Introduction
Oscar C is 6 years and 9 months and currently in Year 1. He was referred to the clinic by his paediatrician, Dr. X, who reported some characteristics of ADHD. A recent audiological assessment revealed significant auditory processing problems. A questionnaire which was completed by Oscar’s classroom teacher has also been provided. A brief, informal narrative sample gained by the clinician in the initial consultation revealed simplified syntax, compromised lexical diversity, immature use of specific grammatical forms and limited vocabulary and verbal fluency.
Based on teacher report, case history information and Oscar’s narrative analysis, it is suspected that Oscar has a learning disability (LD). More specifically Language Learning Disability (LLD). LLD refers to language impairment which potentially affects all aspects of language, both spoken and written. Based on the information provided, it is fair to suspect that Oscar presents with LLD. However, this cannot be confirmed, nor can intervention commence, until further assessment has been conducted.
The purpose of language assessment is to obtain information regarding comprehension and production of language (Paul, 2007). Within these two modalities, the three domains of language need to be evaluated, i.e.: content, form and use. Children, like Oscar, who are hyperactive and present with attention deficits have increasing difficulty trying to attend and concentrate over long periods of time (Miller, 1981). For this reason, the allocated two hours for assessment will be split over three sessions – each forty minutes in length.
Session One
Before the clinician commences with the assessment, it is important to take note of any specific concerns of the client and/or parent-centered issues. Mrs. C had reported that she did not understand why Oscar had been referred for speech pathology and felt that he would eventually grow out of it. It is the role of the clinician to explain the purpose of assessment and how early intervention could potentially benefit Oscar. Only once rapport has been established (with all parties) can assessment get underway.
The CELF-4 will be administered first as this is the most comprehensive of all the tests, investigating disorders of content, form, and use (Paul, 2007). This is a good way to start assessment as the CELF-4 can help to pinpoint areas of difficulty so that they can be probed further. The CELF-4 is particularly useful in the case of Oscar as it covers a broad range of language abilities whilst, at the same time, minimizing student boredom by using age-dependent start points and discontinue rules to shorten test administration time. Due to time constraints, only the 4 core subtests will be administered. These are as follows;
- Concepts and Following directions (C&FD) – Oscar’s teacher has reported that Oscar requires literal interpretation and needs visual clues to process classroom instructions. The C&FD subtest will help to evaluate Oscar’s ability to interpret, recall and execute oral commands (of increasing length and complexity) that contain concepts of functional language.
- Word Structure – Oscar’s narrative sample showed immature use of specific grammatical forms. The Word Structure Subtest will assess Oscar’s knowledge of grammatical rules in an oral sentence completion task.
- Formulating Sentences – Oscar’s narrative sample indicated incomplete and simplified syntactical structures as well as limited vocabulary. This subtest will help to evaluate Oscar’s ability to formulate compound and complex sentences when given grammatical constraints.
- Recalling Sentences -This subtest is used to evaluate the student’s ability to recall and reproduce sentences of varying length and syntactic complexity. This will give insight into Oscar’s auditory memory skills as well as aspects of his receptive and expressive language.
In total, administration of the four core subtests of the CELF-4 will take approximately 45 minutes (35 minutes of testing time + two 5 minute breaks between subtests to ensure that Oscar stays focused). Because Oscar enjoys playing with Lego, the therapist will engage Oscar in games using Lego blocks during the breaks. Oscar’s teacher has expressed her concern about Oscar’s very poor numeracy skills and inability to remember basic number facts. For this reason, numeracy will be informally looked at through play. The focus will be on counting as well as basic addition (as per the grade one mathematics curriculum).
Oscar will be asked to count the number of blocks he is given. Basic arithmetic will also be assessed e.g.: ‘If you have three blocks and I give you one more, how many blocks will you have?’ This one-on-one probing will allow the clinician to gain a better idea of whether Oscar’s numeracy problems are rooted in problematic auditory processing or are language-based. In turn, this will help to determine appropriate follow-up assessment.
