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Created by
Tatyana Elleseff MA CCC-SLP
Smart Speech Therapy LLC
For Individual Use Only.
Do not resell, copy, or share downloads.
Do not remove copyright.
Assessment of Social-Communication Deficits in
Children in School Aged Children
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Overview
This product is aimed at increasing the participants’ knowledge
regarding the role of speech language pathologists in the assessment
of social communication abilities of school-age children
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Presentation Objectives
Learning Objectives:
Learners will be able to
1. Summarize the role of SLP in assessment of pragmatic language
and social cognitive abilities of school-age children
2. List formal assessment instruments used to assess pragmatic
language and social cognitive abilities of school age children
3. Describe informal assessment procedures used to assess pragmatic
language and social cognitive abilities of school age children
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Role of SLPs Relevant to Social Communication Disorders
SLPs play a critical role in the screening, assessment, diagnosis, and treatment of school-age children with social communication disorders Provide prevention information Educate other professionals Screen social communication skills for early detection Conduct a culturally and linguistically relevant comprehensive assessments of social
cognition, Diagnose the presence or absence of social communication disorders Refer the patient/client to other professionals to rule out other conditions Develop culturally and linguistically relevant treatment and intervention plans Recommend related services (if needed) Counsel individuals with social communication disorders and their families Consult and collaborate with all relevant parties to create an intervention plan focused
on functional outcomes Remain informed of research in the area of social communication disorders Advocate for their clients and their families
http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934980§ion=Roles_and_Responsibilities
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Social Communication Skills
More than good eye gaze, nice manners, adequate conversational
abilities or knowing multiple meanings of words
Dynamic and complex process which begins in infancy and continues
to mature well into adulthood
“The ability to adapt your behavior effectively based on the situation
and what you know about the people in the situation for them to
react and respond to you in the manner you had hoped.”
Winner, Michelle Garcia (Oct, 2011) Social Thinking Across the Home
and School Day; YAI Autism Conference.
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Social Communication Skills (cont.)
Ability to initiate social interactions (Prizant & Meyer, 1993)
Ask questions
Obtain help
Initiate academic work
Attend to & interpret social cues (Langton et al, 2000)
Ability to process messages appropriately
Abstract thinking skills
ToM & perspective taking (Baron-Cohen, 1995)
Gestalt processing (Brosnan et al 2004)
Humor (Semrud-Clikeman & Glass, 2010)
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Difficulty with Detection of Social Communication Weaknesses
Tests of communication, typically focus on semantics, syntax,
morphology, and phonology, as these are the performance areas in
which specific skill development can be most objectively measured
(Hill & Coufal, 2005)
Child may receive average scores but present with significant social
pragmatic impairments
Supplemental testing may be URGENTLY needed
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Difficulty with Detection and Recognition of Social
Communication Deficits
May be perceived as challenging behaviors
Severe cases misdiagnosed as Oppositional Defiant Disorder
Common teacher/parent complaints:
“Ignores” presented directions
Follows own agenda
Inappropriately “acts out”
Acts immaturely
Clueless regarding others around him
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What is it really?
Behavior Lack of Skills
Both
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Have you checked their ability to …
Recognize facial expressions
Gage moods
Correctly identify own feelings
Correctly identify other’s feelings
Appropriately initiate social interactions
Appropriately interpret social situations
Create and convey messages to speakers
Relate to peers (“disability barometer”)
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Relevant Assessment Areas
Adaptive Behavior
Pragmatics
Social Emotional Functioning
Problem Solving
Conversational Abilities
Procedural Recall
Narrative Abilities
Listening Comprehension
Executive Function
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Where do we begin?
Data Collection
Create Referral Forms
Give it to the teacher
Send it home
Can’t Assess Everything
Don’t waster TIME!
Target Deficit Areas ONLY!
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SAMPLE FORM: Social Pragmatic Deficits Checklist
Checklist Categories:
•Listening/Processing
•Verbal Expression
•Prosody
•Problem Solving
•Pragmatic Language
•Social Emotional Development
•Behavior •Supplemental* Caregiver/Teacher
Data Collection Form
•Select Assessments Sensitive to
Social Pragmatic Deficits
This checklist was created to assist (SLPs)
in identifying and screening for social
pragmatic language weaknesses/deficits in
school-aged children, who may require assessment and intervention services.
