Utilizing Language Samples for

Clinical Decision Making

Kristina M. Blaiser, PhD, CCC-SLP

Idaho State University

Nicole Martin, MS, CCC-SLP

Utah State University, Sound Beginnings

Why do language samples?

• Standardized assessments often are not

sensitive enough to address specific needs of

children who are DHH

• Quick, functional, more “real life” examples

Language samples

• Measure productivity and complexity/quality

of language

• Simple language samples can work

• Key Components

– Over time

– Across communication domains

Across communication domains

• Phonology

• Morphology

• Syntax

• Semantics

• Pragmatics

Clinical decision making

• Intervention services

• Interprofessional communication

• Parent support/advocacy

CLINICAL DECISION MAKING:

QUALIFICATION, GOALS

Case Study: Time 1

• Walk

• He running

• In school scream

• No

• Yes

• Watching

• Be quiet

• Hearing

• Car

• Take turn with car

• Stop

• Me

• Matt glue

(King, Olson, Shaver & Blaiser, 2009)

Case Study: Time 2

• Who gave you the clip?

• Grandma is walking inside.

• I go to a baseball game.

• A lot of little kid go to the baseball game.

• Lucy didn’t go to the baseball game.

• Lucy go to the football game

• That’s a monster.

• You gotta little monster and I got a big monster.

• Where Erika R at?

• Maybe she go to the bumper car.

• Why no field trip?

• He is getting bigger. He growing up.

(King, Olson, Shaver & Blaiser, 2009)

INTERPROFESSIONAL

COLLABORATION

What are the errors?

• The car go in the garage

• He going to the hospital

• He going back to the hospital over here

• He have to go up to a parking spot

• He going back home now up the road

• He will go back up to the (unintelligible) and the he want to go back home

• he going to see the window

• Oh no! the car fall down.

• He will go back and try again

• He try to use the elevator

• He going back home because he want to play

(King, Olson, Shaver & Blaiser, 2009)

Cole and Flexer, 2011

Language Sample 2

• Did the other group have four friends here? • Do you know what, Sarah? I was sick September 20th. • My birthday’s coming up. How can I get to be five? • I went to Chuckie Cheese’s a long time ago but one of my friends

came, Eric but another friend didn’t come because he was not invited.

• Do you know what? Tomorrow on Tuesday I’m going to take my day off.

• Even, you know what? My dad was at work and I told him about the T-rex dinosaurs.

• My dinosaur name is Sarah ‘cuz I like that name. • Why we have to cut a hole in the dinosaur’s mouth?• Black is my favorite color because so you can see better and I’m

wearing black strip shirt today.• You know, there was a nice shark at Mall of America. • Can you hear it Matt? It’s liquid. • I like ketchup with French fries but not other food.

(King, Olson, Shaver & Blaiser, 2009)

CLINICAL DECISION MAKING:

PLACEMENT

0

1

2

3

4

5

6

7

8

9

1 2 3

MLU

Mean Length of Utterance by Time

SHARING OUTCOMES WITH OTHERS

Family Support

• Communicate progress of speech/language targets achieved in therapy.

• Describe present performance of:– Intelligibility

– Mean Length of Utterance (MLU)

– Words per minute (WPM)

– Number of total words

– Number of different words

– Number of complete sentences with correct syntax and word order

– Variety of syntactic elements used

– Phonological processes observed

Family Support

Place: Therapy Context: Retelling story w/forest animals, looking at book Amount of time observed: 15 min total recorded

CURRENT MONTH: May 2013

It should be noted that the therapist is very familiar with XX’s articulation and was able to benefit from a shared attention of objects. Intelligibility may have been lower to a less familiar listener and without contextual clues during the conversation.

