociatedwithautisticspectrumdisorders(e,.g.,Rouxetal.,1995
Sevinetal.,1995).Recently,acontroversialtherapytechnique,auditoryintegrationtraining(Rimland&Edelson,1995),hasbeendevisedinanattempttoeliminate
these,abnormalresponsestoauditorystimuliseeninsomechildren.

Inagrowingnumberofstudies,childrenwithautismspectrumdisorderhavebeenfoundtobeatincreasedriskformotorabnormalities.Forexample,inarecentlarge
scalestudy,childreninbothhighandlowfunctioninggroupsshowedagreaterfrequencyofmotorabnormalitiesthandidgroupsofchildrenwitheithermental
retardationwithoutautismorSLI(Rapin,1996).However,oromotorimpairmentstendedtobemorecommonandmoresevereamongchildreninthelowfunctioning,
group.Amongthedifficultiesnotedhavebeenakinesia(absentordiminishedmovement),bradykinesia(delayininitiating,stopping,orchangingmovementpatterns)
anddyskinesia(involuntaryticsorstereotypiesDamasio&Maurer,1978)aswellasproblemswithmuscletone,posture,andgait(Page&Boucher,1998).Of
particularinteresttospeechlanguagepathologistswhomaywishtoworkonoralmotoractivitiesineffortstofosterspeechoronmanualgestureshavebeenreportsof
oralandmanualdyspraxia,difficultiesintheperformanceofpurposefulvoluntarymovementsintheabsenceofparalysisormuscularweakness(Page&Boucher,
1998Rapin,1996).

Otherproblemsthataremorecommonamongchildrenontheautisticdisorderspectrumthanamongchildrenwithoutidentifiedproblemsareepilepsy,especiallya
formcalledinfantilespasms,andsleepdisorders(Rapin,1996).ADHD(discussedinchap.5),isalsomoreprevalent(Wender,1995).

Summary

1.Autisticspectrumdisorder,alsotermedPervasiveDevelopmentalDisorder(PDD),encompassesatleastfourrelatedandrelativelyraredisorders:Rettsdisorder,
autisticdisorder,Aspergerssyndrome,childhooddisintegrativedisorder,andpervasivedevelopmentaldisordernototherwisespecified(PDDNOS)accordingthe
diagnosticsystemoftheDSMIV(AmericanPsychiatricAssociation,1994).
Page182

2.Difficultiessharedbychildrenwithautisticspectrumdisordersincludedelayedordeviantlanguage,socialcommunication,andabnormalwaysofrespondingto
people,places,andobjects.

3.Autisticspectrumdisordersfrequentlycooccurwithmentalretardation,perhapsbecauseofasharedcause:underlyingneurologicabnormalities.

4.Althoughthesourceofunderlyingneurologicabnormalitiesisgenerallyunknown,geneticfactorsandprenatalinfectionsaresuspectedinsomecases.

5.Childrenwithautisticspectrumdisorderareoftenunabletoparticipateinstandardizedtestingrequiredforthediagnosisoftheirdisorder,makingtheuseof
observationalmethodsandparentalquestionnairesaveryfrequentandrelativelywellstudiedalternative.

6.Echolalia,pronominalreversals,andstereotypiclanguageareabnormalfeaturesoflanguagethatareseenmorefrequentlyinautisticdisorderthaninother
developmentallanguagedisorders.

7.Otherproblemsaffectingchildrenwithautisticspectrumdisordersincludealackofspontaneous,imaginativeplayandrestrictedpatternsofbehavior,interests,and
activities.Inaddition,thesechildrenareatincreasedriskformotorabnormalities,seizures,andsleepdisorders.

KeyConceptsandTerms

akinesia:absentordiminishedmovement.

autisticdisorder:themajorandmostfrequentlyoccurringdisordercategorywithinthelargerDSMIV(AmericanPsychiatricAssociation,1994)definitionof
PervasiveDevelopmentalDisordersoftenusedsynonymouslywithinfantileautismorKannersautism.

Aspergersdisorder:anautisticdisorderwithinthelargerDSMIVcategoryofPervasiveDevelopmentalDisordersinwhichearlydelaysincommunicationare
absentoftenconsideredsynonymouswithhighfunctioningautism.

bradykinesia:amotorabnormalitycharacterizedbydelaysininitiation,cessation,oralterationofmovementpattern.

childhooddisintegrativedisorder:averyrareautisticdisorderwithinthelargerDSMIVcategoryofPervasiveDevelopmentalDisordersinwhichaperiodofabout
2yearsofnormaldevelopmentisfollowedbyautisticsymptoms.

dyskinesia:amovementabnormalitycharacterizedbyinvoluntaryticsorstereotypies.

dyspraxia:difficultiesintheperformanceofpurposefulvoluntarymovementsintheabsenceofparalysisormuscularweaknessforexample,oraldyspraxia,manual
dyspraxia,verbaldyspraxia(alsofrequentlyreferredtoasverbalapraxia).

echolalia:immediateordelayedrepetitionofapreviousspeakersoronesownutterance.
Page183

epilepsy:achronicdisorderassociatedwithexcessiveneuronaldischarge,alteredconsciousness,andsensoryactivity,motoractivity,orboth.

PervasiveDevelopmentalDisorders(PDDs):thegroupofseveredisordershavingtheironsetinchildhood,characterizedbysignificantdeficitsinsocialinteraction
andcommunication,aswellasthepresenceofstereotypedbehavior,interestsandactivitiesconsideredsynonymouswithautisticdisorderspectrumdisorder.

pervasivedevelopmentaldisordernototherwisespecified(PDDNOS):WithintheDSMIVsystemofdisorderclassification,thisdiagnosisismadewhensome
butnotallofthemajorcriteriaforautisticdisorderaremetalsoreferredtoasatypicalautism.

pronominalreversals:incorrectuseoffirstandthirdpersonpronouns(e.g.,youwanttomeanIwant),whichareconsideredtypicalofautisticspeech.

Rettsdisorder:asevereautosomalpervasivedevelopmentaldisorderaffectingonlygirls,inwhichabriefperiodofnormaldevelopmentisfollowedbyregression
associatedwithsevereorprofoundlevelsofmentalretardation.

stereotypy:frequentrepetitionofameaninglessgestureormovementpattern.

theoryofmind:theabilitytothinkaboutemotions,thoughts,andmotiveseitherinoneselforothersconsideredtobeaprimarydeficitamongindividualswhose
difficultiesfallalongtheautisticdisorderspectrum.

StudyQuestionsandQuestionstoExpandYourThinking

1.OntheInternet,lookforsitesrelatedtoPDD.Forwhichdisorderswithinthatdesignationdoyoufindwebsites?Whoarethemainaudiencesforthesesites?How
dositesresponddifferentlytothesevariousaudiences?

2.OnthebasisofTable7.2,listthemajorcharacteristicsofachildsbehaviorthatwillbeneededtodeterminewhichPDDlabelismostappropriate.

3.OnthebasisofthediscussionofsuspectedcausesofPDD,outlinetwomajorresearchneedsthatshouldbepursuedbyfutureresearchers.

4.ListinorderofimportancetheproblemsotherthanthoseintrinsictoautismitselfpresentedtoadultswhowishtointeractwithchildrenwithPDD.

5.Whatfeaturesofachildscommunicationwouldcauseyoutobemostconcernedthatheorshewasshowingsymptomsofautism?Whatfeaturesofhisorher
language?

6.WhatpracticalproblemsmightaparentofachildwithPDDfacethataredifferentfromthosefacedbyotherparents?

7.Findoutwhatdefinitionofautisticspectrumdisordersisusedinalocalschoolsystem.HowdoesitdifferfromthesystemdescribedinDSMIV(American
PsychiatricAssociation,1994)?
Page184

RecommendedReadings

Angell,R.(1993).Aparentsperspectiveonthepreschoolyears.InE.Schopler,M.E.VanBourgondien,&M.M.Bristol(Eds.),Preschoolissuesinautism.New
York:Plenum.

Campbell,M.,Schopler,E.,Cueva,J.E.,&Hallin,A.(1996).Treatmentofautisticdisorder.JournaloftheAmericanAcademyofChildandAdolescent
Psychiatry,35,124143.

Grandin,T.(1995).Thinkinginpicturesandotherreportsfrommylifewithautism.NewYork:Doubleday.

Schopler,E.(1994).Behavioralissuesinautism.NewYork:Plenum.

Strain,P.S.(1990).Autism.InM.Hersen&V.B.VanHasselt(Eds.),Psychologicalaspectsofdevelopmentalandphysicaldisabilities:Acasebook(pp.73
86).NewburyPark,CA:Sage.

References

AmericanPsychiatricAssociation.(1994).Diagnosticandstatisticalmanualofmentaldisorders(4thed.).Washington,DC:Author.

Angell,R.(1993).Aparentsperspectiveonthepreschoolyears.InE.Schopler,M.E.VanBourgondien,&M.M.Bristol(Eds.),Preschoolissuesinautism(pp.
1738).NewYork:Plenum.

Baltaxe,C.A.M.,&DAngiola,N.(1996).Referencingskillsinchildrenwithautismandspecificlanguageimpairment.EuropeanJournalofDisordersof
Communication,31,245258.

BaronCohen,S.,Allen,J.,&Gillberg,C.(1992).Canautismbedetectedat18months?Theneedle,thehaystack,andtheCHAT.BritishJournalofPsychitary,
161,839843.

Bettelheim,B.(1967).Theemptyfortress.NewYork:CollierMacmillan.Carpentieri,S.,&Morgan,S.B.(1996).Adaptiveandintellectualfunctioninginautistic
andnonautisticretardedchildren.JournalofAutismandDevelopmentalDisorders,26,611620.

Chung,M.C.,Smith,B.,&Vostanis,P.(1995).Detectionofchildrenwithautism.EducationalandChildPsychology,12(2),3136.

Cohen,I.L.(1995).BehavioralprofilesofautisticandnonautisticfragileXmales.DevelopmentalBrainDysfunction,8,252269.

Courchesne,E.(1995).Newevidenceofcerebellarandbrainstemhypoplasiainautisticinfants,children,andadolescents:TheMRimagingstudybyHashimotoand
colleagues.JournalofAutismandDevelopmentalDisorders,25,1922.

Damasio,A.R.,&Maurer,R.G.(1978).Aneurologicalmodelforchildhoodautism.ArchivesofNeurology,35,779786.

DiLavore,P.C.,Lord,C.,&Rutter,M.(1995).ThePreLinguisticAutismDiagnosticObservationSchedule.JournalofAutismandDevelopmentalDisorders,
25,355379.

Eaves,L.C.,&Ho,H.H.(1996).Briefreport:Stabilityandchangeincognitiveandbehavioralcharacteristicsofautismthroughchildhood.JournalofAutismand
DevelopmentalDisorders,26,557569.

Ehlers,S.,&Gillberg,C.(1993).TheepidemiologyofAspergersyndrome:Atotalpopulationstudy.JournalofChildPsychologyandPsychiatry,34,13271350.

Fay,W.(1993).Infantileautism.InD.Bishop&K.Mogford(Eds.),Languagedevelopmentinexceptionalcircumstances(pp.190202).Mahwah,NJ:
LawrenceErlbaumAssociates.

Folstein,S.,&Rutter,M.(1977).Infantileautism:Ageneticstudyof21twinpairs.JournalofChildPsychologyandPsychiatry,18,297321.

Frith,U.(1991).Aspergerandhissyndrome.InU.Frith(Ed.),AutismandAspergersyndrome(pp.136).Cambridge:CambridgeUniversityPress.

Frith,U.(1993).AutismandAspergersyndrome.Cambridge,England:CambridgeUniversityPress.

Gillberg,C.,Nordin,V.,&Ehlers,S.(1996).Earlydetectionofautism:Diagnosticinstrumentsforclinicians.EuropeanChildandAdolescentPsychiatry,5,6774.

Grandin,T.(1995).Thinkinginpicturesandotherreportsfrommylifewithautism.NewYork:Doubleday.

Hall,N.E.,&Aram,D.M.(1996).Classificationofdevelopmentallanguagedisorders.InI.Rapin(Ed.),Preschoolchildrenwithinadequatecommunication(pp.
1020).London:MacKeithPress.
Page185

Haas,R.H.,Townsend,J.,Courchesne,E.,Lincoln,A.J.,Schreibman,L.,&YeungCourchesne,R.(1996).Neurologicabnormalitiesininfantileautism.Journalof
ChildNeurology,11(2),8492.

Kanner,L.(1943).Autisticdisturbancesofaffectivecontact.NervousChild,2,217250.

Lord,C.,Rutter,M.,&LeCouteur,A.(1994).AutismDiagnosticInterviewRevised:arevisedversionofadiagnosticinterviewforcaregiversofindividualswith
possiblepervasivedevelopmentaldisorders.JournalofAutism&DevelopmentalDisorders,24,659685.

Myles,B.S.,Simpson,R.L.,&Becker,J.(1995).AnanalysisofcharacteristicsofstudentsdiagnosedwithhigherfunctioningAutisticDisorder.Exceptionality,5
(1),1930.

Nordin,V.,&Gillberg,C.(1996a).Autismspectrumdisordersinchildrenwithphysicalormentaldisabilityorboth:I.Clinicalandepidemiologicalaspects.
DevelopmentalMedicineandChildNeurology,38,297311.

Nordin,V.,&Gillberg,C.(1996b).Autismspectrumdisordersinchildrenwithphysicalormentaldisabilityorboth:II.Screeningaspects.DevelopmentalMedicine
andChildNeurology,38,314324.

Page,J.,&Boucher,J.(1998).Motorimpairmentsinchildrenwithautisticdisorder.ChildLanguageTeachingandTherapy,14,233259.

Paul,R.(1987).Communication.InD.J.Cohen&A.M.Donnellan(Eds.),Handbookofautismandpervasivedevelopmentaldisorders(pp.6184).NewYork:
Wiley.

Paul,R.(1995).Languagedisordersfrominfancythroughadolescence:Assessmentandintervention.St.Louis,MO:Mosby.

Piven,J.,Harper,J.,Palmer,P.,&Arndt,S.(1996).Courseofbehavioralchangeinautism:AretrospectivestudyofhighIQadolescentsandadults.Journalofthe
AmericanAcademyofChildandAdolescentPsychiatry,35,523529.

Prizant,B.M.,&Wetherby,A.M.(1993).Communicationinpreschoolautisticchildren.InE.Schopler,M.E.VanBourgondien,&M.M.Bristol(Eds.),Preschool
issuesinautism(pp.95128).NewYork:Plenum.

Ramberg,C.,Ehlers,S.,Nyden,A.,Johansson,M.,&Gillberg,C.(1996).Languageandpragmaticfunctionsinschoolagechildrenontheautismspectrum.
EuropeanJournalofDisordersofCommunication,31,387414.

Rapin,I.(1996).Classificationofautisticdisorder.InI.Rapin(Ed.),Preschoolchildrenwithinadequatecommunication.(pp.1020).London:MacKeithPress.

Rimland,B.(1964).Infantileautism.NewYork:Appleton.

Rimland,B.,&Edelson,S.M.(1995).Briefreport:apilotstudyofauditoryintegrationtraininginautism.JournalofAutism&DevelopmentalDisorders,25,61
70.

Roux,S.,Malvy,J.,Bruneau,N.,Garreau,B.,Guerin,P.,Sauvage,D.,&Barthelemy,C.(1994).Identificationofbehaviourprofileswithinapopulationofautistic
childrenusingmultivariatestatisticalmethods.EuropeanChildandAdolescentPsychiatry,4,249258.

Rutter,M.,&Schopler,E.(1987).Autismandpervasivedevelopmentaldisorders:Conceptsanddiagnosticissues.JournalofAutismandDevelopmental
Disorders,17,159186.

Schopler,E.,Reichler,R.J.,&Renner,B.R.(1988).TheChildhoodAutismRatingScale(CARS).Revised.LosAngeles:WesternPsychologicalServices.

Sevin,J.A.,Matson,J.L.,Coe,D.,Love,S.R.,Matese,M.J.,&Benavidez,D.A.(1995).Empiricallyderivedsubtypesofpervasivedevelopmentaldisorders:A
clusteranalyticstudy.JournalofAutismandDevelopmentalDisorders,25,561578.

Shields,J.,Varley,R.,Broks,P.,&Simpson,A.(1996).Hemisphericfunctionindevelopmentallanguagedisordersandhighlevelautism.DevelopmentalMedicine
andChildNeurology,38,473486.

Snow,C.E.,&Pan,B.A.(1993).Waysofanalyzingthespontaneousspeechofchildrenwithmentalretardation:Thevalueofcrossdomainanalyses.InN.W.Bray
(Ed.),Internationalreviewofresearchinmentalretardation(Vol.19,pp.163192).NewYork:AcademicPress.

Sponheim,E.(1996).Changingcriteriaofautisticdisorders:AcomparisonoftheICD10researchcriteriaandDSMIVwithDSMIIIR,CARS,andABC.Journal
ofAutismandDevelopmentalDisorders,26,513525.

Strain,P.S.(1990).Autism.InM.Hersen&V.B.VanHasselt(Eds.),Psychologicalaspectsofdevelopmentalandphysicaldisabilities:Acasebook(pp.73
86).NewburyPark,CA:Sage.
Page186

Trevarthen,C.,Aitken,K.,Papoudi,D,&Robarts,J.(1996).Childrenwithautism:Diagnosisandinterventionstomeettheirneeds.London:JessicaKingsley.

Waterhouse,L.(1996).Classificationofautisticdisorder(AD).InI.Rapin(Ed.),Preschoolchildrenwithinadequatecommunication(pp.2130).London:
MacKeithPress.

Waterhouse,L.,Morris,R.,Allen,D.,Dunn,M.,Fein,D.,Feinstein,C.,Rapin,I.,&Wing,L.(1996).DiagnosisandclassificationinAutism.JournalofAutismand
DevelopmentalDisorders,26,5986.

Wender,E.(1995).Hyperactivity.InS.Parker&B.Zuckerman(Eds.),Behavioralanddevelopmentalpediatrics(pp.185194).Boston:Little,Brown.

Williams,D.(1996).AutismAninsideoutapproach:Aninnovativelookatthemechanicsofautismanditsdevelopmentalcousins.Bristol,PA:Jessica
Kingsley.

Wing,L.(1991).TherelationshipbetweenAspergerssyndromeandKannersautism.InU.Frith(Ed.),AutismandAspergersyndrome(pp.93121).Cambridge,
England:CambridgeUniversityPress.

WolfSchein,E.G.(1996).Theautisticspectrumdisorder:Acurrentreview.DevelopmentalDisabilitiesBulletin,24(1),3355.

WorldHealthOrganization.(1992).TheICD10classificationofmentalandbehavioraldisorders:Clinicaldescriptionsanddiagnosticguidelines.Geneva,
Switzerland:Author.

WorldHealthOrganization.(1993).TheICD10classificationofmentalandbehavioraldisorders:Diagnosticcriteriaforresearch.Geneva,Switzerland:
Author.
Page187

CHAPTER
8

ChildrenwithHearingImpairment

DefiningtheProblem

SuspectedCauses

SpecialChallengesinAssessment

ExpectedPatternsofOralLanguagePerformance

RelatedProblems

Bradleywas5yearsoldwhenitwasdeterminedthathehadamild,bilateralsensorineuralhearingloss.Priortoenteringkindergarten,hisparents
describedhimasashychildwhodislikedlargerplaygroupsandpreferredplayingaloneorwithoneclosefriend.Inanoisy16childclassroom,the
adequacyofhishearingwasfirstquestionedbyhiskindergartenteacher,whoreportedthatsheoftenhaddifficultygettinghisattentionandfoundhispoor
attentionduringcircletimeinconsistentwithhisgoodattentioninoneononesituations.Ahearingscreeningbyaspeechlanguagepathologist,whichwas
performedbecauseofconcernsaboutdelayedphonologicdevelopment,wastheimmediatesourceofareferralforthecompleteaudiologicalexaminationin
whichhishearinglosswasidentified.Afterdetectionofthehearingloss,Bradleywasfittedforbinauralbehindtheearaids.(Helovedthebrightblue
earmoldsandtubinghewasallowedtochoose.)Withinashorttimeofthefitting,Bradleyappearedmoreattentiveduringcircletimeandreadilymade
progressinworkontargetedspeechdistortions.
Page188

Sammy,orSamanthaonformaloccasions,isa3yearoldwhosemoderatehighfrequencyhearinglosswasidentifiedshortlyafterbirthfollowingher
failureonahighriskscreeningconductedbecauseofherfamilyhistoryofhearingloss.Becauseinitiallyanearlevelfittingprovedunfeasible,Sammyused
abodywornaid,whichwasreplacedbyabehindtheearfittingatage1.Sixmonthsago,theuseofanFMtrainerwasextendedtothehomeafter
continuoususeinapreschoolgroupthatshehadattendedsinceage1.Althoughsheisexperiencingsomedelaysinspeech,hercommunication
developmentotherwiseappearsontarget.

Desmondsprofoundhearinglosswasidentifiedusingauditorybrainstemresponse(ABR)duringhis3weekstayinaneonatalintensivecareunit,following
hisprematurebirthat7monthsgestationalagewithabirthweightof3.1pounds.Herequiredventilatorsupportfor5daysafterbirth.Now5yearsold,
DesmondsparentshavebeenfrustratedbyDesmondsslowprogressinorallanguagedevelopmentdespiteyearsofparticipationinspecialeducationand
severalfailedattemptsatsuccessfulamplification.Desmondcurrentlyusesavibrotactileaidtoincreasehisawarenessofenvironmentalsoundsandhis
speechreceptionandisbeingconsideredasacandidateforacochlearimplant.

DefiningtheProblem

Estimatesoftheprevalenceofhearingimpairmentinchildrenvaryfrom0.1to4%orfrom1inevery25to1inevery1,000childrendependingonthedefinitions
used(BradleyJohnson&Evans,1991Northern&Downs,1991).Ofchildrenbetweentheagesof3and17,about52,000haveimpairmentssevereenoughtobe
termeddeafness,wheredeafnesscanbedefinedasahearingloss,usuallyabove70dB,thatprecludestheunderstandingofspeechthroughlistening(Ries,1994).
Whenalllevelsofhearinglossareconsidered,hearingimpairmentisthemostcommondisabilityamongAmericanschoolchildren(Flexer,1994).

Thenegativeimpactofdeafnessforthenormalacquisitionoforallanguagemayseemobvious:Youcannotlearnaboutphenomenawithwhichyouhavelimited
experience.Inaddition,forchildrenwithprofoundhearingloss,thisexperienceislargelyrestrictedtoasensorychannel(i.e.,vision)thatismismatchedtothemost
distinctivecharacteristicsofthatphenomenon(i.e.,orallanguage).Onelineofevidencesuggestinghowgreatthismismatchiscomesfromagrowingbodyofresearch
suggestingthatthestructureoforallanguagesdifferssubstantiallyfromthatofvisuospatiallanguages(suchassignBellugi,vanHoek,LilloMartin,&OGrady,1993).
Nonetheless,thereisresearchsuggestingthatlipreadingbecomesmoreimportanttoorallanguagedevelopmentashearingimpairmentworsens(MogfordBevan,
1993).

Becauselimitingauditoryexposurelimitslearningopportunities,evenchildrenwithmilderhearinglosseswhothereforeobtaingreateramountsofacousticinformation
aboutorallanguagethanchildrenwithgreaterhearinglossesexperiencesignificantconsequencesfortheirspokenlanguagereceptionineverydaysituations.
Therefore,althoughthischapterfocusesmostintentlyonchildrenwithgreaterdegreesofhearingimpairment,italsoalertsreaderstothejeopardyinwhichchildren
Page189

withevenunilateralormildbilateralhearingimpairmentsareplacedwhenitcomestolanguagelearningandacademicsuccess(Bess,1985Bess,Klee,&
Culbertson,1986Carney&Moeller,1998Culbertson&Gilbert,1986Oyler,Oyler,&Matkin,1988).InthePersonalPerspectiveforthischapter,ateenager
describesthewaysinwhichdeafnesshasaffectedherschoollife.

PERSONALPERSPECTIVE
ThefollowingisanexcerptfromthetranscriptofastatementmadebyDarby,ahighschooljuniorwithaprofoundhearingimpairment.Shespeaksaboutthe
academicandpersonalchallengesfacingherinschool:
Ihavenever,andmostlikelyneverwill,hearsoundsinthesamewayasahearingperson.Asaresult,hearingpeopleexperiencethingseverymillisecondoftheday
thatIneverwill.Bythesametoken,Ihaveexperiencedthingsandwillexperiencethingsthatnohearingpersoncan.
Mydeafnessmakesmedifferent,andthatdifferencemakesmestrong.Iseemtogetrespectfromotherpeoplejustfordoingthingsahearingpersoncandowith
ease.Forexample,watchtelevision,usethetelephone,listentomusic,andsoon.Forwhateverreason,IneverthinkaboutthefactthatIamdoingsomethingthat
wouldnormallybedifficultforsomeonewhocouldnthear.Infact,Ihaveneverlookedatmyselfassomeonewhowaslimitedinanyway,someonewhocouldntdo
somethingthatanyotherhearingpersoncoulddoIvealwaysknowthatIwasdifferent,buteventhoughpeoplewouldintimatethatIwasntabletocompeteonthe
sameslevelashearingpeople,Iwouldignorethem,ormaybeIjustdidnthearthem.
IhavealwaysattendedDalton,aprivatehearingschool.Ithasneverbeen,andneverwillbe,easyforme.Ihaveexperiencedperiodsofrejectionandisolation,butI
haveprovenmyselfworthyoftheprivilegeofattendingthisschoolbyreceivinggradesasgoodasmanyofmyhearingpeersandbetterthanmost.
Ihavedefinitelysurvivedtheacademicchallengesofmyschoolandlife.Socially,IstillfeelthoughthatImnotacceptedasatrueequal,buthey,thatstheirproblem,
theydontknowwhattheyremissing.(Ross,1990,pp.304305)

Overalldegreeofhearingloss,ormagnitude,isamajordescriptorofhearingimpairment,usuallybasedonanestimateofanindividualsabilitytodetectthepresence
ofapuretoneatthreefrequenciesimportantforspeechinformation(500,1000,and2000HzBradleyJohnson&Evans,1991).Table8.1listsmajorcategoriesof
hearinglossandprovidessomepreliminaryinformationabouttheeffectsofthatlevelofloss.Althoughdeafnessisnotlistedasacategoryinthetable,itisfrequently
usedtorefertoahearinglossgreaterthanorequalto70dB(Northern&Downs,1991).
Page190

Table8.1
EffectofDifferingMagnitudesofHearingLoss

Average
HearingLevel
(5002000 WhatCanBeHeard HandicappingEffects
Hz) Description WithoutAmplification (IfNotTreatedinFirstYearofLife) ProbableNeeds

0to15dB Normalrange Allspeechsounds None None

Vowelsoundsareheardclearly
15to25dB Slighthearingloss unvoicedconsonantsoundsmaybe
missed
Onlysomeofthespeechsoundsare
25to30dB Mildhearingloss
heardtheloudervoicedsounds
Almostnospeechsoundsareheard
30to50dB Moderatehearingloss whenproducedatnormal
conversationallevel
Nospeechsoundsareheardatnormal
50to70dB Severehearingloss
conversationallevel
70+dB Profoundhearingloss Nospeechorothersoundsareheard retardation,learningdysfunction,
Considerationofneedforhearingaid,
Mildauditorydysfunctioninlanguage
speechreading,auditorytraining,
learning
speechtherapy,preferentialseating
Auditorylearningdysfunction,mild
Hearingaid,speechreading,auditory
languageretardation,mildspeech
training,speechtherapy
problems,inattention
Speechproblems,languageretardation, Alloftheabove,plusconsiderationof
learningdysfunction,inattention specialclassroomsituation
Severespeechproblems,language
Alloftheabove,probableassignmentto
retardation,learningdysfunction,
specialclasses
inattention
Severespeechproblems,language
Alloftheabove,probableassignmentto
specialclasses
inattention

Note.FromHearinginChildren(4thed.,p.14),byJ.L.NorthernandM.P.Downs,1991,Baltimore:Williams&Wilkins.Copyright1994byWilliams&
Wilkins.Reprintedwithpermission.
Page191

Thetermhardofhearingisusedtorefertolesserdegreesofhearinglossthatallowspeechandlanguageacquisitiontooccurprimarilythroughaudition(Ross,
Brackett,&Maxon,1991).

Inadditiontothemagnitudeofloss,relatedvariablesthatinfluencehowchildrenslanguageisaffectedinclude(a)variablesaffectingtheauditorynatureoftheloss
(suchastype,configuration,andwhetherthelossisunilateralorbilateral),(b)theageatwhichthehearinglossisacquired,(c)theageatwhichitisidentified,and(d)
howwellthelossismanaged.

Typeofhearinglossconductive,sensorineural,ormixedreferstothephysiologicalsiteresponsibleforreducedsensitivitytoauditorystimuli.Conductivehearing
lossesresultfromconditionsthatpreventadequatetransmissionofsoundenergysomewherealongthepathwayleadingfromtheexternalauditorycanaltotheinner
ear.Theycanresultfromconditionsthatblocktheexternalearcanalorinterferewiththeenergytransferringmovementoftheossicles(smallbones)ofthemiddleear.
Conductivelossesaregenerallysimilaracrossfrequenciesand,attheirmostsevere,donotexceed60dB(Northern&Downs,1991).Suchlossescanoftenbe
correctedorsignificantlyreducedusingmedicalorsurgicaltherapies(Paul&Jackson,1993).

Oneparticularlycommoncauseofconductivehearinglossismiddleearinfection,otitismedia.Thehearinglossassociatedwiththisconditionmaybethemostwidely
experiencedformofhearingloss,giventhat90%ofchildrenintheUnitedStateshavehadatleastoneepisodeofotitismediabyage6(Northern&Downs,1991).
Althoughnotallepisodesofotitismediaareassociatedwithhearinglosses,whentheyareobservedtheoverallmagnitudesoflosshavegenerallybeenfoundtofall
from20to30dBintheaffectedear(FrialCantekin,&Eichler,1985).

Sensorineuralhearinglossesresultfromdamagetotheinnerearortosomeportionofthenervoussystempathwaysconnectingtheinnereartothebrain.Theyare
responsibleforthemostserioushearinglosses,accountingfororcontributingtomosthearinglossesintheseveretoprofoundrange.Inaddition,theyaccountformost
congenitalhearinglosses(Scheetz,1993)andarerarelyreversible(Northern&Downs,1991).

Mixedhearinglossesrefertolossesinwhichbothconductiveandsensorineuralcomponentsareevident.Becausetheconductivecomponentsofamixedhearing
lossaregenerallytreatable,suchlossesoftenbecomesensorineuralinnaturefollowingeffectivetreatmentfortheconditionunderlyingtheconductiveloss.Forexample,
achildwithDownsyndromemayexperienceamixedlossconsistingofasensorineurallossexacerbatedbypooreustachiantubefunctionandchronicotitismedia.
Effectivemanagementofthemiddleearconditioncanreducethemagnitudeofthelosssubstantiallyinmanycases.Consequently,clinicianswhoworkwithchildren
whohavesensorineurallossesneedtobeespeciallyawarethatanalreadysignificantdegreeoflosscanbefurtherworsenedifmiddleeardiseasegoesundetected.

Centralauditoryprocessingdisordersrefertoabnormalitiesintheprocessingofauditorystimulioccurringintheabsenceofreducedacuityforpuretonesoratamore
pronouncedlevelthanwouldbeexpectedgiventhedegreeofreducedacuity.Inespeciallyseverecases,suchdifficultieshavebeendescribedasaspecifictypeof
languagedisorder:verbalauditoryagnosia(Resnick&Rapin,1991).Althoughcentralauditoryprocessingdisordersreceiveincreasingattentionbyaudiologists,their
sepa
Page192

rabilityfromlanguagedisabilitiesandotherlearningdisabilitiescontinuestobedebated(Cacace&McFarland,1998Rees,1973).

Hearinglossconfigurationreferstotherelativeamountoflossoccurringatdifferentfrequencyregionsofthesoundspectrum.Forexample,ahighfrequencylossis
oneinwhichthelossislargelyorsolelyconfinedtothehigherfrequenciesofthespeechspectrum.Incontrast,aflathearinglossisoneinwhichthedegreeoflossis
relativelyconstantacrossthespectrum.

Knowingthemagnitudeandconfigurationofanindividualshearinglosscanhelpyoupredictwhatsoundswillbedifficultforhimorhertohearatspecificloudness
levels.Apairoffiguresmayhelpillustratethis.Figure8.1consistsoftwofrequencyintensitygraphs(likethoseofatraditionalaudiogram)onwhichareplotteda
varietyofcommonsoundsoccurringatvariousintensitylevelsandfrequencies.TheshadedareaonFigure8.1Aindicatesthesoundfrequenciesandintensitiesthat
mightnotbeheardbychildrenwithseverehighfrequencyhearinglosseschildrensuchasSammy,whowasdescribedatthebeginningofthechapter.Although
Sammywouldeasilyhearenvironmentalsoundssuchascarhornsortelephonesaswellasmanyspeechsoundswhentheyareproducedatconversationalloudness
levels,shewouldprobablymissmostfricativesoundsbecauseoftheirhighfrequency(highpitch)andlowintensity(softness)whentheyareproducedinthesame
conversations.

Figure8.1Brepresentsthekindoflossfrequentlyassociatedwithdeafness,thekindoflossdemonstratedbyDesmond.Thenegligibleamountofauditoryinformation
towhichDesmondhasaccessiswellillustratedbythisfigure.ThecentralityofvisualinformationtoDesmondsinteractionswiththeworldisfurtherbroughthome
whenyouaretoldthateventhebestavailableamplificationwouldprobablyfailtoimproveDesmondsaccesstosoundinformation.Consequently,itisnotsurprising
thatvisionhasbeencalledtheprimaryinputmodeofdeafchildren(Ross,Brackett,&Maxon,1991)andthatmanagementofthecommunicationneedsofsuch
childrenoftenveersawayfrommethodsinwhichauditoryinformationplaysamajorrole(Nelson,Loncke,&Camarata,1993),althoughgrowingeffectivenessof
cochlearimplantsmayincreasethatsomewhat,especiallyascochlearimplantsareusedatyoungerages(TyeMurray,Spencer,&Woodworth,1995).Acochlear
implantentailstheinsertionofasophisticateddevicethatincludesaninternalreceiver/stimulatorandanexternaltransmitterandmicrophonewithamicrospeech
processor(Sanders,1993).Theirrapiddevelopmentandincreasingapplicationmakethemanexcitingdevelopmentinthemanagementofseverehearinglosses.

Whetheroneorbothearsareaffectedrepresentsanotherimportantfactordeterminingthesignificanceofahearingloss.Unilateralhearinglosses,onesaffectingonly
oneear,usuallyhavefewernegativeconsequencesthanbilateralhearinglosses.Thatdoesnotmean,however,thatunilaterallossesareinsignificant.Adequatehearing
inbothearsisofparticularimportancewhenlisteningtoquietsoundsorinnoisysurroundingsespeciallyforchildren.Thisspecialimportanceofbilateralhearingin
childrenarisesbecausetheirincompletelanguageacquisitionmakesusinglanguageknowledgeandenvironmentalcontexttoguessthemessagebeingconveyedbyan
imperfectsignalmuchharderforthemthanitisforadults.InastudyconductedbyBessetal.(1986),aboutonethirdofthechildrenwhoexhibitedunilateralsen
Page193

Fig.8.1.Figuresillustratingthetypesofsoundsthatarelikelytobeheard(unshadedareas)andnotheard(shadedareas)fortwodifferenthearinglosses:asevere
highfrequencyloss(8.1A)andaprofoundhearingloss(8.1B).Forpurposesofclarity,butcontrarytomostinstancesinreallife,thesefiguresrepresenthearinglossas
identicalforeachear.FromHearinginchildren(4thed.,p.17),byNorthernandDowns,Baltimore:Williams&Wilkins.Copyright1991byWilliams&Wilkins.
Adaptedbypermission.
Page194

sorineuralhearinglossesof45dBHLorgreaterwerefoundtohaveeitherfailedagradeorrequiredspecialassistanceinschool.

Despitetheimportanceofthenatureofhearinglossaffectingachildtothatchildsoveralloutcomeforspeechandorallanguage,severalnonauditoryfactorscanplaya
verysignificantrole.Forexample,theageatwhichahearinglossisacquiredhasatremendousimpactontheextenttowhichitwillinterferewiththeacquisitionoforal
language.Congenitalhearinglosses,thosepresentatbirth,aremoredetrimentalthanthoseacquiredinearlychildhood,whichinturnaremoredetrimentalthanthose
acquiredinlaterchildhoodoradulthood.Even3or4yearsofgoodhearingcandramaticallyalterachildslaterlanguageskills(Ross,Brackett,&Maxon,1991).This
facthasledtotheuseofthetermprelingualhearinglosstorefertoahearinglossacquiredbeforeage2,whichisthusthoughttobeassociatedwithamore
significantimpact(Paul&Jackson,1993).

Theageofdetectionofhearinglossinchildrenisyetanothervariableaffectingtheorallanguageofhearingimpairedchildren.Theearlierthedetectionofhearinglossin
children,thebettertheoutcomeforlanguageacquisitionassuming,ofcourse,thatadequateinterventionfollows.Recentlydevisedmethods,suchasthemeasurement
ofauditorybrainstemevokedresponsesandtransientevokedotoacousticemissions,permitthedetectionofevenmildhearinglossinchildrenfromshortlyafterbirth
(Carney&Moeller,1998Mauk&White,1995Northern&Downs,1991).Between10and26%ofhearinglossisestimatedtoexistatbirthortooccurwithinthe
first2yearsoflife(Kapur,1996),thusmakingeffortsatdetectionanongoingneed.

Despitethepossibilityofearlydetection,however,hearinglosswillescapedetectionforvaryingperiodsoftimeinchildrenwhosehearingisnotscreenedoris
screenedpriortotheonsetoftheloss.Inarecentstudy,HarrisonandRoush(1996)surveyedtheparentsof331childrenwhohadbeenidentifiedwithhearingloss.
Theyfoundthatwhentherewasnoknownriskfactor,themedianageofidentificationofhearinglosswasabout13monthsforseveretoprofoundlossesand22
monthsformildtomoderatelosses.Althoughthepresenceofknownriskfactorswasassociatedwithdecreasedageatidentificationformilderlosses(downtoabout
12months),identificationformoreseverelossesremainedaboutthesameinthisgroup(12months).Medianadditionaldelaysofupto10monthswereobserved
betweenidentificationofhearinglossandearlyinterventions.Thesedelaysrepresentpreciouslosttimeforchildrenwhoseauditoryexperienceoftheworldis
compromised.Onlyinlate1999haveeffortstomakeuniversalscreeningofinfanthearingareality(Mauk&White,1995)receivedmomentoussupportintheformof
TheNewbornandInfantHearingScreeningandInterventionActof1999.Thisfederallegislationprovidesnewfundingfornewbornhearingscreeninggrantsto
individualstates.Itishopedthatthisfundingwillcauseallstatestoimplementinfantscreeningprogramsleadingtoarevolutionintheearlyidentificationofhearingloss.

Afourthfactorinfluencinghowhearinglosswillaffectchildrenslanguagedevelopmentisthemanagementoftheloss.Forchildrenwithmildandmoderatebilateralor
unilaterallosses,thereisconsiderableagreementastotheapproachesthatwilloptimizetheiraccesstotheauditorysignalonwhichtheywillrelyforprocessinginfor
Page195

mationaboutorallanguage.Table8.2listssomeofthetypesofinterventionstypicallyconsideredinthehearingmanagementofchildrenwiththeselesserdegreesof
loss.

Whenitcomestochildrenwithgreaterlosses,however,thereismuchcontroversyamongprofessionalsaswellasmembersoftheDeafcommunity(Coryell&
Holcomb,1997).Afrequentbattlegroundforthoseinterestedininterventionsfordeafyoungstersconcernstheprimacyoforalversussignedlanguage.Arguments
favoringanemphasisonorallanguagestressthatthevastmajorityofsocietyareusersoforallanguageand,therefore,deafchildrenshouldbegiventoolswithwhichto
negotiateeffectivelywithinthatcontext.Further,itcanbestressedthattheirfamilieswillalmostalways(90%ofthetime)becomposedentirelyofhearingindividuals
(Mogford,1993).

ArgumentsfavoringanemphasisonsignlanguagestressthattheDeafcommunityisacohesivesubcultureinwhichvisuospatialcommunicationistheeffectivenorm.In
fact,inrecentyears,theDeafcommunityhasbeguntoadvocateforadifferenceratherthandisorderperspectiveonhearingimpairment,apoliticalperspectivethought
tobevitaltotheemotionalandsocialwellbeingofitsmembers(Corker,1996Harris,1995).Argumentsfavoringastrongemphasisonsignlanguagealsosadlynote
thatonlypoorlevelsofachievementinorallanguageandparticularlypoor

Table8.2
InterventionsUsedWithChildrenWhoHaveMild
andModerateHearingImpairment(Brackett,1997)

Method Function

PersonalamplificationFMradio
systemsusedwithremote
microphones
Soundtreatmentofclassrooms(e.g.,
usingcarpets,acousticceilingtiles,
curtains)
Preferentialseating
Inclusioninregularclassroomwith
supplementationthroughpullout
services
Auditorylearningprogram(e.g.,Ling,
1989Stout&Windle,1992)
IncreaseloudnesslevelsofacousticsignalsacousticsignalenhancedrelativetobackgroundnoiselevelsAfarsuperior
meansofdealingwithanoisyclassroomthanpreferentialseating(Flexer,1994)oneofseveraltypesofspecialamplification
systems(Sanders,1993)
Reductionofreverberationandothersourcesofnoise
ReductionofdistancebetweenspeakerandchildcanincreaseaudibilityofasignalSittingnexttoachildisbetterthansitting
infrontofthechild(Flexer,1994),althoughforchildrenwhorequirevisualinformation,thisstrategydecreasesaccessto
visualinformation
Provisionofthewealthofsocialandacademicexperiencesaffordedbyregularclassrooms,withsupportdesignedto
previewandreviewinstructionalvocabularyaswellasworkoncommunicationgoalsinconsistentwithclassroomsetting
(e.g.,theearlieststagesinvolvedinacquiringanewcommunicativebehavior)
Improvementofthechildsattentionanduseofauditoryinformationenhancedbypersonalandclassroomamplification
Page196

levelsofachievementinwrittenlanguage(whichoftenplateausatathirdgradelevel)havebeenthenorminstudiesofindividualswithseveretoprofoundhearinglosses
(Dub,1996Paul,1998).

Totalcommunicationwasoriginallyproposedasthesimultaneoususeofmultiplecommunicationmodes(e.g.,fingerspelling,signlanguage,speech,andspeechreading)
selectedwiththechildsindividualneedsinmind.Asimplemented,however,totalcommunicationhasbeenfoundtypicallytoconsistofthesimultaneoususeofspeech
andoneofseveralsignlanguagesotherthanAmericanSignLanguage(ASL)thatusewordorderandwordinflectionscloselyresemblingthoseofspokenEnglish
(Coryell&Holcomb,1997).Themostprominentexamplesofthesesignlanguages,sometimesreferredtoasmanuallycodedEnglishsystems,areSigningEssential
English(SEE1),SigningExactEnglish(SEE2)andSignedEnglish.Althoughmostclassroomteachersreportusingthisrelativelylimitedformoftotalcommunication
(sometimestermedsimultaneouscommunication),itisinfrequentlyusedamongadultsintheDeafcommunity(Coryell&Holcomb,1997).

Inareviewofstudiesoftreatmentefficacyforhearinglossinchildren,CarneyandMoeller(1998)notedacurrenttrendtowardconsideringorallanguageasapotential
secondlanguagefordeafchildren,tobeacquiredaftersomedegreeofproficiencyinafirst(visuospatial)languageisattained.Thisapproach,termedthebilingual
educationmodel,isseenbysomeashavingthestrengthsassociatedwithlearningalanguage(i.e.,ASL)forwhichacohesivecommunityofusersexists,whileatthe
sametimevaluingtheimportanceofEnglishcompetenceasacurricularratherthanrehabilitativeissue(Coryell&Holcomb,1997Dub,1996).Datasupportingthis
approach,however,arerelativelysparseasyet.Todate,suchdataconsistofevidenceofstrongacademicperformanceinEnglishbydeafchildrenrearedbydeaf
parentswhoareproficientinASLandevidencethatskillsinEnglisharestronglyrelatedtoskillsinASL,independentofparentalhearingstatus(Moores,1987
Spencer&Deyo,1993Strong&Prinz,1997).

ArecentpositionstatementoftheJointCommitteeofASHAandtheCouncilonEducationoftheDeaf(1998)illustratesthegrowinginfluenceoftheDeafcommunitys
insistencethatdeafnessbeviewedasaculturalphenomenonratherthanaclinicalcondition(Crittenden,1993).Inthatpositionstatement,professionalsarecautioned
toadoptterminologythatrespectstheindividualandfamilyorcaregiverpreferenceswhilefacilitatingtheindividualsaccesstoservicesandassistivetechnology.
Sensitivitytoculturalfactorsisarequisiteforspeechlanguagepathologistsinallsettingsworkingwithallpopulations.Forspeechlanguagepathologistsworkingwith
membersoftheDeafcommunity,itisarequirementofcriticalimportancetothedeafchildssocialandemotionaldevelopment.

SuspectedCauses

Whatiscurrentlyknownaboutthecausesofpermanenthearingimpairmentinchildrenisalmostentirelyrestrictedtostudiesfocusedonmoreseriouslevelsofhearing
loss,especiallydeafness.Althoughtheremaybeconsiderableoverlapintheknown
Page197

causesofdeafnessandmilderdegreesofimpairment,differencesalsoexist.Becausethissectionlimitsitselftocausesrelatedtothesemoreseverelevelsofhearing
loss,IremindreadersthatwhatIsayrelateslessclearlytochildrenwithmilderlosses.

Geneticfactorsaresuspectedinabouthalfofallcasesofdeafness(Kapur,1996Vernon&Andrews,1990).Ofthesegeneticallybasedinstancesofdeafness,about
80%areduetoautosomalrecessivedisorders,almost20%areautosomaldominantdisorders,andtheremainingaresexlinked(Fraser,1976).Becauserecessive
disordersdemandthatbothparentsofanindividualcontributeadefectivegenefortheiroffspringtodemonstratethedisorderwithoutnecessarilyshowingevidenceof
thedisorderthemselves,itisrelativelyuncommonforchildrenwithcongenitaldeafnesstohaveparentswhoarealsodeaf.Thisinformationisimportantforappreciating
thatmostcongenitallydeafchildrengrowupwithparentswhosefirstlanguageisoralandwhowillneedtoacquiresignasabelatedsecondlanguageiftheyaretoassist
theirchildsacquisitionofsign.

Geneticallycauseddeafnesssometimesoccurswithinthecontextofgeneticsyndromesinwhichoneormorespecificorgansystems(e.g.,theskeleton,skin,nervous
system)arealsoaffected.About70suchsyndromeshavebeenidentified,includingDownsyndrome,Apertsyndrome,TreacherCollins,PierreRobin,andmuscular
dystrophy(Bergstrom,Hemenway,&Downs,1971).Althoughmostgeneticallycauseddeafnesswillbesensorineuralintype,conductivecomponentsarealso
observed.Somesyndromesareassociatedwithhearinglossesthatareprogressive,causingincreasinghearinglossovertime,oftenatunpredictablerates.Examplesof
suchsyndromesareFriedrichsataxia,severeinfantilemusculardystrophy,andHuntersyndrome,aswellasthecloselyrelatedHurlersyndrome.

Nongeneticcausesofdeafnessincludeprenatalrubella,postnatalinfectionwithmeningitis,prematurity,rhfactorincompatibilitybetweenmotherandinfant,exposureto
ototoxicdrugs,syphilis,Menieresdisease,andmumps(Vernon&Andrews,1990).Fourofthesefactorsprenatalrubella,meningitis,syphilis,andmumpsare
infectiousdiseasesmeaningthattheirsuccessfulpreventioncandrasticallyreduceinstancesofdeafnessfromthosecauses.

Thethreenoninfectiousfactorsmostcommonlyassociatedwithhearinglossinchildrenarerhfactorincompatibility,exposurestoototoxicdrugs,andMenieres.Rh
factorincompatibilityreferstoaconditioninwhichamotherandtheembryosheiscarryinghavebloodtypescharacterizedbydiscrepantrhfactors,acircumstance
thatstimulatestheproductionofmaternalantibodiesagainstthedevelopingchild.Thisconditioniscurrentlyconsideredpreventablethroughmaternalimmunizationor
thetreatmentoftheinfantusingphototherapyortransfusions(Kapur,1996).

Ototoxicityreferstoadrugstoxicitytotheinnerear.Althoughtheuseofdrugswiththissideeffectisusuallyavoidedinpregnantwomenandinfants,theymaybe
requiredastheonlyeffectivetreatmentforsomediseases.Monitoringofhearingcanfrequentlypreventhearinglossinchildrenwhorequiretreatmentwithototoxic
drugsbecauseofinfectionsorcancer(Kapur,1996).

Prematurity,birth2ormoreweekspriortoexpectedduedate(Dirckx,1997),isanincreasinglyfrequentcorrelateofhearingimpairment.Whereasmortalitywas
once
Page198

analmostcertainoutcomeofprematurity,improvedneonatalcareoverthepasthalfcentury(Vernon&Andrews,1990)hasresultedintheincreasedsurvivalof
childrenwhononethelessmayshowresidualeffects.Prematurebirthismostdirectlyassociatedwithhearingimpairmentandothercooccurringdifficulties(e.g.,mental
retardation,cerebralpalsy)throughtheneurologicstressesitplacesontheinfant.Indirectlinksbetweenprematurityandhearingimpairmentlieinthefactthat
prematurebirthisfrequentlyprecipitatedbyconditionsthatarethemselvesassociatedwithhearingimpairment(suchasprenatalrubella,meningitis,andrhfactor
incompatibility).Prematurityincreasesriskofdeafnessby20times(Kapur,1996).

SpecialChallengesinAssessment

Whenassessingtheoralcommunicationskillsofchildrenwithhearingimpairment,thespeechlanguagepathologistisconfrontedwithnumerousthreatstothevalidityof
hisorherdecisionmaking.Therefore,inadditiontotheusualcarethatmustbetakentodeterminetheprecisequestionspromptingassessmentandfactorsthatmay
complicateaccurateinformationgathering,cliniciansworkingwithchildrenwhosehearingistemporarily(e.g.,duringepisodesofotitismedia)orpermanentlyimpaired,
mustconsideralargerthanusualrangeofpossiblecomplicatingfactorsandnecessaryadaptations.Table8.3listssomeoftheconsiderationsrelatedtotheevaluation
oflanguageskillsofachildwithhearingimpairment.

Amajorfirstconsiderationforchildrenwithveryseverehearinglossisthechoiceoflanguageorlanguagesinwhichthechildistobeassessed.Often,testinginbotha
signandanorallanguageisreasonableforobtaininginformationaboutpotentiallyoptimalperformanceaswellasaboutdevelopmentwiththealternativeform.

Complexitiesofthechildshearinglossandofitsmanagementwillneedtobeconsideredinmakingthisdecision,becausechildrenwhomaybeconsidereddeafdonot
alwaysreceiveenoughexposuretosignlanguagetoconsiderittheirfirstlanguage(Mogford,1993).

AlthougheffortstostandardizeassessmentsofASLhavebegun(e.g.,LilloMartin,Bellugi,&Poizner,1985Prinz&Strong,1994Supallaetal.,1994),childrens
performanceinASL(themostcommonsignlanguagesystemintheUnitedStates)isusuallyinformallyassessedbyindividualswithhighlevelsofproficiencyinASL.A
smallnumberofstandardizedtoolshavebeendeveloped.AmongthesearetheCaro

Table8.3
ConsiderationsWhenPlanningtheAssessmentofaChildWithImpairedHearing

Determinewhatmodalityormodalitieswillbeused.
Matchdemandsplacedonhearingtoassessmentquestion.
Ensurethatinstructionsareunderstood.
Identifyanappropriatenormativegroupfornormreferencedinterpretations.
Ensureoptimalattentionandminimaldistractions.
Considertheuseofmodificationsanddescribeinreportsoftesting.
Relyonmultiplemeasuresandteaminputforpreparationandinterpretation.
Page199

linaPictureVocabularyTest(Layton&Holmes,1985),whichisdesignedforusewithchildrenage2years8monthsto18yearswhoseprimarilymodeof
communicationissign.Dub(1996)discussesthecurrentpressingneedforbettermethodsofassessingchildrenscompetenceinbothASLandEnglish.

Forchildrenwithseveretoprofoundhearinglosses,assessmentoforallanguagemayalsorequireinteractionsinASL(e.g.,toassurethatataskisunderstood).
Maxwell(1997)reasonablypointedoutthatdeafindividualsoftenusebothsignandspokenlanguagedependingonthedemandsofthecommunicativesituation,andhe
pointedoutthatdeterminingwhatmodesofcommunicationachildusesaretoooftenbasedonhearsayorthecliniciansownlimitationsinidentifyingthe
communicationsystembeingused.Therefore,speechlanguagepathologistswhoworkfrequentlywithhearingimpairedchildrenshouldbeproficientinsignthemselves
and,ideally,inbothsignedEnglishandASLmodes.Thosewhoarenotproficientbutreceiveoccasionalrequeststoservehearingimpairedchildrenshouldproceed
carefullyindeterminingwhatcanbedoneintheabsenceofsuchproficiencyandshouldbepreparedtomakereferralsasneededtoensureoptimalassessmentdata.
Themajorityofthissectionofthechapterisdevotedtoconsiderationscomingintoplayduringorallanguagetesting.

Forchildrenwithalldegreesofhearingloss,oneofthefirstconsiderationsinorallanguagetestingisthelisteningconditionconfrontingthechild.Forexample,isthe
settinginwhichthetestingisdonerelativelyquiet?Ifveryquiet,optimalperformancemaybeassessed(assumingotherfactorsareoptimal).Iflessquiet,optimal
performancewillbeunlikely,butusefulinformationforextrapolatingtypicalperformanceinsimilarsettingsmaybeobtained.Inmanycases,languageestingis
performedforpurposesofexaminingoptimalperformance.However,ifthepurposeoftestingistodeterminethekindofdifficultyfacingthechildinaconventional
classroom,thentestinginnoisierenvironmentswouldbeindicated.Ying(1990)discussedasystematicapproachtoexaminingthechildsfunctionalauditoryskills
underconditionsvarying(a)accesstobothvisualandauditoryinformationversustoauditoryinformationonlyand(b)auditorystimulithatarecloseversusfarin
conditionsthatare(c)noisyversusquiet.

Knowledgeofthechildslisteningconditionsincludesnotonlyinformationabouttheambientenvironment,butalsoaboutthestatusofthechildshearingandhearing
aidatthetimeoftesting.Recallingthatchildrenshearingcanbeaffectedmorereadilybymiddleearinfectionsthancanadultsmakesitparticularlyimportanttoknow
whetherthechildhasanupperrespiratoryinfectionorisshowingsignsofreducedhearing,suchasalteredresponsetoauditorystimuliorappearingconfusedorinpain
innoisysituations(Flexer,1994).Ascertainingdirectlyorindirectlythatahearingaidhaschargedbatteriesandisfunctioningwellistimewellspentgivenstudies
indicatingthatchildrenshearingaidsarefrequentlyfoundtobefunctioningunacceptably(e.g.,Musket,1981Worthington,Stelmachowicz,&Larson,1986).In
addition,whenhearingaidsareinplacebutnotfunctioningbecauseofadeadbattery,theirusehasbeenfoundtoreducehearingbyanadditional25to30dBat
criticalspeechfrequencies(Smedley&Plapinger,1988).

Ensuringthatdirectionsareunderstoodisobviouslymostcrucialforreceptivelanguagetesting,butcanbecriticalforexpressivelanguagetestingaswell,particularly
whenverbalinstructionsareused.Besidesthestepsdescribedearlier,whichare
Page200

aimedatimprovingthechildsauditoryaccesstoinformation,seatingtomakethetestersfacevisibleandwelllit(notbacklit)canhelp.Becausechildrenwithhearing
lossmayfailtosignaltheirincompleteunderstandingofdirections(Paul&Jackson,1993),theclinicianmustbeparticularlywatchfulforhesitationsorfacialexpressions
indicatingalackofunderstanding.Inaddition,studentsshouldbeencouragedtoaskquestionswhentheyareuncertain(BradleyJohnson&Evans,1991).

Whenthequestionsbeingaskedinanassessmentareinregardtowhetherthechildsperformanceislikethatofhisorherpeers,theticklishquestionofnormsis
presented.Sometimesitisassumedthatthosepeersshouldbeagroupthatissimilarinagetothetestedchild(e.g.,becausethesearethechildrenwithwhomachild
willbecomparedatschoolandwithwhomheorshesharesacommondevelopmentalhistoryBradleyJohnson&Evans,1991).Insuchcases,findingappropriate
normsisrelativelyeasy,andtheuseofpeerswithnormalhearingisquiteappropriate(Brackett,1997Ying,1990).However,usingthatnormativegroupwillnothelp
youfigureoutwhetheranyobserveddecrementsinperformancearedueprimarilytohearingdifferences,orwhetheradditionalcognitiveorenvironmentalbarriersto
languagelearningexist.Forthosequestions,normsshouldideallyconsistofchildrenwithsimilarpatternsofhearingimpairmentandsimilardevelopmentalexperiences.
Alternatively,interpretationsbasedoninformationotherthannormsshouldbeconsidered(fordetaileddiscussionofinformalmethods,seeMaxwell,1997Moeller,
1988Ross,Brackettt,&Maxon,1991andYoshinagaItano,1997).

Table8.4listslanguageteststhathavebeendevelopedforornormedonchildrenwithhearingimpairment(BradleyJohnson&Evans,1991).Evenwhensuchnorms
areavailable,determiningtheappropriatenessofthenormsstillhingesonthetestusersexaminationofthetestmanualforspecificinformationaboutthenormative
sample.Forchildrenwithhearingimpairment,factorsaffectingtherelevanceofnormsincludethegroupsageofonsetofthehearingloss,degreeandtypeofloss,
etiology,presenceofothersignificantproblems,andthecommunicationusedduringtesting(BradleyJohnson&Evans,1991).

Onceanappropriatemeasurehasbeenselected,increasingthechildsattentiontothetaskandminimizingdistractionsfurtherenhancethepossibilityofobtaining
informationreflectingoptimalperformance.Positioningoneselfclosetothechildandpayingcloseattentiontothechildsgazeasasignalofcurrentfocuscanhelp
increaseattentionwhilealsominimizingdistractions(Maxwell,1997).

Bymodifyingtestingprocedures,onerisksinvalidatingnormativecomparisons.However,whentestingmodificationsarenotedinreportsonthetestinganddiscussed
fortheirpossibleeffectsontestvalidity,theirusecanactuallyimprovevaliditybyremovingsourcesoferrorthatareunrelatedtotheskillorattributebeingtested.Ying
(1990)discussedanumberofpossiblemodificationstousewhentestingchildrenwithhearingimpairment.Theseincludeaskingthechildtorepeatallverbalstimulito
ensurethatpoorreceptionisnotunderminingperformanceandusingextrademonstrationitemstoensurethatthechildunderstandsthetaskdemands.Anotherpossible
modificationsherecommendedwasrepeatingverballypresentedtestitems.Also,whenstandardizedinstructionscallforsimultaneouspresentationofverbalandvisual
stimuli,shesuggestedalteringproceduressothattheverbalstimulusispresented
Page201

Table8.4
LanguageTestsforChildrenWithHearingImpairmentThatWereDesignedorAdaptedfor
ChildrenWithHearingImpairment(BradleyJohnson&Evans,1991)

Test Ages DescriptionoftheTest Comments

Testsacross5domains:personalsocial, l Althoughchildrenwithhearingimpairmentaredescribedasan
BatelleDevelopmental
adaptive,motor,communication,andcognitive appropriatepopulationfortesting,neithernormsnorstudies
Inventory(Newborg,Stock, Birthto8
purposeistoidentifychildrenwithhandicaps, validatingthatusearecontainedinthetestmanual
Wnek,Guidubaldi,&Svinicki, yearsofage
determinestrengthsandweaknesses,andhelpin l Adaptationsofitemsinthecommunicationdomainhavebeen
1984)
planninginstructionandmonitoringprogress describedasinappropriate
l Standardizedon150hearingimpairedchildrenenrolledinoral
GrammaticalAnalysisof Skillsassessedforcomprehension,prompted
educationalprogramswhosehearingimpairmentwasnot
ElicitedLanguagePre production,andimitatedproduction,withitems
3to6years described
sentenceLevel(GAELP at3levels:readiness,singlewords,andword
l Nodataforchildrenwhousemanualcommunication
Moog,Kozak,&Geers,1983) combinations
l Scoresexpressedaspercentiles

l Normsobtainedfor3groupsofchildrenwithhearing
impairmentandonenonhearingimpairedgroupconsiderable
informationisavailableaboutthesegroupsoneofthegroups
GrammaticalAnalysisof withhearingimpairmentcamefromtotaleducationbackgrounds
ElicitedLanguageSimple Skillsareassessedintermsofprompted andwastestedusingthatmethod
5to9years
SentenceLevel(GAELS productionandimitation. l 94itemsassessingarticles,modifiers,pronouns,subjectnouns,
Moog&Geers,1985) objectnouns,whquestions,verbs,verbinflections,copula
inflections,prepositions,andnegation
l Scoresexpressedaspercentilesorlanguagequotients
(M=100SD=15)

(Continued)
Page202
Test
GrammaticalAnalysisof
ElicitedLanguageComplex
8to12years
SentenceLevels(GAEL
CMoog&Geers,1980
RhodeIslandTestofLanguage
Structure(Engen&Engen, 5to17+years Designedtoassesscomprehensionofsyntax
1983)
ScalesofEarlyCommunication
Skills(SECSMoog&Geers, 2to9years
1975)
TeacherAssessmentof
GrammaticalStructures
Notspecified
(TAGSMoog&Kozak,
1983)
Table8.4(Continued)
Ages DescriptionoftheTest Comments
l Twogroupsofchildren,onewithandonewithouthearing
impairmentwerestudiedthehearingimpairedchildrenhad
severetoprofoundlevelsofimpairmentandwerewithoutother
problemareas
l 16grammaticalcategoriesareassessed:articles,noun
Skillsareassessedintermsofprompted
modifiers,subjectnouns,objectnouns,nounplurals,personal
productionandimitation
pronouns,indefiniteandreflexivepronouns,conjunctions,
auxiliaryverbs,firstclauseverbs,verbinflections,infinitivesand
participles,prepositions,negation,andwhquestions.
l Scoresexpressedaspercentilesorlanguagequotients
(M=100SD=15)
l Normedon364childrenwithhearingimpairmentrangingfrom
moderatetoprofoundand283childrenwithouthearing
impairmentconsiderableinformationisavailableaboutthe
hearingimpairedgroup
l 100itemsareusedtoassess20sentencetypes,including
simplesentences,imperatives,negatives,passives,dative
sentences,expandedsimplesentences,adverbialclauses,relative
clauses,conjunctionsdeletedsentences,noninitialsubjects,
embeddedimperatives,andcomplements
l Testmaybeorallypresentedorpresentedthrough
simultaneouspresentationofsignedandspokenEnglish
l Resultsarepresentedaspercentilesorstandardscores.
l Standardizedon372childrenfrom2yearsto8years,11
Verbalandnonverbalskillsareassessed
months,withprofoundhearingimpairmentsfromoralprograms
receptivelyandexpressivelythroughteacher
l Interexaminerreliabilitydataonlynotestretestdataor
ratings
validityinformation.
Thereare3levelsofthetest:presentence,simplesentence,
Criterionreferencedteacherratingofchildrens l
andcomplexsentences
grammaticalstructuresatfourlevels:
CanbeusedwithchildrenwhousesignedorspokenEnglish
comprehension,imitatedproduction,prompted l
l Structuresexaminedarelesscomprehensivethaninother
production,andspontaneousproduction
measuresdevelopedbyMoogandhercolleagues
Page203

firstfollowedbythevisualstimulus,thusallowingthechildtolookattheclinicianasheorshespeaks.UseofanFMlisteningsituationduringtestingcanalsobe
recommendedforobtaininginformationaboutoptimalperformance(Brackett,1997).

Itisunlikelythatonemeasureoronepersonwhointeractswithahearingimpairedchildwillcaptureallofthechildsstrengthsandweaknessesasacommunicator
(Moeller,1988).Consequently,thespeechlanguagepathologistwillneedtorelyonmultiplemeasuresandseekteaminputbothasanassessmentisplannedandasit
isinterpreted.Inadditiontotheaudiologist,thechildseducators,psychologists,andespeciallythosewhoknowthechildthebestthechildhimorherselfandthe
childsparentscanbevaluablesourcesofinformation.AnexcellentsourceofrecommendationsforeffectiveinteractionswithfamiliescanbefoundinDonahue
Kilburg(1992)andRoushandMatkin(1996).

ExpectedPatternsofOralLanguagePerformance

Despiteevidencethatevenchildrenwithmildorunilateralhearinglossesareatriskforacademicdifficulties(Bess,1985Bessetal.,1986Carney&Moeller,1998
Culbertson&Gilbert,1986Oyleretal.,1988),relativelylittleisknownabouttheiroralorsignlanguagedevelopment(MogfordBevan,1993).Todate,most
researchonorallanguagedevelopmentinchildrenwithhearingimpairmenthasfocusedonchildrenwithmoreseverecongenitallosses(MogfordBevan,1993)orwith
thefluctuatinghearinglossassociatedwithotitismedia(Klein&Rapin,1992).

Thefluctuatinghearinglossassociatedwithotitismediaappearsmoreimportantwhencombinedwithotherriskfactorsfordisorderedlanguagedevelopmentthanit
doeswhenviewedasasingleexplanatoryfactor(Klein&Rapin,1992Paul,1995).Incontrast,thereisconsiderableevidencethatdeafchildrenandthosewhoare
hardofhearingexperiencedifficultiesacrossallorallanguagedomainsandmodalitiesatleastwhencomparisonsaremadeagainstsameagepeers(MogfordBevan,
1993).

Syntaxhasbeendescribedasthemostseverelyaffectedaspectoflanguageinchildrenwithhearinglossthatoccurscongenitallyorinearlychildhood(Mogford
Bevan,1993).Phonologyisunderstandablyquiteaffected,althoughsomechildrenwhoappeartoderivealloftheirphonologicalinformationvisually(throughspeech
reading)demonstratetheabilitytousethephonologicalcodeandshowmanyphonologicalpatternsconsistentwithyounger,hearingchildren(MogfordBevan,1993).
Documentedsemanticdeficitsinvolvelexicalitemsreferringtosoundsandconceptsrelatedtotheorderingofeventsacrosstime,andpossibly,totheuseof
metaphoricallanguage(MogfordBevan,1993).Pragmaticdeficitsaresometimesdescribedandattributedtothecloserelationshipofpragmaticstosyntaxaswellas
tochangesthatoccurinconversationalinteractiononthepartofspeakerandlistenerwhenoneisdeaf.Adifferentpatternofconversationalinitiationandturntaking
representsthemilieuinwhichsuchchildrenacquiretheirknowledgeoflanguageuse(MogfordBevan,1993YoshinagaItano,1997).Therefore,ithasbeensuggested
thatcomparisonswithhearingpeersmaynotprovetobeausefulmeansofunderstandingthepragmaticdevelopmentofdeafchildren.Inarecentarticle,Yoshinaga
Itano(1997)
Page204

describedacomprehensiveapproachtoassessingpragmatics,semantics,andsyntaxamongchildrenwithhearingimpairmentinwhichtheinterrelationshipsofthese
domainswasstressedandbothinformalandformalmeasureswereused.

RelatedProblems

Childrenwithhearinglossappeartobeatincreasedriskforanumberofproblems(e.g.,Voutilainen,Jauhiainen,&Linkola,1988).Thisincreasedriskmayarise
becausethecauseofthehearinglosshasmultiplenegativeoutcomes(e.g.,somegeneticsyndromesorinfectionscancausebothmentalretardationandhearingloss).
Alternativelyhearinglossmaymakechildrenmorevulnerable(e.g.,childrenwhoarelessabletocommunicateforanyreasonmaybeagreaterriskforpsychosocial
difficulties).Despiteaconvergenceofevidencesuggestingincreasedrisk,thespecificprevalenceofmultiplehandicapsinchildrenwithhearinglossisamatterof
considerabledebate(BradleyJohnson&Evans,1991).Theprevalenceofspecificproblemsalsoappearstoberelatedtoetiology.Forexample,whereaschildren
whosehearingimpairmentsareinheritedtendtohavefeweradditionalproblems(inheritedorunknownetiologies),thosewhosehearingimpairmentisdueto
cytomegalovirusareatincreasedriskforbehavioralproblems(BradleyJohnson&Evans,1991).