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Sample Areas of Difficulty
Check all that apply:
Problem Solving
Difficulty making inferences
Difficulty predicting results of actions
Difficulty determining causes of events
Social Emotional
Difficulty recognizing moods
Difficulty interpreting body language
Difficulty assuming perspectives of others
Executive Functions
Difficulty inhibiting behavior
Difficulty with emotional self-control
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Social Pragmatic Language Assessment:
Useful Standardized Tests
Test of Problem Solving-3 Elementary (TOPS-3)
Test of Problem Solving -2 Adolescent (TOPS-2)
Test of Pragmatic Language-2 (TOPL-2)
Social Emotional Evaluation (SEE)
Social Language Development Test -Elementary (SLDT-E)
Social Language Development Test -Adolescent (SLDT-A)
Listening Comprehension Test Adolescent (LCT-A)
Clinical Evaluation of Language Fundamentals-5: Metalinguistics (CELF-5: M)
Test of Executive Functions (EFT)
Theory of Mind Inventory-2 (TOM-2)
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Test of Problem Solving-3 Elementary (TOPS-3)
Ages 6-11:11
Open ended questions based on photos
Critical thinking to analyze, problem solve, evaluate, make
predictions and inferences, etc
Assesses ability to integrate semantic and linguistic knowledge with
reasoning
Subtests:
Making Inferences
Negative Questions
Problem Solving
Predicting
Determining Causes
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TOPS-3: Strengths and Limitations
Strengths:
Open ended questions allow for spontaneous response formulation
The examiner has an opportunity to assess the student's oral language abilities in the
area of sentence formulation as well as coherence and cohesion all the response
Suitable for children with reported difficulties in the area of decision-
making and verbal reasoning
Limitations:
The vast majority of scenarios deal with typical activities of daily living
What will happen if you break something in the supermarket ?
Why do you have to look both ways when crossing the street?
Many children with social communication deficits may possess mastery
of these skills and as such will easily attain average scores on this test
Requires caution in determination of best candidate for testing
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Test of Problem Solving-2 Adolescent
Ages 12-17:11
Open ended questions
Critical thinking abilities based on student's language strategies using
logic and experience
Analysis, interpretation, evaluation, inferencing, self-regulation, etc
Subtests:
Making Inferences
Determining Solutions
Problem Solving
Determining Perspectives
Transferring Insights
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TOPS-2: Strengths and Limitations
Strengths:
Ability to assess the student’s reading skills by asking them to read and
not just follow along the presented passages
Higher order language scenarios requiring knowledge of sophisticated
vocabulary concepts and words
Limitations:
Student is allowed to keep and reference the manual which has the
potential to inflate testing scores
Students from multicultural backgrounds may not have exposure to
some of the presented scenarios/lack knowledge of certain concepts
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Test of Pragmatic Language-2 (TOPL-2)*
Ages 6-18:11 with two formats per different ages
6:0-7:11 years Shorter version:17 items
8:0-18:11 years Full version: 43 items
Open ended questions re: social situations
Addresses Components of:
Physical Setting
Audience
Topic
Purpose
Visual-gestural cues
Knowledge of Abstractions
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TOPL-2: Strengths and Limitations
Strengths: Good for clients with deficits in the areas of understanding rules of polite
conduct who have very limited/severely impaired perspective taking abilities Best for children with impaired IQ and concomitantly impaired pragmatics
Limitations: Subjective and labor intensive scoring Students with severely impaired social communication abilities but with
Average and Above Average IQ do well on this test due to their ability to memorize the rules of politeness
Does not possess scenarios assessing higher order social communication abilities (e.g., conflict resolution, multiple interpretations, etc.)