May 2013 Apr Mar Feb Jan 2013 Dec Nov Oct Sept 2012

Number of intelligible utterances

in 50 utt: 49 49 50 49 44 48 43 33 29

Number of morphemes

in 50 utterances: 352 331 346 292 185 262 188 161 218

Mean Length of Utterance: 7.04 6.62 6.92 5.84 3.7 5.24 3.76 3.6 5.45

Number of Total Utterances: 50 50 50 50 50 50 50 45 40

Words Per Minute: 56.4 47.5 38.1 34.06 18.8 23.3 34.6 14.6 19.8

Number of Total Words: 310 309 286 264 165 233 173 146 198

Number of Different Words: 152 117 99 112 78 92 74 64 67

% of Intelligibility: 98 98 100 98 88 96 86 73 72.5

# of complete sentences/utterances : 38 37 39 29 11 18 11 8 7

# of sentences w/correct syntax

& word choice 25 utt 12 utt

Family Support

• Discuss impact of rate of speech (WPM) compared to:

– MLU

– Intelligibility

– Number of complete sentences with correct syntax and word order

– Is there an inverse relationship? Fluency vs Accuracy?

– What implications are there for parents to target at home?

Family Support

• Compare Number of Total Words vs.

Number of Different Words

– Implications for vocabulary development

– Appropriate variety of syntactic elements

Family Support

• Measuring progress:

– IEP goals

– TASL

– CASLLS

• Age appropriate progress

– Chronological Age

– Hearing Age

Family Support

• Compare success of speech/language targets

achieved across school and home

environments

• Explain targets to be stabilized in therapy

• Determine targets to be reinforced at home

• Negotiate with mainstream school and related

services

Graduate training

• Plan appropriate activities to provide

opportunities to elicit language targets in

context

• Support transcription process

• Establish clear rules for

reporting/analyzing/interpreting results

Clinician’s Utterance Child’s Utterance/Behavior Skills noted Skills needed Morp NTW

ow did you build the tower? 1. I just buiwd it out of Wegos. Subjective Pronoun Objective Pronoun

Emerging Complexity Preposition

Plural -s

/s/ Distortion Gliding /l/ --> /w/

/v/ Distortion Irregular Past Tense

8 7

Did anyone help you? 2. No. Negation 1 1

3. I just build it. Subjective Pronoun Emerging Complexity

Objective Pronoun

Initial Consonant Deletion /s/ Distortion

Irregular Past Tense

4 4

What kind of tower was it? 4. It was a tall (taw-) tower. Subjective Pronoun Article

Self-Correction

Vowel Distortion 5 6

5. And it was a school. Subjective Pronoun Article

/z/ Distortion /s/ Distortion

5 5

here must have been students

inside. 6. Yeah. 1 1

as it like Sound Beginnings,

or Kindergarten? 7. Kindergarten. 1 1

Can you tell me about what

your kindergarten looks like? 8. It has a giant big building and a big (big

big big) big pway set.

Subjective Pronoun

Gliding /l/ --> /w/ 12 12

ow! What's on the play set? 9. And it has swings and stuff. Subjective Pronoun Plural -s

/z/ Distortion /s/ Distortion

7 6

10. It doesn't have sandboxes. Subjective Pronoun Negation Plural -s

Whispered Speech 6 4

Does it have any cool things

hat Sound Beginnings doesn't have?

11. Yeah. 1 1

12. We have jump rope, basketball hoop,

soccer nets, and (basebaw um) basebaws

and basebaw.

Subjective Pronoun Plural -s

/s/ Distortion Gliding /l/ --> /w/ Whispered Speech

Whole Word Repetition Interjection

Article

14 14

Graduate training

• Analysis of speech and language– Intelligibility

– Fluency

– Vocal Quality

– Speech accuracy• Phonological patterns evident

• Omissions, substitutions, distortions

– Variety of sentence structures• Verb tenses

• Expanded language

• Word order

• Syntactic elements

• Descriptive language

Graduate Training

This sample was taken on client XX on May 7,

2014 in the context of conversation about his

Kindergarten, as well as his favorite movie. XX

was not very talkative throughout the sample,

and the clinician had to probe considerably to

keep XX engaged in the conversation.

Accordingly, this sample is not as spontaneous

as others have been in the past.

