Pediatric & Adolescent Clinic
Evaluation (PACE):
Assessing Children’s Speech and
Language
Getting on the same page
Areas of Discussion

Website
 Coming

soon….
Overview
 link
at bottom of PACE home page
Areas of Discussion

The Assessment
 Language
Comprehension
 Language Expression
 Articulation/Phonology
 Phonemic Awareness/Preliteracy
 Play
 Structural-Functional/Oral-Motor Exams
Areas of Discussion

Making Recommendations
 To
treat or not to treat?
 What
is normal?
 Is the person functional without treatment?
 Are they ready for treatment?
 What do I recommend?
Reports
 Tutorials
 Assignments

Assessing Language
Comprehension over the
Childhood Years
Assessing Language Comprehension

You must do both formal and informal
assessments.
 Formal
 Standardized
tests
 Informal
 Observation
in low structured contexts
 But, you must set up the opportunities!
Assessing Language Comprehension
You must determine if the data collected
support one another.
If they are discrepant, you must ask
yourself “Why?” You will need to try to
figure out why and talk about it in the
report.
Formal Assessment of
Comprehension

Formal assessment measures
 Know
what they assess
 Know how they assess (e.g., pictures, objects,
toys, etc.)
 Know age ranges
Informal Assessment of
Comprehension – 0 ~ 4 years

Areas to consider:

Ability to engage in joint attention

Following directions with/without gestures – some general age
ranges to keep in mind:
12-18 months – follows simple 1 step command
 24 – 30 months – carries out a series of 2 related commands
 3 – 3;6 years – responds to commands involving 2 actions and
responds to commands involving 2 objects.
 3;6 – 4 years – responds to commands involving 3 actions


Answering simple yes/no, wh-questions (age ranges for these)

Responding to various semantic relations

Understanding developmentally appropriate locatives
Informal Assessment of
Comprehension – 3 years and up


Areas to consider:

Answering wh-questions

Understanding developmentally appropriate concepts

Following multi-step directions in the absence of cues
(e.g., Simon Says…)

Making inferences (~4 + years)
See selections from The Clinical Assessment of
Language Comprehension
Assessing Language Expression
over the Childhood Years
Expressive Language – Areas to Consider

Expressive Language

Form

Content

Use
Form
Content
Use
These are separated for simplicity’s sake. But keep in
mind there is overlap between the three areas and they
must all be considered. The interaction between the three
also must be kept in mind.
Expressive Language – Form

Form






MLU
syntactic structure
grammatical morphemes
complex sentences
speech sound production*
intonation, prosody, inflection
*We will talk about the speech sound production
aspects in a separate section
Content
 topics
discussed (here/now; past, present,
future events)
 appropriateness of language to context vs
tangential or echolalic language
 perseverative language
 semantic relations
 vocabulary
 narrative skills
Use
 communicative
intentions
 eye contact/physical proximity and body
language
 topic initiation, maintenance, conclusion
 turn taking skill
 Language use is context and partner
dependent and is best done via informal,
careful observation.
Formal measures
Many formal measures have subtests that
primarily assess in one ‘domain’ – PLS-4,
CELF-P:2/CELF-4 – to help you
diagnostically, BUT
 Do not forget to look at the ‘whole’
picture!

Informal Assessment

Low-structured language sampling



Play-based
Show-n-share
Conversation
Must set up opportunities to discuss a variety of topics including things in
the past, present and future
 Must provide opportunities for child to maintain a conversation initiated by
you
 Must provide opportunities for child to initiate conversation


See also

Owens (3rd ed.) (computer lab)


Chapters 5, 6 and 7 for ‘How To’s’ and ways to analyze the samples
Appendix F for specific “Indirect Elicitation Techniques” to elicit
various types of expressive language
Narratives: Why Assess Them
Predictor of persistent language disorder
 Have ecological validity – natural part of
daily interaction
 Test of language content, form and use;
an interaction between the 3 areas.
 Can set up opportunities for dynamic
assessment – add supports to see if they
help the child.

Narratives
 Discourse
(narrative or expository)
 Story retelling
 Story generation with a picture
 Story generation with a series of
pictures
Hierarchy of Procedures for
Collecting Narratives
Narrative Samples
Spontaneous
Personal
Fictional
Elicited
Personal
Script
Fictional
Story Generation
From The Guide to Narrative Language
Story Retelling
Eliciting Narratives

Narratives
 Discourse
 Low-structured
play for 0 – 4 years
 Show-n-tell for 4 years +
Eliciting Narratives

Narratives

Story Retelling with visual support


Bus Story (story retelling) for 3;9 - 8;3 – with caveats
Sequence Cards (2, 3, 4, 5, 6 step)


Story Retelling without visual support


See Make-A-Book in materials room
Strong Narrative Assessment Procedure (SNAP) for K through
8
Story Generation with visual support

Expression Connection (notebook) – 6 years +
Narrative Test

Test of Narrative Language –
The tiny nutshell description:
 Story
Retell (no picture)
 Story generation with sequence pictures
 Story generation with a single picture
Speech – Formal Assessment of
Articulation/Phonology

Connected speech sample (for all ages)
 Consonant and vocalic repertoires
 Syllable shapes
 Stress patterns
 Consistent or inconsistent consonant or
vocalic errors
 Can
also judge rate, prosody, intonation,
inflection, etc. as appropriate
Speech – Informal Assessment of
Articulation/Phonology
Use a language sample during play/conversation
or…
 CPAC provides story-retelling contexts to set up
opportunities for speech sounds
 Compare errors in connected speech samples to
performance on standardized tests (do they
match?)
 Determine intelligibility rating from connected
speech

