Clinical Discourse Analysis: A Descriptive Assessment Tool

by

Jack S. Damico, Ph.D.

The Doris B. Hawthorne Professor of Special Education and Communicative Disorders

The University of Southwestern Louisiana Lafayette, LA

November 15, 1997 Educational Assessment Systems, Incorporated Albuquerque, New Mexico

Address: Jack S. Damico, Ph.D. The Doris B. Hawthorne Center The University of Southwestern Louisiana P.O. Box 43170, USL Lafayette, LA 70504-3170 (318) 231-6551 [email protected] 2

CAVEAT: CONVERSATION IS ONLY ONE MANIFESTATION OF MEANING- MAKING THAT SPEECH-LANGUAGE PATHOLOGISTS SHOULD FOCUS ON IN ASSESSMENT AND INTERVENTION. THIS PRESENTATION WORKSHOP FOCUSES PRIMARILY ON CONVERSATION....BUT MORE IS AVAILABLE. NOTE SOME OTHER MEANING-MAKING DESCRIPTORS IN THE BIBLIOGRAPHY. ______

WHAT IS THE IMPORTANCE OF LANGUAGE AS COMMUNICATION/CONVERSATION? 1. One's "maps of the world" are sociogenetic in nature. 2. These maps guide one's understanding/ indoctrination into society. 3. Our use of language for conversational interaction is our primary way of learning obtaining group membership problem-solving establishing Face fulfilling our cultural roles. 4. Conversational skills are used to initiate and maintain relationships with others. 5. Due to the importance of language/conversational or discourse skills to accomplish the above-mentioned, poor skills put one at a great disadvantage and will potentially limit one's cultural assimilation, one's self-esteem, and all the roles one might play in society.

The result of poor conversational skills could be “A negative social spiral" (Rice, 1993).

ESTABLISHING EXPERTISE IN CONVERSATIONAL DISCOURSE

To address potential conversational difficulties, we must accomplish the following goals: -- Increase our knowledge of social action outside the realm of communicative disorders -- Develop effective and efficient tools/procedures to describe social action -- Develop effective intervention strategies/techniques to overcome identified problems There have been numerous recent calls in speech-language pathology advocating this agenda: Brinton, Craig & Skarakis-Doyle, 1990 Damico, 1993a Damico, Simmons-Mackie & Schweitzer, 1995 Holland, 1994 Kovarsky & Maxwell, 1997 Kovarsky & Damico, 1997 Rees & Gerber, 1992 Rice, 1993

EXPANDING OUR HORIZONS

There is a long history and a wealth of information on the study of language/conversation in the social sciences. Work in linguistics, anthropology and sociology have given rise to many studies and descriptions that are necessary for our focus on language-as-social action. Most significant is the work in conversation analysis and ethnomethodology: Atkinson & Heritage, 1984 Button & Lee,1987 Duranti & Goodwin, 1992 Garfinkel, 1967 Goffman, 1967 Goodwin, 1981 Goodwin & Heritage, 1990 Heritage, 1984. 3

McDermott & Tylbor,1987 Psathas, 1995 Sacks, 1992 Schegloff, 1988

Some Examples of Interactional Importance from the Literature 1. The Importance of Face 2. Contexualization Cues 3. Discourse Markers 4. Discourse Strategies Access/Invitations Accountings Alternative Interactions Ambiguity Argumentation Clarification Sequences Corrections Direction Giving Dominant Interpretive Framework Forgetfulness Formulaic Expressions/Routinizations Frames Gaze Idioms

Joint Productions Laughter

List Construction Participation Structures Power Relationships Repair Repetition Rhythm/Beat Side Sequences Structuring Participation Turn taking Word Search 5. Audience Design 6. Expectations 7. Compensatory Strategies

DEVELOPMENT OF TOOLS AND PROCEDURES

1. The assessment approach that works best is not a psychological approach but, rather, an anthropological/sociological approach. 2. The focus of assessment should not be on language structure. Rather, the focus should be on the functional aspects of language and communication. Using real language for real purposes in real situations. 3. Recognize Communicative Synergy as an operational concept. 4. Remember three points: AUTHENTICITY OF DATA COLLECTED RICHNESS OF DATA DESCRIPTION THICKNESS OF DATA INTERPRETATION 4

Authenticity is Accomplished by Focusing on

Three Sets of Three Variables 1. Procedures -- Different Technologies -- Different Tools -- Different People 2. Contexts -- Multiple Events -- Relevant Settings -- Multiple Occurrences 3. Skills -- Multiple Manifestations -- Targeted Activities -- Functional Results

This enables you to create a Triangulation of Effort

Four Primary Assessment Technologies A. Structured Probe Activities -- Structure a situation to elicit a specific behavior -- Most Artificial -- Can target specific skills/ abilities B. Behavioral Sampling Procedures -- Collect naturalistic data -- Record it in some manner -- Subsequent analysis after the fact -- Most time consuming -- Can engage in fine grained analysis C. Rating Scales-Protocols-Checklists -- Observe authentic behavior -- Employ valid indices -- Rate on basis of indices -- Easiest and least time consuming approach -- Only as good as the indices -- Most versatile -- Most subjective D. Direct and on-line observation -- Observe in real time and context -- Simultaneous observation and interpretation -- Embedded within the context -- Requires most personal expertise -- Most authentic 5

Rich Description is Accomplished by Focusing on

1. Actual Functional Skills and Abilities that make a difference in the meaning-

making task at hand. 2. Being able to observe these behaviors as they are actually employed. 3. Being able to use these behaviors as potential INDICES of success or failure 4. Being able to use these behaviors as INDICES to help guide your analysis.

Thick Interpretation is Accomplished by Focusing on

BI-LEVEL ANALYSIS PARADIGM 1. This is the description that I have advanced in much of my writing (Damico, 1991; 1993) It essentially describes the same process that the previously described anthropologists go through to infer Cultural Knowledge 2. It must be a framework built into the assessment process that allows the SLP to engage in thick data Interpretation. It is not enough to recognize the fact that poor performance may be due to a host of variables other than intrinsic impairment...... you must be able to systematically account for this possibility in a way that is "institutionalized". 3. Two levels of analysis: First Level: Descriptive Analysis -- Observe from the perspective of the mainstream culture. Function as an AGENT of the system -- Ask the question: "In the context of interest, is this individual a successful or unsuccessful meaning-maker?" Three Criteria: Effectiveness of meaning-making Fluency of meaning-making Appropriateness of meaning-making -- It's at this level of analysis that you focus on the directly observed behaviors ( what they do, say, and make/use) -- This level of analysis merely tells you if there is a potential meaning-making DIFFICULTY. It cannot tell you if there is a DISORDER or DISABILITY Second Level: Explanatory Analysis -- At this level of analysis you work from the perspective of the Meaning-maker. Function as an ADVOCATE of the person. -- Ask the question: "Are these problematic behaviors actually difficulties and, if so, Why does the individual exhibit the difficulties noted during the descriptive analysis?" Several Possibilities: They are not actually problems 6

If they are problems they are due to: Factors Extrinsic to the student Factors Intrinsic to the student A Mixture of extrinsic and intrinsic -- Since you are operating as an advocate, your assumption is that the problems are due to extrinsic factors. -- It's at this level of analysis that you focus on the underlying factors that are not directly or easily observed. -- This level of analysis actually requires inference.... that you make a decision regarding the origin of the COMMUNICATIVE DIFFICULTY (if it exists). Is it due to extrinsic factors (a difference) or intrinsic factors (a disorder). -- To assist in this decision-making, a series of guiding questions or focus items have been developed (Damico, 1991). We will look at them in relation to interpretation of Clinical Discourse Analysis.

