chapter 14 · web viewwhat types of verbal or nonverbal communication strategies have you tried...

Nonverbal and Minimally Verbal Children’s Assessment Protocols

From: Hedge & Pomaville (2008)

Child Case History

Assessment of Nonverbal and Minimally Verbal Children: Interview

Protocol

Orofacial Examination and Hearing Screening

Verbalizations of Nonverbal or Minimally Verbal Children:

Assessment Protocol

Nonverbal Expressive Communication: Qualitative and Quantitative

Assessment Protocol

Nonverbal Receptive Communication: Qualitative and Quantitative

Assessment Protocol

Interaction Between Communicative Partners and the Child:

Assessment Protocol Assessment Report

This section contains a collection of protocols that can be used individually or combined in a

variety of ways to facilitate the evaluation of children who are nonverbal verbal or minimally

verbal.

These protocols can be individualized and printed out as a group and used for a complete

speech and language assessment in a nonverbal or minimally verbal child. Also, one or more

protocols may be selectively printed out and used as needed. In assessing children with multiple

disorders of communication, the clinician may combine these protocols with other protocols

(e.g., speech assessment protocols, language assessment protocols, or voice assessment

protocols).

It should be noted that nonverbal and limited verbal children are extremely heterogeneous,

representing a wide range of ages, cognitive abilities, and motor abilities. Therefore, specific

protocol items may need to be eliminated or adjusted, as needed for a specific child. For

example, the interview protocol includes a wide array of questions that may not apply to all

children. If the child is not in a school setting, or if AAC is not a consideration, then those

questions can be eliminated during the interview.

Note to the clinician: Individualize each protocol as you see fit before printing them for

clinical use. Please delete any extraneous comments or notes found in each of the protocols.

Child Case History

Have the parents or other caregivers fill out the case history form given in Section 1 (Common

Assessment Protocols). Let the case history form guide your interview.

Interview Protocol

Name___________________ DOB __________ Date __________ Clinician ______________

Preparation

Review the “interview guidelines” presented in Chapter 1. Make sure the setting is comfortable with adequate seating and lighting. Record the interview whenever possible. Find out if the parent is comfortable having the child in the same room during the

interview. If so, have something for the child to do (toys, books, etc.). If not, make arrangements for someone else to supervise the child in a different room during the interview. If it is not too distracting, it might be valuable to have a nonverbal or minimally verbal child in the same room, as there may be opportunities to observe communication attempts at this time (e.g., trying to get mom’s attention).

Review the case history ahead of time, noting areas you want to review or obtain more information about.

Introduction

Introduce yourself. Briefly review your plan for the day and how long you expect it to take.

Example: “Hello Mr. /Mrs. [parent’s name]. My name is [clinician’s name] and I am the speech-language pathologist who will be assessing [child’s name] today. I would like to start by reviewing the case history and asking you a few questions. Once we are finished talking, I will spend some time observing [child’s name] as he interacts with you. I may also spend some time working with [child’s name] individually. Today’s assessment should take about [estimate the amount of time you plan to spend].

Who is the person(s) being interviewed? Name(s): Relationship(s) to child:

Interview Questions: These questions may need to be individualized, depending on the child’s age, communication abilities, cognitive abilities, motor abilities, and living situation. If it is decided to use a standardized measurement instrument based on parent or caregiver report, those questions may be integrated into, or used in lieu of, all or some of the questions listed below.

Review the Case History and ask follow-up questions, as needed, regarding the child’s medical, developmental, educational and social history.

Has anyone else in your family had communication problems? Has [child’s name] ever had his [her] hearing tested? If yes, what were the results? If no, do

you suspect any hearing problems?

Has [child’s name] ever had his [her] vision tested? If yes, what were the results? If no, do you suspect any vision problems?

Has [child’s name] ever had his [her] speech or language assessed before? If yes, when and where was this done? What were the results? How did you feel about that?

Has your child received speech-language therapy before? If yes, when and where? What did they work on in therapy? Can you describe the types of activities that were used? How did your child respond? Do you feel the therapy was helpful? Why or why not?

Has your child seen any other specialists for this problem? If so, who and when? What were their recommendations? How have you followed up on this?

Does [child’s name] have any physical problems? Can you describe them to me? Do you have any concerns about [child’s name] fine motor or gross motor skills? Please describe a typical day in the life of your child. (Note information regarding the child’s

routine; opportunities for cognitive, speech, and language stimulation; opportunities for socialization and communication; communication partners; household rules; behavioral problems; etc.)

