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36 Cards in this Set

  • Front
  • Back
Communication disorder
Given age and environment, is the message communicated effectively?

Sending - errors with sound, mechanism, fluency, or understanding

Receiving - errors with sensory input, understanding
Two main goals of diagnostic process
Identify + describe -> decisions regarding treatment/intervention

Diagnosis - name and description of problem
Assessment - means of getting to diagnosis
Models of diagnosis
Medical - emphasizes classification of symptoms into a disorder. Focus on the internal. Disease -> prognosis -> treatment.

Behavioral - focus on task performance rather than behaviors indicative of disease.

Systems - looking at family/cultural context
Impairment v. disability v. handicap
Impairment - physical or psychological problem such as cleft palate, phonological disorder, etc. Refers to etiology.

Disability - how the impairment manifests itself. Refers to a description.

Handicap - how the disability affects everyday life.
Need to consider what during the clinical process?
1. Biological/physical differences
2. Environmental differences
3. Linguistic/cultural differences
4. Individual/personal issues
5. Emotional and psychological issues
6. Etiology and the impact on the individual
1. Biological/physical differences to consider during clinical process
a. age
b. gender
c. medical problems
d. type of disorder: static v. progressive
e. intellectual ability
f. motor skills
g. sensory skills
2. Environmental differences to consider during clinical process.
a. family dynamic: size, support, roles
b. education
c. SES
d. knowledge of medical and educational systems
3. Linguistic/cultural differences to consider during clinical process.
a. language(s) spoken
b. how languages were learned
c. how languages are used
d. religious beliefs
e. customs
4. Individual/personal issues to consider during clinical process.
a. interests/dislikes
b. preferences
c. motivations
d. values
5. Emotional/psychological issues to consider during clinical process.
a. history of psychological disorders
b. personality
c. attitudes
d. self-awareness
6. Etiological issues to consider during clinical process.
a. surgeries
b. medications
c. chronicity
d. severity
Sources of information during assessment.
1. Referral source
2. Interviews
3. Written questionnaires
4. Standardized tests
5. Criterion-referenced tests
6. Clinical observations
7. Non-traditional procedures
8. Clinician-developed procedures
1. Referral source
Can be doctor, teacher, family member, etc.
2. Interviews
a. cater questions to each client
b. be self aware and aware of communicative exchange
-good listening skills: comprehension, evaluation, empathy
c. practical considerations
-to use an outline?
-how to record information?
-how to present ourselves/environment
-questions to ask
-how to provide information
d. types of questions
-open v. closed
-primary v. secondary
-leading v. neutral
3. Written questionnaires
Can be very quick and cheap way of getting information.
4. Standardized tests
a. Norm-referenced tests
-raw scores v. standard scores
-age/grade equivalent scores
-standard error of measurement
-percentile ranks
-confidence interval

Need to consider representativeness of normative sample and stimuli for each client.
5. Criterion-referenced tests
-performance compared to minimum standard for "normal"
-purpose is to distinguish levels of performance over clearly defined domain
-is a deep level test in specific area
-summarized using raw score
-can be designed by clinician
6. Clinical observations
a. quiet observations
-can assess effects of environment on performance
-helps in documenting aspects of behavior and comm. not tested formally
b. structured observations
-environment manipulated by clinician
-serves to test hypotheses about role of (non) linguistic behaviors

Things to consider:

Types of perspectives:
-micro close up: one behavior
-close up: what supports are there in the environment?
-regular lens: looking at environment and levels of complexity
-wide angle lens: looking at whole context of environment and impact on performance

-helps study performance in many contexts
-good for shy clients or when norm tests don't fit
-continual process throughout assessment

-observer's interpretation of events
-okay to what, but not why
7. Non-traditional procedures
a. client-referenced: performance at one point compared with another
b. dynamic assessment
-intervention is part of assessment
-assesses ability to learn
-oriented toward process, not product

-testing the limits
-graduated prompting

-the task
-the individual
-the environment

Levels of intervention:
-no direct intervention
-orienting client to task
-direct intervention
8. Clinician-developed procedures
a. probes
-deep testing of one area
-used to test hypothesis once there is enough info to suspect area of problem
-developed from clinicians' knowledge and crit-ref procedures
Know when to break confidentiality:
-client is causing harm to self/others
-suspected rape, incest, abuse
-criminal activity
-client needs hospitalization
-court requests records

Can only share info with colleagues with permission.
Testing v. screening
Identification: verify if suspected problem exists
Screening: gross decisions, need for further testing, referrals
-parent questionnaires
-norm-ref tests
-clinician's probes
-crit-ref tests: hearing screening, oral mech exam
Hearing screening
Doesn't look for threshold of hearing, just performance in comparison to 20 dB at octave frequencies from 500-4000 Hz.
Oral mechanism examination
Screens for abnormalities that may cause or influence suspected problems.