Ina1979studylookingatadditionalproblemsareasforchildrenwithhearingimpairment(Karchmer,Milone,&Wolk,1979),themostcommonadditionalproblems
werementalretardation(7.8%),visualimpairment(7.4%),andemotionalbehavioraldisorder(6.7%).Althougheachoftheseproblemswasfoundtooccurinless
than10%ofchildrenwithhearingloss,theirprevalencewasstillconsiderablyhigherthaninchildrenwithouthearingloss(BradleyJohnson&Evans,1991).

Theincreasedprevalenceofemotionalbehavioraldisordersisofinterestbecauseofthespecialmanagementissuesthataccompanyit.Biologicalfactorsmaybe
responsibleforemotionalbehavioraldisordersinchildrenwithhearingloss.However,ithasalsobeensuggestedthatmismatchesbetweenthechildscommunication
needsandcapacitiesandthoseofhisorhercaregiversandpeersmaycontributetospecialenvironmentalstressesthatincreaseachildsriskofthesedisorders(Paul&
Jackson,1993).PaulandJacksonprovidedafascinatingdiscussionoftheliteraturedescribingthesubtleandnotsosubtledifferencesinworldexperiencethat
accompanydeafness.

TheoneproblemareainwhichchildrenwithhearinglosswerefoundtobeatreducedriskinthestudybyKarchmeretal.(1979)waslearningdisorders,afindingthat
someauthorshaveattributedtotheeffectsofovershadowing(Goldsmith&Schloss,1986).Overshadowingisthetendencyforprofessionalstofocusonaprimary
problemtoadegreethatcausesthemtooverlookother,significantproblemareas.Althoughovershadowingmaybeonesourceofunderidentificationoflearning
disabilitiesinchildrenwithhearingloss,anotherpossiblesourceiscertainlythetendencyofresearchersandclinicianstodefinelearningdisabilitiesasspecificlearning
disabilities,inwhichproblemsknowntoaffectlearningareexcluded.Thequestionremains,however,whethersomechildrenwithahearinglosshavealearning
disabilitywhoseoriginisunrelatedtothathearingloss.
Page205

Summary

1.Permanenthearinglossinchildrenencompassesboth(a)childrenwhoarehardofhearing,whowilllearnspeechprimarilythroughauditorymeans,and(b)children
whoaredeaf,whomayacquirespeechprimarilythroughvision.

2.Characteristicsofhearinglossesthataffecttheimpactofthelossincludedegreeofloss(mild,moderate,severe,profoundhardofhearing,deafness),typeofloss
(conductive,sensorineural,mixed),configuration(flat,highfrequency,lowfrequency),laterality(unilateralvs.bilateral),andageofonset(congenital,acquired).

3.Geneticsourcesaccountforabout50%ofallcasesofdeafness,withremainingcausesincludinginfectiousdisease,rhfactorincompatibility,andexposureto
ototoxicdrugs.

4.Evenmildorunilateralhearinglosscannegativelyaffectchildrenslanguagelearningandacademicprogress,andthereissomeevidencetosuggestthatthetransient
hearinglossassociatedwithotitismediacaninteractwithotherriskfactorstounderminechildrenslearning,(Peters,Grievink,vanBon,VandenBercken,&Schilder,
1997).

5.Managementofthehearinglossforchildrenwhoarehardofhearingideallyincludesamplification(hearingaidsandFMsystemuse),soundtreatmentofthechilds
languagelearningenvironment,speechlanguageintervention,andclassroomsupportasneeded.

6.Undermostcurrentprogramsofearlyidentificationandsubsequentinterventions,deafnessposesagrimthreattochildrensnormalacquisitionofanorallanguage.

7.Currentcontroversiesindeafnessincludetherelativeimportanceoforalversussignlanguagesinchildrensacquisitionofcommunicationcompetenceandtheroleof
theDeafcultureasapoliticalforce.

8.Challengesintheassessmentofcommunicationofchildrenwithhearinglossincludedifficultiesindeterminingthemode(s)inwhichtoconducttesting(e.g.,oral,
ASL,TotalCommunication)aswellasascarcityofbothappropriatedevelopmentalexpectationsforcommunicationacquisitionandstandardizednormreferenced
measuresforthispopulationinanymode.

KeyConceptsandTerms

cochlearimplant:aprostheticdevicethatprovidesstimulationoftheacousticnerveinresponsetosoundandisusedwithindividualswhohavelittleresidualhearing.

conductivehearingloss:ahearinglosscausedbyanabnormalityaffectingthetransmissionofsoundandmechanicalenergyfromtheoutertotheinnerear.

deafness:ahearinglossgreaterthanorequalto70dBHL,whichprecludestheunderstandingofspeechthroughaudition.
Page206

FM(frequencymodulated)radiosystems:oneofseveralsystemsdesignedtoaddresstheproblemsoflowsignaltonoiseratiosandreverberationoccurringin
settingssuchasclassroomstheseareusedincombinationwithpersonalhearingaids.

hardofhearing:havingadegreeofhearinglossusuallylessthan70dBHL,whichallowsspeechandlanguageacquisitiontooccurprimarilythroughaudition.

hearinglossconfiguration:thepatternofhearinglossacrosssoundfrequenciesforinstance,ahighfrequencylossisoneinwhichthelossisgreatestinthehigh
frequencies.

mixedhearingloss:ahearinglosswithbothconductiveandsensorineuralcomponents.

otitismedia:middleearinfection.

ototoxicity:thepropertyofbeingpoisonoustotheinnerearthatisfoundforsomedrugsandenvironmentalsubstances.

otoacousticemissions:lowlevelaudiofrequencysoundsthatareproducedbythecochleaaspartofthenormalhearingprocess(LonsburyMartin,Martin,&
Whitehead,1997).

overshadowing:thetendencyforprofessionalstofocusonaprimaryproblemtoadegreethatcausesthemtooverlookother,significantproblemareas.

prelingualhearingloss:ahearinglossacquiredbeforeage2,whichisthoughttobeassociatedwithamoresignificantimpact.

prematurity:birth2ormoreweekspriortoexpectedduedate.

rhfactorincompatibility:conditioninwhichthebloodofmotherandinfanthavediscrepantrhfactorsresultinginmaternalantibodyproductionthatcanproveharmful
totheinfantifuntreated.

sensorineuralhearingloss:hearinglossduetopathologyaffectingtheinnerearornervoussystempathwaysleadingtothecortex.

StudyQuestionsandQuestionstoExpandYourThinking

1.Thetendencytohaveadiagnosissuchasdeafnessovershadowothersignificantbutlesssevereconditionsisanunderstandablebutquiteunfortunateclinicalerror.
Howmightyouavoidthiskindoferrorinclinicalpractice?

2.Protectiveearplugs(e.g.,EARClassic)producetheequivalentofamild(approximately2030dB)hearingloss.Findapairandusetheminthreedifferentlistening
conditions.Forexample,talkingwithafriendfacetofaceinaquietsetting,listeningtoalecturefromyourusualseatintheclassroom,andwatchingtheTVnewswith
theloudnesslevelsetatacomfortablelisteninglevel(beforeyouputtheplugsin).Writedownwhatyouhear.

3.RepeattheexperimentfromQuestion2usingonlyoneearplug.Besidesnotingwhatyouhear,notewhetheryouchangedanythingelseaboutyourbehaviorasyou
listenedandtalked.
Page207

4.Brieflydescribeanargumentyoumightmakefavoringtheuseoftotalcommunicationwithadeafchildborntohearingparents.

5.RepeatQuestion4,butargueinfavoroftheuseofASLonlywiththesamechild.

6.Considertheetiologiesdescribedforhearinglossinthischapter.Whatpreventivemeasuresmighthelpreducetheoccurrenceofhearinglossininfants?Arethere
anyofthesemeasuresinwhichyoucouldplayaroleasaschoolbasedspeechlanguagepathologist?Asacitizenofyourlocalcommunity?

7.Listfourthingsyouwouldwanttobesuretorememberasyoupreparefortheorallanguageevaluationofachildwhoishardofhearingandwhoregularlyusesa
hearingaid,wherethepurposeoftheevaluationistodeterminethechildsoptimalperformance.

RecommendedReadings

Carney,A.E.,&Moeller,M.P.(1998).Treatmentefficacy:Hearinglossinchildren.JournalofSpeechLanguageHearingResearch,41,561584.

Northern,J.L.,&Downs,M.P.(1991)Hearinginchildren(4thed.).Baltimore:Williams&Wilkins.

Paul,P.V.,&Quigley,S.P.(1994).Languageanddeafness(2nded.).SanDiego,CA:Singular.

Scheetz,N.A.(1993).Orientationtodeafness.Boston:Allyn&Bacon.

References

AmericanSpeechLanguageHearingAssociationandtheCouncilonEducationoftheDeaf.(1998).Hearingloss:Terminologyandclassificationpositionstatement
andtechnicalreport.ASHA,40(Suppl.18),pp.2223.

Bellugi,U.,vanHoek,K.,LilloMartin,D.,&OGrady,L.(1993).Theacquisitionofsyntaxandspaceinyoungdeafsigners.InD.Bishop&K.Mogford(Eds.),
Languagedevelopmentinexceptionalcircumstances(pp.132149).Mahwah,NJ:LawrenceErlbaumAssociates.

Bergstrom,L.,Hemenway,W.G.,&Downs,M.P.(1971).Ahighriskregistrytofindcongenitaldeafness.OtolaryngologicalClinicsofNorthAmerica,4,369
399.

Bess,F.H.(1985).Theminimallyhearingimpairedchild.EarandHearing,6(1),4347.

Bess,F.,Klee,T.,&Culbertson,J.L.(1986).Identification,assessmentandmanagementofchildrenwithunilateralsensorineuralhearing,lossEarandHearing,7
(1),4351.

Brackett,D.(1997).Interventionforchildrenwithhearingimpairmentingeneraleducationsettings.Language,Speech,andHearinginSchools,28,355361.

BradleyJohnson,S.,&Evans,L.D.(1991).Psychoeducationalassessmentofhearingimpairedstudents:Infancythroughhighschool.Austin,TX:ProEd.

Cacace,A.T.,&McFarland,D.J.(1998).Centralauditoryprocessingdisorderinschoolagedchildren:Acriticalreview.JournalofSpeechLanguageHearing
Research,41,355373.

Carney,A.E.,&Moeller,M.P.(1998).Treatmentefficacy:Hearinglossinchildren.JournalofSpeechLanguageHearingResearch,41,S61S84.

Corker,M.(1996).Deaftransitions:Imagesandoriginsofdeaffamilies,deafcommunitiesanddeafidentities.Bristol,PA:JessicaKingsley.

Coryell,J.,&Holcomb,T.K.(1997).Theuseofsignlanguageandsignsystemsinfacilitatingthelanguageacquisitionandcommunicationofdeafstudents.Language,
Speech&HearingServicesinSchools,28,384394.

Crittenden,J.B.(1993).Thecultureandidentityofdeafness.InP.V.Paul&D.W.Jackson(Eds.),Towardapsychologyofdeafness:Theoreticalandempirical
perspectives(pp.215235).NeedhamHeights,MA:Allyn&Bacon.
Page208

Culbertson,J.L.&Gilbert,L.E.(1986).Childrenwithunilateralsensorineuralhearingloss:Cognitive,academic,andsocialdevelopment.EarandHearing,7(1),
3842.

Dirckx,J.H.(1997).Stedmansconcisemedicaldictionaryforthehealthprofessions.Baltimore:Williams&Wilkins.

DonahueKilburg,G.(1992).Familycenteredearlyinterventionforcommunicationdisorders:Preventionandtreatment.Gaithersburg,MD:Aspen.

Dub,R.V.(1995).Languageassessmentofdeafchildren:AmericanSignLanguageandEnglish.JournaloftheAmericanDeafnessandRehabilitation
Association,29,816.

Engen,E.,&Engen,T.(1983).TheRhodeIslandTestofLanguageStructure.Baltimore:UniversityParkPress.

Flexer,C.(1994).Facilitatinghearingandlisteninginyoungchildren.SanDiego,CA:SingularPress.

Fraser,G.R.(1976).Thecausesofprofounddeafnessinchildhood.Baltimore:TheJohnsHopkinsUniversityPress.

Fria,T.J.,Cantekin,E.I.,&Eichler,J.A.(1985).Hearingacuityofchildrenwithotitismediawitheffusion.OtolaryngologyHeadandNeckSurgery,111,1016.

Goldsmith,L.,&Schloss,P.J.(1986).Diagnosticovershadowingamongschoolpsychologistsworkingwithhearingimpairedlearners.AmericanAnnalsofthe
Deaf,131,288293.

Harris,J.(1995).Theculturalmeaningofdeafness.Brookfield,VT:Ashgate.

Harrison,M.,&Roush,J.(1996).Ageofsuspicion,identification,andinterventionforinfantsandyoungchildrenwithhearingloss:Anationalstudy.Earand
Hearing,17(1),5562.

Kapur,Y.P.(1996).Epidemiologyofchildhoodhearingloss.InS.E.Gerber(Ed.),Thehandbookofpediatricaudiology(pp.314).Washington,DC:Galludet
UniversityPress.

Karchmer,M.A.,Milone,M.N.,&Wolk,S.(1979).Educationalsignificanceofhearinglossatthreelevelsofseverity.AmericanAnnalsoftheDeaf,124,97
109.

Klein,S.K.,&Rapin,I.(1992).Intermittentconductivehearinglossandlanguagedevelopment.InD.Bishop&K.Mogford(Eds.),Languagedevelopmentin
exceptionalcircumstances(pp.96109).Mahwah,NJ:LawrenceErlbaumAssociates.

Layton,T.L.,&Holmes,D.W.(1985).CarolinaPictureVocabularyTest.Austin,TX:ProEd.

LilloMartin,D.,Bellugi,U.,&Poizner,H.(1985).TestsforAmericanSignLanguage.SanDiego:TheSalkInstituteforBiologicalStudies.

Ling,D.(1989).Foundationsofspokenlanguageforhearingimpairedchildren.Washington,DC:A.G.BellAssociationfortheDeaf.

LonsburyMartin,B.L.,Martin,G.K.,&Whitehead,M.L.(1997).Distortionproductionotoacousticemissions.InM.S.Robinette&T.J.Glattke(Eds.),
Otoacousticemissions:Clinicalapplications(pp.83109).NewYork:Thieme.

Mauk,G.W.,&White,K.R.(1995).Givingchildrenasoundbeginning:Thepromiseofuniversalnewbornhearingscreening.VoltaReview,97(1),532.

Maxwell,M.M.(1997).Communicationassessmentsofindividualswithlimitedhearing.Language,Speech,HearingServicesinSchools,28,231244.

Moeller,M.P.(1988).Combiningformalandinformalstrategiesforlanguageassessmentofhearingimpairedchildren.JournaloftheAcademyofRehabilitative
Audiology.MonographSupplement,21,7399.

Mogford,K.(1993).Orallanguageacquisitionintheprelinguisticallydeaf.InD.Bishop&K.Mogford(Eds.),Languagedevelopmentinexceptional
circumstances(pp.110131).Mahwah,NJ:LawrenceErlbaumAssociates.

MogfordBevan,K.(1993).Languageacquisitionanddevelopmentwithsensoryimpairment:Hearingimpairedchildren.InG.Blanken,J.Pitman,H.Grimm,J.C.
Marshall,&C.W.Wallesch(Eds.),Linguisticdisordersandpathologies:Aninternationalhandbook(pp.660679).Berlin,Germany:deGruyter.

Moog,J.S.,&Geers,A.E.(1975).ScalesofEarlyCommunicationSkills.St.Louis,MO:CentralInstitutefortheDeaf.

Moog,J.S.,&Geers,A.E.(1980).Grammaticalanalysisofelicitedlanguage:Complexsentencelevel.St.Louis,MO:CentralInstitutefortheDeaf.
Page209

Moog,J.S.,&Geers,A.E.(1985).Grammaticalanalysisofelicitedlanguage:Simplesentencelevel.St.Louis,MO:CentralInstitutefortheDeaf.

Moog,J.S.,&Kozak,V.J.(1983).Teacherassessmentofgrammaticalstructure.St.Louis,MO:CentralInstitutefortheDeaf.

Moog,J.S.,Kozak,V.J.,&Geers,A.E.(1983).Grammaticalanalysisofwrittenlanguage:Presentencelevel.St.Louis,MO:CentralInstitutefortheDeaf.

Moores,D.F.(1987).Educatingthedeaf.Boston:HoughtonMifflin.

Musket,C.H.(1981).Maintenanceofpersonalhearingaids.InM.Ross,R.J.Roeser,&M.Downs(Eds.),Auditorydisordersinschoolchildren(pp.229248).
NewYork:Thieme&Stratton.

Nelson,K.E.,Loncke,F.,&Camarata,S.(1993).Implicationsofresearchondeafandhearingchildrenslanguagelearning.InM.Marschark&M.D.Clarke
(Eds.),Psychologicalperspectivesondeafness(pp.123152).Hillsdale,NJ:LawrenceErlbaumAssociates.

Newborg,J.,Stock,J.R.,Wnek,L.,Guidubaldi,J.,&Svinicki,J.(1984).BatelleDevelopmentalInventory.Allen,TX:DLMTeachingResources.

Northern,J.L.,&Downs,M.P.(1991).Hearinginchildren(4thed.).Baltimore:Williams&Wilkins.

Oyler,R.F.,Oyler,A.L.,&Matkin,N.D.(1988).Unilateralhearingloss:Demographicsandeducationalimpact.Language,Speech,andHearingServicesinthe
Schools,19,201209.

Paul,P.V.(1998).Literacy&Deafness.Boston:Allyn&Bacon.

Paul,P.V.,&Jackson,D.W.(1993).Towardapsychologyofdeafness:Theoreticalandempiricalperspectives.NeedhamHeights,MA:Allyn&Bacon.

Paul,P.V.,&Quigley,S.P.(1994).Languageanddeafness(2nded.).SanDiego,CA:Singular.

Paul,R.(1995).Languagedisordersfrominfancythroughadolescence:Assessmentandintervention.St.Louis:Mosby.

Peters,S.A.F.,Grievink,E.H.,vanBon,W.H.J.,VandenBercken,J.H.L.,&Schilder,A.G.M.(1997).Thecontributionofriskfactorstotheeffectofearly
otitismediawitheffusiononlaterlanguage,reading,andspelling.DevelopmentalMedicineandChildNeurology,39,3139.

Prinz,P.,&Strong,M.(1994).AtestofASL.Unpublishedmanuscript,SanFranciscoStateUniversity,CaliforniaResearchInstitute.

Rees,N.S.(1973).Auditoryprocessingfactorsinlanguagedisorders:TheviewfromProcrustesbed.JournalofSpeechandHearingDisorders,38,304315.

Resnick,T.J.,&Rapin,I.(1991).Languagedisordersinchildren.PsychiatricAnnals,21,709716.

Ries,P.W.(1994).Prevalenceandcharacteristicsofpersonswithhearingtrouble:UnitedStates.199091.NationalCenterforHealthStatistics.VitalHealth
Statistics,10(188).

Ross,M.(1990).Hearingimpairedchildreninthemainstream.Parkton,MD:YorkPress.

Ross,M.,Brackett,D.,&Maxon,A.(1991).Assessmentandmanagementofmainstreamedhearingimpairedchildren:Principlesandpractices.Austin,TX:
ProEd.

Roush,J.,&Matkin,N.D.(1994).Infantsandtoddlerswithhearingloss:Familycenteredassessmentandintervention.Baltimore:YorkPress.

Sanders,D.A.(1993).Managementofhearinghandicap.EnglewoodCliffs,NJ:PrenticeHall.

Scheetz,N.A.(1993).Orientationtodeafness.NeedhamHeights,MA:Allyn&Bacon.

Smedley,T.,&Plapinger,D.(1988).Thenonfunctioninghearingaid:Acaseofdoublejeopardy.TheVoltaReview,February/March,7784.

Spencer,P.E.,&Deyo,D.A.(1993).Cognitiveandsocialaspectsofdeafchildrensplay.InM.Marschark&M.D.Clarke(Eds.),Psychologicalperspectiveson
deafness(pp.6591).Hillsdale,NJ:LawrenceErlbaumAssociates.

Stout,G.G.,&Windle,J.(1992).DevelopmentalapproachtosuccessfullisteningIIDASLII.Denver:ResourcePoint.

Strong,M.,&Prinz,P.(1997).AstudyoftherelationshipbetweenAmericanSignLanguageandEnglishliteracy.JournalofDeafStudiesandDeafEducation,2
(1),3746.

Supalla,T.,Newport,E.,Singleton,J.,Supalla,S.,Metlay,D.,&Coulter,G.(1994).TestBatteryforAmericanSignLanguageMorphologyandSyntax.
Burtonsville,MD:LinstokPress.

TyeMurray,N.,Spencer,L.,&Woodworth,G.G.(1995).Acquisitionofspeechbychildrenwhohaveprolongedcochlearimplantexperience.JournalofSpeech
&HearingResearch,38(2),327337.
Page210

Vernon,M.,&Andrews,J.F.(1990).Othercausesofdeafness:Theirpsychologicalrole.Thepsychologyofdeafness(pp.4067).NewYork:Longman.

Voutilainen,R.,Jauhiainen,T.,&Linkola,H.(1988).Associatedhandicapsinchildrenwithhearingloss.ScandinavianAudiologicalSupplement,33,5759.

Worthington,D.W.,Stelmachowicz,P.,&Larson,L.(1986).Audiologicalevaluation.InM.J.Osberger(Ed.),Languageandlearningskillsofhearingimpaired
students.AmericanSpeechLanguageHearingAssociationMonographs,23,1220.

Ying,E.(1990).Speechandlanguageassessment:Communicationevaluation.InM.Ross(Ed.),Hearingimpairedchildreninthemainstream(pp.4560).
Parkton,MD:YorkPress.

YoshinagoItano,C.(1997).Thechallengeofassessinglanguageinchildrenwithhearingloss.Language,Speech,andHearingServicesinSchools,28,362373.
Page211

PART
III

CLINICALQUESTIONSDRIVINGASSESSMENT
Page212
Page213

CHAPTER
9

ScreeningandIdentification:DoesThisChildHaveaLanguageImpairment?

TheNatureofScreeningandIdentification

SpecialConsiderationsWhenAskingThisClinicalQuestion

AvailableTools

PracticalConsiderations

Sincehisinfancy,Sergesparentshadsuspectedthattherewassomethingdifferentabouttheirthirdchild.Althoughhewasahealthyandfriendlybaby,he
rarelyvocalizedandusedonlyafewintelligiblewordsbythetimehewas3.Healsoseemedabletoignoremuchofwhatwentonaroundhimwhilebeing
extraordinarilysensitivetoloudnoisessuchasmotorcyclesoraTVturnedupbyhisoldersiblings.OnthebasisofSergesmothersreportsandtheresults
oftheDenverII(Frankenburg,Dodds,&Archer,1990),anearlyeducatoratapreschoolscreeningrecommendedacompletespeechlanguageandhearing
evaluation.

Ameliahadjustgottenbyintheearlygrades.Althoughsheneverperformedparticularlywell,sherarelyfailedassignmentsandneverreceivedafailing
grade.Shewaswellorganized,attentive,andeversoeagertoplease.Herparentswereacceptingofherperformancebecausethey,too,hadneverdone
terriblywellinschooltheyhadjustbeenhappythatshewasenjoyingitsomuch.Allofherenjoymentvanished,
Page214

however,inthefourthgrade,whenthelanguageoftheclassroombecamemorecomplexandmoredependentonthebooksbeingused.Shepretendedtobe
sickinordertoavoidschoolandcriedinfrustrationwhentheworkseemedtoohard.Herteacherandtheschoolspeechlanguagepathologistwereso
alarmedbyherbehaviorandbythequalityofherwrittenandoraldiscoursethattheydecidedanindepthexaminationofherorallanguageandliteracy
skillswasnecessaryimmediately.

TheNatureofScreeningandIdentification

Screeningandidentificationoflanguagedisordersarecloselyrelatedenterprises.ScreeningproceduresaidcliniciansinmakingarelativelygrossdecisionShouldthis
childscommunicationbescrutinizedmorecloselyforthepossiblepresenceofalanguagedisorder?Identification,ontheotherhand,takesthatquestionseveralsteps
further.Doesthischildhavealanguagedisorder,adifferenceinlanguage,orboth?Oftenthiscomplexquestionistiedtoyetanotherquestion:Isthischildeligiblefor
serviceswithinaparticularsetting?

Screening

Inmanycases,referralsbyconcernedparents,teachers,orphysiciansfunctionasindirectscreeningmechanisms.Nonetheless,alternativeproceduresareneededin
caseswhensuchindirectmethodsareunlikelytooccurorareunsuccessful.Althoughdetectionmayreadilyoccuratthebehestofconcernedfamiliesfacingsevere
problems,detectionmaybedelayedwhentheproblemsaremild(e.g.,whentheyconsistofsubtledifficultiesincomprehension)orwhentheyareunaccompaniedby
obviousphysicalorcognitivedisabilities(Prizant&Wetherby,1993).

Screeningistypicallyusedwhenthenumberofindividualsunderconsiderationmakestheuseofmoreelaboratemethodsimpracticalusuallyfromtheperspectivesof
bothtimeandmoney.Muchofthecurrentthinkingaboutscreeninganditsrelationshiptoidentificationareborrowedfromtherealmofpublichealth(e.g.,Thorner&
Remein,1962).Inthatcontext,screeningsaredesignedtobequick,inexpensive,andcapableofbeingconductedbyindividualswithlesseramountsoftraining.
Similarly,inspeechlanguagepathology,theadministrationandinterpretationofscreeningmethodsshouldrequireminimaltimeandexpertise.Nonetheless,validity
continuestobeofcriticalimportancebecauseaninaccuratescreeningprocedureisuselessnomatterhowquickorinexpensiveitmaybe!

Anumberofdifferentkindsofscreeningmechanismsoccurinthedetectionandmanagementoflanguagedisorders.Ofgreatestimportanceforourpurposesis
screeningforthepresenceofalanguagedisorder.Suchascreening,forexample,mightbeperformedonall35yearoldsinagivenschooldistrict,oftenaspartofa
broaderscreeningforavarietyofhealthanddevelopmentalrisks.Anotherexampleofsuchacomprehensivescreeningwouldoccuraspartofneonatalintensivecare
followup.Whenexaminedalone,communicationisscreenedusingagreatvarietyofmeasureswithselectedaspectsofspeech,language,andhearingastheirmajor
foci.
Page215

Inpractice,suchmeasuresareofteninformalandfrequentlymakeuseofseveralmeasuressomeformalandsomeinformaltoincreasethecomprehensivenessof
theexamination.SpecifictoolsusedinamorefocusedapproachtolanguagescreeningarediscussedintheAvailableToolssectionofthischapter.

Whenexaminedaspartofabroaderscreeningeffort,communicationisfrequentlyassessedusingameasuredesignedtoaddressavarietyofmajorareasof
functioning.OneexampleofthesekindsofscreeningmeasuresistheDenverDevelopmentalScreeningTestRevised(Frankenburg,Dodds,Fandal,Kazuk,&
Cohrs,1975Feeney&Bernthal,1996),ascreeningtoolforchildrenfrombirthtoage6thatmakesuseofdirectelicitationandparentalreports.Anotheristhe
DevelopmentalIndicatorsforAssessmentofLearningRevised(DIALRMardellCzudnoswki&Goldenberg,1983),ascreeningtoolforchildrenages26that
isoftenusedtoscreenlargernumbersofchildrenthroughtheuseofateamofevaluators,eachofwhomelicitbehaviorsfromananindividualchildwithinagivenarea.

Ina1986studyofthe19measuresmostcommonlyusedinfederallyfundeddemonstrationprojectsaroundtheUnitedStates,Lehr,Ysseldyke,andThurlow(1986)
foundonly3thattheyjudgedtobetechnicallyadequate:theVinelandAdaptiveBehaviorScales(Sparrow,Balla,&Cicchetti,1984),theMcCarthyScalesof
ChildrensAbilities(McCarthy,1972),andtheKaufmanAssessmentBatteryforChildren(Kaufman&Kaufman,1983).Bracken(1987)notedsimilarproblems
withavailablescreeningmeasures,especiallyamongmeasuresdesignedforchildrenyoungerthan4.Thislackofwelldevelopedcomprehensivescreeningtestsis
particularlyproblematicgiventhedemandinherentintheIndividualswithDisabilitiesEducationAct(IDEA,1990)whichcompelsidentificationofatriskchildrenat
veryyoungages.

Screeningproceduresarealsousedbyspeechlanguagepathologistsduringcomprehensivecommunicationassessmentstodetermine(a)whetherspecificareasof
communication(e.g.,voice,fluency,hearing)needindepthtestingand(b)whetherproblemsexistandthusrequirereferralsinothermajorareasoffunctioning(e.g.,
vision,cognition).Nuttall,Romero,andKalesnik(1999)providedawiderangingdiscussionofvarioustypesofdevelopmentalpreschoolscreenings.

Identification

Essentially,identificationproceduresforlanguagedisordersinchildrenareintendedtoverifytheexistenceofaproblemthatmayhavebeensuspectedbyreferral
sourcesoruncoveredthroughascreeningprogram.Forthepurposesofthisbook,identificationisseenassynonymouswiththetermdiagnosis,whenthattermis
definedastheidentificationofadisease,abnormality,ordisorderbyanalysisofthesymptomspresented(Nicolosi,Harryman,&Kresheck,1996,p.86).Diagnosis
isoftendefinedsothatitincludesthelargersetofquestionsleadingtoconclusionsregardingetiology,prognosis,andrecommendationsfortreatment(e.g.,seeHaynes,
Pindzola,&Emerick,1992).Here,however,thetermidentificationispreferredasameansofexpeditingourfocusonthespecialmeasurementconsiderationsit
entails.
Page216

Identificationdecisionsinvolvingchildrenarecrucialforatleasttworeasons.First,identificationisusuallythefirststepthatenablesthechildtoreceivehelp,ofteninthe
formofintervention.Thisstepisacriticalonebecauseoftheemotional,monetary,andtemporaldemandsthataccompanyinterventionthatwillbemettovarying
degreesbythechild,theparents,thespeechlanguagepathologist,aswellasthelargercommunity.Second,byleadingtoeffectiveintervention,correctidentification
canhelppreventormitigatetheadditionalsocialandscholasticproblemsthatmayaccompanylanguageimpairment.Identificationdecisionsareamongthemost
importantonesmadebyspeechlanguagepathologistsand,therefore,shouldbeamongthemostcarefullymade.

Becauseidentificationdecisionsofteninvolvetheassignmentofalabel,theyareoftenassociatedwithafearonthepartofmanyparentsandsometheorists(Shepard,
1989)thatthechildwillbeequatedwiththedisorder.Forexample,theparentsmayfearthattheirchildwillnolongerbeseenasacute,complicatedchildwhenhe
orshebecomesanautisticchild.Althoughpersonfirstnomenclature(e.g.,referringtoapersonwithautismratherthananautisticpersonor,worseyet,an
autistic)isintendedtomaketheprocessoflabelingmorebenign,thenegativeimplicationsofbeingidentifiedashavingacommunicationdisorderexistnonethelessin
themindsofparentsandperhapsintheunderstandingsofnaiveobservers.Thisisevidentwhenparentsfindonelabelforexample,languageimpairedmore
acceptablethananothersuchaslanguagedelayedascliniciansfrequentlydiscoverduringtheirinteractionswithfamilies(Kamhi,1998).Concernsaboutlabeling
inthespecialeducationcommunityareintenseandhaveledtorecommendationstoavoidlabelsasmuchaspossible,particularlyforyoungerchildrenandincases
whereonlyascreeninghasbeenconducted(Nuttalletal.,1999).

Manyofthemeasurementissuesassociatedwithidentificationmirrorthoseofscreening.However,themorepermanentnatureofidentificationanditsassociationwith
decisionsaboutaccesstocontinuingservicesraisethestakesinthequalityofdecisionmakingrequired.Inthenextsection,specialmeasurementconsiderations
affectingbothscreeningandidentificationarediscussedinsomedetail,witheffortsmadetocallreadersattentiontopointswherethetwodiffer.

SpecialConsiderationsWhenAskingThisClinicalQuestion

IfIwerereadingthisbookasastudent(orasaclinicianwhofindsmeasurementlessinterestingthanIdo),Iwouldbehopingthatmyfriendlyauthorwouldoffer
severaleasystepstowardaccurateandefficientscreeningandidentification.Betteryet,perhapsshewouldtellmeexactlywhichscreeningandidentificationmeasuresI
shouldpurchaseandexactlywhichthreesimplestepsIshouldfollowforinfallibleclinicaldecisionmaking.Sadly,asmuchasIwouldliketohelp,ablanketprescription
fortestpurchasingandusecannotbemadeforallofthetestingsituationsfacingevenaverysmallgroupofreaders.Instead,whatIcandoisprovidebasicinformation
aboutsomespecialconsiderationsandthen,inthenextsection,introducesomeofthemanyavailablemeasuresthatcanbeusedforscreeningandidentification.
Page217

Inthissectionofthechapter,severalspecialconsiderationsareexploredtohelpreadersengageintheprocessoftestselectionandinterpretationforthepurposesof
screeningandidentification.Thesespecialconsiderationsrepresentrefinementsofsomeoftheinformationpresentedinearlierchaptersrefinementsdictatedbythe
particulardemandsofscreeningandidentificationastestingpurposes.

Inlearninghowtochoosethebestpossiblemeasureforagivenpurpose,thetiebetweenmeasurementpurposeandmethodologywasnotalwaysobvioustome.Some
timeago,inmyfirstpublishedarticle,acolleagueandIused10operationaldefinitionsofpsychometricguidelinesofferedbytheAPA,AERA,andNCME(1985)to
evaluate30languageandarticulationtestsusedwithpreschoolchildren(McCauley&Swisher,1984a).Thecriteriaincludedanadequatedescriptionoftester
qualifications,evidenceoftestretestreliability,informationaboutcriterionrelatedvalidity,andothers.Almostinstantly,awellknownlanguageresearcher,JohnMuma
(1985),chastisedus,citing,amongotherreasons,thedangerthatreaderswouldassumethateachofthecriteriaweincludedwasequallyasimportantaseveryother.
Today,asin1985,itseemstomethatalthoughMumafailedtounderstandthebasicintentofthearticle,hewasabsolutelyonthemarkinhisconcernaboutits
fosteringmisunderstanding.Infact,asyouwillseeinthenextchapters,differentpurposesoftestingwilldrawspecialattentiontodifferentaspectsofthemeasuresone
mightuse.Itisimportanttopayattentiontothisironcladconnectioninordertomakeethicaldecisions.

Theappropriatenessofstandardizednormreferencedtestsforpurposesofidentifyingalanguagedisorderordifferenceisalmostuniversallyacceptedintheclinical
literature(e.g.,seeKelly&Rice,1986Merrell&Plante,1997Sabatino,Vance,&Miller,1993cf.Muma,1998).Inaddition,suchinstrumentsarewidelyfavored
forthatpurposebypracticingspeechlanguagepathologists(e.g.,seeHuang,Hopkins,&Nippold,1997).Often,theiruseismandatedasthebackboneofscreening
andidentificationefforts.

Inanidealworld,speechlanguagepathologistswouldbeabletopredictflawlesslywhichchildrenwouldexperiencepersistent,penalizingdifferencesincommunication
basedonadescriptionofeachchildscurrentlanguagestatus.Thus,criterionreferencedmeasureswouldgenerallysufficeforbothidentificationandtreatment
planning.However,giventhecurrentlevelofunderstanding,thebeststrategyisto(a)identifythosechildrenwhoseperformanceseemssufficientlydifferentfromthe
performancesofarelativelylargegroupofpeersastowarrantconcernand(b)supplementthatinformationwithothersourcesofinformation,particularlyfrompersons
familiarwiththechildsfunctionalcommunication.

Becauseofthetiebetweennormreferencedmeasuresandidentificationprocedures,mostofthespecialconsiderationsregardingscreeningandidentificationdiscussed
nextrelatetotheuseofnormreferencedmeasuresindecisionmaking.Thesixspecialconsiderationsinvolve(a)weighingmeasuresensitivityandspecificityintest
selection,(b)decidingoncutoffscores,(c)rememberingmeasurementerrorinscoreinterpretation,(d)wrestlingwiththedisorderdifferencequestion,(e)conducting
comparisonsbetweenscores,and(f)takingintoaccountbaseratesandreferralratesinevaluatingscreeningmeasures.Thefirsttwooftheseconsiderationsaddress
concernsthatwillpri
Page218

marilybedealtwithbytheclinicianpriortouseofaninstrumentinaparticularcase.Thesecondthreeaddressconcernsarisingduringtheprocessoftestuse.Thelast
considerationrelatestoonesthinkingabouthowtoimplementandpotentiallyevaluateascreeningprogramamorespecificconcernthantheotherfive.

WeighingMeasureSensitivityandSpecificityinTestSelection

Onthebasisofpreviousdiscussionsofvalidity,readerscananticipatethatameasureusedtoscreenoridentifychildrenforlanguagedisordersshouldprovideasa
cornerstoneofevidencesupportingitsvalidityconvincingempiricaldocumentationofitsabilitytodistinguishchildrenwithandwithoutsuchdisorders(Plante&Vance,
1994).

Onemethodusedtoexaminetheaccuracyofclassificationachievedbyscreeningandidentificationmeasuresentailsthecomparisonofthemeasureunderstudywitha
measurethatisconsideredvalidoratleastacceptablegiventhestateoftheart.Comparisonagainstanidealisoftendescribedasacomparisonwithagoldstandard,
ameasurethathasbeensothoroughlystudiedthatitisthoughttorepresenttheverybestmeasureavailableforagivenpurpose.Becauseofthescarcityofgold
standardsinarenasrelatedtochildlanguageassessment,themoretypicalscenarioinvolvesacomparisonwithawellstudiedandrespectedmeasure.

Inthecaseofascreeningmeasure,thecomparisonisoftenmadebetweentheresultsofascreeningprocedureandthoseofamoreelaborateandestablishedmethod
ofidentification.Thecomparisonmayinvolvetheuseofamorewellestablishedtestortestbatterythathasbeenindependentlyvalidated.Asyoumayrecognizeinthe
discussionthatfollows,themethodusedtocomparetheseperformancesislargelyanelaborationofthecontrastinggroupsmethoddescribedinchapter3.

Thecomparisonoftenmakesuseofacontingencytable,suchasthatportrayedinFig.9.1andinearliersectionsofthebook.InFig.9.1,twotablesareusedoneto
illustratethecomponentsofthistypeoftableandtheothertoshowahypotheticalexample:theresultsoftheHopefulScreeningTestcontrastedwiththoseofthe
FirmlyEstablishedIdentificationMeasureforagroupof1000individuals.

Asyoucanseefromthefirsttableinthefigure,sensitivityissimplytheproportionoftruepositivesproducedbythemeasure.Thus,itreflectshowfrequentlythose
childrenneedingfurtherevaluationareaccuratelyfoundusingthismeasure.Accordingtoamoreformaldefinition,sensitivityisameasureoftheabilityofatestor
proceduretogiveapositiveresultwhenthepersonbeingassessedtrulydoeshavethedisorder.Specificityisameasureoftheabilityofameasuretogiveanegative
resultwhenthepersonbeingassessedtrulydoesnothavethedisorder.Itisusuallydescribedastheproportionoftruenegativesassociatedwiththemeasure.Thusfor
ascreeningmeasure,specificityreflectshowfrequentlyindividualswillbeheldbackfromadditionalevaluationwhoactuallyshouldntbeevaluatedbecausetheyare
problemfree.Inotherwords,atestorprocedurethatunderidentifieschildrensuffersfrompoorsensitivity,andatestorprocedurethatoveridentifieschildrensuffers
frompoorspecificity.

InthecaseofthehypotheticalHopefulScreeningTestofLanguage,sensitivityseemstobelessthanmostpeoplewouldbehappywith:onthebasisofitsresults,
Page219

Fig.9.1.Informationcontainedinacontingencytableandanexampleshowinghowitcanbeusedtocalculatesensitivityandspecificity.
Page220

22%,orabout1/5,ofchildrenwiththedisorderwouldgoundetectedandthusbeexcludedfromfurtherassessment.Incontrast,themeasuresspecificityisexcellent,
withonlyabout5outofevery100childrenwhoareperformingnormallyrecommendedforunnecessarytesting.

Indiscussionsofwhatconstitutesacceptablelevelsofoverallaccuracyforlanguageidentificationmeasures,Plante&Vance(1994)notedthatoverallaccuracy(i.e.,
thepercentageoftruepositivesplustruenegativesgivenoutoftheentirepopulation)shouldbeatleast90%foranevaluationofgoodand80%foranevaluationof
fair.Thus,althoughtheHopefulScreeningTestofLanguagemightbeconsideredgoodinitsoverallaccuracy(about94%),itssensitivitycannotberegardednearly
sohighly(78%).

Withregardtosensitivityandspecificityforlanguagescreeningprocedures,PlanteandVance(1995)recommendedthatahigherstandardbemetforsensitivitythan
forspecificity.Specifically,theyrecommendedthatsensitivityshouldbeat90%orabove,whereasforspecificitytheyacceptedlevelsof80%asgoodand70%as
fair.Thus,althoughsensitivityandspecificityarebothinverselyrelatedtothefrequencyoferrors(alsocalledmisses)indecisionmakingassociatedwitha
particulartestorprocedure,itisimportanttowanttoexaminethemindependentlyratherthanlumpedtogetherinasinglemeasureofaccuracybecausetheireffects
differ.AsPlanteandVancenoted,sensitivityismoreimportantforscreeningmeasuresthanspecificitybecausetheunderreferralsassociatedwithpoorersensitivitymay
havegreaternegativeeffectsonchildrenthanoverreferralsassociatedwithpoorerspecificity.

TakingPlanteandVances(1995)lineofthoughtonestepfurther,notonlyshouldcliniciansgobeyondoverallaccuracyofclassificationintheirevaluationsof
measures,theyshouldalsoconsidertheimplicationsofameasuressensitivityandspecificitylevelsinlightofthespecifictestingsituation.Propertiesofthattesting
situationincludethegravityofthedecisiontobemadeanditsirreversibility.Forexample,lowersensitivitymaybemoreacceptableinsettingswherefailurestoreferfor
testingortotakestepstowardidentificationwillbecorrectedsuchasasituationinwhichawellinformedteachingstaffwillbelikelytobringachildtotheclinicians
attentionregardlessofpreviousscreeningresults.Similarly,lowerspecificitymaybetoleratedinsituationswheretestingresourcesarenotsorelytaxed(iftherearesuch
places).

Finally,asapointthatcannotbeoverstressedtherelativesensitivityandspecificityofaccessiblealternativesneedstoenterintothecliniciansdecisionmaking:It
makeslittlesensetojumpfromarockingboattoasinkingone.Yetthisistheactionthatmaybetakenregularlybyclinicianswhochooserelianceontheirown
untestedjudgmentoveraflawedbutbetterunderstoodscreeningmechanism.

Lestthereaderhopethatifotherindicatorsofvalidityandreliabilitylookpromisingallislikelytobewellwithregardtoatestssensitivityandspecificity,considera
relevantfindingofPlanteandVances(1994)research.UsingcriteriacloselyrelatedtothoseusedinMcCauleyandSwisher(1984a),PlanteandVancerated21
languagetestsdesignedforusewith4to5yearolds.Theresearchersthenconductedastudyof4oftheteststhatmetarelativelylargernumberofcriteria(6outof
10)todeterminetheirsensitivityandspecificity.Ofthe4theyexamined,onlyoneachieved
Page221

acceptablelevels.Thus,itpaystolookforspecificinformationonsensitivityandspecificityandtodemanditfrompublishersasaprerequisitetopurchase.

Insummary,sensitivityandspecificitydataprovidespecialinsightintothewaythatmeasuresfunctionforpurposesofscreeningandidentification.Thus,theycan
provideenormouslyvaluableevidenceofameasuresvalueforthosepurposes.Whereasformanypurposessensitivityisevenmoreimportantthanspecificity,the
specificcontextinwhichthemeasureisusedandtheavailabilityofpreferablealternativeswillultimatelyaffectclinicalperceptionsofacceptablelevels.Finally,itseems
quiteprobablethattheabsenceofthisinformationfromtestmanuals,althoughcurrentlycommonplace,willberectifiedonlywhencliniciansbegintodiscriminateamong
testsonthisbasisandtodirectlyurgepublisherstotakeaction.

ChoosingaCutoffScore

Onefactorthataffectsbothsensitivityandspecificityisthecutoffusedtodeterminewhetherapositiveornegativeresulthasbeenobtained.Whenascreeningor
identificationdecisionismadeusinganormativecomparison,acutoffscoreisselectedtoindicatethescoreatwhichachildsperformanceisseenascrossingan
invisibleboundarybetweenaregionofnormalvariationforthatparticulargrouponthatparticularmeasureintoaregionsuggestingadifficultyordifferenceworthyof
attention.Clearly,however,thelocationofthecutoffpointisbotharbitraryandsignificant.Shiftingitslocationcandecreaseatestsspecificitywhileincreasingits
sensitivity,orviceversa.Thus,thechoiceofacutoffisnotatrivialmatter.

Clinicallyorientedauthorswritingaboutlanguagedisordershaverecommendedavarietyofpossiblecutoffsforusewhennormreferencedinstrumentsareusedaspart
ofdevelopmentallanguageassessments.Forexample,Owens(1995)notedthatscoresfallingbelowthe10thpercentileareoftenconsideredotherthannormal.
Leonard(1998)alsoobservedthatresearchersfrequentlyusecutoffsfalling1.25or1.5standarddeviationsbelowthemean,thusfallingclosetoOwens10th
percentile.Similarly,Paul(1995)endorsedacutoffatthe10thpercentile,correspondingtoastandardscoreofabout80andazscorefalling1.25standarddeviations
belowthemeanforscoresthatarenormallydistributed.Sheindicatedthatshebasedherrecommendation,inpart,onsimilarlevelspreviouslyrecommendedbyFey
(1986)andLee(1974).However,becauseofconcernsaboutitsarbitrarinessandquestionablepsychometricdefensibility,Paulscompletecriterionissomewhatmore
elaborate.Specifically,sherequired

thatachildthoughtbysignificantadultsinhisorherlifetohaveacommunicationhandicapshouldscorebelowthetenthpercentileorbelowastandardscoreof80on
twowellconstructedmeasuresoflanguagefunctiontobethoughtofashavingalanguagedisorder.(p.5)

Paulsintentionwastomakesurethatthisdefinitionwouldnotstrongarmchildrenwhohadnoreallifeproblemsintodiagnosessimplybecauseofdifferencesintest
scoresthat,althoughdetectable,areoflittleornopracticalsignificance.(Seealongerdiscussionofclinicalorpracticalsignificanceinchap.11.)
Page222

ItisalsoimportanttonotethatPaul(1995)recommendedtheuseoftwowellconstructedmeasures,giventhattheuseofoneortwomeasuresthatarelessthanthat
willunderminetheintentoftherecommendation.Justasachainisnostrongerthanitsweakestlink,abattery(evenofjust2measures)willbenomoreaccuratethanits
leastaccuratemember(Plante&Vance,1994Turner,1988).Becauseofthisconcern,Plante(1998)recentlyrecommendedthatasinglevalidtestalongwitha
secondfunctionalindicator(e.g.,clinicianjudgment,enrollmentintreatment)beusedforverificationofspecificlanguageimpairmentforresearchpurposes.This
recommendationleadstoanobviousparallelforinitialimplicationsandonethatcanbeseenasconsistentwithIDEA(Plante,personalcommunication).

Sometimes,whencutoffsareselectedinaccordancewithtestdeveloperrecommendations,cliniciansandresearchersusedifferentcutoffsfordifferenttests.Usually,
therecommendationsofthetestdevelopersresultinverysimilarcutoffstothosediscussedearlier.Lookingbackatthenormalcurveanditsrelationshiptodifferent
typesofscoresinFig.2.5suggeststhatsmalldifferencesincutoffsshouldresultinonlysmallshiftsinselection,thussuggestingthatthemethodusedtoselectacutoff
probablydoesnotmatter.Surprisingly,however,PlanteandVance(1994,1995)demonstratedthatanempiricallyderivedcutoffcangreatlyenhanceameasures
sensitivityandspecificity.Further,theyshowedthatempiricallyderivedcutoffsarelikelytovaryfromtesttotest,thusmakingtheuseofaonecutofffitsalltests
practicesomethingthattheywouldadviseagainst.Theirworkisdescribedbrieflyinthenextparagraphstohelpillustratethevalueofresearchintobasicmeasurement
issuessuchascutoffselection.

Intheirstudies,PlanteandVance(1994,1995)usedastatisticaltechniquecalleddiscriminantanalysisaformofregressionanalysistoexamineoutcomes
associatedwithdifferentcutoffs.Usingthistechnique,theexperimenterdeterminestowhatextentvariationinscoresisaccountedforbygroupmembershipandthen
examinestheaccuracyofpredictionsofgroupmembershipmadefromaresultingregressionequation.Itallowsonetoexaminethewaysinwhichchangingthecutoff
affectssensitivityandspecificity.

PlanteandVance(1994,1995)recommendedtwostrategiesforensuringtheavailabilityofempiricallyderivedcutoffssuchasthosethatcanbeobtainedthrough
discriminantanalysis.First,theyadvisedclinicianstoinsistthatstandardizedmeasuresoffersuchcutoffsalongwithdataconcerningsensitivityandspecificity.Second,
theynotedthepossibilityofdevelopinglocalcutoffs,aprocessthatrequiresfewerparticipantsthanlocalnormingbutthatcanrequireclinicianswhoattemptittoseek
statisticalassistance(Plante&Vance,1995).

AlthoughnotendorsedbyPlanteandVance(1995),thedevelopmentoflocalnormsmayalsorepresentaresponsiblestrategyforincreasingtheavailabilityofdata
concerningsensitivityandspecificityofdecisionsinsettingswheresufficientresourcesandnumbersofchildren(includingthosewithdisorders)exist(e.g.,seeHirshoren
&Ambrose,1976Norris,Juarez,&Perkins,1989Smit,1986).Softwaredesignedtoaidintheconstructionoflocalnorms(Sabers&Hutchinson,1990)makesthis
strategymorefeasiblethanitoncewas(Hutchinson,1996).Inaddition,thedevelopmentanduseoflocalnormshasbeenrecommendedasameansofdealingwith
Page223

biasintestingthatresultsfromtheuseofinappropriatenorms(e.g.,seeVaughnCooke,1983).

Insummary,then,thecutoffsusedtoidentifychildrensperformanceasfallingbelowexpectationsareoftenarbitrarilysetatabout1.25to1.5standarddeviations
belowthemean.However,greatersensitivityandspecificitycanbeachievedwhenempiricalmethodsareusedtooptimizetheperformanceofthemeasuresused.Not
onlydoesthispracticeconstituteanotherstepthatcanbetakenbytestauthorsandpublisherstoimprovethequalityofclinicaldecisionmakinginthefield,itrepresents
atopicofsuchpracticalsignificanceastoinviteawealthofappliedresearch.Inaddition,asPaul(1995)suggested,thecurrentstateoftheartprecludesrelianceona
singlemeasureorevenasinglebatteryofmeasurestoleadinalockstepfashiontodecisionmaking.Integrationoffunctionaldataaboutthechildwillremaina
necessarycomponentofscreeningandidentificationfortheforeseeablefuture.Asunderstandingoffunctionalorqualitativedatasuchasportfoliosandteacher
reportsofcriticalincidentsincreases(e.g.,Schwartz&Olswang,1996),theirrolewillprobablyincreaseaswell(seechap.10),withbeneficialresultsforthe
sensitivityandspecificityoftheprocess.Further,inmanyclinicalandespeciallyeducationalsettings,thechoiceofcutofftobeusedcanseemandinsomecasesmay
beoutsidethecontrolofthespeechlanguagepathologist.Theroleplayedbyeducationalagenciesinestablishingguidelinesformeasurementuseandclinicians
productiveresponsestothesearediscussedlaterinthischapterinthesectioncalledPracticalConsiderations.

Therearetheoreticalconcerns,too,abouttheuseofcutoffsthatrelatetoourunderstandingoftheverynatureoflanguageimpairmentinallchildren,butparticularlyin
thoseforwhomnoobviouscauseexists:childrenwithSLI.DollaghanandCampbell(1999)recentlycalledattentiontothefactthattheuseofanarbitrarycutoffata
pointalonganormaldistributionofscoresisatoddswiththeoreticalnotionsthatlanguageimpairmentrepresentsanaturalcategory,ortaxon.Instead,theysaythatit
impliesanassumptionthatchildrenwithimpairedlanguagemaysimplyrepresentthosechildrenwhohavelesslanguageability,inthesamewaythatshortpersons
havelessheight.ThispossibilityhasbeenpointedoutbyseveraltheoreticiansaddressingthequestionofetiologyforchildrenwithSLI(e.g.,seeLahey,1990Leonard,
1987)buthasfailedtoreceivesustainedattention.Asanimportantsteptowardrevivingconsiderationofthishypothesis,DollaghanandCampbellnotedthatthe
questionofwhetherlanguageimpairmentrepresentsadistinctcategoryversusthelowerrangeofacontinuumofperformanceisanempiricalonewithpotentially
powerfulrepercussionsforbothassessmentandtreatment.Specifically,asaworkinghypothesistheypredictthatiflanguageimpairmentistaxonic,languagedeficits
wouldbelikelytobemorefocusedandwouldthereforerequiremorefocusedassessmentsandtreatments.

DollaghanandCampbell(1999)alsonotedthatthetimemayberipeforaddressingthequestionofthenatureoflanguageimpairmentbecauseparallelconcernsin
clinicalpsychologywithregardtoschizophreniaanddepressionhavespawnedrichadvancesinmethodology(Meehl,1992Meehl&Yonce,1994,1996).They
conjecturedthattheseadvancesmightprovideanauspiciousstartingpointforadditionalefforts.Amongtheimplicationsofthisworkarethepossibilityofidentifying
thosecutoffsthattrulyidentifychildrenwhoarecategoricallydifferentintheirlanguage
Page224

skillsfromotherchildrenratherthanthosewhosimplyseemquantitativelysuspiciousbecauseoftheirlowerperformances.Thus,thesemethodsmayprovetoprovide
additionalstrategiesformorerationalcutoffselection.

RememberingMeasurementErrorinScoreInterpretation

Onceameasurehasactuallybeenselectedandadministeredandacutofflevelsettledon,theclinicianusesthetesttakersscoretoassistinadecisionregarding
screeningoridentification.Duringthisprocess,becauseoftheweightattachedtoindividualscoresinscreeningandidentificationdecisions,rememberingmeasurement
errorinscoreinterpretationbecomescriticaltosolidclinicaldecisionmakingevenwhenfunctionalcriteriaareincorporated.

Recallthatinchapter3theconceptofSEMwasdescribedasameansofconveyingtheimpactofatestsreliabilityonanindividualscore.Specifically,thelowerthe
reliabilityoftheinstrument,thehighertheerror(quantifiedusingSEM)attachedtotheindividualscore.TheimportanceofreliabilityandSEMisnotduetotheirability
toremoveerror(becausetheycant),butrathertotheirhelpingusunderstandthemagnitudeoferrorweface.

Figure9.2isintendedtoprovideanexampleillustratingtheeffectofSEMonascreeningdecision.Itshowsthesamescoreachievedbyachildontwodifferent
screeningmeasuresonewithalargerSEMandtheotherwithasmallerSEMforthatchildsagegroup.Aroundeachofthesescores,thereisa95%confidence
interval.Theconfidenceintervalrepresentsarangeofscoresinwhichitislikely(althoughnotabsolutelyassured)thatthetesttakerstruescorefalls.A95%
confidencelevelmeansthatthereisaprobabilityof95%thattheintervalcontainsthechildstruescoreand,ofcourse,5%thatitdoesnot.Itisoftenrecommended
thatclinicianscharacterizechildrensperformanceusingtherangeofscoresencompassedwithintheconfidenceinterval,ratherthanasinglescore.Further,ithasbeen
suggestedthattheSEMforameasureshouldbenomorethanonethirdtoonehalfofitsstandarddeviation(Hansen,1999).

Ifascoreof75isusedasacutoffoneachtestintheexample,clearlythetaskofdecidingthatthechildsperformancefallsbelowthatvaluebecomesmuchtrickierfor
testAthanfortestB,despiteidenticalscores.Infact,onemightbetemptedtorefrainfromusingtestAinfavoroftestBwhenscreeningchildrenofthisparticularage.
However,perhapstestAispreferableasascreeningtoolforotherreasons,forexample,becauseithasamoreappropriatenormativesampleandbetterevidenceof
validityforchildrensimilartotheonebeingtested.Inthatcase,theclinicianmaydecidetousethemeasurebutviewtheresultingdatawithgreatercircumspection.

Sometestsmakeitquiteeasytotakeerrorintoaccountduringscoreinterpretationbecauseofthewayinwhichachildsscoresareplottedonthetestform.Fortests
thatdonotprovidethisuserfriendlyfeature,however,thetestusercancalculateaconfidenceintervalusingthetablesandfollowingtheexamplelaidoutinFig.9.3.
Althoughthechoiceofconfidencelevelissomewhatarbitrary,morestringentlevelsareusuallyselectedformoremomentousdecisions.Confidenceintervalsof68,95,
Page225

Fig.9.2.Two95%confidenceintervalscalculatedforthesamescoreusingtwodifferentscreeningmeasures,onewithalargerSEM,ontheleft,andtheotherwitha
smallerSEM,ontheright.

and99%aretheonesmosttypicallyreported,with85and90%usedlessfrequently(Sattler,1988).1

Theoldadageknowyourlimitationsincludingknowthelimitationsofyourdatawouldworkasanaptsummaryofthisbriefsection.InformationaboutSEMcan
helpclarifythesignificanceofreliabilitydataforindividualclientsandcanthusbeusedtohelptheclinicianmakechoicesinthemeasuresheorsheadopts.Further,
throughthe

1AlsonotethatSalviaandYsseldyke(1991)andothers(includingMcCauley&Swisher,1984b,Nunnally,1978)recommendedaslightlymorecomplexprocedure
inwhichanestimatedtruescoreiscalculatedfirst.Thisprocedureisofferedasafirststepinappreciatingthe.potentialvalueofconfidenceintervalsbutshouldnotbe
takenasdefinitive.
Page226

Fig.9.3.Tabletobeusedincalculatingconfidenceintervals,withanexample.FromThetruthaboutscoreschildrenachieveontestsbyJ.Brown,1989,
Language,speech,hearingservicesinschools,20,p.371.Copyright1989byAmericanSpeechLanguageHearingAssociation.Reprintedwithpermission.

useofconfidenceintervalsduringinterpretationofanindividualsperformance,theclinicianisgiventheopportunitytogaugethepossibleeffectofameasuresknown
imperfection(imperfectreliabilityinthiscase).Therefore,whatmayhavebeguntosoundlikearepeatedrefraininthelastthreesectionscanbesoundedagainhere.
Oneshouldalwaysmakeuseofsuchinformationwhenitisreadilyavailable,calculateitifpossible,andencouragetestpublisherstoprovideitwhenitisneitheroffered
norcalculable.
Page227

WrestlingwiththeDisorderDifferenceQuestion

Thediversityofculturalandlanguagebackgroundsrepresentedamonganygroupofchildrencanbequitebreathtaking.EveninVermont,whichisoftencitedasoneof
theleastdiversestatesinthecountry,theschooldistrictofthestateslargestcity,Burlington(population40,000),haschildrenwhosefirstlanguagesinclude
Vietnamese,SerboCroatian,Mandarin,andArabic.Infact,in1998and1999,about25languagesotherthanEnglishwerespokenbychildrenwhoseproficiencyin
Englishwassufficientlylowtorequirespecialintervention.Duringthetimeframe19871988to19981999,thenumberofsuchchildrengrewfromjustbelowto20to
justabout300(Horness,personalcommunication).BecauseseveralnationalcompaniesarerepresentedinBurlington,therearenumerouschildrenwhohavemoved
herefromdifferentregionsoftheUnitedStateswiththeirparents.WhereassomeofthesefamilieshavemovedfromotherNewEnglandregionswithsimilarregional
dialectstoVermont,othershavemovedfromtheDeepSouthorotherregionsclaimingdistinctregionaldialects.Further,childreninthissameschooldistrictcomefrom
familieswithincomesbelowthepovertyleveltothosewithincomesinthestratosphereofaffluence.Onthebasisofthesefewfacts,itseemssafetosaythateach
speechlanguagepathologistworkinginthisschooldistrictconfrontsissuesrelatedtodifferencesinculture,regionaldialect,socialdialect,andprimarylanguageona
dailybasis.EveninVermont!

Asthisexampleillustrates,diversityaffectinglanguageuseamongyoungnativespeakersofEnglishandlanguageusebychildrenwhoareacquiringEnglishasasecond
languageistheruleratherthantheexception.Consequently,professionalswhoworkwithchildrenarechallengedtoremainvigilanttoculturalandlinguisticfactorsin
theselectionanduseofscreeningandidentificationmeasures.

Clearly,themagnitudeofthechallengedifferssubstantiallywhentheclinicianworkswithchildrenwhospeakaminoritydialectofEnglishcomparedwiththosewhoare
beingexposedtoEnglishforthefirsttimeinaschoolsetting.ThislattergroupofchildrenaresometimesreferredtoashavinglimitedEnglishproficiency(LEP).
Regardlessofwhethertheyareseenashavingalanguagedisorder,theywilloftenbeservedthroughanEnglishasaSecondLanguage(ESL)programinschool
systems.Incontrast,thechildrenwhospeakaminoritydialectofEnglishareperhapsmoreeasilymisunderstoodbytheSLPbecausetheirdifferencesindialectmaygo
unappreciated,intheassumptionthattheyarebidialectalthatis,abletousethedialectoftheschoolandaregionalorsocialdialectaswell.Theymayalsoinclude
childrenwhosefirstdialectisunknowntoboththeirclassmatesandthespeechlanguagepathologist,thusfurtherincreasingthecomplexityofthespeechlanguage
pathologistswork.

Regardlessofthedifferencesbetweenthesegroupsofchildren,anytimethereisamismatchbetweenthetoolsbeingusedorbetweentheclinicianslanguageand
cultureandthelanguageandcultureofthechild,theissueofdifferenceversusdisorderbecomesrelevant.Table9.1offersapairofhypotheticalscenariosinwhich
challengesofthistypearepresented.

Beforefiguringoutexactlyhowtorespondtothechallengesoflinguisticandculturaldiversity,however,weneedtoremindourselvesofwhatthreatstovalidityare
Page228

Table9.1
ScenariosIllustratingtheChallengesofCulturalandLinguisticDiversity

LittleEnglish,LittleVietnameseAnExperientialDeficitoraDisorder?
AlthoughVanandatwinsisterwerebornintheSouthwesternUnitedStatestoparentsofVietnameseheritage,Vanwasadoptedatage5byaprofessionalcouplein
NewEnglandafterhewasremovedfromhishomebecauseofsevereneglect.Notmuchwasknownabouthislifebeforetheadoption.However,informants
knowledgeableinVietnameseindicatedthatalthoughhisunderstandinginthatlanguageseemedexcellent,hespokelittle.Duringafosterplacementimmediately
precedinghisadoption,hehadbeguntouseEnglishasfrequentlyasVietnamese,buthecontinuedtobeveryquietaroundeveryoneexcepthisnewparents.The
speechlanguagepathologistandtheeducationalteamassignedtoworkwithVanandhisnewfamilywasinterestedinobtaininginformationaboutVanslanguage
statusinbothlanguages.
AmericanEnglishDialect,ProbablyNotaDisorder,butaProblematicDifference
RaymondmovedfromaschooldistrictinNewOrleansinwhichabout95%ofhisclassmatesinkindergartenwereBlack,toaraciallymixedsuburbofChicagoin
whichaWhitespeechlanguagepathologistwhohadbeenraisedinToronto,Canadawasassignedtoserveashisspeechlanguagepathologist.Concernshadbeen
raisedabouthisspeechintelligibilityandhisvocabularyuseandunderstandingbyhisclassroomteacher,whowasaWhitenativeofIndiana.Althoughboth
professionalshadmanyyearsofexperienceworkingwithchildrenandcolleaguesintheirraciallydiverseschool,neitherhadhadsuchadifficulttimeinunderstandinga
speakerofBlackEnglish.TheywantedtodeterminewhetherRaymondsspeechwassimplydifferentbecauseofhisdialectorwhetheritrepresentedagenuine
problem.AlthoughtheywererelievedtofindoutthatRaymondsfamilyconsideredhimacompetent,ifyoungspeaker,theywereevenmoreperplexedabouthow
theymightsmoothhistransitionintohisnewschool.

interwovenwithdiversity.IbeginbyconsideringthethreatsthatoccurininstanceswhereachildspeaksadialectofEnglishorisacquiringEnglishasasecond
languageforexample,BlackEnglishorSpanishinfluencedEnglish.AmongthethreatstovalidtestinginEnglishthathavebeenmostthoroughlydiscussedarethose
arisingfromthepotentialformeasurestousesituations,directions,formats,orlanguagethatareinconsistentwiththechildspreviousexperience(Taylor&Payne,
1983).Here,thechiefconcernisincorrectlyrespectingthepresenceofalanguagedifference,adifferenceinlanguageuseassociatedwithsystematicvariationin
semantics,phonology,andsoon,whencomparedwiththeidealizeddialectthatistypicallyrepresentedinstandardizedlanguagemeasures.Thedanger,ofcourse,is
erroneouslyidentifyingadifferenceasadisorder.ASHA(1993)hasdefinedlanguagedifferencemoreelaborately

asavariationofasymbolsystemusedbyagroupofindividualsthatreflectsandisdeterminedbysharedregional,social,orcultural/ethnicfactors.Aregional,socialor
ethnicvariationofasymbolsystemisnotconsideredadisorderofspeechorlanguage.(p.41)

Forchildrenusingminoritydialects,Englishlanguagemeasuresdevelopedwithoutattentiontodialectalandaccompanyingculturalvariationareespeciallyproblematic
forpurposesofscreeningandidentification.Theadvantagesanddisadvantages
Page229

ofalternativesforchildrenwhospeakBlackEnglishandotherminoritydialectsfuelcontinuingdiscussion(e.g.,seeDamico,Smith,&Augustine,1996Kamhi,
Pollock,&Harris,1996Kayser,1989,1995Reveron,1984Taylor&Payne,1983Terrell&Terrell,1983VanKeulen,Weddington,&DeBose,1998Vaughn
Cooke,1983).

Notsurprisingly,manystrategiesforcopingwiththiscomplexissuehavebeenconsidered,butnonearecompletelysatisfactoryforusewithchildrenspeakingminority
dialects(VaughnCooke,1983Washington,1996).Whenthecontinuinguseofnormreferencedinstrumentsforthesechildrenisentertained(e.g.,seeKayser,1989
VaughnCooke,1983),itisgenerallyrecognizedthattherearefewexistingmeasuresthathavebeenfoundtobesuitable.Thestrategiesthathavebeenrecommended
andtriedincludethedevelopmentofalternativenorms,eitherthroughaddingminoritiesinsmallnumberstonormativesamplesorobtainingnormativedataforminority
childrenideasthatare,respectively,ineffectiveorimpracticalinaddressingaproblemswiththenorms(e.g.,VaughnCooke,1983).Asecondmethodinvolves
modifyingobjectionabletestcomponents(e.g.,Kayser,1989),andathirdinvolvesdevelopingalternativescoringrulesdesignedtogivecreditforcorrectanswersin
thedialectbeingconsidered(e.g.,Terrell,Arensberg,&Rosa,1992).Bothoftheselattermethodshavebeenfoundlackingbecausetheyinvalidatethenorms,thus
transformingthetargetedmeasureintoaninformalcriterionreferencedmeasure.Table9.2listssomemodificationsintestadmin

Table9.2
ModificationsofTestingProcedures

1. Rewordinstructions.
2. Provideadditionaltimeforthechildtorespond.
3. Continuetestingbeyondtheceiling.
4. Recordallresponses,particularlywhenthechildchangesananswer,explains,comments,ordemonstrates.
Comparethechildsanswerstodialectortofirstlanguageorsecondlanguagelearningfeatures.Rescorearticulationandexpressivelanguagesamples,giving
5.
creditforvariationordifferences.
6. Developseveralmorepracticeitemssothattheprocessoftakingthetestisestablished.
Onpicturevocabularyrecognitiontests,havethechildnamethepictureinadditiontopointingtothestimulusitemtoascertaintheappropriatenessofthelabel
7.
forthepictorialrepresentation.
8. Havethechildexplainwhytheincorrectanswerwasselected.
Havethechildidentifytheactualobject,bodypart,action,photograph,andsoforth,particularlyifheorshehashadlimitedexperiencewithbooks,line
9.
drawings,orthetestingprocess.
10. Completethetestinginseveralsessions.
11. Omititemsyouexpectthechildtomissbecauseofage,language,orculture.
12. Changethepronunciationofvocabulary.
13. Usedifferentpictures.
14. Acceptculturallyappropriateresponsesascorrect.
15. Haveparentsorothertrustedadultadministerthetestitems.
16. Repeatthestimulimorethanspecifiedinthetestmanual.