With whom does [child’s name] communicate with throughout the day? Does [child’s name] attend any type of school or preschool? When? Where? How does he

[she] communicate there? How are your child’s preacademic or academic skills? What is your child’s primary method of communication? How does [child’s name] communicate with you? How does [child’s name] communicate with other family members? How does [child’s name] communicate with other children? How does [child’s name] communicate with strangers? How does [child’s name] tell you he [she] wants or needs something? (points, gestures,

vocalizes, pulls on you, etc.) Does [child’s name] make eye contact when he [she] tries to communicate with you? Does [child’s name] try to say words? Does [child’s name] have any true words that you and others understand? If yes, what are

they? About what percent of your child’s speech is understood by you? By others? Does [child’s name] ever combine words together? If yes, can you give me some examples? How does [child’s name] react when others do not understand? What does [child’s name] do when he is upset or does not get what he [she] wants? How do

you react to this? Does your child exhibit any specific behavior problems that you are concerned about? How

do you handle these? Does your child exhibit any antisocial or socially inappropriate behaviors? How do you

handle these? Does [child’s name] exhibit any self-stimulating behaviors (e.g., rocking, flapping arms,

spinning, etc.)? If yes, when do they occur? Does [child’s name] seem to understand what you say to him [her]? Can you give me an

example? Does your child respond to his [her] name? How? Does [child’s name] answer questions? How? Does [child’s name] follow directions? Can you give me an example? Does [child’s name] attempt to imitate others? Can you give me some examples?

What types of play activities does your child engage in? Does [child’s name] play with objects appropriately? Does [child’s name] use objects to pretend? For example, does he [she] pretend to talk on a

toy phone or pretend to drink from a cup? Does your child use toys for banging, mouthing, spinning, manipulating, or exploring in other

ways? Does [child’s name] play with other children? Does [child’s name] play with other adults? If

yes, does your child take turns, share toys, or make eye contact when playing with others? Is English your child’s first language? If not, what other language(s) is he [she] exposed to? What language is spoken most often in the home?

The following questions are more specific to AAC. They can be selected and added as part of any assessment where there is a possibility that AAC might be considered.

What types of verbal or nonverbal communication strategies have you tried with your child? (The clinician may need to provide examples of verbal and nonverbal communication strategies.)

Have you ever considered nonverbal communication strategies such as sign language, gestures, pictures, electronic devises or other things that might help your child communicate?

These are also sometimes called augmentative or alternative communication (AAC) systems or devices. Which ones have you tried or considered?

Have you ever seen or known anyone else who used a nonverbal communication system? Do you have specific concerns regarding nonverbal communication strategies? (If yes,

address their concerns here. They can also be addressed as part of the postassessment counseling if AAC is recommended.)

I’m not saying that [child’s name] will need a nonverbal communication system, but if we think it would help him [her] to communicate would you be open to trying it or learning more about it?

How do you think other family members will feel about this? Will they be supportive? Will they use the system to communicate with [child’s name]?

At home, who will be the primary person responsible for helping [child’s name] use the AAC system, and for helping others learn to communicate with [child’s name]?

At school, who will be the primary person responsible for helping [child’s name] use the AAC system, and for helping others learn to communicate with [child’s name]?

At [other environments the child is in], who will be the primary person responsible for helping [child’s name] use the AAC system, and for helping others learn to communicate with [child’s name]?

Some AAC systems or devices don’t cost anything, others may have a minimal cost involved, and still others are relatively expensive. Can you tell me about any financial resources or limitations that we should consider as we move forward with our assessment? Once we complete our assessment and make our recommendations, we will also provide you with additional information regarding costs and possible funding resources.

Closing the Interview

Summarize the major points that you gathered from the interview, allowing the parent or caregiver to interrupt or correct information, as needed.

Is there anything else you would like me to know about [child’s name] communication? Do you have any questions for me at this point? Thank you very much for you input. The information has been very helpful. Now, I want to observe the different ways that [child’s name] communicates with you. I would

like you to spend a few minutes playing with him [her]. I may ask you to do some specific things with [child’s name], but other than that, just interact as you normally would. At some point, I may ask you to sit off to the side or leave the room so that I can work individually with [child’s name] for a few minutes. Once we are finished, I will sit down to share my findings with you.

Orofacial Examination and Hearing Screening

Complete the Orofacial Examination and Hearing Screening Protocol given in Section 1

(Common Assessment Protocols). Use this protocol along with the Instructions for Conducting

the Orofacial Examination: Observations and Implications.