Look at:
-face: general symmetry at rest, movement of mouth, eyes, eyebrows
-lips: structure, any scar tissue
-lip function: strength and function in (non)speech tasks
-dentition: development, condition, alignment (underbite, overbite, crossbite, overjet front teeth)
-tongue: structure, strength, movement ([non]speech, DDK rates)
-velopharyngeal structure: soft palate, pharynx, function (non)speech
-cleft palate: color, fistulas, scarring, submucous cleft, torous, blue line on ridge, light coming through nose
Things to consider when evaluating a test
1. Will test aid in answering clinical questions?
2. Read manual info for
a. reliability
b. validity
c. norms
d. raw score conversion
3. Read about
a. adequacy for test's purpose
b. adequacy for client
4. Evaluate
a. representativeness of construct
b. adequacy for client
c. number
d. presentation
e. practicality
f. ease of administration and scoring
5. Study test's definition of construct
Issues in diversity
1. Linguistic competence: client's knowledge about language overall, whether or not in testing dialect
2. Communicative competence: client's knowledge about comm. act, even if not the same as testing act
3. Linguistic bias: test bias from client speaking different dialect/language than test
4. Cultural bias: test bias from client being unfamiliar with testing conditions and expectations

Ways to alter tests:
-obtain norms for each group
-translate test or accept dialect variations
-develop new test
-develop culturally/linguistically valid procedure
Response to intervention (RTI)
Systematic evaluation of cause and effect relationship between academic and/or behavioral intervention and student's response.

1. Tier 1
-uses regular teacher
-assessment involves rate of growth and overall achievement
-SLP provides info about oral language to teacher

2. Tier 3
-for non-responders to Tier 1
-regular teacher and/or support teacher
-assessment same as above
-SLP role same as above

3. Tier 3
-SLP as teacher
-non-responders to above two tiers
-assessment involves eligibility for special ed
Validity and reliability
1. Validity: does the test measure what it should?
a. construct: does the test measure what it should?
-developmental studies
-factor analysis
-convergent validation
-divergent validation
b. content: what is the consistency of the content with the construct?
-adequacy/completeness of items
-adequacy of procedure
-face validity (caution)
c. criterion: does this measure relate to tests that measure same construct?
-predictive validity
-concurrent validity

2. Reliability: will the same results be found with repeat testings?
a. test-retest: same score with repeat testings?
b. split-half: similar score with odd v. even questions?
c. interjudge
d. intrajudge
Statistical concepts
1. Measures of central tendency
a. mean
b. mode
c. median

2. Measures of dispersion
a. variance
b. standard deviation

3. Normal curve
a. most people fall around mean
b. mean usually 0, SD 1

4. Correlation
a. not cause and effect
b. positive (/), negative (\), or none
Sensitivity v. specificity
1. Sensitivity: measurement of how often a test correctly identifies a positive case.
2. Specificity: measurement of how often a test correctly identifies a negative case.
Test administration
1. Be prepared with procedures and materials
2. Know how to calculate chrono age
3. Reinforce behavior, not accuracy
4. Be self aware
5. If adjusting test, follow these guidelines:
a. reword instructions
b. modify length, modality, or complexity of directions
c. provide more time for response
d. continue beyond ceiling
e. record all responses
f. give more practice items
g. allow different response modalities
h. darken/enlarge materials
i. give more breaks
j. omit biased items
k. repeat materials as needed
l. consider client when scoring

Remember to not compare to norms if any of the above are used.
Report writing
1. Purpose: to summarize, share, and record diagnostic process, results, recommendations

2. Variables to consider
a. audience
b. main purpose
c. work site

3. SOAP format:
S: subjective (interview and case history)
O: objective (assessment results)
A: assessment
P: plan (recommendations)

4. General format
a. routine info
b. statement of problem
c. historical info
d. evaluation results
e. clinical impressions
f. summary
g. recommendations
Cycle of grief
May need to counsel client/family once diagnosis is made.

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
Defense mechanisms
1. Denial
2. Displacement
3. Reaction formation
4. Projection
5. Avoidance
6. Rationalization

Techniques to help with these:
1. Reassurance
2. Focusing
3. Binding
Team assessment
1. Multidisciplinary
a. all separate assessments, meetings, staff development, and plans
b. informal communication

2. Interdisciplinary
a. separate assessments
b. family meets with team (rep)
c. shared plans between team
d. independent staff development
e. team meetings with family

3. Transdisciplinary
a. assessment, plan, meetings, and development all done as team
b. family communicates with all members at regular meetings
1. Principle I: hold paramount the welfare of the clients.

2. Principle II: honor responsibility to achieve/maintain highest professional competence.

3. Principle III: honor responsibility to public by providing accurate information

4. Principle IV: honor responsibility to profession and colleagues with harmonious professional relationships