Note.FromSpeechandLanguage,AssessmentofSpanishSpeakingChildren,byH.Kayser,1989,Language,Speech,andHearingServicesinSchools,20,
p.244.Copyright1989byAmericanSpeechLanguageHearingAssociation.Reprintedwithpermission.
Page230

istrationthathavebeenproposedforusewithminoritychildrenwhohavebeentestedwithexistingnormreferencedteststhesemodificationsmightprofitablybe
appliedincaseswhereadescriptionofthechildsresponsestocertainkindsofstimuliiswanted.Usually,however,thosecaseswillexistnotduringidentificationofa
languageimpairment,butduringthedescriptiveprocessthatfollowsit(seechap.10).Afourthmethodconsistsofsupplementingexistingnormreferencedmeasures
withdescriptivetools(VaughnCooke,1983),whichseemstopresentaverydifficultinterpretationchallengetotheclinicianbecausenormreferencedmeasureswillbe
assumedtobebiased,anddescriptivemeasuresareusuallynotuptothechallengeofidentification.

Findingmorewidespreadapprovalthanthosemethodsjustdiscussedarestrategiesthatentailtheabandonmentofcurrentlyavailablemeasures.Theseinclude(a)the
substitutionofdescriptivemethods(suchaslanguagesampleanalysisorcriterionreferencedmeasurese.g.,seeDamico,Smith,&Augustine,1996Leonard&
Weiss,1983Schraeder,Quinn,Stockman,&Miller,1999)and(b)developmentofnew,moreappropriatenormreferencedinstruments(VaughnCooke,1983
Washington,1996).Soleuseofcriterionreferencedapproaches,suchaslanguagesampling,hasthechiefdisadvantageofinsufficientdatasupportingthatstrategyin
screeningandidentification.WashingtonalsonotedthatlanguageanalysesthatmightbeconductedforyoungspeakersofBlackEnglisharehamperedbytheabsence
ofappropriatenormsbecausenormativedataarecurrentlyavailableonlyforadolescentsandadults.However,themanyproponentsofacriterionreferencedor
descriptiveapproach(e.g.,seeDamico,Secord,&Wiig,1992RobinsonZaartu,1996)wouldarguethatdespitetheirdrawbacks,descriptivestrategiesofferthe
leastdangerousofthechoices.Notmuchprogresshasbeenmadeinthedevelopmentofappropriatenormreferencedinstrumentshowever,thatmaychangein
responsetopressuresforimprovednonbiasedassessment.Inaddition,perusalofrecentlydevelopedtestssuggeststhatmoresophisticatedeffortsarebeingmadeto
considerdialectuseinthedevelopmentoftestsformorediversepopulations.Thishasincludedthetestdevelopersexaminationofitembiasforminoritychildren
(Plante,personalcommunication).Dependingonwhenitisobtained,theresultingdatacanbeusedinthetestsearlydevelopmenttoleadtolessbiasedtestingorcan
bepresentedtoshowthatarelativelyunbiasedmeasurehasbeenachieved.

Beyondtherealmoftraditionalrecommendationsforimprovinglanguageassessmentvalidityfordiversegroupsofchildren,attentionhasbeenpaidrecentlytothe
developmentofmethodsthatseektoreducetheeffectsofpriorknowledgeandexperienceonperformance.Twoapproachesofparticularinterestareprocessing
dependentmeasuresanddynamicassessmentmethods.Thedevelopmentofprocessingdependentmeasuresinvolvestheuseoftaskswitheitherhighnoveltyorhigh
familiarityforallparticipants(e.g.,Campbell,Dollaghan,Needleman,&Janosky,1997).Dynamicassessmentmethodsfocusonthechildslearningofnewmaterial
ratherthanacquiredknowledge.Thisisdoneasameansoflevelingtheeffectsofpriorexperienceandobtaininginformationabouthowtosupportthechildslearning
beyondtheassessmentsituation(e.g.,GutierrezClellan,Brown,Conboy,&RobinsonZaartu,1998Olswang,Bain,&Johnson,1992Pea,1996).Although
proposedasbeingapplicabletoidentificationdecisions,thesetwotypesofmeasuresaremorefrequentlyusedfordescriptivepurposesandarediscussedmore
thoroughlyinthenextchapter.
Page231

AssessmentsdesignedtoaddresstheneedsofchildrenwhocanbedescribedashavingLEParegrowinginnumber.Table9.3illustratessomeofthemeasuresthatare
beingdevelopedforusewithchildrenfromdiverselinguisticandculturalbackgrounds.Clearlyatthispoint,themajorityofthesemeasureshavebeendevelopedfor
childrenwithSpanishastheirfirstlanguage.Someofthesemeasuresaredevelopedfromscratchandthuscantakeadvantageoftheexistingknowledgebase
concerningdevelopmentanddisordersinthetargetlanguages.Incontrast,othersarelittlemorethantranslationsofexistingtestsapracticethatrequiresconsiderable
careandmaystillresultinmeasuresthatdonotgetattheheartofmajordevelopmentaltasksinthelanguage.Forexample,translationscanbehamperedbyitemsthat
donothavetruecounterpartsorthatwillrequiregreaterlinguisticcomplexitytoconveyinformationinthetargetlanguagethanintheoriginal.Consumersshouldbe
cautionedtobeskepticaloftheirowncomfortlevelwithsuchadaptationsoffamiliartests.Further,theywillwanttobecarefulofthematchbetweenthedialectspoken
bythechildandthedialectinwhichatestiswritten.

Iencourageyoutolookatmorethoroughdiscussionsofthespecialchallengesposedduringtheidentificationoflanguageimpairmentinseveralgroupswhosefirstor
majorlanguageordialectiseithernotEnglishornotthedialectofEnglishtypicalofstandardizedtests.Sourceswarrantingparticularattentionexistforchildrenwhoare
NativeAmerican(Crago,Annahatak,Doehring,&Allen,1991Leap,1993RobinsonZaartu,1996),HispanicAmerican(Kayser,1989,1991,1995),Asian
American(Cheng,1987Pang&Cheng,1998),andwhospeakBlackEnglish(Kamhietal.,1996VanKeulenetal.,1998)andregionaldialects(Wolfram,1991).

ConductingComparisonsbetweenScores

Cliniciansrarelycomparescoresondifferentinstrumentsaspartofscreening.Instead,suchcomparisonsoccurmorecommonlyduringidentification.Theyare
particularlycommoninsettingsrequiringacomparisonofnonverbalandverbalskillscalledcognitivereferencing.Despitewidespreadcriticismofthispractice(Aram,
Morris,&Hall,1993Fey,Long,&Cleave,1994Kamhi,1998Krassowski&Plante,1997Lahey,1988),itsuseisnonethelessmandatedinseveralstatesto
justifyservices.Inaddition,ithassometimesbeenusedinresearchdefinitionsofSLIandotherlearningdisabilities(seealengthierdiscussionofthispointinchap.5).
Comparisonsofthiskindarealsousedasameansofidentifyingstrengthsandweaknessesinpreparationforplanninginterventionadescriptiveusethatistouchedon
inthenextchapter.

Whensinglepairsofscoresarecompared,thecomparisonisfrequentlyreferredtoasdiscrepancyanalysiswhenlargernumbersofscoresarecompared,itismore
frequentlyreferredtoasprofileanalysis.Numerousdiscussionsofthehazardsofthistypeofcomparisonareprovidedintheliterature(e.g.,McCauley&Swisher,
1984bSalvia&Ysseldyke,1998).Thefocusofthecurrentdiscussionistheuseofsuchcomparisonsinidentification.

Forpurposesofillustration,imaginethatachildsoverallscoreonalanguagemeasureistobecomparedwithherperformanceonanonverbalmeasureofintelli
Page232

Table9.3
SelectedTestsDesignedforChildrenWhosePrimaryLanguageIsNotEnglish
(Compton,1996Roussel,1991)

OralLanguage
Modalities&
Test Ages Language Domains Reference

BilingualSyntaxMeasure Tsang,C.(n.d.)BilingualSyntaxMeasureChinese.
GradesK12 Chinese ESem
Chinese(Tsang,n.d.) Berkeley,CA:AsianAmericanBilingualCenter.
SpanishStructured
Werner,E.O.,&Kresheck,J.S.(1989).Spanish
PhotographicExpressive 30to511
Spanish E StructuredPhotographicExpressiveLanguageTest.
LanguageTest(Werner& 40to95
Sandwich,IL:Janelle.
Kresheck,1989)
BerSilSpanishTest(Beringer, Beringer,M.(n.d.).BerSilSpanishTest.RanchoPalos
4to12years Spanish RSem,Morph
n.d.) Verdes,CA:TheBerSilCompany.
CarrowWoolfolk,E.(n.d.).AustinSpanish
AustinSpanishArticulationTest
3yearstoadult Spanish EPhon ArticulationTest.Allen,TX:DLMTeaching
(CarrowWoolfolk,n.d.)
Resources.
ComptonSpeechand
Compton,A.J.,&Kline,M.(n.d.).ComptonSpeech
LanguageScreening
3to6years Spanish R&EPhon,Sem,Syn andLanguageScreeningEvaluationSpanish.San
EvaluationSpanish(Compton
Francisco:InstituteofLanguage.
&Kline,n.d.)
TestdeVocabularioen Dunn,L.M.,Lugo,D.E.,Padilla,E.&R.,EDunn,L.M.
ImagenesPeabody(Dunn, 26to1711 Spanish RSem (1986).TestdeVocabularioenImagenesPeabody.
Lugo,Padilla,&Dunn,1986) CirclePines,MN:AmericanGuidanceService.
Page233

ExpressiveOneWordPicture Gardner,M.E(n.d.).ExpressiveOneWordPicture
VocabularyTestSpanish 2to11 Spanish ESem VocabularyTestSpanish.SanFrancisco:Childrens
(Gardner,n.d.) HospitalofSanFrancisco.
PreubadelDesarrolloInicial Hresko,W.P.,Reid,D.K.,&Hammill,D.D.(n.d.).
delLenguaje(Hresko,Reid,& 3to7 Spanish RSem,Syn PreubadelDesarrolloInicialdelLenguaje.San
Hammill,n.d.). Antonio,TX:ProEd.
ClinicalEvaluationofLanguage Semel,E.,Wiig,E.H.,&Secord,W.(n.d.).Clinical
R&ESem,Morph,
Function3SpanishEdition 6to21 Spanish EvaluationofLanguageFunction3SpanishEdition.
Syn,Prag
(Semel,Wiig,&Secord,n.d.) SanAntonio,TX:PsychologicalCorporation.
DelRioLanguageScreening Toronto,A.S.,Leverman,D.,Hanna,C.,Rosenzweig,
Test(Toronto,Leverman, P.,&Maldonado,A.(n.d.).DelRioLanguage
3to6 Spanish RSem
Hanna,Rosenzweig,& ScreeningTest.Austin,TX:NationalEducational
Maldonado,n.d.) Laboratory.
PreschoolLanguageScale3 Zimmerman,I.L.,Steiner,V.,&Pond,R.(1992).
(Zimmerman,Steiner,&Pond, Birthto6years Spanish E&R PreschoolLanguageScale3.SanAntonio,TX:
1992) PsychologicalCorporation.
Hedrick,D.L.,Prather,E.M.,Tobin,A.R.,Allen,D.
SequencedInventoryof
Y.,Bliss,L.S.,&Rosenberg,L.R.(1984).Sequenced
CommunicationDevelopment 04to40 Spanishtranslation E&R
InventoryofCommunicationDevelopmentRevised
Revised(Hedricketal.,1984)
Edition.Seattle,WA:UniversityofWashingtonPress.
BilingualSyntaxMeasure Tsang,C.(n.d.).BilingualSyntaxMeasureTagalog.
GradesK12 Tagalog E
Tagalog(Tsang,n.d.) Berkeley,CA:AsianAmericanBilingualCenter.

Note.E=Expressive.R=Receptive.ESem=ExpressiveSemantics,etc.Morph=Morphology.Phon=Phonology.Syn=Syntax.Prag=Pragmatics.
Page234

gence.Imaginethatshereceivesastandardscoreof70ontheformerand90onthelatter.Onthefaceofthiscomparison,itlookslikethereisquiteadifference.
However,differencesbetweenscores,alsocalleddifferencescoresordiscrepancies,areoftenlessreliablethanthescoresonwhichtheyarebased.Infact,the
likelihoodthatobserveddifferencesareduetoerrorratherthanrealdifferencesisaffectedbythreefactors:thereliabilityofeachmeasure,thecorrelationofthetwo
measures,andthesimilarityoftheirnormativesamples(Salvia&Ysseldyke,1998).

Thetaskofassessingnormcomparabilityisasstraightforwardaslookingoverdescriptionsofeachnormativegrouptodeterminewhethertheyseemtodifferinways
thatcouldaffectthescorestobecompared.Toseewhythisisnecessary,recallthatthestandardscoresbestusedtosummarizetestperformanceincludethegroup
meanintheircalculation.Therefore,somethingaboutthenormativegroupmaypushonegroupmeanhigher(e.g.,onegroupismoreeliteinsomesensethanthe
other).Consequently,onewouldfaremorepoorlyinacomparisonagainstthatgroupthanagainstagroupwithalowermean,evenifonestrueabilitiesinthetwo
areaswerecomparable.Toprovideapoignantexample,imaginearuthlessclinicianhasdecidedtocompareyourlanguageandnonverbalskillsusingscoresobtained
bycomparingyourperformancesagainstthoseofNobellaureatesinliteraturefortheformerandfifthgradersforthelatter.Notonlycouldyoulegitimatelyquestionthe
inappropriatenessofthenormsasabasisofeachofthescores,youcouldalsovehementlyprotesttheresultingcomparison.Thankfully,flagrantmismatchesbetween
testnormsusedincomparisonsmaynotoccuroutsideofexampleslikethisone.However,ifoverlooked,moresubtlemismatchescannonethelesscontributetopoor
decisionsandinappropriateclinicalactions.

Takingtesterrorandtestcorrelationintoaccountislessstraightforwardthaninspectingnorms.Onthebasisofideasanalogoustothoseusedforcalculatinga
confidenceintervalaroundasinglescore,however,itispossibletocalculateaconfidenceintervalaroundadifferencescore.SalviaandYsseldyke(1998)described
twomethodsbasedondifferingassumptionsaboutthecausalrelationshipofthetwoskillsbeingcompared.Inadditiontotheactualscoredata,bothmethodsrequire
informationaboutthereliabilityofthemeasuresbeingusedandabouttheircorrelation.Whereastherelevantinformationaboutreliabilityandthenatureofnormative
samplesshouldbereadilyavailableforindividualmeasures,informationaboutthecorrelationbetweenmeasureswilloftenbelacking.Inthatevent,abandoningadirect
comparisonandinsteadnotingtheresultsofeachtestassupportingornotsupportingtheidentificationofaprobleminagivenareamayrepresentthebestalternative
(McCauley&Swisher,1984b).

Evenwhenadifferencebetweentwoscoresisfoundtobereliable,SalviaandGood(1982)pointedout,adifferenceofthatmagnitudemaynotbeparticularly
uncommon,or,evenmoreimportantly,itmaynotbefunctionallymeaningful.Becauseoftheresourcesinvolved,determiningthefunctionalsignificanceofdifferencesin
skilllevelsrepresentsyetanotherareainwhichcliniciansmustlooktotheresearchliteraturetohelptheminterprettheirclinicaldata.Fortunately,incaseswhere
comparisonsbetweenscoresaffectidentificationdecisions,thereisarichliteratureexaminingtheseissues(e.g.,forSLI).Clinicianscanbemoreactiveandworkto
changepolicyinsettingsinwhichtheuseofdiscrepanciesismandatedforpurposesforwhichtheyhavebeenfoundtolackmeaning.
Page235

Insummary,comparingscoresisamorecomplicatedendeavorthanitfirstappears,involvingasitdoesnotonlythechildstestscoresbutalsothepropertiesofthe
twotests,especiallytheirnormsandintercorrelaltion.Awellreasonedconservatisminundertakingidentificationsbasedonsuchcomparisonsshouldbejoinedbya
healthyappetitefortheclinicalliteratureexploringtheirsignificance.

TakingintoAccountBaseRatesandReferralRates

Eachofthespecialconsiderationsaddressedearlierhadamorespecificfocusontestselectionorontheuseoftestswithaparticularchild.Twootherfactorsthat
affectscreeningandidentificationdecisionsreallyrepresentfeaturesoftheclinicalenvironment:therarityofthedisorder(thebaserateofthedisorder)andthe
frequencywithwhichreferralsaremadeinaparticularsetting(thereferralrate).Inthissection,thesetwotopicsarediscussedbrieflybecauseoftheireffecton
screeningprograms.

Thelowerthebaserateofthedisorderthatis,therarerthedisorderinthegeneralpopulationthemorelikelyitbecomesthatthepositiveresultsofscreeningor
identificationareactuallyfalsepositivesratherthantruepositives(Hummel,1999).Shepard(1989)pointedoutthatalthoughpeopleunderstandthatclassificationerror
willoccurbasedonfalliblemeasuresanddecisionprocesses,theyfailtoappreciatethatthaterrorwillfallequallyonthosechildrenwhoareidentifiedashavinga
disorderasthosewhoarenot,evenwhenthevaliditycoefficientforthemeasurebeingusedisquitelarge.Sheconcludedthatwhenbaseratesarelow,evenwith
reasonablyvalidmeasures,theidentificationswillbeequallydividedbetweencorrectdecisionsandfalsepositivedecisions(Shepard,1989,p.551).Thisproblemis
particularlyacutewhenmeasuresarelessvalidforagivenpopulation,suchasminoritychildren,whereoveridentificationisverylikelytoresult(Schraederetal.,1999).

Concernaboutlowbaserateshasledpublichealthresearchersandpsychologistsinterestedinrarepsychiatricoutcomes(e.g.,suicide)todevelopseveralstrategies
designedtotargetscreeningatsubsetsofthelargerpopulationwithhigherbaserates.Theseincludestrategiesthatincludetheuseofmultistepscreeningprocedures
andtheapplicationofscreeningprocedurestosubgroupswhoareexpectedtohavehigherprevalenceratesthanthegeneralpopulation(Derogatis&DellaPietra,
1994).Currently,theprevalenceofchildhoodlanguagedisordersacrossalltypesisnotparticularlylow,ascanbeillustratedbythefactthatitisestimatedthatchildren
withlanguagedisordersconstitute53%ofallspeechlanguagepathologistscaseloads(Nelson,1993).Nonetheless,itissufficientlylowthatcarefulselectionof
groupsforlanguagescreeningmakesgoodsense.Childrenaboutwhomconcernsareexpressedorwhoaredemonstrativelyfailinginsomeaspectoftheiradaptation
toschoolorhomeenvironmentsmakeobviouscandidatesformorefocusedscreeningsandindeedareoftenseenforscreeningpriortomorecomprehensive
evaluations.

Screeningprogramsinpreschooleducationareassociatedwithenormousdifferencesinreferralrates(Thurlow,Ysseldyke,&OSullivan,1985,ascitedinNuttallet
al.,1999),theratesatwhichchildrenwhoarescreenedarereferredonforadditionalassessment.Thisvariabilityleadstoconcernsaboutoverreferralwhenreferral
ratesareparticularlyhighandunderreferralwhentheyareparticularlylow.Because
Page236

overreferralsneedlesslytaxclinicalresources,parentalconcern,andthechildspatience,whereasunderreferralsdeprivechildrenofneededattention,stepstostudy
andalterreferralrateshavebeenrecommended.Changesinthetargetsforscreeningandthecriteria(includingcutoffs)usedcanbemadetoaddressverified
inadequaciesinthescreeningmechanism.Inaddition,theuseofasecondlevelscreeningusingmeasuresthatareintermediateintheirefficiencyandcomprehensiveness
betweeninitialscreeningsandfullfledgedassessmentshasbeenrecommended(Nuttalletal.,1999).

AvailableTools

Screening

Availablescreeningmeasuresdifferintermsofwhetherinformationisobtaineddirectlybythespeechlanguagepathologistandwhetherthemeasurementisformalor
informal.Screeningmethodsincludetheuseofnormreferencedstandardizedtoolsaswellasinformalcliniciandevelopedmeasures.Overthepastfewyearstherehas
beengrowinginterestinthedevelopmentofquestionnairesthatmightbeusedtoincreasetheinvolvementofparentsandothersfamiliarwiththechildandimprovethe
qualityofinformationobtainedfromthem.Morerecentlystill,therehasbeenaninterestinthedevelopmentofcriterionreferencedauthenticassessmentsinwhich
specificminimalcompetenciesareevaluatedinafamiliarsetting.Schraederetal.(1999)describedsuchaprotocolthatwasdevelopedforusewithyoungspeakersof
BlackEnglish.BecauseitselementswereselectedfortheirhighdegreeofoverlapwithfeaturesofStandardAmericanEnglish,Schraederandhercolleaguessuggested
itspotentialrelevanceformanychildreninthetargetedagegroupof3yearolds.

ParentQuestionnairesandRelatedInstruments

Althoughhistoricallysomeinstrumentshaveincorporatedtheuseofparentreportforveryyoungchildren(e.g.,theSequencedInventoryofCommunicative
Development,Hedrick,Prather,&Tobin,1975),extensivedevelopmentofparentquestionnairesforlanguagedisorderscreeninghasblossomedonlyinthepast
decade.Theuseofsuchinstrumentsiswelcomedfromafamilycenteredperspective(Crais,1993)becauseparentsaregiventheopportunitytosharetheirexpertise
concerningthechildaspartoftheircollaborationintheassessmentprocess.Inaddition,thesemeasuresalsoshowgoodpotentialforefficient,validusefroma
psychometricpointofview.Oneobviousadvantagethattheyhaveovertheclinicianadministeredproceduresistheirabilitytoobtaininformationthathasbeen
accumulatedbytheparentovertimeusingquestionsthatcoveravarietyofsituationsandsettings.Forsomechildrenandatsometimes,thetestingadvantageis
irrefutable:Thechildwillsimplynotcooperateformoredirecttestingorissothoroughlyaffectedbythetestingsituationastomaketheresultsofstructured
observationshopelesslyflawed.Evenwhenchildrenaremoreamenabletointeractingwithstrangers,parentquestionnairesmayhelpremovethesubtlerinvalidating
influenceoftheclinicianonthechildsbehavior(Maynard&Marlaire,1999).
Page237

Onthebasisofagrowingnumberofstudies,itappearsthatparentquestionnairesmayreliablyandvalidlybeusedtoobtaininformationaboutanumberoflanguage
areas,especiallyexpressivevocabularyandsyntaxalthoughmostindividualmeasuresarestillveryundeveloped.Leadingthetrendtowardincreaseddevelopmentof
thesemeasures,theMacArthurCommunicationDevelopmentInventories(Fensonetal.,1991)hasbeenthoroughlystudied(e.g.,Bates,Bretherton,&Snyder,
1988Dale,Bates,Reznick,&Morisset,1989Reznick&Goldsmith,1989).Inaddition,ithasalsobeeneffectivelyadaptedforusewithotherlanguages,including
Italian,Spanish,andIcelandic(Camaioni,Castelli,Longobardi,&Volterra,1991JacksonMaldonado,Thal,Marchman,Bates&GutierrezClellan,1993
Thordardottir&EllisWeismer,1996).Othertoolsthatassesscommunicationmorebroadlyhavealsobeendevelopedbuthavereceivedlesswidespreadattentionand
validation(e.g,Girolametto,1997Hadley&Rice,1993Haley,Coster,Ludlow,Haltiwanger,&Andrellos,1992).Table9.4listsfiveinstrumentsforusewith
Englishspeakingchildrenundertheageof3,eachofwhichconsistsofaparentquestionnaireormakesuseofparentreportforatleastsomeitems.

Questionnairesthattakeadvantageofthefamiliarityofotheradultswiththechildusuallyclassroomteachersarealsobeingdeveloped(Bailey&Roberts,

Table9.4
InstrumentsforUseWithChildrenUnder3YearsofAge,
IncludingParentReports

Receptiveor AreasofLanguage
MeasureandSource Agescovered
Expressive Covered

LanguageDevelopmentSurvey(Rescora,1989).FromThelanguagedevelopment
survey:Ascreeningtoolfordelayedlanguageintoddlers.JournalofSpeechand 2yearolds E Semantics
HearingDisorders,54,587599.
MacArthurCommunicativeDevelopmentInventories(Fenson,Dale,Reznick,Thal,
Bates,Hartung,Pethick,&Reilly,1991).SanDiego,CA:SanDiegoStateUniversity, 8monthsto2years E Semantics
CenterforResearchinLanguage.
ReceptiveExpressiveEmergentLanguageTest(2nded.Bzoch&League,1971).
0to3years RandE
Austin,TX:ProEd.
Pragmatics,play,
RosettiInfantToddlerLanguageScale(Rosetti,1990).EastMoline,IL:
0to3years RandE comprehension,
LinguiSystems.
expression
Phonology,
SequencedInventoryofCommunicationDevelopmentRevised(Hedrick,Prather,&
4monthsto4years RandE morphology,syntax,
Tobin,1984).Seattle,WA:UniversityofWashingtonPress.
semantics
Page238

1987Sanger,Aspedon,Hux,&Chapman,1995Semel,Wiig,&Secord,1996Smith,McCauley,&Guitar,inpressStokes,1997).Resultsofthesehavealso
beencomparedwithparentquestionnaires(Whitworth,Davies,&Stokes,1993)andagainstformalassessments(Botting,ContiRamsden,&Crutchley,1997).
Usually,however,thesequestionnaireshavenotbeendevelopedforuseintheidentificationprocess,butrathertodescribethenatureofproblemsfacingthechildinthe
classroom.Thus,theywillbeconsideredinthenextchapter,whichdealswithdescription.

NormReferencedStandardizedMeasures

Standardizedmeasuresarenotwellestablishedasscreeningtoolsinthefield.Only50%ofthe109cliniciansinOregonrespondingtoasurveyconcerningtheirtestuse
reportedthattheyusedstandardizedmeasuresforscreening(Huangetal.,1997).AnotherrelatedresultfromthatsamestudywasthatonlyIscreeningtest(the
ScreeningTestofAdolescentLanguage,Prather,Breecher,Stafford,&Wallace,1980)appearedinthelistof10teststhataremostcommonlyusedbyspeech
languagepathologistsintheirworkwithfouragegroups(03,45,612,and1319).Nonetheless,standardizedscreeningofyoungerchildrenhasreceivedincreased
attentionwiththeIDEArequirementthatchildrenwithcommunicationdisordersbeidentifiedbeforeenteringschool(Nuttall,Romero,&Kalesnik,1999Sturner,
Layton,Evans,Heller,Funk,&Machon,1994).

Stumeretal.(1994)reviewed51measuresavailableforspeechandlanguagescreeningcoveringatleastsomepartofthe36yearagespan.Inthatreview,the
researchersfoundthatonly6ofthemeasurestheyexaminedprovidedsufficientnormativedata,andwerebothbrief(i.e.,requiring10minutesorless)and
comprehensive(i.e.,coveringmorethanonemodalityordomain).Thus,despiteaplayingfieldfilledwithmanyplayers,thenumberofinstrumentsthatwarrantserious
considerationasacomprehensivelanguagescreeningtoolarerelativelyfew.Table9.5describesthefourtoolssupportedinSturneretal.sreview.

DespitethefocusofSturneretal.(1994)onpreschoolscreeningmeasures,manyofthemeasuresstudiedbySturneretal.alsoextendtocoverschoolagechildren.
Nonetheless,theavailabilityofmeasuresforbothyoungerschoolagechildrenandadolescentsisgreatlyreducedcomparedwiththoseavailableforpreschoolers.This
isprobablydue,forthemostpart,tothevariousreferralmechanismsthatcanreducetheneedforformalscreenings.Also,thepersistentnatureoflanguageproblems
meansthatscreeningofolderchildrenandadolescentsforlanguagedisorderswillusuallyonlybeneededifscreeningshavebeenabsentorineffectiveatyoungerages.

Identification

NormReferencedStandardizedInstruments

Evenchildrenwithinanyspecificcategoryofdevelopmentallanguagedisorders(i.e.,languagedisorderassociatedwithhearingloss,autismspectrumdisorder,mental
retardation,andSLI)varyconsiderablyintheareasoflanguagethatareaffected.Thus,itisimportanttobequitecomprehensiveintheidentificationprocess,
particularlybecause
Page239

Table9.5
CommunicationScreeningMeasuresforChildrenBetween3and7YearsofAgeThatWereFoundtoBeBrief,NormReferenced,andComprehensive(Definedas
Phonology[Articulation]andOtherLanguageDomains)
bySturner,Layton,Evans,Heller,Funk,andMachon(1994)

Ages Reviewedin
Test Covered Expressive Receptive Semantics Morphosyntax Phonology Pragmatics MMY?

CommunicationScreen
3to7
(Striffler&Willis,1981) X X X
years

FluhartyPreschoolSpeechand
LanguageScreeningTest
2to6
(Fluharty,1978) X X X X X X
years

PhysiciansDevelopmentalQuick
<1to6
Screen(Kulig&Baker,1975) X
years

StephensOralLanguageScreening
PreKlst
Test(Stephens,1977) X X X
grade

SentenceRepetitionScreeningTest

(Sturner,Kunze,Funk,&Green,1993) 4to5
X
years

TexasPreschoolScreening(Haber&Norris,
4to6
1983) X X
years

Note.MMY=MentalMeasurementYearbooks.
Page240

partofthatprocesswilloftenbetheidentificationofwhichaspectsoflanguageareaffectedMorecomprehensivecoverageacrossmodalities(receptive,expressive)
anddomainsoflanguage(e.g.,syntax,phonology)canbeachievedthroughtheuseofameasuredesignedforthatpurpose(e.g.,theTestofLanguage
DevelopmentPrimary:3Newcomer&Hammill,1997).Itcanalsobeachievedthroughtheuseofabatteryofteststhatprovidemorecomprehensivecoverageor
throughacombinationofthesemethods.Evenwhenacomprehensivemeasureisused,however,certainaspectsoflanguagefunction(especiallypragmaticsand
discourse)arealmostcertainlyoverlooked.

TheAppendixlistsover50teststhathavebeendescribedasusefulintheidentificationprocess.Thetableincludesverybasicinformationaboutthetestsidentifying
information,content,andintendedpopulation.Almostallofthemeasurespublishedbetween1989and1996havebeenreviewedfortheMentalmeasurements
yearbookonlinereviewservice,thusallowinganyonewithaccesstotheInternetanopportunitytoexamineatleastone,andoftentwo,independentreviews.Earlier
testsarelikelytohavebeenreviewedintheMentalmeasurementyearbookprintedvolumes.Testspublishedafterabout1996arelikelytobereviewedsoon,
perhapsevenbeforethepublicationofthisbook.

AlthoughtheAppendixisnotintendedtobeexhaustive,thenumberoftestsitincludesillustratesthestaggeringtaskfacingclinicianswhomustchooseamongthem.Itis
interestingtonotetherelativelylargenumberofteststhathavebeencreatedinthe1990sandtherelativelysmallnumberofpublishinghousesresponsiblefortheir
availabilityifnottheiroriginalconstruction.Ontheplusside,thismeansthatineffortstoincreasethequalityofavailablemeasures,individualcliniciansandthe
professioncanfocustheircooperativeinteractionswithfewerparties.Onthenegativeside,itmeansthatpublishersareofteninthepositionofcompetinglargelywith
theirownproductsaprospectthatmakesitunlikelyforfreemarketpressurestohelpdrivethequalityoftestshigher.

CriterionReferencedMeasures

Intherealmofcriterionreferencedmeasures,specificmeasuresobtainedthroughlanguageanalysis(e.g.,meanlengthofutterance,orMLU14morphemecount
typetokenratio)aregainingincreasingsupportintheidentificationprocess(e.g.,Arametal.,1993).Inparticular,someresearchershaveusedMLUasan
identificationtoolandfoundittobemoreconsistentwithclinicianjudgmentsthancertaintestdata(M.Dunn,Flax,Sliwinski,&Aram,1996).Usually,however,MLU
isusedincombinationwithnormreferencedmeasures(Leonard,1998).Becauselanguageanalysismeasuresaretypicallyconsideredmoreusefulindescriptionthan
identification,thenextchaptercontainsamoredetailedaccountofrecentstudiesinwhichtheirstrengthsandlimitationsareexamined.Nonetheless,itisimportantto
reiterateherethattheiruseinidentificationisgrowinginsignificance.

PracticalConsiderations

Inchapter4,severalvariablesaffectingclinicianswerehighlightedfortheirpotentialeffectsonspeechlanguagepathologists.Thesevariablesincludedfederal
legislation,localregulations,andglobalchangesinperspectivetowardbehavioralproblems.In
Page241

casesofscreeningandidentification,particularlyastheyarepracticedinschoolsettings,thosevariablescandramaticallyaffecttheshapeofpracticebothforbetter
andforworse(Cirrinetal.,1989).Inthisbriefsection,theeffectsofthesefactorsonscreeningandidentificationareprimarilydiscussedthroughpracticeconstraints
relatedtodeterminingchildrenseligibilityforservices.

In1989,NyeandMontgomeryexaminedthecriteriausedin47statestoidentifychildrenashavingalanguagedisorder.Theyusedacaseexampleinwhicha13year
oldgirlwhomovedfrequentlybecauseherfatherwasinthemilitaryhadvariouslybeenconsideredlanguagedisorderedinonestate,learningdisabledinanother,
ineligibleinathird,andeligibleonlyfortutorialsupportinafourth.(Nye&Montgomery,1989,p.26).Inthe47statestheyexamined,theyfoundthatalthoughmost
providedspecificdefinitionsoflanguagedisorder,thedefinitionswerehighlyinconsistentfromonestatetothenext.Onlyaboutahalfofthestatesmadesome
referencetothecomponentsoflanguage,andamongthosethatdid,semanticsandsyntaxwereincludedfarmorefrequentlythanphonology,morphology,and
pragmatics.Twentyonestatesrequiredtheuseofatleastonestandardizedlanguagetestandonly7requireduseofalanguagesample.Threedifferentmeansoffinding
eligibilitywereidentifiedacrossthestatestheuseofadiscrepancyformula,aratingseverityscale,andprofessionalreport.NyeandMontgomerynotedthepoor
reliabilitylikelytobeattachedtotheuseofratingseverityscales.Consistentwiththepoorevaluationofdiscrepancyscoreseveninthe1980s,theauthorsexpressed
dismayattherelativefrequencywithwhichdiscrepancyformulaswereused.However,theyseemedtohavecombinedinstancesinwhichacutoffisused(e.g.,1.5
standarddeviationsbelowthemeanonastandardizedmeasure)withthetrulymorenotoriousinstancesofcognitivereferencinginwhichadiscrepancyisfound
betweentwomeasuresforagivenchild.Thispracticemakestheextentofcognitivereferencingdifficulttodeterminefromtheirreport.Intheirconclusions,Nyeand
Montgomerypointedouttheneedforgreateruniformityinterminologyandcriteriausedwiththispopulation.

Incaseyouhavebeenreadingthisaccountandhopingthatthingschangedrapidly,abrieflookatsimilarvariables4yearslater(Apel,Hodson,Shulman,&Gordon
Brannan,1994)willbeofinterest.Apelandhiscolleaguesexaminedtheeligibilityguidelinesformoststates(dataforTennesseecouldnotbeobtained)andforthe
DistrictofColumbia.Thedatashowedcontinuinginadequacyinthedefinitionsbeingused.DefinitionsoflanguageusedbystateDepartmentsofEducationincluded
referencetobothoralandwrittenlanguageonly40%ofthetime,withthemajorityofstatedefinitionsincludingeithernoreferencetooralorwrittenlanguage(40%)or
definitionsaddressingorallanguageonly(20%).Specificguidelinesforeligibilitywereoftenmissing(46%)orwerequiteheterogeneous.Althoughstandardscores
oftenfiguredinavailableguidelines,cutoffswerequitevariable(rangingfrom1.5togreaterthan2standarddeviationsbelowthemean),encouragementtousemultiple
standardizedmeasureswasoftenabsent,andseverityratingsweresometimesusedasbasesforeligibility.Whenspecificcriteriaforpreschoolchildrenweresought,
only8states(16%)haddevelopedcriteriaforthatpopulationandthetypesofcriteriausedwerequitevariable.Amongthepracticesincorporatedintheseguidelines
weretheuseofpercentagedelayasthesolecriterionoraspartofamorecomplexcriteriona
Page242

practicethat,unfortunately,reliesontheuseofnotoriouslyunreliableageequivalentscores.

Inshort,4yearsdidnotappeartohaveresultedinmanyimprovementsinthepracticesreflectedinstateregulations.Wherearewetoday?Astudyofstateregulations
comparablewiththoseofNyeandMontgomery(1989)andApeletal.(1994)iscurrentlyunderwaybyASHA(SusanKarr,personalcommunication).Althoughthese
dataareintheprocessofbeinganalyzed,itseemsunlikelythatthefitbetweenlegislativelyinfluencedpracticeandbestpracticeswillhavebeenbroughtintomuch
betteralignmentthanthatreportedadecadeagobyNyeandMontgomery.Onepositivetrend,however,istheintentionofthedevelopersofthismostrecentreportto
pairrecommendationsforcomponentscomprisingadefensiblesetofguidelineswithpreliminaryfollowupeffortsdesignedtoresultintheredraftingofguidelinesinat
leastasmallnumberofstates(SusanKarr,personalcommunication,October,1999).

In1997,MerrellandPlantecalledattentiontotheneedformorestudiesaimedatfurtheringthedevelopmentofempiricalbasesfortestselection.Inparticular,they
notedthatsuchstudiescanminimizetestselectionbasedonsubjectivegrounds,suchastestfamiliarityandtherecommendationsormandatesofsupervisorsor
districts.Althoughrespondingtolegalandworkplaceobligationsisanecessarypartofclinicalpractice,thenatureoftheresponsecangobeyondasimplecompliance
withanunsatisfactorystatusquo.Moresatisfyingandethicalresponsesincludeincreasingtheknowledgebaseoftheprofessionthroughstudiesintendedtoidentifybest
practices,increasingtheknowledgebaseofindividualsaroundmeasurementissues,andworkingwithprofessionalorganizationsatthestateandnationallevelstoeffect
neededchanges.

Summary

1.Screeningprocedures,whichtypicallyaredesignedtobeefficientintermsoftimeandotherresources,leadtodecisionsthatachildreceivefurtherassessment.
Strategictargetingofgroupstobescreenedandtheuseofmultiplestepsinscreeningprocedurescanimprovescreeningaccuracywhenconcernsaboutrarityofthe
disorder(lowbaserates)andaboutoverlyhighreferralratesareencounteredinaparticularsetting.

2.Identificationinvolvesthedeterminationthatalanguageproblemexists,usuallythroughtheuseofnormativecomparisonsfacilitatedbynormreferencedmeasures.
MethodsusedinidentificationareoftenaffectedbytheeligibilityrequirementsinstitutedbystateDepartmentsofEducation.

3.Measuresofsensitivityandspecificityprovideimportantempiricalbasesfortestselection.

4.Cutoffscoresareusedinresearchandclinicalpracticetostandardizeidentificationdecisions.Althoughtheirempiricaldeterminationisfeasible,theyareoftenrelated
tostateeligibilityrequirementsandarebestusedinconjunctionwithawarenessofthepossibleinfluenceofmeasurementerrorandfunctionalcriteriathatassociatetest
performancewithrealworldeffectsonthechildssocialfunctioning.
Page243

5.Forallchildren,butparticularlyforthosewithlimitedEnglishproficiencyordialectusethatdifferssubstantiallyfromtheclinicians,thecliniciansattentiontothe
effectsoflanguagedifferenceandculturaleffectsonassessmentcanenhancevalidity.Althoughcontroversypersistsinthefaceofaninadequatebutgrowingliterature
onthesubjectoflanguageandculturalinfluencesonassessment,clinicalstrategiesformitigatingnegativeeffectsonassessmentabound.

6.Whenscoresondifferentmeasuresarecomparedwithoneanotherduringtheidentificationprocess,factorsrequiringconsiderationincludetheeffectsoftesterror,
testcorrelation,anddifferencesinnormativegroups.

7.Althoughmostmeasuresusedinscreeningofolderchildrenarestandardizednormreferencedtests,theuseofparentquestionnairesforyoungerchildrenand
criterionreferencedmeasuresderivedfromlanguageanalysesisbecomingmorecommonwithincreasingresearch.

8.Amongpracticalfactorsaffectingtheselectionofmeasuresforuseinscreeningandidentificationarestateguidelines,whichhavehistoricallybeenslowtorespondto
professionalrecommendationsregardingbestpractices.

KeyConceptsandTerms

cutoffscore:thescorethatservesasadecisionboundaryinscreeningoridentification,suchthatscoresaboveaparticularlevelareseenarepresenting
nonproblematicperformanceandthosebelowthatlevelareseenasindicativeofpotentialdisorderordifference.

goldstandard:ameasureusedasthebasisforcomparisonwhenasecondmeasureisbeingevaluated.Itisthoughttoprovideatruemeasurementofthebehavioror
characteristicbeingmeasured.

languagedifference:adifferenceinlanguageusereflectingsystematicvariationinphonology,syntax,semantics,andsoforth,whencomparedwiththedialectthatis
typicallyrepresentedinstandardizedlanguagemeasures.

limitedEnglishproficiency(LEP):languagedifficultiesinEnglishthatappeartoberelatedprimarilytoineffectiveorinsufficientexposuretothelanguageratherthan
toalanguagedisorder,whichmaynonethelessbecoexisting.

personfirstnomenclature:usingtermssuchasachildwithimpairedlanguageinsteadofalanguageimpairedchildtoavoidundueemphasisontheroleofthe
probleminunderstandingthechild.

referralrate:therateatwhichchildrenwhoarescreenedarereferredonforadditionalassessment.

sensitivity:theabilityofameasuretogiveapositiveresultwhenthepersonbeingassessedtrulyhasthedisorder.

specificity:theabilityofameasuretogiveanegativeresultwhenthepersonbeingassessedtrulydoesnothavethedisorder.
Page244

StudyQuestionsandQuestionstoExpandYourThinking

1.Whatmighttheeffectsofpoorsensitivitybeonthefollowingdecisions?
Screeningsforhearinglossinchildrenwithknownlanguageimpairments
Identificationtestingforchildrenseligibilityforcommunicationproblemswarrantingearlyinterventionservicesand
Determinationofthepresenceofalanguagedisorderinabilingualchild.

2.Whatmighttheeffectsofpoorspecificitybeonthefollowingdecisions?
Screeningsofalargegroupofkindergartenchildrenforspeechandlanguagedisorders
Identificationoforallanguagedisorderinchildrenwhoarefailingacademicallyand
LanguagescreeningsforchildrenwhospeakSpanishinfluencedEnglish.

3.Imaginethatyouareaschoolspeechlanguagepathologistwhoisinterestedinobtaininginformationaboutthespecificityandsensitivityofyourownscreening
procedures?Howmightyouobtaintheinformationyouneedforlookingatbothhitsandbothkindsofmissesfalsepositivesandfalsenegatives?Whichkindof
informationwillbemostdifficulttoobtain?

4.UseAppendixAandyourreadingofthischaptertoconsiderthefollowingquestions.Whatdomainsoflanguageandwhatagegroupsappeartobelesswell
representedinstandardizedtests?Besidesthosereasonsgiveninthetext,canyouthinkofreasonsforthesepatterns?

5.TaketwomeasureslistedinAppendixAthataresaidtotargetoneormorelanguagedomainsandmodalitiesincommon.Compareandcontrastthecontentofthese
sharedcomponentsintermsofnumbersandkindsofitems,tasks,andstimuli.

6.Onthebasisofwhatyouhaveread,createalistof5researchquestionsthat,ifanswered,wouldgreatlyimprovescreeningandassessmentpracticesinspeech
languagepathology.

RecommendedReadings

AmericanSpeechLanguageHearingAssociation(1993).Definitionsofcommunicationdisordersandvariations.Asha,35(Suppl.10),4041.

Hansen,J.C.(1999).Testpsychometrics.InJ.W.Lichtenberg&R.K.Goodyear(Eds.),Scientistpractitionerperspectivesontestinterpretation(pp.1530).
Boston:Allyn&Bacon.

Maynard,D.W.,&Marlaire,C.L.(1999).Goodreasonsforbadtestingperformance:Theinteractionalsubstrateofeducationaltesting.InD.Kovarsky,J.Duchan,
&M.Maxwell(Eds.),Constructing(in)competence(pp.171196).Mahwah,NJ:LawrenceErlbaumAssociates.

References

AmericanSpeechLanguageHearingAssociation(1999).Guidelinesforrolesandresponsibilitiesoftheschoolbasedspeechlanguagepathologist[Online].
Available:http:/www.asha.org/professionals/library/slpschool_i.htm#purpose.
Page245

Apel,K.,Hodson,B.,Shulman,B.,&GordonBrannan,M.(November,1994).Severityratingsandeligibilitycriteria:A(confused?)stateoftheunion.
MiniseminarpresentedtotheannualconventionoftheAmericanSpeechLanguageHearingAssociation,NewOrleans,LA.

Aram,D.M.,Morris,R.,&Hall,N.E.(1993).Clinicalandresearchcongruenceinidentifyingchildrenwithspecificlanguageimpairment.JournalofSpeechand
HearingResearch,36,580591.

Bailey,D.,&Roberts,J.E.(1987).TeacherChildCommunicationScale.ChapelHill,NC:UniversityofNorthCarolina.

Bates,E.,Bretherton,I.,&Snyder,L.(1988).Fromfirstwordstogrammar:Individualdifferencesanddissociablemechanisms.Cambridge,England:
CambridgeUniversityPress.

Botting,N.,ContiRamsden,G.,&Crutchley,A.(1997).Concordancebetweenteacher/therapistopinionandformallanguageassessmentscoresinchildrenwith
languageimpairment.EuropeanJournalofDisordersofCommunication,32,317327.

Bracken,B.A.(1987).Limitationsofpreschoolinstrumentsandstandardsforminimallevelsoftechnicaladequacy.JournalofPsychoeducationalAssessment,4,
313326.

Brown,J.(1989).Thetruthaboutscoreschildrenachieveontests.Language,Speech,andHearingServicesinSchools,20,366371.

Bzoch,K.R.,&League,R.(1971).TheReceptiveExpressiveLanguageEmergentLanguageScaleRevised.Gainesville,FL:LanguageEducationDivision,
ComputerManagementCorporation.

Camaioni,L.,Castelli,M.C.,Longobardi,E.,&Volterra,V.(1991).Aparentreportinstrumentforearlylanguageassessment.FirstLanguage,11,345359.

Campbell,T.,Dollaghan,C.,Needleman,H.,&Janosky,J.(1997).Reducingbiasinlanguageassessment:Processingdependentmeasures.JournalofSpeech
LanguageHearingResearch,40,519525.

Cheng,L.L.(1987).AssessingAsianlanguageproficiency:GuidelinesforevaluatinglimitedEnglishproficientstudents.Rockville,MD:Aspen.

Cirrin,F.M.,Bashir,A.,Brinton,B.,Damico,J.S.,Dublinske,S.,Edwards,E.B.,Grimes,A.M.,Kamhi,A.G.,Prelock,P.A.,Rodriguez,J.M.,Shulman,B.B.,
Tibbits,D.F.,&Westby,C.(March,1989).Issuesindeterminingeligibilityforlanguageintervention.ASHA,113118.

Compton,C.(1996).Aguideto100testsinspecialeducation.UpperSaddleRiver,NJ:GlobeFearonEducationalPublisher.

Crago,M.B.,Annahatak,B.,Doehring,D.G.,&Allen,S.(1991).Firstlanguageevaluationbynativespeakers:Apreliminarystudy.JournalofSpeechLanguage
PathologyandAudiology,15,4348.

Crais,E.R.(1993).Familiesandprofessionalsascollaboratorsinassessment.TopicsinLanguageDisorders,14(1),2940.

Dale,P.,Bates,E.,Reznick,S.,&Morisset,C.(1989).Thevalidityofaparentreportinstrumentofchildlanguageattwentymonths.JournalofChildLanguage,
16,23949.

Damico,J.S.,Secord,W.A.,&Wiig,E.H.(1992).Descriptivelanguageassessmentatschool:Characteristicsanddesign.InW.Secord(Ed.),Bestpracticesin
schoolspeechlanguagepathology:Descriptive/nonstandardizedlanguageassessment(pp.18).SanAntonio,TX:PsychologicalCorporation.

Damico,J.S.,Smith,M.,&Augustine,L.E.(1996).Multiculturalpopulationsandlanguagedisorders.InM.D.Smith&J.S.Damico(Eds.),Childhoodlanguage
disorders(pp.272299).NewYork:Thieme.

Derogatis,L.R.,&DellaPietra,L.(1994).Theuseofpsychologicaltestingfortreatmentplanningandoutcomeassessment.InM.E.Mareish,(Ed.),Theuseof
psychologicaltestingfortreatmentplanningandoutcomeassessment(pp.2254).Hillsdale,NJ:LawrenceErlbaumAssociates.

Dollaghan,C.,&Campbell,T.(1999,November).Ischildlanguageimpairmentataxon?PaperpresentedattheAmericanSpeechLanguageHearingAssociation,
SanFrancisco.

Dunn,L.M.,&Dunn,L.M.(1997).PeabodyPictureVocabularyTestIII(3rded.).CirclePines,MN:AmericanGuidanceService.

Dunn,L.M.,Lugo,D.E.,Padilla,E.R.,&Dunn,L.M.(1986).TestdeVocabularioenImagenesPeabody[PeabodyPictureVocabularyTest].CirclePines,MN:
AmericanGuidanceService.

Dunn,M.,Flax,J.,Sliwinski,M.,&Aram,D.M.(1996).Theuseofspontaneouslanguagemeasuresascriteriaforidentifyingchildrenwithspecificlanguage
impairment:Anattempttoreconcileclinicalandresearchincongruence.JournalofSpeechandHearingResearch,39,643654.
Page246

Erickson,J.G.,&Iglesias,A.(1986).AssessmentofcommunicatindisordersinnonEnglishproficientchildren.InO.Taylor(Ed.),Natureofcommunication
disordersinculturallyandlinguisticallydiversepopulations(pp.181218).SanDiego,CA:CollegeHillPress.

Feeney,J.,&Bernthal,J.E.(1996).TheefficiencyoftheRevisedDenverDevelopmentalScreeningTestasalanguagescreeningtool.Language,Speech,
HearingServicesinSchools,27,330332.

Fenson,L.,Dale,P.,Reznick,S.,Thal,D.,Bates,E.,Hartung,J.,Pethick,S.,&Reilly,J.(1991).TechnicalmanualfortheMacArthurCommunicative
DevelopmentInventories.SanDiego,CA:SanDiegoStateUniversity.

Fey,M.(1986).Languageinterventionwithyoungchildren.SanDiego,CA:CollegeHillPress.

Fey,M.,Long,S.,&Cleave,P.(1994).ReconsiderationofIQcriteriainthedefinitionofspecificlanguageimpairment.InR.Watkins&M.Rice(Eds.),Specific
languageimpairmentsinchildren(pp.161178).Baltimore:PaulH.Brookes.

Fluharty,N.(1978).FluhartyPreschoolSpeechandLanguageScreeningTest.Boston:TeachingResources.

Frankenburg,W.K.,Dodds,J.,&Archer,P.(1990).DenverII:Technicalmanual.Denver,CO:DenverDevelopmentalMaterials.

Frankenburg,W.K.,Dodds,J.,Fandal,A.,Kazuk,E.,&Cohrs,M.(1975).TheDenverDevelopmentalScreeningTest:Revised.Denver,CO:Denver
DevelopmentalMaterials.

Girolametto,L.(1997).Developmentofaparentreportmeasureforprofilingtheconversationalskillsofpreschoolchildren.AmericanJournalofSpeechLanguage
Pathology,6,2533.

GutierrezClellen,VF.,Brown,S.,Conboy,B.,&RobinsonZaartu,C.(1998).Modifiability:Adynamicapproachtoassessingimmediatelanguagechange.Journal
ofChildrensCommunicationDevelopment,19,3142.

Haber,J.S.,&Norris,M.L.(1983).TheTexasPreschoolScreeningInventory:Asimplescreeningdeviceforlanguageandlearningdisorders.ChildrensHealth
Care,12(1),1118.

Hadley,P.A.,&Rice,M.L.(1993).Parentaljudgmentsofpreschoolersspeechandlanguagedevelopment:AresourceforassessmentandIEPplanning.Seminars
inSpeechandLanguage,14,278288.

Haley,S.M.,Coster,W.J.,Ludlow,L.H.,Haltiwanger,J.T.,&Andrellos,P.J.(1992).Pediatricevaluationofdisabilityinventory,Version1.0.Boston:New
EnglandMedicalCenterHospitals.

Hansen,J.C.(1999).Testpsychometrics.InJ.W.Lichtenberg&R.K.Goodyear(Eds.),Scientistpractitionerperspectivesontestinterpretation(pp.1530).
Boston:Allyn&Bacon.

Haynes,W.O.,Pindzola,R.H.,&Emerick,L.L.(1992).Diagnosisandevaluationinspeechpathology(4thed).EnglewoodCliffs,NJ:PrenticeHall.

Hedrick,D.,Prather,E.,&Tobin,A.(1975).SequencedInventoryofCommunicationDevelopment.Seattle,WA:UniversityofWashingtonPress.

Hirshoren,A.,&Ambrose,W.R.(1976).Language,Speech,andHearingServicesinSchools,7(2),8689.

Huang,R.,Hopkins,J.,&Nippold,M.A.(1997).Satisfactionwithstandardizedlanguagetesting:Asurveyofspeechlanguagepathologists.Language,Speech,and
HearingServicesinSchools,28,1229.

Hummel,T.J.(1999).Theusefulnessoftestsinclinicaldecisions.InJ.W.Lichtenberg&R.K.Goodyear(Eds.),Scientistpractitionerperspectivesontest
interpretation(pp.59112).Boston:Allyn&Bacon.

Hutchinson,T.A.(1996).Whattolookforinthetechnicalmanual:Twentyquestionsforusers.Language,Speech,andHearingServicesinSchools,27,109121.

IndividualsWithDisabilitiesEducationAct(IDEA).Pub.L.No.101476,104Stat.1103(1990).

JacksonMaldonado,D.,Thal,D.,Marchman,V.,Bates,E.,&GutierrezClellen,V.(1993).EarlylexicaldevelopmentinSpanishspeakinginfantsandtoddlers.
JournalofChildLanguage,20(3),523549.

Kamhi,A.(1998).Tryingtomakesenseofdevelopmentallanguagedisorders.Language,Speech,andHearingDisordersinSchools,29,3544.

Kamhi,A.,Pollock,K.E.,&Harris,J.L.(Ed.).(1996).CommunicationdevelopmentanddisordersinAfricanAmericanchildren:Research,assessment,and
intervention.Baltimore:PaulH.Brookes.

Kaufman,A.S.,&Kaufman,N.L.(1983).KaufmanAssessmentBatteryforChildren.CirclePines,MN:AmericanGuidanceService.

Kayser,H.(1989).SpeechandlanguageassessmentofSpanishspeakingchildren.Language,Speech,andHearingServicesinSchools,20,226244.
Page247

Kayser,H.(1991).Interpretersinspeechlanguagepathology.TexasJournalofAudiologyandSpeechPathology,17,2829.

Kayser,H.(Ed.).(1995).Bilingualspeechlanguagepathology:AnHispanicfocus.SanDiego,CA:SingularPublishingGroup.

Kelly,D.J.,&Rice,M.L.(1986).Astrategyforlanguageassessmentofyoungchildren:Acombinationoftwoapproaches.Language,Speech,andHearing
ServicesinSchools,17,8394.

Krassowski,E.,&Plante,E.(1997).IQvariabilityinchildrenwithSLI:ImplicationsforuseincognitivereferencingindeterminingSLI.JournalofCommunication
Disorders,30,19.

Kulig,S.G.,&Baker,K.A.(1975).PhysiciansDevelopmentalQuickScreenforSpeechDisorders.Galveston,TX:DepartmentofPediatrics,Universityof
TexasMedicalBranchatGalveston.

Lahey,M.(1988).Languagedisordersandlanguagedevelopment.NewYork:Macmillan.

Lahey,M.(1990).Whoshallbecalledlanguagedisordered?Somereflectionsandoneperspective.JournalofSpeechandHearingDisorders,55612620.

Leap,W.L.(1993).AmericanIndianEnglish.SaltLakeCity,UT:UniversityofUtahPress.

Lee,L.(1974).Developmentalsentenceanalysis.Evanston,IL:NorthwesternUniversityPress.

Lehr,C.A.,Ysseldyke,J.E.,&Thurlow,M.L.(Eds.).(1986).Assessmentpracticesinmodelearlychildhoodeducationprograms.PsychologyintheSchools,24,
390399.

Leonard,L.(1987).Isspecificlanguageimpairmentausefulconstruct?InS.Rosenberg(Ed.),Advancesinappliedpsycholinguistics,1:Disordersoffirst
languageacquisition(pp.139).NewYork:CambridgeUniversityPress.

Leonard,L.(1998).Childrenwithspecificlanguageimpairment.Cambridge:MassachusettsInstituteofTechnologyPress.

Leonard,L.,&Weiss,A.L.(1983).Applicationofnonstandardizedassessmentprocedurestodiverselinguisticpopulations.TopicsinLanguageDisorders,3(3),
3545.

MardellCzudnoswki,C.,&Goldenberg,D.(1983).DevelopmentalIndicatorsforAssessmentofLearningRevised(DIALR).Edison,NJ:ChildcraftEducation
Corporation.

Maynard,D.W.,&Marlaire,C.L.(1999).Goodreasonsforbadtestingperformance:Theinteractionalsubstrateofeducationaltesting.InD.Kovarsky,J.Duchan,
&M.Maxwell(Eds.),Constructing(in)competence(pp.171196).Mahwah,NJ:LawrenceErlbaumAssociates.

McCarthy,D.A.(1972).ScalesofChildrensAbilities.SanAntonio,TX:PsychologicalCorporation.

McCauley,R.J.,&Swisher,L.(1984a).Psychometricreviewoflanguageandarticulationtestsforpreschoolchildren.JournalofSpeechandHearingDisorders,
49,3442.

McCauley,R.J.,&Swisher,L.(1984b).Useandmisuseofnormreferencedtestsinclinicalassessment:Ahypotheticalcase.JournalofSpeechandHearing
Disorders,49,338348.

Meehl,P.E.(1992).Factorsandtaxa,traitsandtypes,differencesofdegreeanddifferencesinkind.JournalofPersonality,60,117174.

Meehl,P.E.,&Yonce,L.J.(1994).Taxometricanalysis:I.Detectingtaxonicitywithtwoquantitativeindicatorsusingmeansaboveandmeansbelowaslidingcut
(MAMBACprocedure).PsychologicalReports,74(MonographSupplement1V74),10591274.

Meehl,P.E.,&Yonce,L.J.(1996).Taxometricanalysis:II.Detectingtaxonicityusingtwoquantitativeindicatorsinsuccessiveintervalsofathirdindicator
(MAXCOVprocedure).PsychologicalReports,78(MonographSupplement1V78),10911227.

Merrell,A.,&Plante,E.(1997).Normreferencedtestinterpretationinthediagnosticprocess.Language,Speech,andHearingServicesinSchools,28,5058.

Muma,J.(1985).Nonewsisbadnews:ResponsetoMcCauleyandSwisher(1984).JournalofSpeechandHearingDisorders,50,290293.

Muma,J.(1998).Effectivespeechlanguagepathology:Acognitivesocializationapproach.Mahwah,NJ:LawrenceErlbaumAssociates.

Nelson,N.W.(1993).Languageinterventioninschoolsettings.InD.K.Bernstein&E.Tiegerman(Eds.),Languageandcommunicationdisordersinchildren
(3rded.,pp.273324).NewYork:Merrill.

NewbornInfantHearingScreeningandInterventionAct.Pub.L.No.106113.113Stat1501(1999).

Newcomer,P.L.,&Hammill,D.D.(1997).TestofLanguageDevelopmentPrimary:3.Austin,TX:ProEd.
Page248

Nicolosi,L.,Harryman,E.,&Kresheck,J.(1996).Terminologyofcommunicationdisorders(4thed.).Baltimore:Williams&Wilkins.

Norris,M.K.,Juarez,M.J.,&Perkins,M.N.(1989).Adaptationofascreeningtestforbilingualandbidialectalpopulations.Language,Speech,andHearing
ServicesinSchools,20,381390.

Nunnally,J.(1978).Psychometrictheory(2nded.).NewYork:McGrawHill.

Nuttall,E.V.,Romero,I.,&Kalesnik,J.(Eds.).(1999).Assessingandscreeningpreschoolers:Psychologicalandeducationaldimensions(2nded.).Needham
Heights,MA:Allyn&Bacon.

Nye,C.,&Montgomery,J.K.(1989).Identificationcriteriaforlanguagedisorderedchildren:Anationalsurvey.Hearsay:TheJournaloftheOhioSpeechand
HearingAssociation,Spring,2633.

Olswang,L.,Bain,B.,&Johnson,G.(1992).Usingdynamicassessmentwithchildrenwithlanguagedisorders.InS.F.Warren&J.Reichle(Eds.),Causesand
effectsincommunicationlanguageintervention(pp.187215).Baltimore:BrookesPublishing.

Owens,R.E.(1995).Languagedisorders:Afunctionalapproachtoassessmentandtreatment(2nded.).Boston:Allyn&Bacon.

Pang,V.O.,&Cheng,L.L.(Eds.).(1998).Strugglingtobeheard.TheunmetneedsofAsianPacificAmericanchildren.Albany,NewYork:StateUniversityof
NewYorkPress.

Paul,R.(1995).Languagedisordersfrominfancythroughadolescence.Assessmentandintervention.St.Louis,MO:MosbyYearbook.

Pea,E.(1996).Dynamicassessment:Themodelanditslanguageapplications.InK.Cole,P.Dale,&D.Thal(Eds.),Advancesinassessmentofcommunication
andlanguage(pp.281308).Baltimore:BrookesPublishing.

Plante,E.(1998).CriteriaforSLI:TheStarkandTallallegacyandbeyond.JournalofSpeech,Language,andHearingResearch,41,951957.

Plante,E.,&Vance,R.(1994).Selectionofpreschoolspeechandlanguagetests:Adatabasedapproach.Language,Speech,andHearingServicesinSchools,
25,1523.

Plante,E.,&Vance,R.(1995).Diagnosticaccuracyoftwotestsofpreschoollanguage.AmericanJournalofSpeechLanguagePathology,4,7076.

Prather,E.M.,Breecher,S.V.A.,Stafford,M.L.,&Wallace,E.M.(1980).ScreeningTestofAdolescentLanguage(STAL).Seattle,WA:Universityof
WashingtonPress.

Prizant,B.M.,&Wetherby,A.M.(1993).Communicationandlanguageassessmentforyoungchildren.InfantsandYoungChildren,5,2034.

Rescorla,L.(1989).Thelanguagedevelopmentsurvey:Ascreeningtoolfordelayedlanguageintoddlers.JournalofSpeechandHearingDisorders,54,587599.

Reveron,W.W.(1984).LanguageassessmentofBlackchildren:Thestateoftheart.PapersintheSocialSciences,4,7994.

Reznick,S.,&Goldsmith,L.(1989).Amultipleformwordproductionchecklistforassessingearlylanguage.JournalofChildLanguage,16,91100.

RobinsonZaartu,C.(1996).ServingNativeAmericanchildrenandfamilies:Consideringculturalvariables.Language,Speech,andHearingServicesinSchools,
27,373384.

Rosetti,L.(1990).RosettiInfantToddlerLanguageScale.EastMoline,IL:LinguiSystems.

Roussel,N.(1991).AppendixA:AnnotatedbibliographyofCommunicativeAbilitiesTest.InE.V.Hamayan&J.S.Damico(Eds.),Limitingbiasinthe
assessmentofbilingualchildren(pp.320343).Austin:ProEd.

Sabatino,A.D.,Vance,H.B.,&Miller,T.L.(1993).Definingbestdiagnosticpractices.InH.B.Vance(Ed.),Bestpracticesinassessmentforschoolandclinical
settings(pp.128).Brandon,VT:ClinicalPsychologyPublishing.

Sabers,D.,&Hutchinson,T.(1990).Usernormssoftware.Chicago:RiversidePublishing.

Salvia,J.,&Good,R.(1982).Significantdiscrepanciesintheclassificationofpupils:Differentiatingtheconcept.InJ.T.Neisworth(Ed.),Assessmentinspecial
education(pp.7782).Rockville,MD:Aspen.

Salvia,J.,&Ysseldyke,J.E.(1991).Assessment(5thed.).Boston:HoughtonMifflin.

Salvia,J.,&Ysseldyke,J.E.(1998).Assessment(7thed.).Boston:HoughtonMifflin.

Sanger,D.,Aspedon,M.,Hux,K.,&Chapman,A.(1995).Earlyreferralofschoolagechildrenwithlanguageproblems.JournalofChildhoodCommunication
Disorders,16,39.
Page249

Sattler,J.M.(1988).Assessmentofchildren.SanDiego:Author.

Schraeder,T.,Quinn,M.,Stockman,I.J.,&Miller,J.F.(1999).Authenticassessmentasanapproachtopreschoolspeechlanguagescreening.AmericanJournal
ofSpeechLanguagePathology,8,195200.

Schwartz,I.S.,&Olswang,L.B.(1996).Evaluatingchildbehaviorchangeinnaturalsettings:Exploringalternativestrategiesfordatacollection.TopicsinEarly
ChildhoodSpecialEducation,16,82101.

Semel,E.,Wiig,E.H.,&Secord,W.A.(1966).ObservationRatingScales.ClinicalEvaluationofLanguageFundamentals(3rded.).SanAntonio:The
PsychologicalCorporation.

Shepard,L.A.(1989).Identificationofmildhandicaps.InR.Linn(Ed.),Educationalmeasurement(3rded.,pp.545572).NewYork:AmericanCouncilon
EducationandMacmillan.

Smit,A.(1986).Agesofspeechsoundacquisition:Comparisonsandcritiquesofseveralnormativestudies.Language,Speech,andHearingServicesinSchools,
17,175186.

Smith,A.R.,McCauley,R.J.,&Guitar,B.(inpress).DevelopmentoftheTeacherAssessmentofStudentCommunicativeCompetence(TASCC)forchildrenin
grades1through5.CommunicationDisordersQuarterly.

Sparrow,S.,Balla,D.,&Cicchetti,D.(1984).VinelandAdaptiveBehaviorScales.CirclePines,MN:AmericanGuidanceService.

Stephens,M.I.(1977).StephensOralLanguageScreeningTest(SOLST).Peninsula,OH:InterimPublishers.

Stokes,S.F(1997).Secondarypreventionofpaediatriclanguagedisability:Acomparisonofparentsandnursesasscreeningagents.EuropeanJournalofDisorders
ofCommunication,32,139158.

Striffler,N.,&Willis,S.(1981).TheCommunicationScreen.Tucson,AZ:CommunicationSkillBuilders.

Sturner,R.A.,Kunze,L.,Funk,S.G.,&Green,J.A.(1993).Elicitedimitation:Itseffectivenessforspeechandlanguagescreening.DevelopmentalMedicineand
ChildNeurology,35,715726.

Sturner,R.A.,Layton,T.L.,Evans,A.W.,Heller,J.H.,Funk,S.G.,&Machon,M.W.(1994).Preschoolspeechandlanguagescreening:Areviewofcurrently
availabletests.AmericanJournalofSpeechLanguagePathology,3,2536.

Taylor,O.L.,&Payne,K.T.(1983).Culturallyvalidtesting:Aproactiveapproach.TopicsinLanguageDisorders,3,820.

Terrell,S.L.,Arensberg,K.,&Rosa,M.(1992).Parentchildcomparativeanalysis:Acriterionreferencedmethodforthenondiscriminatoryassessmentofachild
whospokearelativelyuncommondialectofEnglish.Language,SpeechandHearingServicesinSchools,23,3442.

Terrell,S.L.,&Terrell,F.(1983).Distinguishinglinguisticdifferencesfromdisorders:Thepast,present,andfutureofnonbiasedassessment.TopicsinLanguage
Disorders,3,107.

Thordardottir,E.T.,&EllisWeismer,S.(1996).Languageassessmentviaparentreport:DevelopmentofascreeninginstrumentforIcelandicchildren.First
Language,16,265285.