Speech – Formal Assessment of
Articulation/Phonology

There are some articulation tests that are
standardized down to age 2;0
The question is, how easy is it to get
a 2-year-old to sit for your test?
Speech – Formal Assessment of
Articulation/Phonology

For children over the age of 3, any (ageappropriate) articulation or phonology test
(e.g., SPAT, Goldman-Fristoe, HAPP-3) will
do.
Speech – Issues in the Assessment
of Articulation/Phonology

Developmental articulation delay


See age ranges of normal consonant development to
determine if the child has a problem.
Phonological Delays/Disorders
 Use
information you learned in Articulation
and Phonological Disorders class.
Speech – Issues in the Assessment of
Articulation/Phonology

Dyspraxia
 For
motor planning problems
 Hierarchy
for Motor Speech Examination
 Motor Speech Examination form – any one that
you like as long as it is comprehensive
Speech – Issues in the Assessment of
Articulation/Phonology

Determining if a child needs speech
treatment depends on a variety of factors:
 Age-appropriateness
of errors/patterns
 Typical vs atypical errors/patterns
 Effect of errors on intelligibility
 Level of stimulability
 Child’s (not parents’) awareness and distress
Stimulability

Purpose:
 Brief
trial teaching to determine client’s ability
to produce a correct (or improved) production
of an erred sound. Indicates readiness to
learn (important prognostic indicator).
 Also consult “Eliciting Sounds: Techniques and
Strategies for Clinicians, 2nd Edition,” by
Secord et al
Stimulability

It is highly advisable to practice teaching
stimulabilty techniques with your colleagues
before you actually try to do it on a client.


This will help you know what types of prompts and
cues that you can use to help elicit a sound, so you
won’t “freeze up” in the eval. 
Only do stimulability on sounds actually in error
(not just because the parent wrote it on the
form).
Assessing Phonemic Awareness
General Information about Phonemic
Awareness

Standardized Tests
 CTOPP
(Clinical Test of Phonological
Processing)
 PAT (Phonological Awareness Test)
 CELF-P:2 & CELF-4  have
PA screening subtests
Assessing Play
Assessment of Play

Play is considered a “window into cognition”

As one of our previous students wrote in a
report:

“Informal play assessments provide an opportunity to
examine a child’s understanding of objects and
events, and their relationship. As knowledge of
objects and events grows, so does the foundation for
acquiring language.”
Informal Assessment of Play

Resources:

Assessing Linguistic Behaviors (Carpenter’s Play
Scale, in computer lab)

“Observation of Cognitive Development” from
Transdisciplinary Play-Based Assessment (notebook)
Structural-Functional/Oral-Motor
Exams
After the Information is Collected:
Making Recommendations
Making Recommendations: To Treat
or Not to Treat

Is treatment warranted?
 Consider
developmental norms – is the child
within normal limits?
 Functionality
 Readiness to learn
What is Normal??
Test Scores and What they Mean
SCORE INTERPRETATIONS RELATIVE TO
THE NORMAL CURVE
Decision
Superior
Above average
z-score range
> +1.65
+1.01 to +1.65
Normal (WNL)
+/- 1.0
Borderline
-1.01 to -1.65
Deficient
< -1.65
(In your reports for
us – use “significantly delayed” or
“area of significant difficulty”)
Scores and Informal Observations

You must consider test scores within the
context of what the child is actually doing
with communication.

Do the scores and what you see the child
doing match?

If they don’t, why not?
Functionality

Do the areas of difficulty determined by
the assessment impair the child’s ability to
 Interact
with family and peers?
 Do well in school?

If so, treatment may be warranted.
 In
articulation treatment – sometimes our test
scores indicate a serious delay, but if you look
at the qualitative data, treatment may actually
not be warranted.
Readiness to Learn

Stimulability or Dynamic Assessment
 Is
the child ready to learn these new
behaviors?
 Cognition
can play a big role in this.
 If
not, it may make more sense to wait a little
for treatment, or consider a different
approach
 e.g.,
Parent training
So treatment is warranted: What do I
recommend?

This will be unique to each case.
 You
will need to draw on all your knowledge
gained from previous classes to make
educated suggestions.
 Your recommendations will need to match the
needs of the family.
 Some
families will want to know where to go to
get help.
 Some families will want to specifically know what
they can be doing to help.
 Some families do not want help.
What Goes in the Recommendation
Section?
Since this practicum is focused on clients
who have already been accepted into
our program for the summer, we will
recommend treatment.
 What should be the focus of treatment?
 What are some broadly written
behavioral objectives?
What Goes in the Recommendation
Section?
Suggestions for parents or other
professionals to help with child’s needs
Parent Articles
Recommended books
Recommended websites
During the assessment…
During the assessment, we try to stay out
of the room unless we see you struggling.
 Please do not be offended if we come in
to help you.
 If you are struggling but for some reason
we have not come in, please call for us.
 Do your best.
 Make no assumptions and ask lots of
questions.

Tutorials
There are a number of tutorials that you should carefully
review:
1.
2.
3.
4.
5.
6.
Preplanning *
Day of Evaluation *
Hearing Screening *
Interviewing *
PACE Reports
Report Writing Hints
* Please be sure to review these before your first
evaluation session.
If you have questions…
Please do not hesitate to ask
your supervisor!