Verbalizations of Nonverbal or Minimally Verbal Children:Assessment Protocol


Typical Vocalization Communicative Context

Atypical Vocalizations List phonetically transcribed or described atypical vocalizations or idiosyncratic noises: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

True Words and Word ApproximationsList true words and word approximations below. Word approximations should be phonetically transcribed. Circle “O” if you observed the child using the word, and “R” if it was reported by a family member or caregiver.

True Word orApproximation

Phonetic Transcription

Observed or Reported Communication Context

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

Words Combinations

Word Combinations(transcribe, as needed)


O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

Phonetically Consistent Forms (PCFs)

A PCF is a vocalization that is stable and consistently produced in the context of certain objects, persons, or situations. PCFs usually consist of vowels or consonant-vowel combinations.

Phonetically Consistent Forms(transcribe, as needed)


O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

O R

Add additional rows, as needed.

The Child’s Imitative Phonetic and Basic Language Skills

1. Did the child imitate nonspeech sounds, such as that of a car, a bell, or animal sounds? No Yes

If yes, provide examples:

2. Did the child imitate speech sounds? No Yes


3. Did the child imitate simple words? No Yes


4. Did the child imitate simple phrases? No Yes


Comments on the Child’s Verbal Speech and Language Skills:

Nonverbal Expressive Communication: Qualitative and Quantitative Assessment Protocol


Prior to initiating the assessment, arrange the room in a way that encourages the child to interact. Provide access to a variety of age-appropriate toys, books, and stimulus items. The assessment should include observations of spontaneous play as well as the child’s responses during various tasks designed to evoke social interaction, initiation of communication, joint attention, requests, declaratives, and protest. This protocol is worded to document the child’s interaction with the clinician; however the same activities and protocol can be used to observe the child’s interaction with others. This assessment is based on observation of the child while interacting with: (circle all that apply)

the clinician parent(s) sibling(s)other children other: __________________________________

Expressive CommunicationCommunicationSkill

Child-Specific Strategy Behavior Scoring

SocialInteraction During Play Activities

1. Engage the child in spontaneous play activities.

Does the child become upset when the clinician attempts to interact? Does the child avoid interacting or prefer to play by him or herself?

Y N

Y N

2. After a few minutes, turn away and play with something by yourself.

Does the child seek out the attention of the clinician? How does the child get the clinician’s attention?

Y N

Y N

3. Spend several minutes playing. Include activities that require “turn-taking.”

Does the child make eye contact? Does the child sustain eye contact appropriately? Does the child engage in turn-taking?Are the child’s facial expressions and emotional responses appropriate to the context/activity?

Y N

Y N

Y N

Y N

How does the child express frustration, anger, or discomfort?

Other Comments:

Initiation of Communication

Eliminate all but 1 or 2 toys or books from the room. Sit with your back to the child and read the book or play with the toy.

Does the child attempt to initiate communication?

If yes, how? (quantify these behaviors by tallying the number of times each one occurs)

Y N

vocalizing, such as grunting or yelling

grabbing

hitting

making eye contact

smiling

moving an object or handing something to the clinician to get attention

other:

Joint AttentionJoint attention means that both parties are looking at or attending to the same object or event. Engage in one or more of the following activities together: play with a toy look at a book work on a puzzle

When pointing to pictures in a book, does the child’s eye gaze follow? Does the child engage in joint attention during these activities? If yes, for how long is it maintained?

How does the child get the clinician to attend to something? (quantify these behaviors by tallying the number of times each one occurs)

Y N

Y N

vocalizing

pointing

moving the

clinician’s hand

physically turning the clinician’s head

moving an object toward the clinician

other:

Request for a Desired Object or Action(Imperative)

1. Place a number of “desired toys” or a “desired food item” in the room, but out of the child’s reach.2. Engage in an activity such as blowing bubbles or playing with a toy. Stop and put the item up on a shelf. How does the child react?3. Activate a wind-up toy and then let it run down. How does the child react?4. Blow up a balloon or throw a paper airplane. Let it fly around the room. How does the child react when it stops?5. Engage in a familiar song/game, such as “peek-a-boo” or “wheels on the bus.” Stop. How does the child react?6. For one or more of the activities above (1-5), model a correct verbal response, such as “bubble,” “go,” or “more”.7. For one or more of

Does the child request something? If yes, how? (quantify these behaviors by tallying the number of times each one occurs)

Y N

vocalizing

crying

pointing

gesturing an action or “more”

moving toward the object

manipulating the clinician’s hand to do something

reaching to be picked up

other:

How does the child respond to clinicians’ modeling? (quantify these behaviors by tallying the number of times each one occurs)

attempts to imitate verbalizations

attempts to imitate gestures

other:

the activities above (1-5), model a correct gestural response or “sign,” such as “want,” “bubble,” or “more.” Use hand-over-hand modeling to help the child gesture, then reinforce by responding positively to it.

