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Assessment of Language and Literacy a Process of Hypothesis Testing for Individual Differences

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Assessment of Language and Literacy a Process of Hypothesis Testing for Individual Differences LWW/TLD TLD200067 January 27, 2011 15:34 Char Count= 0 Top Lang Disorders Vol. 31, No. 1, pp. 24–39 Copyright c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Language and Literacy A Process of Hypothesis Testing for Individual Differences Cheryl M. Scott, PhD Purpose: Older school-aged children and adolescents with persistent language and literacy im- pairments vary in their individual profiles of linguistic strengths and weaknesses. Given the mul- tidimensional nature and complexity of language, designing an assessment protocol capable of uncovering linguistic variation is challenging. A process of clinical reasoning characterized as hy- pothesis testing is described to assist in language and literacy assessment. In-depth and explanatory assessment can contribute to establishing a common language across professionals and disciplines concerned with these impairments. Methods: Hypothesis testing relies on (a) review of research on language impairment variations found in the school-aged population and (b) careful analysis of content and form of commonly used assessment tools. A case study illustrates application of this material with a 10-year-old child. Results: Major sources of language variation include language and reading profiles, linguistic components and levels (word, sentence, text), gatekeeping factors, and explanations of language and literacy impairments. Three hypotheses and assessment tools that would be useful in attempts to confirm each hypothesis are described. Conclusions: Uncov- ering the “core” features of a persistent language and/or literacy impairment is difficult. Casting the process as one of testing hypotheses derived from research and analysis of testing tools has the potential to (a) assist language clinicians in determining best assessment practices and (b) im- prove communication among professionals. Key words: assessment, language comprehension, language impairments, language tests, reading disorders, school-aged children and adolescents with language impairment, specific language impairment HILDREN and adolescents with persis- as psychology, neuropsychology, pediatric Ctent oral and written language impair- psychiatry, developmental behavioral pedi- ments have often seen several different pro- atrics, special education/learning disabilities, fessionals for purposes of assessment and/or speech-language pathology (SLP), school psy- intervention. Because their basic language im- chology, and audiology. Their parents, with a pairments can impact such critical domains as sense of urgency, arrive at each new appoint- literacy, academic achievement, and social re- ment with an expanding portfolio of profes- lationships, it is not uncommon to find that sional reports and individualized educational these children have “made the rounds”among plans. Frequently, they are frustrated, having several professionals from disciplines such heard several labels for their child’s problem (e.g., auditory processing disorder, dyslexia, learning disability, language impairment) and several (sometimes conflicting) recommen- Author Affiliation: Department of Communication dations for treatment. Although the indi- Disorders and Sciences, Rush University Medical vidualized educational planning process re- Center, Chicago, Illinois. quires different professionals to endorse a Corresponding Author: Cheryl M. Scott, PhD, Depart- plan of treatment, evidence of true collab- ment of Communication Disorders and Sciences, Rush University Medical Center, 600 S. Paulina St, 1015 A, oration across disciplines is sometimes hard Chicago, IL 60612 (cheryl m [email protected]). to discern in the record. When consultation DOI: 10.1097/TLD.0b013e31820a100d outside the school setting is sought, parents 24 Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. LWW/TLD TLD200067 January 27, 2011 15:34 Char Count= 0 Assessment of Language and Literacy 25 are often on their own to integrate find- commonly specialists, including psychiatry ings from several professionals. Sometimes and developmental behavioral pediatrics. Al- the only constant in this journey is that though the children differ on many dimen- the academic gaps between their child and sions (e.g., presence/absence of comorbid the child’s peers continue unabated (Catts, conditions such as attention-deficit hyperac- Bridges, Little, & Tomblin, 2008). tivity disorder), the common denominator for Like the other authors in this issue of Top- those referred is academic struggle. Some ics in Language Disorders, I am concerned have been “in the system” since they qual- about this scenario. To use the allegory of ified for early intervention as a late talker, the blind man and the elephant, it seems that then continued into a preschool early child- different professionals sometimes “see” only hood education program, and eventually met their part of the elephant. Would it not be eligibility criteria for special education ser- better if there was consensus on (a) how the vices in school in one or more categories (usu- elephant works (see Foorman, Arndt, & Craw- ally speech language impairment and/or spe- ford, 2011), (b) what we call the parts of the cific learning disability). Others have a shorter elephant, and (c) how different professionals history in special education, and some have can make complementary contributions to a never received services even though it seems more successful elephant. In this article, I de- clear that they could have benefited. The scribe a clinical model for assessing language questions that these physicians raise when re- and literacy impairments in older children ferring to us are (a) whether and how a lan- and adolescents as one type of contribution guage disorder is impacting school achieve- that has the potential to improve communi- ment, and (b) if so, what can be done about cation about, and understanding of, language it. impairments across disciplines. The model ad- The assessment model, characterized as a dresses multiple levels, domains, and modal- hypothesis-testing process, is covered in three ities of language and, importantly, draws on sections. First is an overview of several types research that helps explain connections be- of oral and written language impairment vari- tween them. The goal is to uncover individual ations found in the school-aged population. profiles of language and literacy impairment Awareness of these variations informs the at a level of explicit detail and integration hypothesis-testing process. The second sec- that can support cross-disciplinary communi- tion codifies this variation as several clinical cation. The desired outcome for the child is a hypotheses and presents a plan for obtaining more targeted intervention that all profession- the information necessary to confirm (or not als can endorse and reinforce. confirm) each hypothesis. Finally, a case study The model that I will describe is not spe- is presented that illustrates the hypothesis- cific to one work setting, but it has grown testing nature of language assessment. out of my work as a SLP working with older children and adolescents∗ with language and VARIATION IN LANGUAGE IMPAIRMENT literacy impairments. Because I work in an urban academic medical center, many of the Although heterogeneity is often asserted children who I see are referred by pedia- in literature on language impairments, there tricians, some in general practice, but more are fewer discussions about how assessment can be structured to reveal individual differ- ences. A careful assessment that captures this variation would seem to be a first step in ∗ Older children and adolescents between the ages of ap- bridging the gap (or chasm) that often exists proximately 9 and 14 years with oral and written language impairments constitute the group of interest in this arti- between (a) the actual language knowledge cle. Use of the term child or children assumes this age and skills required to function in a classroom range. and (b) common language assessment and Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. LWW/TLD TLD200067 January 27, 2011 15:34 Char Count= 0 26 TOPICS IN LANGUAGE DISORDERS/JANUARY–MARCH 2011 intervention practices (as described recently lexical (vocabulary) skills are relatively higher by Wallach, 2010). The process of uncover- (Laws & Bishop, 2003)—a pattern that dif- ing a unique language profile is one of start- fers for children with Fragile X syndrome ing with one or more hypotheses about the (Abbeduto, Brady, & Kover, 2007). In stud- nature of oral and/or written language impair- ies involving children with autism who are ments and their variations and planning an as- verbal but language impaired, Kjelgaard and sessment protocol that allows for confirma- Tager-Flusberg (2001) report profiles resem- tion. An internal conversation about how a bling children with specific language impair- child’s oral and written language problems in- ment (SLI). Both groups are especially poor on teract might go something like the following: grammatical tasks and have difficulty repeat- ing long sentences and nonwords correctly. Everything I know about this child points to a spe- Grammatical impairment, in particular cific comprehension deficit that impacts both lis- tening and reading. I don’t think the classic dyslexic tense marking, has long been considered as a profile of word reading inaccuracy explains her clinical marker of children with the primary problems.
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