ADP: Language Assessment and Treatment

1. ADP: Language Assessment and Treatment Sara S. Plager, M.Ed., CCC Chief and Senior Clinical Lecturer Speech-Language Pathology Department of Communicative Disorders

2. Definitions Hearing Acuity: • The clearness/sharpness of hearing ability. • Involves the reception of sound.

3. Definitions Central/Auditory Processing • How the brain interprets the sounds • Involves the perception of sound • Difficulties in discrimination, identifying and/or retaining sounds after the ear has heard them

4. Central/Auditory Processing, con’t Typically there will be problems in: • Listening in the presence of background noise • Localizing sounds • Following directions

5. Central/Auditory Processing, con’t And problems with: • Attending • Daydreaming • Distractibility • Fatigue towards the end of class • Disruptive behaviors

6. Definitions Language Processing • How the brain attaches meaning to the sound groups that form words, sentences, stories, etc. • Also occurs in reading

7. Language Processing, con’t Typically the deficits/problems include: • Delayed responses • The need to rehearse statements • The need for frequent review of newly learned material

8. Language Processing con’t There tend to be difficulties understanding: • Language concepts • Abstract ideas • Idioms • Colloquial expressions • Humor • Words with multiple meanings • Inferences

9. Language Processing con’t • Figurative language • Logic • Defining • Comparing • Contrasting • General listening • Note taking • Inconsistent performance in academic work and behaviors

10. Language Processing, con’t Can co-exist with: • Learning Disabilities (LD) • Attention Deficit/Hyperactivity Disorder (ADHD) • Other pragmatic/social deficits

11. Assessment Language Battery • Vocabulary (receptive and expressive) • Grammar (morphology and syntax) • Language Concepts (defining, comparing, contrasting) • Phonological awareness • Auditory memory • Non-verbal intelligence

12. Assessment, con’t Receptive Vocabulary • Receptive One-Word Picture Vocabulary Test-2000 (ROWPVT-2000) -ages 2 thru 18-11 • Peabody Picture Vocabulary Test-III (PPVT-III) -ages 2-6 thru 90 • Picture Vocabulary subtest of the Test Of Language Development-P:3 (TOLD-P:3) -ages 4 thru 8-11 • Vocabulary Subtest of the Test for Auditory Comprehensions of Language-3 (TACL-3) -ages 3 thru 9-11

13. Assessment, con’t Expressive Vocabulary • Expressive One-Word Picture Vocabulary Test-2000 (EOWPVT-2000) -ages 2 thru 18-11 • Expressive Vocabulary Test (EVT) -ages 2-6 thru 90 • Relational Vocabulary Subtest of the TOLD-P:3 -ages 4 thru 8-11 • Oral Vocabulary Subtest of the TOLD-P:3 -ages 4 thru 8-11

14. Assessment, con’t Grammar (morphology and syntax) • Grammatical Morphemes Subtest (receptive) of the TACL-3 • Elaborated Phrases and Sentences Subtest (receptive) of the TACL-3 • Grammatic Understanding subtest (receptive) of the TOLD-P:3 • Grammatic Completion Subtest (expressive) of the TOLD-P:3

15. Assessment, con’t Auditory Memory • Token Test for Children-Revised -ages 3 thru 12-6 • Concepts and Directions Subtest of the Clinical Evaluation of Language Fundamentals-3 (CELF-3) -ages 6 thru 21) • Auditory Number Memory subtests of the Test of Auditory-Perceptual Skills-Revised (TAPS-R) -ages 4 thru 12-11

16. Auditory Memory, con’t • Auditory Sentence Memory Subtest of the TAPS-R -ages 4 thru 12-11 • Auditory Word Memory Subtest of the TAPS-R -ages 4 thru 12-11 • Auditory Interpretation of Directions Subtest of the TAPS-R -ages 4 thru 12-11

17. Assessment, con’t General Language, Language Processing, Thinking, Reasoning, and Pragmatics • Language Processing Test-Revised (LPT-R) -ages 5 thru 11-11 • Listening Test -ages 6 thru 11 • Auditory Processing Subtest of the TAPS-R -ages 4 thru 12-11

