Posted in Assessment

Dynamic Assessment: What is it & how do I use it?

I mentioned dynamic assessment a bit in one of my previous posts about culturally & linguistically appropriate assessment, but I felt there was much more to be discussed in terms of what dynamic assessment actually is and how it is used. Dynamic assessment (DA) is an interesting mode of assessment because unlike standardized assessment tests which involve the interpretation of quantitative scores, DA focuses on analyzing a child’s thinking and learning process during tasks. Based on how much support the child needs during the assessment and how they proceed through the tasks, the clinician using DA can make inferences about what strategies or intervention methods would be best for the child.

Some methods for the dynamic assessment of language include: 

1) Testing the limits:

  • This involves determining the highest level at which a child can respond, using a series of probes and elaborated feedback or verbalization.
  • Unlike simple feedback (simply indicating whether an answer is correct), elaborated feedback includes feedback about why a child’s response was correct or not and an explanation of the principles involved in the task (i.e., “The reason that Tommy was sad, not happy, was because in the story it said…”).
  • Verbalization involves asking children to describe the question or task and how they arrived at their answer (i.e., “How did you know that Tommy was sad in the story?”).
  • The administration of a test can also be modified to focus on generating questions which will help a child understand how they are thinking about a test question (i.e., “What would happen if…”, “How did you know that?”, etc.) and enable their awareness of the targeted skill(s).

2) Graduated prompting:

  • Graduated prompting involves using a hierarchy of predetermined prompts (from minimal prompting to maximal prompting) to determine the child’s readiness to learn specific targets.
  • Prompts should vary in the level of contextual support they provide.
  • Predictions can be drawn about the child’s response to intervention by looking at their responses to the test procedures and new tasks.
  • Below is an example of a hierarchy which may be used for the dynamic assessment of sentence structure (DASS), provided by Hasson et al. (cited below in the additional resources).
Table taken from Hasson et al. (2012), cited below.

3) Test-teach-retest:

  • This method begins with the “test” or evaluative component to determine the area(s) where a child needs more support.
  • The “teach” component involves the examiner teaching the child the principles of the task. This provides an opportunity for the child to learn from the examiner.
  • Finally, the “retest” component typically involves the re-administration of a task in the area of focus (i.e., if reading comprehension was targeted, a new reading passage will be presented to the child). This provides an opportunity for the child to reveal their competence to the examiner and provides insight into how the child responded to the “teach” step.

Dynamic assessment can be a great approach to assessment because it encourages a focus on the “process” behind tasks. Modifications and flexibility during assessment can help ensure that a child understands the tasks and expectations. It also informs clinicians on the stimulability and readiness of a child to begin intervention tasks. I think this form of assessment would be especially helpful when working with “difficult to test” populations (i.e., bilingual children, children who use AAC, children with behavioural challenges, etc.), since other assessment methods (i.e., standardized assessment tests) may not best assess the competences of these children.

For more information, check out these additional resources:

De Lamo White, C., & Jin, L. (2011). Evaluation of speech and language assessment approaches with bilingual children. International Journal of Language & Communication Disorders/Royal College of Speech & Language Therapists, 46(6), 613.

Gutierrez-Clellen, V. F., & Pena, E. (2001). Dynamic assessment of diverse children: A tutorial. Language, Speech, and Hearing Services in Schools, 32(4), 212-224.

Hasson, N., Dodd, B., & Botting, N. (2012). Dynamic assessment of sentence structure (DASS): Design and evaluation of a novel procedure for the assessment of syntax in children with language impairments: Dynamic assessment of sentence structure (DASS). International Journal of Language & Communication Disorders, 47(3), 285-299.

Spencer, T. D., Petersen, D. B., & Adams, J. L. (2015). Tier 2 language intervention for diverse preschoolers: An early-stage randomized control group study following an analysis of response to intervention. American Journal of Speech-Language Pathology/American Speech-Language-Hearing Association, 24(4), 619.

Posted in Assessment

Culturally & Linguistically Appropriate Assessment

Many schools in Ontario and Canada now have a culturally diverse population of students, which means that speech-language pathologists need to consider how to provide assessments which are culturally and linguistically fair. In the case of students referred for assessment who are English Language Learners (ELLs), SLPs will need to consider the child’s expressive and receptive knowledge in both their Native language and English to determine how to proceed with the assessment.