CLINICAL DISCOURSE ANALYSIS

SOME GENERAL COMMENTS ABOUT CLINICAL DISCOURSE ANALYSIS

1. CDA is a conversational sampling procedure oriented toward functional aspects of social action at the descriptive level of analysis. 2. This descriptive procedure is designed to call attention to potential conversational difficulties. By itself, it cannot determine the presence or absence of a language disorder. (See interpretation section). 3. The problematic behaviors identified by CDA were field-generated and serve as indices of potential conversational difficulties. 4. Although this procedure is intended to apply many of the principles from ethnography of speaking and conversation analysis, it is only a superficial hybrid of these more elaborate and interpretive research methodologies. 5. Clinical Discourse Analysis attempts to embrace the COMPLEXITY of social action 6. Clinical Discourse Analysis REQUIRES detailed interpretation based upon the interactive setting and social dyad. 7. Clinical Discourse Analysis is not a tool that can be employed solely to obtain quantitative data (numbers) 8. Interpretation requires a knowledge and analysis of complex conversational strategies and variables. 9. Like a powerful engine in an automobile, Clinical Discourse should be used strategically. It is not necessary to use CDA with every client. 10. Data interpretation should be based on PATTERNS not numbers. 11. The Problematic Behaviors initially identified with Clinical Discourse Analysis may be due to difficulties with the Social Dyad (How the interaction is occurring or 7

where or why) The Assessor/Interpreter (How the data is analyzed) The Target Participant (due to various conversational objectives or due to impairment or due to differences) A combination of any of these variables

Development of Clinical Discourse Analysis

1. Developed while working in the Albuquerque Public Schools (1976-1978) 2. Recognized that the contemporary tests and sampling procedures were poor 3. Determined that more attention to function rather than superficial aspects of language was needed. 4. Initiated a data-grounded and interpretive Research Project 5. Created a set of criteria to identify individuals who appeared to exhibit language difficulties. Had to meet three criteria: Diagnosed as language disordered by professionals using state standards Recognized as having poor social skills by their teachers Poor (below grade level) academic performance 6. Identified a large number of participants (N>30?) Six years to 22 years of age 7. Collected Large data samples from each in authentic conversational dyads 8. Transcribed the samples and then cycled through them listening and identifying behaviors that were problematic (seemed to interfere with the conversation) these would serve as potential functional indices of difficulty 9. Isolated each of these behaviors: labeled them and wrote a definition for each. 10. Had 27 problematic behaviors at this time 11. Created and applied a set of criteria to “refine” these behaviors -- Had to have occurred in at least two participants -- Had to have psychological reality (others could agree and easily ID them) -- Had to meet at least one of the following: * the behavior is a skill that should develop in normal communicators by 4 years of age. * the behavior had been independently identified as a characteristic of conversational difficulty by researchers * the behavior was found to have some discriminative power as demonstrated by some experiments by Damico 12. Reduced or refined the behaviors down to 17 13. Searched for a theoretical Framework to employ and to anchor the descriptive behaviors to an acceptable theory (H.P. Grice’s Cooperative Principle) 14. Asked two groups (SLPs and Linguists) to conduct a “forced choice” and place the behaviors under one of Grice’s four Conversational Maxims. 15. Designed a procedure for “other behaviors” that might be identified 16. Field tested the procedure and developed interpretive screens for rich interpretation 17. Collected some data on occurrence of “temporal mapping problems” in typical communicators to determine “normal range of variation”. 8

18. First presented at ASHA as a miniseminar in 1980. 19. Published in 1985. CLINICAL DISCOURSE ANALYSIS (Jack S. Damico, l985) ______Name: ______Date: ______DOB: ______CA ______School: ______Examiner: ______Grade: ______

QUANTITY (Instances of Occurrence) INFORMATIONAL REDUNDANCY (RED) ______FAILURE TO PROVIDE INFORMATION (FSI) ______NONSPECIFIC VOCABULARY (NSV) ______NEED FOR REPETITION (NR) ______

QUALITY MESSAGE INACCURACY (MI) ______

RELATION POOR TOPIC MAINTENANCE (PTM) ______INAPPROPRIATE RESPONSE (IR) ______FAILURE TO ASK RELEVANT QUESTIONS (RQ) ______SITUATIONAL INAPPROPRIATENESS (SI) ______INAPPROPRIATE SPEECH STYLE (ISS) ______

MANNER LINGUISTIC NONFLUENCY (LNF) ______REVISION BEHAVIOR (R) ______DELAYS BEFORE RESPONDING (DR) ______FAILURE TO STRUCTURE DISCOURSE (DS) ______TURN-TAKING DIFFICULTY (TTD) ______GAZE INEFFICIENCY (GI) ______INAPPROPRIATE INTONATIONAL CONTOUR(IC) ______

TOTAL NUMBER OF UTTERANCES: ______TOTAL NUMBER OF DISCOURSE ERRORS: ______TOTAL NUMBER OF UTTERANCES WITH PROBLEMATIC BEHAVIORS: ______PERCENT OF UTTERANCES WITH PROBLEMATIC BEHAVIORS: ______PATTERNS OF DIFFICULTY: ______9

______KEY: .... = pause longer than 3 seconds ( ) = embedded utterance __/ __ ___ = intonational contour [ ] = thoughtful pause // = interruption ] = overlap between speakers -- = Revision or restart { } = contextualization cue

THE COOPERATIVE PRINCIPLE (H.P. Grice, 1975)

Categories of the Cooperative Principle

1. Quantity: The quantity of information to be provided. A. Make your contribution as informative as is required B. Don’t make the contribution more informative than is required C. Conciseness 2. Quality: Try to make your contribution one that is true. A. Do not say what you believe to be false and represent it as true B. Do not say for which you lack adequate evidence 3. Relation: Be relevant. A. Your contribution to conversation should be appropriate to the immediate needs at each stage of the transaction. 4. Manner: This is the act of relating not to what has been said but, rather, to HOW what is said is to be said. A. Avoid Obscurity of expression B. Avoid Ambiguity C. Be brief and orderly

CLINICAL DISCOURSE ANALYSIS: Definitions

QUANTITY CATEGORY 1. Informational Redundancy ( RED). This involves the continued and inappropriate fixation on a proposition. The speaker will

continue to stress a point or relate a fact even when the listener has acknowledged its reception and tried to proceed. Example Examiner: ...any way, I'm glad you enjoy the fair. Let's talk about something else. How do/ "Did you ever see the bicentennial fair? Examiner: No, didn't see it. Hey, do you like your teacher? "She's really OK. She lets me work on my bulletin board...she also lets me play with the cars." Examiner: The cars? Which cars are those? 10

"The model cars in the state fair exhibit. How much do you really like the state fair?"

2. Failure to Provide Significant Information to the Listener (FSI). The speaker does not provide the amount or type of information needed by the listener for comprehension. Example Examiner: So, how would I get to your house from here? "Turn right there where we play baseball and my house is down a little bit."

3. The Use of Nonspecific Vocabulary (NSV). The speaker uses deictic terms such as "this", "that", “then", "there", pronominals, proper nouns, and possessives when no antecedent or referent is available in the verbal or nonverbal context. Consequently, the listener has no way of knowing what is being referenced. Individuals displaying this difficulty also tend to overuse generic terms such as "thing" and stuff" when more specific information is required. Example Examiner: Well then, what is your favorite toy? "My favorite thing is...oh, stuff"

4. Need for Repetition (NR). Repetition is required prior to any indication of comprehension in spite of the fact that the material is not apparently difficult. Example Examiner: What did the little boy do then? "...... " Examiner: What did the boy do then? "...wh...What?" Examiner: When he saw this (points to picture) what did the boy do? "he ran" QUALITY CATEGORY 5. Message Inaccuracy (MI). An attempted communication involves the relating of inaccurate info.