Thorner,R.M.,&Remein,Q.R.(1962).Principlesandproceduresintheevaluationofscreeningfordisease.PublicHealthMonograph,67,408421.

Turner,R.G.(1988).Techniquestodeterminetestprotocolperformance.EarandHearing,9,177189.

VanKeulen,J.E.,Weddington,G.T.,&DeBose,C.E.(1998).Speech,language,andlearningandtheAfricanAmericanchild.Boston:Allyn&Bacon.

VaughnCooke,FB.(1983).Improvinglanguageassessmentinminoritychildren.Asha,25,2934.

Washington,J.A.(1996).IssuesinassessingthelanguageabilitiesofAfricanAmericanchildren.InA.G.Kamhi,K.E.Pollock,&J.L.Harris(Eds.),
CommunicationdevelopmentanddisordersinAfricanAmericanchildren(pp.3554).Baltimore:Brookes.

Weddington,G.T.(1987).Theassessmentandtreatmentofcommunicationdisordersinculturallydiversepopulations.Unpublishedmanuscript.

Whitworth,A.,Davies,C.,&Stokes,S.F(1993).Identificationofcommunicationimpairmentsinpreschoolers:Acomparisonofparentandteachersuccess.
AustralianJournalofHumanCommunicationDisorders,21,112133.

Wolfram,W.(1991).DialectsandAmericanEnglish.EnglewoodCliffs,NJ:PrenticeHall.
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CHAPTER
10

Description:WhatIstheNatureofThisChildsLanguage?

TheNatureofExaminingChange

SpecialConsiderationsforAskingThisClinicalQuestion

AvailableTools

PracticalConsiderations

Nigelisa9yearoldwithmildmentalretardationwhoseplacementinamultiageclassroomiscomplicatedbyamoderatehearinglossandADD.A3year
reevaluationconductedatthebeginningoftheschoolyearincludedextensiveaudiologicalassessmentaswellasstandardizedlanguagetestingthat
confirmedparticulardifficultiesinexpressivephonologyandmorphosyntax.Languagesamplingandaclassroomchecklistwereusedtohelpdeterminethe
educationalimpactofNigelsdifficultiesandtohelpplanaccommodationsanddevelopNigelsindividualizededucationalplan.

Taohasalonghistoryofcommunicationproblemsthathavechangedwithage.Shewasdiagnosedwithautismatage4,thenAspergerssyndromeatage
8.Now,atage12,withappropriateaccommodationsandintensivetreatment,sheisinaregularjuniorhighschool.Speechlanguageinterventionhas
centeredonaddressingherpragmaticchallengeswithpeersandteachers.Goalsinthisareahavebeenidentifiedandtrackedduringthesemesterusinga
varietyofdescriptivemeasures
Page251

createdbyherclinicians.RecentlyadynamicassessmentdesignedtoexamineTaosemergingawarenessoftheperspectivesofotherswasundertakenas
partofthisprocess.

TheNatureofDescription

Describingtheirskillsandtheproblemsfacedbychildrenwithsuspectedlanguageimpairmentssometimesoccursaspartofscreening,thusprecedingtheuseofformal
proceduresassociatedwithidentification.Moreoften,descriptionrepresentsacriticalcomponentofinitialassessmentsandcontinuesthroughoutallofthelatersteps
involvedinspeechlanguagemanagement.Withsuchpervasiveness,descriptionundoubtedlyconstitutesthemajormeasurementtaskfacingclinicians.

Thepurposesservedbydescriptionarevaried.Descriptivemeasuresareinitiallyusedtocharacterizethespecificareasoflinguisticorcommunicativedifficultyfacinga
child,thefunctionallimitationsthosedifficultiesimpose,andincreasinglytheeffectsonthechildssocialrolesthatareassociatedwiththechildslanguagedisorder
(Goldstein&Geirut,1998).Atthesametime,descriptivemeasurescanbeusedtohelpplaninitialtreatmentstrategies,choosespecifictreatmentgoals,andprovide
thebasisforlatercomparisons.Duringtreatment,descriptiveprobesespeciallyofuntreatedbutrelatedstimuliandotherdescriptivemeasuresarelikelytoprovide
someofthebestevidenceoftreatmenteffectiveness(Bain&Dollaghan,1991Olswang&Bain,1994Schmidt&Bjork,1992)becausetheyreflecttheextentto
whichgeneralizationisoccurring.Infact,muchoftheprofessionsrecentfocusonmeasuringoutcomestodocumentthevalueoftreatment(seeFrattali,1998)involves
thedevelopmentanduseofdescriptivemeasures.

Despitetheubiquityofdescriptivemeasures(andperhapsbecauseofit),themeasurementchallengestheypresentcanbeoverlooked,oratleastunderappreciated
(Leonard,Prutting,Perozzi,&Berkley,1978McCauley,1996Minifie,Darley,&Sherman,1963).Illustratingagrowinginterestinthosechallenges,Secord(1992)
devotedanentirebooktodescriptive,nonstandardizedlanguageassessment.Inanearlychapterofthatbook,Damico,Secord,andWiig(1992)notedthateffective
descriptiveassessmentproceduresneedtobeasrigorousasnormreferencedtests(p.1).Thesourceofthatrigor,however,ismuchlessobviousthanthat
associatedwithmeasuresusedforpurposesofclassification.

Muchoftherigorassociatedwithmethodsusedintheidentificationoflanguageimpairmentappearstoresideinthehandsofothers(e.g.,testauthorsandpublishers,
individualresearchers).Incontrast,fordescriptivemeasures,theresponsibilityforrigorfallslargelyintothehandsoftheclinician.AsLeonard(1996)observed,such
measuresareessentiallyexperimentaltasksoftencreatedbycliniciansandsometimesborroweddirectlyfromexperimenters.Fortunately,increatingand
understandingsuchmeasures,theclinicianhasalliesintheincreasingnumberofclinicianresearchersinspeechlanguagepathologyandrelatedfieldswhodevelopand
shareindividualmethodsandreflectionsonthemeasurementchallengestheypresent.Inthischapter,Itrytopassalongsomeoftheirinsightsanddirectreadersto
particularlyhelpfulexamples.
Page252

SpecialConsiderationsforAskingThisClinicalQuestion

Theprocessofdescriptioncansometimesusenormreferencedmeasurement.Whenprofilesofperformanceareexaminedtoassessbroaderpatternsofstrengthsand
challengeswithindifferentareasofcommunication,standardizednormreferencedmeasurescanprovideusefulinformation(Olswang&Bain,1991).Thisisespecially
truewhenlimitationsduetotestcontentandmeasurementerroraretakenintoaccount(McCauley&Swisher,1984Salvia&Ysseldyke,1981).

Usually,however,theprocessofdescriptionmakesuseofcriterionreferencedmeasurement.Suchmeasurementcanfunctionatseverallevelsofdetailfrommore
globalcategorizationsoflanguagefunctionindifferentmodalitiestothedetaileddescriptionofaspecificlanguageorcommunicationskill(e.g.,frequencyofuseofa
particulargrammaticalmorphemeorcommunicativeintentinagivenconversationalcontext).Althoughsuchdescriptionsmaynotalwaysfitwithinaviewof
measurementastheassignmentofnumberstobehaviors,theyfitwithinthebroaderviewofbehavioralmeasurementasasimplificationprocessorasinformation
compressionusedtoaiddecisionmaking(Barrow,1992Morris,1994).Thus,aswithallcasesofmeasurement,ourcentralconcernwithvalidityremains(APA,
AERA,&NCME,1985Messick,1989).However,validityisfosteredthroughmeansthatmaysuperficiallyappearunrelatedtothepsychometricconcernsdescribed
fornormreferencedinstruments.Forexample,ratherthanastudyofcriterionrelatedvalidityusingnumerousparticipantsandothernormreferencedmeasures,
evidencefordescriptivemeasuresmayinvolvethecollectionofsupportingqualitativeandsubjectivedataforamuchsmallernumberofcases,orevenasinglecase.
Becauseaprincipalvalueofsuchmeasuresistheirclosetietoaspecificconstruct,theusersalertnesstothenatureofatargetedconstructandthedegreetowhicha
specificmeasureservesasanacceptableindicatorofitrisesinimportancefromlargetogargantuanproportions.

Damicoetal.(1992)discussedthreecomplexcharacteristicspivotaltoeffectivedescriptiveassessmenttechniques:authenticity,functionality,andrichnessof
description.Authenticityisusedtorefertothreerelatedconcepts:linguisticrealism,ecologicalvalidity,andpsychometricveracity.Linguisticrealisminvolvesthe
treatmentofcommunicationindatacollectionandanalysisasacomplexandsynergisticprocesswiththesharingofmeaningasitsgoal,whereasecologicalvalidity
referstothepreservationofnaturalcommunicativecontextsinassessment.Thethirdconcept,psychometricveracity,encompassesthetraditionalconceptsofreliability
andvalidityaswellastheclinicalpracticalityofthemeasuresintermssuchastimeandrequiredresources.Concernsregardingauthenticityhaveledtotheuseofthe
termauthenticassessmenttorefertoassessmentsdesignedwithauthenticityastheirparamountvirtue(e.g.,Schraeder,Quinn,Stockman,&Miller,1999).

ThetermfunctionalityasusedbyDamicoetal.(1992)relatestoeffectiveness,fluency,andappropriatenessofconveyedmeaning.Thiscriterionfocusesnotjuston
obtaininginformationaboutclientsunderlyingcompetencebutalsoabouttheirabilitytoputknowledgeintoplayeffectivelytoachievecommunicationgoals.Thecrite
Page253

rionofrichnessofdescription,citedbythosesameauthors,entailstheuseofassessmentproceduresdesignedtoprovidedetaileddescriptionsofcommunicative
performanceleadingtoexplanatoryhypothesesfordetectedcommunicationdifficulties.Thiscriterion,then,associatesdescriptivemeasureswiththemanipulationof
variablesintheenvironment(materialsused,identityofcommunicationpartner,etc.)thatcanbestudiedfortheirimmediateeffectonperformance.

Iurgereaderstoexaminetheoriginalsource(Damicoetal.,1992)inordertogetadeeperfeelfortheintricaciesinvolvedinassessmentthatpreservethose
characteristicsofcommunicationthatmakecommunicationwhatitis.Ialsosuggest,however,thattheoverarchingpointDamicoandhiscolleaguesweremakingisthat
descriptivemeasuresofcommunicationneedtobevalidtheyneedtomeasurewhattheypurporttomeasure.Specifically,totheverygreatextenttowhich
communicationisembeddedinsocialinteraction,intendedtosharemeaning,andconstrainedbythephysiologicalandsocialmakeupofitsusers,itsmeasurementmust
honorthosepropertiesorsufferthefateofreducedvalidity.TheworkofDamicoetal.andnumerousothers(e.g.,Kovarsky,Duchan,&Maxwell,1999Lund&
Duchan,1983,1993Muma,1998)isextremelyvaluableincallingattentiontothesespecialpropertiesanendeavormadeallthemorenecessarybythefrequent
equatingofprinciplessuchasvalidityonlywithnormreferencedmeasurement.

Becauseofgrowingsensitivitytothedemandsforawideningrangeofdescriptivemeasures,adviceaboutconstructionofsuchmeasuresbycliniciansthemselveshas
becomeincreasinglyavailable(e.g.,Miller&Paul,1995Vetter,1988).Providingasuccinctfoundationfortheserecommendations,Vetteroutlinedasystematic
processfordevelopinginformalassessmentprocedures.Inanearlierpublicationoncriterionreferencedmeasures(McCauley,1996),Imodifiedthatprocess
somewhatandhavemodifieditfurtherinFig.10.1throughtheadditionofastepencouragingclinicianstoseekoutexistingprobesforpossibleuseoradaptation.

IntheprocessoutlinedinFig.10.1,thecrucialfirststepistheformulationofthespecificclinicalquestion.Inquestionsofdescription,theclinicianisrelatively
unencumberedbytheexternal,regulatoryforces(e.g.,staterequirements)thataffectboththekindsofclinicalquestionsthatareaskedandthemethodsusedtoanswer
them.However,thatdoeslittletodecrease,andmayevenincrease,theclinicalperspicacityrequiredatthisstep.ThemultiplelevelsofWHOsclassificationsystems
(WHO,1980,1998)comeintoplayinthecomplexityofthisstep.Recallthattheselevels(e.g.,impairment,disorder,disability,andhandicapinthe1980version)
considerthebroadereffectsofhealthconditionsandtherolethatsocietyplaysindeterminingtheimplicationsofagivenconditionfortheindividual.Theselevelsbring
tomindthechallengeofdescribingachildscommunicationintermsofeffectsonthechildsparticipationinsocialroles,aswellasinthespecificsoflexicon,grammar,
andsoforth.Consequently,theclinicianwhowishestodescribeachildscommunicationwillneedtochooseselectivelyfromalargenumberofpossiblelevelsand
areasforwhichdescriptionispossible.Insodoing,thecliniciancanfocusonasmallernumberofclinicalquestionswhoseanswerscanhaveapowerfulimpactonthe
childstreatmentandsubsequentfunctioning.

TheremainingstepsinVettersprocessentailtailoringtheproceduretomeetthedemandsofaspecificclinicalquestionandclient,implementingit,andthenevaluat
Page254

Fig.10.1.Stepsinthedevelopmentofaninformalmeasure.

ingitseffectivenessideallythroughtheaccumulationofdataspanningseveralclients.Thecliniciansreactionstothisevaluativestepintheprocesscaninclude
changinginstructionsorthespecificitemsused,increasingthenumberofitemsusedinordertoincreasereliability,orabandoningtheprocedurealtogether.

Particularlywhenameasurelendsitselftousewithnumerouschildren,additionalstepssuchasamorerigorousevaluationofreliabilityandthedevelopmentoflocal
Page255

normscanbewellworththeadditionaleffort.CirrinandPenner(1992)discussedhowdescriptivemeasurescanbeimplementeddistrictwide.Theirrecommendations
makeuseofmultiplestagestoensurefeasibilityandvalidity.Amongfactorsthattheystressedaretheneedto(a)usepilotprocedureswithasmallnumberofclinicians
priortowidespreaduse,(b)conductinitialtrainingandfollowupsessionsforallusers,and(c)undertakeadistrictwidetrialperiod.CirrinandPennerstressedthe
valueoflocalnormsasameansofimprovingeligibilitydecisions,buttheyalsoacknowledgedtheheavyadministrativedemandsthisentailsintermsofexpertiseand
stafftime.Insodoing,theypointtooneofthechiefchallengesofdescriptivemeasuresmakingtheirconstructionandusefitwithinthesometimesharshdemandsfor
efficiency(especiallytimedemands)facingmostspeechlanguagepathologists.However,itshouldalwaysberememberedthatcuttingcornersbypayingtoomuch
attentiontobeingefficientcanresultinanincompletepictureofachildsproblemthatwillresultinthelongruninfargreaterlossesoftime.Thisissuewillreceive
additionalattentionlaterinthechapterinthesectionentitledPracticalConsiderations.

AvailableTools

Onereasonthatdescriptioncanseemrelativelyperplexingfromameasurementperspectiveisthediversityofavailabletoolsandstrategies.Thisdiversityincludestools
thatarequitestandardized,toolsproposedinformallyinresearchorclinicalpublications,andtoolsthattheclinicianmaydecidetodevelopondemandtoaddressa
specificclinicalquestionforwhichnocommerciallydevelopedalternativeisavailable.Althoughnotexhaustive,arelativelydetailedlistofavailabletypesofsuch
measureshasbeenofferedbyDamicoetal.(1992)languagesampleanalyses,probes,ratingscales,andonlineobservations.Althoughonecanbroadlycategorize
thetoolsandstrategieslistedbyDamicoetal.(1992)asnormreferencedandcriterionreferencedmeasuresfallingatvariouslevelsofstandardization,considering
themingreaterdetailseemswarranted.Consequently,allofthecategoriesdescribedbyDamicoetal.aswellasstandardizednormreferencedmeasuresand
standardizedcriterionreferencedmeasuresarebrieflydiscussedinthissection.

Twoadditionalassessmentstrategiesarealsohighlighteddynamicassessment(GutierrezClellen,Brown,Conboy,&RobinsonZaartu,1998Lidz,1987,Lidz&
Pea,1996)andqualitativemeasures(Olswang&Bain,1994Schwartz&Olswang,1996).Thesetechniquesaresingledoutforspecialattentionbyvirtueoftheir
emergingstatusasinnovativeapproachestodescription.Althoughdynamicassessmenthasreceivedconsiderableattentionintheprofessionalliterature(Butler,1997),
theuseofqualitativemeasuresrepresentsarefinementofclinicalpracticethathasreceivedlessdirectcriticalattention.

1.StandardizedNormReferencedMeasures

Standardizednormreferencedmeasuresarefrequentlyusedtocharacterizeareasofgreaterorlesserdeficitatypeofdescriptionthatinvolveswhatissometimes
termedprofileanalysisordiscrepancyanalysis.Forexample,manycliniciansmakeuseof
Page256

thestructureofavailablenormreferencedtestsinwhichbothreceptiveandexpressiveskillsareexaminedtodeterminetheextentofproblemsineacharea.
Additionally,theymaymakeuseofsubteststructure,whenitisavailable,tofurtherrefinealistofmorespecificstrengthsandchallenges.Forexample,theclinicianmay
noteachildsbetterperformanceonreceptivesubtestswithlongerstimuli(e.g.,listeningtoparagraphs)thanonthosewithshorterstimuli(e.g.,wordclasses).

Inchapter9,problemsinprofileanalysiswerediscussedinrelationtousingprofilesinidentificationdecisions(seethesectiononconductingcomparisonsbetween
scores).Asabriefreprise,theseproblemsrelatetothedifficultyindistinguishingrealdifferencesbetweenscoresfromthoseduetomeasurementerrorortodifferences
innormativegroups.Inaddition,whenmeasuresusedinaprofilearehighlycorrelated,thecomparisonmayofferlittleornonewinformation(Olswang&Bain,1994
Turner,1988).Finally,evendifferencesbetweentestsorsubteststhatarereal(i.e.,arenotduetoerror)andhaveoccurredonmeasuresofindependentskillsmaynot
representdifferencesthatareanygreaterthanthosethatmaybeobservedinnormaldevelopment(Berk,1984Olswang&Bain,1991).Thestrategyofsimply
distinguishingbetweenageappropriateandnonageappropriatefunctioningseemsausefulalternativetomoreelaboratebutproblematicstrategiesofinterpretation
(McCauley&Swisher,1984).Thisstrategyconsistsofmakingdecisionsabouttheadequacyoffunctioninginagivenareaindependently,ratherthaninrelationto
functioninotherareas.

Severaldifficultiesinadditiontothosedescribedinchapter9arisewhennormreferencedtestsareusedtoidentifyadetailedsetofstrengthsandchallengesfor
purposesofdescription.Onedifficultyliesintherelativelysmallnumberofcontentareasforwhichsubtestsareavailable.Lookingonlyatthoseareasforwhich
subtestsdoexistisquiteakintothestoryoftheintoxicatedsoulwholooksunderthelamppostforlostkeys.Turningtononnormreferencedmeasurespresentsa
logical,soberalternativeinmanysuchcases.

Evenwhenasubtestcontainsitemsthatseemperfectlyrelevanttoadescriptionofachildscommunication,however,normreferencedtestscanalsobeused
erroneouslyineffortstoprovidedetailedinformation.Treatingindividualitemsorevensubtestsasreliabledescriptorsislikelytobeerroneousinpartbecauseofthe
unreliabilityofsmallsamplesizes(i.e.,thesmallamountofthechildsbehaviorthatwassampledMcCauley&Swisher,1984).Inaddition,becauseitemsinsuchtests
areusuallyselectedmoreoftenbecausetheydiscriminatebetweenindividualsthanbecauseofthespecificcontenttheyreflect,theycanprovideaspottyrepresentation
ofthespecificcontentarea(McCauley&Swisher,1984).

Inadditiontotheiruseinprofiles,normreferencedtestsareusedinoutofleveltesting,thepracticeofusingatestthatmaynotbeappropriateforaclientofagiven
agetosampleasetofbehaviors.Thisdescriptiveinformationisintendedtohelpdefinewhatanindividualdoesanddoesnotdoinresponsetoastandardtaskandset
ofstimuli.Althoughthispracticeisprobablymostfrequentlyusedwithindividualswithmentalretardation,itcanbeusedatanytimewhenmoreappropriatemeasures
arewanting(Berk,1984).Whenusedinthisway,themeasureistreatedasifitwerecriterionreferenced,withthesamplingofcontentbecomingcriticallyimportantto
itsvalue.Theproblemofsmall,unrepresentativesamplesofbehaviordescribedearlierwillrequirecautiousinterpretationor,moreprobably,asearchforamore
appropriatetool.
Page257

2.StandardizedCriterionReferencedMeasures

Criterionreferencedmeasureshavetraditionallybeenapplaudedfortheirdescriptivepowers.Afterall,theyaregenerallyconstructedtoenableadescriptionofan
individualsknowledgebase,ratherthantofacilitatecomparisonsbetweenindividuals.However,therearerelativelyfewcriterionreferencedmeasuresof
communicationthatdemonstratethesamedegreeofstandardizationseeninnormreferencedtests.Becausecriterionreferencedmeasuresrequiremorecomprehensive
coverageofsmallercontentareas,thedemandforanysinglemeasuremaynotbesufficienttosupportmoreextensivedevelopment.Recallingalsothatinterestinthe
measurementcommunityhasonlylatelyturnedtocriterionreferencing,itiseasytounderstandwhyinformalcriterionreferencedmeasuresabound.Nonetheless,afew
moreelaboratelydevelopedcriterionreferencedmeasuresexist,andmanyareinvariousstagesofdevelopment.

Specifictypesofproceduresusedtocollectdataforcriterionreferencedinterpretationvarysignificantlyandincludeeachofthemeasurementtypesdiscussedinthe
remainderofthischapter.Thedecisiontohighlightstandardizedcriterionreferencedmeasuresinthisseparatesectionwasbasedonadesiretoemphasizethepotential
valueofstrengtheningsuchmeasuresthroughtheadditionalempiricalscrutinythataccompaniestheirformaldevelopment.

Table10.1providesseveralexamplesofcriterionreferencedmeasuresencompassingdiversecommunicationdomainsandmodalities.Theyvaryintheextenttowhich
theyhavebeenstandardized.However,ataminimumtheydemonstrateseveralofthehallmarksofstandardizationforacriterionreferencedinstrument:developmentof
guidelinesforappropriateuse,administrationprocedures,scoringprocedures,andmethodofinterpretation.

3.Probes

Probesinvolvetheuseofstructuredtasksorcontextsintendedtoelicitagivenbehavior(Damicoetal.,1992).Althoughthatdefinitioncanalsoapplytothecontents
ofstandardizedmeasures,thetermprobeismoretypicallyreservedformoreinformalmeasures.Elicitationgreatlyincreasestheprobabilityofobtaininginformation
aboutagivenbehaviorwithinagiventimespan,particularlyforthosebehaviorsthatoccurlessfrequentlyinnaturalconversation.However,elicitationprocedures
representpotentialintrusionsonthenaturalnessoftheelicitedbehavior.Thispotentialmeansthat,insofarasnaturalnessisamajorconcernindescription,theiruse
shouldprimarilybelimitedtobehaviorsthatoccuronlyrarelywithoutelicitation.Inaddition,specialcareshouldbetakenduringtheirconstructiontopreservethe
authenticityofthecommunicationexchangeinwhichtheyareembedded.Whensuchcareisseenasimpractical,theresultingdatamorecloselyresemblea
standardizedtestinminiaturethanadescriptiveproceduremeetingthemoreintensedemandsfornaturalnessofcontextdesirableforthistypeofmeasurementquestion.
Dataobtainedfromprobesarefrequentlyevaluatedbytheclinicianintermsofnumberorpercentagecorrect.(SeethediscussionofobservationalcodesunderOn
LineObservationslaterinthischapter.)
Page258

Table10.1
AListofSomeCriterionReferencedMeasuresAvailablefortheDescriptionofLanguageDisordersinChildren

Reviewedin
Mental Receptive
Measurements and/or
TestName Reference Yearbooks Ages Expressive Phonology Semantics Morphology Syntax Pragmatics

Foster,R.,Giddan,J.J.,&
Assessmentof
Stark,J.(1983).Assessmentof 3yearsto
Childrens
ChildrensLanguage 6years,11 R X X
Language
Comprehension.PaloAlto,CA: months
Comprehension
ConsultingPsychologistsPress.
MillerYoder Miller,J.F.,&Yoder,D.E.
Language (1984).MillerYoderLanguage 4to8
R X X
Comprehen ComprehensionTest.Austin, years
sionTest TX:ProEd.
Blank,M.,Rose,S.A.,&
Preschool Berlin,L.J.(1978).Preschool 2years,9
Language LanguageAssessment monthsto5
R/E X X
Assessment Instrument(PLAI).San years,8
Instrument Antonio,TX:Psychological months
Corporation.
Receptive
Bzoch,K.R.,&League,R.
Expressive
(1991).ReceptiveExpressive 0to3
Emergent R/E X X X X
LanguageTest2.Austin,TX: years
LanguageTest
ProEd.
2
WiigCriterion Wiig,E.(1990).WiigCriterion
Referenced ReferencedInventoryof 4to13
E X X X X
Inventoryof Language.SanAntonio: years
Language PsychologicalCorporation.
Page259

Anextendedexampleinwhichmeasuresvaryinginnaturalnessaredescribedmayhelpreadersseethetradeoffsbetweennaturalness,efficiency,andtheclinicians
controlofvariablesaffectingperformance.Theproceduresinthisexamplederivefromattemptstoexaminephonologicalperformanceonasinglesoundorsound
patterninsomedetailandovertime.Thefirstpartofthisexamplewascreatedin1967,whenElbert,Shelton,andArndtdevelopedtheSoundProductionTask(SPT).
Inthattask,theclientimitatedtheproductionof30to60itemscontainingaparticulartargetsound.SomeitemsontheSPTconsistedofnonsensesyllables,othersof
singlewords,andothersofshortphrasescontainingthesound.TheSPTwasdesignedtoobtainrelativelylargenumbersofobservationsinvaryingphoneticand
linguisticcontexts,whileavoidingrepeated,inappropriateuseofentirenormreferencedtestsoritemsfromthem.

Inastudyofpatternsofacquisitionfor/s/and/r/intreatment,DiedrichandBangert(1980)usedtheSPT,buttheyalsodevisedalessreactiveprocedure,thatis,one
thatwasmorecovertintermsofitsfocusandthuslessapttoelicituncharacteristicallycarefulspeechfromthetestedchild.Forthissecondprocedure,calledthe
TalkingTask(TT),theclinicianengagedina3minuteconversationwiththechildandcovertlynotedthenumberofcorrectproductionsoutofthoseattempted.
AlthoughtheTTrepresentedaninterestinginnovation,itlefttheclinicianatthemercyofchance,inthatinfrequentlyoccurringsoundsmightoccuronlyafewtimes
duringthe3minutesamplesomethingthatmightbeaddressedbydefiningthesamplelengthintermsofacertainnumberofattempts,ratherthanintermsoftime.

In1981,Secorddevelopedasetoftasks,theClinicalProbesofArticulationConsistency(CPAC),recentlyreplacedbytheSecordContextualArticulation
Tests(SCATSecord&Shine,1997),whichbearssomerelationshiptoeachoftheseprevioustwotasks.IntheSCAT,probesforeachconsonant/r/andvocalic/
/areelicitedinprevocalicandpostvocalicpositions,aswellasinclustersinimitationsofsinglewords,shortphrases,andsentencesaswellasindelayedretellings
ofastorycontainingmanywordswiththetargetsound.Thus,thissetofprobescanefficientlyhelptheclinicianconsiderthepossibleeffectsoflinguisticcomplexity
(singleword,sentence,narrativecontexts)andphoneticcontext(postvocalic,prevocalic,andclustercontexts).However,naturalnessissomewhatreducedinastory
retellingformatandisreducedstillfurtherinimitation.Thesekindsoftradeoffsaboundintheconstructionofprobes,makingthesharingofsuccessfulcreationswith
colleaguesasubstantialandtimesavingcontribution.

InabookentitledAssessingchildrenssyntax(McDaniel,McKee,&Cairns,1996),avarietyofelicitationstrategiesforbothcomprehensionandproductionare
discussedindetailbyresearcherswhohaveconsiderableexperienceintheirapplication.Table10.2listsanumberoftheseelicitationstrategies.Thedescriptionsof
thesestrategiesrevealthecommontechniquesavailabletobothprofessionaltestauthorsandclinicianswishingtoconstructasyntacticprobeforaparticularclient.

Informalprobeshavealsobeendevelopedtoexaminepragmaticskillsanareainwhichthereisadearthofstandardizedmeasures(Lund&Duchan,1993).For
example,Lucas,Weiss,andHall(1993)describedthedevelopmentofaprobedesignedtoexaminetheextenttowhichchildrenwithcommunicationdisordersare
sufficiently
Page260

Table10.2
ElicitationStrategiesforAssessingtheComprehensionandProductionofSyntaxinChildren

Strategy Description StrengthsandWeaknesses

Production
Thechildisaskedtorepeatanutterance(usuallyasingle
sentence)exactlyasproducedbyanadult.Itisassumedthatonly
Elicitedimitation(Lust,Flynn,
structuresreflectingthechildsgrammaticalcompetencewillbe
&Foley,1996)
produced.Aneasytechnique,evenforchildrenasyoungas1or l
2.
Situationsarecreatedtoincreasethelikelihoodthatthechildwill
attempttoproduceagivenstructure,usuallyincludingtheuseofa
leadinsentencethatisproducedbytheadulttoprovidethe l
Elicitedproduction(Thorton, contextandingredientsforproductionofthestructurewithout
1996) modelingit.Sometimesthistechniquemakesuseofapuppet
whocanbeaskedquestions,directedtodothings,orcorrected.
Typicallyusedwithnormallydevelopingchildren3yearsand
older.
lStrengths:Youcanchoosestimuliverypreciselyandknow
whatthechildisattemptingtosay.Studiesshowgoodagreement
withcomprehensionandotherdata.Thetechniqueisapplicable
withsmallchangesforchildrenfromawiderangeofculturesand
languagesandcanbeusedatrelativelylowdevelopmentallevels.
Weaknesses:Stimulusdesigniscomplexduetotheneedto
controlvariablesthatarenotofdirectinterest(e.g.,cognitive
demand,attention,grammaticalcomplexity,sentencelength).The
techniquehasbeencriticizedforrelyingundulyonshortterm
memory.
l Strengths:Generationofthetargetedstructurerestsmore
entirelywiththechildandisunlikelytobeduetochance.Alarge
numberofsuchprobeshavebeendescribedintheresearch
literature.
Weaknesses:Thechildsenjoymentleveliskeytothesuccess
ofthestrategybecausesheorheneedstobeanactive
participant.Theawkwardnessassociatedwithanoresponse
fromthechildmaybeintensifiedrelativetoothermethodsand
maymakechildrenlesswillingtocontinue.Workingoutthe
detailsrequiredtoelicitproductionmayrequireconsiderable
pilotingwithadultsornormallydevelopingchildren.Similarly,
correctproductionsarefarmorestraightforwardlyinterpreted
thanincorrectoruntargetedproductions.
Page261

Thechildisseatedonaparentslap,hearsastimulusandthenis
presentedsimultaneouslywithtwonovelvideoimagesone
Comprehensionintermodal
matchingandtheothernotmatchingwhathasbeensaid.Greater
preferentiallooking(Hirsh
timespentwatchingthematchingvideoisexpectedfor
Pasek&Golinkoff,1996)
comprehendedstructures.Usedforchildrenbetween12months
and4yearsofage.
l Strengths:Minimalactionisrequired.Useofvideosallowsthe
presentationofdynamicrelationships.Canbeusedatlower
developmentallevelsthanmanyothertasks.
l Weaknesses:Considerabletimeandexpertisearerequiredto
createthevideostimuli.Onlyafewstimulicanbestudiedatany
pointintime.
Strengths:Thistechniquehasbeenwidelyusedtoassess
l

understandingorgrammaticalityofspecificphonological
distinctions,lexicalcomprehensionorcomprehensionofspecific
Thechildhearstheadultorarecordedvoicepresentingaverbal morphosyntacticstructure.Ittendstoproduceresults
Pictureselectiontask(Gerken stimulusandthenpointstooneoftwotofourpictures.Typically comparabletoobjectselectionwhereeithertaskisfeasible.
&Shady,1996). thistaskisusefulwithnormallydevelopingchildren20to24 l Weaknesses:Considerabletimecanberequiredtoproduce

monthsandolder. comparabletargetandfoilitems.Althoughuseoftaperecorded
speechorsyntheticspeechcanhelpincreasechildrensattention,
itincreasesthecomplexityoftaskconstruction.Failuresto
respondaredifficulttointerpret.
Strengths:Thetaskhasalonghistoryofuseandiseasyand
l

inexpensivetouse.Itcanbefunforthechildandcanbe
particularlyeffectiveinassessingunderstandingofanaphoraand
pronominalization.Itisrelativelyopenendedtaskthatmaybe
lesssensitivetoresponsebiasthanmanyothers,yetmaybe
Thechildisaskedtouseprovidedpropstoactoutasentence associatedwithatendencytorepeatedlyuseaproponceitis
ActingOutTasks(Goodluck,
thatisreadorplayedbackfromtape.Typicallyusedforchildren pickedup.
1996)
olderthan3years. l Weaknesses:Itcannotbeusedwithconstructionsor

predicatesthataredifficulttoactoutandcanbeassociatedwith
responsesthataredifficulttointerpret.Becauseofthecognitive
complexityofthetask,ittypicallyisusedfornormallydeveloping
childrenolderthan3years,thuslimitingusewithchildrenwith
languagedifficulties.
Page262

informativeintheirutterancesastheyparticipateinaroleplayinggame.Thechildisassignedtheroleofwarehousemanagerandisapproachedbythecliniciantoy
buyerandaskedwheredifferenttoysmightbefoundinthewarehouse.Inasimilarvein,Roeper,deVilliers,anddeVilliers(1999)recentlydescribedtheirongoing
effortstodesignanextensivenumberofprobesforassessingimportantinteractingknowledgeinpragmatics,semantics,andsyntaxfor5yearoldsforexample,the
needtoknowspecificsemanticandsyntacticformstoachieveparticularpragmaticfunctions.Elaboratelydevelopedintermsofthematerials,instructions,andscoring
procedures,boththeprobesdevelopedbyLucasetal.andthosedevelopedbyRoeperetal.illustratethatameasuresformalityisbetterconceivedofasacontinuum
thanadichotomy.Further,thethoroughdescriptionoftheprobesofferedbyLucasetal.illustratetheextenttowhichsharingtheresultsofwelldevelopedprobescan
increasetheefficiencyofcliniciansefforts.

Professionaljournalsandagrowingnumberofbooksonlanguagedevelopmentanddisordersdescribenumerousclinicalandresearchprobes(e.g.,Brinton&Fujiki,
1992Lund&Duchan,1993Miller,1981Miller&Paul,1995Simon,1984).Table10.3showcasesamodestsampleoftheseprobesforchildrenacrossawide
rangeofagesanddevelopmentallevels.Itisofferedtohelpprovideafeelfortheheterogeneityandconsiderablepotentialofsuchmeasures.

4.RatingScales

Ratingscalesconsistofassigningnumeralsorlabelstoanindividualsbehaviorinaparticularcontext.Ratingscalesaretypicallycompletedbytheclinicianorother
observeraftertheobservationofindividualcommunicationevents.Attimes,suchscalescanbeusedtohelpobserverssummarizetheirexperienceacrossmultiple
observationexperiences.Ratingscalesdifferfromonlineobservations,anothertypeofdescriptivemeasure,inthatonlinejudgementsaremadeduringratherthan
aftertheactualcommunicativeevent.

Ratingscaleshavealengthyhistoryinpsychologyandspeechlanguagepathology(e.g.,seeSchiavetti,1992),butprimarilyinresearchratherthanclinicalsettings(e.g.,
Burroughs&Tomblin,1990Campbell&Dollaghan,1992).However,increasingattentiontothedocumentationofchildrensfunctionallimitations(Goldstein&
Gierut,1998)maycauseratingscalestobeusedwithgreaterfrequencyinthefuture.

Twotypesofratingscalesthathavebeenmostinfluentialinspeechlanguagepathologyareintervalscalinganddirectmagnitudeestimation(Campbell&Dollaghan,
1992Schiavetti,1992).Theseratingscalesareusuallyusedtocomparealargenumberofstimulusexamplessomethingthatisnotalwaysdonewithratingscales.
Whenintervalscalingisused,theraterassignseachcharacteristicorbehaviorbeingratedtoalinearlypartitionedcontinuum,whichismarkedoffusingnumeralsor
descriptivelabels.Thus,forexample,aratermightbeaskedtorateabehavioronacontinuumfromuncommontomostcommon,usinga6or7pointscalethatmight
looksomethinglikethis:
Page263

orthis:

Whendirectmagnitudeestimationisused,theraterisaskedtorateeachcharacteristicorbehavioreitherasaproportionofastandardstimulusprovidedaspartof
theratingsystemorasaproportionofotherratedstimuli.Thus,forexample,Camp

Table10.3
ASampleofProbesUsedintheDescriptionofChildrensLanguage

ApproximateAgeofChildfor
WhomtheTaskCouldBe
Used
Procedure(Source) (IfSpecified) Description

Childisaskedtoperformactionsthatthechildsparent(s)believesheorshemayunderstandon
Comprehensionofactionwords
12to24months familiarobjectsandpeople.Unconventionalactionsmayberequestedtohelpdistinguishaction
(Miller&Paul,1995)
unconnectedtotherequestfromintentionalresponses.
Bellugisnegationtest(Miller, Thechildisaskedtoprovidethenegativeofanutteranceproducedbyanadult.Variationscan

1981) includedifferentauxiliaries,negativewithindefinites,imperatives,andmultipropositionalsentences.
Productionofquestionforms TheMessengerGame.Thechildisaskedtogetinformationfromathirdparty,ideallyonewhois

(Lund&Duchan,1993) outofview.Forexample,Askherhowshegottothisschool?
Comprehensionofnonliteral
meaning(Lund&Duchan, Earlyadolescence Jokeexplanations.Thechildisaskedtoexplainajokethatheorshefindshumorous.
1993)
Comprehensionofclassroom
Classroomdirectionsandvocabularythatarethoughttobedifficultforthechildareincorporated
directionvocabulary(Miller& 6to12years
ininstructionsthatthechildmustfollowusingpaperandpencil.
Paul,1995)
Productionofsequential MiddleandHighschool Descriptionforusingapayphone.Childisshownapictureofapayphoneandaskedtogiveastep
description(Simon,1984) students bystepdescriptionofhowitisused.
Page264

bellandDollaghan(1992)describedamethodinwhichnostandardstimulusisprovided.Intheirstudy,listenerswereinstructedtoassignanynumberoftheirchoiceto
thefirstof36speechsamplestheywereaskedtorate.Latersampleswerethenratedsubjectivelyonthebasesof(a)theirproportionalinformativenessrelativetothe
otherjudgmentsmadeinthesampleand(b)theunderstandingthathighernumbersweretobeassociatedwithgreaterinformativenessthanlowernumbers.

TheObservationalRatingScalesthatareincludedaspartofthethirdeditionoftheClinicalEvaluationofLanguageFundamentals(Semel,Wiig,&Secord,1996)
provideanexampleofhowaratingscalecanbeusedtoenrichthecliniciansunderstandingoftheschoolagechildandhisorhercommunicationenvironment.They
arementionedherebecauseoftherelativedearthofsuchscalesforschoolagechildren,althoughtheyarebecomingmorecommonforexample,theFunctional
StatusMeasures(EducationalSettings)ofthePediatricTreatmentOutcomesForm(ASHA,1995)andtheTeacherAssessmentofStudentCommunicative
Competence(Smith,McCauley,&Guitar,inpress).Inaddition,theObservationalRatingScalesareofparticularinterestbecauseoftheirnovelinclusionofparallel
ratingformssothatcomparableinformationcanbeobtainedfromthechild,hisparent(s)andteacher(s).Theyrepresentanexampleoftheintervalscalingmethod,one
inwhichindividualsareaskedtorespondinasummativefashiontopastobservations.

EachscaleoftheObservationalRatingScalesconsistsof40itemsaddressingtroublesfacingthechildinlistening(9items),speaking(19items),reading(6items),
andwriting(6items).Toillustratethenatureoftheseitems,letmeindicatethatthefirstlisteningitemisIhavetroublepayingattentionforthestudentversion(often
completedwiththespeechlanguagepathologist)MychildhastroublepayingattentionfortheparentversionandThestudenthastroublepayingattentionforthe
teacherversion.Eachitemisratedasoccurringnever,sometimes,often,oralways,withDK(Dontknow)usedtomarkitemsforwhichtheraterfeelsunabletopass
judgment.TheObservationalRatingScalesalsodescribeproceduresfortheobserverstoidentifyandprovideexamplesoftheirtopfiveconcerns,thuspavingtheway
forfunctionallyorientedinterventionplanning.

Thechiefappealsofratingscalesaretheapparenteasewithwhichtheycanbecreatedandadministered,aswellastheirwideapplicability(Pedhazur&Schmelkin,
1991Salvia&Ysseldyke,1998).Thesevirtues,however,maymasktheirsusceptibilitytoanumberofproblems,especiallyonesstemmingfrompoorlydefinedpoints
alonganintervalscaleandfromdifferencesintroducedbydifferentraters.Inabriefreviewofsuchmeasurementissuesfacingratingscales,PedhazurandSchmelkin
(1991)concludedthatratingsmayoftentellmoreabouttheratersthanabouttheobjectstheyrate(p.121).Theycitedarichliteratureinwhichtheperceptual
aspectsoftheratingtaskmakeratersvulnerabletoanumberoftypesofbias.Twocommontypesofbiasincludehaloeffects,inwhichratersallowimpressionsof
generalcharacteristicsorpreviousknowledgetohaveaconsistenteffectonratings,andleniencyeffects,inwhichoverlypositivejudgmentsappeartooccurbecause
theraterisfamiliarwiththepersonwhosecharacteristicsarebeingrated(Primavera,Allison,&Alfonso,1996).

Anadditionalchallengetovaliduseofratingscalesliesintheneedtoachieveasuccessfulfitbetweenthenatureofthecharacteristicbeingratedandthetypeofscal
Page265

ingmethodusedtorateit(Campbell&Dollaghan,1992Schiavetti,1992).Inparticular,researchershavenotedadifferenceinwhatkindofscaleisappropriate
dependingonwhethertheratedcharacteristicfallsalongametatheticversusaprotheticcontinuum.Onametatheticcontinuum,ratersresponsestodifferences
betweenratedentitiesseemtoreflectqualitativedistinctionswhereasonaprotheticcontinuum,ratersresponsestodifferencesbetweenratedentitiesappearto
reflectquantitativedistinctions(Stevens,1975).Theclassiccontrastivepairillustratingthesetwotypesofcontinuumarepitchandloudness.Withoutlookingaheadto
thenextparagraph,canyouanticipatewhichofthosetwocharacteristicsofsoundisprothetic(i.e.,characterizedbyquantitativeratherthanqualitativedifferences)?

Ifyoudecidedthatloudnesswasprothetic,youareinagreementwithalargebodyofresearchsuggestingthatpeopletendtotreatjudgmentssuchasloudnessasif
theywerejudgementsaboutwhetherastimulushadmoreorlessofsomething(Stevens,1975).Incontrast,pitchdifferencestendtobejudgedasiftheyrepresent
qualitativelydifferentstimuli.Well,thechallengetodevisingappropriateratingscalesisthatwhereasdirectmagnitudeestimationcanvalidlybeusedtomeasureeither
typeofcharacteristic,intervalscalingappearstoonlybevalidformeasuringcharacteristicsthataremetathetic.

CampbellandDollaghan(1992)suggestedthatbecauseofthelackofresearchdeterminingwhichlanguagecharacteristicsaremetatheticversusprothetic,direct
magnitudeestimationisalessriskychoiceforresearchersandclinicianswhowishtouseratingscalesintheirdescriptionsofchildrenslanguagedisorders.Theynoted
thatdirectmagnitudeestimationcanbeusedtoprovideacomparisonofchildrensspontaneouslyproducedlanguageagainstthatoftheirpeers.Amongthemost
importantusestheysawforsuchjudgmentsweretheexaminationofchangeoccurringasresultoforintheabsenceoftreatment.Inparticular,CampbellandDollaghan
describedamethodinwhich10to15listenerscouldbeusedtoprovideratingswithastablepercentageofvariability.

Specifically,CampbellandDollaghan(1992)had13listenerscomparetheinformativenessamountofverbalinformationconveyedbyaspeakerduringaspecified
periodofspontaneouslanguageproduction(p.50)achievedbythreechildrenwhohadsustainedseverebraininjurywiththreeagematchedcontrols,whenboth
setsofchildrenwereengagedinavideonarrationtask(Dollaghan,Campbell,&Tomlin:1990).(Recallthattheparticularsofthedirectestimationmethodinvolvedin
thisstudyweredescribedearlierinthechapterwhenthatratingmethodwasintroduced.)Theuseofthistechniqueprovidedsocialvalidationtotherecoverypatterns
shownbythe3childrenwithbraininjurywhoparticipatedinthestudy.Therelativelylargenumberofratersrequiredforuseofdirectmagnitudeestimationmay
precludeitsuseinmanyclinicalsituations.However,itmayprovevaluableasameansofvalidatingmoreefficientmethodsofsocialvalidation.Inaddition,itmayprove
valuableasamethodthatcouldprovideexactlytheinformationrequiredforcertainclinicalsituations.Forexample,itmightbeusedasdescribedbyCampbelland
Dollaghantosupporttoarelativelycostlyorlengthytreatmentapproachforagivenchildorgroupofsimilarchildren.

Notsurprisingly,then,itappearsthattheuseofratingscalesasadescriptivemeasurementtool,likeothersdiscussedinthissection,hasagreatercomplexitythanmight
Page266

atfirstbeapparent.Thus,wiseuserswillrequireasmuchevidenceregardingvalidityaspossibleforspecificmethodspriortodecidingtoimplementthemclinically.
Furtherevidenceoftheirpromiseshouldpromptuserstowanttoparticipateinprovidingsuchevidence.

5.LanguageAnalysis

Languagesamplingandanalysishaveenjoyedalonghistoryofuseinstudiesofchildrenslanguageacquisition(e.g.,Brown,1973Miller,1981Templin,1957).The
varietyofproceduresrecommendedforelicitationoflanguagesamplesandforthederivationofmeasuresbasedonthemhasgrownappreciablyoverthepast40years
andhaschangedasunderstandingsofthenatureoflanguageimpairmentshavechanged(Evans,1996aGavin,Klee,&Membrino,1993Miller,1996Stromswold,
1996).

Inastudyofsome253Americanspeechlanguagepathologistswhoworkwithpreschoolchildren,KempandKlee(1997)foundthat85%ofthemusedlanguage
analysisintheirpractice,withmostpreferringnonstandardizedformstoformalprocedures.Languageanalysesaresometimesavoidedbyclinicianswhoreportthatthey
donothavethetimetoincorporatethemintopracticeorthattheylackthecomputerresourcesthatwouldmaketheirusemoretimeefficient(Kemp&Klee,1997).
However,theseobjectionsarerapidlybeingaddressedbytherefinementandproliferationofcomputerizedanalysisprograms(Long,1999).Innovationssuchas
transcriptionlaboratoriesstaffedbynonprofessionaltranscribers,thecreationofdatabasesreportingfindingsforlargenumbersofchildren,andtheavailabilityof
analysisproceduresatnocostalsopointtogreaterpracticalityoflanguageanalysisinthefuture(Evans&Miller,1999Miller,1996Long,personalcommunication,
January7,2000Miller,Freiberg,Rolland,&Reeves,1992).

Amongthenumerousdiscussionsextollingthevirtuesoflanguagesamplingandanalysis,EvansandMiller(1999)offeredonethatisparticularlypowerful:

Thelanguagesample,bycontrast[withavailablestandardizedtools],representsthechildsintegrationofspecificinterventiongoalswithinthelargercommunication
contextandprovidesclinicianswithanopportunitytoassesschildrenslanguageskillsdynamicallyacrossarangeofsituationsthatvaryincommunicativedemand(e.g.,
freeplay,interview,narration,picturedescription).Languagesamplescanbecollectedasoftenasnecessarywithoutperformancebias,andchangesinchildrens
abilitiescanbedocumentedacrossawiderangeoflinguisticlevels.(Evans&Miller,1999,pp.101102)

Additionally,suchanalysescanexaminenotonlymanyaspectsoflanguage,butcanalsobeusedtoexaminehowcomplexityinoneareamayimpactanotheratheme
ofgrowinginterestintheevolutionoflanguageassessmenttools.Althoughlanguageanalysesaretypicallyusedtoassessaspectsofexpressivecommunication,theyare
alsofrequentlyusedasameansofexaminingreceptiveskills.Inparticular,itseemsthatchildrensresponsestothedirectionandcommentsoftheirconversational
partnersprovidedatathatarevaluedbymanyclinicians(Beck,1996).Inthenextsection,theevolution
Page267

oflanguagesamplingandanalysisisdescribedtohelpreadersunderstandthevarietyofavailablemeasuresandhowthesemeasureshavechangedovertime.

TheEvolutionofLanguageAnalyses

In1996a,Evansreviewedthechangesinemphasisinlanguagesamplingtechniquesthathaveaccompaniedchangesintheoreticalperspectivesonlanguage
developmentandlanguagedisorders.Inparticular,shediscussedtheinfluenceofthreedominantresearchparadigmsspanningthepasthalfcentury:(a)thebehaviorist
learningparadigm,(b)theformalistcompetencebasedparadigm(encompassinggenerativesyntax,generativesemantics,andanarrowinterpretationofsyntax,
Evans,1996a,p.208)and(3)thefunctionalistparadigm.Abriefsummaryofhercommentsisrelevanttoanyoneusinglanguageanalysisbecausesomanyofthe
measuresassociatedwithearlierparadigmsremainavailableandinwidespreadusesometimesinrevisedversionsandsometimesintheiroriginalform(Kemp&
Klee,1997).

Intheheydayofthebehavioristlearningparadigm,therolesoftheenvironmentonlearningandthewordastheunitofanalysiswereemphasized.Languageacquisition
wasunderstoodtooccurthroughthereinforcementofcorrectuseofwordsandsentences(wordsequences).Althoughstandardizedlanguagetests(e.g.,thePeabody
PictureVocabularyTest,IllinoisTestofPsycholinguisticAbilities)dominatedlanguageassessmentmethodsduringthisperiod,languageanalysistechniqueswere
usedaswellandemphasizedcountsordescriptionsofdifferentverbalbehaviors(e.g.,typetokenratio,measuresofsentencelength).

ThesecondparadigmdiscussedbyEvans(1996a),theformalistcompetencebasedparadigm,wasdesignedtoaddressthegenerativityofchildrenslanguage,thatis,
theuseofnovelandthereforeunmodeledandpresumablyunreinforcedutterances(e.g.,overregularizationofpasttense,asinhegoed.).AsEvansnotes,this
paradigmwasmadepossiblebylinguistictheoryoftheday(particularlytheworkofChomsky),inwhichamajorgoaloflinguistsbecametheidentificationoflanguage
independentcompetencies,termedlinguisticuniversals.Suchuniversalswerethoughttosuggestfeaturesoflanguagesandlinguisticstructurethatwerelikelytooccur
inalllanguages.

Evans(1996a)suggestedthatinitialorientationswithintheformalistparadigmwerelargelysyntacticinnatureandproceededontheassumptionthatdomainsof
languagesyntax,semantics,andsoforthcouldbeviewedindependently.Anassumptionwasalsomadethatvariabilityinperformancewasmorelikelytobea
functionofachildsknowledgethanafunctionofcontextualfactors.AccordingtoEvanssaccount,laterdevelopmentsinthisparadigm,fueledbytheoryanddata
fromavarietyofsources,shiftedthefocussomewhatfirsttosemantics,thentopragmatics.Evanspointedoutthatlanguageanalysesassociatedwiththeformalist
periodsimilarlyshifted,althoughsometimessubtly,fromlargelysyntacticmeasures(e.g.,DevelopmentalSentenceScoring,DSSLanguageSampling,Analysis,and
Training,LSATandLanguageAssessmentRemediationandScreeningProcedure,LARSP)tomeasuresfocusingonsemantics(e.g.,meanlengthofutterancein
morphemes,MLUm)and,later,onpragmatics(e.g.,Roth&Spekman,1984).
Page268

Evans(1996a)notedthat,throughoutthisperiod,thechildstaskinlanguageacquisitionwaslargelyseenasthatofacquiringcompetenceintheunderlyingrulesofthe
ambientlanguage.Predictably,then,childhoodlanguagedisorderswithinthisparadigmwereseenasdifficultiesinacquiringtherulesoftheindividualsubsystemsof
language.InEvanssview,languageassessmentshavethusgrownthroughaccretiontorequireelaborateanalysesacrosssemantics,syntax,andpragmaticsaprocess
thathasbeenmademorefeasiblethroughmoderntechnology.AmongtheanalysessheassociateswiththisperiodaretheSystematicAnalysisofLanguageTranscripts
(SALTMiller&Chapman,1982,1998)andtheChildLanguageAnalysisprograms(CLANMacWhinney,1991).

Evans(1996a)suggestedthatfunctionaltheories,thelastofthethreeparadigms,werepromptedbydifficultiesinaccountingforchildrensvariabilityacrosscontexts.If
ruleacquisitioniswhatistakingplace,thenaformevidencingthatruleshouldeitherbepresentornotpresentinachildsproductionsnotpresentinsomesituations,
butnotothers,withsomeconversationalpartners,butnotothers.ThefunctionalistparadigmisreflectedinworkssuchasBatesandMacWhinney(1989).According
toEvans,itisbasedonthefollowingpremise:

Variabilityinspeakerperformanceissimplythefinalsolutiontotheinteractionamongtheinternalstateofacomplexsystem(i.e.,theunderlyingspeakercompetence),
thestructureofthesystem(e.g.,wordorder,lexicalitems,morphonology,suprasegmentals),andtheimpactofexternalconstraintssuchasrealtimelanguage
processingdemands.(Evans,1996a,p.254)

Withinthefunctionalistparadigm,then,variabilitybecomesamajorsourceofinformationaboutthecurrentstateofachildsdynamicsystem(linguisticand
nonlinguistic)asitrespondstoexternalconditions(e.g.,situationalorattentionalfactors).Increasedvariabilityisseenasanopportunityforpositivechange.Inaddition,
thisparadigmemphasizesthenecessityofexaminingtheinterplayoflanguagedomains,anareaidentifiedbynumerousauthorsasamongthemostexcitingchallenges
facingcliniciansthisdecade(Howard,Hartley,&Muller,1995).

Evans(1996b)providedanexampleofsuchinteractionswhenshefoundfewermorphosyntacticomissionsinthespeechofchildrenwithSLIwhentheirutterances
occurredwithinaconversationalturnratherthanadjacenttoashiftinconversationalturn.Numerousstudiesbeyondthosejustcited(e.g.,Crystal,1987Panagos&
Prelock,1982Paul&Shriberg,1982)arguedthatrichandpowerfulunderstandingsofchildrensspeechandlanguagedevelopmentemergefromthekindsofdetailed
analysescalledforbycurrenttheory.

Certainlyoneofthemajoradvantagesoflanguagesampling,then,isthevarietyofquestionstowhichtheresultingsamplecanbeput.Forexample,Dollaghanand
Campbell(1992)describedataxonomyofwithinutterancedisruptionsarisingfromlanguageratherthanfluencydisorderstohelpcharacterizethesubtledeficitslying
acrosslanguagedomainsthatplagueyoungspeakerswithlanguagedisorders,bothdevelopmentalandacquired.

Table10.4listssomeofthestandardizedmeasurescurrentlyusedtodescribechildrenslanguageskillsbasedonlanguagesamples.Inthistable,avarietyofinforma
Page269

Table10.4
ToolsAvailableforDetailedAnalysesofLanguageSamples
(Evans,1996aLong,1999Owens,1998)

Procedures ContentofAnalyses Computerized?

Assigningstructuralstage(Miller,1981) Morphology,Syntax
Communicationanalyzer(Finnerty,1991) Morphology,Syntax
ComputerizedLanguageAssessment,Remediation,andScreeningProcedure(LARSPBishop,1985) Morphology,Syntax
Computerizedprofilingversions6.2and1.0(Long&Fey,1989) Morphology,Syntax,Narrative
Computerizedlanguageanalysis(CLANMacWhinney,1991) Morphology,Syntax,Narrative
Computerizedlanguageerroranalysisreport(CLEARBakervandenGoorbergh,1990) Morphology,Syntax,Pragmatics
Computerizedprofiling(CPLong,Fey&Channell,1998) Morphology,Syntax
Developmentalsentencescoring(DSS)ComputerProgram(Hixson,1985) Morphology,Syntax
Semantics,Morphology,
Content,form,anduseanalysis(Lahey,1988)
Syntax,andPragmatics
IndexofProductiveSyntax(IPSynScarborough,1990) Morphology,Syntax
Languageassessment,remediation,andscreeningprocedure(LARSP:,Crystal,Fletcher,&Garman,1989) Morphology,Syntax
Languagesampling,analysis,andtraining(LSATTyack&Gottsleben,1974) Morphology,Syntax
Lingquest(Mordecai,Palin,&Palmer,1985) Morphology,Syntax
Parrotearlylanguagesampleanalysis(PELSAWeiner,1988) Morphology,Syntax
Profileinsemanticsgrammar(PRISMGCrystal,1982) Semantics
Profileinsemanticslexicon(PRISMLCrystal,1982) Morphology
Pyeanalysisoflanguage(PALPye,1987) Morphology,Syntax
Systematicanalysisoflanguagetranscripts(SALTMiller&Chapman,1998) Morphology,Syntax,Narrative

tionabouttheprocedureandchildrenforwhomitwouldbeusefulareprovided.Inaddition,thoseproceduresthatareavailableoncomputerareindicated.Recently,
oneofthesecomputerizedprograms,CP(Long,Fey&Channell,1998)hasbeenmadeavailablewithoutchargeatthefollowingInternetwebsite:
http://www.cwru.edu/artsci/cosi/cp.htm(Long,January7,2000,personalcommunication).

Readersareremindedthatcomputerizedmeasuresshouldbeviewedhopefully(Long,1991,1999Long&Masterson,1993),butwithcautionaswell(Cochran&
Page270

Masterson,1995).Afterall,computersrenderitpossibletoconductlanguageanalysesthatwouldbeprohibitivelytimeconsumingifperformedbyhand,buttheyalso
makeitpossibletomakereallysillyorwrongheadedmistakesmorequicklythaneverforexample,tousethewronganalysisforaparticularchild.Theuserofsuch
measuresmustexerciseasmuchcautionaseverinselectingthespecificsampletobeusedasinputandinbuyingintothespecifictechniquesused.Further,one
shouldrecognizethatalthoughlanguagesamplesarenaturalinthesensethattheyareoftennotconsciouslystructuredbytheclinician,theyarenonethelesssubjectto
thesamecontextualeffectsthataffectnormreferencedtestperformance(Plante,February18,2000,personalcommunication).Agrowingliteratureonthesubjectof
languageanalysescanhelpcliniciansdeterminewhatisavailableandlikelytobeusefulfortheirclients(Cochran,&Masterson,1995Long,1991,1999Long&
Masterson,1993).

Althoughadetailedaccountofevenasingleanalysistoolisbeyondthescopeofthisbook,asummaryofsomerecentresearchmayhelpthereaderseethewealthof
informationobtainablethroughlanguageanalysis.Table10.5listssomepatternsofdisorderedlanguageperformancethatcanbedescribedusingtheSALT(Miller,
1996).MillerandKlee(1995)usedthesecategoriestocharacterizeproblemsof256childrenfromages2years,9monthsto13years,8months.Thedatawere
basedonconversationalandnarrativesamples,contextsthatwereselectedbecauseofthewealthofresearchontheformerandtheimportantconnectiontoliteracyof
thelatter(Miller,1996).MillerandKlee(1995)foundsignificantnumbersofchildrenatvaryingagesfallinginoneormorecategories,withonly20childrennot
describedbyanycategory.

Forpreschoolchildren,oneveryspecificmeasurethathasremainedinuseinarelativelyconsistentformacrosstheparadigmsdescribedbyEvanshasbeentheMLU,
measuredinmorphemes.GuidelinesforthecalculationofMLUasdescribedChapman(1981)areshowninTable10.6.MLUisregularlyusedclinically(Kemp&
Klee,1997Miller,1996)andhasbeenincorporatedinseveraloftheproceduresdescribedinTable10.4,includingSALT.Itsuseisbasedonthepremisethat,at
leastinyoungerchildren,increasingsyntacticcomplexitywillalsorequireincreasingutterancelengthespeciallywhenlengthismeasuredinmorphemesandtherefore
wouldbesensitivetoincreasesineitherwordsorgrammaticalorderivationalmorphemes.

NumerousstudieslendcredencetothevalueofMLUindescribinglanguagechangethroughthepreschoolyears(Conant,1987Rondal,Ghiotto,Bredart,&
Bachelet,1988Scarborough,Wyckoff,&Davidson,1986).In1993,Blake,Quartaro,andOnoratifoundevidencethatMLUcorrelatedhighlywithameasureof
grammaticalcomplexityobtainedusingtheLARSPuntilanMLUof4.5wasreached.FindingssuchasthesehaveprovidedconsiderablesupportforMLUs
widespreaduseinresearchasameansofgroupingchildrenaccordingtolanguageskill(Miller,1996),buttheappropriatenessofMLUdependsontheprecisefocus
ofthestudy.1Recentresearch(e.g.,Aram,Morris,&Hall,1993)hasalsosuggestedthediagnosticutility

1Leonard(1996)describedseveralalternativemeasuresforequatingresearchgroupsthatwillbemoreappropriateincertaincircumstances,includingmeannumberof
argumentsexpressedperutterance,meannumberofopenclasswordsperutterance,measuresofunstressedsyllableproductionorwordfinalconsonantproduction,
andexpressivevocabulary.
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Table10.5
AClinicalTypologyofDisorderedLanguagePerformance
BasedonUseoftheSALT

Clinicaltypes Characteristics

Utteranceformulation MazerevisionsatwordandphraselevelunitsincreasedMLUpauseswithinandbetweenutteranceswordordererrors
Wordfinding Mazerevisionsandrepetitionsatwordandpartwordlevelunitspauseswithinutteranceswordomissionswordchoiceerrors
Hypoverbalrate Decreasednumberofutterancesandwordsperminutepauseswithinandbetweenutterances
Hyperverbalrate Increasednumberofutterancesandwordsperminute,whichmaybecombinedwithreducedsemanticcontent
Noncontingentutterancespronominalreferenceerrorsproblemswithtopicmaintenance,newversusoldinformation,andnarrative
Pragmaticordiscourse
structure
Semanticorreference Overgeneralization,wordchoice,andNounPhraseVerbPhrasesymmetryerrorsabandonedutterancesredundancy
DecreasednumberofdifferentwordsandtotalnumberofwordsdelayedsyntacticdevelopmentasmeasuredinMLUandother
Delayeddevelopment
detailedsyntacticanalyses

Note.SALT=SystematicAnalysisofLanguageTranscriptsMLU=meanlengthofutteranceNPVP=n.FromProgressinAssessing,Describing,andDefining
ChildLanguageDisorder,byJ.Miller,1996,inK.N.Cole,P.S.Dale,andD.J.Thal(Eds.),AssessmentofCommunicationandLanguage(p.319),Baltimore:
BrookesPublishing.Copyright1996byBrookesPublishing.Reprintedwithpermission.inclinicalsettings,particularlywhereproductiondifficultiesareprominent
featuresofthechildsdifficulties.

TechnicalConsiderations:SampleSizeandVariationsinLanguageSamplingConditions

Recently,Mumaetal.(1998)reportedonastudyconductedseveralyearsearlierinwhichlanguagesampleswereobtainedfromagroupofsevennormallydeveloping
childrenbetweentheagesof2years,2monthsand5years,2months.Theynotedthat200300utteranceswereneededtoobtainacceptableerrorratesonmany
grammaticalstructuresrelatedtothechildsuseofdifferentgrammaticalsystems(nominal,auxiliary,verbal)andgrammaticaloperations(useofrelativeclauses,do
insertion,participleshifts,etc.).Specificallytheyfounda15%errorrateforthe200300utterancesamplesversuserrorratesof55and40%,respectively,for50
utteranceand100utterancesamples.Notsurprisingly,then,thesedatasuggestthatthemorespecificthenatureoftheinformationthatwillbelookedforinthe
languageanalysis(i.e.,whetherdetailedinformationaboutspecificstructuresissought),thelongerthesamplewillneedtobe(Plante,February20,2000,personal
communication).

Inasimilarstudy,GavinandGiles(1996)conductedaSALTanalysisonlanguagesamplesofvaryingsizesbasedoneitherincrementsoftime(12or20minutes)or
numberofutterances(25175,in25wordincrements).Studyparticipantswere20childrenfrom31to46monthsofage.Theresearchersexaminedthetestretest
relia
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Table10.6
ASummaryoftheMethodforCalculatingMeanLengthofUtterance(MLU)in
Morphemes,asDescribedbyChapman(1981)asanAdaptationFromBrown(1973)

PreparingthespeechsampleforcalculationofMLU
l Thechildsspeechissegmentedusingthecriterionofterminalintonation(risingorfalling).
l TheseproceduresdifferfromthoseofBrown(1973)inthatasampleofthefirstconsecutive50utterances(includingthefirstpageoftranscription)ratherthan

100utterances(excludingthefirstpage)isrecommended.
l Excludedfromthesampleofutterancesareunintelligibleorpartiallyunintelligibleutterances.Includedaredoubtfultranscriptionsandexactutterancerepetitions.
Countingmorphemesineachutterance
Morphemesaredefinedasminimalmeaningfulunitsofalanguage,withdogandsgivenasexamples.CountingrulesbasedonthoseofBrown(1973)aregivento
addressthegreateruncertaintyofwhatconstitutesamorphemeinthespeechofachild.Thetotalcountforeachutteranceiscalculated,summed,anddividedbythe
totalnumberofutterancesspokentoyieldtheMLU.Thecountingrulesaregivenverbatim:
Stutteringismarkedasrepeatedeffortsatasinglewordthewordiscountedonceinthemostcompleteformproduced.Inthefewcaseswhereaword
(1)
isproducedforemphasis,orthelike(no,no,no),eachoccurrenceiscountedseparately.
(2) Suchfillersasmmoroharenotcounted,butno,yeah,andhiare.
Allcompoundwords(twoormorefreemorphemes),propernouns,andritualizedreduplicationscountassinglewords.Someexamplesarebirthday,
(3) racketyboom,choochoo,quackquack,nightnight,pocketbook,seesaw.Thejustificationforthisdecisionisthatthereisnoevidencethatthe
constituentmorphemesfunctionassuchforthesechildren.
(4) Allirregularpastsoftheverb(got,did,went,saw)countasonemorpheme.Again,thereisnoevidencethatthechildrelatesthesetopresentform.
Alldiminutives(doggie,mommie)countasonemorphemebecausethesechildrendonotseemtousethesuffixproductively.Diminutivesarethestand
(5)
formsusedbythechild.
Allauxiliaries(is,have,will,can,must,would)countasseparatemorphemesasdoallcatenatives(gonna,wanna,hafta,gotta)Thecatenativesare
(6) countedassinglemorphemes,ratherthanasgoingtoorwantto,becauseevidenceisthattheyfunctionassuchforchildren.Allinflections,forexample,
possessive(s),plural(s),thirdpersonsingular(s),regularpast(ed),andprogressive(ing),countasseparatemorphemes.(Chapman,1981,p.24)
Chapman(1981)identifiedseveralspecialcharacteristicsofasamplethatmayaffecttherepresentativenessoftheMLU:highrateofimitation(i.e.,>20%ofthe
childsutterances),frequentselfrepetitionswithinaspeechturn,ahighproportionofanswersoccurringinresponsetoadultquestions(i.e.,>3040%ofthechilds
utterances),frequentuseofroutines(suchascounting,sayingthealphabet,nurseryrhymes,songfragments,commercialjingles,orlongutterancesmadeupby
listingobjectsinabookortheroom),andahighproportionofutterancesinwhichclausesareconjoinedbyand.Amongthestrategiesshesuggestedfor
addressingtheseproblemsarecalculationsconductedwithandwithoutimitations,selfrepetitions,frequentroutines,andresponsestoquestions.Inaddition,she
suggestedobtainingadditionalsampleswithanotheradultwhoasksfewerquestionswhenhighratesofquestionresponsesarenotedandtheuseofanothermeasure
(theTunit)whenahighproportionofutterancesconsistofclausesconjoinedbyand.
Page273

bilityoffourmeasures(MLU,numberofdifferentwords,totalnumberofwords,andmeanssyntacticlength)insamplesatthesedifferentlengths.Theyfoundthatonly
atthelargestnumberofutterances(about175)didreliabilitycoefficientsmeetorexceed.90,thevalueconsideredacceptablefordiagnosticuse.