These are some questions I had when learning about how to conduct a culturally and linguistically appropriate assessment. I think the answers provide ways that SLPs can make assessment fair for all students:

What is a “silent period” and is it normal?
A “silent period” is a common second-language acquisition phenomenon. It occurs when children are first exposed to a second language, and focus on listening and comprehension. During this period children are often very quiet and speak little in order to focus on understanding the new language. According to the American Speech-Language-Hearing Association, the younger the child, the longer the silent period tends to last (older children may remain in the silent period for a few weeks to a few months, while preschoolers may be relatively silent for a year or more).

Can I still use norm-referenced standardized tests to assess ELLs?
Yes, but interpret the results with caution and supplement the test with other assessment tools. The child’s scores compared to the norms would also be invalid (since certain items on the test may be culturally or linguistically specific to North America/English), and thus the tests could not be used to gain conclusive quantitative data. However, they may give an SLP some preliminary information about the areas where a child may excel or need more practice. It is important to supplement standardized tests with other information, such as a language sample, observation of the child in the classroom, a review of the child’s classwork, information about the child’s expressive and receptive abilities in English and/or other languages from teachers and parents, etc.

White & Jin (cited below in the Additional Resources) discuss a variety of assessment procedures which can be used with bilingual children, including the following:
• Dynamic assessment, which commonly involves a test-teach-retest format, can be a good option for assessing bilingual children. This type of assessment integrates both assessment and therapy simultaneously, to provide information on the child’s level of performance and the impact of intervention on performance, to shed light on the strategies which would best support the child’s learning.
• Criterion-referenced (CR) measures, or measures of the child’s level of performance on a particular skill, can also be good alternative to norm-referenced standardized measures. CR measures tend to be informal (i.e., language sampling, probing, etc.) and allow the clinician to use materials which are familiar to the child, thus reducing cultural and linguistic bias.
• A sociocultural approach to assessment, although more time-consuming and intensive, takes a holistic view of the child’s developing speech and language skills in the context of their social and cultural environment.
• The RIOT procedure is one representation of the sociocultural approach, which includes the following components:
Review all documentation, client records, clinical history and educational records.
Interview parents, teachers, and relevant others to glean the child’s language history, family dynamics, interactions, cultural differences, etc.
Observe the child in multiple settings with a variety of different people.
Test all languages which the child speaks using (modified) formal and informal assessments (i.e., language sampling, dynamic assessment, etc.).

What should I say to bilingual parents or parents of ELLs in terms of Native language (L1) vs. English language use?
• Parents should know that learning two languages at home (i.e., English and a Native language like Hindi or Mandarin) does not cause confusion or a language problem in young children
• Children with language delay can also learn two languages (without the languages being kept separate, i.e., only L1 at home and only English at school), and will not become more delayed if they hear or learn two languages (However, speech and language difficulties will be heard in both languages)
• Even if a child has a language delay, parents should still continue to use both their L1 and/or English, to increase the child’s opportunities to talk, play, and get to know friends and family members who speak either language
• If the parents are not fluent or comfortable speaking in English, they should speak and read books with the child in L1 to ensure the child still has exposure to good language models

In terms of language use, what might I expect of children who are learning two languages?
Hoff & Core (cited below in the Additional Resources) provide some “need to know” facts about the language development of bilingual children:
• A measure of total vocabulary provides the best indicator of young bilingual children’s language learning capacity.
• Bilingual children can have different strengths in each language.
• Learning two languages takes longer than learning one. Thus, on average, bilingual children lag behind monolingual children in single language comparisons.
• The quantity and quality of bilingual children’s input in each language influence their rates of development in each language.

It is normal for children learning a second language to:
• Use one language more than the other
• Mix words from both languages in the same sentence (aka “code-switching”)
• Make mistakes in the new language until they learn all the rules
• Lose language skills and fluency in their L1 as they learn English (in order to prevent this, parents should be encouraged to reinforce and maintain L1 by using it at home, even if the child chooses to respond in English)

For more information, check out these additional resources:
De Lamo White, C., & Jin, L. (2011). Evaluation of speech and language assessment approaches with bilingual children. International Journal of Language & Communication Disorders / Royal College of Speech & Language Therapists, 46(6), 613.