RELATION CATEGORY 6. Poor Topic Maintenance (PTM). The speaker makes rapid and inappropriate changes in the topic without providing transitional cues to the listener. Example "...but I missed it (an early T.V. program) cuz I went to bed." Examiner: That early? You must have had a hard day. "Yeah" Examiner: What made it such a hard day? "the raking" 11

Examiner: That's hard work isn't it? "Our teacher said, uh...whoever wins in checkers—I won!-- goes to McDonald."

7. Inappropriate Response (IR). The individual makes a response that indicates a radically unpredictable interpretation of meaning. It is as though the individual were operating on an independent discourse

agenda. Example Examiner: How do you like school? "I don't know him yet."

8. Failure to Ask Relevant Questions (FQ). The individual does not seek clarification of information that is unclear. Consequently, there is little or no "verbal play" or clarification if the message received from the speaker

is unclear or too difficult for the individual to comprehend.

9. Situational Inappropriateness.(SI). The behavior tends to account for a generalized lack of relevance. The speaker's utterance is not only irrelevant to the discourse, but it may also occur in an inappropriate social or interactional situation. Example Examiner: Come in and sit down, Rich. It's nice to meet you. "Why does twenty years go by so fast?" Examiner: Pardon, what did you say? "Why does twenty years go by so fast? Examiner: .....Why do you ask that question? "I don't know...Do you always blink your eyes like that?"

10. Inappropriate Speech Style (ISS). The speaker does not change the structural, lexical, or prosodic form of his utterances according to the needs of the audience or the context. This may involve the occurrence of dialectal structural forms, code switching, style-shifting, language transfer, or interlanguage phenomena or idiosyncratic language codes . MANNER CATEGORY 11. Linguistic Nonfluency (LNF). The speaker's production is disrupted by repetitions, unusual pauses, and hesitation phenomena. Example "sh...uh..she..um..she comes at dinner."

12. Revision Behaviors.(R). The speaker seems to come to dead ends in a maze, as if starting off in a certain direction, then coming back to a starting point and beginning anew after each 12

attempt. There may be false starts and self-interruptions. Example "Well, you see...if you want-- sometimes when you ca— a lot of times when you can't go out, you can just play with your twin brothers."

13. Delays Before Responding (DR). Communicative exchanges initiated by others are followed by pauses of inordinate length at turn-switching points. This does include delays in responding to questions. Example Examiner: Well, what did you do at recess? "...... played tag."

14. Failure to Structure Discourse (DS). This problematic behavior is the most global of the 17. It occurs when the discourse of the speaker lacks forethought and organizational planning. Due to this characteristic, the discourse is confusing--even if all of the propositional content is present.

15. Turn-Taking Difficulty (TTD). The participant in a conversational interaction does not attend to the cues necessary for the appropriate exchange of conversational turns. This results in one of two possible outcomes. First, the individual does not allow others to add information. This is characterized by interruptions or consistent/inappropriate bids for a turn Example Examiner: Well I think that the be/ "I like the green one best." Examiner: Yes, that's a nice one. How about the red one?" Do you wa/ "Can we find more like this one?"

The second possibility involves an opposite reaction. Rather than always bidding for a turn, this individual does not read the switching cues appropriately and therefore, does not hold up his/her part of the interaction. Example Examiner: ...so this school year is almost over. "...it's not over though is it?" Examiner: Not over, no it's not. "What do you mean by that?" Examiner: Well, most of the year is gone...but not all of it. You know? "...... "

16. Gaze Inefficiency (GI). The individual's use of eye contact is inconsistent or uncharacteristic of gaze utilized in the mainstream cultural context used as the criterion during this assessment. Consequently, the attempts to "color" communication or help direct the interaction with gaze are inappropriate or ineffective. 13

17. Inappropriate Intonational Contour (IC). The speaker's ability to embellish or "color" or contextualize his meaning through linguistic/tonal suprasegmentals such as pitch levels, vocal intensity and other inflectional contours is ineffective or inappropriate.

GUIDELINES FOR USING CLINICAL DISCOURSE ANALYSIS ______

ELICITATION AND DATA COLLECTION

1. It is essential that the data collection involve conversational interaction. This procedure is designed to focus on the give-and-take of conversation and not picture description, narratives, question-and-answer formats or close-ended interviews. 2. It is important that the conversational partner (of the targeted individual) play by the actual "rules of conversation" and function as a true conversationalist. From a practical standpoint this might mean: -- both partners might provide a large amount of talk -- most topics will naturally arise and develop -- you don't violate "felicity conditions". For example, you don't feign ignorance of something that you know or you don't ask the targeted individual to perform redundant or meaningless tasks. -- Much of what is discussed comes from the "here and now" or from everyday or recent past experiences. -- Share as much information yourself as you expect the targeted individual to share. 3. When addressing the issue of "how much data to collect?", don't focus on the idea of obtaining a sufficient number of utterances. Rather, focus on AUTHENTICITY of the data. That is, how much confidence do you have that the data sampled really is an indication of the individual's typical performance and his/her best performance? There are some guidelines that can typically be used to increase the potential of authentic data: -- Collect data from a full range of speech events -- Collect data from recurrent instances of those events -- Collect data using several data collection approaches. Never rely on Clinical Discourse Analysis by itself to provide you with the data needed to describe the meaning-making proficiency of an individual. 4. Authenticity is not determined by a number of utterances or contexts, it is determined by your degree of judgment and confidence is the representativeness of the behavior. It is 14

best to collect conversational data from several instances of conversation. The fewer samples and contexts sampled, the greater the chance of non-authenticity. 5. Don't think of context as only involving physical setting. Contextual variables also include -- social setting -- overt behaviors used to frame and organize -- language phenomena spoken by both parties -- extra situational variables including background knowledge, experiences and motivations. 6. The context is very dynamic and frequently changes instanteously. 7. The conversational interaction should be tape-recorded so that it can be transcribed and analyzed at a later time.

SEGMENTATION OF THE SAMPLE

1. The segmentation is accomplished using two types of data from the sample: A. Phonological Unit - a segment of speech separated by the contours of intonation, stress, and a pause in the subject's voice. This is usually marked by a definite pause preceded by a diminishing of force and a drop in pitch of voice (or a rise for queries). B. Communication Unit - a segment of speech containing and defined by the presence of a proposition that provides conceptual information (as expressed by a predicate -- explicit or implied -- taking one or more argument). Typically, this unit can't be broken down or further divided without loss of essential meaning (but see note 2.2 below). 2. The phonological and communication units usually co-occur. When this is not the case, always segment according to the meaning component (communication unit). #Meaning# (terminal juncture, meaning unit, tj) = 1 unit #Meaning, Meaning# = 2 units of transcription #partial meaning# Meaning# = 1 unit of transcription #partial meaning, partial meaning, Meaning# = 1 unit 2.1- Communication Units need not be complete structurally "Where are you going?" "Home" (1 unit) 2.2- Compound sentences that contain only 1 conjoining device and that fall within a phonological unit are counted as one utterance (e.g., “and”, “then”, “and then”). "I'm going to the store and I will buy bread" 2.3- Conjoined sentences that have undergone subject or predicate deletion are counted as one utterance. "I was coming home but ran into a big snowstorm" 2.4- Adjoined utterances are counted as one utterance provided they are within one phonological unit. --Temporal link: before, after, when, while "After its put in cans, its shipped out" 15

--Casual link: because "She let me stay because I was broke" --Conditional link: if "If its cold we might have a frost" --Purposive link: so "The oil repels water so it can swim" --Disjunctive link: instead, although, but "Instead of getting some sleep, they went fishing" --Parenthicals and asides are counted separately "I have a pretty star (it blinks!) on my tree"

TRANSCRIPTION OF THE SAMPLE

1. Preserve the speaker-hearer dyad. This means collecting and transcribing behavior from both interactants. It is helpful to do so in a regular format. 2. Retain all non-linguistic contextual information. 3. Preserve the contextualization cues 4. Utilize the key on the form as a standard coding procedure. 5. Number the line in the transcription. 6. Place different transcription units on different lines. 7. Keep the transcription accurate across all interactants. 8. Do not omit any “verbal segments” that seem incomplete. These false starts and mazes are important indices of temporal mapping problems.