DeclarativesAttempt to evoke by presenting a novel item or event into the environment. For example, have the child remove an unseen object from a bag. How does the child react?

Does the child attempt to name or comment on the object?

Is there a verbal response?

Is there a gestural response? Other:

Y N

Y N

Y N

Protest

During the previously described activities identify ways in which the child expresses displeasure or shows that they do not want a particular toy or activity.

How does the child show displeasure? (quantify these behaviors by tallying the number of times each one occurs)

says “no”

shakes head to indicate “no”

vocalizes (yells, grunts, other noises)

cries

turns away, moves away, or runs away

hits, pinches, kicks

pushes objects away

pushes clinician’s hand away

other:

Types of Play the Child Engages In

Use the activities described above to assess the types of play the child engages in.

Does the child engage in primitive play routines? (quantify these behaviors by tallying the number of times each one occurs)

Does the child demonstrate functional use of an object such as pushing a car, flying an airplane, or brushing his/her hair with a hair brush? Does the child engage in symbolic play or “pretend”? Does the child participate appropriately as a play partner, including the demonstration of turn-taking? Other:

Y N

engaging in sensorimotor exploration

mouthing objects

shaking or “spinning” objects

banging objects

Y N

Y N

Y N

Nonverbal Receptive Communication: Qualitative and Quantitative Assessment Protocol


Receptive CommunicationCommunicationSkill Child-Specific Strategy Scoring

Comprehension of Single Words

1. Have the child identify people or objects in the environment. “Where is mommy/daddy/ name of sibling or other person who accompanied the child?”“Where is the window/chair, etc.?”

2. Have the child identify body parts named by the clinician.“Where is your nose?”“Show me your eyes.”

3. Place several common objects or toys on the table (e.g., ball, car, cup, doll teddy bear, etc.).“Where is (name toy/object)?”“Show me (name toy/object).”“Give me (name toy/object).”

4. Repeat #3 using age-appropriate picture stimuli of common objects, or family members. This activity can also be used to assess the child’s understanding of shapes or colors.

5. Look at a book together and ask the child to identify pictures in the book.

Qualitative Analysis:What was the child’s mode of response? pointing

eye gaze

other:

Does the child’s accuracy improve with repetition? Y NDoes the child’s accuracy improve with cueing? Y N visual cuing

tactile cuing

other:

Quantitative Analysis:Quantify the child’s receptive vocabulary by tallying a “+” every time the child correctly identifies the stimulus item, and a “-“ every time the child is incorrect. The clinician may choose to list the actual stimulus words, as appropriate. body part identification

identification of objects or toys

identification of pictures

Understanding ofBasic Concepts (these words are often used as modifiers)

1. Utilize several contrasting objects or pictures to represent all or some of the following concepts: big/little, long/short, empty/full, happy/sad, rough/smooth, soft/hard, hot/cold, high/low, tall/short, fast/slow. For example: Place a large ball and a small ball on

the table and ask the child: “Show me the big one.” or “Show me the little one.”

Place pictures on the table representing a full glass and an empty glass and ask the child: “Show me the full glass.” or “Show me the empty glass.”

2. Assess number concepts by placing several objects (e.g., blocks) on the table and tell the child:“Give me one block.”“Give me two blocks.”“Give me [number] blocks.”

Quantify the child’s understanding of basic concepts by tallying a “+” every time the child correctly identifies the stimulus item, and a “-“ every time the child is incorrect. big little long short empty full happy sad rough smooth soft hard hot cold high low tall short fast slow numbers:

other:

total % correct =

Understanding Singular versus Plural

1. Place several of the same object on the table (e.g., balls, blocks, cars, etc.). Say to the child:“Give me the ball.”“Give me the balls.”Repeat with different objects.

2. Place pictures showing a singular form (e.g., cat) and a plural form (e.g., cats) on the table and say to the child:“Show me the cat.”“Show me the cats.”Repeat with different objects.

Quantify the child’s understanding of singular and plural by tallying a “+” every time the child correctly identifies the stimulus item(s), and a “-“ every time the child is incorrect.

singular formo pictureso objects

total % correct for singular forms =

plural formo pictureso objects

total % correct for plural forms =

Understanding of Pronouns

Display pictures of children and animals performing various actions, such as a boy jumping, a girl jumping, a horse jumping, and a group of children jumping. Say to the child:“Show me he is jumping.”“Show me she is jumping.”“Show me it is jumping.”“Show me they are jumping.”Repeat with different pictures.