Theimplicationofthesefindingsextendsbeyondasimpleadmonitionforclinicianstoattempttoobtainlargersamplesizesonwhichtobaselanguageanalysesorfor
themtobeveryawareofthepotentialforerrordogginganalysesbasedonsmallersamplesalthoughthoseareclearandpotentimplications.Evenmoreimportantly,
however,theyillustratetheconnectionbetweenreliabilityandsamplesizethathauntsmanyifnotmostdescriptivemeasures.Obviously,rarerstructuresorphenomena
aremorelikelytobevulnerable,butadditionalresearchwillprovehelpfulinguidingustowardbestpracticesinourchoiceoftoolsandsamplesizes.

Theconditionsunderwhichlanguagesamplesarecollectedareknowntoaffectnumerousmeasuresobtainedinlanguageanalyses(Agerton&Moran,1995Landa&
Olswang,1988Miller,1981MoellmanLanda&Olswang,1984Terrell,Terrell,&Golin,1977).Evenapartiallistingofsomeofthevariablesaffectingachilds
productionscanleaveonequitedauntedforexample,raceandfamiliarityofcommunicationpartner,stimulusmaterials,numberofcommunicationpartners,number
andtypesofquestionsasked,typeofcommunicationrequired(e.g.,narrative,descriptionofaprocedure),tonameafew!Itispossibletoleavethesevariables
uncontrolledasisoftendonewhenanunstructuredconversationbetweenclinicianandchildisusedasthesample.Insuchcases,theclinicianwillwanttoconsider
thesevariablesinhisorheranalysisandinterpretationprocess.

Asanalternativetounstructuredlanguagesamples,structuredsamplingtaskshavebeenrecommendedasprovidingmorerelevant(i.e.,valid)informationforsome
clinicalquestions.Followingisalistoffivesetsoftasksdesignedtoelicitstructuredlanguagesamplesforschoolagechildren(Cirrin&Penner,1992):

1. describinganobjectorpicturethatisintheview
2. recallingatwoparagraphstorytoldbytheclinicianwithoutpictures
3. describingaperson,place,orthingthatisnotpresentintheimmediatesurroundings
4. providingadescriptionofhowtodosomethingfamiliar(e.g.,makingasandwich)and
5. tellingwhatthechildwoulddoinagivensituation(e.g.,wakinguporseeingahouseonfire)

Thislistillustratestasksthatmanipulatesomeofthevariablesthatmaypresentachildwithparticulardifficulty,thusallowingthecliniciantotargetlanguagesamplingfor
thoseareasofspecialimportancefortheindividualchild.However,itisimportanttorememberthateachoftheseconditionsislikelytoaffectmoreaboutthechilids
productionsthansimplythevariablethatappearstobemanipulated.Forexample,onthebasisoftheprecisewayinwhichthetaskissetupbytheclinician,variables
beyondthedesiredtopicorleveloflanguagecomplexitywillprobablybeaffected.
Page274

Inanotherefforttohelpcliniciansstandardizetheconditionsunderwhichtheycollectconversationallanguagesamples,CampbellandDollaghan(1992)offereda
sequenceoftopicquestionsthattheysuggestedbeusedinorder,butonlyasspurstoconversation.Thus,onlytopicsthatthechildwouldshowgenuineinterestin
wouldbecontinued.Further,additionaltopicsintroducedbythechildwouldbepursuedaslongastheycontinuedtointerestthechild.Theintendedresultwas
increasedconsistencyacrossexaminers.Inbrief,thesequencebeginswithquestionsaboutthechildsage,birthdate,andsiblingsthenproceedstoquestionsabout
familypets,favoritehomeactivities,andschoolaffairsandcloseswithquestionsaboutvacations,favoritebooks,andTVshows.Althoughthislistisrelatively
conventional,thedecisionofagroupofcolleaguestoadoptitorsomeotherconsistentsetofstarterquestionsmighthelplendgreaterconsistencytothelanguage
samplesobtainedacrosschildren.This,inturn,wouldincreasetheintegrityoflocalmeasuresthatmightbemadeusingthedatafromanumberofclients.However,it
shouldbenotedthatstandardizationinthiswayisnotnecessarilygoingtoaddtotherepresentativenessofthesamplefortheindividualchildthatmaybestbe
achievedbyenteringoneofachildsfavoriteactivitiesandsimplyobservingwhathappensthere.

6.OnLineObservations

ThiscategoryofdescriptivemeasuresischaracterizedbyDamicoetal.(1992)asrealtimeobservationandcodingofbehaviorsexhibitedduringcommunicative
interactionsastheyhappen.Thus,thesemeasuresdifferfromratingscalesthatarecompletedoutsideofthattimeframe.Althoughnotatallrareinresearchon
communication,Damicoetal.notedtherelativeraritywithwhichtheyareappliedbyspeechlanguagecliniciansinclinicalpractice.

McReynoldsandKearns(1983)describedfivekindsofobservationalinformationorcodesthatarefrequentlyusedinappliedresearchsettingstoobtainonline
measures:(a)trialscoring,(b)eventrecording,(c)intervalrecording,(d)timesampling,and(e)responseduration.Aseachoftheseisdescribed,thereaderwillsee
thatthesesamecategoriescanbeusedtodescribetheoutcomesofprobes.Thechiefdifferencebetweenprobesandonlineobservationsisthatthelatterinvolves
responsestoamorenaturalisticcommunicationevent,whereastheformerinvolvesagreaterlevelofcontrivanceonthepartoftheclinician.

Intrialscoring,responsesfollowingaspecificstimulusortrialarescoredascorrectorincorrect.Suchresponsescanoccureithernaturallyorwithprompting.
Althoughcorrectversusincorrectarethemostcommonlyusedlabelsappliedtoresponsesintrialscoring,anumericalcode(whichmayinfactrepresentatypeof
ratingscale)maybeusedtoprovidegreaterdetailaboutthenatureofresponses.Oneexampleofanumericalcodeisthemultidimensionalscoringsystemusedinthe
PorchIndexofCommunicativeAbilityinChildren(Porch,1979),whichusesa16pointscoringsystemtoreflect5dimensions(accuracy,responsiveness,
completeness,promptness,andefficiency).Readersshouldnotethatonlyrarelyaresuchcombinationsofratingscalesandtrialscoringusedinonlinesituations
becauseoftheintensedemandsontherater,whichleavessuchmeasuresquitevulnerabletoproblemswithreliability.
Page275

Ineventrecording,acodeisestablishedconsistingofbehaviors(includingverbal,nonverbal,orboth)ofinterest.Thatcodeisthenusedtosummarizethetargeted
childsbehaviorsoveragiventimeperiod(e.g.,a15minuteperiod).Oneexampleofacodethatmightbeusedineventrecordingwouldbetheonedevelopedby
DollaghanandCampbell(1992).Thatcodehadbeendevelopedtodescribewithinutterancespeechdisruptions(i.e.,pauses,repetitions,revisions,andorphans
linguisticunitssuchassoundsorwordsthatarenotreliablyrelatedtoothersuchunitswithinanutterance).WhereasDollaghanandCampbellusedthatcodeinan
analysisofpreviouslyrecordedlanguagesamples,itcouldalsobeusedforonlineobservation.

Intervalrecordingandtimesampling,twosamplingmethodsthatarecloselyrelated,arealsocloselyrelatedtoeventrecording(McReynolds&Kearns,1983).In
intervalrecording,asettimeperiodisdividedintoshort,equalintervals(e.g.,10seconds)andeventsarenotedashavingoccurredonceiftheyoccuratanypoint
duringtheinterval.Intimesampling,asettimeperiodisagaindividedintointervals,butonlythepresenceofthebehaviorattheveryendoftheintervalisrecorded.
Inadditiontothedesignationofintervalsdevotedtoobservation,thisapproachalsoincludesrecordingintervalsinwhichnoobservationsareattempted.Intime
sampling,therefore,a7.5secondobservationintervalmightbefollowedbya2.5secondrecordinginterval.Timesamplinghasbeenthoughttobeassociatedwith
fewerproblemsaffectingaccuracythanintervalrecording.However,bothmethodsrequirethatcarebetakenintheselectionofintervalsizes(McReynolds&Kearns,
1983).Intervalsthataretooshortarelikelytoincreaserecordingerrorsthosethataretoolongarelikelytoloseinformationduetowantingobserverattention.

ThelastoftheobservationalcodesdescribedbyMcReynoldsandKearns(1983)istherecordingofresponseduration,inwhichthedurationofaspecificeventof
interest(e.g.,pauseduration)isrecordedusingastopwatchorothertimingdevice.Althoughresponsedurationmaynotbeapplicabletomanylanguagephenomena,it
cannonethelessprovequiteusefulfromtimetotimeforchildrenwithlanguagedisorders.Forexample,afunctionalmeasureforachildwithSLIwhodemonstrates
pragmaticdifficultiesmightconsistoftimespentengagedinconversationwithoneormorepeersduringrecess.Alternatively,timespentinperseverativeor
noncommunicativespeech(e.g.,repeatedrecitationofatelevisioncommercial)duringagroupactivitymightbeusedasafunctionalmeasureforachildwithautism.

Damico(1992)providedanexampleofanonlineobservationalsystem,calledSystematicObservationofCommunicativeInteraction(SOCI),whichmakesuseof
eventrecordingandtimesampling.InSOCI,problematicverbalandnonverbalbehaviorsarerecordedalongwithinformationaboutseveraldimensions(suchas
illocutionarypurpose)eachtimeitoccurswithinafixedtimeperiod(a10secondperiodthatconsistsofa7secondobservationand3secondrecordinginterval).
Recordedbehaviorsincludefailuretoprovidesignificantinformation,nonspecificvocabulary,messageinaccuracy,poortopicmaintenance,inappropriateresponse,
linguisticnonfluency,andinappropriateintonationcontour.Fourtosevenrecordingperiodsofapproximately12minuteseacharerecommended.Althoughsomedata
regardingreliabilityofthisprocedurearementionedinDamico(1992),clearlythistypeofprocedurewarrantsadditionalevidencetoprovidebetterguidanceregarding
itsinterpretationandvalidity.
Page276

7.DynamicAssessment

Dynamicassessmentproceduresrepresentalargenumberofproceduresthataredesignedtoexamineachildschangingresponsetolevelsofsupportprovidedby
theclinician.Proponentsofdynamicassessmentmightbalkatitsinclusioninthelistofmeasuresreviewedinthischapter,maintainingthatitrepresentsanapproachto
assessmentthatisentirelydifferentfromtherest.Infact,forproponentsofdynamicassessment,mostotherformsofdescriptiveassessmentcanbelumpedintothe
single,usuallylessdesirablecategorystatic.Withinthisconceptualization,staticassessmentsassumeaconstantsetofstimuliandinteractionsbetweenthechildand
tester,whereasdynamicassessmentsassumeachangingsetofstimuliandinteractionsthataremanipulatedtoprovidearicherdescriptionofhowthechilds
performancecanbemodified.Referredtoasdynamicassessmenthere,awidevarietyofrelatedassessmentstrategiesfallwithinthiscategory.

Tothoseunfamiliarwiththetermdynamicassessment,OlswangandBain(1991),twoofitsforemostadvocatesinlanguageassessment,helpfullynoteditsstrong
resemblancetoamorefamiliarandvenerableconcept.Specifically,theycompareitwithstimulability,inwhichunaidedproductions(usuallyinarticulationtesting)are
followedbyeffortstoobtainthechildsbestproductionswhenaidedbythecliniciansvisual,auditory,andattentionalprompts.Inbothstimulabilityandindynamic
assessmentprocedures,facilitatingactionsonthepartoftheclinicianaredesignedtohelpdeterminetheupperlimitsofachildsperformance.Asaresult,the
boundariesofassessmentandtreatmentareblurred.Thisblurringhasledtotheuseofthetermmediatedlearningexperience(Feuerstein,Rand,&Hoffman,1979
Lidz&Pea,1996)torefertoonemodelofdynamicassessment.Italsoforeshadowstheintegrationofsuchassessmenttechniquesintotreatment(e.g.,Norris&
Hoffman,1993).

InitiallyappliedincognitiveandeducationalpsychologybyFeuersteinandothers(e.g.,Feuerstein,Rand,&Hoffman,1979Feuerstein,Miller,Rand,&Jensen,1981
Lidz,1987),dynamicassessmentmodelsaretypicallybasedontheworkofVygotsky(1978),whoproposedthezoneofproximaldevelopment(ZPD)asa
conceptualizationofthemovingboundaryofachildslearning.Thezoneofproximaldevelopmentisdefinedasthedistancebetweentheactualdevelopmentallevelas
determinedbyindependentproblemsolvingandthelevelofpotentialdevelopmentasdeterminedthroughproblemsolvingunderadultguidanceorincollaborationwith
morecapablepeers(Vygotsky,1978,p.86).Problemsolvingorbehaviorslyingwithinthiszonearethoughttorepresentthoseareaswherematurationisoccurring
andtocharacterizedevelopmentprospectivelyratherthanretrospectivelyasisdonewithtypical,staticassessment(Vygotsky,1978).

TheZPDhasbeeninterpretedasbeingindicativeoflearningreadiness.Therefore,itsdescriptionthroughdynamicassessmenthasbeenconsideredespeciallyusefulfor
identifyingtreatmentgoals(Bain&Olswang,1995Olswang&Bain,19911996).Specifically,OlswangandBain(1991,1996)suggestedthattasksthatchildren
performwithlittleassistancedonotwarranttreatment,andthosethatchildrenfailtoperform,evenwhenprovidedwithmaximalassistance,arenotyetappropriate
targets.Instead,themostappropriatetargetsarelikelytobethosethatchildrenperformonly
Page277

whengivenconsiderableassistance.Modifiabilityofperformanceinresponsetoadultfacilitationhasalsobeenshowntopredictgeneralizationofperformancetonew
situations,suchthatchildrenwhodemonstratelessmodifiabilityshowlesstransfer(Campione&Brown,1987Olswang,Bain,&Johnson,1992).

AnotherbenefitofdynamicassessmentobservedbyOlswangandBain(1991)isthatdynamicassessmentstrategiesallowthecliniciantodeterminenotonlywhatthe
childislearning,butalsohowthatlearningcanbesupportedthroughthemanipulationofantecedentandconsequentevents.Theynotethatwhereasconsequentevents
suchasthenatureofreinforcement(e.g.,tangiblevs.social)andscheduleofreinforcement(e.g.,continuousvs.variable)havereceivedattentionformanyyearsin
speechlanguagepathology,antecedenteventsreceivegreaterattentionindynamicassessment.Amongtheantecedenteventshighlightedindynamicassessmentarethe
useofmodelsorprompts,theselectionofthemodalitiesofstimuliorcuesthatareused,andthenumberofstimuluspresentationsthatareprovided.

Table10.7providesahierarchyofverbalcuesusedtoprovidedifferinglevelsofsupportforchildrenwithspecificexpressivelanguageimpairmentlearningtwoword
utterances(Bain&Olswang,1995).Inthestudy,whichwasdesignedtovalidatethe

Table10.7
ASampleHierarchyofVerbalCues

Condition Cue

Opportunitytochildsattention
Generalstatement
Ohlookatthis.
Opportunityplusanelicitationcue
Elicitationquestion Whatshappening?
Whatshedoing?
Moresalientopportunitycontrastingparticularfeatureofwhatistobecoded
Closeorsentencecompletion Lookthedogissittingand__.
(manipulatingdogsoitiswalking)
Repetitionofopportunity+embeddedordelayedmodelandelicitationcue
Indirectmodel
See,thedogiswalkingwhatishedoing?
Opportunityplusadirectmodelofdesiredutterancewithoutelicitationcueparticipantspontaneouslyimitatesthe
Directmodelevokingspontaneousimitation utterance
Dogwalk.
Opportunityplusadirectmodelofdesiredutterancewithanelicitationstatement
Directmodelplusanelicitationstatement
Tellme,dogwalk.

Note.Thistablerepresentsasamplehierarchyofverbalcuesarrangedfromthoseprovidingleasttomostsupportfortheproductionoftwowordutterancesin
childrenwithspecificexpressivelanguageimpairmentwhoareproducingfewornoutterancesofthistype.ThisexampleusescuesdesignedtoelicitAgent+Action
(dogwalk)asrelevantobjectsaremanipulated.FromExaminingReadinessforLearningTwoWordUtterancesbyChildrenWithSpecificExpressiveLanguage
Impairment:DynamicAssessmentValidation,byB.A.BainandL.B.Olswang,1995,AmericanJournalofSpeechLanguagePathology,4,p.84.Copyright
1995byAmericanSpeechLanguageHearingAssociation.Reprintedwithpermission.
Page278

useofdynamicassessment,15childrenwhowereproducingfewornotwowordutteranceswereassessedusingstandardizedmeasures,languagesamples,and
dynamicassessment,thentreatedfor3weeks.Constructvaliditywassupportedthroughthedemonstrationthatmoresupportivecues(i.e.,thoseprovidingmore
information)resultedinmorecorrectlyproducedtwowordutterancesthanlesssupportivecues.Inaddition,predictivevaliditywassupportedthroughthe
demonstrationthatchildrenwhoshowedthegreatestresponsivenesstothehierarchy(respondedtothelesssupportivecues)showedthegreatestlanguagechangeover
thestudyperiod.Oneunexpectedfindingwasthatlanguagesamplingwasassociatedwithagreatervarietyofwordcombinationsandtwowordutterancetypesthan
wasdynamicassessment.Thisfindingwasinconsistentwiththeoutcomeneededtosupportconcurrentvalidity,thussuggestingtheneedforfurtherstudy.

Thecollaborativenatureoftheinteractionpromotedindynamicassessmentisthoughttohaveimmediatebenefitstothechildsmotivation.Lidz(1996)describedthis
interactionaspromotingrapportbuildingandmotivationalvariables,includingreducedanxiety,[suchthat]assessmentbecomesmoreofaninstructionalconversation
thanatest(p.11).Atthesametime,anumberofauthors(GutierrezClellen,Brown,Conboy,&RobinsonZaartu,1998Lidz,1996)notedthattheuseofdynamic
assessmentallowsthecliniciantodeterminehowassessmentconditionsfacilitateorobstructthechildsattentionorarousal,perception,memory,conceptual
processing,andmetacognitiveprocessing.Thus,dynamicassessmentmayprovideinformationnotonlyaboutthechildscurrentandpotentialleveloffunctioningona
giventask,butalsoaboutthechildslearningneedsandstylethatextendbeyondthetaskathand.

Becauseofitscomplexity,dynamicassessmentisrecommendedforsome,butnotallchildrenwhoselanguagerequiresdescription.Muchoftheearlyworkondynamic
assessmentwasdirectedatitsuseforchildrenwithmentalretardation(Feuersteinetal.,1979).Morerecentlyithasreceivedconsiderableattentionasanonbiased
approachforusewithchildrenwhocomefromlinguisticallyorculturallydiversecommunities(GutierrezClellenetal.,1998Lidz,1996Lidz&Pea,1996Pea,
Quinn,&Iglesias,1992).Reducedbiasisexpectedforatleastthreereasons.First,dynamicassessmenttechniquescaneithercircumventoralterasneededthe
unfamiliarlanguageandinteractionroutinesthatmaypenalizechildrenfromnondominantculturalbackgrounds.Second,thecollaborativenatureoftheinteractionof
childandcliniciancanfacilitatemorerelaxed,confident,and,consequently,valideffortsfromthechild.Third,theembeddingofinstructionindynamicassessmentcan
reducetheeffectsofpreviousexperience,amajorsourceofbiasforchildrenwholacktheexperiencesofthemainstreamculture(Lidz,1996).

BainandOlswang(1995)summarizedthepromiseofdynamicassessmenttechniquesasfollows:

Dynamicassessmentoffersclinicianstheopportunitytoobtaininformationastowhototreat,whentotreat,whattotreat,howtotreat,andtodetermineprognosis.
Suchinformationwillenableclinicianstomakeinformeddecisionsastheyprovideservicestochildrenwithlanguageimpairment.(p.90)
Page279

Agrowingbodyofdatabolstersportionsoftheseclaims(e.g.,seeLong&Olswang,1996Olswang&Bain,1996).However,thecomplexityandvarietyof
proceduresfittingwithintheumbrellaofdynamicassessmentmeanthatmuchworkremainstobedonetooptimizethevalidityoftheseproceduresforindividual
childrenandassessmentpurposesoreventounderstandtheextenttowhichtraditionalpsychometricconceptscanbeappliedtotheirevaluation(Embretson,1987).

8.QualitativeMeasures

Speechlanguagepathologistshavealwayspaidattentiontoaverywiderangeofinformationsourcesbeyondthosedescribedthusfarinthechapter,includingteacher
andparentcomments,clientobservations,interviews,andofficialdocuments.Morerecently,sourcessuchasstudentjournals,portfolios,clinicianjournals,andcritical
incidentreports,orstandouts,havebeenadded(Schwartz&Olswang,1996Silliman&Wilkinson,1991).OlswangandBain(1994)usedthetermsdescriptive
andqualitativetorefertothesesourcesofinformationanddescribedthemassubjective,incontrasttothemoretypical,operationallydefinedquantitativedata.
OlswangandBainbasedtheirdiscussionofsuchmeasuresontheworkofauthors(e.g.,Bogdan&Biklen,1992Glesne&Peshkin,1992)describingqualitative
research,anumbrellatermusedtodescribeseveralresearchstrategiesinwhichsubjective,inductive,andrichlydescriptivemeasuresaresystematicallyusedto
examineparticipantsperspectivesonphenomenaofinterest.Becauseofthiscloseconnectiontoatypeofresearchthatmaybeunfamiliartomanyreaders,abrief
discussionofqualitativeresearchisofferedasbackground.

Historically,qualitativeresearchmethodshavebeendevelopedsomewhatindependentlyinanthropology,nursing,education,sociologyandsocialwork,amongother
disciplines(Bogdan&Biklen,1998Lancy,1993),buthaveshownincreasingcrossfertilization.Recently,thesemethods.,especiallythosedescribedas
ethnographic,havebeguntobeadoptedinresearchand,toalesserextent,inclinicalpracticeinspeechlanguagepathology(Kovarsky,1994Kovarskyetal.,
1999Silliman&Wilkinson,1991Westby,1990).Athoroughdescriptionofqualitativeresearchisbeyondthescopeofthistext,having,infact,servedasthefocus
foradazzlingarrayoftextsinjustthepastdecade(e.g.,Berg,1998Bogdan&Biklen,1998Creswell,1998Denzin&Lincoln,2000Kelley,1999Lancy,1993
Taylor&Bogdan,1998).Nonetheless,abriefoverviewofsomeofthetheoreticalthreadsunitingdifferentapproacheswithinqualitativeresearchcanhelpguideour
thinkingabouthowqualitativedatamaybeusedintheassessmentofchildrenslanguagedisorders.

Qualitativeresearchstrategieshavebeendescribedasdemonstrating,togreaterorlesserdegrees,thefollowing5features,manyofwhichclearlycontrastwith
quantitativestrategies(Bogdan&Biklen,1998).First,thefocusofqualitativeresearchisanaturalcontextinwhichtheresearcherservesastheprimaryinstrument.
Second,dataaredescriptive,ratherthanquantitative,innature.Third,interactivesocialprocesses,ratherthanproducts,areofinterest.Fourth,methodsareinductive
thus,abstractionsaremadefromthedatathatarepresent,ratherthantestedfromdatathat
Page280

aresoughtout.Fifth,meaningasexperiencedbyindividualsfromtheirpersonalperspectivesisofparamountinterest.Fromaclinicalvantagepoint,oneofthechief
attractionsofqualitativemethodsistheirpotentialtoguidecliniciansintheuseofdatathatmayhavepreviouslybeenseenasillicit.

Oneofthemajorsourcesofevidenceforthevalidityofqualitativedataliesintheprocessoftriangulation,whichcanbedefinedasthebelievabilityprovidedby
repeatedexamplesofagivenbehaviorobtainedinavarietyofsettingsorusingavarietyofmethods(Schwartz&Olswang,1996).Janesick(1994)describesfive
kindsoftriangulation:triangulationacross(a)datasources,(b)researchersorevaluators,(c)multipleperspectives,(d)multiplemethods,and(e)disciplines.Itisthe
preponderanceofevidencegainedundertheseconditionsthatvalidatesfindings(Berg,1998).Someauthors(e.g.,Bogdan&Biklen,1998)objectthattheterm
triangulationisuseddifferentlybydifferentauthorsandthusarguethattheexactmethodsusedtoproviderichsupportforvalidityneedtobespecified.However,itis
ausefultermforcapturingthewayinwhichvalidity,orbelievability,isalternativelycharacterizedwithinthisresearchparadigm.Also,interestingly,itisrelatedtothe
conceptpervadingmainstreampsychometricdiscussionsthattheoreticalconstructsneedtobestudiedusingseveralindicators(Pedhazur&Schmelkin,1991
Primavera,Allison&Alfonso,1996).Whenthinkingabouthowqualitativedatamaycomplementquantitativedescriptionsofthelanguageandlinguisticcontextfor
childrenwithlanguageimpairment,theconceptpointstowardaneedformultiplesourcesandsettings.

Althoughadditionalresearchmayhelpusunderstandhowsuchdatacanbestbeusedincombinationwithmoreestablished,quantitativemeasures,existingworkon
qualitativeresearchcanpointtothetypesofquestionsforwhichqualitativedatamaybebestsuited(Schwartz&Olswang,1996).Specifically,questionsthatrelateto
thediversewaysinwhichachildisviewedinhisorherlinguisticcommunityortothespecialexpectationsfallingonaspecificchildinaspecificcommunitymaybestbe
addressedusingqualitativedata.Thus,questionsthataddressconcernsabouthandicapanddisability,whichrelatetofunctionalandparticipativeeffectsofimpairments
(WHO,1980),maybeveryeffectivelyansweredusingqualitativemethods.

PracticalConsiderations

Numerouspracticalconsiderationsaffectthewayinwhichspeechlanguagepathologistscurrentlydescribelanguagedisordersinchildren.Influencesrelatedtothe
considerationofthelargercontextsinwhichlanguageimpairmentsoccurincludemovementstowardincreasinguseofassessmentsinwhichseveralprofessionals
contributetheirinsightsintothefunctioningofachild(coordinatedassessmentstrategies).Inaddition,therehasbeenacontinuingmovementinthepastfewdecades
towardassessmentsforschoolagechildreninwhichthefunctionaldemandsofacademicsettingsarerecognizedasthechiefchallengesfacingthem(curriculumbased
assessment).Thesecoordinatedapproachestowardassessmentcouldhavebeenprofitablydiscussedinchapter9,whichdealtwithidentification.Nonetheless,they
arediscussedherebecauseofthecloserconnectionofdescriptionthanidentificationto
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treatmentplanningtheareaofclinicaldecisionmakingthoughttobenefitmostfromcoordination.

Beyondtheseassessmentstrategies,perhapsthemostimportantpracticalconsiderationaffectingthedescriptivemeasureschosenbycliniciansisthatoftimeandother
practicalresources.Inthissection,theroleofcoordinatedassessmentstrategiesandotherpracticalfactorsisdiscussedbrieflytoillustratesomeoftheforcesshaping
descriptivepracticesinworkwithchildrenwithlanguageimpairments.

CoordinatedAssessmentStrategies

Childrenwithlanguageimpairmentexperiencearangeofneedsthatrequiretheattentionandcareofindividualsfromavarietyofdisciplines,forexample,speech
languagepathologyandaudiology,psychology,socialwork,occupationaltherapy,physicaltherapy,andavarietyofotherhealthprofessionals.Asachildsphysical
problemsandotherproblemsincreaseinnumber,coordinationofassessmentsandinterventionsconductedbytheseprofessionalsbecomecrucial(Linder,1993
Rosetti,1986).Withoutcoordination,professionalsmayworkatcrosspurposeswithfamilies,overwhelmthemwithexcessiveorcontradictoryrecommendationsand,
asaresult,facilitatesmallgainsinindividualdomainswhileunderminingtheoverallqualityofthechildslife(Calhoon,1997Raver,1991).Rosettidescribedthe
difficultyfacingaprofessionalworkingalonewithachildwithmanyproblemsassufferingfromtunnelvision,inwhichthechildmaybeviewedfromtheexceedingly
narrowperspectiveofthatsingleindividualsacademicandprofessionalbackground.Particularlyforveryyoungchildrenwithmultipleneeds,theneedforcoordination
hasbeenrecognizedinlegislationandinthedevelopmentofsophisticatedstrategiesofcoordination.Threegeneralstrategiesthatattempttomeettheneedsofchildren
andfamiliesaremultidisciplinary,interdisciplinary,andtransdisciplinaryapproaches(Calhoon,1997Raver,1991).

Multidisciplinaryassessmentinvolvesparallelplanning,administration,andinterpretationprocessesinwhichparentsinteractindependentlywithindividual
disciplines.Interdisciplinaryassessmentinvolvescoordinationthroughteamplanningofassessmentconsultationwithteammembersasassessmentsoccurwithin
individualdisciplinesandparentinvolvementisencouraged.Transdisciplinaryassessmentinvolvessharedassessmentsconductedbytheentireteam.Thisapproach
involvesparticipationofallteammembersaswellasthechildsparentsthroughouttheplanning,administration,andinterpretationprocess.Twoexamplesofspecific
transdisciplinaryapproachesincludeplayandarenaassessment,inwhichacriterionreferencedmeasurementstrategyisimplementedwithinanaturalisticcontext.
Whereasmultidisciplinaryandinterdisciplinaryapproachestendtopredominateinsystemsdesignedforolderchildren,transdisciplinaryapproacheshavebecome
particularlypopularfortheassessmentofinfantsandtoddlers(Calhoon,1997).

Attemptsatthecoordinationofdisciplines,particularlythosethatincreasetheinvolvementofparents,arepresumedtoincreasethevalidityofmeasurementandthe
effectivenesswithwhichclinicaldecisionscanbeimplemented(Crais,1993).Further,greatercoordination,particularlywithparents,isrequiredthroughIDEA(1990).
Page282

Asaconsequence,itislikelythatincreasingattentionwillbepaidtothevalidationofcoordinatedapproachestoassessmentandtothedevelopmentofmethodsto
increasetheirefficiency.

CurriculumBasedAssessment

Forschoolagechildrenwithlanguageimpairments,coordinationofdisciplinesisoftenmorelimitedthanforyoungerchildren,althoughitisatleastasvital.Forschool
agechildren,coordinationwillentailcollaborationbetweenclassroomteachers,specialeducators,andspeechlanguagepathologists.Forthisagegroup,collaborative
assessmentapproachisthetermmostfrequentlyusedtorefertothewayinwhichprofessionals(speechlanguagepathologistsinthiscase)attempttocoordinate
theiractivitieswiththoseoftheotherprofessionalsservingthechildinaschoolsetting.Curriculumbasedassessmentisoneparticularlywidespreadcomponentof
collaborativeassessmentapproaches(Prelock,1997).

Collaborationenablesthespeechlanguagepathologistandothermembersoftheeducationalteamtounderstandthespecificlanguageandcommunicationdemands
facingthechildwithagiventeacher,classroom,andcurriculum.Thepurposesofthiscollaborationaretodeterminewhatdemandspresentparticularchallengestothe
childandtoidentifyteamresourcesforaddressingthem(Creaghead,1992Prelock,1997Silliman&Wilkinson,1991).

Curriculumbasedassessmenthasbeendefinedbroadlyasevaluationofastudentsabilitytomeetcurriculumobjectivessothatschoolsuccesscanbe
achieved(Prelock,1997,p.35).Addingmoredetailtothisconcept,Nelson(1989,1994)calledattentiontothepresenceofnumerouskindsofcurricula.Thus,for
example,inadditiontotheofficialcurriculumoftheschooldistrict,therearetheculturalcurriculumconsistingofunspokenexpectationsbasedonthemainstreamculture
andtheundergroundcurriculumconsistingoftherulesaffectingpeersocialinteractions.

Inordertounderstandandrespondtoschoolcurriculainboththebroadandmoredetailedsenses,thespeechlanguagepathologistwillalmostalwaysneedtouse
criterionreferencedmeasures.Suchmeasuresaresometimesaimedatcharacterizingtheeducationalsettinganditsdemandsandsometimesaimedatdetermining
whetherthechildisorisnotabletomeetthosedemands.Identifyingthetaxingaspectsoflanguageandcommunicationwithintheclassroomwillbenefitnotjustthe
childwithlanguageimpairmentsbutallstudentswithinthatclassroom(Prelock,1997).Obviously,thebenefitofcollaborativecurriculumbasedassessmentstochildren
withlanguageimpairmentsisthepossibilityofdescribingandthenrespondingtotheirdifficulties.Theseresponsesbythespeechlanguagepathologistandotherteam
memberscanresultinaccommodationsorotheractivestepstofostergreatersuccessintheregularclassroom.Inessence,curriculumbasedassessmentscanhelp
preventimpairmentfromnecessarilybeingrealizedasadisabilityorhandicap,intheterminologyoftheICIDH(WHO,1980).Alternatively,itcanalsobeseenas
preventingimpairmentfrombeingrealizedasalimitationinactivitiesorparticipationopportunities,intheterminologyofICIDH2(WHO,1998).
Page283

OtherPracticalFactors

Practicalfactorsbeyondthosediscussedinthischapter,suchastimeandmoney,appeartoaffectthewaysinwhichcliniciansconductlanguageassessments(Beck,
1996Wilson,Blackmon,Hall,&Elcholtz,1991),includingassessmentsdesignedtoplanfortreatment(Beck,1996).Timedemandsseemtostemfromthepressures
oflargecaseloads.Inparticular,whereasASHA(1993)recommendedcaseloadsizesof40,ShewanandSlater(1993)foundthatschoolclinicianshaveaverage
caseloadsof52!Beckssurveyfoundthatcliniciansfrequentlyreportedthattheydidnothavesufficienttimetoconductcompleteassessments.Inaddition,clinicians
alsoreportedinsufficientfundstobuyadequatematerialsforassessment.OtherdatafromthesamesourceledBecktoponderwhetherfrequencyofusemightresult
frompropertiesofatestassimpleasitsbeingappropriateforawideagerangeanditsaddressingbothreceptiveandexpressiveconcerns.Thispossibilityledherto
commentthesearecertainlynottheidealcriteriaonwhichtobaseselectionofassessmentmethods(Beck,1996,p.58).

Further,Beck(1996)andWilsonetal.(1991)didnotobtaindetailedinformationabouttheentirerangeofdescriptivemeasuresusedbyclinicians.However,theydid
findthatlanguagesamplingisverywidelyused.Giventheexpressedconcernsabouttimeandmoney,however,itseemslikelythatthetimeconsumingdescriptive
measuresandmanyoftheexcitingbutemergingdescriptivemeasuresdescribedinthischaptermaynotmakeitintotherepertoireoftechniquesusedbyclinicians.At
leastthisconclusionseemsreasonableintheabsenceofconsiderableeffortonthepartofindividualcliniciansandtheprofession.Theseeffortsmaytaketheformof
workingtoreducecaseloadsizesandincreasebudgets.Alternatively,theymaytaketheformofresearchstudiesaimedatincreasingtheefficiencyandvarietyof
descriptivemeasures.Fortunately,thereiswidespreadrealizationthatdescriptivemeasuresarethemostappropriatetoolstouseinaddressingmanycriticalclinical
questionsthefirststepneededtoengagetheattentionofindividualcliniciansandoftheprofessionasawhole.

Summary

1.Descriptivemeasurementoflanguagepresentsbothgreaterchallengesandgreaterrewardstothepracticingclinicianthandoesassessmentaimedatscreeningor
identificationbecauseofitssteadfasttietotheheartofclinicalpractice:interventionsdesignedtoimprovethesocial,communicativelivesofchildren.

2.Evenmorethanmeasuresusedinidentification,descriptivemeasuresoflanguagerequirescrupulousattentionbythecliniciantoachieveamatchbetweenthespecific
clinicalquestionbeingposedandmethodusedtoachieveit.Thisistruelargelybecausethespecificityofthequestionbeingaskednecessitatestheuseofinformal
measuresthatcanonlybevalidatedthroughtheactionsoftheindividualclinician.

3.Damicoetal.(1992)describedauthenticity,functionality,andrichnessofdescriptionascriticalcharacteristicsfordescriptivemeasures.

4.
Page284

Awealthofstrategieshavebeenproposedforuseindescription,includingstandardizednormreferencedmeasures,standardizedcriterionreferencedmeasures,
probes,ratingscales,languageanalysis,onlineobservations,dynamicassessment,andqualitativemeasures.

5.Becausechildrenwithspeciallanguageneedsoftenrequiretheattentionofotherprofessionalsaswell,assessmentframeworkshavearisenthatreflectdiffering
degreesofcoordinationacrossdisciplines,aswellasdifferingdegreesofparentinvolvement.Theserangefrommultidisciplinarytointerdisciplinarytotransdisciplinary
assessments.

6.Thenatureofcoordinatedassessmenteffortschangesaccordingtotheageofthechild,withyoungerchildrenmorefrequentlyservedusingmethodsthatinvolvea
greaterdegreeofintegrationacrossprofessionsandolderchildrenservedusingmethodsthatacknowledgetheprimacyoftheschoolenvironmentfortheschoolage
child.Termsassociatedwithcoordinatedassessmentsincludearenaandplaybasedassessmentmethodsforyoungerchildrenaswellascurriculumbased
assessmentforolderchildren.

7.Recentinnovations,suchasdynamicassessmentandthethoughtfuluseofqualitativemeasures,challengeresearchersandclinicianswithopportunitiesforaricher
descriptionoftheeffectsoflanguagedisordersonchildren,includingthosefromnonmainstreamcultures.

8.Futuredevelopmentswithregardtodescriptivemeasuresarelikelytoincludethedevelopmentandvalidationofnewmethodsaswellasthedevelopmentofbetter
practicesleadingtomoreefficientandeffectiveapplicationofexistingapproaches.

KeyConceptsandTerms

authenticassessment:assessmentoccurringwhenskillstobeassessedareselectedtorepresentrealisticlearningdemandsconductedinreallifesettings,suchas
classrooms,inwhichartificialandstandardconditionsareavoided(Schraederetal.,1999).

authenticity:themostcomplexofthreeprimarycharacteristicsdescribedbyDamicoetal.(1992)asnecessaryfordescriptivemeasuresitincludesrespectforand
preservationoftheintricateandmeaningdirectednatureofcommunicationaswellastraditionalconceptsofreliabilityandvalidity.

collaborativeassessmentapproach:anyofseveralapproachesinwhichprofessionalsfromdifferentdisciplines(e.g.,speechlanguagepathologists,audiologists,
specialeducators)worktogethertoprovideinformationleadingtoeffectiveandefficientinterventionforagivenchild.

curriculumbasedassessment:assessmentaimedatexaminingachildsskillsandchallengesinrelationtocurriculardemandsforpurposesofplanninginterventions
thatmayoccurwithinandoutsideoftheclassroom.

directmagnitudeestimation:atypeofratingmethodinwhichstimulitoberatedarecomparedwithoneanotheroragainstastandardstimulus.
Page285

dynamicassessment:avarietyofapproachestodescriptioninwhichstimuliandproceduresaremodifiedtoidentifythechildspotentialperformancewithadult
collaborationtohelpdeterminetreatmentgoalsandfacilitativemethodsconsideredespeciallyusefulasameansofnonbiasedassessmentforchildrenwhoarebilingual
orfromnondominantculturalbackgrounds.

eventrecording:anobservationalmethodinwhichthefrequencyofspecificbehaviors(events)isrecordedacrosstheentireobservationaltimeperiod.

functionality:oneofthreeprimarycharacteristicsdescribedbyDamicoetal.(1992)asnecessaryfordescriptivemeasures,consistingoftheirabilitytocapturea
childsskillintransmittingmeaningeffectively,fluently,andappropriately.

intervalrecording:Amethodofobtainingonlineobservationaldatainwhichtheobservernotesthepresenceofabehaviorortargetedcharacteristicwithina
relativelyshorttimeframe(e.g.,10seconds).

intervalscaling:Aratingtechniqueinwhichratersareaskedtoassignanumberorverballabeltoasetofrelatedstimuli.

metatheticcontinuum:thetypeofratingshownwhenratersresponsestodifferencesbetweenratedentitiesseemtoreflectqualitativedistinctions.Auditorystimuli
differinginpitchappeartobetreatedinthisfashionbyraters.

multidisciplinaryassessment:assessmentinwhichprofessionalsinvolvedwithachildworkinparalleltoplan,conduct,andinterprettheirindividualassessmentswith
interactionsbetweenprofessionalsoccurringinalessstructuredfashionthaninterdisciplinaryortransdisciplinaryassessments.

probe:aninformalmeasureinwhichtheclinicianattemptstodeviseconditionsthatwillelicitaresponsedemonstratingachildsknowledgeofaparticularareaofform,
content,oruse.

protheticcontinuum:thetypeofratingshownwhenratersresponsestodifferencesbetweenratedentitiesappeartoreflectquantitativedistinctions.Auditorystimuli
differinginloudnessappeartobejudgedinthisfashionbyraters.

qualitativeresearch:arangeofresearchstrategiesdesignedtobenaturalistic,descriptive,inductiveinnature,andconcernedwithprocessandmeaning(Bogdan&
Biklen,1998).

richnessofdescription:oneofthreeprimarycharacteristicsdescribedbyDamicoetal.(1992)asnecessaryfordescriptivemeasuresitentailstheuseofsufficient
detailtoleadtoanunderstandingofcausalitythatmaybeusedinplanningtreatment.

timesampling:amethodofobservationinwhichtheobservationtimeperiodisdividedintointervalsandthepresenceofatargetedbehaviorisrecordedattheendof
eachinterval.

transdisciplinaryassessment:assessmentsinwhichteammembersfromdifferentdisciplinessharemaximallyintheassessmentprocessspecificexamplesofthis
typeofassessmentincludearenaandplaybasedassessments,whichareusedmostfrequentlywithinfantsandtoddlers.
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trialscoring:therecordingofaresponseascorrectorincorrectfollowingaspecificstimulusortrial(McReynoldsandKearns,1983).

triangulation:anapproachtovalidationinwhichconvergentfindingsaresoughtacrossvaryingmethods,datacourses,anddatasourcesrecentlyemphasizedin
relationtoqualitativeresearchmethods.

zoneofproximaldevelopment(ZPD):therangeofbehaviorslyingbetweenindependentfunctioningandfunctioningthatmustbefacilitatedbyamoreexpert
interactionpartnerthoughttoillustrateachildsemergingmasteryorlearningreadiness.

StudyQuestionsandQuestionstoExpandYourThinking

1.Onthebasisofyourreadingofthischapter,formulatethreeideasforresearchprojectsaimedatclarifyingsomepsychometriccharacteristic(e.g.,validityfora
purpose,reliability)ofaspecificdescriptivemeasure,thusmakingitmoreclinicallyuseful.

2.Lookatarecentissueofajournalcontainingarticlesonchildrenwithlanguageimpairments.SeeifyoucanfindexamplesofprobesthatcouldbeaddedtoTable
10.3.

3.Engageinaconversationwithtwodifferentpeopleforaperiodof10minuteseach,ideallytaperecordingitwiththeirknowledgesothatyoucangobackoverthe
conversations.Thencreatealistofthefactorsaffectingyourwordchoice,thelengthofyoursentences,thestructureofyoursentences,thenatureofyourturntaking,
andsoforth.Canyougrouptheitemsonyourlistintorelatedfactors?Onceyouhavedonethis,considertheextenttowhichchildrenscommunicationsarelikelytobe
similarlyaffectedinthecourseofcollectingalanguagesample.

4.Considerwaystotriangulateinformationaboutachildslackofsuccessinareadingclassinaregularfirstgradeclass.Developasmallsetofrelatedquestionsabout
thechildandthecontextandthenconsiderwhatkindsofmeasuresmightprovideyouwitharichunderstandingofthechildsdifficulties.

5.Findoutwhatcoordinatedassessmentmethodsexistinanyclinicalsettingsthatservechildrentowhichyouhaveaccess.Considerwhatbenefitsmightbegained,
andatwhatcosts,ifgreaterintegrationweretooccuracrossprofessionalroleswithinthatsetting.

RecommendedReadings

Damico,J.S.,Secord,W.A.,&Wiig,E.H.(1992).Descriptivelanguageassessmentatschool:Characteristicsanddesign.InW.Secord(Ed.),Bestpracticesin
schoolspeechlanguagepathology:Descriptive/nonstandardizedlanguageassessment(pp.18).SanAntonio,TX:PsychologicalCorporation.

Kovarsky,D.(1994).Distinguishingquantitativeandqualitativeresearchmethodsincommunicationsciencesanddisorders.NationalStudentSpeechLanguage
HearingAssociationJournal,21,5964.

Olswang,L.B.,&Bain,B.A.(1991).Whentorecommendintervention.Language,Speech,andHearingServicesinSchools,22,255263.
Page287

References

Agerton,E.P.,&Moran,M.J.(1995).EffectsofraceanddialectofexamineronlanguagesampleselicitedfromSouthernAfricanAmericanPreschoolers.Journal
ofChildhoodCommunicationDisorders,16,2530.

AmericanPsychologicalAssociation,AmericanEducationalResearchAssociation,NationalCouncilonMeasurementinEducation.(1985).Standardsfor
educationalandpsychologicaltesting.Washington,DC:APA.

AmericanSpeechLanguageHearingAssociation.(1993).Guidelinesforcaseloadsizeandspeechlanguagedeliveryintheschools.Asha,35(Suppl.10),3339.

Aram,D.M.,Morris,R.,&Hall,N.E.(1993).Clinicalandresearchcongruenceinidentifyingchildrenwithspecificlanguageimpairment.JournalofSpeechand
HearingResearch,36,580591.

Bain,B.A.,&Dollaghan,C.(1991).Thenotionofclinicallysignificantchange.Language,Speech,andHearingServicesinSchools,22,264270.

Bain,B.A.,&Olswang,L.B.(1995).Examiningreadinessforlearningtwowordutterancesbychildrenwithspecificexpressivelanguageimpairment:Dynamic
assessmentvalidation.AmericanJournalofSpeechLanguagePathology,4,8191.

BakervandenGoorbergh,L.(1990).CLEAR:Computerizedlanguageerroranalysisreport.ClinicalLinguisticandPhonetics,4,285293.

Barrow,J.D.(1992).Piinthesky:Counting,thinking,andbeing.NewYork:OxfordUniversity

Bates,E.,&MacWhinney,B.(1989).Functionalismandthecompetitionmodel.InB.MacWhinney&E.Bates(Eds.),Thecrosslinguisticstudyofsentence
processing(pp.373).NewYork:CambridgeUniversityPress.

Beck,A.R.(1996).Languageassessmentmethodsforthreeagegroupsofchildren.JournalofChildrensCommunicationDevelopment,17,5166.

Berg,B.L.(1998).Qualitativeresearchmethodsforthesocialsciences.(3rded.).Boston:Allyn&Bacon.

Berk,R.A.(1984).Screeningandidentificationoflearningdisabilities.Springfield,IL:Thomas.

Bishop,D.V.M.(1985).AutomatedLARSP(LanguageAssessment,Remediation,andScreening)[Computerprogram].Manchester,England:Universityof
Manchester.

Blake,J.,Quartaro,G.,&Onorati,S.(1993).Evaluatingquantitativemeasuresofgrammaticalcomplexityinspontaneousspeechsamples.JournalofChild
Language,20,139152.

Bogdan,R.C.,&Biklen,S.K.(1992).Qualitativeresearchforeducation:Anintroductiontotheoryandmethods(2nded.).Boston:Allyn&Bacon.

Bogdan,R.C.,&Biklen,S.K.(1998).Qualitativeresearchforeducation:Anintroductiontotheoryandmethods(3rded.).Boston:Allyn&Bacon.

Brinton,B.,&Fujiki,M.(1992).Settingthecontextforconversationallanguagesampling.InW.Secord(Ed.),Bestpracticesinschoolspeechlanguage
pathology:Descriptive/nonstandardizedlanguageassessment(pp.919).SanAntonio,TX:PsychologicalCorporation.

Brown,R.(1973).Afirstlanguage:Theearlystages.Cambridge,MA:HarvardUniversity.

Burroughs,E.I.,&Tomblin,J.B.(1990).Speechandlanguagecorrelatesofadultsjudgmentsofchildren.JournalofSpeechandHearingDisorders,55,485
494.

Butler,K.G.(1997).Dynamicassessmentatthemillennium:Atransienttutorialfortoday!JournalofChildrensCommunicationDevelopment,19,4354.

Calhoon,J.M.(1997).Comparisonofassessmentresultsbetweenaformalstandardizedmeasureandaplaybasedformat.InfantToddlerIntervention,7,201
214.

Campbell,T.,&Dollaghan,C.(1992).Amethodforobtaininglistenerjudgmentsofspontaneouslyproducedlanguage:Socialvalidationthroughdirectmagnitude
estimation.TopicsinLanguageDisorders,12,4255.

Campione,J.,&Brown,A.L.(1987).Linkingdynamicassessmentwithschoolachievement.InC.S.Lidz(Ed.),Dynamicassessment:Aninteractionalapproach
toevaluatinglearningpotential(pp.82116).NewYork:Guildford.

Chapman,R.(1981).Computingmeanlengthofutteranceinmorphemes.InJ.FMiller(Ed.),Assessinglanguageproductioninchildren(pp.2225).Baltimore:
UniversityParkPress.
Page288

Cirrin,F.M.,&Penner,S.G.(1992).Implementingchangetodescriptivelanguageassessmentapproachesintheschools.InW.Secord(Ed.),Bestpracticesin
schoolspeechlanguagepathology:Descriptive/nonstandardizedlanguageassessment(pp.23131).SanAntonio,TX:PsychologicalCorporation.

Cochran,P.S.,&Masterson,J.J.(1995).NOTusingacomputerinlanguageassessment/intervention:Indefenseofthereluctantclinician.Language,Speech,
Hearing,ServicesinSchools,26,213222.

Conant,S.(1987).TherelationshipbetweenageandMLUinyoungchildren:AsecondlookatKleeandFitzgeraldsdata.JournalofChildLanguage,14,169
173.

Crais,E.R.(1993).Familiesandprofessionalsascollaboratorsinassessment.TopicsinLanguageDisorders,14(1),2940.

Creaghead,N.A.(1992).Classroominteractionalanalysis/scriptanalysis.InW.Secord(Ed.),Bestpracticesinspeechlanguagepathology:
Descriptive/nonstandardizedlanguageassessment(pp.6572).SanAntonio,TX:PsychologicalCorporation.

Creswell,J.W.(1998).Qualitativeinquiryandresearchdesign:Choosingamongfivetraditions.ThousandOaks,CA:SagePublications.

Crystal,D.(1982).Profilinglinguisticdisability.London:EdwardArnold.

Crystal,D.(1987).Towardabuckettheoryoflanguagedisability:Takingaccountofinteractionbetweenlinguisticlevels.ClinicalLinguisticsandPhonetics,1,7
22.

Crystal,D.,Fletcher,P.,&Garman,M.L.(1989).Grammaticalanalysisoflanguagedisability(2nded.).London:Whurr.

Damico,J.S.(1992).Systematicobservationofcommunicativeinteraction:Avalidandpracticaldescriptiveassessmenttechnique.InW.Secord(Ed.),Best
practicesinschoolspeechlanguagepathology:Descriptive/nonstandardizedlanguageassessment(pp.133143).SanAntonio,TX:PsychologicalCorporation.

Damico,J.S.,Secord,W.A.,&Wiig,E.H.(1992).Descriptivelanguageassessmentatschool:Characteristicsanddesign.InW.Secord(Ed.),Bestpracticesin
schoolspeechlanguagepathology:Descriptive/nonstandardizedlanguageassessment(pp.18).SanAntonio,TX:PsychologicalCorporation.

Denzin,N.K.,&Lincoln,Y.S.(2000).Thehandbookofqualitativeresearch(2nded.).ThousandOaks,CA:Sage.

Diedrich,W.M.,&Bangert,J.(1980).Articulationlearning.Houston,TX:CollegeHillPress.

Dollaghan,C.,&Campbell,T.(1992).Aprocedureforclassifyingdisruptionsinspontaneouslanguagesamples.TopicsinLanguageDisorders,12,5668.

Dollaghan,C.,Campbell,T.,&Tomlin,R.(1990).Videonarrationasalanguagesamplingcontext.JournalofSpeechandHearingDisorders,55,582590.

Elbert,M.,Shelton,R.L.,&Arndt,W.B.(1967).Ataskforevaluationofarticulationchange:I.Developmentofmethodology.JournalofSpeechandHearing
Research,10,281289.

Embretson,S.E.(1987).Towarddevelopmentofapyschometricapproach.InC.S.Lidz(Ed.),Dynamicassessment:Aninteractionalapproachtoevaluating
learningpotential(pp.141170).NewYork:Guilford.

Evans,J.L.(1996a).Plottingthecomplexitiesoflanguagesampleanalysis.InK.N.Cole,P.S.Dale,&D.J.Thal(Eds.),Assessmentofcommunicationand
language(pp.207256).Baltimore:BrookesPublishing.

Evans,J.L.(1996b).SLIsubgroups:Interactionbetweendiscourseconstraintsandmorphologicaldeficits.JournalofSpeechandHearingResearch,39,655660.

Evans,J.L.,&Miller,J.F.(1999).Languagesampleanalysisinthe21stcentury.SeminarsinSpeechandLanguage,20,101115.

Feuerstein,R.,Miller,R.,Rand,Y.,&Jensen,M.(1981).Canevolvingtechniquesbettermeasurecognitivechange?JournalofSpecialEducation,15,201219.

Feuerstein,R.,Rand,Y.,&Hoffman,M.(1979).Thedynamicassessmentofretardedperformers.Baltimore:UniversityParkPress.

Finnerty,J.(1991).Communicationanalyzer[Computersoftware].Lexington,MA:EducationalSoftwareResearch.

Frattali,C.(Ed.).(1998).Measuringoutcomesinspeechlanguagepathology.NewYork:Thieme.

Gavin,W.J.,&Giles,L.(1996).Samplesizeeffectsontemporalreliabilityoflanguagesamplemeasuresofpreschoolchildren.JournalofSpeech,Language,and
HearingResearch,39,12581262.
Page289

Gavin,W.J.,Klee,T.,&Membrino,I.(1993).Differentiatingspecificlanguageimpairmentfromnormallanguagedevelopmentusinggrammaticalanalysis.Clinical
LinguisticsandPhonetics,7,191206.

Gerken,L.,&Shady,M.(1996).Thepictureselectiontask.InD.McDaniel,C.McKee,&H.S.Cairns(Eds.),Methodsforassessingchildrenssyntax(pp.287
302).Cambridge,MA:MITPress.

Goldstein,H.,&Geirut,J.(1998).Outcomesmeasurementinchildlanguageandphonologicaldisorders.InC.Frattali(Ed.),Measuringoutcomesinspeech
languagepathology(pp.406437).NewYork:Thieme.

Goodluck,H.(1996).Theactingouttask.InD.McDaniel,C.McKee,&H.S.Cairns(Eds.),Methodsforassessingchildrenssyntax(pp.147162).Cambridge,
MA:MITPress.

GutierrezClellen,V.F.,Brown,S.,Conboy,B.,&RobinsonZaartu,C.(1998).Modifiability:Adynamicapproachtoassessingimmediatelanguagechange.
JournalofChildrensCommunicationDevelopment,19,3142.

HirshPasek,K.,&Golinkoff,R.M.(1996).Theintermodalpreferentiallookingparadigm:Awindowontoemerginglanguagecomprehension.InD.McDaniel,C.
McKee,&H.S.Cairns(Eds.),Methodsforassessingchildrenssyntax(pp.105124).Cambridge,MA:MITPress.

Hixson,P.K.(1985).DevelopmentalSentenceScoringcomputerprogram[Computerprogram].Omaha,NE:ComputerizedLanguageAnalysis.

Howard,S.,Hartley,J.,&Muller,D.(1995).Thechangingfaceofchildlanguageassessment:19851995.ChildLanguageTeachingandTherapy,11,722.

Janesick,V.J.(1994).Thedanceofqualitativeresearchdesign.InN.K.Denzin&Y.S.Lincoln(Eds.),Handbookofqualitativeresearch(pp.209219).
ThousandOaks,CA:Sage.

Kelley,D.L.(1999).Measurementmadeaccessible:Aresearchapproachusingqualitative,quantitativeandTQMmethods.ThousandOaks,CA:Sage.

Kemp,K.,&Klee,T.(1997).Clinicallanguagesamplingpractices:ResultsofasurveyofspeechlanguagepathologistsintheUnitedStates.ChildLanguage
TeachingandTherapy,13,161176.

Kovarsky,D.(1994).Distinguishingquantitativeandqualitativeresearchmethodsincommunicationsciencesanddisorders.NationalStudentSpeechLanguage
HearingassociationJournal,21,5964.

Kovarsky,D.,Duchan,J.,&Maxwell,M.(Eds.).(1999).Constructing(in)competence.Mahwah,NJ:LawrenceErlbaumAssociates.

Lahey,M.(1988).Languagedisordersandlanguagedevelopment.NewYork:Macmillan.

Lancy,D.(1993).Qualitativeresearchineducation:Anintroductiontothemajortraditions.WhitePlains,NY:Longman.

Landa,R.M.,&Olswang,L.(1988).Effectivenessoflanguageelicitationtaskswithtwoyearolds.ChildLanguageTeachingandTherapy,4,170192.

Lee,L.(1974).Developmentalsentenceanalysis.Evanston,IL:NorthwesternUniversityPress.

Leonard,L.(1996).Assessingmorphosyntaxinclinicalsettings.InD.McDaniel,C.McKee,&H.S.Cairns(Eds.),Methodsforassessingchildrenssyntax(pp.
287302).Cambridge,MA:MITPress.

Leonard,L.,Prutting,C.A.,Perozzi,J.A.,&Berkley,R.K.(1978).Nonstandardizedapproachestotheassessmentoflanguagebehaviors.Asha,20,371379.

Lidz,C.S.(1987).Dynamicassessment:Aninteractionalapproachtoevaluatinglearningpotential.NewYork:Guilford.

Lidz,C.S.(1996,November).Dynamicassessment:Theory,applicationandresearch.HandoutforseminarpresentedattheAmericanSpeechLanguage
HearingAssociationmeeting,Seattle,WA.

Lidz,C.S.,&Pea,E.D.(1996).Dynamicassessment:Themodel,itsrelevanceasanonbiasedapproach,anditsapplicationtoLatinAmericanpreschoolchildren.
Language,Speech,andHearingServicesinSchools,27,367372.

Linder,T.W.(1993).Traditionalassessmentandtransdisciplinaryplaybasedassessment.InT.W.Linder(Ed.),Transdisciplinaryplaybasedassessment(pp.9
22).Baltimore:BrookesPublishing.

Long,S.H.(1991).Integratingmicrocomputerapplicationsintospeechandlanguageassessment.TopicsinLanguageDisorders,11,117.

Long,S.H.(1999).Technologyapplicationsintheassessmentofchildrenslanguage.SeminarsinSpeechandLanguage,20,117132.

Long,S.H.,&Fey,M.E.(1989).ComputerizedProfilingVersion6.2(MacintoshandMSDOSseries)[Computerprogram].Ithaca,NY:IthacaCollege.
Page290

Long,S.H.,Fey,M.,&Channell,R.W.(1998).Computerizedprofiling(CP)[computerprogram].Cleveland,OH:DepartmentofCommunicationSciences,Case
WesternReserveUniversity.

Long,S.H.,&Masterson,J.J.(1993,September).Computertechnology:Useinlanguageanalysis.Asha,35,4041,51.

Long,S.H.,&Olswang,L.B.(1996).ReadinessandpatternsofgrowthinchildrenwithSELI.AmericanJournalofSpeechLanguagePathology,5,7985.

Lucas,D.R.,Weiss,A.L.,&Hall,P.K.(1993).Assessingreferentialcommunicationskills:Theuseofanonstandardizedassessmentprocedure.Journalof
ChildhoodCommunicationDisorders,15,2534.

Lund,N.J.,&Duchan,J.(1983).Assessingchildrenslanguageinnaturalisticcontexts.EnglewoodCliffs,NJ:PrenticeHall.

Lund,N.J.,&Duchan,J.(1993).Assessingchildrenslanguageinnaturalisticcontexts.(3rded.).EnglewoodCliffs,NJ:PrenticeHall.

Lust,B.,Flynn,S.,&Foley,C.(1996).Whychildrenknowwhattheysay:Elicitedimitationasaresearchmethodforassessingchildrenssyntax.InD.McDaniel,C.
McKee,&H.S.Cairns(Eds.),Methodsforassessingchildrenssyntax(pp.5576).Cambridge,MA:MITPress.

MacWhinney,B.(1991).TheCHILDESproject:Toolsforanalyzingtalk.Hillsdale,NJ:LawrenceErlbaumAssociates.

McCauley,R.J.(1996).Familiarstrangers:Criterionreferencedmeasuresincommunicationdisorders.Language,Speech,HearingServicesinSchools,27,122
131.

McCauley,R.,&Swisher,L.(1984).Useandmisuseofnormreferencedtestsinclinicalassessment:Ahypotheticalcase.JournalofSpeechandHearing
Disorders,49,338348.

McDaniel,D.,McKee,C.,&Cairns,H.S.(Eds.)(1996).Methodsforassessingchildrenssyntax.Cambridge,MA:MITPress.

McReynolds,L.V.,&Kearns,K.(1983).Singlesubjectexperimentaldesignsincommunicativedisorders.Austin,TX:ProEd.

Messick,S.(1989).Validity.InR.L.Linn(Ed.),Educationalmeasurement(3rded.,pp.13103).NewYork:AmericanCouncilonEducationandMacmillan.

Miller,J.F.(1981).Assessinglanguageproductioninchildren:Experimentalprocedures.Baltimore,MD:UniversityParkPress.

Miller,J.F.(1996).Progressinassessing,describing,anddefiningchildlanguagedisorder.InK.N.Cole,P.S.Dale,&D.J.Thal(Eds.),Assessmentof
communicationandlanguage(pp.309324).Baltimore:BrookesPublishing.

Miller,J.F.,&Chapman,R.(1982).SALT:SystematicanalysisofLanguageTranscripts[computersoftware].Madison,WI:UniversityofWisconsinMadison,
WaismanResearchCenter,LanguageAnalysisLaboratory.

Miller,J.F.,&Chapman,R.(1998).SALT:SystematicanalysisofLanguageTranscripts[computersoftware].Madison,WI:UniversityofWisconsinMadison,
WaismanResearchCenter,LanguageAnalysisLaboratory.

Miller,J.,Freiberg,C.,Rolland,M.B.,&Reeves,M.(1992).Implementingcomputerizedlanguagesampleanalysisinthepublicschools.TopicsinLanguage
Disorders,12(2),6982.

Miller,J.F.,&Klee,T.(1995).Computationalapproachestotheanalysisoflanguageimpairment.InP.Fletcher&B.MacWhinney(Eds.),Thehandbookofchild
language(545572).Oxford:Blackwell.

Miller,J.F.,&Paul,R.(1995).Theclinicalassessmentoflanguagecomprehension.Baltimore:BrookesPublishing.

Minifie,F.,Darley,F.,&Sherman,D.(1963).Temporalreliabilityofsevenlanguagemeasures.JournalofSpeechandHearingResearch,6,139149.

MoellmanLanda,R.,&Olswang,L.B.(1984).Effectsofadultcommunicationbehaviorsonlanguageimpairedchildrensverbaloutput.AppliedPsycholinguistics,
5,117134.

Mordecai,D.R.,Palin,M.W.,&Palmer,C.B.(1985).Lingquest1[computersoftware].Columbus,OH:Macmillan.

Morris,R.(1994).Areviewofcriticalconceptsandissuesinthemeasurementoflearningdisabilities.InR.Lyon(Ed.),Framesofreferencefortheassessmentof
learningdisabilities:Newviewsonmeasurementissues(pp.615626).Baltimore:BrookesPublishing.
Page291

Muma,J.(1998).Effectivespeechlanguagepathology:Acognitivesocializationapproach.Mahwah,NJ:LawrenceErlbaumAssociates.

Muma,J.,Morales,A.,Day,K.,Tackett,A.,Smith,S.,Daniel,B.,Logue,B.,&Morriss,D.(1998).Languagesampling:Grammaticalassessment.InJ.Muma(Ed.),
Effectivespeechlanguagepathology:Acognitivesocializationapproach(pp.310345).Mahwah,NJ:LawrenceErlbaumAssociates.

Nelson,N.W.(1989).Curriculumbasedlanguageassessmentandintervention.Language,Speech,andHearingServicesinSchools,20,170184.

Nelson,N.W.(1994).Curriculumbasedlanguageassessmentandinterventionacrossthegrades.InG.P.Wallach&K.G.Butler(Eds.),Languagelearning
disabilitiesinschoolagechildrenandadolescents:Someprinciplesandapplications(104131).NewYork:Merrill.

Norris,J.,&Hoffman,P.(1993).Wholelanguageinterventionforschoolagechildren.SanDiego,CA:SingularPublishing.

Olswang,L.B.,&Bain,B.A.(1991).Whentorecommendintervention.Language,Speech,andHearingServicesinSchools,22,255263.

Olswang,L.B.,&Bain,B.A.(1994).Datacollection:Monitoringchildrenstreatmentprogress.AmericanJournalofSpeechlanguagePathology,3,5566.

Olswang,L.B.,&Bain,B.A.(1996).Assessmentinformationforpredictingupcomingchangeinlanguageproduction.JournalofSpeechandHearingResearch39,
414423.

Olswang,L.B.,Bain,B.A.,&Johnson,G.A.(1992).Usingdynamicassessmentwithchildrenwithlanguagedisorders.InS.F.Warren&J.Reichle(Eds.),Causes
andeffectsincommunicationandlanguageintervention(pp.187215).Baltimore:BrookesPublishing.

Panagos,J.,&Prelock,P.(1982).Phonologicalconstraintsonthesentenceproductionsoflanguagedisorderedchildren.JournalofSpeechandHearingResearch,
25,171176.

Paul,R.,&Shriberg,L.(1982).Associationsbetweenphonologyandsyntaxinspeechdisorderedchildren.JournalofSpeechandHearingResearch,25,536
546.

Pedhazur,R.J.,&Schmelkin,L.P.(1991).Measurement,design,andanalysis:Anintegratedapproach.Hillsdale,NJ:LawrenceErlbaumAssociates.

Pea,E.,Quinn,R.,&Iglesias,A.(1992).Theapplicationofdynamicassessmentmethodstolanguageassessment:Anonbiasedprocedure.JournalofSpecial
Education,26,269280.

Prelock,P.A.(1997).Languagebasedcurriculumanalysis:Acollaborativeassessmentandinterventionprocess.JournalofChildrensCommunication
Development,19,3542.

Primavera,L.H.,Allison,D.B.,&Alfonso,V.C.(1996).Measurementofdependentvariables.InR.D.Franklin,D.B.Allison,&B.S.(Gorman(Eds.),Design
andanalysisofsinglecaseresearch(pp.4192).Mahwah,NJ:LawrenceErlbaumAssociates.

Pye,C.(1987).ThePyeanalysisoflanguage[computersoftware].Lawrence,KS:Author.

Raver,S.A.(1991).Transdisciplinaryapproachtoinfantandtoddlerintervention.InS.A.Raver(Ed.),Strategiesforteachingatriskandhandicappedinfants
andtoddlers.Atransdisciplinaryapproach(pp.2644).NewYork:Merrill.

Roeper,T.,deVilliers,J.,&deVilliers,P.(1999,November).Whatevery5yearoldshouldknow:Syntax,semanticsandpragmatics.Presentationtothe
AmericanSpeechLanguageHearingAssociationconvention,SanFrancisco.

Rondal,J.A.,Ghiotto,M.,Bredart,S.,&Bachelet,J.F.(1988).Agerelation,reliability,andgrammaticalvalidityofmeasuresofutterancelength.JournalofChild
Language,14,433446.

Rosetti,L.(1986).Highriskinfants:Identification,assessment,andintervention.Boston:CollegeHill.

Roth,F.,&Spekman,N.(1984).Assessingthepragmaticabilitiesofchildren:PartI.Organizationalframeworkandassessmentparameters.JournalofSpeechand
HearingDisorders,49,211.

Salvia,J.,&Ysseldyke,J.E.(1981).Assessmentinremedialandspecialeducation(2nded.).Boston:HoughtonMifflin.

Scarborough,H.S.(1990).Indexofproductivesyntax.AppliedPsycholinguistics,11,122.