Eriks-Brophy, A. (2014). Assessing the language of Aboriginal Canadian children: Towards a more culturally valid approach. Canadian Journal of Speech-Language Pathology and Audiology, 38(2), 152-173.

Hoff, E., & Core, C. (2015). What clinicians need to know about bilingual development. Seminars in Speech & Language, 17;36;(2), 089-099.

Language Background Questionnaires in Different Languages:

Intelligibility in Context Scale in Different Languages:

University of Alberta’s Child English as a Second Language Resource Centre:

Red Flags for Speech-Language Impairment in Bilingual Children:

Bilingualism in Ontario
A website with information and a blog about bilingualism in Ontario, created by a speech-language pathology faculty member at Laurentian University

Posted in Assessment, Perspectives from the Field

Perspectives from the Field: Speaking to a School Board SLP (Part II)

I recently spoke to an SLP in the Peel District School Board about her thoughts on assessment. Assessment and intervention varies across school boards, so I was interested to hear about what the approach is like in Peel.

On the “standard assessment”…
The SLP mentioned that the following tests and tools are typically used in an assessment battery:
• Peabody Picture Vocabulary Test (PPVT)
• Expressive Vocabulary Test (EVT)
• Clinical Evaluations of Language Fundamentals (CELF)
• A reading and/or writing assessment (i.e., Phonological Awareness Test)
• An informal spelling test
• A review of writing samples (i.e., past assignments the child has completed)

A full language assessment can take 8-10 hours, and thus the SLP stated that it is important to carefully consider when it is or is not appropriate to complete an extensive, formal assessment. She also stated that she likes that the CELF is comprehensive in the sense that it “covers a little bit of everything”.

On assessing English language learners (ELLs)…
The SLP explained that she works with a diverse population of students where bilingual and multilingual students are the norm at her schools, rather than the exception. Many of these children have enough exposure to English that they can be tested using standardized tests such as the CELF. However, in the case of children who are not as proficient in English, she explained that she will often administer the CELF, but will not report the child’s percentile scores. Instead, she interprets the CELF results as a “starting point” in her assessment. She observes the child in the classroom, reviews the child’s class work, and consults with teachers and parents about the child’s strengths and weaknesses to gather more information for her assessment. She stated that even without standardized test results, she is still able to set intervention goals to target for these children based on the abovementioned sources of information.

I think this highlights the importance of assessment beyond standardized tests, since there may not always be a test or set of norms which is best suited for each child, especially when working with children from a highly diverse background of cultures and languages. Standardized tests are important, but usually need to be supplemented with other information in order to fully understand the child’s capabilities.

Since this SLP works in a diverse school board, she has the advantage of being able to access translators when a child and/or the child’s parents do not know very much English. Thus, information can still be reliably gathered from the child and their parents. This resource may be more difficult to acquire in a school board where encountering multilingual children is less common.

On writing effective assessment reports…
I also wanted to get the SLP’s thoughts on the “Strategies and Recommendations” section of the assessment report, since we discussed the issues surrounding generic or redundant recommendations (i.e., Almost identical/vague recommendations across both the psychoeducational assessment report and the speech and language assessment report) in class. The SLP agreed that strategies included in assessment reports are often too generic to be meaningful for educators. She mentioned that she tries to address this issue by recommending apps, programs, or workbooks to teachers (i.e., Explode the Code phonics program) because teachers often prefer hands on materials. I think this is a great approach because both teachers and parents can then have tangible resources to help the child develop their speech and language skills.

Expect some future blog posts where I delve deeper into assessment tests, tools, and resources!

Posted in Cognition & Executive Function

What’s in a Label?

ASD, ADHD, SLI, DLD…the list goes on! All of these acronyms represent a label which may be associated with a child receiving speech and language services (i.e., Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder, Specific Language Impairment, Developmental Language Disorder, etc.). It can seem overwhelming to navigate an abundance of diagnostic labels, and this is especially true in the domain of language. Currently, there is no agreed upon label used to universally describe children with unexplained language problems.