Quantify the child’s understanding of pronouns by tallying a “+” every time the child identifies the correct picture and a “-“ every time the child is incorrect. he

she

it

they

total % correct for pronouns =

Understanding of Prepositions

1. Ask the child to move object, such as:“Put the block in the box.”“Put the block under the box.”“Put the doll on the chair.”“Put the doll behind the chair.”“Put the block beside the box.”Repeat with different objects.

2. Display pictures that represent the various prepositions and ask the child to identify the correct one, such as:“Show me the dog is under the table.”

Quantify the child’s understanding of prepositions by tallying a “+” every time the child correctly places an object or identifies the correct picture and a “-“ every time the child is incorrect. in

under

on

behind

beside

total % correct for prepositions =

Comprehension of Simple Questions

If the child has a verbal or gestural strategy for indicating “yes” and “no,” ask several simple, concrete questions. Intermix the questions so both “yes” and “no” responses are required. Ask questions such as: Is your name ______? (ask with

correct and incorrect name) Do you have a brother/sister? Do you have a dog/cat? Is this a ball? (hold up a ball or

something other than a ball) Is this your shirt? (point to child’s

shirt or a different clothing item) Is this my nose? (point to your nose

or other body part)

What was the child’s mode of response?

Quantify the child’s understanding of questions by tallying a “+” every time the child correctly responds with “yes” or “no” and a “-“ every time the child is incorrect.

total % correct for yes-no questions =

Comprehension of Basic Commands

1. These tasks may need to be adjusted depending on the child’s physical capabilities. Ask the child to follow some simple directions, such as: stand up sit down raise your hand stomp your feet throw the ball kiss the baby (doll) tickle the teddy bear

2. Note the child’s ability to follow directions during the previous tasks: Understanding of Basic Concepts, Understanding Singular versus Plural, and Understanding of Prepositions.

3. If the child does well on 1 & 2, try some complex or multiple-part commands, such as: Stand up and raise your hand. Go get the book and put it in the box. Pick up the bear and put it on your

head. Give me the ball and the truck. Kiss the baby and tickle the bear.

Quantify the child’s understanding of basic commands by tallying a “+” every time the child responds correctly and a “-“ every time the child is incorrect.

simple, concrete directions

total % correct for simple, concrete directions =

complex and multipart directions

total % correct for complex and multipart directions =

Interaction Between Communicative Partners and the Child: Assessment Protocol


Communicative Partner (CP): Relationship:

Observe the parent or communicative partner (CP) as they interact with the child. Identify the communicative behaviors that are demonstrated by the CP. This information can be helpful in assessing the communication strategies being used, and in identifying areas that need to be addressed in the intervention plan. In order to quantify these behaviors, place a tally mark in the “Yes” column each time the behavior occurs. Place a tally mark in the “No” column each time there is an opportunity for the given behavior to occur, but it does not.

Communicative BehaviorWas the behavior

demonstrated?Yes No

The parent/CP encourages communication by looking at the child expectantly.The parent/CP reinforces communication through action or verbalization.The parent/CP talks at the child’s eye level.The parent/CP successfully interprets the child’s verbalizations.The parent/CP successfully interprets the child’s nonverbal communicative intent.The parent/CP creates communication opportunities.The parent/CP does not reduce communication opportunity by anticipating the child’s needs ahead of time.The parent/CP attempts to establish joint reference with the child.The parent/CP talks about present context (here and now).The parent/CP reduces his or her sentence length when speaking to the child.The parent/CP reduces his or her sentence complexity when speaking to the child.The parent/CP uses a slower speech rate when speaking to the child.The parent/CP repeats frequently (redundancy).The parent/CP paraphrases utterances in different ways. The parent/CP uses exaggerated intonation patterns.The parent/CP places stress on important words.The parent/CP uses concrete, high-frequency vocabulary.The parent/CP does not dominate the conversation.The parent/CP avoids excessive questions and commands.The parent/CP demonstrates self-talk.The parent/CP demonstrates parallel talk.The parent/CP demonstrates expansion.

Other Observations or Comments:

Assessment Report

Use the Assessment Report Outline given in Section 1 (Common Assessment Protocols). Expand

the sections relevant to AAC assessment and include all relevant information gathered through

the case history, interview, assessment procedures, and reports from other professionals.

Remember that the confidential information in this report should not be shared with anyone

other than the child’s parents or legal guardians unless a written “Permission to Release

Information” has been obtained.

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