Nacogdoches Independent School District/SFASU Stanley Speech and Hearing Clinic
Full and Individual Evaluation
Determination of Disability and Educational Needs
Student Name:
Grade
:
Date of Birth :
Age
:
Sex
:
School
:
Parent(s) :
Address
:
City
: Nacogdoches
State
: TX
Zip
:
Phone
: (936)
Report Date:
Reason for Referral:
~ participated in a speech and language screening on ~. Concerns were noted in the
areas of ~. ~ was then referred for a Speech and Language Evaluation with parent
consent .This evaluation will aid in determining if a disability condition exists and
whether the condition affects ~’s development to such a degree that there is a need for
special education intervention and services.
Physical/Health Assessment:
Information provided by the parent, ~:
~ was born at ~ weeks gestation by ~ with no reported complications. It was reported
that ~. Significant health issues since birth reported include ~. No major illnesses or
hospitalizations were reported. ~ is not currently taking any medications regularly. No
developmental concerns were reported. ~ passed a vision screening conducted by ~ on
~/11. He/She passed a hearing screening completed by ~ on ~/11. Based on the
information provided, parent report and informal observations, ~’s hearing and vision
appear to be within functional limits at this time.
Developmental Assessment:
Social/Emotional Development:
Information provided by the parent, ~:
~ lives at home with his/her ~. It was reported that ~ is a ~ ~ year old who gets along
age appropriately with other family members, neighbors and playmates. Mrs. ~ also
reported that ~ enjoys playing with ~. He/She also reported that ~ responds
appropriately to discipline. Cultural and/or lifestyle factors do not appear to influence ~’s
learning at this time. There does not appear to be a lack of educational opportunities at
this time.
Communication and Language Assessment:
Language Development:
Information provided by the parent, ~:
~’s Home Language survey was completed on ~. The language survey indicated that
currently his/her dominant language is English and that he/she expresses
himself/herself best orally. Based on this information regarding his/her language
abilities, the remainder of the evaluation was conducted in English. ~ reported no
concerns/concerns with ~
Information provided by the assessment:
~ was evaluated by a graduate student clinician under the direct supervision of a
licensed Speech Language Pathologist in the areas of language and articulation using
informal as well as standardized measures. He/She interacted with the clinician
throughout the assessment and complied willingly with directives given to him/her.
Test Conditions and Behaviors:
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Testing was conducted using standard procedures.
Conditions for this testing session were considered to be adequate.
Distractions were minimal and insignificant at this time.
Rapport was established and maintained adequately for testing.
Adequate eye contact was achieved and maintained during testing.
In general, ~~ appeared cooperative during testing and did appear to exert an
effort to respond appropriately.
Overall, the examiner felt that the results of this test were a valid estimate of
current functioning abilities in this area.
~~ did/did not wear glasses or hearing aids during testing.
Information provided by the parent, ~:
Mrs. ~ reported ~.
Information provided by the assessment:
PRESCHOOL LANGUAGE SCALE-5
The Preschool Language Scale-5 (PLS-5; Zimmerman, Steiner & Pond, 201) is a
revision of the Preschool Language Scale-Fourth Edition (PLS-4). The PLS-5 is an
individually administered instrument that assesses receptive and expressive language
skills in infants and young children birth through 7 years, 11 months. The PLS-5
provides age equivalents and standard scores for the subscales of Auditory
Comprehension and Expressive Communication, as well as for Total Language.
Examiner:
~, SFASU Graduate Student Clinician
~, MS, CCC/SLP
Date of Exam: ~/11
Auditory Comprehension
Raw Score:
Standard Score:
Percentile Rank:
Age Equivalent:
Expressive Communication
Raw Score:
Standard Score:
Percentile Rank:
Age Equivalent:
Total Language Score
Raw Score:
Standard Score:
Percentile Rank:
Age Equivalent:
The Auditory Comprehension Subscale was used to evaluate ~’s receptive language
skills in the areas of attention, semantics, structure, and integrative thinking skills.
Results yielded a raw score of ~ which converted to a standard score of ~ placing ~ in
the ~ percentile. His/her performance was (within normal limits or ~standard deviations
below the mean/above the mean) when compared to the performance of children the
same chronological age and indicated a (mild, moderate, severe) receptive language
disorder or indicated the presence of age appropriate receptive language skills.
Strengths included ~. Weaknesses included ~.
The Expressive Communication Subscale was administered to addresses the areas of
vocal development, social communication, semantics, structure, and integrative thinking
skills. Results yielded a raw score of ~ which converted to a standard score of ~
placing~ in the ~ percentile. His/her performance was (within normal limits or ~standard
deviations below the mean/above the mean) when compared to the performance of
children the same chronological age. Results yielded a raw score of ~ which converted
to a standard score of ~ placing~ in the ~ percentile. His/her performance was (within
normal limits or ~standard deviations below the mean/above the mean) when compared
to the performance of children the same chronological age and indicated a (mild,
moderate, severe) expressive language disorder or indicated the presence of age
appropriate expressive language skills. Strengths included ~. Weaknesses included ~.
The Total Language results represent a combination of the Auditory Comprehension
and Expressive Communication subscales to provide an overall assessment of
language skills. Results yielded a raw score of ~ which converted to a standard score
of ~ placing~ in the ~ percentile. His/her performance was (within normal limits or
~standard deviations below the mean/above the mean) when compared to the
performance of children the same chronological age and indicated ~
Speech Development:
Information provided by the parent, ~:
~ was reported to use ~. He was reported to use ~.