In a review of terminology used for this population, Professor Dorothy Bishop at the University of Oxford found that 132 different terms were being used to describe children with unexplained language problems. Consistency and consensus across professionals regarding which label to use to describe children with unexplained language disorders could allow the focus to shift to how to best serve and support this population, rather than how to label it.

Some may argue that a label isn’t needed in order to set goals and establish an intervention plan for a child with a significant language problem. However, establishing diagnostic criteria for what constitutes a significant language problem allows clinicians to determine who needs help and researchers to determine which children to study in interventions. Professor Bishop’s review also provided a table with some interesting pros and cons for diagnostic labels:

Table taken from Bishop (2014), cited below.

It’s difficult for me to be vehemently for or against diagnostic labels, because there are valid points on both sides of the argument. In terms of labels being detrimental, I can certainly see how a label can be associated with stigma or negatively influence the construction of a child’s identity. However, when conducting a mental “risks vs. benefits” analysis, I think that if a label allows a child and his or her family to receive the supports they need it is worth the potential adjustment to the label. A label may actually serve as a source of relief for parents, since it may finally explain the difficulties encountered by their child! Our role as an SLP doesn’t stop at providing services for the child; in situations where children, parents, or other caregivers may find it difficult to accept a diagnostic label which is now part of the child’s identity, we must support families and provide them with the appropriate resources to move forward.

For more information, check out these additional resources:

Bishop, D. V. M. (2014). Ten questions about terminology for children with unexplained language problems. International Journal of Language & Communication Disorders, 49(4), 381-415.

Categories of Exceptionalities for Special Education in Ontario:

Posted in Cognition & Executive Function

The Neurocognitive Model of Language & Executive Function

The neurocognitive model of language and executive function (I know…it’s quite a mouthful!) allows us to create and store representations of the world around us. This provides us with language (a label system for our representations) and mental life (i.e., mental thoughts and actions, the ability to manipulate thoughts in novel and alternate ways, ability to set goals, etc.).

The featured image above (created by Dr . Lisa Archibald) illustrates the interaction between all of the elements involved in our representation system. Throughout our Development Language Disorders course we are learning how one of these elements (i.e., working memory) or a combination of these elements (i.e., experience-based knowledge network) can have huge implications on a child’s ability to learn and make progress. The Model also highlights the importance of differentiated instruction and a universal design for learning approach (i.e., providing multiple means of representation, action and expression, and engagement in activities) which allows all children to participate and achieve success.

Thus, it is important for SLPs to consider the neurocognitive model during both assessment and intervention for a variety of reasons:

  • The model allows us to consider a child’s cognitive competencies as a whole (i.e., experience-based knowledge network, language skills, time and space awareness, metacognitive skills, fluid intelligence, crystallized intelligence, etc.) and this may alter which tools we choose during assessment (i.e., informal vs. standardized assessment, dynamic assessment, etc.) and service delivery (i.e., structured drill vs. following the child’s lead).
  • Using materials which are salient and culturally appropriate to the client may allow better activation of the child’s experience-based knowledge network (i.e., pragmatic knowledge, semantic knowledge, and episodic memory) and thus increase participation.
  • To establish entrenchment of a particular grammatical form the child must be provided with frequent exposure to the target (i.e., via distributed practice).
  • A child’s affective qualities (i.e., personality traits, temperaments, self-regulation skills, etc.) can impact the “ease” of assessment (i.e., easy to test vs. more difficult to test) or influence the format which will be most effective during intervention (i.e., working in a small group, one-on-one intervention, etc.).
  • A child’s conative qualities (i.e., impulse, desire, volition, striving, coping, etc.) will also determine if they have the motivation to complete tasks and the self-regulation required to attend to tasks in various settings.
  • We must consider the child’s environment (i.e., exposure to experiential opportunities, social relationships, classroom practices, etc.) and whether it is conducive to the child’s individual needs and learning. If it is not, we must consider which elements of the environment can be altered (i.e., classroom environment vs. experiential opportunities at home).
Posted in Perspectives from the Field

Perspectives from the Field: Speaking to a School Board SLP (Part I)

I recently spoke to a Speech-Language Pathologist (SLP) in the Peel District School Board and gained some insight into service delivery and professional collaboration in the school board setting.