CODING OF THE BEHAVIORS IN THE SAMPLE

1. It is essential that all behaviors are coded. Do not engage in the process of interpretation at this stage. 2. Use the standard codes for the problematic behaviors (See form). 3. Use the Clinical Discourse Analysis definitions to identify and code the problematic behaviors. 4. Place the analysis on the actual transcript. The standard symbology (see form) should be used and the behavior should be coded by placing the symbol over the behavior. 5. Remember that description and identification of problematic difficulties is the primary object of the analysis. If a behavior can be validly described by the use of two symbols, then use them. It results in more subtle description. 6. If there is a problematic behavior that cannot be coded with one of the CDA behaviors, code and document it using the following strategy: A. Identify the behavior and describe it in writing. B. Provide a descriptive term that uniquely identifies it. C. Determine which Gricean category it best fits. D. Add the problematic behavior and code it with the others 16

7. After initial coding, it is frequently helpful to listen to the tape again while treading the transcript. Check your transcription and your coding -- particularly the temporal mapping problems. 8. Beware of the tendency for “prescriptionism” in coding. You must code what is present, but don’t be overly judgmental. 9. There are a number of "pitfalls" in the behavioral coding. Some information to assist in accurate coding is listed below by problematic behaviors:

Informational Redundancy -- Key: "Continued and inappropriate fixation". -- Usually revealed as a limited number of topics or a limited repertoire of topics. -- Grammatical redundancy is not informational redundancy. -- Don't confuse a repeat for clarification or emphasis or re-establishment of a previous topic as this behavior. -- A repeat is not a fixation.

Failure to Provide Significant Information -- Remember to focus on content not form. For example, a complete sentence is not necessary for meaning transmission. Ellipsis is not a problematic behavior. Don't code it as one. -- This behavior is most easily observed when asking for specific information or when the individual spontaneously provides directions or instructions. -- Note antecedents or linguistic context to provide information. This is acceptable. -- Key: If you know what the child is talking about...even if the information doesn't appear to be available, then it is not a problematic behavior.

Use of Nonspecific Vocabulary -- Generic terms are acceptable for glossing over. -- Generic terms are acceptable when utilizing nonverbal or other contextual information. -- The key phrase in the definition is "when no antecedent or referent is available" -- Make certain that you only code initial instances of nonspecific pronominals. -- Key: If you know what the child is talking about...even if the information doesn't seem to be available, then it is not a problematic behavior.

Need for Repetition -- When you have asked a question and you must rephrase, restate, or move to another question or topic, this is typically a manifestation of this behavior.

Message Inaccuracy -- Key: Inaccuracy or mis-information -- The question has been addressed but the response (though a potential response) is inaccurate 17

-- May note this as an obvious contradiction of the context -- It doesn't matter if the person believes that he is relaying false information or not. The key is inaccuracy. -- Incorrect answers in class are coded here. -- Not a gauge of moral integrity. -- Confabulation within the same question frame is coded here

Poor Topic Maintenance -- This can also be due to a poor transition as well as no transition....perhaps its triggered by a somewhat related idea. -- Typically find that the topics cannot be sustained -- even when attempted -- Distractibility may be one “general feeling” when this is a problem -- If there is a feeling of “losing your verbal feet”, note whether this is due to a rapid or inappropriate topic shift -- Even if a reason for the shift is obvious, if it was a poor transition, code it now and interpret later.

Inappropriate Response -- Key: Focus is on a plausible response -- Inaccurate responses that are within the same question frame are not coded here. See message inaccuracy -- The key phrase is “radically unpredictable interpretation” -- if you must reassert the propositional Question or it is lost -- code it here -- When this relational problem comes after a query, code it here. This is a way to distinguish between PTM, SI and IR.

Failure to ask relevant Questions -- This is based more on lack of behavior -- More interpretive -- Ask the question: Does the individual try to obtain clarification or make repair when he doesn't catch the question or doesn't understand the verbal environment? -- Types of behaviors linked to this lack of clarification would be: no response inappropriate response after a delay repetition of Q or of his previous utterance stereotypic responses non-attentiveness

Situational Inappropriateness -- A generalized lack of relevance -- A more all-encompassing category -- due to social or interactional inappropriateness -- may be reflected in distinct social “faux pas” or extreme boorishness -- often does not read social contextualization cues 18

-- violations of social constraints -- A more “catch-all” category

Inappropriate Speech Style -- This is the category for coding difficulties in the superficial aspects of language structure -- Code switching that is inappropriate is coded here. -- Language transfer phenomena and dialectal differences are coded under This category. -- Idiosyncratic terms and language structure coded here. -- Inappropriate speech registers and style shifting are included here.

Linguistic Nonfluency -- Major caution: Count all behaviors. Use a "trips the ear" criteria. -- Beware of multiple coding -- temporally contiguous instances are counted as one instance. Particularly if they haven't moved past some propositional information. -- Note that there are filled LNFs. -- Review the tape after transcription to help find these -- We all produce these behaviors. It appears that the frequency of occurrence is the key to difficulty. You must code all instances and then interpret.

Revisions -- “Mazing” is a key descriptor -- Even phoneme revisions are noted and coded.

Delays before Responding -- Can have a filled DR -- Simply code the occurrences. Issues of thoughtful pauses, multiple questions, complex syntax and processing thought-provoking queries will be handled in the interpretation phase. -- Nonfluency before answering a question is a DR

Structuring Discourse -- Usually suprasentential

Turn Taking Difficulty -- there can be two types: Violating constraints and cues to inappropriately take the turn Not upholding the turn -- Violations of Adjacency principles coded here -- Code all turn breaks. -- Note if an individual continues on inappropriately when overlap occurs. -- Don't place back-channels or assessment reactions here. 19

Gaze Inefficiency -- This is very culturally determined. -- Focus on what the context requires and then interpret after you code according to the context.