Session Two
The aim of the second session will be to assess reading and spelling. According to Owens (2004), both reading and spelling assessments should be a portion of any thorough language evaluation.
To start, The Neale Analysis of Reading Ability will be administered. This is a standardized test with Australian norms, which assesses oral reading and decoding skills (Cain & Oakhill, 2006). Oscar’s teacher has mentioned that Oscar experiences difficulty with phonics – which is an important precursor to literacy. The Neale will help to establish how Oscar’s reading ability and comprehension compare with other children his age.
The test takes approximately 20 minutes to administer. Upon completion, Oscar will be allowed some free time to engage in structured play whilst the Pragmatics Profile of Everyday Communication (PPEC) is discussed with his mother. During a conversation with Oscar, he was observed to make little eye contact or facial expression and his speech was noted to be quite loud. For this reason, the PPEC will be included as part of the assessment battery.
This PPEC enables the clinician to build a comprehensive picture of a child’s pragmatic and communicative skills in everyday situations by means of a structured interview with the primary caregiver. Due to time constraints, the PPEC will only be administered in part. Approximately 10 minutes will be spent administering the interview online and an additional 5 minutes will be used to explain to Oscar’s mother how to go about completing the remainder of the interview at home. Going through the PPEC in this way will give Oscar’s mother the opportunity to ask questions and gain a good idea of the types of responses expected. The completed interview will be brought to the next session.
Thereafter, the therapist will administer the Astronaut Invented Spelling Test (AIST). Although not designed to be a diagnostic tool, the AIST provides insight into the child’s phonemic awareness, letter-sound knowledge, and early orthographic skills (Gordan & Weiss, 2007). These are all critical for the development of literacy. The AIST takes approximately 10 minutes to administer which will lead to the conclusion of Session Two.
Session Three
Once reading and spelling have been assessed, phonological awareness (PA) can be investigated. The importance of assessing/remediating PA skills lies in its importance in identifying/supporting children who are at risk of reading failure. The reason for assessing reading and spelling first is to observe if there is a delay in either area. In Oscar’s case, this will most likely be evident and thus PA skills will be assessed to pinpoint problem areas that could potentially benefit from intervention.
In terms of intervention, it should be noted that working on phonological awareness on its own is meaningless and that PA skills should always link back to the main goal of enhancing oral language and facilitating reading development. According to the teacher report, Oscar experiences difficulty with sound/letter correspondence and rhymes associated with sounds. The Sutherland Phonological Awareness Test-Revised (SPAT-R) is a highly regarded standardized test that assesses a broad range of PA skills. It comprises 13 subtests and takes approximately 15 minutes to administer.
Upon completion of the SPAT-R, Oscar will be engaged in a fun game of ‘Simon Says’ with the aim to informally assess auditory memory. Auditory memory is extremely important for students as it allows them to listen to a teacher and recall what was said (Owens, 2004).
Oscar’s teacher has commented on Oscar’s inability to follow auditorily given classroom instructions. This could be attributed to Oscar’s auditory processing problem (already established) or to poor auditory memory. Weak numeracy skills could possibly also be attributed to this. The Simon Says activity will therefore assess auditory memory. Based on this, the clinician will be able to make a more informed decision as to whether a formal test (such as the Test of Auditory Processing Skills – 3rd Edition (TAPS-3)) needs to be administered in a follow-up assessment.
The last 20 minutes of the session will be spent administering the Test of Narrative Language (TNL). This is because Oscar’s previous narrative sample indicated narrative development to be below the expected level for his age. At a macrostructural level, Oscar’s story grammar appears to be consistent with Applebee’s Stage 4: the Chain Narrative (Westby, 1984). This is age-equivalent to a 4 ½ – 5-year-old child. Having said this, it should be noted that the narrative sample gained was through an informal screening process only and therefore not entirely conclusive. The main purpose of the TNL is to assess children’s ability to listen, understand and produce narratives.