Takes excessively long to administer Difficult to generate goals based on administration due to the cumulative
nature of the results Generation of goals requires in depth item analysis, which in turn requires
more analysis time
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Social Emotional Evaluation (SEE)
Ages 6-12:11 (color drawings)
Assesses knowledge of social situations and emotional reactions
Subtests:
Recalling Facial Expressions (unscored pretest)
1. Identifying Common Emotions
2. Recognizing Emotional Reactions
3. Understanding Social Gaffes
4. Understanding Conflicting Messages
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SEE: Strengths and Limitations
Strengths:
Best for children with impaired IQ/ very impaired Theory of Mind (ToM)
Portions of it can be used to assess abilities of cognitively and linguistically impaired children Recalling Facial Expressions
1. Identifying Common Emotions
2. Recognizing Emotional Reactions
Understanding Conflicting Messages subtest is useful for administration with higher socially functioning children
Limitations:
First two subtests are significantly easier than the last two subtests, which is a problem because the test provides cumulative z scores
Students who do very well on the first two and poorly on the last two subtests often end up with significantly inflated scores
As a result many children in need of services may not qualify for them
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Social Language Development Test –Elementary: Normative Update
Ages 6-11:11
Focuses on language-based skills of social interpretation and
interaction with friends
Assesses students' language-based responses to portrayed, peer-to-
peer situations
Subtests:
Making Inferences
Interpersonal Negotiations
Multiple Interpretations
Supporting Peers
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SLDT-E:NU: Strengths and Limitations
Strengths: Assesses sophisticated social communication constructs (perspective
taking, conflict resolution, multiple interpretations, etc.) in children as young as 6 years of age
Open-ended questions are far more illustrative of real world experiences
Subtest subdivision offers in depth understanding of students’ error breakdowns
Terrific for goal generation
Limitations: Not suitable for students with low IQ (< 70), students with more severe
forms of ASD, or students with severe language impairment and limited vocabulary inventories For more information: https://www.smartspeechtherapy.com/review-
of-social-language-development-test-elementary-what-slps-need-to-know/
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SLDT-E: NU and Multicultural Considerations
May not be suitable for English Language Learners (ELL) with suspected social
pragmatic deficits due to the:
Potential for linguistic /cultural bias since answers could be marked
incorrect due to:
Lack of vocabulary knowledge
Lack of exposure
Low socioeconomic status (SES)
Lack of formal schooling
Limited opportunities outside the home
Multiple Interpretations Subtest
May be confusing to some children
Interpreted as trick questions
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Social Language Development Test -Adolescent : Normative Update
Ages 12-17:11
Ability to interpret and respond to sarcasm, engage in peer-to-peer
perspective-taking, respond to sensitive information and rumors as
well as understand socially complex emotions
Subtests:
Making Inferences
Interpreting Social Language
Problem Solving
Social Interaction
Interpreting Ironic Statements
Identifies atypical social language behaviors
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SLDT-A:NU: Strengths and Limitations
Strengths: Student requires to appropriately respond to both portions of select
subtests in order to earn credit Tests ability to interpret not just sarcasm and irony but also tone of
voice Open-ended questions are far more illustrative of real world
experiences Subtest subdivision offers in depth understanding of students’ error
breakdowns which results in terrific goal generation applicable to the real world experience
Limitations: Similar to the SLDT-E: NU this test is not suitable for students with low
IQ (< 70), students with more severe forms of ASD, or students with severe language impairment and limited vocabulary inventories
For more information: https://www.smartspeechtherapy.com/review-of-social-language-development-test-adolescent-what-slps-need-to-know/
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SLDT-A: NU and Multicultural Considerations
Too abstract/hypothetical to answer “What is he thinking?” if child
is unused to that style of questioning
Questions pertaining to topics such as dating or dieting are based on
exposure/prior experience
May not be appropriate for children 12-16 years of age
Interpreting Social Language subtest
Heavily based on vocabulary knowledge
Problem Solving subtest
Responses may be incongruous with personal cultural values
Interpreting Ironic Statements
Based on idioms
If lack knowledge then ↓ score)
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Listening Comprehension Test Adolescent (LCT-A)
Ages 12-17:11
Composed of 12 story passages and 4 “messages” which assess the
student’s problem solving and inferencing abilities, empathy and
decision making, etc.
Subtests
Main Idea
Details
Reasoning
Vocabulary and Semantics
Understanding Messages
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LCT-A: Strengths and Limitations
Strengths: The Main Ideas subtest assesses the student's Gestalt Processing abilities
which is the capacity of see the ‘Big Picture” vs. focus on small/irrelevant details
Requires synthesis of the presented information
Verbal Reasoning subtest requires extrapolation of text information to reach an appropriate conclusions
Great opportunity to test the student’s semantic flexibility skills which are important for narrative development as well as social communication
Limitations:
This is not a test of social communication and as such only the Main Ideas subtest is truly applicable to the determination of the student’s weaknesses as well as goal generation
Definitely requires significant supplementation of formal/informal social communication testing tasks and procedures
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Clinical Evaluation of Language Fundamentals 5: Metalinguistics
For ages 9-22, it includes 4 tests (can be administered individually
or as part of a battery) of higher-level language skills that are
embedded in upper-grade curricula and are critical to classroom
success.