Inappropriate Intonational Contour -- This does include intonational performance due to motoric problems. -- Flat or inconsistent contour typical occurrences -- Key is when the result is mixed messages or inefficient contextualizing INTERPRETATION OF THE DATA

Key Concepts: Describing Authentic Social Action Pragmatic Mapping Forced Adaptations Patterns and Systematicity Subtle Complexity

1. This phase is HEAVY on your knowledge and informed judgment. Don’t be intimidated. Exposure and experience will make you better. ** Read the literature ** Analyze some normals ** Gain experience with procedure ** Embrace the complexity 2. Once you gain more experience, the screens an be employed quickly and effectively. 3. There must be a framework built into the assessment process that allows the SLP to account for conversational complexity. 4. It is not enough to recognize the fact that problematic performance may be due to Differences or strategic reasons as well as deficits...... you must be able to systematically account for this possibility in a way that is "institutionalized". 5. There is a tendency for prescriptionism in interpretation as well....use the questions/screens listed below to help you prevent this tendency from influencing your interpretations. 6. Don’t be too concerned if you miss behaviors. The pattens will reveal themselves if you are systematic and if problems actually do exist. 7. You may use both qualitative (discussion of patterns and behaviors) and quantitative (numbers and percentages) data. Don’t over-extend their interpretive power. ** numbers alone can’t determine level of difficulty or whether or not there is a problem or disability. ** the patterns and types of behaviors are more important ** the changes in occurrences of behaviors may be important 8. It is key to remember that the behaviors on Clinical Discourse Analysis do 20 serve as effective indices for potential problems during conversation. They may serve as “road maps” telling you where to look for problems. They may be viewed as potential “Forced Adaptations”. But this is an interpretation accomplished with completion of the bi-level analysis paradigm.

Two Distinct Levels of Analysis A. Descriptive Analysis Phase Focus on Overt Behaviors that may serve as Indices of Problems Functional Difficulties and Strengths and Adjustments Clinical Discourse Analysis is one such procedure Identify and Code all Problematic Behaviors Look for Patterns 1) Collect all the data 2) Move through data and note co-occurrences 3) Determine numbers and percentages 4) Determine whether there is enough to consider potential problems * Do these behaviors interfere with social activities * Do they bother others * Are there specific and troubling patterns * Are there sufficient occurrences * Are the types of behaviors unusual * Do they prevent success of the three criteria Effectiveness Appropriateness Fluency 5) If problems exist from the perspective of the context of interest, then move to the second analysis level.

B. Explanatory Analysis Phase Focus on Causes and ask Why do the problematic behaviors occur? This process typically involves the combining of LOW INFERENCE data (observational data, test results, interview information on background, etc) to form HIGH INFERENCE JUDGMENTS. There are sets of questions and considerations that can assist in addressing this process . This process will result in the following: * A summary of the data collected 21

* A deeper interpretation of the data to comment on 1) whether there are difficulties 2) what areas of functioning are affected 3) whether these difficulties are due to impairment 4) what contextual variables are significant 5) what is the student's intervention potential Process 1. Take each of the problematic behaviors (individually or the pattern) 2. Analyze it (them) to see why they occur 3. Start with an assumption of normalcy 4. Apply the questions of screens detailed below

9. The following Explanatory Questions/Screens are designed to force you to consider the potential causal factors for the occurrence of the problematic behaviors in the conversational sample. These are designed into several general categories of consideration. Proceed in the following order. This will prevent you from mistakes due to a prescriptionistic bias.

Screen One: Are the problematic behaviors manifestations of Normal Conversational Strategies? -- Interactional strategies are often used to “opt” out or to maintain control. Ambiguity (FSI....RED...NR) -- Defense of Face -- Discourse markers to gain control (LNF....R) -- Avoidance manifested as Poor Topic Maintenance -- Word Search as attention getting device -- Forgetting as an interactional resource -- Nonfluency to maintain the floor -- Mid-gaze or “Thinking Face” to signal need for co- participation -- Message inaccuracy as bantering or to get a reaction

Screen Two: Are the problematic behaviors merely in random variation or operating within normal limits? -- Temporal Mapping Problems are especially relevant here (Linguistic Nonfluency, Revisions, Delays before Responding) ** Normal range of occurrence (6% - 24% of utterances) ** Can increase these in all of us by operating outside of the level of comprehensibility and/or comfort 22

** Best to note significant change in occurrence with Concomitant change in level of complexity -- There does not seem to be a pattern or repeated occurrences ** Simple communicative breakdown -- Delays before responding as a reaction to multiple questions, thought-provoking queries, complex syntax and processing.

Screen Three: Are the problematic behaviors due to procedural mistakes by the assessor? -- Incorrect Coding Procedures ** Too Prescriptionistic or biased ** Multiple NSV on pro-nominals ** FSI for lack of lexical specificity despite comprehension ** Message inaccuracies as Inappropriate Responses -- Violation of Sincerity Constraints -- Operated beyond the level of comprehensibility ** Give Rise to Temporal Mapping Problems -- Not a conversational interaction -- Inappropriate contextualization cues

Screen Four: Are the problematic behaviors due to language or dialectal differences between the individual and the language code of the context of interest? -- Inappropriate speech style due to VBE or code switching -- Culture of Poverty and “restricted code” -- Note the problems in L2 but not in L1 -- Due to interlanguage phenomena -- Due to normal L2 acquisition phenomena -- Due to language transfer errors

Screen Five: Are the problematic behaviors due to cultural differences/ interferences that affect interactional expectancies or strategies? -- Different eye gaze -- Different nonverbal contextualization -- Different clarification strategies -- Silence as a conversational device

Screen Six: Is there an indication of extreme test anxiety during the observational assessment in one context but not in others?

Screen Seven: Is there significant performance inconsistency between different observation periods in the same context? 23

Screen Eight: Have any contextual variables of significant been identified?

Screen Nine: Is there any evidence that the problematic behaviors noted can be explained according to any bias effect that was in operation before, during, or after the assessment? -- Is the student in a subtractive bilingual/cultural environment? -- Is the student a member of a disempowered community? -- Are negative or lowered expectations for this student held by the student, the student's family, or the educational staff? -- Were specific indications of bias evident in the prereferral, referral, administrative, scoring, or interpretative phases of the evaluation?

Screen Ten: Are the Problematic Behaviors Potential Compensatory Strategies? -- “Isy” as a discourse marker -- Simmons-Mackie & Damico, 1996; 1997

Screen Eleven: Are there any remaining (unaccounted for) Problematic Behaviors or Patterns of behaviors that reveal an underlying linguistic systematicity during the descriptive analysis phase? -- This question applies only to the problematic behaviors that are still remaining after application of the ten screens. -- Isolate turns/utterances containing remaining problematic behaviors -- Is there significant performance inconsistency between different input or output modalities? -- Perform a systematic linguistic analysis on these data points looking for consistency in appearance of problematic behaviors. * Grammatical (primarily syntagmatic) Crystal profiles (1982) SALT (Miller & Chapman, 1983) * Semantic (primarily paradigmatic) PRISM (Crystal, 1982) Perceptual/Language Distancing Displacement Levels of Abstraction Cohesion/Coherence (Halliday & Hasan, 1976)

-- Look for large changes in the occurrence of the problematic behaviors as the complexity of one of these dimensions increases (e.g., an increase in grammatical complexity from LARSP Level IV to LARSP Level V causes an increase in the 24 number of linguistic nonfluencies from 18% to 39%.