On the ins and outs of service delivery…
The SLP highlighted how multiple models of service delivery are used in the school board, but noted that the multidisciplinary or “pull out” model is not used very frequently in her board, since many SLPs find it inefficient for their large caseloads. She mentioned that an interdisciplinary team discusses referrals and how to approach intervention for students (the team usually includes a social worker, teacher, psychologist, and other relevant professionals depending on the child, such as an occupational therapist), and then a consultative approach is often used in the classroom to provide teachers with the modelling and coaching needed to implement suggestions. The SLP explained that she often uses scaffolding and modelling to help kindergarten teachers adjust the inquiry-based approach used in kindergarten classrooms, so that it can better cater to children with learning disabilities (i.e. “How” and “Why” questions may be more difficult for these children, so strategies like expanding and extending may need to be utilized). She has also used the transdisciplinary model in the form of co-teaching a literacy program called Links to Literacy with classroom teachers, to help children learn concepts like print awareness and decoding.

On collaborating with other professionals…
Outside of the interdisciplinary team which meets to discuss referrals and students currently receiving intervention, the SLP mentioned that she often collaborates with other professionals (such as teaching assistants) when assessing and crafting recommendations for children with special needs. She stated that professionals who work closely with these children know their needs and skills best (i.e., education or teaching assistant, occupational therapist currently working with child, etc.), so joint visits in a more natural setting provide useful information regarding what strategies would work best for a child. I also found it interesting to learn that school settlement workers can be closely involved with SLPs to help acquire informed consent from the parents of students who are new immigrants and/or ELLs. Additionally, if a child will be seen by CCAC as opposed to a school board SLP, she stated that these parents also often need help understanding that they will receive a home program in the interim, before a child will receive services from CCAC later on. We also discussed how in some cases, a child may be receiving services from both a school board SLP and a private practice SLP, so consent is required from the parents to allow open communication between these two SLPs. Open communication is essential in these circumstances, because my partner mentioned how the SLPs often work on separate goals (to ensure that the child is not confused by working on the same goal but with 2 SLPs, each potentially using a different technique).

As a student interested in working in the school board as an SLP someday, I found my conversation with this SLP very informative!

Posted in SLP Issues in Education

Models of Service Delivery

We recently discussed four models of service delivery in class (ranked from least integrative to most integrative): Multidisciplinary, Consultation, Interdisciplinary, and Transdisciplinary. Various factors seem to determine which model is best to use at the school board, classroom, or client-level, such as considerations related to caseload or the amount of resources available. After our discussion in class today, I thought I would summarize each model and discuss the advantages and disadvantages of each type. Some of the information provided regarding these models was obtained from an article by Salima Suleman and colleagues (cited below).

Multidisciplinary Model
• Characterized by a division between professionals (i.e., teacher and SLP), with little to no communication between professionals
• Professionals work directly with the same population
• The pullout model is an example of a multidisciplinary model
• Beneficial for children who may need one-on-one attention in order to focus during therapy sessions
• Easier to document interaction with child and monitor progress across each session
• Some communication disorders better addressed with pull out model (i.e., articulation disorders)
• Can better control environment (i.e., quiet setting, free of distractions, private, etc.)
• Lack of inter-disciplinary communication may not maximize child’s success (i.e., if strategies are only being utilized during therapy, even though majority of time is spent in classroom)
• Time-consuming and inefficient to employ the pull out model with a large caseload

Consultation Model
• This model involves a referral system, where experts are called in to comment on and make recommendations on a case
• One-way transfer of information
• One professional is the expert (i.e., SLP) providing information to the other (i.e., teacher)
• One professional may not work directly with the population
• This model can take the form of…
Modeling: The intervention agent (i.e., teacher) observes the expert (i.e., SLP) completing a task so that they can later implement it on their own
Coaching: The consultant offers support and tips to the intervention agent
Scaffolding: Both professionals engage in dialogue
Fading: The expert withdraws support as the intervention agent becomes more confident in his/her abilities
• Inter-disciplinary communication allows both professionals to discuss observations and progress related to the child, and means the child has the support of both professionals
• More efficient mode of service delivery than multidisciplinary model (can provide service to more children)
• Modelling allows for classroom integration of the SLP and allows the SLP to become familiar with the classroom setting in which the child must learn and communicate
• The child will be provided with more models than if a multidisciplinary approach was used (since the teacher spends more time with the child in the classroom and can now provide models)
• It may be easier to transition to an interdisciplinary model or transdisciplinary model in the future if a consultative approach is used first, since the SLP and teacher have had previous inter-professional contact
• The expert’s advice may not be adopted by the other professional (i.e., teacher may not use strategies suggested by SLP) or the advice may be carried out incorrectly
• The classroom environment may not be conducive to productivity if it is too chaotic for the child to focus and learn from the models presented
• It may be more difficult to monitor the child’s progress since the SLP is not seeing him/her regularly

