Assessing communication disorders in children: A brief overview

Formal testing procedure/ Assessment

A formal assessment is a standardized test procedure involving a written document such as a test (e.g., Receptive Expressive and Emergent Language Scale), administered under controlled conditions, following a specific protocol and procedure. Most SLPs use norm-referenced tests for assessing speech and language skills but criterion reference tests (e.g., Transdisciplinary play-based assessment, Assessment, Evaluation, and Programming System for Infants and Children) can be used by uniformly standardizing administering and scoring procedures.

Norm-referenced assessment tools (e.g., Preschool Language Scale, Clinical Evaluation of Language Fundamentals - 4, Receptive one-word picture vocabulary test, Expressive one-word picture vocabulary test) are standardized tests that allow clinicians to compare children's performance with age-matched peers, in addition to this they also provide quantitative data and standardized scores for diagnostic purposes and tracking progress over time. These tests are composed of empirically selected materials, with different directions for using them, to adequately determine norms and also provide data on reliability and validity. For children with problems needing attention, a screening test is administered and to describe the various components of the disorder a diagnostic test is administered. These tests offer advantages such as being highly objective, reliable, and valid in assessing broad content areas, and they help in identifying specific problematic areas. However, numerous tools are available for evaluating communication skills, making it hard to choose the most appropriate one. A web-based survey done by Denman et al., 2023 on different standardized measures used by Australian SLP’s to evaluate school children with language difficulties reveals that even though there are multiple assessment tools available for evaluating language skills, only a few were used regularly (e.g., Clinical evaluation of language fundamentals - Preschool). However, each tool has unique abilities to be useful in different situations but there is no one tool or set of tools that are specific to a child or clinician. 2, 3, 4, 5 Also, the results obtained from norm-referenced tools only measure a child’s language ability in comparison with his/ her peers but they are not tailored to measure a child who is from a different cultural and linguistic background. There are multiple studies done to address the issues faced by clinicians in assessing language abilities in children from various cultural and linguistic backgrounds. The results of these studies indicate that clinicians must put efforts on developing resources that are regionally accepted and validated to adhere the regional competences to minimize bias and misdiagnosis. In addition to this clinicians should have access to developmental norms of communication skills for multiple languages used by diverse children that they encountered in their clinics. 6, 7, 8

Information from the parents or caregivers and Parent-reported measures

To extract the necessary information from the parents/ caregivers about the child’s communication development and to create a comprehensive clinical profile clinicians rely on methods like obtaining a detailed case history via semi-structured interviews, administering norm-referenced parent-reported measures such as inventories (e.g., MacArthur–Bates Communication Developmental Inventory), questionnaires (e.g., Ages and Stages Questionnaire -3), rating scales, and checklists (e.g., Children’s Communication Checklist - 2) which allows the SLPs to enable individualization and offer a range of viewpoints while interpreting the overall diagnosis. A series of studies was conducted by Crais and Bishop et.al, 2009 where they reported that parents can be reliable informants in extracting relevant information about their child’s communicative and developmental abilities as they observe their children in a more naturalistic environment and this information will provide valid and reliable results to support the clinical decision. 5, 9, 10 Nevertheless, drawbacks include the possibility of a lack of impracticality, individual biases, and judgment. Overall, this strategy provides both advantages and disadvantages, but it also provides a comprehensive communication profile of the child to the clinicians. 2

Speech-language sampling

Collecting a child’s speech and language samples is crucial for understanding communication skills. These samples can be obtained in various situations and settings such as conversation with family members, caregivers, etc., structural play, narration, and expository speech. A couple of studies indicate that language samples provide a piece of valuable information about the child’s pragmatic and discourse abilities, there is a high correlation between language sample measure and standardized test scores, and it is a crucial component of the comprehensive assessment. 12, 13 Language samples can be elicited using various methods like when the child is playing with different toys, elicited description using a single object or an event, interviewing the child by using different topics, and Narrative elicitation by encouraging the child to narrate a story. Play-based assessments can be incorporated, as play serves the key role in observing and documenting the child’s behavior, here parents or caregivers are facilitators who take turns to elicit target behaviors while the clinician becomes the observer who tracks the child’s responses. There are few criterion-based (e.g., transdisciplinary play-based assessment) and norm-based (e.g., communication and symbolic behavior scale developmental profile) assessment tools available for assessing play behaviors in children. The results obtained during the assessment can be directly implemented into intervention. 5 A study by Eisenberg et al., 2018 examined the impact of language samples in two different ways, the first one was during play and the second was elicited description. The collected sample was analysed using developmental sentence scoring (DSS), a diagnostic tool developed by Lee in 1974. Findings of the study indicated a significant difference in DSS scores between the samples, but sentence points were significantly higher for the play sample. Although there was a correlation between samples, the correlation for DSS was below an acceptable level. The agreement between sample types for pass-fail decisions on DSS scores was only moderate. Therefore the information collected using these procedures provides the best diagnostic data, and scope for individualization, and also helps to identify functional deficits concerning language. On the other hand, drawbacks include the process being time-consuming, difficulty in collecting representative samples, and clinicians must have higher expertise. The data collected during the assessment has less accuracy and reliability. 2, 3, 12

Dynamic assessment

Dynamic assessment is a process that evaluates the child’s learning potential using a test-teach-retest approach. In this approach, the clinicians first measure the current performance of the child later teach them specific strategies, and observe how they respond to instruction, later the mediated learning experience is measured and compared. Few studies have emphasizes incorporating dynamic assessment with standardized tools for children from different linguistical and cultural backgrounds to avoid misdiagnosis and add more validity to the clinical decision-making process. 7 A systematic scoping review by Bamford et al., 2022 highlights the broad scope and variability of dynamic assessment.The review discusses the framework of dynamic assessment which aids clinicians in evaluating children’s communication skills, identifying appropriate methodologies, and increasing transparency. This approach improves implementation fidelity and reduces the challenge of applying a broad and variable research base, particularly in assessing children with communication disorders. This approach helps clinicians to determine the baseline, identify the potential goals, and teach effective intervention strategies. This approach can be adapted for assessing children with multicultural backgrounds. However, the potential behaviors can be missed during the assessment due to a lack of objectivity, insufficient clinical experience, or skills. 2, 3, 14, 15