Scarborough,H.S.,Wyckoff,J.,&Davidson,R.(1986).Areconsiderationoftherelationbetweenageandmeanutterancelength.JournalofSpeechandHearing
Research,29,394399.
Page292

Schiavetti,N.(1992).Scalingproceduresforthemeasurementofspeechintelligibility.InR.Kent(Ed.),Intelligibilityinspeechdisorders:Theory,measurement
andmanagement(pp.1134).Philadelphia:JohnBenjamins.

Schmidt,R.A.,&Bjork,R.A.(1992).Newconceptualizationsofpractice:Commonprinciplesinthreeparadigmssuggestnewconceptsfortraining.Psychological
Sciences,3,207217.

Schraeder,T.,Quinn,M.,Stockman,I.J.,&Miller,J.F.(1999).Authenticassessmentasanapproachtopreschoolspeechlanguagescreening.AmericanJournal
ofSpeechLanguagePathology,8,195200.

Schwartz,I.S.,&Olswang,L.B.(1996).Evaluatingchildbehaviorchangeinnaturalsettings:Exploringalternativestrategiesfordatacollection.TopicsinEarly
ChildhoodSpecialEducation,16,82101.

Secord,W.A.(1981).CPAC:ClinicalProbesofArticulationConsistency.SanAntonio,TX:PsychologicalCorporation.

Secord,W.A.,&Shine,R.E.(1997).SecordContextualArticulationTests.Sedona,AZ:RedRockEducationalPublications.

Semel,E.,Wiig,E.H.,&Secord,W.A.(1996).ClinicalEvaluationofLanguageFundamentals3.SanAntonio,TX:PsychologicalCoproration.

Shewan,C.,&Slater,S.(1993).Caseloadsofspeechlanguagepathologists,Asha,35,64.

Silliman,E.R.,&Wilkinson,L.C.(1991).Communicatingforlearning:Classroomobservationandcollaboration.Gaithersburg,MD:AspenPublishers.

Simon,C.(1984).Evaluatingcommunicativecompetence:Afunctionalpragmaticprocedure.Tucson,AZ:CommunicationSkillBuilders.

Smith,A.R.,McCauley,R.J.,&Guitar,B.(inpress).DevelopmentoftheTeacherAssessmentofStudentCommunicativeCompetence(TASCC)forchildrenin
grades1through5.CommunicationDisordersQuarterly.

Stevens,S.S.(1975).Psychophysics.NewYork:Wiley.

Stromswold,K.(1996).Analyzingspontaneousspeech.InD.McDaniel,C.McKee,&H.S.Cairns(Eds.),Methodsforassessingchildrenssyntax(pp.2353).
Cambridge,MA:MITPress.

Taylor,S.J.,&Bogdan,R.(1998).Introductiontoqualitativeresearchmethods:Aguidebookandresources(3rded.).NewYork:Wiley.

Templin,M.C.(1957).Certainlanguageskillsinchildren.Minneapolis:UniversityofMinnesotaPress.

Terrell,F.,Terrell,S.L.,&Golin,S.(1977).Languageproductivityofblackandwhitechildreninblackversuswhitesituations.LanguageandSpeech,20,377383.

Thorton,R.(1996).Elicitedproduction.InD.McDaniel,C.McKee,&H.S.Cairns(Eds.),Methodsforassessingchildrenssyntax(pp.77102).Cambridge,
MA:MITPress.

Turner,R.G.(1988).Techniquestodeterminetestprotocolperformance.EarandHearing,9,177189.

Tyack,D.,&Gottsleben,R.(1974).Languagesampling,analysis,andtraining.PaloAlto,CA:ConsultingPsychologistsPress.

Vetter,D.K.(1988).Designinginformalassessmentprocedures.InD.E.Yoder&R.D.Kent(Eds.),Decisionmakinginspeechlanguagepathology(pp.192
193).Baltimore:BrookesPublishing.

Vygotsky,L.S.(1978).Mindinsociety:Thedevelopmentofhigherpsychologicalprocesses.EditedbyM.Cole,V.JohnSteiner,S.Scribner,&E.Souberman.
Cambridge,MA:HarvardUniversityPress.

Weiner,F.F.(1988).ParrotEasyLanguageSampleAnalysis(PELSA)[Computersoftware].StatePark,PA:ParrotSoftware.

Westby,C.E.(1990).Ethnographicinterviewing:Askingtherightquestionstotherightpeopleintherightways.JournalofChildhoodCommunicationDisorders,
13,101111.

Wilson,K.,Blackmon,R.,Hall,R,&Elcholtz,G.(1991).Methodsoflanguageassessment:AsurveyofCaliforniapublicschoolclinicians.Language,Speech,and
HearingServicesinSchools,22,236241.

WorldHealthOrganization.(1980).ICIDH:TheInternationalClassificationofImpairments,Disabilities,andHandicaps.Geneva,Switzerland:WorldHealth
Organization.

WorldHealthOrganization.(1998).Towardacommonlanguageforfunctioninganddisablement:ICIDH2:TheInternationalClassificationofImpairments,Activities
andParticipation.Geneva,Switzerland:WorldHealthOrganization.
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CHAPTER
11

ExaminingChange:IsThisChildsLanguageChanging?

TheNatureofExaminingChange

SpecialConsiderationsforAskingThisClinicalQuestion

AvailableTools

PracticalConsiderations

Davidis8yearsoldandwasdiagnosedattheageof7withafatalformofageneticneurodegenerativedisease,adrenoleukodystrophy.Hehaddeveloped
normallyuntilaboutage6,whenhebeganshowingsignsofclumsinessandbehaviorproblemsthathadinitiallybeenattributedtothestressesofacross
countrymoveandbeginningfirstgrade.Currently,hefollowssimpleverbaldirectionswithsomeconsistencybutrarelyspeaks.Hisfamilyisinterestedin
bothhiscurrentlevelofcomprehensionandininformationabouttherateatwhichhiscommunicationskillsaredecliningsothattheycanfacilitatethe
childsparticipationinthefamilyandplanmoreforhisongoingcare.

Tamika,a5yearoldgirlwithspecificexpressivelanguageimpairment,hasbeenseenfortreatmentsinceage3.Initiallyhertreatmentwasaimedat
increasingthefrequencyandintelligibilityofsinglewordproductionsmorerecentgoalshavefocusedonheruseofgrammaticalmorphemesand
monitoringcomprehensionofdirections.InhereffortstoadjustTamikastreatmentandmonitorheroverallprogress,Tamikasspeechlanguage
pathologistusesperiodicstandardizedtestingalongwithfrequent
Page294

informalprobes,includingprobesoftreated,generalization,andcontrolitems.Thespeechlanguagepathologistisconcernedaboutherabilitytoassessthe
trueimpactoftreatmentonTamikassocialcommunicationwithpeersandfamilymembersbecauseTamikasfamilyspeaksBlackEnglish,whereasthe
cliniciandoesnot.ShewouldliketofindanappropriateassessmentstrategytohelpdocumentTamikasongoingcommunicationskills.

ThefivecertifiedspeechlanguagepathologistsworkingwithinasmallVermontschooldistrictareeagertodemonstratetheefficacyoftheirworkwith
schoolagechildrenbecauseofconcernsaboutcutbacksinneighboringspecialeducationbudgets.TheydecidetoparticipateinASHAsNationalOutcomes
MeasurementSystemandbegincollectingdataforeachoftheirstudents.Inaddition,becauseoftheircommitmenttoimprovingthequalityoftheir
practice,theyalsodecidetouseacomputerizedlanguagesamplingsystemwithalloftheirpreschoolandfirstgradechildrenwithlanguageproblems.

TheNatureofExaminingChange

TheexaminationofchangeinchildrenslanguagedisordersactuallyencompassesafairlylargenumberofrelatedquestionsIsthischildsoveralllanguagechanging?
Whataspectsinparticulararechanging?Isobservedchangelikelytobeduetotreatmentratherthantomaturationorotherfactors?Shouldaspecifictreatmentbe
continued,orhasmaximumprogressbeenmade?Shouldterminationoftreatmentoccur?Howeffectiveisthisparticularclinicalpracticegroupinachievingchangewith
thechildrenitserves?Theseassessmentquestionspresentsomeofthemostchallengingissuesfacingspeechlanguagepathologyprofessionals(e.g.,Diedrich&
Bangert,1980Elbert,Shelton,&Arndt,1967Mowrer,1972Olswsang,1990Olswang&Bain,1994).

Describedwithregardtoasinglechild,methodsusedtoexaminechangewillfueldecisionsregardinghowthechildmovesthroughagiventreatmentplan,whether
alternativetreatmentstrategiesshouldbeexplored,and,finally,whethertreatmentshouldbeterminated.Providingamoreformalcategorization,CampbellandBain
(1991)drewontheframeworkofRosenandProctor(1978,1981)todescribethreedimensionsorkindsofchange:ultimate,intermediate,andinstrumental.

Ultimateoutcomesconstitutegroundsforendingtreatment,andtheyshouldbeestablishedattheinitiationoftreatment.Theyaresimilartolongtermtreatment
objectives,withlevelsoffinalexpectedperformancedefinedintermsofageappropriate,functional,ormaximalcommunicativeeffectiveness(Campbell&Bain,
1991,p.272).Modificationofanultimateoutcomemightoccur.Forexample,afunctionaloutcomelevelmightinitiallybesetforachildbecauseofexpectationsthat
performanceatalevelwithsameagepeerswasunrealistic.However,iftreatmentdatasuggestedotherwise,arevisioninoutcomelevelwouldbeappropriate
(Campbell&Bain,1991).

IntermediateoutcomeswereseenbyCampbellandBain(1991)asmorespecificandnumerousforagivenclient.Theyrelatetoindividualbehaviorsthatmustbe
acquiredinorderfortheultimateoutcometobeachievedandforprogressionthrough
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agivenhierarchicallyarrangedtreatmenttooccur.Datafromtreatmenttaskswithinasessionaregivenasanexampleofsuchdata.

Instrumentaloutcomesillustratethelikelihoodthatadditionalchangewilloccurwithoutadditionaltreatment(Campbell&Bain,1991).Datadocumenting
generalizationfitintothisthirdcategory.CampbellandBainacknowledgedthatthistypeofoutcomeischallengingtoidentifybecauseofthedifficultyinknowingat
whatpointevidenceofgeneralizationreliablypredictsimprovementtowardsultimateoutcomes.

Thefeaturethatmostcomplicatestheassessmentofchangeinchildrenisthatchildrensbehaviorischaracterizedbychangestemmingfromavarietyofsources,most
ofwhicharerelatedtogrowthanddevelopment.Withfewexceptions,childreneventhosewithquitesignificantdifficultiesarebenefitingfromdevelopmental
advancesthatenhancetheircommunicationskills.Sometimeschangeoccursbroadlyandsometimesinsomeareasmorethanothers.Evenchildrenwhohavesustained
severebraindamageduringearlychildhoodwillexperiencedevelopmentalbenefitsaswellasthephysiologicalbenefitsofbiologicalrecovery.Onlyafewexceptionsto
thisupwardtrendexistforexample,inchildrenwithverysevereneurologicdamageorwithneurodegenerativediseaseandinchildrenwhotendtoregressin
performancewhentherapyiswithdrawn(e.g.,somechildrenwithdevelopmentaldyspraxiaofspeechormentalretardation).Inallcases,however,thespeech
languagepathologistsassessmentofwhetherchangeisoccurringandwhyitisoccurringmustbegaugedonanterrainthatisrarelyflatandissometimesaseriesof
foothills.

Clinicalquestionsinvolvingchangemakeuseofmanyofthesametypesofmeasuresdiscussedinchapters9and10andoftenexaminesimilarissuesacrosstheadded
dimensionoftime.Nonetheless,despitetheirimportanceforworkwithchildrenwithlanguagedisorders,atleastuntilrecentlysuchquestionshavegenerallyreceived
lessattentionthanquestionsrelatedtoscreening,identification,ordescriptionatagivenpointintime.Thankfully,avarietyofexternalfactorsaffectingclinicalpractice
describedinprecedingchapters,suchasthedemandforgreateraccountabilityinschoolsandhospitals,arehelpingtoencourageandevenmandategreaterresearch
attentiontotheassessmentofchange(Frattali,1998bOlswang,1990,1993,1998).

Once,broadquestionsregardingthevalueoftreatmentapproacheslayprincipallywithinthepurviewofresearchers,whoconductedtreatmentefficacyresearchin
highlycontrolledconditions.Overthepastdecade,however,concernsaboutaccountabilityhavecausedindividualprofessionalsinspeechlanguagepathologyto
becomemoreactiveincollectingandusingsuchdataaswell(Eger,1988Eger,Chabon,Mient,&Cushman,1986).Theprimaryemphasisonevidenceobtainedin
tightlycontrolledconditionshasbeenshiftedtoincludeemphasesonevidenceobtainedundertheveryconditionsinwhichtreatmentistypicallyconducteddatathat
aretypicallyreferredtoasoutcomes.

Inthischapter,thespecificconsiderationsaffectingtheassessmentofchangeinclinicalpracticeareaddressed,followedbythespecialconsiderationsrelatingtotools
thatareavailabletoaddressthisissue.Finally,practicalconsiderationsrelatedtooutcomeassessmentarediscussedforthewaysinwhichtheyshapeprofessional
practicesinthisareaofassessment.
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SpecialConsiderationsforAskingThisClinicalQuestion

Atleastfourspecialconcernscomplicatetheprocessofansweringclinicalquestionsregardingchange:(a)identifyingreliable,orreal,change(b)determiningthatthe
changethatisobservedisimportant(c)determiningresponsibilityforchangeand(d)predictingthelikelihoodoffuturechange(Bain&Dollaghan,1991,Campbell&
Bain,1991McCauley&Swisher,1984Schwartz&Olswang,1996).Theseconcernsaffectbothglobalinferencesregardingachildsoverallprogressultimate
outcomesaswellasthemorespecificdecisionsinvolvedinspecifictreatmentgoalsintermediateandinstrumentaloutcomes(Bain&Dollaghan,1991Campbell&
Bain,1991Olswang&Bain,1996).

IdentificationofReliableandValidChange

Becauseexaminationofchangedependsonacomparisonofmeasurementsmadeonatleasttwooccasions,reliabilityinthemeasurementofchangeisnomorecertain
thanthereliabilityofasinglemeasurement.Infact,thereiseveryindicationthatitislessso(McCauley&Swisher,1984Salvia&Ysseldyke,1995).Inordertoget
anideaoftheeffectofmeasurementerrorontheexaminationofchange,considerthecaseofachildwhosescoreonaspecificmeasuretaken4monthsapartchanges
from15to30,where80isthehighestpossiblescore.Initially,thischangewouldappeartobecauseforsomedegreeofcelebrationmorerestrainedifyoulooked
justatthenumberofpointsgainedoutofthenumberpossiblelessrestrainedifyoulookedatthefactthatthechildhaddoubledhisscore.However,onceyouremind
yourselfthatmeasuresvaryintheirreliability(sometimesquitewildly),yourealizethatmoreinformationisneededbeforepartyinvitationscanbesentout.Depending
onthereliabilityofthemeasure,eachobservedscorecouldfallquiteoffthemarkofthetesttakersrealscore,withunfortunateconsequencesforthebelievabilityof
observationsaboutthedifferencebetweenthetwotestings.Thedifferencebetweenthesetwoscorescouldbedescribedasadifferencescoreor,morefrequentlyin
thiskindofsituation,againscore.

Infact,gainscoresareoftenlessreliablethanthemeasuresonwhichtheyarebased(Mehrens&Lehman,1980Salvia&Ysseldyke,1995).Althoughconcernsabout
gainscoresaretypicallyexpressedinrelationtostandardizednormreferencedmeasures,theyapplyequallytootherquantitativemeasures.Thenatureofthemeasure
usedintheprecedingexamplewasintentionallyambiguousinordertoemphasizethatpoint.

Theadvantageofsomestandardizednormreferencedtestsistheavailabilityofinformationallowingonetoestimatetheriskoferrorassociatedwithindividualgain
scores.Usingthestandarderrorofmeasurementandmethodslikethoseusedtoexaminedifferencescoreswhentheyoccurinprofiles,itispossibletoexaminethe
likelihoodthatadifferencescoreisreliable(Anastasi,1982Salvia&Ysseldyke,1995).Indeed,sometestsincludegraphicdevicesontheirscoringsheetsthatwill
helpusersdeterminewhetheradifferenceislikelytobereliable.However,thereisstillreasontobelievethatnumerousnormreferencedtestscontinuetofailtoprovide
thisinformationforusers(Sturneretal.,1994).
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Theproblemfacingnormreferencedinstruments,however,isequallysharedorevenmoreintenseforinformalmeasures:Informalquantitativemeasureswillalmost
neverprovidethatinformation.Thus,additionalstrategiesareneededforprovidingevidenceofreliabilitythatis,evidencethatameasureislikelytobeconsistent
overshortperiodsoftime,whenusedbydifferentclinicians,andsoforthandisthusabletoreflectrealchange,ratherthanerror,whenitoccurs.Asyouwillseelater
inthischapter,singlesubjectdesignsconstitutethemostpowerfulofthesestrategies.

Asasophisticatedobserverofpsychometricproperties,youmaybewaitingfortheothershoetodropthevalidityshoe.Althoughitmightbepossiblefordevelopers
ofhighlydevelopedstandardizedmeasurestostudytheabilityoftheirmeasuretocapturesignificantchangeasaformofcriterionrelatedvalidityevidence,theyalmost
neverdoso.Instead,formostmeasuresinspeechlanguagepathologyandotherappliedbehavioralsciencesaswell,theexaminationofvalidityhasbeencouchedin
termsofdiscussionsofimportance:Isobservedchangethatappearstobereliablealsoimportant?

DeterminingThatObservedChangeIsImportant

Issuesabouttheimportanceofchangecanbecomplex.Theyincludequestionssuchas,Isthechangelargeenoughtobesignificant?andIsthenatureofthechange
suchthatitislikelytoaffectthechildscommunicativeandsociallife?ThesearesomeofthequestionsthatBainandDollaghan(1991)exploredunderthenotionof
clinicallysignificantchange.

Anumberofcomplementaryindicatorsofimportancehavebeenputforward.Themostimportantoftheseare(a)effectsizeDidmuchhappen?(Bain&
Dollaghan,1991)(b)socialvalidationDiditmakeadifferenceinthispersonscommunicativelife?(Bain&Dollaghan,1991Campbell&Bain,1991Kazdin,
1977,1999Schwartz&Olswang,1996)and(c)theuseofmultiplemeasures(Campbell&Bain,1991Olswang&Bain,1994Schwartz&Olswang,1996).

EffectSize

Inthestatisticalandresearchdesignliterature,adistinctionismadebetweenstatisticalsignificanceandsubstantiveimportance,ormeaningfulness.Thatdistinction,
althoughoftenoverlookedbyresearcherswhofocusonstatisticalsignificanceasifitweretheholygrail(Young,1993),isavaluableoneforourthinkingaboutthe
clinicalimportanceofchangeweobserveinchildren.Effectsize,whichreferstothemagnitudeofdifferenceobserved,isfrequentlydiscussedinrelationtosubstantive
importance,orclinicalsignificance,andisdiscussedatsomelengthlaterinthissection.

Statisticalsignificanceisarelativelystraightforwardconcept.Specifically,whenaresearchfindingisstatisticallysignificant,astatisticaltesthassuggestedthatthefinding
isunlikelytohaveoccurredbychance,thatitisrare(PedhazurandSchmelkin,1991).Morecomplex,however,isthematterofdeterminingwhetherastatistically
significantfindingismeaningful,thatis,whetheritsaysanythingimportantaboutthematterunderstudy(PedhazurandSchmelkin,1991).Atermfrequentlyusedto
refertothemeaningfulnessorsubstantiveimportanceofadifferencetoclinicaldecisionmak
Page298

ingisclinicalsignificance(Bain&Dollaghan,1991Bernthal&Bankson,1998).Othertermsappliedtothisconceptintherichpsychologicalliteratureonthetopic
includesocialvalidity,clinicalimportance,qualitativechange,educationalrelevance,ecologicalvalidityandculturalvalidity(Foster&Mash,1999).

Aresearchexampleusingadifferencebetweentwogroupsatasinglepointintimecanhelpillustratethedistinctionbetweenstatisticalsignificanceandsubstantive
importance.Inaresearchstudyonemightcomparetheperformanceoftwogroupsonagiventestwith100itemsandfindthatthetwogroupsdifferedintheir
performancebyjust2items.Further,thedifferencemightbeshowntobestatisticallysignificant.Despitethestatisticalsignificance,however,mostobservers,ifaware
ofthesizeofthedifference,wouldconsideradifferenceofjust2pointstomeritnomorethanayawnnomatterhowmuchverbalarmwavingtheresearcherin
questionmightusetoinspireinterest.Incontrast,ifamuchlargerdifferencehadbeenobtainedandfoundtobestatisticallysignificant,mostobserverswouldbemoved
toraptattention,havingbeenpersuadedthatthebasisforgroupassignmentshadatleastsomesortofimportantrelationshiptothesubjectcoveredbythetest.

Usingananalogousclinicalexample,onecanimagineachievingaveryconsistentresultwhenusingaparticulartreatmentwithagivenchildforinstance,Tamika,from
theintroductionofthischapter.PerhapsTamikamakesgainsofoneortwoitemsonuntreatedprobesthatareusedoverthecourseofasemestertomonitorher
progressintheuseofgrammaticalmorphemes.Thatrelativelyhighconsistency(orreliability)ofchange,however,wouldprobablynotpleaseyou(orTamika)and
wouldprobablysendyouscramblingtofindanalternative,moreeffectiveinterventionstrategy.TheclinicalsignificanceofchangeobservedforTamikasimplywould
notwarrantcontentmentwiththecurrenttreatment.

Effectsize,whichcanbemeasuredinavarietyofways,generallyreferstothemagnitudeofthedifferencebetweentwoscoresorsetsofscores,orofthecorrelation
betweentwosetsofvariables(Pedhazur&Schmelkin,1991).Authorsregularlysuggestthatresearchersinspeechlanguagepathologyandelsewhereappeartofixate
onstatisticalsignificanceattheexpenseofeffectsizeorothermeasuresthataremoreamenabletodecisionsaboutthevalueofinformationtodecisionmaking(e.g.,
Pedhazur&Schmelkin,1991Young,1993).Becauseinformationaboutthereliabilityofdifferencescoresisdifficultandoftenimpossibletocomebyforthemeasures
cliniciansusetoexaminechange,cliniciansandtheirconstituentsaremuchmorelikelytowanttoinspecttheactualmagnitudeofchangeswithaneyetowarditsclinical
meaning.Effectsizealonecannotbethesoledatausedtodeterminethemeaningofaparticulardifferencebecauseotherfactorswillneedtobetakenintoaccount
(e.g.,thesocialsignificanceofthedifference,thelikelygeneralizabilityofthedifference).However,itcanbeanimportantelementinthatprocess(Bain&Olswang,
1995).

BainandDollaghan(1991)describedacoupleofstrategiesforlookingateffectsize.Oneofthesestrategiesusesstandardscores,takesintoaccounttheabsolute
amountofchangethathasoccurred,andisthereforeprimarilylimitedtousewithnormreferencedstandardizedmeasures.Theotherusesageequivalentscores,looks
attherelativesizeofchange,andissubjecttothevagariesassociatedwiththatinferiormethodofcharacterizingperformance.
Page299

Usingstandardscorestoexaminechange,BainandDollaghan(1991)notedthattheamountofchangecanbeexpressedintermsofstandarddeviationunitsand
comparedagainstanarbitrarystandard.Thus,adifferencemightbeconsideredofpracticalsignificanceifitmetorexceededachangeofsomanystandarddeviation
unitswiththoseauthorsciting1standarddeviationasafrequentlyusedstandard.Forinstance,imaginethatatTime1,achildreceivesastandardscoreof70ona
testwithameanof100andstandarddeviationof10.Then,atTime2,thechildreceivesascoreof81onthatsametest.Theamountofchangewouldbeconsidered
ofclinicalsignificancebecauseitcorrespondedtoslightlymorethanonestandarddeviation.

Aslongasthemeasurethatisbeingusedhasbeencarefullyselectedforitsvalidityforthegivenchildandcontentarea,thismethodseemsareasonableoneformany
purposes.Inparticular,itsuseisstrengthenedifthetimeperiodencompassedbythecomparisonresultsinacomparisonagainstasinglenormativesubgroup.
Specifically,ifachildsperformancecanbecomparedwithjustasinglenormativesubgroupovertime(e.g.,allofthechildrenage5years,1monthto6years),then
theextravariabilityintroducedbycomparinghisherfirstperformancewithonesetofchildren(e.g.,thechildrenfrom5yearsto5years,6months)andthenwith
another(e.g.,thechildrenfrom5years,7monthsto6years)canbeavoided.

Theuseofstandardscoresisalsopreferabletothesamemethodappliedusingageequivalentscoresandacutoffestablishedaroundacertainageequivalentgain
(Bain&Dollaghan,1991)becauseofthepoorreliabilityofsuchscores(McCauley&Swisher,1984).Admittedly,atthispoint,selectionofthecutoffinthisstrategy
usingstandardscoresisarbitraryhowmuchchangeshouldberegardedasclinicallysignificantcanserveasapointofconsiderableargument.However,additional
researchbytestdevelopersandotherscouldvalidatespecificlevelsinamannerquiteanalogoustothatproposedforcutoffsusedinotherareasofclinicaldecision
making(Plante&Vance,1994).

TheProportionalChangeIndex(PCI),thealternativestrategyforexaminingeffectsizedescribedbyBainandDollaghan(1991),providesarelativemeasureof
changearisingfromtheworkofWolery(1983).Themeasureisrelativeinthesensethatitattemptstoexaminetherateofchangecharacteristicofthechildsbehavior
fortheperiodbeforetreatmentascomparedwiththerateobservedduringtreatment.Specifically,thePCIistheproportioncreatedwhenthechildspreintervention
rateofdevelopmentisdividedbythechildsrateofdevelopmentduringintervention.Thepreinterventionrateofchangeisestimatedbydividingthechildsage
equivalentscoreonameasuretakenjustbeforethebeginningoftreatmentbyhisageinmonths.Therateofdevelopmentduringinterventionisestimatedbydividingthe
gainscoreobtainedforthatmeasurewhenitisreadministeredafteraperiodoftreatmentbythedurationoftreatment.Forachildwhosebehaviorisbeingmonitored
overtimewithoutintervention,themeasuremightbeusedtoexaminetheperiodbeforeobservationwiththatobservedduringtheperiodofobservation.Themeritof
thisparticularmeasureisthatittakesintoaccountthenumberofmonthsactuallygained,thenumberofmonthsinintervention[orobservation]andthechildsrateof
developmentatthepretestdate(Wolery,1983,p.168).Figure11.1illustratesthecalculationofPCIfortwochildren:Shana,whoshowsexcellentgainsinreceptive
vocabulary,withtwiceas
Page300

Fig.11.1.AhypotheticalexampleshowingthecalculationoftheProportionalChangeIndex(Bain&Dollaghan,1991Wolery,1983)fortwochildren.
Page301
Page302

muchprogressintreatmentaspriortotreatmentandJason,whoshowsprogressinreceptivevocabularyacquisitionthatisnobetterintreatmentthanithadbeenprior
totreatment.

IfthetworatesofchangeusedintheequationforPCIaresimilar,thecalculatedvalueforPCIwillapproachavalueofone.Ontheotherhand,iftreatmentorother
factorshaveaccelerateddevelopment,thePCIshouldbepositive,withlargerPCIsindicatinggreateracceleration.Thus,forexample,aPCIof3wouldimplythat
changehadoccurredthreetimesasquicklyduringtreatmentasprecedingit.Alternatively,aPCIof.5wouldsuggestthatchangehadoccurredathalftherateduring
thetreatmentorobservationperiodasprecedingit.

Asdescribedearlier,thePCIisusuallyrecommendedforitsutilityinexaminingchangeduringaperiodofinterventioninwhichpositivechangeisexpected.
Nonetheless,itmightalsobeusedifonewereinterestedinexaminingalterationsinratesofchangeoccurringunderconditionslikethosedescribedforDavidatthe
beginningofthechapter.RecallthatDavidhadbeendiagnosedwithaneurodegenerativediseasethatwaspredictedtoresultinskillloss.Itmightalsobeusedunder
conditionsinwhichproblemsindevelopmentweresuspected(asinthecaseofasuspectedlatetalker),butthechildsclinicianhadoptedforawatchandsee
strategywithaplanned6monthreevaluation.

Bain&Dollaghan(1991)notedthatthePCIrestsontwoproblematicassumptions,withthefirstbeingthatchangeinchildrensskillsoccursataconstantrateinthe
absenceofintervention.Aplausiblealternativetothisassumptionisthatchangemayoccuratvaryingratesduringdevelopmentwithchildrensbehaviorssometimes
racingahead,sometimesholdingsteady,andsometimes,perhaps,evenregressingforatime.TheproblemwiththeassumptionofconstantchangeembodiedinthePCI
isaddressedtosomeextentbytheuseofsinglesubjectdesigns,aspecificmethodthatisdescribedingreaterdetaillaterinthechapter.Singlesubjectdesignsescape
thisassumptionthroughthecliniciansactiveexaminationofchangepatternsduringperiodsinwhichinterventionisnotoccurringaswellaswhenitis.Thankfully,too,
thequestionofwhetherchangeisconstantcanbeaddressedempirically.Althoughadditionalinformationisneededtodeterminetheextenttowhichthisassumptionis
tenable,effortstoexaminepatternsofchangeareunderwayandsuggestthatovershortertimeperiodstheassumptionofaconstantrateofchangeisprobablyfalse
(Diedrich&Bangert,1980Olswang&Bain,1985).

ThesecondproblematicassumptionofthePCIliesinitsuseofageequivalentscoresandthetemptationthatitpresentsforclinicianstouseteststhatpresentsuch
scoreswithoutmuchinthewayofempiricalsupporteitherfortheageequivalentscoresorforthetestinitsentirety.BainandDollaghan(1991)acknowledgedthis
potentialdrawbackandimplicitlyrecommendedthatcliniciansshouldsearchforthehighestqualitymeasurestousefordocumentingchange.However,theyalso
suggestedthatintheabsenceofsuchmeasures,thePCImayofferabetteralternativethanthesimpleassumptionthatagaininageequivalentscoresovertime
representsprogress.

AnadditionallimitationaffectingthePCIistheneedforuserstoadoptanarbitrarybasisfordeterminingwhenacertainamountofchangeissufficienttosupporttheuse
oftimeandotherresourcesrequiredtoachieveaparticulargain.Thusfar,nomeas
Page303

uredescribedhereinorproposedelsewherehasbeenabletoclaimarationalbasisforitsparticularstandardorcutoff.

Inprinciple,then,thetwomeasuresofeffectsizethatIhavedescribed(standardscoregainscoresandPCI)seemtorepresentstrongcontendersforuseindecisions
abouttheimportanceofobservedchangebothforchangeobservedduringtreatmentorforchangeobservedoveraperiodoftimeinwhichinterventionisnotused
butachildsperformanceismonitored.However,additionalresearchisneededtovalidatetheiruseindecisionmaking,particularlyinthecaseofthePCIinwhichthe
strengthofthelogicbehindthemeasureisunderminedbyitsdependenceonageequivalentscores.Ialsocallreadersattentiontothefactthatbothofthesemethods
willmorereadilybeimplementedforstandardizednormreferencedteststhanforothertypesofmeasuresthatmightbeusedtodescribeachildslanguage.

SocialValidation

Inexaminingtheimportanceofchange,cliniciansarealmostalwaysinterestedinconsideringwhetherobservedchangesconformtotheoreticalexpectations,especially
developmentalexpectations,thatimplyahierarchyoflearninginwhichsomebehaviorsareseenasprerequisitestoothers(Bain&Dollaghan,1991Lahey,1988).Put
differently,cliniciansareinterestedindeterminingwhetherthechildhasmadegainsthattheoreticallyappeartobemovementsalongtherightpath.Gainsonthose
behaviorsthatareseenasprecursorstofurtheradvancementarejudgedtobemoreimportantthanthosethatarenot.

Additionally,clinicianshavealwaysvaluedandsometimessolicitedfamilyandteacherreportsassertingprogressasdefactoevidencethatchangehasoccurredandis
important.Thiswayofthinkingabouttheimportanceoflanguagechangefallsunderthetermsocialvalidation.Socialvalidationalsocomplementstheuseofeffectsize
infosteringtherichestpossibleconceptualizationofimportance.Acknowledgingthatsuchevidencehasvalueisconsistent,firstofall,withanappreciationthatthe
functionalandsocialeffectsofcommunicationdisorderswarrantgreaterincorporationintoclinicalpractice(Frattali,1998bGoldstein&Geirut,1998Olswang&
Bain,1994).

Inadifferentcontext(discussingresearchsignificanceasopposedtoclinicalsignificance),PedhazurandSchmelkin(1991)offeredaquotationfromGertrudeStein:A
differenceinordertobeadifferencemustmakeadifference(p.203).Ifrephrasedslightly,thisquotationalsoseemstospeaktoeffortstoexaminetheimportanceof
changeinchildrenslanguage:Forchangeinachildslanguagetobesignificant,itmustmakeadifferenceinthechildslife.

Useofmeasurestoexaminethefunctionalandsocialimpactofchangeisalsoconsistentwiththegrowingappreciationofqualitativedatadescribedinthelastchapter.
Becausequalitativedataareunapologeticallysubjectiveinnature(Glesne&Peskin,1992),theymaybeusedveryeffectivelymoreeffectivelythanreamsof
quantitativedatatoaddressquestionsrelatedtothesocialcontextsupportingandaffectingachildandtohowthechildisviewedinthatcontext.Overthepastfew
decades,quantitativeaswellasqualitativemeasureshavereceivedgrowingattentionforthepurposeofassessingfunctionandsocialimpactsoftreatment(Bain&
Dollaghan,1991
Page304

Campbell&Bain,1991Campbell&Dollaghan,1992Koegel,Koegel,VanVoy,&Ingham,1988Olswang&Bain,1994Schwartz&Olswang,1996).

Kazdin(1977)describedaprocessbywhichsuchmeasurescanbeusedtolookattheimportanceofbehavioralchange.Inparticular,hefocusedonbehavioral
changeachievedthroughappliedbehavioranalysisandbasedhisworkonthatofWolfandhiscolleagues(e.g.,Maloneyetal.,1976Minkinetal.,1976Wolf,
1978).Kazdindefinedsocialvalidationastheassessmentofthesocialacceptabilityofintervention,wheresuchacceptabilitycouldbeassessedwithregardto
interventionfocus,procedures,andimportantlyforthisdiscussionbehaviorchange.Morerecently,hehasdefinedclinicalsignificanceasthepracticalorapplied
valueorimportanceoftheeffectofaninterventionthatis,whethertheinterventionmakesreal(e.g.,genuine,palpable,practical,noticeabledifferenceineverydaylife
totheclientsorotherswithwhomtheclientsinteract(Kazdin,1999,p.332).AlthoughKazdinandnumerousotherauthorsworkingintheareaofclinicalpsychology
(e.g.,Foster&Mash,1999Jacobson,Roberts,Berns,&McGlinchey,1999Kazdin,1999)havecontinuedtoelaborateontheconceptsoutlinedinKazdin(1977),
basicissuesraisedinthatearlierworkremainrelevant.Inparticular,thisrelevancederivesfromthelackofempiricalvalidationsupportingmanyofthehighlydeveloped
measuresofclinicalsignificanceproposedintheclinicalpsychologyliterature(Kazdin,1999).

Kazdin(1977)recommendedtwogeneralapproachestothesocialvalidationofbehaviorchangethathavebeenembracedbyanumberofresearchersinchild
languagedisorderssocialcomparisonandsubjectiveevaluation(Bain&Dollaghan,1991Campbell&Bain,1991Campbell&Dollaghan,1992Olswang&Bain,
1994Schwartz&Olswang,1994).Socialcomparisoninvolvescomparisonsconductedpreandpostinterventionbetweenbehaviorsexhibitedbythechildreceiving
interventionwiththoseofagroupofsameagepeerswhoareunaffectedbylanguageimpairment(Campbell&Bain,1991).Astutereaderswillfindthismethod
reminiscentofanormativecomparison.However,insteadofcomparisonsonastandardizedmeasureagainstarelativelylargegroupofostensiblepeers,herethe
childsperformanceonamoreinformalmeasure(usuallyacliniciandesignedprobe)iscomparedagainstthatofarelativelysmallgroupofactualpeers.Thevalueof
thistechniquewillcertainlybeaffectedbythecaretakentochoosearepresentative,ifsmall,comparisongroup.Inaddition,itmayalsoprovemostvaluableincases
whereanormreferencedcomparisonusingalargergroupisunavailablebecausenoappropriatemeasuresorappropriatenormativesamplesexistforthetargeted
behaviorandparticularclient.

Subjectiveevaluationinvolvestheuseofproceduresdesignedtodeterminewhetherindividualswhointeractfrequentlywiththechildseeperceivedchangesas
important(Kazdin,1977).Methodsthathavebeenproposedforthesepurposesinspeechlanguagepathologyrangefromquiteinformaltorelativelysophisticated.
Thus,forexample,attheinformalendofthecontinuum,ithasbeensuggestedthatparents,teachersandotheradultswhoarefamiliarwiththechildbeaskedto
appraisetheadequacyofachildsperformancefollowingaperiodofintervention(Bain&Dollaghan,1991Campbell&Bain,1991).Clearlythesedatamaybe
qualitativeinnature(Olswang&Bain,1994Schwartz&Bain,1995)andwouldbenefitfromthecliniciansuseoftriangulationwithothersources,asdiscussedinthe
previouschapter,
Page305

thusimplyingtheuseofmultiplemeasures.ThisisconsistentwiththeideaemphasizedinKazdins(1999)recentwork,thatclinicalsignificanceinvariablyincludesa
frameofreferenceorperspective(p.334).

Amoreintermediatelevelofcomplexitymightinvolveuseofanexistingratingscale,suchastheObservationalRatingScalesoftheClinicalEvaluationofLanguage
Functions3(Semel,Wiig,&Secord,1996),inwhichasimilarratingscaleiscompletedbythechild,theparent(s),andaclassroomteacher.Thegrowinginterestin
thedevelopmentoffunctionalmeasuresforusewithchildreninschoolsettingswillcertainlyprovidemanynewalternativesofthiskind.Additionofthistypeofmeasure
totheverydetailedmeasuresofprogressbeingusedforTamikamaynotonlyprovidestrongevidenceoffunctionalimpact,butmayalsohelpreducepossiblebiasin
theassessmentofprogressachievedbyachildwhospeaksadialectusuallyunderrepresentedinstandardizedmeasures.

Ahigherlevelofcomplexityintheuseofsubjectiveevaluationwouldinvolvetheuseofapanelofnaivelistenerswhocouldbeaskedtousearatingstrategysuchas
directmagnitudeestimationtomakejudgmentsaboutsomeaspectofthecommunicativeeffectivenessofachildsproductions.CampbellandDollaghan(1992)
describedtheuseofa13personpanelthatwasaskedtoratetheinformativeness(amountofverbalinformationconveyedbyaspeakerduringaspecifiedperiodof
spontaneouslanguage,p.50)ofutterancesproducedbyninechildrenwithbraindamageandtheircontrols.Thisexampleofsocialvalidationisparticularlycomplex
giventhatCampbellandDollaghanappliedahybridmethodthatusedbothsocialcomparisonandsubjectiveevaluationcomponents.Althoughmethodsascomplexas
theseareprobablynotpracticalinmanyclinicalsettings,theyprovideavaluableillustrationofhowflexiblesocialvalidationprocedurescanbe.

Insummary,socialvalidationmethodsaddgreatlytoourestimationofhowimportantanobservedchangeis.Inparticular,theycanhelpusseehowobserved
differencesmakeachangeinachildscommunicativeandsocialfunctionsandopportunities.Theyvarydramaticallyintermsoftheircomplexityandsophistication.
Further,becausetheycanbeappliedtoqualitativeaswellasquantitativedata,theuseofinformalmeasuresisanespeciallyattractivefeature.

UseofMultipleMeasures

Theaugmentationofmeasuresdesignedtodirectlyassesslinguisticbehaviorswithmeasuresintendedtoprovidesocialvalidationconstitutesoneveryimportantwayin
whichmultiplemeasuresmaybeusedtoenhanceourabilitytoteaseoutthecontributionoftreatmenttochange.However,thekindsofmultiplesourcesofdata
recommendedbyclinicalresearchersdonotstopthere(Campbell&Bain,1991Olswang&Bain,1994Schwartz&Olswang,1996).Theyextendtoconsidering
thevalueofmultipleindicatorsinhelpingonebestaddresstheconstructofinterestanideathatwasintroducedinFig.2.2andinchapter2.Whethertheconstructis
onerelatedtoaparticularlinguisticskillortoachildscommunicativefunctionwithinagivensetting,thereisgeneralagreementthatmakinguseofseveralmeasurescan
bestsupportconclusionsabouttheconstructunderconsideration.
Page306

Writingfromaresearchperspective,Primavera,Allison,andAlfonso(1996)notedthatCookandCampbell(1979)introducedtheideaofmultioperationalisminto
behavioralresearch,inwhichaconstructisoperationalizedusingasmanyindicatorsaspossibleinordertotrulycaptureitsessence.Inasimilarvein,Pedhazurand
Schmelkin(1991)offeredadetailedaccountexplainingwhytheuseofasingleindicatorofaconstructalmostalwaysposesinsurmountableproblems(p.56)related
toknowingtowhatextenttheindicatorreflectstheconstructratherthanerror.Whereasresearchersmayhavegreateropportunitiesandrewardsforpracticing
multioperationalism,clinicians,too,canbenefitfromitsapplication.Whenaclinicianusesasinglemeasure(e.g.,asingletestofreceptivevocabulary)tosupport
conclusionsaboutaconstruct(e.g.,receptivelanguage),boththeclinicianandhisorheraudienceeitherimmediatelyfeelskepticalthatthepart(receptivevocabulary)
representsthewhole(receptivelanguage)orshouldfeelskepticaliftheygiveitmuchthought.Evenifconclusionsarelimitedtothoseaboutreceptivevocabulary,
however,aquickreminderaboutthenatureofmostsuchteststhattheyfrequentlyaddressonlypictureablenounsshouldcausethecliniciantopause.Clearly,the
singleindicatorseemsunlikelytocapturetheconstructofinterest.Thetimedemandsofclinicalpracticecansometimesmakethecollectionofevenonemeasureseem
onerousandtheideaofmultiplemeasuresanauthorsfantasyandcliniciansnightmare.However,becomingawareofthevalueofsuchmeasuresmayhelpclinicians
decidetotaketheextratimeandprovidesupportforthatdecisioninselectcases.Further,incaseswheretheuseofmultiplemeasureshasnotseemedpractical,itcan
helpleadtomorelimitedandthereforemorevalidinterpretations.

Inthissection,threeprincipalstrategiesforexaminingtheimportanceofchangewerebrieflyintroduced:useofmultiplemeasures,socialvalidationandeffectsize.
AuthorssuchasBain,Campbell,Dollaghan,andOlswanghavebeguntoventuredeepintotheliteraturesofrelateddisciplinestoexplorethisrelativelynewterritoryfor
theresourcesitmightcontributetomeasurementincommunicationdisorders.Giventhevalueoftheirworktodate,theireffortswillundoubtedlycontinueandbejoined
bythoseofotherswhorespondtorecentcallsformorepersuasiveevidencethatspeechlanguagepathologyservicesmakeadifferenceforchildrenwith
communicationdisorders.

DeterminingResponsibilityforChange

Whereasdeterminingtheextenttowhichchangeinlanguagehasoccurredanddeterminingitsimportancearecloselyrelatedtasks,verifyingtheclinicianscontributions
tothatchangeisanaltogetherdifferentandmoredauntingtask.Granted,simplynotingtheextenttowhichchangehasoccurredanditsnaturecanbeusefulininstances
wherenointerventionhastakenplaceforexample,incaseswhereachildsdevelopmentisbeingmonitoredbecauseofsuspicionthatthechildisalatetalker.More
commonly,assessmentofchangeforchildrenintreatmentinvolvescaseswhereallstakeholdersarecomfortablewiththeunexaminedassumptionthatchangewillbe
primarilytheresultofinterventionefforts.However,therearetimeswhendemonstratingthattreatmentisresponsibleforobservedchangesiscrucial.Inthiseraof
growingattentiontoaccountabilityandqualityassurance,thesetimesarebecomingmorecommon(Eger,1988Frattali,1998a1998b).
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Thedifficultyinpinningdowncausalexplanationsforhumanbehaviororbehaviorchangeisadrivingforcebehinddevelopmentsinpsychologyandrelateddisciplines
overthepast100years.Againandagain,theproblemwithdeterminingcausalityseemstoberulingoutalternativeexplanationsincaseswherestringentcontrolover
potentialcausesiseithernotpossibleornotethical.Treatmentforlanguagedisordersinchildrenpresentstheclassicdifficultyinthisregard.Thepossibilityoffactors
otherthantreatmentsuchasdevelopment,environmentalinfluences,andchangesinthechildsphysiologythroughrecoveryfromadiseaseprocessortraumamake
itverydifficulttoidentifytreatmentsorindirectmanagementstrategiesashavingcausedgainsthatareseeninachildsperformance.

Atleasttwodesignelementshaveprovidedalogicalbasisforincreasingtheplausibilitythatgainsinperformanceseenwhileachildisundergoingtreatmentare
attributabletotreatmentratherthantoalternativeexplanations.Thesetwoelementsarerepeatedobservationsoveraperiodoftimepriortotheonsetoftreatmentand
theuseoftreatment,generalization,andcontrolprobes.Bothoftheseelementshavebeenincorporatedintotheframeworkofresearchknownassinglesubject
experimentaldesign(Franklin,Allison,&Gorman,1996Kratochwill&Levin,1992McReynolds&Kearns,1983).Inaddition,eachhasbeenidentifiedseparately
asameansofenhancingsupportfortreatmentasacausalfactorincasesofbehavioralgains(Bain&Dollaghan,1991Campbell&Bain,1991Olswang&Bain,
1994Schwartz&Bain,1996).

PretreatmentBaselines

TheuseofmultipleobservationsoveraperiodoftimepriortotheinitiationoftreatmentisfrequentlyreferredtoasabaselineortheAconditioninasinglesubject
experimentaldesign.Multipleobservationsfunctionasawindowintothestabilityofthebehaviorandthemeasureusedtocharacterizeit.Iflittlevariationisobserved,it
seemsmostlikelythatthebehaviorisnotchangingandthatthemeasurebeingusedtotrackthebehaviorisnotintroducingerror(i.e.,thatitisprobablyreliable).This
meansthatdeparturesfromstabilityobservedaftertheonsetoftreatmentcanbemorereadilyattributedtotreatmentthantoeithertheinstabilityofthebehaviorbeing
measuredortomeasurementerror.Thepresenceofstabilityduringbaselineobservationsmightalternativelybeinterpretedassuggestingthatthebehaviorbeing
measuredandthemeasurebeingusedforthatpurposearevarying:inwaysthatcanceleachotheroutamostunlikelyprospect.

Incontrast,whenconsiderablevariationisobserved,itcanbedifficulttodeterminewhichofthetwopossiblesourcesofvariation(changeinthebehaviorvs.errorin
themeasurement)istheculprit.Consequently,asarule,baselinesareeasiesttointerpretandtheyprovidethestrongestsupportforobservingchangesthatmightoccur
underconditionssuchastreatment,whentheyaresufficientlylengthy,shownoobvioustrends,andappeartobestable(McReynolds&Kearns,1983).Withregardto
length,threeobservationsisoftenreferredtoasaminimum(McReynoldsandKearns,1983),withlongerbaselinesrequiredifthebehaviorshowsatrendorotherlack
ofstability.Thepresenceofatrend(consistentincreaseordecreaseindatavaluesinthedirectionofexpectedchangewithtreatment)canbeproblematic,ascanlack
ofstabilityin
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whichbothincreasesanddecreasesinaspecificmeasurearenoted.Becausestabilityisarelativequality,weagainareinapositionoflookingtowardexpertadviceto
helpusagreeonanacceptablerangeofvariation.McReynoldsandKearns(1983)pointedtoahistoricstandardof5to10%.However,theynotedthatlowerlevels
ofstabilityachievedduringabaselinewillsimplynecessitategreateramountsofchangetojustifyclaimsofeffectivetreatment.

Proponentsofsinglesubjectexperimentaldesignswhoarethechiefresourcesforinterpretingbaselinedatahaveoftensuggestedthatvisualinspectionofsuchdatais
sufficientforthedetectionofstabilityandsystematicchange.Recently,however,thecomplexityofthisjudgmenttaskhasledtoquestionsaboutitsuse(Franklin,
Gorman,Beasley,&Allison,1996Parsonson&Baer,1992).Inparticular,researchershavenotedatendencyforvisualanalysistofailtodetectchangewhenithas
actuallyoccurred,thussuggestingalackofsensitivitytosmallerlevelsofchange.Thisreducedsensitivitymaypresentseriousproblemsforclinicianswhobelievethat
smallamountsofchangewillbeimportanttodocumentingtheeffectoftheirtreatment.Ontheotherhand,forthosewhoattempttotargetbehaviorsonwhichthey
expectlargerchanges(largereffectsizes,touseourpreviousterminology)thereductioninsensitivitymayrepresentareasonabletradeoffagainsttherelativesimplicity
ofgraphicanalysis.Nonetheless,clinicianswhomaywishtorelyonvisualanalysiswoulddowelltolookintotheemergingcomplexitiesofthisaidtodatainterpretation
(Franklinetal.,1996Parsonson&Baer,1992).Researchersandclinicianswithsufficientresourcesmightalsoconsideralternativeinterpretationsthatmakeuseof
emergingmethods(Gorman&Allison,1996).

Treatment,Control,andGeneralizationProbes

Theideaoftreatmentandcontrolprobesdrawsonceagainonthesinglesubjectexperimentaldesignliterature(Bain&Dollaghan,1991).Inthatcontext,treatment
probesrepresentquantitativemeasuresfocusingonbehaviorsthatareorwillbethetargetoftreatment.Theyareusuallytheminimumtypeofdatacollectedtoprovide
evidenceofchange.Incontrast,controlprobesrepresentquantitativemeasuresobtainedperiodicallyoverthecourseofastudytoallowthecliniciantomonitorthe
effectsofextraneousvariablesonanindividualsbehavior.Theyareusuallyconstructedorselectedsothattheymeasurebehaviorsthatareunrelatedtothetreated
behavior.Ifthetreatedbehaviorshowschangewhereastheuntreated,controlbehaviormonitoredusingcontrolprobesdoesnot,thenthecliniciancanfeelconfident
thatmaturationandotherfactorshavenotproducedglobaladvancesfromwhichtreatedstimuliwouldhavebenefitedwithorwithouttheimplementationoftreatment.
(Ofcourse,oneoftheperilsinvolvedintheselectionofcontrolprobesisthatdevelopmentalforcesmaycausechangesinthebehaviortheyareusedtotrackeven
withoutadirecteffectoftreatmentDemetras,personalcommunication,February,2000).

Generalizationprobesareusedtotrackbehaviorsthatarerelatedbutdistinctfromthosereceivingtreatment.Thus,theiruseinvolvesaviolationoftheexpectedlack
ofrelationshipfromtreatedbehaviorscharacteristicofcontrolprobeswithinsinglesub
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jectdesigns(Bain&Dollaghan,1991Fey,1988).Intheconstructionofgeneralizationprobes,theclinicianlooksforbehaviorsthatarerelatedtotreatedbehaviorsin
amannerthoughtlikelytocausegeneralizationthatwillaffectthem.Onthebasisofthecurrentunderstandingofgeneralization,generalizationprobeswouldbe
expectedtoshowsimilarbutsmallerchangesthantreatmentprobesinresponsetotheimplementationofaneffectivetreatment.Althoughgeneralizationacross
behaviorsmaybethemostcommondimensioninwhichgeneralizationprobesarestudiedclinically,generalizationacrosssituationswillalsoproveofinterestaswill
generalizationacrosstime(McReynolds&Kearns,1983).

Theuseofgeneralizationandcontrolprobesallowsforacleardemonstrationthattreatmentisbehavingaspredictedrelativetothetargetedbehavior.Specifically,their
usecanhelpdemonstratethattreatmentishavingitsgreatesteffectontreatedbehaviors,alessereffectonuntreatedorothergeneralizationbehaviors,andnoeffecton
controlbehaviors.Theirusecanthuscontributetotheplausibilityofargumentsthattreatment,ratherthanthemyriadofothervariablesthatmighthelpachildsbehavior
improve,istheagentresponsibleforobservedchange.CampbellandBain(1991)furtherarguedthatevidenceofgeneralizationobtainedduringtreatmentoffers
speechlanguagepathologiststheirclearestopportunitytoshowinstrumentaloutcomes(i.e.,outcomessuggestingthelikelihoodthattreatmentwillleadtoadditional
outcomeswithoutfurthertreatment).Moresupportforthesevariedmeasurescomesfromthemotorlearningliterature,inwhichitwasobservedthatdataobtained
duringalearningcondition(e.g.,atreatmentsession)canoverestimatelearningcomparedtogeneralizationormaintenancedata(e.g.,seeSchmidt&Bjork,1992).

Anexampleillustratingtheuseoftreatment,generalization,andcontrolprobesisdescribedinBainandDollaghan(1991)aspartofasinglesubjectdesign.Usingthe
caseofahypotheticalpreschoolerwithSLI,theysuggestedatreatmenttargetconsistingoftheproductionofatwowordsemanticrelationAgent+Action.Asa
generalizationbehavior,theyproposedtheproductionofAction+Objectbecauseitssharedcomponent,Action,wasthoughttomakegeneralizationlikely.Finally,as
acontrolbehavior,theyproposedtheproductionofEntity+Locativebecauseitseemedunlikelytochangewithoutdirecttreatment.Eachprobeconsistedofthe
childspercentageofcorrectproductionof10unfamiliarexemplarsthattheclinicianattemptedtoelicitthroughmanipulationofseveraltoysandthecontext.

Treatment,generalization,andcontrolprobesofteninvolveelicitedbehaviorssuchasthosedescribedunderthatheadingintheprecedingchapter.However,other
measures,suchasperformanceonlanguagesamplesandanalyses,couldalsoserveasmeasuresthatmightbeusedtoexaminetreatment,generalization,andprobe
behaviors.Althoughthereisatendencyfortreatmentprobestobeobtainedfrequentlysothattheprocessoftreatmentaswellastheproductmaybeilluminated
(McReynolds&Kearns,1983),generalizationandcontrolprobesarefrequentlyevaluatedonalessfrequentbasis(Bain&Dollaghan,1991).Thefrequencywith
whichtreatmentprobesareusedmaydependontheexpectedrateofchangeBainandDollaghanpointedoutthatthebehaviorsofachildwithcognitivedelays
indicativeofanoverallslowerrateoflearningmayrequirelessfrequentcollectionofdata.
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DeterminingWhetherAdditionalChangeIsLikelytoOccur

Asanadditionalaspectofexaminingchange,authorshavesometimescalledattentiontothevalueofpredictingwhetherfuturechangeislikely.Inparticular,thisgeneral
questionhasbeenaskedspecificallywithregardtoaddressingpredictionsofchangeattwodifferentendsofthetreatmentprocess:initiationandtermination.First,
successfulpredictionofwhetherchangeislikelymighthelpinjudgingwhethertreatmentshouldbeinitiatedbecauseofachildsreadinessforchangeinaparticular
area(Bain&Olswang,1995Long&Olswang,1996Olswang&Bain,1996).Second,successfulpredictionmighthelpinjudgingwhethertreatmentshouldbe
terminated,oratleasttemporarilydiscontinued,becauseadditionalchangeisunlikely(Campbell&Bain,1991Egeretal.,1986).Bothkindsofquestionswillrequire
substantialempiricalinvestigationstoarriveatuniversalrecommendationsforbestpractices.Nonetheless,eachdependsonevidencethataparticulartechniqueisvalid
forpredictingagivenoutcomethussuggestingthatevidenceofpredictivecriterionrelatedvalidityisattherootofbothofthesequestions.Thisrealizationisimplicitin
theworkofBainandOlswang(1995),inwhichtheysoughttodemonstratethepredictivevalidityofdynamicassessmenttosupportitsuseindeterminingreadinessfor
theproductionoftwowordphrases.

Posingthequestionofwhentreatmentmightmostprofitablybeinitiatedgoesbeyondtheclinicalassumptionthattreatmentshouldbeundertakenanytimeachildis
foundtodemonstrateasignificantprobleminlanguageorcommunicationskills.Thequestionitselfsuggeststhepossibilitythattherearetimeswhenchildrenmayexhibit
evidenceofalanguagedisorderbutthattreatmentwouldbeunlikelytobeeffectiveeitherinaglobalsenseorinrelationtoaspecificdomainorbehavior.Timingthe
onsetoftreatmentoratleasttheonsetoftreatmentaimedatspecifictargetstocoincidewithchildrensareasofreadinesscouldbeexpectedtoyieldmajor
enhancementstotreatmentefficiency(Long&Olswang,1996).

OlswangandBain(1996)discussedtheuseofprofilinginstaticassessmentversusdynamicassessmentastoolstouseinaddressingthequestionofreadiness.Theuse
ofprofiles,whicharemostoftencreatedbycomparingachildsperformancesonseveraltestsorsubtests,wasdiscussedatsomelengthinchapter9.Eventhoughthe
useofprofileshasbeenlargelydebunkedasastrategyforhighlightingdomainsorchildrenthatmightexhibitthegreatestchangeintreatment,OlswangandBain(1996)
decidedbothtopursueitasoneofthefewmethodsinstaticassessmentthathasbeenproposedforaddressingthepredictionoffuturechangeandtocompareitwith
techniquesfromdynamicassessment.

Oneofthegreatestpromisesofdynamicassessmenthasbeenitsuseinidentifyingthemovingboundaryofachildslearning,orzoneofproximaldevelopment(ZPD
Olswang&Bain,1996Vygotsky,1978).Asdescribedinchapter10,theZPDisthoughttoreflectthelociofachildsactivedevelopmentalprocessesandthusto
suggestareasinwhichtreatmentmightbeaimedtoachieveoptimalchange.Asaresultofthispromise,OlswangandBain(1996)decidedtocomparetherelative
meritsofprofilesbasedonstaticassessmentsaswellasperformancesonotherselectedvariablesversusmeasuresofdynamicassessmenttechniquesinpredicting
responsesto
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treatment.Thedynamicmeasureswerefoundtohavethestrongercorrelationthanthestaticmeasurestoameasureofchange(PCI)calculatedfollowinga3week
treatmentperiod.

TheresultsoftheirstudyledOlswangandBain(1996)toproposethatdynamicassessmentproceduresarebetterthanothertechniquesatdeterminingthelikelihoodof
immediatechange.However,theynotedthatadditionalresearchisneededtodeterminewhetherobservedchangeswouldhaveoccurredevenintheabsenceof
treatment.Theymightalsohavenotedthatadditionalresearchisneededtodeterminewhetherthepredictivepowersofdynamicassessmentwouldhaveperformedas
welloverlongerperiodsoftreatment.

AsCampbellandBain(1991)advised,decisionsregardingtreatmentterminationcanbebasedonpredeterminedexitcriteriaorondemonstrationsthatnochangehas
occurredoveragivenperiodoftime.Suchdecisions,however,canalsobebasedonempiricalevidencethatadditionalchangeisunlikely.Thislastalternativethus
demandsapredictionoffuturechangelevelsakintothatsoughtbyOlswangandBainintheireffortstoidentifyharbingersofchangepriortotreatmentinitiation.

CampbellandBain(1991)touchedonthepossibilityofpredictingfuturechangeforpurposesofmakingarationaldecisionabouttheendoftreatmentintheir
discussionofultimateorinstrumentaloutcomes.Whereasultimateoutcomescanbedefinedasachildsachievementofageappropriateormaximalcommunicative
effectiveness,suchoutcomescanalsobedefinedasfunctionalcommunicativeeffectiveness,whichimpliesthatthechildhasachievedhisorherbestapproximationof
maximalcommunicativeeffectiveness.Additionally,instrumentaloutcomescanbedefinedasoutcomessuggestivethatadditionalchangewillbeforthcominginthe
absenceoftreatment.Thenotionsoffunctionalcommunicativeeffectivenessandinstrumentaloutcomeseachinvolveimplicationsrelatedtothepredictionoffuture
change.Specificallywhenfunctionalcommunicativeeffectivenessisseenasalegitimateultimateoutcome,itisalmostinvariablybecausetheprospectofadditional
changeisseenasunlikelyorasprohibitiveintermsofthetimeandeffortrequiredtoproduceit.Similarly,instrumentaloutcomesdependonthenotionthatadditional
changeislikely.

Atthispointintime,itappearsthatgeneralizationdata,suchasthatdescribedintheprecedingsection,mayrepresentthebestmethodforaddressingquestions
regardingfuturechange.Researchdesignedtoidentifymoreappropriatemethodsofpredictingfuturechangewillundoubtedlyneedtoproceedhandinhandwith
researchaimedatunderstandingthenatureoflanguagelearningandofthreatstolanguagelearningposedbylanguagedisordersbeforesubstantialprogressonthese
clinicalquestionscanbemade.Measuresofpredictivevaliditywillalsoundoubtedlyplayaroleinhelpingusarriveatsatisfyinganswers.

AvailableTools

Thekindsoftoolsavailableforuseinaddressingquestionsofchangeinchildrenslanguagedisorderslargelyoverlapthoseavailablefordescriptionthatweredescribed
intheprecedingchapter.Therefore,inthischapter,discussionofavailabletoolsis
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quitebriefandfocusesonthosemeasuresthataremostfrequentlyusedtoexaminebehavioralchangeandthespecialconsiderationsthatarisewhentheyareusedfor
thatpurpose.Theonlynewtooltobeintroducedinthischapterissinglesubjectdesigns,afamilyofmethodsthathasbeenalludedtothroughoutthischapterbuthas
notbeenadequatelyintroducedasaspecificmethodforexaminingchange.

Standardized,NormReferencedTests

Repeatedadministrationofstandardized,normreferencedtestsisprobablythemostwidespreadmethodusedbyspeechlanguagepathologiststoexaminebroad
changesinlanguagebehaviorsovertime(McCauley&Swisher,1984).Moresothanothermeasuresusedtoexaminechange,standardizednormreferenced
measuresareoftenaccompaniedbydataconcerningtheirreliabilityandvalidity.Thisrepresentsadistinctpotentialadvantagebecausesuchdatacanenhancethe
cliniciansabilitytodeterminewhetherobservedchangesarelikelytobereliableandimportant.Regrettably,however,normreferencedmeasuresoftendonotprovide
sufficientlydetaileddatatomakethispotentialareality(Sturneretal.,1994).

Asadditionalbarrierstotheireffectiveuseforevaluatingchange,thereareanumberofpitfallsthatmustbeavoided.Themostimportantoftheserelatestothe
tendencyforsuchmeasurestohavebeendevisedsothattheyaremoresensitivetolargedifferencesinknowledgebetweenindividualsthantosmalldifferences
(Carver,1974McCauley&Swisher,1984).Yetitissmalldifferencesthatarecharacteristicofthechangesmostlikelytooccurintreatmentwithinagivenindividual
(Carver,1974McCauley&Swisher,1984).Thus,clinicianswhousesuchmeasurestoassesschangemustbeawarethattheireffortsarelikelytoproveinsensitiveto
veryimportantchangesinbehaviorsthatsimplyarenotaddressedbyagiventest.Suchtestsshouldbeusedwhenbroadchangesareofinterest.

AmongotherpossiblepitfallscitedbyMcCauleyandSwisher(1984),aswellasothers,aretheneedtoavoidsituationsinwhichthetestisexplicitlytaughtbyawell
meaningclinicianorimplicitlytaughtthroughrepeatedadministrationsthatoccursocloselyintimeastoallowthechildanunwarrantedadvantageatthesecond
administration.Anotherpitfallistheuseofnormreferencedinstrumentstoassesschange,whichcanbeproblematicifchangesinthenormativegroupsoccuroverthe
timeintervalstudiedorifdifferentmeasures(albeitthosethatostensiblytapthesamebehavior)areusedatdifferenttimes.Now,itmaybetemptingtoviewchangeas
havingoccurredbecauseachildhasreceivedarelativelybetterscoreonTestBofLanguageBehaviorXthansheorhedidonTestAofLanguageBehaviorX.
However,thehugeamountoferrorthatcouldbeintroducedbydifferencesinthecontentofTestsAandB(despitetheirsimilarnames)aswellasbydifferencesin
theirnormativesamplesarelikelytomakesuchaconclusioncompletelyerroneous.

Onemethodthathasbeenrecommended(e.g.,McCauley&Swisher,1984)ashelpingremovetheadditionalerrorassociatedwithgainscoreshasbeentosimply
reexamineachildwiththesameinitialquestion:Isthischildslanguage(ortheparticularaspectofitthatisunderscrutiny)impaired?However,arecentstudylookingat
remissionratesforreadingdisabilityamongchildrenexaminedintwostudiesover
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a2yeartimeperiodsuggestedthatmeasurementerrorcanleadtosignificantoverestimatesofrecoveryratesevenwhenthismorecautiousstrategyisapplied
(Fergusson,Horwood,Caspi,Moffitt,&Silva,1996).However,thechiefsourceofdifficultywasnotinhowchangewasexamined,butthatthequestionof
measurementerrorhadnotbeenexploredsufficientlybytheoriginalinvestigatorsatthetimeofthechildrensoriginaldiagnoses.CarefulanalysisbyFergussonandhis
colleaguessuggestedthattheoveridentificationofmanychildrenattheirfirsttesting,duetoalackofappreciationoftestingerror,wasthevillain.Itisnowanempirical
questiontodeterminewhetherthefindingsofFergussonetal.areechoedintheidentificationofchildrenashavingalanguageimpairment.However,Iincludethisbrief
descriptionoftheirworkhereasacautionarytalesuggestingthatcarefuluseofnormreferencedmeasuresinassessingchangebeginswiththeircarefulusein
identificationprocesses.

Inshort,despitetheirfrequentusefortheassessmentofchange,normreferencedtestsaremostusefulwhenbroadchangesareexpectedandwhencliniciansare
carefultoavoidtheseveralproblemsthatcanunderminethevalidityoftheiruseforthispurposeaswellasforpurposesofidentification.

StandardizedCriterionReferencedMeasures

Becausecriterionreferencedmeasuresaremoreoftendevelopedsothattheyexhaustivelyexamineknowledgewithinagivendomain,theyhavebeenhailedas
superiortonormreferencedmeasuresforpurposesofexaminingchange(Carver,1974McCauley,1996McCauley&Swisher,1984).However,theirrelativerarity
(asshownbythesamplingofsuchtoolsinTable10.1)meansthattheirvalueinassessinglanguagechangeinchildrenhasnotbeenextensivelyevaluated.

Cliniciansneedtoexaminedocumentationforsuchmeasurestodeterminewhethertheauthorhaspresentedareasonableevidencebasesupportingtheirusetoexamine
changeovertime.Especiallydesirableisevidencesuggestingthatchangesinperformanceofspecificmagnitudesarelikelytoreflectsignificantfunctionalchangesin
performance.Nonetheless,wheretheyareusedasasimpledescriptionofthespecificcontentonwhichgainshavebeenachieved,suchevidenceisnotascritical.

ProbesandOtherInformalCriterionReferencedMeasures

Asarguedthroughoutthisbook,probeshavearelativeadvantageintheirmalleabilitytothespecificclinicalquestionsposedbythespeechlanguagepathologist.Thus,
theycanbedevisedorselectedtoaddressveryspecificquestionsaboutchangethatcoincidewiththeveryfocusoftreatmentforagivenchild.Thattheyareoften
relativelybriefandstraightforwardininterpretationrepresentfurtheradvantages.

Tocontemplatethepossiblepitfallsoftheuseofprobes,however,readersneedonlyreturntotheirdescriptioninchapter10.Withouttheconsiderableeffortentailed
instandardization,cliniciandevisedprobesorprobesthatareborrowedfromothernonstandardizedsourcesareunknownwithrespecttoreliabilityandvalidity.
Althoughtheirpossiblefittothequestionbeingaskedpresentsagreatpotentialforexcellentconstructvalidity,thetendencyforprobestobehaphazardlyconstructed,
Page314

administered,andinterpretedrepresentsapotentiallydevastatingthreattothatpotential.Becauseoftheexpectationthatrepeateduseofprobeswillberequiredifthey
aretobeusedtoassesschange,thestandardizationstrategiesdescribedinFigure10.1becomeparticularlyvitaldefensesagainstthosethreats.