18. Assessment, con’t • Test of Oral and Written Language Scales (OWLS) -ages 3 thru 21 • Test of Pragmatic Language (TOPL) -ages 5 thru 13-11 • TOLD-P:3 -ages 4 thru 8-11 • CELF-4 -ages 6 thru 21

19. Assessment, con’t Nonverbal Intelligence • Test of Nonverbal Intelligence-3 -ages 6 thru adult

20. Assessment, con’t Phonological Awareness • Lindamood Auditory Conceptualization Test-Revised (LAC) -grades K thru adult • Comprehensive Test of Phonological Processing (CTOPP) -ages 5 thru 24-11 • Test of Phonological Awareness (TOPA) -ages 5 thru 8-11

21. Assessment, con’t Plager’s typical battery • Age 6 thru 12-6 -EOWPVT-2000 -TOLD-P:3* -Token Test for Children (1st or 2nd ed) -TONI-3 -LAC *Will add in the TACL-3 if the Grammatic Understanding subtest of the TOLD-P:3 was low

22. Assessment, con’t Plager’s typical battery • Age 12-7 thru 21 -ROWPVT-2000 -EOWPVT-2000 -OWLS -Concepts and Directions subtest of the CELF-3 -TONI-3 -LAC

23. Assessment, con’t • Tricks of the trade: -If I “know” something isn’t right and none of these test scores reflect deficiencies, then I will do the LPT-R and/or a TOPL.

24. Interpretation and Considerations • Compare the TONI-3 SS to the Total SS • Compare receptive SS to expressive SS • Compare the various language realms/subtests to each other • Note behavioral observations • Note response “rise time” • Note auditory discrimination errors • Note L/R orientation • Note handwriting/fine motor skills/strength • Note impulsivity, attending, focus to detail • Note general “attitude”

25. Impressions • The pattern of language difficulties appears c/w a language processing deficit. • Test profile appears c/w a language learning disability. • Significant difficulty with perception and conceptualization of speech/sound units, indicative of a dysfunction that disrupts the spelling/reading process and interferes with the acquisition of spelling/reading.

26. Impressions, con’t • Significant difficulty following longer (greater than ___ critical elements) and syntactically more complex directions, indicative of auditory memory and/or language processing and/or depressed attending skills. • Based on the language profile (exp scores higher than rec scores), it would be easy to assume, based on verbal output, that child understand more/all/most of what is said to him, however, this is not the case. Child tends to be more of a “social butterfly”.

27. Recommendations • School records and IEP request for review • Based on profile obtained (verbal/non-verbal gap, increased response/”rise-time”, gaps among various language realms, rec/exp gap, word discrimination errors, difficulty focusing during external auditory stimuli, declining scores, etc), testing for Auditory Processing Disorders (APD) and/or psychoeducational testing should be completed.

28. Recommendations, con’t • Language therapy • Further testing for dyslexia/reading disorders. • Implementation of the Earobics home computer program (phonological awareness). • Keep directions short and syntactically simple -Given in a logical, time-ordered sequence -Use cueing words (“first”, “next”, “last”) -Verify direction prior to implementation -Completion of one direction prior to giving next direction

29. Recommendations, con’t -Encourage child to ask for further clarification. -Avoid embedded clauses and wording in the negative • Monitor impulsivity and attending skills in the classroom • Use “readying cues” (“Listen”, “Get ready”, “Here’s the next one”, etc)

30. Recommendations, con’t • Intervention for teaching memory strategies -chunking -intonation -list-making (pictures and words) -over-practice • Multi-modal approach to teaching -visual/written -gestural -verbal/auditory

31. Recommendations, con’t • Encourage use of a school agenda • Use chore charts and/or lists at home and at school • Avoid timed tests • Allow additional time between the time a question is asked and that a response is expected • Alternative classroom placement may want to be considered

32. Recommendations, con’t • Continued monitoring of ADHD symptoms at home and at school (defer to school personnel for monitoring and to physician for recs re: changes to medications and/or doseages. • Implementation of strategies to encourage/reinforce slowing down and not rushing thru school work/homework