10. Determine Appropriate Placement * A plan of action detailing what further service delivery should occur. This should include: 1. What should be done 2. Who should do it 3. When services are provided 4. What support will be provided 5. How follow-up is accomplished

BIBLIOGRAPHY

Introduction Brinton, B., Craig, H.K., & Skarakis-Doyle, E. (1990). Peer commentary on "Clinical pragmatics: Expectations and realizations". Journal of Speech - Language Patholoqy and Audiology, 14, 7-12. Damico, J.S. (1993a). Establishing expertise in communicative discourse: Implications for the speech-language pathologist. In D. Kovarsky, M. Maxwell, & J. Damico (Eds.). Language interaction in clinical and educational settings, ASHA Monographs, 30, 92-98. Rockville, MD: American Speech-Language-Hearing Association. Damico, J.S. and Damico, S.K. (1993). Language and social skills from a diversity perspective: Considerations for the speech-language pathologist. Language. Speech, and Hearing Services in the Schools, 24, 236-243. Damico, J.S., Simmons-Mackie, N.N., & Schweitzer, L.A. (1995). Addressing the third law of gardening: methodological alternatives in aphasiology. Clinical Aphasiology, 23, 83-93. Gallagher, T.M. (l991). Language and social skills: Implications for assessment and intervention with school-age children. In T. Gallagher (Ed), Pragmatics of language: Clinical practice issues. (pp. 11- 41). San Diego, CA: Singular Press. Gallagher, T.M. (1993). Language skill and the development of social competence in school-age children. Language, Speech. and Hearing Services in the Schools, 24, 199-205. Holland, A.L. (1994). A look into a cloudy crystal ball for specialists in neurogenic language disorders. American Journal of Speech-Language Pathology, 3, 34-36. Kovarsky, D. & Damico, J.S. (1997). Language and context: Some issues of practice. Language, Speech, and Hearing Services in Schools, 28, 308 - 313. Kovarsky, D. & Maxwell, M. (1997). Rethinking the context of language in the schools. Language, Speech, and Hearing Services in Schools, 28, 219- 230. Prutting, C.A. (1982). Pragmatics as social competence. Journal of Speech and Hearing Disorders, 47, 123-134. Rees, N.S. & Gerber, S. (1992). Ethnography and communication: Social role relations. Topics in Language Disorders, 12, 1527. Rice, M.L. (1993). Don't talk to him; he's weird: A social consequences account of language and social interactions. In A. Kaiser & D. Gray (Eds.), Enhancing children's communication: Research 25

foundations for intervention. (pp. 139-158). Baltimore, MD: Paul H. Brookes.

Conversation Analysis and Social Action Atkinson, J.M., & Heritage, J. (1984). Structures of social action. Cambridge: Cambridge University Press. Bauman, R., & Sherzer, J. (1989). Explorations in the ethnography of speaking. (2nd Edition). New York: Cambridge University Press. Bell, A. (1984). Language style as audience design. Language in Society, 13, 145-204. Button, G. & Lee, J.R.E, (Eds.) (1987). Talk and Social Organisation. Clevedon, England: Multilingual Matters. Duranti, A., & Goodwin C. (1992). Rethinking Context: Language as an Interactive Phenomenon. Cambridge: Cambridge Univ. Press. Erickson, F. & Shultz, J. (1981). When is a context? Some issues and methods in the analysis of social competence. In J. Green & C. Wallat (Eds.) Ethnography and language in educational settings. (pp.147-160). Norwood, NJ: Ablex Publishing. Garfinkel, H. (1967). Studies in ethnomethodology. Englewood Cliffs, NJ: Prentice Hall. Goffman, E. (1967). Interaction Ritual: Essays in Face to Face Behavior. Garden City, NY: Doubleday. Goffman, E. (1974). Frame Analysis: An Essay on the Orqanization of Experience, New York: Harper & Row. Goodwin, C. (1981). Conversational orqanization: Interaction between speakers and hearers. New York: Academic Press. Goodwin, M.H. (1990). He - said - she - said: Talk as social organization among Black children. Bloomington: Indiana University Press. Goodwin, C. & Heritage, J. (1990). Conversational analysis. Annual Review of Anthropology, 19, 283-307. Gumperz, J. (1982). Language and social identity. Cambridge: Cambridge University Press. Gumperz, J. (1983). Discourse Strategies. Cambridge: Cambridge University Press. Heritage, J. (1984). Conversation analysis. In J. Heritage, Garfinkel and Ethnomethodology. Cambridge: Polity Press McDermott, R.P. & Tylbor, H. (1987). On the necessity of collusion in conversation. In L. Kedar (Ed.). Power through discourse. (pp. 153-170). Norwood, NJ: Ablex Publishing. Psathas, G. (1995). Conversation analysis: The study of talk-in-interaction. Thousand Oaks, CA: Sage Publications. Sacks, H.(1992). Lectures on conversation Vol I & II. Oxford: Blackwell. Sacks, H., Schegloff, E.A. and Jefferson, G. (1974) A simplest systematics for the organization of turn-taking for conversation. Language, 50, 696-735. Schegloff, E. (1988). Discourse as an interactional achievement: An exercise in conversation analysis. Linguistics in context: Connecting observation and understanding. In D. Tannen (Ed). (pp. 135-158) Washington, DC: Georgetown University Press. Schegloff, E.A. (1994) Turn organization: one intersection of grammar and interaction. In E. Ochs, E.A. Schegloff and S. Thompson (Eds.) Interaction and Grammar (Cambridge: Cambridge University 26

Schenkein, J. (1978). Studies in the Organization of Conversational Interaction. New York: Academic. Schiffrin, D. (1987). Discourse markers. Cambridge: CUP.

Illustrations of Conversational Behaviors (Normal) Eriks-Brophy, A. & Crago, M.B. (1993) Inuit efforts to maintain face: Elements from classroom discourse with Inuit children. In D. Kovarsky, M. Maxwell, & J. Damico (Eds.). Language interaction in clinical and educational settings. 30. ASHA Monograph Series. Rockville, MD: American Speech-Language Hearing Association. Ferrara, K. (1992) The interactive achievement of a sentence: joint productions in therapeutic discourse. Discourse Processes, 15, 207-228. Goodwin, C. (1987) Forgetfulness as an interactive resource. Social Psychology Quarterly, 2, 115-131. Goodwin, M.H. and Goodwin, C. (1986) Gesture and co-participation in the activity of searching for a word. Semiotica, 62, 51-72. Goodwin, C. & Goodwin, M. (1992). Interstitial argument. In A.D. Grimshaw (Ed.), Conflict Talk: Sociolinguistic investigations of arguments in conversations. (pp. 85-117). Cambridge: CUP. Jefferson, G. (1973) A case of precision timing in ordinary conversation: overlapped tag-positioned address terms in closing sequences. Semiotica, 9, 47-96. Kendon, A. (1967). Some functions of gaze-direction in social interaction. Acta Psychologica, 26, 22-63. Philips, S. (1978). Participant structures and communicative competence: Warm Springs Children in Community and Classroom. In M.A. Lourie & N.F. Conklin (Eds.), A Pluralistic Nation. Rowley, MA: Newbury House. Rundquist, S. (1992). Indirectness: A gender study of flouting Grice’s maxims. Journal of Pragmatics, 18, 431-449. Sacks, H. (1987). On the preferences for agreement and contiguity in sequences in conversation. In J. Button and J. Lee (Ed.), Talk and social organization. (pp. 152-205). Clevedon, England: Multilingual Matters, Ltd. Schegloff, E.A. (1968). Sequencing in conversational openings. American Anthropologist, 70, 1075-1095. Schegloff, E.A. (1981). Discourse as an interactional achievement: Some uses of uh-huh and other things that come between sentences. In D. Tannen (Ed.), Analyzing Discourse: Text and Talk. Georgetown University Roundtable on Languages and Linguistics 1981. (pp. 71-93). Washington D.C.: Georgetown University Press. Scollon R. & Scollon, S.K. (1981). Narrative, Literacy and Face in Interethnic Communication Norwood, N.J.: Ablex Publishing. Shiffrin, D. (1987). Discourse Markers. London: Cambridge University Press. Tannen, D. (1990). Gender differences in topical coherence: Creating involvement in best friends’ talk. Discourse Processes, 13, 73-90. Tarone, E. (1980). Communication strategies, foreigner talk and repair in interlanguage. Language Learning, 30, 417-431. Ulichny, P. & Watson-Gegeo, K.(1989). Interactions and authority: The dominant interpretative 27

framework in writing conferences. Discourse Processes, 12, 309-328.