Chapman (2000) reported in a large study of narrative production in school-aged children that story production tasks were found to be highly educationally relevant and should play a significant role in the evaluation of children with developmental LLD.
Follow Up Assessment
Three other assessments have to be administered beyond the allocated two hours because they are able to offer useful information about Oscar’s auditory perception, as well as his auditory processing skills. The tests recommended are Test of Auditory Processing Skills-3 (TAPS-3), Test of Language Development, Fourth Edition (TOLD-4), and Developmental Test of Auditory Perception (DTAP). Time required for carrying out these tests is around 2 hours. They will help to identify additional developmental problems Oscar may have and state whether there is a need to refer to other professionals.
TAPS-3
TAPS-3 should be taken first because it requires half of the total time to be carried out. The test itself is not complicated and even entertaining; it is great to start with because it allows testing a wide range of Oscar’s skills. It consists of 9 subtests that focus on the concepts of “word discrimination, word memory, phonological segmentation, sentence memory, phonological blending, auditory comprehension, numbers forward, auditory reasoning, and numbers reversed” (Maanum, 2009, p. 149).
The greatest advantage of this test for Oscar is that it is untimed; approximately, it will take an hour but the boy is still not limited in giving answers to the questions. Moreover, Oscar’s narrative analysis has revealed that he uses limited number of word classes and simplified syntactic structures. This test may give explanation to these problems, for instance, pointing at the boy’s poor sentence memory or word discrimination.
TOLD-4
TOLD-4 should be carried out after TAPS-3 because these two tests have similar elements and the findings may then be compared to make sure that the assessment is valid. Besides, TOLD-4 explores some aspects that TAPS-3 does not cover; these aspects primarily include picture, relational and oral vocabulary. This test is good for identification of Oscar’s oral language strengths and weaknesses and of his level of oral language skills as such (Salvia, Ysseldyke, & Bolt, 2009).
TOLD-4 also consists of 9 subtests that measure different aspects of the child’s oral language. According to the results of narrative analysis, Oscar’s speech may be characterized by numerous disruptions which are a sign of immature vocabulary. Primary version of TOLD-4 will measure his understanding of spoken English, his understanding of the meaning of the sentences, his ability to imitate words and sentences, and his word articulation (whether he is able to utter specific English sounds and words) all of which may explain his problems with vocabulary construction. Thus, this test may show where it is necessary for Oscar to refer to an otolaryngologist or related specialists.
DTAP
Finally, DTAP should be carried out last because it is the easiest and takes the least time. This test allows assessing Oscar’s comprehension skills; what is more important, it allows measuring his auditory perception without invoking his reasoning. In this way, his comprehension will be assessed in different contextual settings. DTAP is aimed to test Oscar’s ability to distinguish between different non-language sounds (though language-related sounds are also presented).
The greatest value of this test for Oscar consists in its evaluating auditory perception skills with and without background noise (auditory processing assessment carried out earlier revealed that Oscar had problems with auditory processing in the presence of background noise). This test will help to identify whether Oscar’s auditory processing problem detected earlier was transient or is permanent. In the latter case, there is a sense in referring to a neurologist to discover the reasons for the boy’s auditory processing problems.
Reference List
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- Bellis, T, (2003). When the Brain Can’t Hear. Baltimore: Pocket Books.
- Brown, R. (1973). A first language: The early stages. London: George Allen & Unwin Ltd.
- Cain, K. & Oakhill, J. (2006). Assessment matters: issues in the measurement of reading comprehension. The British Journal of Educational Psychology, 76, 697-708.
- Chapman, R. (2000). Children’s language learning: An interactionist perspective. Journal of Child Psychology and Psychiatry, 41, 33-54.
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- Salvia, J., Ysseldyke, J., & Bolt, S. (2009). Assessment: In special and inclusive education. Mason: Cengage Learning.
- Miller, J. (1981). Assessing language production in children. Boston, MA: Allyn & Bacon.
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