Information provided by the assessment:
GOLDMAN-FRISTOE TEST OF ARTICULATION - 2
The Goldman Fristoe Test of Articulation-2 (GFTA-2; Goldman & Fristoe, 2000) is an
individually administered instrument that provides a systematic measure of articulation
of the consonant sounds in simple and complex contexts. The GFTA-2 is divided into
three subtests: Sounds-in-Words, Sound-in-Sentences, and Stimulability. Norms are
provided for ages two through 21. The number of errors on the Sounds-In-Words
subtest can be converted to standard scores with a mean of 100 and a standard
deviation of 15.
Examiner:
~, SFASU Graduate Student Clinician
~, MS, CCC/SLP
Date of Exam: ~/11
Sounds-In-Words Subtest:
~ was given the Sounds-In- Words Subtest of the Goldman Fristoe Test of Articulation 2
in order to assess ~’s articulation skills at the single word level. Results were as
follows:
Substitutions:
Initial position:
Medial position:
Final position:
Omissions:
Initial position:
Medial position:
Final position:
Distortions:
Initial position:
Medial position:
Final position:
Raw Score:
Standard Score:
Percentile:
Test-Age Equivalent:
On the Goldman-Fristoe Test of Articulation-2, Sounds-in-Words subtest, ~ exhibited ~
sound errors on the items administered. He/she obtained a standard score of ~placing
him/her in the ~percentile when compared with other children his/her same
chronological age. These scores indicated ~’s articulation skills (were within normal
limits/ the presence of a mild/moderate/severe articulation disorder)
Sounds-in-Sentences Subtest:
The Goldman-Fristoe Test of Articulation-2, Sounds-in-Sentences subtest was
administered to sample articulatory skills in connected speech. A total of ~ sound errors
were recorded on this subtest. Sampled errors in connected speech were
approximately the same as those recorded in isolated words. The errors noted were ~
Oral Facial Examination:
An oral facial examination was administered in order to evaluate the structure and
function of ~’s oral mechanism. (include findings from form…facts about structure first,
then facts about function, and judgment about whether or not the oral mechanism is
adequate for the normal production of speech…use example below as a guide)
ex: ~’s lips and tongue were found to be of normal size, shape and symmetry. The
relationship of the mandible to the maxilla was within normal limits. The soft palate
appeared to be within normal limits. However, the hard palate was extremely high and
narrow. ~ was able to protrude and retract his lips in rapid succession. He elevated,
depressed protruded, retracted and lateralized his tongue. Velopharyngeal closure was
assessed on production of /a/ and found to be within normal limits. Diadochokinetic rate
was within normal limits. All structures and functions of ~’s oral mechanism were
judged to be adequate for the normal production of speech.
Sensori-Motor Assessment:
According to parent information, teacher information and informal observation, fine and
gross motor areas appear to be commensurate with his/her age. Mrs. ~ reported no
concerns with motor development at this time.
Adaptive Behavior Assessment:
Adaptive behavior was assessed informally using parent and teacher information. ~’s
overall adaptive behavior is commensurate with his/her age. It was reported that ~ can
perform all skills age appropriately with the exception ~.
Assistive Technology Needs:
Assistive technology was assessed informally using parent information and observation.
There are no indications that ~ is in need of the use of any assistive technology in order
for him/her to benefit from the educational environment.
Summary/Determination of Disability:
~ is a ~ year, ~ month old ~ who participated with good effort throughout the
assessment. Environment was appropriate for testing and results are considered to be
a valid indicator of ~ ability. According to the assessment results, ~’s receptive and
expressive language skills appear to be ~ at this time. ~ articulation skills appear to be
~ at this time. Vocal parameters, fluency, and orofacial structure were informally
observed and appear to be adequate for the production of speech. Based on the data
above, ~ does/does not appear to meet eligibility criteria as a student with a Speech
Impairment in the area of ~ at this time. The ARDC will make the final determination of
the eligibility for special education based on the student’s education services.
Recommendations for the Admission Review Dismissal Committee (ARDC):
 Provide speech therapy to target the ~.
 Provide a home program to assist in the remediation of targeted concepts.
Assurances:
The Multidisciplinary Team assures that:
____ Tests, or evaluation materials, and procedures used for the purposed evaluation
were selected and administered so as not to be racially or culturally discriminatory.
____Any standardized tests have been validated for the specific purpose for which they
were used.
____Any standardized tests were administered by trained personnel in conformance
with the instructions provided by their producers.
____ More than one procedure was used for determining whether a student has a
disability and for determining an appropriate educational program for the student
____ Tests were selected and administered so as best to ensure that if a test was
administered to a child with impaired sensory, manual, or speaking skills the test results
accurately reflect the student's aptitude or achievement level or other factors the test
purports to measure, rather than reflecting the student's impaired sensory, manual, or
speaking skills (unless those skills are the factors that the test purports to measure).
____Technically sound instruments were used to assess the relative contributions of
cognitive and behavior factors, in addition to physical or developmental factors.
____The evaluation provides relevant information that directly assists persons in
determining the educational needs of the child.
_N/A_ Materials and procedures used to assess a student with limited English
proficiency were selected and administered to ensure that they measure the extent to
which the student has a disability and needs special education, rather than measuring
the student's English language skills.
____ Information has been drawn from a variety of sources such as aptitude and
achievement tests, parent input, teacher recommendations, physical condition, social or
cultural background, and adaptive behavior.
Signature of Core Evaluation Team Members:
_______________________________
~, MS, CCC/SLP
Speech Language Pathologist
~, 2011
_______________________________
~
SFASU Graduate Student Clinician
~, 2011