DynamicAssessmentMethods

Thegrowingliteratureaimedatexploringtheutilityofdynamicassessmentmethodsinpredictingreadinessforlanguagechange(Bain&Olswang,1995Long&
Olswang,1996Olswang&Bain,1996)supportsahopefulbutquestioningviewregardingtheuniformitywithwhichsuchtechniquessucceed.Althoughbydefinition
suchmethodsareintendedtoelicitconditionsthatchangeachildslikelihoodofacquiringamorematurebehavior,theymayattimesprovidenomorethantransient
predictionswithatenurethatmakesthemoflesservalueforsignalingtreatmentfocus.Nonetheless,explorationoftheirpredictivevalueinspecificdomainsandfor
specificclientswarrantsfurtherinvestigation.Inthemeantime,theirgreatestpromiseappearstolieintheinsightstheyprovideregardinghowinterventionmightbest
takeplaceandinprovidingmorevalidassessmentsforchildrenwhoarehighlyreactivetoatesting.Therearealsonumeroussuggestionsthattheypromisetoprovide
morevalidassessmentsthanotheravailablemethodsforchildrenfromdiversebackgroundswhomaylacktheexperiencesassumedbymoreconventionaltesting
methods.

SingleSubjectDesigns

Intheirgroundbreakingworkontheapplicationofsinglesubjectexperimentaldesignstospeechlanguagepathology,McReynoldsandKearns(1983)notedthat
suchdesignshadthepromiseofwideapplicationbycliniciansbecauseoftheirpracticalityandclinicalrelevance.Despitetheirwideacceptanceasanalternative
methodofscientificinquiry,however,suchdesignshavebeenresistedbyspeechlanguagecliniciansindailypracticeprobablybecausetheirpracticalityfallsshortof
thatdemandedbymostclinicalsettings.Nonetheless,theyremainthestrongestavailablemethodwhentheclinicalquestionathandcentersonwhethertreatmentisthe
likelycauseofobservedchangesinbehavior.

Themostfrequentlyusedmeasuresinsinglesubjectdesignsareelicitedprobesandotherinformalmeasures,whicharereferredtoasdependentmeasuresinthis
context.Theseinformalmeasuresoftenlackthedocumentationregardingvalidityandreliabilitythatcanadornmoreformalmeasures.Nonetheless,theiruseis
strengthenedbytheirclosetietothespecificconstructforwhichtheyhavebeencreatedorselected.Ideally,theyrepresenthighlydefensibleoperationalizationsofthe
behaviororabilityofinterest.Theiruseisfurtherstrengthenedwhenmeasuresofinterandintraexamineragreement,orotherbasicmeasuresaimedatdemonstrating
reliability,areobtained.Theycanalsobeenhancedbyblindmeasurementproceduresinwhichthepersonmakingthemeasurementisunawareofthepurposeitwill
serveor,ideally,theindividualonwhomitwasobtained(Fukkink,1996).
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Aspartofthesystematicstructuringofobservationsthatunderliestherationalebehindsinglesubjectdesigns,dependentmeasuresareobtainedfrequentlyandcanthus
providepersuasiveevidenceofconsistencyorchange.Inaddition,thetemporalstructureofsuchdesignsisintendedtoprovidelogicalsupportfortheroleoftreatment
versusalternativeexplanationsasagentsofchange.Onthebasisoftheseideals,singlesubjectexperimentaldesignshavebeenlaudednotonlyfortheirabilityto
providesuperiorevidenceaboutcausationattheleveloftheindividualbutalsoaboutboththeoutcomeandprocessoftreatment(McReynolds&Kearns,1983
McReynolds&Thompson,1986).

Asimpleconsiderationofafewofthebooksonthesubjectsuggeststhatdetaileddiscussionofthemethodsandlogicsupportingtheapplicationofsinglesubject
designsincommunicationdisordersiswellbeyondthescopeofthisbook(e.g.,Franklin,Allison,&Gorman,1996Kratochwill&Levin,1992McReynolds&
Kearns,1983).Nonetheless,asimpleexamplecanbeusedtoillustratethelogicthatsupportscausalinterpretationofsuchdesignsandthustheirpotentialfor
addressingthequestionofwhethertreatmentislikelytoberesponsibleforachildsbehavioralchange.TheexampleIshowinFig.11.2isahypotheticalexamplefrom
BainandDollaghan(1991).Itwasdescribedpreviouslyforitsuseofcontrol,generalization,andtreatmentprobes.Itisdescribedhereforthewayinwhichthestability
ofdata,timingoftreatment,anddemonstrationsofchangeleadonetotheconclusionthatobservedchangesprobablyresultedfromtreatment.

AsyoulookatFig.11.2,noticefirstthetopgraph,inwhichprobesfortheprimaryfocusoftreatment(Agent+Action)arestudiedfirstwithoutthepresenceof
treatmentduringabaselinecondition.Becausethebaselineisclearlyunchanging,itisreasonabletoconcludethatfactorssuchasmaturation,informalinstructionbya
parent,andsofortharenotplayingaroleinthechildsacquisitionofthetargetformpriortotheinitiationoftreatment.Althoughtheinitiationoftreatmentdoesnot
resultininstantaneouschange,changedoesoccuroverthecourseofthetreatmentinterval.Further,thatchangeseemslikelytobeduetotheeffectsoftreatmentrather
thanalternativeexplanatoryfactorsbecauseoftheimplausibilitythatsuchfactorswouldcommencebychanceinsuchcloseproximitytotheonsetoftreatment.
Whereasinmostsinglesubjectdesigns,theperiodlabeledwithdrawalisconsideredasecondbaseline,hereitisdescribedaswithdrawalbecausetheexperimenter
wouldprobablyexpectsomeadditionalgrowth(generalization)duetolearningeffects.Thiskindofdesigninwhichtreatmentisabsent,thenpresent,thenabsentagain
isoftenreferredtoasanABAorwithdrawaldesign.

ABAdesignsareoftenavoidedinclassicalsinglesubjectdesignsincaseswhereaneffectivetreatmentwouldbeexpectedtoshowcarryoverinthisway.Instead
suchdesignswouldmoretypicallybeusedforbehaviorsthatareexpectedtoreturntobaselinewhentreatmentisended.Whenlanguagedevelopmentisstudied,
however,thepresenceofgeneralizationisnotconsideredaseriousdetractorfromthelogicofanexperimentwhenitoccursaspartofasetofpredictionsmadein
advancebytheclinicianorexperimenter.

InthesecondgraphofFig.11.2,aseconddependentmeasure(orgeneralizationprobe),Action+Object,isobservedwiththeexpectationthatitsrelationshiptothe
targetedvariable,Agent+Action,willcausesomedevelopmentalchangetooccur
Page316

Fig.11.2.Ahypotheticalmultiplebaselinesinglesubjectdesignthatmakesuseoftreatment(Agent+Action),generalization(Action+Object),andcontrol(Entity+
Locative)probes(Graphs1,2,and3,respectively).FromTheNotionofClinicallySignificantChange,byB.A.BainandC.A.Dollaghan,1991,Language,
Speech,andHearingServicesinSchools,22,p.266.Copyright1991bytheAmericanSpeechLanguageHearingAssociation.AmericanSpeechLanguage
HearingAssociation.Reprintedwithpermission.

duringtreatmentandpossiblybeyond.However,thepresenceofaninitialperiodofstabilitypriortotheonsetofchangeinthismeasureisagainhelpfulinstrengthening
theplausibilityoftheargumentthattheobservedchangeislikelytoresultfromthetreatmentratherthanotherfactors.Inaddition,thatargumentisstrengthenedifthe
generalizationprobedoesnotimprovetothesameextentasthetargetprobe,ordoessofollowingadelayrelativetotheactualtargetoftreatment.

InthethirdgraphofFig.11.2,thecontrolprobe,Entity+Locative,isshownwithastablebutlongerbaseline,thusindicatingthatextraneousvariablesareunlikelyto
Page317

beactingonthechildslanguagedevelopmentfortheentiredurationofthebaseline.Itisimportantthatthebaselineforthisvariable,whichwaspredictedtobe
unaffectedbygeneralization,remainedstablethroughouttheentiretyoftreatmentdirectedatAgent+Actionanditswithdrawalperiodinordertosupportthetreatment
effectontheothervariables.Asimportantly,itbeginstoshowimprovementonlyaftertheinitiationoftreatmentinwhichithasbecomethedirecttarget.

Thepracticalrequirementsintermsofdatacollectionanddisplayarenotinconsequentialforsinglesubjectdesigns.However,asthisexampleillustrates,theydonot
havetobeoverlyburdensomeeither,withthechiefinvestmentherebeingtheperiodic(andstaggered)collectionofprobedatafortwoadditionalforms.Thiscost
seemswellworthitwhenweighedagainstthevalueofevidencedocumentingtheeffectivenessofthetreatmentusedfortwodifferenttargetsandofrealtimeinsights
intothegeneralizationpatternsoftheindividualchild.

Inadditiontonumerousbooksdealingmorecomprehensivelywiththelargenumberofdesignsthatcanbeappliedinclinicalsettings(Franklin,Allison,&Gorman,
1996Kratochwill&Levin,1992McReynolds&Kearns,1983),asetofthreeclassicarticles(Connell&Thompson,1986Kearns,1986McReynolds&
Thompson,1986)representawonderfulinitiationtothepromisesuchdesignsholdforcliniciansinterestedinchildrenslanguagedisorders.

PracticalConsiderations

Withregardtoassessingchange,thelargestpracticalconsiderationappearingonthehorizonhasbeenthepresenceofprofessionalandsocietalforcesurgingclinicians
tofindmeasuresthatdocumentthevalueofwhattheydoonabroaderscaleandwithgreaterregularity.Therefore,althoughotherpracticalissuesexistasveryreal
pressuresoncliniciansdecisionmakingregardingalloftheareasofchangediscussedinthischapter,theissueofoutcomemeasurementseemstowarrantthefull
attentionoftheremainingpagesofthischapterand,indeed,theconcludingpagesofthisbook.

Inspeechlanguagepathology,interestinhowlanguagetreatmentaffectschildrenhasbeenaroundforquitesometime(e.g.,Schriebman&Carr,1978Wilcox&
Leonard,1978).However,acontinuingcomplainthasbeenthatnotenoughsuchresearchontreatmentisbeingdone(e.g.,McReynolds,1983Olswang,1998),and
theresearchthatisbeingdoneinvolvestreatmentproceduresthat,althoughusefulforpurposesofscientificrigor,cannotreadilybeappliedtorealclinicalsettings.
Thus,thegeneralizabilityofasmallresearchbasehasbeenatissue.Nonetheless,existingtreatmentresearchhasprovidedatleastsomepreliminaryevidenceofthe
effectivenessoftreatmentextendingbeyondtheleveloftheindividualclinician.

Morerecently,interestinaccountability(e.g.,Eger,1988Egeretal.,1986Mowrer,1972)hasarisenatagrassrootslevelbecauseofgrowingdemandsfrom
individualconsumersandtheiradvocates.ThisinteresthasbeenjoinedinanintensetopdownfashionbyASHAasitrespondstoprotectitsmembersrolesinfast
changinghealthcareandeducationalsystems(Frattali,1998a,bHicks,1998).Inachapteraddressingthespecificnatureoftopdownpressuresnecessitatinggreater
attentiontooutcomes
Page318

assessmentinspeechlanguagepathology,Hicks(1998)describedatleastthreesourcesofinfluencetowhichtheprofessionmustrespond:

1. accreditingagencies(e.g.,theRehabilitationAccreditationCommissiontheJointCommissiononAccreditationofHealthcareOrganizations,JCAHOASHAs
ProfessionalServicesBoard,PSB)
2. payerrequirements(e.g.,MedicareMedicaidandManagedCareOrganizations,MCOs)and
3. legislativeandregulatoryrequirements(e.g.,OmnibusBudgetReconciliationActof1987,PublicLaw100203,andtheSocialSecurityAct,Part484)

Atfirstglance,theseforceswouldseemtocomeprimarilyfromthoseclinicalsettingsthatserveadultsand,thus,itmightbethoughtthattheywouldnotaffectclinicians
whoworkwithchildreninprimarilyeducationalsettings.However,asappreciationofthevalueofoutcomesmeasureshasbecomemorewidespreadandasthegreat
dividebetweeneducationandhealthcarebreaksdown(asillustratedinMedicaidfundingforsomechildrenenrolledinschoolprograms),theblissfulluxuryof
consideringtreatmentoutcomessomeoneelseschallengehasallbutdisappeared.Eger(1998)notedthatCongressspassingoftheEducationofAllHandicapped
ChildrenActof1975(P.L.94142)servedasapossibleprecursortoformaloutcomesmeasurementactivitiesinspecialeducationbecauseitincludedasoneofits
fourmaingoalstheassessmentandassuranceofeducationaleffectiveness.Thepassageofthe1997amendmentstoIDEA(P.L.10517)furtherreinforcesthe
importanceoffurtherdevelopmentsinthisarea.Inordertorespondtothechallengesfacingtheprofessionsacrosssettings,ASHAhasbegunthedevelopmentof
treatmentoutcomesmeasuresthatcanbeusedbygroupsofclinicianstodocumenttheirvalueandprovideabasisforcomparisonsbyimportantgroups(e.g.,school
districts,thirdpartypayers).

Atthispoint,readerswhoareunfamiliarwiththeterminologythataccompaniesoutcomesmeasurementmayfeelatadbewildered.Therefore,somebackgroundonthe
relationshipbetweentreatmentefficacyresearchandtreatmentoutcomesresearchseemsinorder.Despitesomeimportantunderlyingsimilaritiesandoverlapping
methods,animportantdistinctioncanbemadebetweenthesetwoterms(Frattali,1998aOlswang,1998).Olswang(1998)pointedoutthatbothefficacyresearchand
outcomeresearchrepresentstrategiesforexaminingtheinfluenceoftreatmentonindividualswithcommunicationdisorders.Nonetheless,whereasefficacyresearch
emphasizestheimportanceofdocumentingtreatmentasacauseforchange,outcomesresearchemphasizesthebenefitsassociatedwithtreatmentasitisadministered
inrealworldcircumstances.Frattali(1998a)describedthedistinctionquitesuccinctlybysayingthatefficacyresearchisdesignedtoprove,whereasoutcomes
researchcanonlyidentifytrends,describe,ormakeassociationsorestimates(p.18).Whereaspastefficacyresearchhasfocusedprimarilyonthebehaviorsthat
fallattheimpairmentlevelintermsoftheICIDHclassificationsystem,abroadeningofconcernstoembracebehaviorsfallingatthelevelsofdisorderandhandicapis
anemergingtrend(Olswang,1998).
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Treatmentefficacyisoftendefinedasencompassingtreatmenteffectiveness,efficiency,andeffects(e.g.,seeKreb&Wolf,1997Olswang,1990,1998).Treatment
effectivenessreferstothetraditionalideaofwhetherornotagiventreatmentislikelytoberesponsibleforobservedchangesinbehavior.Treatmentefficiency
referstotherelativeeffectivenessofseveraltreatmentsortotheroleofcomponentsofatreatmentincontributingtoitseffectiveness.Finally,treatmenteffectsrefers
tothespecificchangesthatcanbeseeninaconstellationofbehaviorsinresponsetoagiventreatment.Similarcomponentshavealsobeenidentifiedasfallingwithinthe
provinceoftreatmentoutcomesaswell(Kreb&Wolf,1997).

Whereastreatmentefficacyresearchisusuallyconductedunderoptimalconditions,oratleastwellcontrolledclinicalconditions,outcomesmeasurementis,by
definition,conductedundertypicalconditions(Frattali,1998bOlswang,1998).Onthedownside,thismeanstreatmentoutcomesresearchwillalmostneverbeableto
contributetoargumentsaboutthecauseandeffectrelationshipsoftreatmentsandobservedbenefits.Nonetheless,outcomesresearchwillalmostalwaysbeinabetter
positionthantreatmentefficacyresearchtoaddressconcernsaboutthevalueofservicesofferedtoprofessionalconstituencies(e.g.,withinagivenhospitalorschool
district).Consequently,outcomesresearchhasaveryspecialvaluetoindividualclinicians.Itcanenablethemtodemonstrateaccountabilitynotintheabstract,based
ontreatmentsconductedsolelybyotherclinicianresearchersworkingundercontrolledconditions,butbycomparingtheirownoutcomeswiththoseobtainedbyothers
throughparticipationinthelargescale,multisiteeffortsthatarecharacteristicofsuchresearch.

In1997,theNationalCenterforTreatmentEffectivenessinCommunicationDisordersbeganworkonadatabasethatwillinvolvecliniciansinthecollectionof
outcomesdataonanationalbasis.Thiscomplexdatabase,theNationalOutcomesMeasurementSystem(NOMS),willeventuallyincludeinformationaboutallof
thepopulationsservedbyspeechlanguagepathologistsandaudiologists.Currently,however,NOMSislimitedtoinformationaboutadultsseeninhealthcaresettings,
preschoolchildrenwhoareservedinschoolorhealthcaresettings,andchildreninkindergartenthroughthesixthgradewhoareseeninschools.(Notethatdata
concerninginfanthearingscreeningsarejustbeginningtobecollected.)Inordertoparticipate,schoolbasedcliniciansworkcooperativelytoprovidedataforagiven
schoolsysteminwhichatleast75%ofthespeechlanguagepathologistsholdASHAcertificationandinwhichallstudentswillbeincludedinthedatathatare
collected.Thesetworestrictionsaredesignedtoimprovethequalityandrepresentativenessofthedata.

Forschools,datafortheNOMSarecollectedatthebeginningandconclusionofservices,oratthebeginningandendoftheschoolyear,withdatacollection
proceduresdesignedtotakenomorethan5to10minutesperchild.Dataincludeinformationaboutdemographics,eligibilityforservices,thenatureoftreatment(i.e.,
modelofservices,amount,andfrequencyofservices),teacherandfamilysatisfaction,andtheresultsoftheFunctionalCommunicationMeasures(FCMs),a7
pointscaledevelopedbyASHA.Thescaleaddressesfunctionalperformancewithintheeducationalenvironment.ItincludesitemssuchasThestudentrespondsto
questionsregardingeverydayandclassroomactivitiesandThestudentknowsandusesageappropriate
Page320

interactionwithpeersandstaff.Theseitemsareratedonthefollowingscale:0=Nobasisforrating1=Doesnotdo2=Doeswithmaximalassistance3=
Doeswithmoderatetomaximalassistance4=Doeswithmoderateassistance5=Doeswithminimaltomoderateassistance6=Doeswithminimal
assistanceand7=Does.

ASHAsgoalsfortheNOMSarelofty.Besidesdemonstratingpositiveoutcomesforchildrenreceivingspeechlanguagepathologyservices,itishopedthatthe
NOMSwillfacilitateadministrativeplanning(e.g.,caseloadassignments)aswellasindividualdecisionsaboutintervention.Amongparticularaspirationsarethatitwill
provideinformationaboutwheninterventionismosteffective,howmuchprogresscanbeexpectedoveranacademicyear,whatservicedeliverymodelandfrequency
ofserviceresultsinthegreatestgainsforagivenkindofcommunicationdisorder,andwhatentranceanddismissalcriteriaarereasonable.Inaddition,itishopedthat
comparativeNOMSdatamightallowindividualschoolsystemsorgroupsofschoolsystemstodemonstratetheireffectivenessandefficiencyinwaysthatwillhelpthem
negotiateinaneraofstrainededucationalresources.Thesuccessofthesysteminmeetingthesegoalswilldependgreatlyonwidespreadparticipationallowingthe
representativesamplesrequiredforspecificgeneralizationssuchasthosejustdescribed.Intermsoftheutilityofthesystemforprovidingcomparativedataacross
schoolsystemsorunits,agreatertailoringofreportsavailabletoparticipantsmaybenecessarybeforethoseaspirationscanbeactualized.

BeyondtheNOMS,Eger(1998)describednumerouswaysinwhichanoutcomesapproachcanbeincorporatedwithinschoolpractice.Theserangefromsimple
modificationsofthewaygoalsandobjectivesarewrittenforindividualizededucationalplans(IEPs)tothedevelopmentofempiricallymotivateddismissalcriteriato
moreelaborateinvestigationsofeffectivenessofspecificservicedeliverymodels(e.g.,classroombasedinterventions,selfcontainedclassroom).Thesethreeexamples
runthegamutfromthosethatcanbeimplementedbytheindividualcliniciantothoserequiringmoreextensiveresources,akintothoserequiredbytheNOMS.

IntermsofhowtheindividualspeechlanguagepathologistscanmodifytheIEPstheywrite,Eger(1998)providedanexample.Shenotedthatagoalthatmight
currentlybewrittenasThestudentwillimproveexpressivelanguageskillscouldbereplacedwithoneormoreofthefollowing:Thestudentwillapplyproblem
solvinganddecisionmakingskillsinmathandEnglishclasses,Thestudentwilluselanguagetocreatedialogueswithteachersandpeerstofacilitatelearning,or
Thestudentwillbeabletofollowwrittendirectionsonobjectivetests(Eger,1998,p.447).

Regardlessofwhetherspeechlanguagepathologistsworkingwithchildrenactivelyworktoincludeanoutcomesperspectiveintheirpractice,theoutcomesmovement
willundoubtedlydriveextensivechangesinclinicalpracticeoverthenextdecade,especiallyastheserelatetothedocumentationofchangeinchildrenscommunication.
Responsiblereactionstothesechangeswilldependonsensitivitytothemeasurementvirtues(i.e.,functionalityandthedevelopmentofcommonbestpractices)aswell
asthemeasurementperils.Manyoftheseperilsarethosesharedwithallmeasurementstrategies,suchasconcernsaboutthequalityofdatacollectionatitssourceand
thesizeofthesampleusedforanyparticulardecision.Some,however,areuniquetosuchalargeundertakingtherelinquishmentofdecisionsabouthow
interpretation
Page321

willtakeplaceand,thus,thepossiblerelinquishmentoffeelingsofpersonalresponsibilityaswell.Still,itisanexcitingtimeformeasurementincommunicationdisorders,
oneinwhichsizeableresourcesmayfinallybefunneledtosomeofthequestionsthatmosttroublespeechlanguagepathologists.Thedesiredoutcomeofsuch
investmentsistheproliferationofinnovativemeasurementstrategiesandrefinementofexistingtoolstohelpusarriveatasophisticatedarmamentariumoftoolsfor
addressingourclinicalquestions.

Summary

1.Theassessmentofchangeunderliesbothcriticalandcommonplacedecisionsmadeinthemanagementofchildrenslanguagedisorders.Theseincludedecisions
aboutindividuals,suchaswhentobeginandendtreatmentandwhethertreatmenttacticsshouldbealteredduringthecourseoftreatment.

2.Whenquestionsoftreatmentefficacyandaccountabilityareraised,theassessmentofchangecanalsofueldecisionsabouttherelativemeritofvarioustreatment
approachesortherelativeproductivityofgroupsofclinicians.

3.Threetypesofoutcomesobservedinclinicalsettingsincludeultimateoutcomes,intermediateoutcomes,andinstrumentaloutcomes.Whereasultimateoutcomes
relatetodecisionsabouttreatmenttermination,intermediateandinstrumentaloutcomesrelatetoclinicaldecisionsmadeduringthecourseoftreatment.

4.Measurementerrorpresentsanespeciallydifficultchallengetointerpretationwhenmeasuresareexaminedatmultiplepointsintime,suchaswhenpastchangeis
examinedorfuturechangeispredicted.

5.Clinicallysignificantchangemustnotonlybereliable,itmustalsorepresentanimportantchangetothelifeofthechild.Threemethodsusedtoaddresswhetheran
observedchangeislikelytobeimportantinvolveconsiderationsofeffectsize,socialvalidation,andtheuseofmultiplemeasures.

6.Determiningthatpositivechangesinachildslanguagearecausedbytreatmentismadeextraordinarilydifficultbythethankfullyunavoidablebutnonetheless
confoundinginfluencesofgrowthanddevelopment.Increasedunderstandingofthoseinfluenceswithinandacrosschildrenareneededtohelpaddressthisverythorny
measurementproblem.

7.Singlesubjectexperimentaldesignsoffercliniciansthebestcurrentlyavailablemeansfordemonstratingthattreatmentisresponsibleforobservedchanges,buthave
thusfarbeenusedprimarilybyresearchers.

8.Measurementelementsstrengtheningargumentsthattreatmentisthecauseofobservedchangesincludethepresenceofpretreatmentbaselinesandtheuseof
treatment,generalization,andcontrolprobes.

9.Treatmentefficacyresearchisconcernedwithdocumentingwhethertreatmentiseffective,efficient,andwhethertheeffectsoftreatmentextendtoanumberof
significantbehaviors.

10.
Page322

Treatmentoutcomesresearchisdesignedtodemonstratebenefitsassociatedwithtreatmentasitisconductedineverydaycontexts.Cooperationfromallmembersof
theprofessionisneededtocollectsomekindsofparticularlypersuasivetreatmentoutcomesdata,suchasthosebeingcollectedintheNOMSdatabasebyASHA.

KeyConceptsandTerms

clinicallysignificantchange:achangethatmakesanimmediateimpactonthecommunicativelifeofachildorthatrepresentssignificantprogresstowardthe
acquisitionofcriticalaspectsoflanguage.

effectsize:themagnitudeofthedifferencebetweentwoscoresorsetsofscores,orofthecorrelationbetweentwosetsofvariables.

FunctionalCommunicationMeasures(FCMs):oneofseveralratingscalesdesignedbyASHAforuseintrackingfunctionalcommunicationgainsmadebyclients.

gainscores:thedifferencebetweenscoresobtainedbyanindividualattwopointsintimewhenthatdifferencerepresentsapositivechangeinperformancealsocalled
differencescores.

instrumentaloutcomes:individualbehaviorsacquiredduringtreatmentthatsuggestthelikelihoodofadditionalchangegeneralizationprobedatafunctionas
instrumentaloutcomes.

intermediateoutcomes:individualbehaviorsthatmustbeacquiredforprogressintreatmenttohaveoccurredtreatmentprobedatacanfunctionasintermediate
outcomes.

NationalOutcomesMeasurementSystem(NOMS):anoutcomesdatabaseforspeechlanguagepathologyandaudiologythatisbeingdevelopedtoaddressthe
professionsneedforlargescaleoutcomesdata.

outcomemeasurement:theuseofmeasuresdesignedtodescribetheeffectsoftreatmentconductedundertypical,ratherthancontrolledconditions.

ProportionalChangeIndex(PCI):amethodforexaminingtherateofchangeobservedinagivenbehaviorduringtreatmentrelativetothatobservedpriorto
treatment.

singlesubjectexperimentaldesigns:agroupofrelatedresearchdesignsthatpermittheusertosupportclaimsofcausalrelationshipbetweenvariables,suchasthe
effectoftreatmentonatargetedbehavior.

socialcomparison:asocialvalidationmethodthatinvolvestheuseofacomparisonbetweenlanguagebehaviorsofagivenchildorgroupofchildrenandthoseofa
smallgroupofpeers.

socialvalidation:methodsusedtoindicatethesocialimportanceofchangesoccurringintreatment.
Page323

subjectiveevaluation:asocialvalidationmethodinwhichproceduresareusedtodeterminewhetherindividualswhointeractfrequentlywithachildwhoisreceiving
treatmentseeperceivedchangesasimportant.

treatmenteffectiveness:thedemonstrationthatatreatment,ratherthanothervariables,isresponsibleforchangesinbehavior(Kreb&Wolf,1997Olswang,
1990).

treatmenteffects:changesinmultiplebehaviorsthatappeartoresultfromagiventreatment(Olswang,1990).

treatmentefficacyresearch:researchdesignedtodemonstratethecomplexpropertyofatreatmentthatincludesitseffectiveness,efficiency,andeffects(Olswang,
1990,1998).

treatmentefficiency:theeffectivenessofatreatmentrelativetoanalternativeamoreefficienttreatmentisoneinwhichgoalsareaccomplishedmorerapidly,
completely,ormorecosteffectivelythanalessefficienttreatment(Olswang,1990).

ultimateoutcomes:individualbehaviorsthatsignalsuccessfultreatment,eitherbecauseageappropriateorfunctionallyadequatelevelsofperformancehadbeen
achievedorbecausefurthertreatmentwouldbeunlikelytoyieldsignificantadditionalgains.

StudyQuestionsandQuestionstoExpandYourThinking

1.Arrangetoseeaclinicalcasefileforachildwhoisreceivingtreatmentforalanguagedisorder.Listthewaysinwhichchangeiscurrentlydocumented.Consider
waysinwhichthatdocumentationmightbestrengthenedincludinghoweffortsmightbemadetoaddresschangesineducationalorsocialfunctionaswellasinthe
natureofimpairment.

2.Discusstheadvantagesanddisadvantagesofusingastandardbatteryofnormreferencedteststolookatachildsoveralllanguagefunctioningovertime.Ifyou
weretodevisesuchabattery,whatwouldyoulookforinitscomponents?Wouldthatbatterydifferonthebasisoftheetiologyofthedisorder?Ifso,how?

3.Withregardtothedifferenttoolsthatmightbeusedtoexaminechange,discusshowyoumightexplainthatmethodtoachildsparents.

4.VisitthewebsitefortheNOCMSathttp://www.asha.org/nctecd/treatment_outcomes.htm.DeterminewhatbarriersmightexisttoparticipatingintheNOMS.On
thebasisoftheinformationyouobtainedinthischapterandthroughthatwebsite,whatargumentsmightbemadetojustifyeffortstoovercomethesebarriers?

5.LookatthetreatmentefficacystudiesforchildlanguagedisorderscollectedattheNOMSwebsiteundertheEfficacyBibliographieslink.Onthebasisofthe
informationyoucangleanfromreadingthetitlesofarticleslistedthere,whatkindsofaspectsoftreatmentefficacyseemtohavegottenthegreatestattention?

6.Onthebasisofwhatyouknowaboutclinicaldecisionsregardingchange,discussspecificchangesthatmightwarranttheuseofamethodsuchasasinglesubject
Page324

designorsocialvalidationtechniques.Althoughthesemethodsaremorecomplexthansomeothermethods,theyhavetherespectiveadvantagesofdemonstratingthe
cliniciansresponsibilityforchangeorthesocialimpactofchange.

RecommendedReadings

Bain,B.A.,&Dollaghan,C.(1991).Thenotionofclinicallysignificantchange.Language,Speech,andHearingServicesinSchools,22,264270.

Kazdin,A.E.(1999).Themeaningsandmeasurementofclinicalsignificance.JournalofConsultingandClinicalPsychology,67,332339.

Kreb,R.A.,&Wolf,K.E.(1997).Treatmentoutcomesterminology.InR.A.Kreb&K.E.Wolf(Eds.),Successfuloperationsinthetreatmentoutcomes
drivenworldofmanagedcare.Rockville,MD:NationalStudentSpeechLanguageHearingAssociation.

Schwartz,I.S.,&Olswang,L.B.(1996).Evaluatingchildbehaviorchangeinnaturalsettings:Exploringalternativestrategiesfordatacollection.TopicsinEarly
ChildhoodSpecialEducation,16,82101.

References

Anastasi,A.(1982).Psychologicaltesting(5thed).NewYork:Macmillan.

Bain,B.A.,&Dollaghan,C.(1991).Thenotionofclinicallysignificantchange.Language,Speech,andHearingServicesinSchools,22,264270.

Bain,B.A.,&Olswang,L.B.(1995).Examiningreadinessforlearningtwowordutterancesbychildrenwithspecificexpressivelanguageimpairment:Dynamic
assessmentvalidation.AmericanJournalofSpeechLanguagePathology,4,8191.

Bernthal,J.E.,&Bankson,N.W.(1998).Articulationandphonologicaldisorders(4thed.).EnglewoodCliffs,NJ:PrenticeHall.

Campbell,T.,&Bain,B.A.(1991).Treatmentefficacy:Howlongtotreat:Amultipleoutcomeapproach.Language,Speech,andHearingServicesinSchools,22,
271276.

Campbell,T.,&Dollaghan,C.(1992).Amethodforobtaininglistenerjudgmentsofspontaneouslyproducedlanguage:Socialvalidationthroughdirectmagnitude
estimation.TopicsinLanguageDisorders,12(2),4255.

Carver,R.(1974).Twodimensionsoftests:Psychometricandedumetric.AmericanPsychologist,29,512518.

Connell,P.J.,&Thompson,C.K.(1986).Flexibilityofsinglesubjectexperimentaldesigns.PartIII:Usingflexibilitytodesignandmodifyexperiments.Journalof
SpeechandHearingDisorders,51,214225.

Cook,T.D.,&Campbell,D.T.(1979).Quasiexperimentation:Designandanalysisissuesforfieldsettings.Boston:HoughtonMifflin.

Diedrich,W.M.,&Bangert,J.(1980).Articulationlearning.Houston,TX:CollegeHillPress.

EducationforAllHandicappedChildrenActof1975.Pub.L.No.94142.89Stat.773(1975).

Eger,D.(1988).Accountabilityinaction:Entry,measurement,exit.SeminarsinSpeechandLanguage,9,299319.

Eger,D.(1998).Outcomesmeasurementintheschools.InC.Frattali(Ed.),Measuringoutcomesinspeechlanguagepathology(pp.438452).NewYork:
Thieme.

Eger,D.,Chabon,S.S.,Mient,M.G.,&Cushman,B.B.(1986).Whenisenoughenough?Articulationtherapydismissalconsiderationsinthepublicschools.Asha,
28,2325.

Elbert,M.,Shelton,R.L.,&Arndt,W.B.(1967).Ataskforevaluationofarticulationchange:I.Developmentofmethodology.JournalofSpeechandHearing
Research,10,281289.

Fergusson,D.M.,Horwood,L.J.,Caspi,A.,Moffitt,T.E.,&Silva,P.A.(1996).The(artefactual)remissionofreadingdisability:Psychometriclessonsinthestudy
ofstabilityandchangeinbehavioraldevelopment.DevelopmentalPsychology,32,132140.
Page325

Fey,M.(1988).Generalizationissuesfacinglanguageinterventionists:Anintroduction.Language,Speech,andHearingServicesinSchools,19,27221.

Foster,S.L.,&Mash,E.J.(1999).Assessingsocialvalidityinclinicaltreatmentresearch:Issuesandprocedures.JournalofConsultingandClinicalPsychology,
67,308319.

Franklin,R.D.,Allison,D.B.,&Gorman,B.S.(Eds.).(1996).Designandanalysisofsinglecaseresearch.Mahwah,NJ:LawrenceErlbaumAssociates.

Franklin,R.D.,Gorman,B.S.,Beasley,T.M.,&Allison,D.B.(1996).Graphicaldisplayandvisualanalysis.InR.D.Franklin,D.B.Allison,&B.S.Gorman
(Eds.),Designandanalysisofsinglecaseresearch(pp.119158).Mahwah,NJ:LawrenceErlbaumAssociates.

Frattali,C.(1998a).Measuringmodalityspecificbehaviors,functionalabilities,andqualityoflife.InC.Frattali(Ed.),Measuringtreatmentoutcomesinspeech
languagepathology(pp.5588).NewYork:Thieme.

Frattali,C.(Ed.).(1998b).Measuringtreatmentoutcomesinspeechlanguagepathology.NewYork:Thieme.

Fukkink,R.(1996).Theinternalvalidityofaphasiologicalsinglesubjectstudies.Aphasiology,10,741754.

Glesne,C.,&Peshkin,A.(1992).Becomingqualitativeresearchers:Anintroduction.WhitePlains,NY:Longman.

Goldfried,M.R.,&Wolfe,B.E.(1998).Towardamoreclinicallyvalidapproachtotherapyresearch.JournalofConsultingandClinicalPsychology,66,143
150.

Goldstein,H.,&Geirut,J.(1998).Outcomesmeasurementinchildlanguageandphonologicaldisorders.InC.Frattali(Ed.),Measuringoutcomesinspeech
languagepathology(pp.406437).NewYork:Thieme.

Gorman,B.S.,&Allison,D.B.(1996).Statisticalalternativesforsinglecasedesigns.InR.D.Franklin,D.B.Allison,&B.S.Gorman(Eds.),Designandanalysis
ofsinglecaseresearch(pp.159214).Mahwah,NJ:LawrenceErlbaumAssociates.

Hicks,P.L.(1998).Outcomesmeasurementrequirements.InC.Frattali(Ed.),Measuringoutcomesinspeechlanguagepathology(pp.2849).NewYork:
Thieme.

IndividualswithDisabilitiesEducationAct(IDEA)Amendmentsof1997.Pub.L.10517.111Stat.37(1997).

Jacobson,N.S.,Roberts,L.J.,Berns,S.B.&McGlinchey,J.B.(1999).Methodsfordefininganddeterminingtheclinicalsignificanceoftreatmenteffects:
Description,application,andalternatives.JournalofConsultingandClinicalPsychology,67,300307.

Kamhi,A.(1991).Clinicalforum:Treatmentefficacy,anintroduction.Language,SpeechandHearingServicesinSchools,22,254.

Kazdin,A.E.(1977).Assessingtheclinicalorappliedsignificanceofbehavioralchangethroughsocialvalidation.BehaviorModification,1,427452.

Kazdin,A.E.(1999).Themeaningsandmeasurementofclinicalsignificance.JournalofConsultingandClinicalPsychology,67,332339.

Kazdin,A.E.,&Weisz,J.R.(1998).Identifyinganddevelopingempiricallysupportedchildandadolescenttreatments.JournalofConsultingandClinical
Psychology,66,1936.

Kearns,K.P.(1986).Flexibilityofsinglesubjectexperimentaldesigns.PartII:Designselectionandarrangementofexperimentalphases.JournalofSpeechand
HearingDisorders,51,204214.

Koegel,R.,Koegel,L.K.,VanVoy,K.,&Ingham,J.(1988).Withinclinicversusoutsideofclinicselfmonitoringofarticulationtopromotegeneralization.Journal
ofSpeech&HearingDisorders,53,392399.

Kratochwill,T.R.,&Levin,J.R.(1992).Singlecaseresearchdesignandanalysis:Newdirectionsforpsychologyandeducation.Hillsdale,NJ:Lawrence
ErlbaumAssociates.

Kreb,R.A.,&Wolf,K.E.(1997).Treatmentoutcomesterminology.Successfuloperationsinthetreatmentoutcomesdrivenworldofmanagedcare.Rockville,
MI:NationalStudentSpeechLanguageHearingAssociation.

Lahey,M.(1988).Languagedisordersandlanguagedevelopment.NewYork:Macmillan.

Long,S.H.,&Olswang,L.B.(1996).ReadinessandpatternsofgrowthinchildrenwithSELI.Language,Speech,andHearingSerivcesinSchools,5,7985.

Maloney,D.M.,Harper,T.M.,Braukmann,C.J.,Fixsen,D.L.,Phillips,E.L.,&Wolf,M.M.(1976).Teachingconversationrelatedskillstopredelinquentgirls.
JournalofAppliedBehavioralAnalysis,9,371.
Page326

McCauley,R.J.(1996).Familiarstrangers:Criterionreferencedmeasuresincommunicationdisorders.Language,Speech,andHearingServicesinSchools,27,
122131.

McCauley,R.J.,&Swisher,L.(1984).Useandmisuseofnormreferencedtestsinclinicalassessment:Ahypotheticalcase.JournalofSpeechandHearing
Disorders,49,338348.

McReynolds,L.V.(1983).Discussion:VII.Evaluatingprogrameffectiveness.ASHAReports12,298306.

McReynolds,L.V.,&Kearns,K.P.(1983).Singlesubjectexperimentaldesignsincommunicativedisorders.Austin,TX:ProEd.

McReynolds,L.V.,&Thompson,C.K.(1986).Flexibilityofsinglesubjectexperimentaldesigns.PartI:Reviewofthebasicsofsinglesubjectdesigns.Journalof
SpeechandHearingDisorders,51,194203.

Mehrens,W.,&Lehman,I.(1980).Standardizedtestsineducation(3rded.).NewYork:Holt,Rinehart&Winston.

Minkin,N.,Braukmann,C.J.,Minkin,B.L.,Timbers,G.D.,Timbers,B.J.,Fixsen,D.L.,Phillips,E.L.,&Wolf,M.M.(1976).Thesocialvalidationandtrainingof
conversationalskills.JournalofAppliedBehavioralAnalysis,9,127139.

Mowrer,D.(1972).Accountabilityandspeechtherapyinthepublicschools.Asha,14,111115.

Olswang,L.B.(1990).Treatmentefficacyresearch:Apathtoqualityassurance.Asha,32,4547.

Olswang,L.B.(1993).Treatmentefficacyresearch:Aparadigmforinvestigatingclinicalpracticeandtheory.JournalofFluencyDisorders,18,125131.

Olswang,L.B.(1998).Treatmentefficacyresearch.InC.Frattali(Ed.),Measuringtreatmentoutcomesinspeechlanguagepathology(pp.134150).New
York:Thieme.

Olswang,L.B.,&Bain,B.A.(1985).Monitoringphonemeacquisitionformakingtreatmentwithdrawaldecisions.AppliedPsycholinguistics,6,1737.

Olswang,L.B.,&Bain,B.A.(1994).Datacollection:Monitoringchildrenstreatmentprogress.AmericanJournalofSpeechLanguagePathology,3,5566.

Olswang,L.B.,&Bain,B.A.(1996).Assessmentinformationforpredictingupcomingchangeinlanguageproduction.JournalofSpeechandHearingResearch39,
414423.

Parsonson,B.S.,&Baer,D.M.(1992).Thevisualanalysisofdata,andcurrentresearchintothestimulicontrollingit.InT.R.Kratochwill&J.R.Levin(Eds.),
Singlecaseresearchdesignandanalysis:Newdirectionsforpsychologyandeducation(pp.1540).Hillsdale,NJ:LawrenceErlbaumAssociates.

Pedhazur,R.J.,&Schmelkin,L.P.(1991).Measurement,design,andanalysis:Anintegratedapproach.Hillsdale,NJ:LawrenceErlbaumAssociates.

Plante,E.,&Vance,R.(1994).Selectionofpreschoolspeechandlanguagetests:Adatabasedapproach.Language,Speech,andHearingServicesinSchools,
25,1523.

Primavera,L.H.,Allison,D.B.,&Alfonso,VC.(1996).Measurementofdependentvariables.InR.D.Franklin,D.B.Allison,&B.S.Gorman(Eds.),Designand
analysisofsinglecaseresearch(pp.4189).Mahwah,NJ:LawrenceErlbaumAssociates.

Rosen,A.,&Proctor,E.K.(1978).Distinctionsbetweentreatmentoutcomesandtheirimplicationsfortreatmentprocess:Thebasisforeffectivenessresearch.
JournalofSocialServiceResearch,2,2543.

Rosen,A.,&Proctor,E.K.(1981).Distinctionsbetweentreatmentoutcomesandtheirimplicationsfortreatmentevaluation.JournalofConsultingandClinical
Psychology,49,418,425.

Salvia,J.,&Ysseldyke,J.E.(1995).Assessment.(6thed.).Boston:HoughtonMifflin.

Schmidt,R.A.,&Bjork,R.A.(1992).Newconceptualizationsofpractice:Commonprinciplesinthreeparadigmssuggestnewconceptsfortraining.Psychological
Sciences,3,207217.

Schreibman,L.,&Carr,E.G.(1978).Eliminationofecholalicrespondingtoquestionsthroughthetrainingofageneralizedverbalresponse.JournalofApplied
BehaviorAnalysis,11,453463.

Schwartz,I.S.,&Olswang,L.B.(1996).Evaluatingchildbehaviorchangeinnaturalsettings:Exploringalternativestrategiesfordatacollection.TopicsinEarly
ChildhoodSpecialEducation,16,82101.

Semel,E.,Wiig,E.H.,&Secord,W.A.(1996).ClinicalEvaluationofLanguageFundamentals3.SanAntonio,TX:PsychologicalCoproration.

Sturner,R.A.,Layton,T.L.,Evans,A.W,Heller,J.H.,Funk,S.G.,&Machon,M.W.(1994).Preschoolspeechandlanguagescreening:Areviewofcurrently
availabletests.AmericanJournalofSpeech,Language,andHearing,3,2536.
Page327

Vygotsky,L.S.(1978).Mindinsociety:Thedevelopmentofhigherpsychologicalprocesses.Cambridge:HarvardUniversityPress.

Wilcox,M.J.,&Leonard,L.B.(1978).ExperimentalacquisitionofWhquestionsinlanguagedisorderedchildren.JournalofSpeechandHearingResearch,21,
220239.

Wolery,M.(1983).Proportionalchangeindex:Analternativeforcomparingchildchangedata.ExceptionalChildren,50,167170.

Wolf,M.M.(1978).Socialvalidity:Thecaseforsubjectivemeasurementorhowappliedbehavioranalysisisfindingitsheart.JournalofAppliedBehavior.
Analysis,11,203214.

Young,M.A.(1993).Supplementingtestsofstatisticalsignificance:Variationaccountedfor.JournalofSpeechandHearingResearch,36,644656.
Page328

APPENDIXA
Page329

NormReferencedTestsDesignedfortheAssessmentofLanguageinChildren,
ExcludingThoseDesignedPrimarilyforPhonology(AppendixB)

Oral
Language Written
Modalities Language ReviewedinMMY?
Test Ages andDomains Included? CompleteReference (x=ComputerForm)

AssessingSemantic Barrett,M.,Zachman,L.,&Huisingh,R.(1988).Assessing
SkillsThrough 3to9years RandESem no SemanticSkillsThroughEverydayThemes.EastMoline,IL: no
EverydayThemes LinguiSystems.
3yearsto6 ESem,
BanksonLanguage Bankson,N.W.(1990).BanksonLanguageTest2.San
years,11 Morph,Syn, no x
Test2 Antonio,TX:ProEd.
months Prag
Boehm,A.E.(1986).BoehmTestofBasicConcepts
BoehmTestofBasic
3to5years RSem no PreschoolVersion.SanAntonio,TX:Psychological x
ConceptsPreschool
Corporation.
BoehmTestofBasic Kindergarten Boehm,A.E.(1986).BoehmTestofBasicConceptsRevised.
RSem no x
ConceptsRevised toGrade2 SanAntonio,TX:PsychologicalCorporation.
BrackenBasic
Bracken,B.A.(1986).BrackenBasicConceptScale.San
ConceptScale 2to8years RSem no x
Antonio,TX:PsychologicalCorporation.
Revised
3yearsto7
CarrowElicited CarrowWoolfolk,E.(1974).CarrowElicitedLanguage
years,11 EMorph,Syn no x
LanguageInventory Inventory.Austin,TX:LearningConcepts.
months
ClinicalEvaluationof RandESem, Semel,E.,Wiig,E.H.,&Secord,W.A.(1996).Clinical
Language 6to21years Syn,Rapid no EvaluationofLanguageFundamentals3.SanAntonio,TX: x
Fundamentals3 Naming PsychologicalCorporation.
ClinicalEvaluationof
Wiig,E.H.,Secord,W.,&Semel,E.(1992).Clinical
Language 3to6years, RandESem,
no EvaluationofLanguageFundamentalsPreschool.San x
Fundamentals 11months Syn
Antonio,TX:PsychologicalCorporation.
Preschool

(Continued)
Page330

AppendixA(Continued)

Oral
Language Written
Modalities Language ReviewedinMMY?
Test Ages andDomains Included? CompleteReference (x=ComputerForm)

Communication
RandESem, Johnston,E.B.,&Johnston,A.V.(1990).Communication
AbilitiesDiagnostic 3to9years no x
Syn,Prag AbilitiesDiagnosticTest.Chicago:Riverside.
Test
Comprehensive RandESem, CarrowWoolfolk,E.(1999).ComprehensiveAssessmentof
AssessmentofSpoken 3to21years Morph, no SpokenLanguage.CirclePines,MN:AmericanGuidance no
Language Syntax,Prag Service.
Comprehensive
Wallace,G.,&Hammill,D.D.(1994).Comprehensive
Receptiveand 4to17years,
RandESem no ReceptiveandExpressiveVocabularyTest.SanAntonio,TX: x
ExpressiveVocabulary 11months
PsychologicalCorporation.
Test
EvaluatingAcquired
RandESem, Riley,A.M.(1991).EvaluatingAcquiredSkillsin
Skillsin 3monthsto8
Morph, no CommunicationRevised.SanAntonio,TX:Psychological x
Communication years
Syntax,Prag Corporation.
Revised
ExpressiveOneWord
Gardner,M.F.(1990).ExpressiveOneWordPicture
PictureVocabulary 2to12years ESem no x
VocabularyTestRevised.Austin,TX:ProEd.
TestRevised
ExpressiveVocabulary Williams,K.T.(1997).ExpressiveVocabularyTest.Circle
2to90years E no no
Test Pines,MN:AmericanGuidanceService.
FullertonLanguage 11yearsto RandESem, Thorum,A.R.(1986).FullertonLanguageTestfor
no x
TestforAdolescents adult Morph,Syntax Adolescents(2nded.).SanAntonio,TX:ProEd.
LanguageProcessing 5to11years, Richard,G.J.,&Hanner,M.A.(1985).LanguageProcessing
ESem no x
TestRevised 11months TestRevised.EastMoline,IL:LinguiSystems.
OralandWritten
LanguageScales: CarrowWoolfolk,E.(1995)OralandWrittenLanguage
3to21years
Listening RandE no Scales:ListeningComprehensionandOralExpression.Circle x
fororal
Comprehensionand Pines,MN:AmericanGuidanceService.
OralExpression
Page331

OralandWritten CarrowWoolfolk,E.(1996).OralandWrittenLanguage
Writing
LanguageScales: 5to21years E Scales:WrittenExpression.CirclePines,MN:American x
Morph,Syn
WrittenExpression GuidanceService.
PatternedElicitation
Young,E.C.,&Perachio,J.J.(1993).ThePatterned
SyntaxTestWith ESem,
3to7years no ElicitationSyntaxTestwithMorphophonemicAnalysis. x
Morphophonemic Morph,Syn
Tucson,AZ:CommunicationSkillBuilders.
Analysis
PeabodyPicture 2to90+ Dunn,L.,&Dunn,L.(1997).PeabodyPictureVocabulary
RSem no no
VocabularyTestIII years TestIII.CirclePines,MN:AmericanGuidanceService.
PorchIndexof
Porch,B.E.(1979).PorchIndexofCommunicativeAbilityin
CommunicativeAbility 4to12years RandE no x
Children.Chicago:Riverside.
inChildren
Birthto6 Zimmerman,I.L.,Steiner,V.,&Pond,R.(1992).Preschool
PreschoolLanguage RandESem,
years,11 no LanguageScale3.SanAntonio,TX:Psychological no
Scale3 Morph,Syntax
months Corporation.
ReceptiveOneWord 12yearsto15 Brownell,R.(1987).ReceptiveOneWordPictureVocabulary
PictureVocabulary years,11 RSem no TestUpperExtension.Novato,CA:AcademicTherapy x
TestUpperExtension months Publications.
ReceptiveOneWord 2years,11
Gardner,M.F.(1985).ReceptiveOneWordPicture
PictureVocabulary monthsto12 RSem no x
VocabularyTest.Novato,CA:AcademicTherapyPublications.
Test years
ReynellDevelopmental 1yearto6 Reynell,J.,&Gruber,C.P.(1990).ReynellDevelopmental
LanguageScalesU.S. years,11 RandE no LanguageScale.US.Edition.Windsor,Ontario,Canada: x
Edition months NFERNelson.
StructuredPhoto
4to9years,5 Werner,E.,&Kresheck,J.D.(1983).StructuredPhotographic
graphicExpressive EMorph,Syn no MMY9a
months ExpressiveLanguageTestII.Sandwich,IL:Janelle.
LanguageTestII
TestforExamining 3yearsto7 Shipley,K.G.,Stone,T.A.,&Sue,M.B.(1983).Testfor
Expressive years,11 ESyn no ExaminingExpressiveMorphology.Tucson,AZ: MMY10b
Morphology months CommunicationSkillBuilders.

(Continued)
Page332

AppendixA(Continued)

Oral
Language Written
Modalities Language ReviewedinMMY?
Test Ages andDomains Included? CompleteReference (x=ComputerForm)

Hammill,D.D.,Brown,V.L.,Larsen,S.C.,&Wiederholt,J.
TestofAdolescentand RandESem, Writing:Sem,
12to21years L.(1994).TestofAdolescentandAdultLanguage3.Austin, x
AdultLanguage3 Morph,Syn Syn
TX:ProEd.
TestofAdolescent/ German,D.J.(1990).TestofAdolescent/AdultWordFinding.
12to80years EWF no x
AdultWordFinding SanAntonio,TX:PsychologicalCorporation.
TestofAuditory 3yearsto9
RSem, CarrowWoolfolk,E.(1999).TestofAuditoryComprehension
Comprehensionof years,11 no no
Morph,Syn ofLanguage3.Austin,TX:ProEd.
Language3 months
5yearsto8
TestofChildrens Reading, Barenbaum,E.,&Newcomer,P.(1996).TestofChildrens
years,11 E x
Language writing Language.SanAntonio,TX:ProEd.
months
3yearsto7
TestofEarlyLanguage RandESem, Hresko,W.P.,Reid,K.,&Hammill,D.D.(1991).Testof
years,11 no x
Development Syn EarlyLanguageDevelopment(2nded.).Austin,TX:Proed.
months
TestofLanguage Wiig,E.H.,&Secord,W.(1989).TestofLanguage
5to18years, RandESem,
Competence no CompetenceExpandedEdition.SanAntonio:Psychological x
11months Syn,Prag
Expanded Corporation.
TestofLanguage 8yearsto12 Hammill,D.D.,&Newcomer,P.L.(1997).TestofLanguage
RandESem,
Development years,11 no DevelopmentIntermediate:3.CirclePines,MN:American x
Syn
Intermediate:3 months GuidanceService.
TestofLanguage 4yearsto8 RandE
Newcomer,P.,&Hammill,D.(1997).TestofLanguage
Development years,11 Phon,Sem, no x
DevelopmentPrimary:3.Austin,TX:ProEd.
Primary:3 months Syn
PhelpsTerasaki,D.,&PhelpsGunn,T.(1992).Testof
TestofPragmatic 5to13years,
RandE no PragmaticLanguage.SanAntonio,TX:Psychological x
Language 11months
Corporation
TestofPragmaticSkills RandESem, Shulman,B.B.(1986).TestofPragmaticSkills(Revised).
3to8years no no
(Revised) Prag Tucson,AZ:CommunicationSkillBuilders.
Page333

3yearsto7
TestofRelational Edmonston,N.,&Thane,N.L.(1988).TestofRelational
years,11 RSem no x
Concepts Concepts.Austin,TX:ProEd.
months
6to12
German,D.J.(1989).TestofWordFinding.SanAntonio,TX:
TestofWordFinding years,11 EWF no x
PsychologicalCorporation.
months
6to12
TestofWordFinding German,D.J.(1991).TestofWordFindinginDiscourse.
years,11 EWF no x
inDiscourse Chicago:RiversidePublishing.
months
TestofWord Wiig,E.H.,&Secord,W.(1992).TestofWordKnowledge.
5to17 RandESem no x
Knowledge SanAntonio,TX:PsychologicalCorporation.
6yearsto14
TestofWritten McGhee,R.,Bryant,B.R.,Larsen,S.C.,&Rivera,D.M.
years,11 Writing x
Expression (1995).TestofWrittenExpression.SanAntonio:ProEd.
months
TestofWritten 17years,11 Hammill,D.D.,&Larsen,S.C.(1988).TestofWritten
E Writing x
Language2 months Language2.SanAntonio,TX:PsychologicalCorporation.
12yearsto17 Bowers,L.,Huisingh,R.,Orman,J.,Barrett,M.,&LoGiudice,
TheWordTest
years,11 ESem no C.(1989).TheWordTestAdolescent.EastMoline,IL: no
Adolescent
months LinguiSystems.
Bowers,L.,Huisingh,R.,Barrett,M.,&LoGiudice,C.,&
TheWordTest
7to11years ESem no Orman,J.(1990).TheWordTestRevisedElementary.East no
RevisedElementary
Moline,IL:LinguiSystems.
TokenTestfor DiSimoni,F.(1978).TokenTestforChildren.Chicago:
3to12years RSem,Syn no MMY9
Children Riverside.
3yearsto10
UtahTestofLanguage Mecham,M.J.(1989).UtahTestofLanguageDevelopment
years,11 RandESyn no x
Development3 3.Austin,TX:ProEd.
months
WoodcockLanguage
RandESem, Woodcock,R.W.(1991).WoodcockLanguageProficiency
ProficiencyBattery 2to95years reading,writing x
Syn Revised.Chicago:Riverside.
Revised

Note.Modalitiesanddomainsareabbreviatedasfollows:Receptive(R),Expressive(E),Semantics(Sem),Morphology(Morph),Syntax(Syn),Pragmatics(Prag),
Phonology(Phon),andWordFinding(WF).ThepresenceofareviewintheMentalMeasurementsYearbook(MMY)databaseorprintseriesisnotedinthefinal
column,withxindicatingacomputerizedversionandnumeralsrepresentingthespecificprintvolumecontainingthereview.
aMitchell,J.V.(Ed.).(1985).Theninthmentalmeasurementsyearbook.Lincoln,NE:BurosInstituteofMentalMeasurement.
bConoley,J.C.,&Kramer,J.J.(Eds.).(1989).Thetenthmentalmeasurementsyearbook.Lincoln,NE:BurosInstituteofMentalMeasurement.
Page334

APPENDIXB
Page335

NormReferencedandCriterionReferencedTestsDesignedPrimarilyfortheAssessmentofPhonologyinChildren

Criterion
referenced
(CR)and/or Reviewedin
Norm MMY?(x=
referenced computer
TestwithReferenceInformation (NR) Ages Stimuli,Processes,andOtherFeatures form)

AssessmentLinkBetweenPhonologyand
Articulation:ALPHA(Reviseded.)(Lowe,1995). NR/CR
Mifflinville,PA:SpeechandLanguageResources.
AssessmentofPhonologicalProcessesRevised
CR
(Hodson,1986).Danville,IL:InterstatePress.
ArizonaArticulationProficiencyScale,2nded.
(Fudala&Reynolds,1994).LosAngeles:Western NR/CR 16to1311
PsychologicalServices.
BanksonBernthalTestofPhonology(Bankson&
NR/CR
Bernthal,1990).Chicago:RiversidePress.
FisherLogemannTestofArticulatoryCompetence
CR
(Fisher&Logemann,1971).Boston:HoughtonMifflin.
Sentenceorsinglewordselicitedusingdelayedimitation
30to811 no
andpictures15processesexamined
Singlewordselicitedusingobjects30processes
Preschoolto
including10basicprocessesthatareusedincalculating x
age10
overallscorethatallowsclarificationofseverity
Singlewordsandstimuliforelicitedconnectedspeech
consonants,consonantclusters,vowels,anddiphthongs
x
areassessedomission,substitution,anddistortionerror
analysisalsoallowscalculationofseverity
Singlewords10mostfrequentlyoccurringprocessesin
30to911 x
standardizationsamples
Singlewordandsentenceformsincludingconsonants,
2to3years
consonantclusters,vowels,anddiphthongsareassessed ?
andup
place/manner/voicinganalysisonly

(Continued)
Page336

AppendixB(Continued)

Criterion
referenced
(CR)and/or Reviewedin
Norm MMY?(x=
referenced computer
TestwithReferenceInformation (NR) Ages Stimuli,Processes,andOtherFeatures form)

44singlewordsand2setsofpicturesforconnected
GoldmanFristoeTestofArticulation2(Goldman& speechelicitationerroranalysisdoesnotinclude
NR/CR 2to21years x
Fristoe,2000).Austin,TX:ProEd. features,buttheKhanLewisisdesignedforusewiththe
earlierversionofthistest
Limitednormativedataassessproductionsat4levels:
KaufmanSpeechPraxisTestforChildren(Kaufmann, 2yearsto6 oralmovement,simplephonemic/syllabic,complex
NR/CR no
1995).Detroit:WayneStateUniversityPress. years phonemic/syllabic,andspontaneouslengthand
complexity
StimulusmaterialsarethoseoftheGoldmanFristoe
KhanLewisPhonologicalAnalysis(Khan&Lewis, TestofArticulationRevised15phonological
NR/CR 2to6years x
1986).CirclePines,MN:AmericanGuidanceService. processesoneofthefewtestswithnormativedatafor
processes
NaturalProcessAnalysis(Shriberg&Kwiatkowski, Analysismethodforcontinuousspeechsample8natural
CR anyage no
1980).NewYork:JohnWiley&Sons. processes
PhonologicalProcessAnalysis(Weiner,1979). preschool
CR Singlewordsorsentences16phonologicalprocesses no
Baltimore:UniversityParkPress,1979. children
Page337

PhotoArticulationTest(Pendergast,Dickey,Selmar&
NR/CR
Soder,1984).Austin,TX:ProEd.
ScreeningTestforDevelopmentalApraxiaofSpeech
NR/CR
(Blakely,1980).Austin,TX:ProEd.
SCAT.SecordConsistencyofArticulationTests
(Secord,1997).Sedona,AZ:RedRockEducational CR
Publications.
SmitHandArticulationandPhonologyEvaluation
(SHAPESmit&Hand,1997).LosAngeles:Western NR/CR
PsychologicalServices.
TemplinDarleyTestsofArticulation(Templin&
Darley,1969).IowaCity,IA:BureauofEducational NR/CR
ResearchandService,UniversityofIowa.
Singlewordandstimulitoelicitedconnectedspeech
includingconsonants,consonantclusters,and
3to12years MMY9a
diphthongsomissions,substitutions,anddistortionsare
scored
Scoresgivenforexpressivelanguagediscrepancy,
vowelsanddiphthongs,oralmotormovement,verbal
4to12years sequencing,articulation,motoricallycomplexwords, x
transpositions,prosody,andtotalbasedonasmall
population
Twotestcomponents(1)ContextualProbesof
ArticulationCompetence(CPAC)probesfor
productionofindividualsoundsandprocessesinwords,
allages no
clustersandsentence,(2)SPACStorytellingProbes
ofArticulationCompetence(SPAC)probesfor
productioninanarrativetask
Singlewordselicitedthroughpicturesordelayed
3to9years no
imitation11processesexamined
Singlewordsseveralsubtests,includingscreening,Iowa
Pressureconsonantstest(thoseaffectedby
3to8years MMY7b
velopharyngealinsufficiency),vowels,anddiphthongs
omissions,substitutions,anddistortionsarescored

Note.ThepresenceofareviewinMentalMeasurementsYearbook(MMY),withxindicatingacomputerizedversionandnumeralsrepresentingthespecificprint
volumecontainingthereview.
aMitchell,J.V.(Ed.).(1985).Theninthmentalmeasurementsyearbook.Lincoln,NE:BurosInstituteofMentalMeasurement.
bBuros,O.K.(Ed.).(1992).Theseventhmentalmeasurementsyearbook.HighlandPark,NJ:GryphonPress.
Page338
Page339

AUTHORINDEX
Entriesinitalicsappearinreferencelists.