Interdisciplinary Model
• This model involves professionals working together and engaging in two-way communication
• Each profession maintains their own unique role
• Professionals work directly with the same population
• In the classroom, this model can take the form of…
One-teach/One-drift: One professional takes on the primary teaching duties, while the other one helps individual students)
One-teach/One-observe: One professional takes on the primary teaching duties, while the other observes
Station Teaching: Each professional teaches at a separate center
Remedial Teaching: One professional re-teaches previously taught material
Supplemental Teaching: One professional teaches the same material but in a new way and with new materials
• Each professional’s expertise can shine since they each carry out their distinct role, but inter-professional contact still allows for information to be shared
• Since both professionals work with the same population, observations can easily be shared and discussed between both parties
• The SLP can become familiar with the classroom setting in which the child must learn and communicate
• Both professionals need to take time to determine how they will coordinate duties within the classroom
• It may be easier for teacher to take the lead role more often
• May be difficult to implement over large caseloads which span multiple grade levels (insufficient time to coordinate with several teachers in multiple classrooms)

Transdisciplinary Model
• This model involves a large amount of professional overlap and professionals sharing roles and responsibilities
• Professionals work directly with the same population
• Requires extensive communication because professionals are assuming the roles of professionals in other disciplines (i.e., SLP taking on role of teacher, and vice versa)
• Model can take the form of…
Parallel Teaching
• Each professional has the opportunity to learn about another discipline
• Since one professional may not be as clearly identified as the “SLP”, this model may draw attention away from the specific children who need SLP services
• Some professionals may only be comfortable in their own distinct role or find it difficult to adopt another role
• This model requires a great deal of collaboration and is time-consuming for both professionals
• Both professionals will need additional training
• Difficult to implement in areas with a scarcity of SLPs and large caseloads

Reflecting on these Models
After my school board placement, I gained experience implementing the multidisciplinary and consultation models. I enjoyed utilizing the multidisciplinary or “pull out” approach because it allowed me to focus my attention on one to three children at a time, in a controlled setting. In the pull out model I felt the children were able to focus solely on their speech and language without being distracted by other classroom activities. However, in schools with larger caseloads I quickly saw how this pull out approach was inefficient, since we have a narrow time frame available to see many children between lunch, recesses, and assemblies. I liked how the consultative model brought teachers into the mix, since many were receptive to implementing strategies for their students with communication disorders. However, after observing the demands which teachers were managing during busy school days, I could see how speech and language goals could be forgotten when trying to address the curriculum and other school activities. Thus, I think consistent follow-up is an important piece to the consultative model. Although I didn’t observe the inter-disciplinary model, I think it would certainly be feasible to implement certain sessions using this model (i.e., a social-emotional literacy unit). Similarly, if the caseload and resources would allow it, I think the transdisciplinary model would be a wonderful way to develop inter-professional collaboration skills.

For more information, check out these additional resources:

Suleman, S., McFarlane, L., Pollock, K., Schneider, P., Leroy, C., & Skoczylas, M. (2014). Collaboration: More than “working together” an exploratory study to determine effect of interprofessional education on awareness and application of models of specialized service delivery by student speech-language pathologists and teachers. Canadian Journal of Speech-Language Pathology & Audiology, 37(4), 298.

Swenson, N. C. & Williams, V. (2015). How to Collaborate: Five Steps for Success. Perspectives on School-Based Issues, 16(4), 122-130.

CASLPO Reference Guide for Speech-Language Pathologists Employed in the School Board Setting: