ADP: Language Assessment and TreatmentSara S. Plager, M.Ed., CCC

Chief and Senior Clinical LecturerSpeech-Language Pathology

Department of Communicative Disorders

Definitions

Hearing Acuity:

• The clearness/sharpness of hearing ability.

• Involves the reception of sound.

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

Central/Auditory Processing, con’t

Typically there will be problems in:

• Listening in the presence of background noise

• Localizing sounds

• Following directions

Central/Auditory Processing, con’t

And problems with:

• Attending

• Daydreaming

• Distractibility

• Fatigue towards the end of class

• Disruptive behaviors

Definitions

Language Processing

• How the brain attaches meaning to the sound groups that form words, sentences, stories, etc.

• Also occurs in reading

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

Language Processing con’t

There tend to be difficulties understanding:• Language concepts• Abstract ideas• Idioms• Colloquial expressions• Humor• Words with multiple meanings• Inferences

Language Processing con’t

• Figurative language• Logic• Defining• Comparing• Contrasting• General listening• Note taking• Inconsistent performance in academic work and

behaviors

Language Processing, con’t

Can co-exist with:

• Learning Disabilities (LD)

• Attention Deficit/Hyperactivity Disorder (ADHD)

• Other pragmatic/social deficits

Assessment

Language Battery• Vocabulary (receptive and expressive)• Grammar (morphology and syntax)• Language Concepts (defining, comparing,

contrasting)• Phonological awareness• Auditory memory• Non-verbal intelligence

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

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

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

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

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

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

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

Assessment, con’t

Nonverbal Intelligence

• Test of Nonverbal Intelligence-3

-ages 6 thru adult

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

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

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

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.

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”

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.

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”.

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.

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

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)

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

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

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