Illustrations of Conversational Behaviors (Disabled) Armstrong, E.M. (1991). The potential of cohesion analysis in the analysis and treatment of aphasic discourse. Journal of Clinical Linguistics and Phonetics, 5, 39-51. Ferguson, A. (1996). Describing competence in aphasic/normal conversation. Clinical Linguistics and Phonetics, 10, 55-63. Goodwin, C. (1995). Co-constructing meaning in conversations with an aphasic man. In S. Jacoby & E. Ochs (Eds.) Research in Language and Social Interaction (Special issue of Construction). 28, 233-260. Higginbotham, D.J., Mathy-Laikko, P. & Yoder, D. (1988). Studying conversations of augmentative system users. In L. Bernstein (Ed.), The Vocally impaired: Clinical practice and Research, 265-294. New York: Grune and Stratton. Klippi, A. (1991). Conversational dynamics between aphasics. Aphasiology, 5, 373-378. Klippi, A. (1996). Conversation as an achievement in aphasics. Studia Fennica Linguistica 6 . Helsinki: The Finnish Literature Society Kovarsky, D. (1990). Discourse markers in adult-controlled therapy: Implications for child-centered intervention. Journal of Childhood Communication Disorders, 13, 29-42. Laakso, M. (1997). Self-iniatiated repair by fluent aphasic speakers in conversation. Studia Fennica Linguistica 8. Helsinki: Finnish Literature Society. Light, J. (1988). Interaction involving individuals using augmentative and alternative communication systems: state of the art and future directions. Augmentative and Alternative Communication. 4, 66-82. Milroy, L. & Perkins, L. (1992). Repair strategies in aphasic discourse: towards a collaborative model. Clinical Linguistics and Phonetics, 6, 27-40. Oelschlaeger, M. & Damico, J.S. (In press). Joint productions as a conversational strategy in aphasia. Clinical Linguistics and Phonetics Oelschlaeger, M. & Damico, J. (In Press). Spontaneous verbal repetition: A social strategy in aphasic conversation. Aphasiology. Simmons-Mackie, N.N. & Damico, J.S. (1996). The contribution of discourse markers to communicative competence in aphasia. American Journal of Speech-Language Pathology, 5,37-43. Simmons-Mackie, N.N. & Damico, J.S. (1997). Reformulating the definition of compensatory strategies in aphasia. Aphasiology, 11, 761-781. Simmons-Mackie, N.N. & Damico, J.S. (In press). Social role negotiation in aphasia therapy: Competence, incompetence, and conflict. In J. Duchan, D. Kovarsky, & M. Maxwell (Eds.) Studies in normal and pathological discourse. New York: Erlbaum

Press.

Assessment Bishop, D. & Adams, C. (1989). Conversational characteristics of children with semantic-pragmatic disorder. II. What features lead to a judgment of inappropriate? British Journal of Disorders of Communication, 24, 241-263. 28

Brinton, B., & Fujiki, M. (1992). Setting the context for conversational language sampling. Best Practices in School Speech - Language Pathology, 2, 9-19. Copeland, M. (1989). An assessment of natural conversation with Broca’s aphasics. Aphasiology, 3, 301-306. Damico, J.S. (1991). Descriptive assessment of communicative ability in limited English proficient students. In E.V. Hamayan & J.S. Damico (Eds.), Limiting bias in the assessment of bilingual students. (pp. 157-218) Austin, TX: PRO-ED Damico, J.S. (1985). Clinical Discourse Analysis: A functional approach to language assessment. In C.S. Simon (ed.) Communication Skills and Classroom Success: Assessment of language - learning disabled students. (pp. 165-204) San Diego: College-Hill Press. Damico, J.S. (Ed.) (1992a). Descriptive and nonstandardized assessment in the schools. Best Practices in School Speech Language Pathology, 2. (The Psychological Corporation...512-299-1061) Damico, J.S. (1992b. Systematic Observation of Communicative Interaction: A valid and practical descriptive assessment technique. Best Practices in School Speech - Language Pathology, 2, 133-144. Damico, J.S. (1993b). Language assessment in the adolescent student: Addressing critical concerns. Language Speech. and Hearing Services in Schools, 24, 29-35. Damico, J.S. and Oller, J.W., Jr. (1985). Spotting_Language Problems. San Diego: Los Amigos Research Associates. Damico, J.S., Secord, W.A., & Wiig, E.H. (1992). Descriptive language assessment at school: Characteristics and design. Best Practices in School Speech - Language Pathology, 2. Kovarsky, D. (1992). Ethnography and language assessment: Toward the contextualized description and interpretation of communicative behavior. Best Practices in School Speech - Language Pathology, 2, 115-122. Loban, W. (1976). Language development: K - 12. Urbana, IL: National Council of Teachers of English. McTear, M. & Conti-Ramsden, G. (1992). Pragmatic disability in children. San Diego, CA: Singular Press. Perkins, L. (1995). Applying conversational analysis to aphasia: Clinical implications and analytic issues. European Journal of Disorders of Communication, 30, 372-383. Prutting, C.A. and Kirchner, D.M. (1987). A clinical appraisal of the pragmatic aspects of language. Journal of Speech and Hearing Disorders, 52, 105-119. Rice, M.L., Sell, M.A., & Hadley, P.A. (1990). The Social Interactive Coding System (SICS): An on-line, clinically relevant descriptive tool. Language, Speech. and Hearing Services in Schools, 21, 2-14. Simmons-Mackie, N.N. & Damico, J.S. (1996). Accounting for handicaps in aphasia: Communicative assessment from an authentic perspective. Disability and Rehabilitation: An international, multidisciplinary journal., 18, 540-549. Wilkinson, R. (1995a). Aphasia: Conversation analysis of a non-fluent aphasic person. In M. Perkins & S. Howard (Eds.) Case Studies in Clinical Linguistics. (pp. 271- 292) London: Whurr. Wilkinson, R. (1995b). The application of conversation analysis to the assessment of aphasic talk-in-interaction. Ph.D. thesis, University of Central England, Birmingham. 29

Language Evaluation Summary Report

Name: DOB: June 6, 1980 DOE: June 12/16, 1985

------, a five year old male, was seen for a communication and language evaluation between June 12th and June 16th, 1985. This evaluation was conducted over several days in order to obtain as natural a sample of his communicative behavior as possible. --- was referred to this clinician by his father, Dr. ------. At the time of the referral, Dr. ------expressed concern over reports received from ---'s preschool, the Land of Oz. As detailed in a report dated May 20, 1985, it was recommended that --- receive a complete language evaluation to determine "if he has any deficits which underlie the developmental lag in language development".

This report concerns the evaluation of ---'s communicative abilities and is based upon his performance during actual communicative events with his father, mother, and two speechlanguage pathologists. These events were detailed through the use of audiotape recording and systematic and direct observation. In addition, the Preschool Language Assessment Instrument (PLAI) was administered in an attempt to support or reject the observational analysis. A heavy reliance was placed upon naturalistic assessment procedures because it was determined that highly structured and formal language assessment tools would be inappropriate. This is due to the lack of construct validity found in formal language tests and ---'s reluctance to perform in highly structured testing situations. For additional information on ---'s performance on formal and standardized psychological tests, consult the Psychological Evaluation.