Graduate Training May

2014 April 2014

March 2014

February 2014

January 2014

December 2013

November 2013

October 2013

September 2013

July 2013

Number of at

least half-

intelligible utterances*

50 45 47 47 50 50 48 49 50 50

Mean length of

utterance

5.42 6.6 5.1 5.84 5.26 4.1 4.16 6.06 5.52 10.26

Number of total

utterances

50 50 50 50 50 50 50 50 50 50

Words per

minute

42 75 70 84 81 54 52 130 63 58

Number of total words

257 317 254 273 277 209 194 281 284 464

Number of different words

109 120 107 109 86 77 85 106 104 127

Number of

complete

sentences with correct syntax

and word order (longer than 1 word)

19 16 16 18 10 18 18 5 8

Graduate Training

Frequent Patterns (May)

Gliding of /l/: 64% (25/39) - 93% initial, 73% medial, 27% final

Distortion of /s/: 69% (20/29) - 66% initial, 89% medial, 80% final Gliding of /r/: 38% (11/29) - 0% initial, 58% medial, 9% final

Distortion of /z/: 52% (12/23) - 52% final Stopping of /ð/: 31% (8/26) - 31% initial

Frequent Patterns (April) Gliding of /l/: 79% (23/29) - 86% initial, 100% medial, 60% final

Distortion of /s/: 65% (20/31) - 58% initial, 75% medial,64% final

Distortion of /z/: 71% (17/24) - 50% medial, 75% final

Gliding of /r/: 22% (9/41) - 56% initial, 21% medial, 6% final

Stopping of /ð/: 58% (15/26) - 58% initial, 50% medial

Graduate Training

Graduate Training

• Pragmatics

– Conversational turn-taking

• Initiate topic

• Topic maintenance

– Stage of play skills

– Using objects to represent other objects

– Eye contact

– Appropriate volume for conversational partner

Graduate Training

• Interpreting Results

– Representational of current abilities

– Anecdotal insights

– Comparing results from previous samples

– Age Appropriate progress

• IEP Goals & Objectives

• TASL

• CASLLS

Graduate TrainingXX's utterances were shorter overall, which contributed to a slightly

decreased mean length of utterance, as well as a significant decrease in his number of words spoken per minute. However, he was more intelligible than in past samples, and his utterances were also more syntactically correct. This data can be interpreted to mean that there is an inverse correlation between XX's rate of speech, and his overall intelligibility and accuracy of syntax.

XX demonstrated some instances of whole word repetitions and word finding errors throughout the sample. He tended to use repetitive phrases for emphasis (e.g. "a lot a lot"), in the place of more descriptive vocabulary terms.

XX's voice was quite harsh, and he demonstrated more instances of whispered speech than in the recent past. Furthermore, he did not demonstrate effective self-monitoring of his saliva. These issues can possibly be attributed to the fact that XX may have been coming down with a cold, as he frequently coughed throughout the sample as well.

Substitutions are coded in blue, distortions are coded in green, and deletions are coded in red. Selections coded in purple represent whispered speech.

Graduate Training

• Clinical decisions

– Evaluate success of past intervention strategies

• Predict scaffolding needed in future

– Determine targets to be addressed in therapy

– Identify targets to be reinforced at home and in other school settings

– Referral for related services

• Professional reporting/discussing

• Collaborate with supervisor, parents, other professionals

BENEFITS OF USING EVIDENCE FOR

DECISION MAKING

In summary

Advantages of using Language Samples

• Use data to make decisions, monitor progress

• Real-life samples of language

• Effective way to look across domains

Resources

• http://www.asha.org/uploadedFiles/asha/pub

lications/cicsd/1991AGuideforAssessing.pdf

• https://www4.uwm.edu/chs/faculty_staff/upl

oad/Heilmann-Perspectives-2010.pdf

References

• King, E., Shaver, J., Olson, E., & Blaiser, K. (2009). Preschool

children with hearing loss: Trends in spoken language

development. ASHA Convention: New Orleans, LA.

• Moog, J. S., & Biedenstein, J. J. (2006). Teacher assessment of

spoken language. (2nd ed.) St. Louis, MO: The Moog Center

for Deaf Education.

• Wilkes, E.M., (1999). Cottage acquisition scales for listening,

language, and speech. (5th ed.) San Antonio, TX: Sunshine

Cottage School for Deaf Children.