Abbeduto,L.,149,155,166

Abkarian,G.,160,164

Aboitiz,F.,119,141

Agerton,E.P.,273,287

Aitken,K.,169,186

Alcock,K.,118,145

Alfonso,V.C.,264,280,291,306,326

Allen,D.,114,130,143,171,172,173,178,186,233

Allen,J.,175,184

Allen,M.J.,22,47,55,56,57,58,59,66,68,76

Allen,S.,231,245

Allison,D.B.,264,280,291,306,307,308,315,317,325,326

Ambrose,W.R.,222,246

AmericanCollegeofMedicalGenetics,153,164

AmericanEducationalResearchAssociation(AERA),10,12,31,47,50,62,72,75,76,89,96,105,107,252,287

AmericanPsychiatricAssociation,111,114,115,130,134,140,148,149,150,161,164,169,170,171,172,173,178,180,181,182,183,184

AmericanPsychologicalAssociation(APA),10,12,31,47,50,62,72,75,76,89,96,105,107,217,228,244,252,287

AmericanSpeechLanguageHearingAssociation(ASHA),82,84,85,104,107,196,207,264,287

Anastasi,A.,36,47,55,60,61,62,76,96,107,296,324

Andrellos,P.J.,237,246

Andrews,J.F.,197,198,210

Angell,R.,181,184

Annahatak,B.,231,245

Apel,K.,241,242,245

Aram,D.M.,116,117,118,119,128,130,140,143,170,184,231,240,245,270,287

Archer,P.,213,246

Arensberg,K.,229,249

Arndt,S.,171,185

Arndt,W.B.,259,288,294,324

Aspedon,M.,238,248

Augustine,L.E.,82,108,229,230,245

Bachelet,J.F.,270,291

Bachman,L.F.,103,107

Baddeley,A.,125,141

Badian,N.,27,47

Baer,D.M.,308,326

Bailey,D.,237,245
Page340

Bain,B.A.,230,248,251,252,255,256,276,277,278,279,286,287,291,294,295,296,297,298,299,300,302,303,304,305,307,308,309,310,311,
314,315,316,324,326

Baker,K.A.,239,247

Baker,L.,133,140

Baker,N.E.,7,13

BakervandenGoorbergh,L.,269,287

Ball,E.W.,137,140

Balla,D.,163,166,215,249

Baltaxe,C.A.M.,176,184

Bangert,J.,259,288,294,302,324

Bankson,N.W.,29,40,47,298,324,329,335

Barenbaum,E.,332

BaronCohen,S.,175,184

Barrett,M.,329,333

Barrow,J.D.,252,287

Barsalou,L.W.,7,12

Barthelemy,C.,181,185

Bashir,A.,135,140,241,245

Bates,E.,237,245,246,268,287

Batshaw,M.L.,149,164

Battaglia,F.,153,154,155,160,166

Baumeister,A.A.,147,149,152,154,156,158,164

Baumgartner,J.M.,120,142

Beasley,T.M.,308,325

Beck,A.R.,266,283,287

Becker,J.,170,185

Bedi,G.,125,126,144

Bedor,L.,125,142

Beitchman,J.H,130,140

Bejar,I.I.,66,77

Bell,J.J.,158,165

Bellenir,K.,151,152,159,164

Bellugi,U.,158,166,188,198,207,208

Benavidez,D.A.,178,181,185

Berg,B.L.,279,280,287

Bergstrom,L.,197,207

Beringer,M.,232

Berk,R.A.,6,13,56,76,158,163,165,256,287

Berkley,R.K.,251,289

Berlin,L.J.,258

Bernthal,J.E.,29,40,47,215,246,298,324,335

Berns,S.B.,304,325

Bess,F.H.,189,192,203,207

Bettelheim,B.,173,184

Biederman,J.,161,165

Bihrle,A.,158,166

Biklen,S.K.,279,280,287

Bishop,D.V.M.,114,118,119,124,130,140,141,144,269,287

Bjork,R.A.,251,292,309,326

Blackmon,R.,283,292

Blake,J.,270,287

Blakeley,R.W.,337

Blank,M.,258

Bliss,L.S.,103,107,233

Bloodstein,O.,159,165

Boehm,A.E.,329

Bogdan,R.C.,279,280,287,292

Bondurant,J.,121,141

Botting,N.,238,245

Boucher,J.,181,185

Bow,S.,121,122,141

Bowers,L.,333

Bracken,B.A.,215,245,329

Brackett,D.,191,192,194,195,200,203,207,209

Bradley,L.,27,47

BradleyJohnson,S.,188,189,200,201,204,207

Braukmann,C.J.,304,325,326

Bredart,S.,270,291

Breecher,S.V.A.,238,248

Brennan,R.L.,102,108

Bretherton,I.,237,245

Bridgman,P.W.,19,47

Brinton,B.,133,141,241,245,262,287

Broks,P.,173,185

Bronfenbrenner,U.,79,107

Brown,A.L.,226,245,272,277,287

Brown,J.,226,245

Brown,R.,266,287

Brown,S.,230,246,255,278,289

Brown,V.L.,332

Brownell,R.,331

Brownlie,E.B.,133,140

Bruneau,N.,181,185

Bryant,B.R.,59,77,333

Bryant,P.,27,47

Brzustowicz,L.,117,141

Buckwalter,P.,114,118,145

Bunderson,C.V.,31,47

Buros,O.,337

Burroughs,E.I.,262,287

Butkovsky,L.,122,143

Butler,K.G.,132,145,255,287

Byma,G.,125,144

Bzoch,K.R.,59,76,103,107,237,245,258

Cacace,A.T.,192,207

Cairns,H.S.,259,290
Page341

Calhoon,J.M.,281,287

Camarata,M.,122,143

Camarata,S.,115,122,141,143,192,209

Camaioni,L.,237,245

Campbell,D.,55,76,306,324

Campbell,M.,184

Campbell,R.,120,141

Campbell,T.,223,230,245,262,264,265,268,274,275,287,288,294,295,296,304,305,307,309,311,324

Campione,J.,277,287

Cantekin,E.I.,191,208

Cantwell,D.,133,140

Carney,A.E.,189,194,196,203,207

Carpentieri,S.,171,185

Carr,E.G.,317,326

Carr,L.,124,142

CarrowWoolfolk,E.,232,329,330,331,332

Carver,R.,57,76,312,313,324

Casby,M.,128,141

Caspi,A.,313,324

Castelli,M.C.,237,245

Chabon,S.S.,295,310,317,324

Channell,R.W.,269,290

Chapman,A.,238,248

Chapman,J.P.,8,13

Chapman,L.J.,8,13

Chapman,R.,158,166,268,272,287,290

Cheng,L.L.,231,245

Chial,M.R.,30,47

Chipchase,B.B.,130,144

Chomsky,N.,123,141

Chung,M.C.,174,175,184

Cibis,G.,161,166

Cicchetti,D.,163,166,215,249

Cirrin,F.M.,241,245,255,273,288

Clahsen,H.,124,141

Clark,M.,118,121,122,135,141,143

Cleave,P.L.,116,124,128,141,144,231,246

Clegg,M.,133,140

Cochran,P.S.,269,270,288

Coe,D.,178,181,185

Cohen,I.L.,153,165,173,178,184

Cohen,M.,120,141,149,164,165

Cohen,N.J.,134,141

Cohrs,M.,215,246

Compton,A.J.,232

Compton,C.,104,108,232,245

Conant,S.,270,288

Conboy,B.,230,246,255,278,289

Connell,P.J.,317,324

Connor,M.,152,161,165

Conoley,J.C.,103,104,108,333

Conover,W.M.,30,47

ContiRamsden,G.,238,245

Cook,T.D.,306,324

Cooke,A.,158,165

Cooley,W.C.,151,152,165

Cooper,J.,126,144

Cordes,A.K.,66,68,76

Corker,M.,195,207

Coryell,J.,195,196,207

Coster,W.J.,237,246

Courchesne,E.,173,184,185

Crago,M.,118,124,135,141,142,231,245

Craig,H.K.,133,141,268

Crais,E.R.,79,81,108,236,245,281,288

Creaghead,N.A.,10,13,282,288

Creswell,J.W.,279,288

Crittenden,J.B.,196,207

Cromer,R.,149,165

Cronbach,L.J.,66,76

Crutchley,A.,238,245

Crystal,D.,268,269,288

Cueva,J.E.,184

Culatta,B.,23,48

Culbertson,J.L.,189,192,203,207,208

Cunningham,C.,121,122,141

Curtiss,S.,117,118,144

Cushman,B.B.,295,310,317,324

Dale,P.,237,246

Damasio,A.R.,181,184

Damico,J.S.,82,108,229,230,241,245,251,252,253,255,257,274,275,283,284,285,286,288

DAngiola,N.,176,184

Daniel,B.,271,291

Darley,F.,251,290,337

Davidson,R.,270,291

Davies,C.,238,249

Davine,M.,134,141

Davis,B.,128,145

Dawes,R.M.,8,13

Day,K.,271,291

deVilliers,J.,262,291

deVilliers,P.,262,291

DeBose,C.E.,229,231,249

DellaPietra,L.,235,245

Demers,S.T.,84,85,108

Denzin,N.K.,279,288

Derogatis,L.R.,235,245
Page342

Deyo,D.A.,196,209

Dickey,S.,337

Diedrich,W.M.,259,288,294,302,324

DiLavore,P.,174,175,184

Dirckx,J.H.,197,208

DiSimoni,F.,333

Dobrich,W.,135,144

Dodds,J.,213,215,246

Doehring,D.G.,231,245

Dollaghan,C.,223,230,245,251,262,264,265,268,274,275,287,288,296,297,298,299,300,302,303,304,305,307,308,309,315,316,324

DonahueKilburg,G.,82,83,108,203,208

Donaldson,M.D.C.,158,165

Dowdy,C.A.,134,141

Downey,J.,158,165

Downs,M.P.,188,189,190,191,193,194,197,207,209

Dub,R.V.,196,208

Dublinske,S.,241,245

Duchan,J.,253,259,262,263,279,289,290

Dunn,Leota,40,51,57,71,76,232,245,331

Dunn,Lloyd,40,51,57,71,76,232,245,331

Dunn,M.,171,172,186,240,245

Durkin,M.S.,147,148,165

Dykens,E.M.,149,152,153,158,159,161,164,165

Eaton,L.F.,161,165

Eaves,L.C.,171,184

Edelson,S.M.,181,185

Edmonston,A.,333

Edwards,E.B.,241,245

Edwards,J.,118,124,141,142

Edwards,S.,159,160,164,166

Eger,D.,295,306,310,317,318,320,324

Ehlers,S.,171,174,175,180,184,185

Ehrhardt,A.A.,158,165

Eichler,J.A.,191,208

Eisele,J.A.,119,140

Ekelman,B.,130,140

Elbert,M.,259,288,294,324

Elcholtz,G.,283,292

EllisWeismer,S.,124,125,141,237,249

Ellis,J.,23,48

Embretson,S.E.,279,288

Emerick,L.L.,215,248

Engen,E.,202,208

Engen,T.,202,208

Erickson,J.G.,62,77

Evans,A.W.,104,109,238,239,249,296,312,326

Evans,J.,125,141,266,267,268,288

Evans,L.D.,188,189,200,201,204,207

Eyer,J.,125,142

Fandal,A.,215,246

Farmer,M.,133,141

Faust,D.,7,8,13

Fay,W.,176,184

Feeney,J.,215,246

Fein,D.,171,172,173,178,186

Feinstein,C.,171,172,173,178,186

Feldt,L.S.,102,108

Fenson,L.,237,246

Ferguson,B.,133,140

FergusonSmith,M.,152,161,165

Fergusson,D.M.,313,324

Feuerstein,R.,276,278,288

Fey,M.,116,128,141,221,231,246,269,290,309,325

Finnerty,J.,269,288

Fiorello,C.,84,85,108

Fisher,H.B.,335

Fiske,D.W.,55,76

Fixsen,D.L.,304,325,326

Flax,J.,240,247

Fleiss,J.L.,68,77

Fletcher,J.M.,21,48

Fletcher,P.,118,145,269,288

Flexer,C.,188,195,199,208

Fluharty,N.,239,246

Flynn,S.,260,290

Foley,C.,260,290

Folstein,S.,173,184

Foster,R.,258

Foster,S.L.,298,304,325

Fowler,A.E.,159,165

Fox,R.,157,165

Francis,D.J.,21,48

Frankenburg,W.K.,213,215,246

Franklin,R.D.,307,308,315,317,325

Fraser,G.R.,197,208

Frattali,C.,87,108,251,288,295,303,306,318,319,325

Fredericksen,N.,66,77

Freedman,D.,30,48

Freese,P.,130,133,135,143,145

Freiberg,C.,266,290
Page343

Fria,T.J.,191,208

Fristoe,M.,336

Frith,U.,173,178,181,184

Fudala,J.,335

Fujiki,M.,133,141,262,287

Fukkink,R.,314,325

Funk,S.G.,104,109,238,239,249,296,312,326

Gabreels,F.,147,166

Gaines,R.,161,166

Galaburda,A.,119,141

Gardiner,P.,157,167

Gardner,M.F.,40,48,60,77,100,108,233,330,331

Garman,M.L.,269,288

Garreau,B.,181,185

Gathercole,S.,125,141

Gauger,L.,119,121,141

Gavin,W.J.,266,271,289

Geers,A.E.,201,202,208,209

Geirut,J.,251,262,289,303,325

Gerken,L.,261,289

German,D.J.,54,77,332,333

Gertner,B.L.,133,141

Geschwind,N.,119,120,141,142

GeschwintRabin,J.,154,166

Ghiotto,M.,270,291

Gibbons,J.D.,30,47

Giddan,J.J.,258

Gilbert,L.E.,189,203,208

Giles,L.,271,289

Gilger,J.W.,117,118,140,142

Gillam,R.,126,128,140,142,145

Gillberg,C.,171,174,175,180,184,185

Girolametto,L.,237,246

Glaser,R.,58,77

Gleser,G.D.,66,76

Glesne,C.,279,303,325

Goldenberg,D.,215,247

Goldfield,B.A.,302

Goldman,R.,336

Goldman,S.,134,142

Goldsmith,L.,204,208,237,248

Goldstein,H.,251,262,289,303,325

Golin,S.,273,292

Golinkoff,R.M.,261,289

Good,R.,234,248

Goodluck,H.,261,289

Gopnik,M.,118,124,135,141,142

GordonBrannan,M.,241,242,245

Gorman,B.S.,307,308,315,317,325

Gottlieb,M.L.,165

Gottsleben,R.,269,292

Gould,S.J.,20,47,48

Graham,J.M.,151,152,165

Grandin,T.,178,184

Green,A.,161,166

Green,J.A.,239,249

Greene,S.A.,158,165

Grela,B.,125,142

Grievink,E.H.,205,209

Grimes,A.M.,241,245

Gronlund,N.,31,48,67,71,76,77

Grossman,H.J.,149,165

Gruber,C.P.,331

Gruen,R.,158,165

Gruner,J.,120,144

Guerin,P.,181,185

Guidubaldi,J.,201,209

Guitar,B.,10,13,238,249,264,292

GutierrezClellen,V.F.,230,237,246,255,278,289

Haas,R.H.,173,185

Haber,J.S.,239,246

Hadley,P.,121,133,141,142,237,246

Haley,S.M.,237,246

Hall,N.E.,116,128,135,140,142,170,184,231,245,270,287

Hall,P.,259,290

Hall,R.,283,292

Hallin,A.,184

Haltiwanger,J.T.,237,246

Hammer,A.L.,96,100,108

Hammill,D.D.,40,48,54,57,77,103,109,233,240,247,330,332,333

Hand,L.,337

Hanna,C.,233

Hanner,M.A.,330

Hansen,J.C.,224,244,246

Harper,T.M.,171,185,304,325

Harris,J.L.,229,231,246

Harris,J.,195,208

Harrison,M.,194,208

Harryman,E.,215,248

Hartley,J.,268,289

Hartung,J.,237,246

Haynes,W.O.,215,248

Hecaen,H.,120,144
Page344

Hedrick,D.,233,236,237,246

Heller,J.H.,104,109,238,239,249,296,312,326

Hemenway,W.G.,197,207

Hersen,M.,164,165

Hesketh,L.J.,125,141

Hesselink,J.,121,142

Hicks,P.L.,317,318,325

Hirshoren,A.,222,246

HirshPasek,K.,261,289

Hixson,P.K.,269,289

Ho,H.H.,171,184

Hodapp,R.M.,149,152,153,158,159,161,164,165

Hodson,B.,241,242,245,335

Hoffman,M.,276,278,288

Hoffman,P.,276,291

Holcomb,T.K.,195,196,207

Holmes,D.W.,199,208

Hopkins,J.,104,108,217,238,246

Horodezky,N.,134,141

Horwood,L.J.,313,324

Howard,S.,268,289

Howe,C.,153,154,155,160,166

Howlin,P.,133,144

Hresko,W.,54,77,103,109,233,332

Hsu,J.R.,68,77

Hsu,L.M.,68,77

Huang,R.,104,108,217,238,246

Huisingh,R.,329,333

Hummel,T.J.,235,246

Hurford,J.R.,132,140,142

Hutchinson,T.A.,96,107,108,222,246,248

Hux,K.,238,248

Iglesias,A.,278,291

Impara,J.C.,103,104,108

Ingham,J.,304,325

Inglis,A.,133,140

Ingram,D.,124,142

Inouye,D.K.,31,47

Isaacson,L.,134,141

Jackson,D.W.,121,142,194,200,204,209

JacksonMaldonado,D.,237,246

Jacobson,J.W.,148,165,304,325

Janesick,V.J.,280,289

Janosky,J.,230,245

Jauhiainen,T.,204,210

Jenkins,W.,125,126,143,144

Jensen,M.,276,288

Jernigan,T.,121,142

Johansson,M.,171,180,185

Johnson,G.A.,277,291

Johnson,G.,230,248

Johnston,A.V.,330

Johnston,E.G.,330

Johnston,J.R.,115,142

Johnston,P.,126,143

Jones,S.S.,31,48

Juarez,M.J.,222,248

Kahneman,D.,8,13

Kalesnik,J.O,215,216,235,236,238,248

Kallman,C.,125,144

Kamhi,A.,8,13,115,116,128,142,216,229,231,241,245,246

Kanner,L.,181,185

Kaplan,C.A.,130,144

Kapur,Y.P.,194,197,198,208

Karchmer,M.A.,204,208

Kaufman,A.S.,215,246

Kaufman,N.L.,215,246,336

Kayser,H.,229,231,246,247

Kazdin,A.E.,297,304,305,324,325

Kazuk,E.,215,246

Kearns,K.P.,68,76,77,274,275,286,290,307,308,309,314,315,317,325,326

Kelley,D.L.,279,289

Kelly,D.J.,217,247

Kemp,K.,266,267,270,289

Kent,J.F.,64,77

Kent,R.D.,8,13,64,77

Kerlinger,F.N.,19,48

Keyser,D.J.,104,108

Khan,L.M.,336

King,J.M.,161,166

Kingsley,J.,156,166

Klaus,D.J.,58,77

Klee,T.,189,192,203,207,266,267,270,289,290

Klein,S.K.,203,208

Kline,M.,232

Koegel,L.K.,304,325

Koegel,R.,304,325

Koller,H.,156,161,166
Page345

Kovarsky,D.,253,279,286,289

Kozak,V.J.,201,202,209

Kramer,J.J.,333

Krassowski,E.,127,142,231,247

Kratochwill,T.R.,307,315,317,325

Kreb,R.A.,319,323,324,325

Kretschmer,R.,121,141

Kresheck,J.,215,232,248,331

Kuder,G.F.,69,77

Kuehn,D.P.,120,142

Kulig,S.G.,239,247

Kunze,L.,239,249

Kwiatkowski,J.,336

Lahey,M.,10,13,48,118,124,128,141,142,223,231,247,269,289,303,325

Lancee,W.,133,140

Lancy,D.,279,289

Landa,R.M.,273,289

Larsen,S.C.,332,333

Larson,L.,199,210

Layton,T.L.,104,109,199,208,238,239,249,296,312,326

LeCouteur,A.,175,185

League,R.,59,76,103,107,237,246,258

Leap,W.L.,231,247

Leckman,J.F.,149,152,153,159,164,165

Lee,L.,218,247

Lehman,I.,296,326

Lehr,C.A.,215,247

Lehrke,R.G.,152,166

Lemme,M.L.,120,142

Leonard,C.,119,121,141

Leonard,L.,114,117,118,119,121,122,123,124,125,126,128,130,131,132,137,140,142,221,223,230,240,247,251,270,289,317,327

Leverman,D.,233

Levin,J.R.,307,315,317,325

Levitsky,W.,120,142

Levitz,M.,156,166

Levy,D.,125,143

Lewis,N.P.,336

Lidz,C.S.,255,276,278,289

LilloMartin,D.,188,198,207,208

Lincoln,A.J.,173,185

Lincoln,Y.S.,279,288

Linder,T.W.,281,289

Ling,D.,195,208

Linkola,H.,204,210

Lipsett,L.,134,141

Locke,J.,125,143

Loeb,D.,124,143

Logemann,J.A.,335

Logue,B.,271,291

LoGuidice,C.,333

Lombardino,L.,119,121,141

Loncke,F.,192,209

Long,S.H.,116,128,141,231,246,266,269,270,278,289,290,310,314,325

Longobardi,E.,237,245

LonsburyMartin,B.L.,206,208

Lord,C.,174,175,184,185

Love,S.R.,178,181,185

Lowe,R.,335

Lubetsky,M.J.,147,161,166

Lucas,C.R.,259,290

Luckasson,R.,148,166

Ludlow,L.H.,237,246

Lugo,D.E.,232,245

Lund,N.J.,253,259,262,263,290

Lust,B.,260,290

Lyman,H.B.,76

Machon,M.W.,104,109,238,239,249,296,312,326

Macmillan,D.L.,148,149,166

MacWhinney,B.,268,269,287,290

Maino,D.M.,161,166

Maloney,D.M.,304,325

Malvy,J.,181,185

Marchman,V.,237,246

MardellCzudnoswki,C.,215,247

Marks,S.,158,166

Marlaire,C.L.,63,77,236,244,247

Martin,G.K.,206,208

Mash,E.J.,298,304,325

Masterson,J.J.,269,270,288,290

Matese,M.J.,178,181,185

Matkin,N.D.,189,203,209

Matson,J.L.,178,181,185

Matthews,R.,133,145

Mauk,G.W.,194,208

Maurer,R.G.,181,184

Mawhood,L.,133,144

Maxon,A.,191,192,194,200,209

Maxwell,L.A.,154,166,199,200,208

Maxwell,M.M.,253,279,289
Page346

Maynard,D.W.,63,77,236,244,247

McCarthy,D.A.,215,249

McCauley,R.J.,7,12,13,35,38,48,102,104,108,217,220,225,231,234,238,247,249,251,252,253,256,264,290,292,296,299,312,313,326

McClave,J.T.,30,48

McDaniel,D.,259,290

McGhee,R.,333

McGlinchey,J.B.,304,325

McKee,C.,259,290

McFarland,D.J.,192,207

McReynolds,L.V.,68,76,77,274,275,286,290,307,308,309,314,315,317,326

Mecham,M.J.,333

Meehl,P.E.,8,13,223,247

Mehrens,W.,296,326

Mellits,D.,125,144

Membrino,I.,266,289

Menolascino,F.J.,161,165

Menyuk,P.,130,143

Merrell,A.M.,104,108,217,242,247

Mervis,C.B.,158,166

Merzenich,M.,125,126,143,144

Messick,S.,4,13,76,77,252,290

Mient,M.G.,295,310,317,324

Miller,J.F.,158,166,230,235,236,249,252,253,262,258,263,266,268,269,270,271,273,284,288,290,292

Miller,R.,276,288

Miller,S.,125,126,143,144

Miller,T.L.,217,248

Milone,M.N.,204,208

Minifie,F.,251,290

Minkin,B.L.,304,326

Minkin,N.,304,326

Mislevy,R.J.,66,77

Mitchell,J.V.,333,337

Moeller,M.P.,189,194,196,200,203,207,208

MoellmanLanda,R.,273,290

Moffitt,T.E.,313,324

Mogford,K.,195,208

MogfordBevan,K.,188,203,208

Moldonado,A.,233

Montgomery,A.A.,104,109

Montgomery,J.K.,241,242,248

Moog,J.S.,201,202,208,209

Moores,D.F.,196,209

Morales,A.,271,291

Moran,M.J.,273,287

Mordecai,D.R.,269,290

Morgan,S.B.,171,184

Morishima,A.,158,165

Morisset,C.,237,245

Morris,P.,79,107

Morris,R.,116,128,140,171,172,173,178,186,231,245,252,270,287,290

Morriss,D.,271,291

Mowrer,D.,294,317,326

Mulick,J.A.,148,165

Muller,D.,268,289

Muma,J.,79,108,217,247,253,271,290,291

Murphy,L.L.,104,108

Musket,C.H.,199,209

Myles,B.S.,170,185

Nagarajan,S.,125,126,144

Nair,R.,133,140

Nanda,H.,66,76

Nation,J.,130,140

NationalCouncilonMeasurementinEducation(NCME),10,12,31,47,50,62,72,75,76,89,96,105,107,252,287

Needleman,H.,230,245

Neils,J.,117,118,143

Nelson,K.E.,122,143,192,209

Nelson,N.W.,235,247,282,291

Newborg,J.,201,209

Newcomer,P.L.,40,48,57,77,103,108,240,247,332

Newcorn,J.H.,161,165

Newhoff,M.,121,143

Newman,P.W.,10,13

Newport,E.,198,209

Nicolosi,L.,215,248

Nielsen,D.W.,6,10,13

Nippold,M.A.,104,108,134,143,217,238,246,248

Nitko,A.J.,49,58,67,71,77

Nordin,V.,171,174,175,184,185

Norris,J.,276,291

Norris,M.K.,222,248

Norris,M.L.,239,246

Northern,J.L.,188,189,190,191,193,194,207,209

Nunnally,J.,225,248

Nuttall,E.V.,215,216,235,236,238,248

Nyden,A.,171,180,185

Nye,C.,241,242,248

OBrien,M.,114,145

OGrady,L.,188,207
Page347

Olsen,J.B.,31,47

Olswang,L.B.,128,129,143,223,230,248,249,251,252,255,256,273,276,277,278,279,280,286,287,289,290,291,292,294,295,296,297,298,
302,303,304,305,307,310,311,314,317,318,319,323,324,325,326

Onorati,S.,270,287

Orman,J.,333

Ort,S.I.,149,165

Owens,R.E.,221,248

Oyler,A.L.,189,203,209

Oyler,R.F.,189,203,209

Padilla,E.R.,232,245

Page,J.L.,23,48,181,185

Palin,M.W.,269,290

Palmer,P.,171,185,269,290

Pan,B.A.,174,185

Panagos,J.,268,291

Pang,V.O.,231,248

Papoudi,D.,169,186

Parsonson,B.S.,308,326

Passingham,R.,118,145

Patell,P.G.,133,140

Patton,J.R.,134,141

Paul,P.V.,194,196,200,204,207,209

Paul,R.,128,143,174,176,177,185,203,209,221,222,223,248,253,262,263,268,290,291

Payne,K.T.,228,229,249

Pedhazur,R.J.,10,13,17,18,22,23,24,28,48,55,56,76,264,280,291,297,298,303,306,326

Pembrey,M.,117,143

Pea,E.,230,248,255,276,278,289

Pendergast,K.,337

Penner,S.G.,255,273,288

Perachio,J.J.,331

Perkins,M.N.,222,248

Perozzi,J.A.,251,289

Perret,Y.M.,149,164

Peshkin,A.,279,303,325

Peters,S.A.F.,205,209

Pethick,S.,237,246

PhelpsGunn,T.,332

PhelpsTerasaki,D.,332

Phillips,E.L.,304,325,326

Piercy,M.,125,144

Pindzola,R.H.,215,248

Pisani,R.,30,48

Piven,J.,171,185

Plake,B.S.,104,108

Plante,E.,104,108,116,118,120,121,127,135,141,142,143,217,218,220,222,231,242,247,299,326

Plapinger,D.,199,209

Poizner,H.,198,208

Pollock,K.E.,229,231,246

Polloway,E.A.,134,141

Pond,R.E.,59,77,233,331

Porch,B.E.,274,331

Prather,E.M.,233,236,237,238,246,248

Prelock,P.A.,241,245,268,282,289,291

Primavera,L.H.,264,280,291,306,326

Prinz,P.,196,198,209

Prizant,B.M.,171,174,185,214,248

Proctor,E.K.,294,326

Prutting,C.A.,251,289

Purves,R.,30,48

Pye,C.,269,291

Quartaro,G.,270,287

Quigley,S.P.,207

Quinn,M.,230,235,236,249,252,284,292

Quinn,R.,278,291

Radziewicz,C.,81,109

Rajaratnam,N.,66,76

Ramberg,C.,171,180,185

Rand,Y.,276,278,288

Rapcsak,S.,120,143

Rapin,I.,114,130,143,171,172,173,174,178,179,180,181,185,186,191,203,208,209

Raver,S.A.,281,291

Records,N.L.,7,10,13,114,130,133,135,143,145

Rees,N.S.,192,209

Reeves,M.,266,290

Reichler,R.J.,175,185

Reid,D.,54,77,103,109,233,332

Reilly,J.,237,246

Remein,Q.R.,6,13,214,249

Renner,B.R.,175,185

Reschly,D.J.,148,149,166

Rescorla,L.,128,143,237,248

Resnick,T.J.,191,209

Reveron,W.W.,229,248

Reynell,J.,331

Reynolds,W.M.,335
Page348

Reznick,S.,237,246

Rice,M.L.,117,119,121,124,133,141,142,143,144,217,237,247,249

Richard,G.J.,330

Richardson,M.W.,69,77

Richardson,S.A.,156,161,166

Ries,P.W.,188,209

Riley,A.M.,330

Rimland,B.,173,181,185

Risucci,D.,130,145

Rivera,D.M.,333

Robarts,J.,169,186

Roberts,J.E.,237,245

Roberts,L.J.,304,325

RobinsonZaartu,C.,230,231,248,255,278,289

Roby,C.,136,144

Rodriguez,B.,128,129,143,241,245

Roeleveld,N.,147,166

Roeper,T.,262,291

Rolland,M.B.266,290

Romeo,D.,121,141

Romero,I.,215,216,235,236,238,248

Rondal,J.A.,159,160,161,164,166,270,291

Rosa,M.,229,249

Rose,S.A.,258

Rosen,A.,294,326

Rosen,G.,119,141

Rosenbek,J.C.,64,77

Rosenberg,L.R.,233

Rosenberg,S.,149,155,166

Rosenzweig,P.,233

Rosetti,L.,237,248,281

Ross,M.,189,191,192,194,200,209

Ross,R.,117,118,144

Roth,F.,267,291

Rothlisberg,B.A.,103,109

Rounds,J.,7,13

Rourke,B.,21,48

Roush,J.,194,203,208,209

Roussel,N.,232,248

Roux,S.,181,185

Rowland,R.C.,3,13

Ruscello,D.,40,48

Rutter,M.,133,144,169,173,174,175,184,185

Sabatino,A.D.,217,248

Sabers,D.L.,100,107,109,222,248

Sabo,H.,158,166

Salvia,J.,33,35,36,48,63,64,77,96,102,107,109,225,231,233,248,252,264,291,296,326

Sanders,D.A.,192,195,209

Sandgrund,A.,161,166

Sanger,D.,238,248

Sattler,J.M.,37,47,48,76,158,166,225,226,249

Sauvage,D.,181,185

Scarborough,H.,135,144,269,270,291

Schachter,D.C.,133,137,140,144

Scheetz,N.A.,191,207,209

Schiavetti,N.,262,265,292

Schilder,A.G.M.,205,209

Schlange,D.,161,166

Schloss,P.J.,204,208

Schmelkin,L.P.,10,13,17,18,22,23,24,28,48,55,56,76,264,280,291,297,298,303,306,326

Schmidt,R.A.,251,292,309,326

Schopler,E.,169,175,184,185

Schraeder,T.,230,235,236,249,252,284,292

Schreibman,L.,173,185,317,326

Schreiner,C.,125,126,143,144

Schupf,N.,152,167

Schwartz,I.S.,223,249,255,279,280,292,296,297,304,305,307,324,326

ScientificLearningCorporation,126,144

Secord,W.A.,10,13,59,77,230,233,238,245,249,251,252,253,255,257,259,264,274,283,284,285,286,288,292,305,326,329,332,333,337

Selmar,J.,337

Semel,E.,59,77,233,238,249,264,292,305,326,329

Sevin,J.A.,178,181,185

Shady,M.,261,289

Shanteau,J.,7,13

Shaywitz,B.,21,48

Shaywitz,S.E.,21,48

Shelton,R.L.,259,288,294,324

Shenkman,K.,118,135,143

Shepard,L.A.,235,249

Sherman,D.,251,290

Sherman,G.,119,141

Shewan,C.,283,292

Shields,J.,173,185

Shine,R.E.,259,292

Shipley,K.G.,331

Short,R.J.,148,166

Shriberg,L.,268,291,336

Shu,C.E.,158,165
Page349

Shulman,B.,241,242,245,332

Siegel,L.,121,122,141

Silliman,E.R.,279,282,292

Silva,P.A.,313,324

Silverman,W.,152,167

Simeonsson,R.J.,148,166

Simon,C.,262,263,292

Simpson,A.,173,185

Simpson,R.L.,170,185

Slater,S.,283,292

Sliwinski,M.,240,247

Smedley,T.,199,209

Smit,A.,222,249,337

Smith,A.R.,238,249,264,292

Smith,B.,174,175,184

Smith,E.,114,145

Smith,M.,82,108,229,230,245

Smith,S.,271,291

Smith,T.E.C.,134,141

Snyder,L.,237,245

Snow,C.E.,123,144,174,185

Snow,R.,63,77

Snowling,M.J.,130,144

Soder,A.L.,337

Sowell,E.,121,142

Sparks,S.N.,155,166

Sparrow,S.S.,149,163,165,166,215,249

Spekman,N.,266,290

Spencer,L.,192,196,209

Sponheim,E.,174,185

Sprich,S.,161,165

St.Louis,K.O.,40,48

Stafford,M.L.,238,248

Stagg,V.,157,166

Stark,J.,258

Stark,R.E.,115,125,137,144

Stein,Z.A.,147,148,165

Steiner,V.,59,77,233,331

Stelmachowicz,P.,199,210

Stephens,M.I.,104,109,239,249

Stephenson,J.B.,158,165

Stevens,G.,60,77

Stevens,S.S.,20,43,48,265,292

Stevenson,J.,133,144

Stewart,T.R.,7,13

Stillman,R.,63,77

Stock,J.R.,201,209

Stockman,I.J.,230,235,236,249,252,284,292

Stokes,S.,238,249

Stone,T.A.,331

Stothard,S.E.,130,144

Stout,G.G.,195,209

Strain,P.S.,184,185

Stratton,K.,153,154,155,160,166

StrayGunderson,K.,151,164,166

Striffler,N.,239,249

Strominger,A.,135,140

Stromswold,K.,266,292

Strong,M.,196,198,209

Sturner,R.A.,104,109,238,239,249,296,312,326

Sue,M.B.,331

Supalla,S.,198,209

Supalla,T.,198,209

Svinicki,J.,201,209

Sweetland,R.C.,104,108

Swisher,L.,35,48,104,108,115,120,141,143,217,220,225,231,234,247,252,256,290,296,299,312,313,326

Tackett,A.,271,291

TagerFlusberg,H.,126,144

Taitz,L.S.,161,166

Tallal,P.,115,117,118,121,125,126,137,142,143,144,145

Taylor,O.L.,228,229,249

Taylor,S.J.,279,292

Templin,M.C.,266,292,337

Terrell,F.,229,249,273,292

Terrell,S.L.,229,249,273,292

Teszner,D.,120,144

Thal,D.,237,246

Thane,N.L.,333

Thompson,C.K.,315,317,324,326

Thordardottir,E.T.,237,249

Thorner,R.M.,6,13,214,249

Thorton,R.,260,292

Thorum,A.R.,330

Thurlow,M.L.,215,247

Tibbits,D.F.,241,245

Timbers,B.J.,304,326

Timbers,G.D.,304,326

Timler,G.,128,145,146

Tobin,A.,233,236,237,246

Tomblin,J.B.,7,10,13,114,117,118,121,122,130,133,135,142,143,144,145,262,265,287

Tomlin,R.,265,288

Torgesen,J.K.,59,77

Toronto,A.S.,233

Toubanos,E.S.,103,109
Page350

Townsend,J.,173,185

Tracey,T.J.,7,12,13

Trauner,D.,121,145

Trevarthen,C.,169,186

Tsang,C.,232,233

Turner,R.G.,6,10,13,222,249,256,292

Tversky,A.,8,13

Tyack,D.,269,292

TyeMurray,N.,192,209

Tynan,T.,157,167

Tzavares,A.,120,144

Udwin,O.,160,166

vanBon,W.H.J.,205,209

VandenBercken,J.H.L.,205,209

vanderLely,H.,124,145

vanderSpuy,H.,121,122,141

VanHasselt,V.B.,164,165

vanHoek,K.,188,207

VanKeulen,J.E.,229,231,249

vanKleeck,A.,82,109,128,145

VanRiper,C.,62,77

VanVoy,K.,304,325

Vance,H.B.,217,248

Vance,R.,104,108,120,143,218,220,222,247,299,326

VarghaKadeem,F.,118,145

VaughnCooke,F.B.,223,229,230,249

Veale,T.K.,126,145

Veltkamp,L.J.,161,167

Vernon,M.,197,198,210

Vetter,D.K.,10,13,96,109,253,292

Volterra,V.,237,245

Vostanis,P.,174,175,184

Voutilainen,R.,204,210

Vygotsky,L.S.,276,292,310,327

Wallace,E.M.,238,248

Wallace,G.,330

Wallach,G.P.,132,145

Walters,H.,133,140

Wang,X.,125,126,144

Warren,K.,63,77

Washington,J.A.,229,230,249

Wasson,P.,157,167

Waterhouse,L.,169,171,172,173,178,186

Watkins,K.,118,145

Watkins,R.V.,114,121,130,145

Wechsler,D.,18,48

Weddington,G.T.,229,231,249

Weiner,F.F.,269,292,336

Weiner,P.,135,145

Weiss,A.,7,13,230,247,259,290

Welsh,J.,122,143

Wender,E.,134,145,181,186

Werner,E.O.,232,331

Wesson,M.,161,166

Westby,C.,241,245,279,292

Wetherby,A.M.,171,174,185,214,248

Wexler,K.,124,144

White,K.R.,194,208

Whitehead,M.L.,206,208

Whitworth,A.,238,249

Wiederholt,J.L.,332

Wiig,E.D.,31,48

Wiig,E.H.,59,77,230,233,238,245,249,251,252,253,255,257,258,264,274,283,284,285,286,288,292,305,326,329,332,333

Wiig,E.S.,31,48

Willis,S.,239,249

Wilcox,M.J.,317,327

Wild,J.,133,140

Wilkinson,L.C.,279,282,292

Williams,D.,176,186

Williams,F.,24,28,48

Williams,K.T.,97,103,109,330

Wilson,A.,158,165

Wilson,B.,130,133,140,145

Wilson,K.,283,292

Wiltshire,S.,103,109

Windle,J.,195,209

Wing,L.,171,172,173,178,180,186

Wise,P.S.,157,165

Wnek,L.,201,209

Wolery,M.,299,300,327

Wolf,M.M.,304,305,319,323,324,325,326

Wolfram,W.,231,249

WolfSchein,E.G.,169,173,175,186

Wolk,S.,204,208

Woodcock,R.W,333

WoodleyZanthos,P.,152,154,164

Woodworth,G.G.,192,198,209

WorldHealthOrganization,85,87,109,169,186,253,280,282,292
Page351

Worthington,D.W.,199,210

Wulfeck,B.,121,145

Wyckoff,J.,270,291

Yaghmai,F.,120,141

Yen,W.M.,22,47,55,56,57,58,59,68,76

YeungCourchesne,R.,173,185

Ying,E.,199,200,210

Yoder,D.E.,8,13,258

Yonce,L.J.,223,245

YoshinagoItano,C.,200,203,210

Young,E.C.,331

Young,M.A.,29,48,297,298,327

Ysseldyke,J.E.,33,35,36,48,64,77,96,102,107,109,215,225,231,234,247,248,252,264,291,296,326

Yule,W.,160,166

Zachman,L.,329

Zelinsky,D.G.,149,165

Zhang,X.,114,145

Zielhuis,G.A.,147,166

Zigler,E.,149,165

Zigman,A.,152,167

Zigman,W.B.,152,167

Zimmerman,I.L.,59,77,233,331
Page352
Page353

SUBJECTINDEX
Pagenumbersfollowedbyatindicatetablesandthosefollowedbyanfindicatefigures.

14morphemecount,240

Abilitytesting,30,44

Accountability,295,306309,315,317

Achievementtesting,30,44

Acquiredepilepticaphasia,seeLandauKleffnersyndrome

Actingouttasks,261

Activity,ICIDH2proposeddefinitionof,87

AfricanAmericanculture,

BlackEnglish,236

familyattitudes,83

Agedifferentiationstudiesofconstructvalidity,seeConstructvalidity,developmentalstudiesof

Ageequivalentscores,3536t,44

Agreementmeasures,6869f

Akinesia,181182

Alternateformsreliability,6768,71

AmazingUniversityofVermontTest,32

AmericanSignLanguage(ASL),196

AmericanSpeechLanguageHearingAssociation,317,319320

Anastasi,Anne,autobiographicalstatement,6061

Anxietydisorder,134,138

Arenaassessment,281,284

ArizonaArticulationProficiencyScale,2nded.,335t

Asianculture,83

Aspergersdisorder,169,171172t,180t,182

Aspergersyndrome,seeAspergersdisorder

AspergerSyndromeScreeningQuestionnaire(ASSQ),175

AssessingSemanticSkillsThroughEverydayThemes,329t

AssessmentLinkBetweenPhonologyandArticulation:ALPHA(Reviseded.),335t

Assessmentofchange,

importanceof,294,317321

outcomemeasurementand,294295,317,322

predictionoffuturechange,310311

recommendedreadings,324

specialconsiderations,296311

typesofmethodsused,

dynamicassessment,310311,314

informalcriterionreferencedmeasures,313314

normreferencedtests,312313

singlesubjectexperimentaldesigns,314317,316f

standardizedcriterionreferencedmeasures,258t,313

AssessmentofChildrensLanguageComprehension,258t

AssessmentofPhonologicalProcessesRevised,335t
Page354

AssigningStructuralStage,269t

Attentiondeficithyperactivitydisorder(ADHD),133134,138

definition,134

specificlanguageimpairmentand,133134

Atypicalautism,seePervasivedevelopmentaldisordernototherwisespecified(PDDNOS)

Auditoryintegrationtraining,181

Auditorytraining,190

AustinSpanishArticulationTest,232t

Authenticassessment,236,252,284

Authenticity,252,284

Autism,seeAutisticspectrumdisorder

Autisticdisorder,

definition,170t,182

highfunctioning,174,176,179t

lowfunctioning,180t

othertermsfor,169

symptomsof,169

Autisticspectrumdisorder,

behavioralchecklistsandinterviews,174175t

classificationofsubgroups,169,178

DSMIVdiagnosticcategories,169

dyspraxiaand,181

fragileXsyndromeand,153,173

mentalretardationand,169,171

motorabnormalities,179t180t,181

personalperspective,176177

playand,170,174,178

pragmaticdeficits,169170t,172,174,179t,180t

prevalence,169

recommendedreadings,184

sensorydifferences,181

sleepdisordersand,181

stereotypicalbehaviors,170t,178

suspectedcauses,173174

genetic,173

infectiousdisease,173

neurologic,173

suspectedneurologicabnormalities,173

theoryofmindand,181

writtenlanguageand,179

AutismDiagnosticInverviewRevised(ADIR),175t

BanksonBernthalTestofPhonology,335t

BanksonLanguageTest2,329t

Baselinemeasures,307,315317,316f

BatelleDevelopmentalInventory,201t

Behavioralobjectives,19,44

Beliefinthelawofsmallnumbers,8,11

Bellugisnegationtest,263

BerSilSpanishTest,232t

BilingualSyntaxMeasureChinese,232t

BilingualSyntaxMeasureTagalog,232t

Bioecologicalmodelofdevelopment,79

Blindmeasurementprocedures,definitionof,314

BoehmTestofBasicConceptsPreschool,329t

BoehmTestofBasicConceptsRevised,329t

BrackenBasicConceptScaleRevised,329t

Bradykinesia,181,182

Bronfenbrenner,influenceindevelopmentalresearch,79

CarolinaPictureVocabularyTest,199

CarrowElicitedLanguageInventory,329t

Caseexamples,1,2,3,3842,113114,168169,187188,213214,228t,250251,293294

Caseloadsandassessmentpractices,283

Causation,

confusionwithcorrelation,2930,43

singlesubjectdesignandstudyof,307

Centralauditoryprocessingdisorders,191

Chaptersummary,11,4647,7576,106107,137,161162,181182,205,242243,283284,323324

ChecklistforAutisminToddlers(CHAT),175t

ChildhoodAutismRatingScale(CARS),175t

Childhooddisintegrativedisorder,169,172t,182

Chinese,232t

Chromosomes,162

Classicalpsychometrictheory,6667

Classicaltruescoretheory,seeClassicalpsychometrictheory

Clinicaldecisionmaking,

definition,4,11

disconfirmatorystrategyin,8

ethicsand,50,72

fallaciesin,7,8

measurementand,252

modelof,7,9f

typesof,5t

ClinicalEvaluationofLanguageFundamentals3,264,329t

ClinicalEvaluationofLanguageFundamentals3SpanishEdition,233t

ClinicalEvaluationofLanguageFundamentalsPreschool,329t

ClinicalProbesofArticulation(CPAC),259

Clinicallysignificantchange,321322

Clinicalsignificance,29,44,297306,321

Cochlearimplants,192,205

Coefficientalpha,69
Page355

Coefficientofdetermination,29

Cognitivereferencing,seealsoDiscrepancytesting

definition,127,138,

problemswith,127128,231235

Collaborativeassessmentapproaches,280282

typesof,281

foryoungerchildren,236237

CommunicationAbilitiesDiagnosticTest,330t

CommunicationAnalyzer,269t

CommunicationScreen,239t

ComptonSpeechandLanguageScreeningEvaluationSpanish,232t

ComprehensiveAssessmentofSpokenLanguage,330t

ComprehensiveReceptiveandExpressiveVocabularyTest,330t

ComputerizedLanguageAnalysis(CLAN),268

ComputerizedLanguageErrorAnalysisReport(CLEAR),269t

ComputerizedProfilingVersion6.2and1.0,269t

Computersandlanguageassessmentandtreatment,31,44,126

Concurrentvalidity,59t,6162

Conductdisorder,134,138

Confidenceinterval,70,73,224226,225f

Confirmatorystrategyindecisionmaking,78,11

Congenitalaphasia,seeSpecificlanguageimpairment

Constructvalidity,

centralityof,53,72

contrastinggroupsevidence,5355,54t,74

convergentanddiscriminantvalidation,5556,74

definition,52,73

developmentalstudiesof,5354,54t,74

factoranalysisand,55

Content,FormandUseAnalysis,269

Contentrelatedvalidity,seeContentvalidity

Contentvalidity,seealsoItemanalysis,

Contentcoverage,56

Contentrelevance,56

Definition,73

Expertevaluationof,56

Testdesignand,56

Contexts,

affectingchildrenandfamilies,7983,80f,83t,87

affectingclinicians,7980f,84t,8488,240242,283,317321

Coordinatedassessmentstrategies,280282,284

Correlation,2628,27f

Correlationcoefficients,interpretationofmagnitude,28t

Correlationcoefficients,typesof,28

Criterionreferencedmeasures

constructionof,3334f,58,253255,254f

definitionof,31,44

examplesof,32t

interpretationof,31,43,60

scoresfor,38,101102

useinscreeningandidentification,217,230,236

Criterionrelatedvalidity,6162,74

concurrentvalidity,59t

criterionselection,61

predictivevalidity,59t,6162,310

Culturalvalidity,seeClinicalsignificance

Curricula,typesof,282

Curriculumbasedassessment,280,282,284

Cutoffscore

confidenceintervalsand,224226

definition,33,243

determininglocalcutoffs,222

empiricalselectionof,222

recommendedlevelsforidentificationoflanguageimpairment,221224

Cuttingscore,seeCutoffscore

Deafculture,195196

Deafness,seeHearingimpairment,deafness

Decisionmatrix,56f,11,219f

DelRioLanguageScreeningTest,233

DenverDevelopmentalScreeningTestRevised,215

Derivedscores,3537,44

Descriptionoflanguage,seeDescriptivemeasures

Descriptivemeasures,seealsoCriterionreferencedmeasuresInformalmeasures

characteristicsof,252253,283

criterionreferencedtestsas,257

normreferencedtestsas,255256

purposes,230

recommendedreadings,286

typesof

criterionreferenced,257,258t

dynamicassessment,276279,277t,310311

onlineobservations,274275

normreferenced,255256

probes,seealsoInformalmeasures,257,259261,260t261t,263t,285,308310,316f

qualitativemeasures,279280

ratingscales,262266

useinexaminingtreatmenteffectiveness,251

useintreatmentplanning,251

validityand,250255,280,283

Developmentaldysphasia,seeSpecificlanguageimpairment
Page356

DevelopmentalIndicatorsforAssessmentofLearningRevised,215

Developmentalscores,seeAgeequivalentscoresGradeequivalentscores

DevelopmentalSentenceScoring(DSS),267,269t

DeviationIQ,38

Diadochokinesis,64

Diagnosis,seeIdentification

DiagnosticandStatisticalManualofMentalDisordersIV,

diagnosticcategoriesrelatedtoautisticdisorder,170t

diagnosticcategoriesrelatedtospecificlanguageimpairment,114115t

Dichotomousscoring,69

Differencescores,116,296

Differentialdiagnosis,3,12

Directmagnitudeestimation,263,284

Disability,

ICIDHdefinitionof,86

Discrepancyanalysis,seeDiscrepancytesting

Discrepancytesting,seealsoCognitivereferencing

criticismsof,116,231235

mentalretardationand,158,162

specificlanguageimpairmentand,116

stateregulationsand,241242

useindescription,255257

Discriminantanalysis,222

Distributions,statistical,24,37f,4344

Downsyndrome,

definition,162

dementiaand,5,152

healthproblemsand,151152

patternofstrengthsandweaknesses,159t

personalperspective,156

prevalence,150152,151f,152f

Dynamicassessment,276279

definition,276,

samplehierarchyofcues,277t

useinidentification,278

useinplanningtreatment,276278

usewithchildrenfromdiversecultures,230,278

usewithchildrenwithmentalretardation,278

validation,278279

Dyskinesia,181182

Dyspraxia,181182

Echolalia,176,179,182

Ecologicalvalidity,seeClinicalsignificance

Eduationalrelevance,seeClinicalsignificance

Effectsize,123,138,297303,322323,seealsoClinicalsignificance

Elicitationstrategies,

imitation,260t

production,260t

syntax,260t261t

Eligibilityforspecialeducationservices,241242

Emotional/Behavioralproblems

hearingimpairmentand,204

mentalretardationand,161

specificlanguageimpairmentand,133134

Enablingbehaviors,6365,74,100

EnglishasaSecondLanguage(ESL),227

Epilepsyandlanguagedisorders,119,161,181,183

Error,seeMeasurementerror

EvaluatingAcquiredSkillsinCommunicationRevised,330t

Eventrecording,275,285

Expertsystems,7

Expressivelanguagedisorder,114115t

ExpressiveOneWordPictureVocabularyTestRevised,330t

ExpressiveOneWordPictureVocabularyTestSpanish,233t

ExpressiveVocabularyTest,97f99f,103,109,330t

ExtendedoptionalinfinitiveaccountofSLI,124

Facevalidity,61,74

Factoranalysis,74

Fallaciesindecisionmaking,78

Familyassessment,81

Familymembersaspartnersinassessment,78,81,236237,281

FastForWord,126,138

Fetalalcoholeffect(FAE),153,163

Fetalalcoholsyndrome,153155t,163

FisherLogemannTestofArticulatoryCompetence,335t

FluhartyPreschoolSpeechandLanguageScreeningTest,239t

FMradiosystems,206

Formativetesting,30,31

FragileXsyndrome

attentiondeficitandhyperactivitydisorder,153

autismand,153,173

definition,163

genderand,152

prevalenceand,152

sensoryproblems,153

FullertonLanguageTestforAdolescents,330t
Page357

FunctionalCommunicationMeasures(FCMs),319320,322

FunctionalStatusMeasures(EducationalSettings)ofthePediatricTreatmentOutcomesForm,264

Functionality,252,285

Gainscores,296,322,seealsoDifferencescores

Generalallpurposeverbs,129t,138

GeneralprocessingdeficitaccountsofSLI,124125,138

Generalizabilitytheory,66

Generalization,295,311,315

Genetics,

basicconcepts,150,162163

chromosomaldisorders,150

concordance,117,138

Downsyndromeand,150151f

familystudiesofspecificlanguageimpairment,117118

fragileXsyndromeand,152153,154f

geneticdisordersversusinheriteddisorders,151

hearingimpairmentand,197

incompletepenetrance,118,138

pedigreestudiesofspecificlanguageimpairment,117

premutation,152153,

specificlanguageimpairmentand,117119

transmissionmodes

autosomalversusXlinked,118,162

dominantversusrecessive,118

twinstudiesofspecificlanguageimpairment,117

GoldmanFristoeTestofArticulationRevised,336t

Goldstandard,218,243

Gradeequivalentscores,35,36t,44

Grammar,recommendedtutorialtext,132

GrammaticalAnalysisofElicitedLanguageComplexSentenceLevels(GAELC),201t

GrammaticalAnalysisofElicitedLanguagePresentenceLevel(GAELP),201t

GrammaticalAnalysisofElicitedLanguageSimpleSentenceLevel(GAELS),201t

Grammaticalcomplexity,seeLinguisticcomplexity

Grammaticalmorphemes,

inflectionalmorphemes,133

specificlanguageimpairmentand,131,133

Handicap,

ICIDHdefinitionof,86

objectionstouseofthisterm,8687

Hardofhearing,definition,191,206

HealthandPsychosocialInstruments(HaPI)database,105

Hearingaids,195

Hearingimpairment,

academicdifficulties,189,203

ageatidentification,194

assessmentofAmericansignlanguage(ASL),198199

bilingualmodeloflanguagedevelopmentforDeafchildren,196

causes

genetic,197

infectiousdisease,197

ototoxicagents,197,206

prematurity,197198,206

rhincompatibility,197,206

configurationof,192193f,206

deafness

culturalconsiderations,195,196,seealsoDeafculture

definition,188,205

differencesfromotherlevelsofhearingimpairment

effectsonorallanguageacquisition,203204

emotional/behavioraldisordersand,204

implicationsfororallanguageassessment,

norms,200

procedures,199201t

interventions

formildandmoderatehearingimpairment,190t,195t

forprofoundhearingimpairment,190t

lateralityof,192

magnitudeof,189190t

personalperspective,189

prelingual,194

prevalence,188

recommendedreadings,207

signlanguage,188,195196

specialconsiderationsinassessmentplanning,198200,203

syndromesassociatedwith,197

totalcommunicationand,195196

typesof,

centralauditoryprocessingdisorders,191192

conductive,191,205

mixed,191,206

sensorineural,191,206

Hispanicculture,83t

Homogeneityofitemcontent,69
Page358

ICIDH:InternationalClassificationofImpairments,Disabilities,andHandicaps,8587,282

ICIDH2:InternationalClassificationofImpairments,Activities,andParticipationoftheWorldHealthOrganization,87

IDEA,seeLegislation,IndividualswithDisabilitiesEducationActof1990(IDEA)

Identificationoflanguageimpairment,

cognitivereferencingand,231235

definition,215

diagnosisversus,215

disorderversusdifferencequestion,227231

federallegislationand,seeLegislation

importanceof,216

localregulationsand,128

recommendedcutoffs,221224

recommendedlevelsofsensitivityandspecificity,220,222

recommendedreadings,244

specialchallengesin,217236

useofcriterionreferencedmeasuresin,238240

useofnormreferencedmeasuresin,217240

useofstandardizedmeasuresin,217

IllinoisTestofPsycholinguisticAbilities,267

IndexofProductiveSyntax(IPSyn),269t

Imitation,260t

Impairment,

ICIDHdefinitionof,86

ICIDH2proposeddefinitionof,87

Indicators

definition,17,19f,43,44

formative,18,19,44

reflective,18,45

valueofmultipleindicators,305306

IndividualEducationalPlans(IEPs),81,320

IndividualizedFamilyServicePlans(IFSPs),81

IndividualswithDisabilitiesEducationAct(IDEA),84,106,108

Informalmeasures,seealsoCriterionreferencedmeasuresDescriptivemeasures

developmentof,254f

relationshiptocriterionreferencedmeasures,251

relationshiptoexperimentalmeasures,251

reliability,6869t

Informativeness,265

Instrumentaloutcomes,295,311322

Intelligencetesting,20,seealsoCognitivereferencing

Interdisciplinaryteams,281

forchildrenwithautisticspectrumdisorder,3

forchildrenwithhearingimpairment,203

requirementfornondiscriminatoryassessment,85

Interexamineragreement,69t,74

Interexaminerreliability,70,74

Intermediateoutcomes,294,322

Internalconsistency,seeReliability,typesof

Intervallevelofmeasurement,21t22,4344

Intervalrecording,275,285

Intervalscaling,262,285

Itemanalysis,5759,74

Itemdifficulty,57

Itemdiscrimination,57

Itemformats,100

Itemtryout,57

Janglefallacy,56

Jinglefallacy,56

KaufmanAssessmentBatteryforChildren,215

KaufmanSpeechPraxisTestforChildren,336t

KEfamily,118

Keyconceptsandterms,1112,4446,7375,106,138139,162163,182183,205206,243,284286,322323

KhanLewisPhonologicalAnalysis,336t

KuderRichardsonformula20(KR20),69

Labeling

negativeeffectsof,216

purposesof,216

LandauKleffnersyndrome,119

LanguageAssessment,Remediation,andScreeningProcedure(LARSP),269t

Language

development,

asaguidetotreatmentplanning,130

regressioninchildhooddisintegrativedisorder,172t

regressioninRettsdisorder,172t

regressioninLandauKleffnersyndrome,119

variabilityin,128129

domains,90

modalities,90

LanguageDevelopmentSurvey,237t

Languagedifference,228,243
Page359

Languagediversity,

currentlevelsofdiversity,82,227

implicationsforscreeningandidentification,3,33,81,227231,243

norms,33,229230

recommendedreadings,231

Languageimpairmentversuslanguagedelay,130,132,216

LanguageknowledgedeficitaccountsofSLI,123124

LanguageProcessingTestRevised,330t

Languagesampleanalysis,266274

analysismethods,267271

computerizedprograms,266,269t270

elicitationprocedures,269t,273274

factorsaffectingresults,271,273274

historyofuse,266271,283

innovationsin,266

useinassessingchange,266

useinexamininginteractionsinlanguageperformance,268

useinidentification,240

useintreatmentplanning,266

usewithdiversepopulations,230

LanguageSampling,Analysis&Training(LSAT),267,269t

Languagetests,

criterionreferencedmeasures,32t

forchildrenunderage3,237t

forchildrenwithhearingimpairment,201t202t

forlanguagesotherthansignlanguagesorEnglish,232t233t

normreferencedmeasures,329t337t

processingdependentmeasures,230

signlanguages,198199

writtenlanguage,329t337t

Latentvariables,18

Latetalkers,128130,129t,138

Learningdisabilitiesandmeasurementissues,18

Learningreadiness,seeAssessmentofchange,predictionoffuturechange

Legislation

EducationforAllHandicappedChildrenActof1975(PL94142),84,108

EducationoftheHandicappedActAmendmentsof1986,81,108

IndividualswithDisabilitiesEducationActof1990(IDEA),84,85,106,108,281282

IndividualswithDisabilitiesEducationActAmendmentsof1997,84,85,108,318

NewbornandInfantHearingScreeningandInterventionActof1999,194

LimitedEnglishproficiency(LEP),227,243

Lingquest,269

Linguisticcomplexity,259,266

Linguisticuniversals,267

Lipreading,seeSpeechreading

Localnorms,33,44,222223

MacArthurCommunicativeDevelopmentInventories,237t

Magneticresonanceimaging(MRI),119120,139

Manualcommunication,seeSignlanguages

Mastery,33

Maximalperformancemeasures,64

McCarthyScalesofChildrensAbilities,215

Mean,24,45

Meanlengthofutterance(MLU),240,267,270271

calculationof,272t

Measurementofbehavior

definition,4,12,252

historyof,20,49

levelsof,2023

relationshiptoselectionofappropriatestatisticalmethods,23

Measurementerror,224226f

assessmentofchangeand,296

baseratesand,235

referralratesand,235

relationshiptoreliability,67,224

types,6

falsenegatives,219f

falsepositives,219f

Measurementscales,seeMeasurementofbehavior,levelsof

Median,25,45

Mentalmeasurementsyearbookseries,104105,106,240

Mentalretardation

adaptivefunctioningand,147,162

ageatidentification,147,161162

alcoholand,153154

attentiondeficitandhyperactivitydisorder,153,159t161,160t,

autismand,153,171

causes

nonorganic,155156

organic,149155

toxins,153154,156

cerebralpalsyand,147

communicationstrengthsandweaknesses,159t160t

definitionsof,147,148t,163
Page360

Mentalretardation(Continued)

dementiaand,152,162

emotional/behavioraldisorders,153,159t161,160t

familial,155

fetalalcoholsyndromeand,153155f

fluencydisorder,159t

fragileXsyndromeand,149,152153,154f

hearingimpairmentand,151,155,159t,160t

longtermoutcomes,171

maltreatmentand,161

personalperspective,156

prevalence,147,161

recommendedreadings,164

sensorydifferences,151,153,155,159t160t

severity,147,148

MillerYoderLanguageComprehensionTest,258t

Mixedexpressivereceptivelanguagedisorder,114115,115t

Mode,25,45

MosaicDownsyndrome,151,163

Multidisciplinaryassessment,281,285

Multiplemeasures,223,305306,seealsoMultipleoperationalism

Multipleoperationalism,306

Nationalnorms,32,45

NationalOutcomesMeasurementSystem(NOMS),294,319320,322323

NativeAmericanculturefamilyattitudes,83t

NaturalProcessAnalysis,336t

Nominallevelofmeasurement,2021t,43,45

Nondiscriminatoryassessment

definitionof,85,106

methodsforachieving,229231,278

Nonparametricstatistics,30,45

Nonreciprocallanguage,seeStereotypiclanguage

Normalcurve,seeNormaldistribution

Normaldistribution,30,37f

Normativegroup,32,45,101,234

Normreferencedmeasures

constructionof,3334f,5758

definitionof,31,45

examplesof,32t

interpretationof,31,43,60,218227,234

scores,3435,101

useindescription,255256

useinscreeningandidentification,217

Norms

definition,32,45

local,33,44

national,32,45

ObservationalRatingScales,305

Observedscore,66,74

Omegasquared,29

Operationaldefinitions,19,45

OralandWrittenLanguageScales:ListeningComprehensionandOralExpression,330t

OralandWrittenLanguageScales:WrittenExpression,331t

Ordinallevelofmeasurement,21t22,43,45

Otitismedia,129,151,191,199,203,205206

Otoacousticemissionsandearlyidentificationofhearingimpairment,194,206

Outliers,24

Outofleveltesting,158,163,256

Overshadowing,204

Paperandpenciltests,31,45

Parallelformsreliability,seeAlternateformsreliability

Parametricstatistics,30

Parentinvolvementinassessment,236,304

Parentquestionnaires,236238

ParrotEarlyLanguageSampleAnalysis(PELSA),269

Participation,ICIDH2proposeddefinitionof,87

PatternedElicitationSyntaxTestwithMorphophonemicAnalysis,331t

PeabodyPictureVocabularyTest,267

PeabodyPictureVocabularyTestIII,5152,57,71,331t

PearsonProductMomentcorrelationcoefficient,28,43

Percentileranks,36

Performancestandard,38

Performancetesting,31,45

Perisylvianareas,119120

Personfirstnomenclature,216,243

Pervasivedevelopmentaldisorder(PDD),169,172t,183

Pervasivedevelopmentaldisordernototherwisespecified(PDDNOS),169,172t,183

Phenotype,117,139

Phonologicalawareness,137,139

Phonologicalmemorydeficitaccountofspecificlanguageimpairment,125

PhonologicalProcessAnalysis,336t

Phonologytests,335t337t

PhotoArticulationTest,337t

PhysiciansDevelopmentalQuickScreen,239t

Pictureselectiontask,261
Page361

Placementtesting,30

Playbasedassessment,281,284

PorchIndexofCommunicativeAbilityinChildren,274,331t

PraderWillisyndrome,158

Predictivevalidity,seeCriterionrelatedvalidity,predictivevalidity

Preferentiallooking,261t

Preferentialseating,190t,195

Prelingualhearingloss,206

PreLinguisticAutismDiagnosticObservationSchedule(PLADOS),175

PreschoolLanguageAssessmentInstrument(PLAI),258t

PreschoolLanguageScale3(PLS3),331t

PreschoolLanguageScale3Spanishedition,233t

PreubadelDesarrolloInicialdelLenguaje,233t

Principlesandparametersframework(Chomsky),123124

Proband,117,139

Probes,seealsoCriterionreferencedmeasuresDescriptivemeasuresInformalmeasures

controlprobes,308,315

generalizationprobes,251,308309,315

phonology,259

pragmatics,259,260

sourcesforfinding,259,260t261t

syntax,260t261t

treatmentprobes,308309,315

Profileanalysis,seeDiscrepancytesting

ProfileinSemanticsGrammar(PRISMG),269t

ProfileinSemanticsLexicon(PRISML),269t

Pronominalreversals,176,183

ProportionalChangeIndex(PCI),299303,322

Psychiatricdiagnosesandlanguageimpairment,134

Publicrelationsvalidity,73,seealsoFacevalidity

PyeAnalysisofLanguage(PAL),269t

Qualitativechange,seeClinicalsignificance

Qualitativemeasures,279280

Qualitativeresearch,280,285

Range,26,45

Ratingscales,262266

haloeffects,264

leniencyeffects,264

metatheticcontinuum,265,285

protheticcontinuum,265,285

Ratiolevelofmeasurement,21t23,43,45

Rawscores,3435

Recasts,122,139

ReceptiveExpressiveEmergentLanguageTest2,103,237t,258t

ReceptiveOneWordPictureVocabularyTestUpperExtension,331t

ReceptiveOneWordPictureVocabularyTest,331t

Regionaldialect,82,227231

Reificationandintelligencetests,20

Reliability

coefficients,66

definition,6566,75

differencesinmethodsforcriterionversusnormreferencedmeasures,67,102

factorsaffecting,71,72

recommendationregardinglevels,102

relationshiptoagreement,6869f

relationshiptovalidity,51,65f66,73

typesof,73

alternateformsreliability,6768,71

internalconsistency,6870

testretestreliability,6768,75

Restrictionofrange,effectonreliability,71

Rettsdisorder,169,172t,183

ReynellDevelopmentalLanguageScalesU.S.Edition,331t

RhodeIslandTestofLanguageStructure,202

Richnessofdescription,253,285

Riskfactors

definitionof,116,139

forlanguageimpairment,116127

RosettiInfantToddlerLanguageScale,237t

ScalesofEarlyCommunicationSkills(SECS),202

Schoollanguage,82

Scores,typesof

ageequivalent,3536t,44

criterionreferenced,38

gradeequivalent,3536t,44

normreferenced,3438

percentileranks,36

standardscores,3637,46

Screening,seealsoIdentification

baseratesand,235236

characteristicsof,214,242,

comprehensiveteststhatincludecommunication,215

federalandlocallegislation,240242

indirectmethods,214

languagemeasuresfor,236239t
Page362

Screening,(Continued)

reasonsfor,214215

referralrates,235236,243

ScreeningTestforDevelopmentalApraxiaofSpeech,337t

SecordConsistencyofArticulationTests(SCAT),259,337t

Segregationstudies,seeGenetics,pedigreestudiesofspecificlanguageimpairment

SEM,seeStandarderrorofmeasurement(SEM)

Sensitivity

definitionof,218,243

languagetestsand,220221

SentenceRepetitionScreeningTest,239t

SequencedInventoryofCommunicationDevelopment(SICD),236237t

SequencedInventoryofCommunicationDevelopment(SICD)Spanishtranslation,233t

Severityratings,43,

Sexchromosomes,163

Signlanguages,

testsof,198199

varietiesof,196

SignedEnglish,196

SigningEssentialEnglish(SEE1),196

SigningExactEnglish(SEE2),196

Simultaneouscommunication,seeHearingimpairment,totalcommunicationand

Singlesubjectexperimentaldesigns,

clinicaluseof,307310,314

definition,322

interpretationof,307308,315317

recommendedreadings,317

statisticalversusvisualanalysis,308

withdrawal,315

SmitHandArticulationandPhonologyEvaluation,337t

Socialcomparisonasamethodofsocialvalidation,304,322

Socialdeprivation,effectsondevelopment,156

Socialdialect,82,227231

Socialvalidation,297,303,322

Socialvalidity,seeClinicalsignificance

SoundProductionTask(SPT),259

Spanish,231233t,237

SpanishStructuredPhotographicExpressiveLanguageTest,232t

Specificlanguageimpairment(SLI)

academicdifficultiesand,132,134135

alternativetermsfor,114116,119

argumentstructureand,131t

braindifferences,119121

affectingdominance,119

perisylvianareas,119121

planumtemporale,119120f

versusdamage,119

definitionof,114115,137,139

demographicvariablesand,121122

emotional/behavioraldisordersand,133

environmentalvariablesand,121123

figurativelanguageand,132t,134

genderdifferencesand,114

geneticfactors,117119

illusoryrecovery,135

languagepatterns,130133t,137

longtermoutcomes,135

morphologicaldeficitsand,131t

narrativeskillsand,132

natureof,223224

personalperspective,136

phonologyand,131t,135,137

pragmaticsand,132t

prevalence,114

recommendedreadings,140

subgroupidentification,115,130

suspectedcauses,116127

syntacticdeficitsand,131t

theoreticalaccounts(afterLeonard),123127

crosslinguisticdataand,123125,

linguisticknowledgedeficitaccounts,123124,138

generalizedprocessingdeficitaccounts,124125

specificprocessingdeficitaccounts,125126,139

writtenlanguageand,135,137

Specificity,

definition,218,243

languagetestsand,218221,222

Speechreading,188,190t

Splithalfreliability,6869

Stability,67

Standarddeviation,25,46

Standarderrorofmeasurement(SEM),67,70,75,101,224

Standardscores,3637,46

StandardsforEducationalandPsychologicalTesting,50,62,89,96,105,107

Statisticalmeasures

ofcentraltendency,2425,43

ofvariability,2426,43

Statisticalsignificance,2829,46,297

StephensOralLanguageScreeningTest,239t

Stereotypiclanguage,177

Stereotypy,182183
Page363

Stimulabilitytesting,relationshiptodynamicassessment,276

Strabismus,161,163

StructuredPhotographicExpressiveLanguageTestII,331t

Subjectiveevaluationasamethodofsocialvalidation,304305,323

Summativetesting,31

SurfacehypothesisaccountofSLI,125

Syndrome,definitionof,149

SystematicAnalysisofLanguageTranscripts(SALT),268,269t,271t

Tagalog,233

TalkingTask(TT),259

TeacherAssessmentofStudentCommunicativeCompetence(TASCC),264

TeacherAssessmentofGrammaticalStructures(TAGS),202

Teacherquestionnaires,237238

TemplinDarleyTestsofArticulation,336t

Temporalprocessingaccountofspecificlanguageimpairment,125126

Terminationoftreatment,4,310311

Test,

definition,49,75

effectoflengthonreliability,71

Testadministration,

adaptations,63,157158,200,203,229t

importanceof,10,63

motivation,63

suggestionsfor,64t

TestdeVocabularioenImagenesPeabody,232t

TestforExaminingExpressiveMorphology,331t

Testmanuals,howtouse,88103

TestofAdolescentandAdultLanguage,332t

TestofAdolescent/AdultWordFinding,332t

TestofAuditoryComprehensionofLanguage3,332t

TestofChildrensLanguage,332t

TestofEarlyLanguageDevelopment,332t

TestofEarlyReadingAbilityDeaforHardofHearing,103,109

TestofLanguageCompetenceExpanded,332t

TestofLanguageDevelopmentIntermediate:3,57,332t

TestofLanguageDevelopmentPrimary:3,240,332t

TestofPragmaticLanguage,332t

TestofPragmaticSkills(Revised),332t

TestofRelationalConcepts,333t

TestofWordFinding,333t

TestofWordFindinginDiscourse,333t

TestofWordKnowledge,333t

TestofWrittenExpression,333t

TestofWrittenLanguage2,333t

Testreviewguide,

annotated,90f92f

basicform,93f95f

completedexample,97f99f

Testreviews

clientoriented,8889,106

computerizedsourcesof,1045

populationoriented,8889,106

stepsin,88103

sourcesofpublishedreviews,103105,104t

Testingoflimits,158

TexasPreschoolScreening,239t

Theoreticalconstruct,1819f,43,46,51,57,306

Theory,18,46

Theoryofmind,181,183

Timesampling,275,285

TokenTestforChildren,333t

Transdisciplinaryassessment,281,285

Treatment

effectiveness,319,323

effects,319,323

efficacyresearch,295,318,321

efficiency,319,323

outcomes,294295

outcomesresearch,318

Trialscoring,274,286

Triangulationofqualitativedata,280,286

Trisomy21,151,163

Truescore,66,75

Tscore,38

TurnerSyndrome,158

Typetokenratio,240

Ultimateoutcomes,294,311,323

UtahTestofLanguageDevelopment3,333t

Validity

centralitytodiscussionsofmeasurementquality,50

definition,51,75

factorsaffecting,10,61,6266,235236

typesof,seeValidation,strategiesofevidencegathering
Page364

Validation

differencesforcriterionversusnormreferencedmeasures,5660

strategiesofevidencegathering,5262

contentvalidity,52,56t60

criterionrelatedvalidity,52,6162,310

constructvalidity,5256,53f

Variable,19,46

Variance,25,46

Varianceaccountedfor,29

Verbalauditoryagnosia,191

VinelandAdaptiveBehaviorScales,163,215

Visuospatiallanguages,seeSignlanguages

Watchandseepolicytowardlatetalkers,128

WechslerIntelligenceScaleforChildrenRevised,18

WiigCriterionReferencedInventoryofLanguage,258t

Williamssyndrome,158,160t,163

WoodcockLanguageProficiencyBatteryRevised,333t

WordTestAdolescent,333t

WordTestRevised,333t

WorldHealthOrganization,85

Writtenlanguage,241

Zoneofproximaldevelopment(ZPD),276,286

Zscores,37