Behavioral/Cognitive Evaluation

--- presented himself as a cooperative child during the observational periods. Although he was initially reluctant to separate from his father, he did so within the first six minutes of the observational period. On subsequent observations with the same observers, however, he still took several minutes to separate from his father. During the observational periods --- tended to focus upon objects more than people. For example, he was primarily concerned with a calculator, then a stuffed toy, then a ship rather than the interactions of the individuals around him. When --- interacted with his father and the observers, he used 30 the objects around him as initators. This is a common interactional pattern in young children and it reflects a different -- though not necessarily a negative -- interactional style. 31

Based upon ---'s play activities and performance during the observational periods, it is determined that his symbolic play skills and his cognitive abilities are within normal limits. As detailed by the Westby Symbolic Play Scale, --- is performing somewhere between the 4 to 5 year period in these areas. During the observations he was observed to plan and then execute several pretend play sequences with a stuffed toy and then with a toy boat. He also was able to coordinate more than one event at a time when required to do so and demonstrated several instances of advance planning and problem solving. For example, he utilized the information given to him about an insect and its habitat to decide to place it in a particular environment despite some size and shape difficulties. Further indications of his level of symbolic functioning is his ability to handle mathematical concepts and his use of intermittent symbolic processing strategies.

Interactional Evaluation

Based upon the use of the data obtained through observation, analysis of language samples, and the PLAI, --- does exhibit an interactional difficulty. An analysis of his communicative interactions through the use of Systematic Observation of Communicative Interaction (SOCI) revealed that 31.09% of his spontaneous interactions contained one or more type of problematic behavior. This percentage of interactions with problematic behaviors is considerably more than would be expected in an individual with normal interactional abilities. An analysis of his problematic behaviors is revealing. The most frequently observed difficulty was with inappropriate responses. During the 24 minute observational period he responded inappropriately fifteen (15) times. He also exhibited frequent problems with the negotiation of turns during conversation (11 instances), required multiple repeats before he responded (11 Instances), and exhibited a language-related nonfluency on eleven (11) occasions. The occurrence of each of these behaviors with the frequency indicated will interfere with - -'s interactional attempts and so are indicative of a communication deficit.

A similar pattern of deficit was found during the analysis of ---'s spontaneous language samples. These two samples -- totalling 121 utterances -- revealed problematic behaviors in 33.8% of his utterances. Again, there was a high percentage of linguistic nonfluency and inappropriate responses. This finding tends to substantiate the interactional deficits found during the direct observational periods.

Due to the high percentages of communicative errors in ---'s interactions, it is determined that he exhibits a moderate language disorder in his oral dialogic manifestations of language. It is therefore appropriate to conduct an explanatory analysis of his language skills. To accomplish this, the problematic behaviors contained in the language samples were analyzed using two different approaches. First, a syntactic analysis -- David Crystal's Language Assessment, Remediation and Screening Procedure (LARSP) -- was used. Looking at the communicative breakdowns according to Clinical Discourse Analysis, 31.5% of his breakdowns occurred when his syntax was at Crystal's levels IV and V and only 15.7% of the breakdowns occurred at Crystal's level III or below. This suggests that part of his interactional deficit is due to his syntactic difficulty. An analysis of the entire sample utilizing the LARSP indicated that --- is functioning between Crystal's Stage V and Stage VI. He was able to form clause and phrase structures with four or more independent elements and he utilized a number of recursive devices to do so. For example, in the two samples, --- produced 21 major sentences that had multiple clauses. Of these, 15 were subordinate clauses -- though all were adverbial in nature. The 32 remaining 6 multiple clausal sentences utilized "and" as the coordinating device. He also utilized ellipsis effectively and this is also indicative of a Stage V ability. The small percentage of multiple clausal sentences and the utilization of only two recursive devices (adverbial and "and"), however, suggests that Stage V (recursion) is not yet fully achieved. Further, although --- does exhibit some Stage VI abilities, his syntactic error patterns -- especially those noted in his verb phrases -- indicate incomplete acquisition at this stage. For example, there are problems with his ability to code distinctions between aspect and tense. Due to the heavy reliance on both syntax and semantics to make aspect and tense distinctions, he has some difficulty. --- also experienced some difficulty when he attempted to use several optional transformations simultaneously. For example, when he attempted to use both a negation transformation and attempted to code aspect, he could not handle the multiple operations ("not want mommy putting tapes away"). This is an error that we could expect at Stage VI. Finally, --- exhibited some difficulty using his syntactic abilities to code deictic information. In several of his adverbial clauses, he utilized an inappropriate locative. Based upon the LARSP, --- appears to be functioning at about a 36 to 4-6 year level in terms of his syntactic ability.

The second approach to explanatory analysis that was utilized was Marion Blank's hierarchy of abstraction. Blank has detailed four levels of abstraction based upon the distance between one's perception and his use of language. Level I consists of a language user simply describing what he sees. This is referred to as Matching Perception. Level II is more abstract in that the child must resist the attraction to global perceptions and respond to different aspects of his perceptions as selected by the language of others. This is referred to as Selective Attention to Perception. Level III, even more abstract, is Reordering Perception. This level requires that the child reject specific perceptual characteristics that dominate his perception and instead internally manipulate their experience according to the language input. Finally, Level IV -- Reasoning about Perception -- requires that the child go beyond his perceptions and reflect on impliclations and underlying explanation. This last level is much more abstract and starts coming into use only around 4 years of'age. Blank's hierarchy has been applied to a number of populations and age ranges and has been used successfully in explaining the underlying cause for some language disorders. Consequently, this analysis was applied to ---'s language sample and to the observational analysis.

The results of this analysis is very revealing. Based upon the combined data from both the language samples and the observational analysis, --- appears to have significant problems operating above Blank's Level II. 74% of ---'s problematic behaviors occurred when the language used was at Levels III and IV. This indicates significant problems dealing with abstract language. If broken down another way -- coding language according to the four levels and determining the actual success rates at each level -- this pattern of deficit is even clearer. At Level I only 8.8% of the utterances contained problematic behaviors. At Level II this percentage increased to 25.7%. At Level III and at Level IV the percentages of problematic behaviors increased to 66% and 81.25% respectively. This does indicate a problem with ---'s ability to use increasingly abstract language.

It should be noted that while the occurrence of problematic behaviors are indicative of interactional difficulty, there are also several positive indicators. First, --- did use a wide variety of illocutionary acts during the observational periods. During the observations, he used a wide variety of constatives, directives and acknowledgments. He also exhibited some positive attending skills when others were 33 talking. --- did utilize indirect speech acts appropriately on nine (9) different occasions and changed the style and content of his speech at least twelve (i2) times when his listener changed. He also used several relational terms and exhibits a strong ability to ask questions (below Level IV). Each of these abilities are appropriate for ---'s chronological level and indicate a positive prognosis for change.

Summary

In summary, ------exhibits a moderate communicative disorder characterized by interactional difficulties in his oral dialogic use of language. The most noticable problematic behaviors, inappropriate responses, a need for repetition, poor turn taking abilities, and linguistic nonfluency occurred most frequently when --- attempted to interact at a specific level of linguistic abstraction (Blank's Levels III and IV) and at a specific syntactic level (Crystal's Stages V and VI). ---'s use of symbolic play and his cognitive abilities appear to be functioning within normal limits for his chronological age level. The following recommendations are made: Care be taken in the interpretation of psychological and educational measures due to the heavy reliance on language abilities to accomplish these tasks. --- be seen for language therapy focusing on his learned interactional patterns and emphasizing his use of linguistic abstraction and more advanced forms of syntactic development.