Measures the student’s ability to think about and use language to
make inferences, manipulate conversational speech given a context,
use words in multiple ways, and use language in a non-literal
manner.
Making Inferences
Conversation Skills
Multiple Meanings
Figurative Language
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CELF-5:M: Strengths
Assesses student’s abilities to use figurative and ambiguous language and produce open ended responses as well as formulate sentences given presented context and select words
Assesses student’s ability to interpret contextual and situational demands of conversation
Allows for identification of more subtle language based difficulties in verbal children with average to high average intelligence (or Emerging Social Communicators as per Winner, 2011) who present with metalinguistic and social pragmatic language weaknesses in the following areas: Social predicting and inferencing Conversational rules and breakdown repairs Knowledge of high-level and abstract vocabulary words Identification and usage of ambiguous and figurative language Coherent and cohesive discourse and narrative formulation Knowledge and use of multiple meaning words in a variety of
conversational and text-embedded contexts
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CELF-5:M: Limitations
Test administration begins at 9 years of age which is very late since much younger
children can present with glaring metalinguistic deficits
Presence of visual and written stimuli on select testing subtests since children are
not provided with multiple-choice answers or written support in daily social and
academic situations
Score over inflation may occur with children who do well given compensatory
strategies but who have difficulty generating novel spontaneous responses
Many higher functioning students with ASD or language deficits will pass this test
with flying colors (e.g., Nuance Challenged Social Communicators, Winner,
2011)
Not appropriate for the Severely Challenged and Challenged Social
Communicators (Winner, 2011)
For more information: https://www.smartspeechtherapy.com/test-review-celf-5-
metalinguistics/
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Test of Executive Functions (EFT)
For children 7-12:11 years of age, it is a test of language skills which affect
executive functions of working memory, problem solving, inferring, predicting
outcomes, and shifting tasks.
Attention and Immediate Memory - Auditory
Pay attention to details from short passages & answer follow-up questions
Attention and Immediate Memory - Auditory and Visual
Answer questions about what you've heard and seen in the pictures
Working Memory and Flexible Thinking
Generate novel responses and answer 2 critical thinking questions based on
short passages
Shifting
Quickly and accurately shift your thinking by naming a member of a related
category after you hear 4 items in a related category e.g., “Add, subtract, multiply
and divide are math words. Now tell me a grammar word”)
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EFT: Strengths and Limitations
Strengths: Assesses problem solving, inferring, predicting outcomes, and shifting tasks all
the skills associated with social communication weaknesses Requires extrapolation of text information to reach an appropriate conclusions
on select subtests Laden with sophisticated vocabulary words so it’s a terrific opportunity to test
the student’s semantic flexibility skills which are important for narrative development as well as social communication
Requires synthesis of the presented information
Limitations: This is not a test of social communication Definitely requires significant supplementation of formal/informal social
communication testing tasks and procedures Not for students with intellectual disabilities, severe language impairment and
limited vocabulary inventories, or students with significant memory and language processing deficits
For more information: https://www.smartspeechtherapy.com/the-executive-functions-test-elementary-what-slps-and-parents-need-to-know/
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The Theory of Mind Task Battery: (Hutchins & Prelock, 2016)
Taps a wide range of
ToM domains
Variety of content
Easy – difficult
Co-developed with
the ToMI-2
Subscales:
Early: ~ 1-3.5 yrs
Basic: ~ 3.5 – 6.5
yrs
Advanced: ~ 6.5 –
10 yrs
• Consists of 15 test questions embedded in 9 tasks
• All content presented in storybook format
• Color illustrations of persons from a variety of racial and ethnic
backgrounds
• Items presented in ascending difficulty (empirically determined)
• Memory control questions are must be passed for credit on the
test questions
Task A: basic emotion-recognition
Task B: desire-based emotion
Task C: seeing-leads-to-knowing
Task D: line of sight
Task E: perception-based action
Task F: first-order false belief
Task G: belief- and reality-based emotion and second
order emotion
Task H: inferring belief of another when interpreting a
statement of desire in the context of a change location
Task I: second-order false belief Author slides used w/t Dr.
Hutchins’ permission
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TOM-2 Parent Questionnaire (Hutchins & Prelock, 2016)
60 items designed to tap a wide
range of social-cognitive
understandings
“My child understands
whether someone hurts
another on purpose or by
accident.”
Empirically-derived subscales:
Early
Basic
Advanced
Rationally-derived subscales:
Emotion Recognition
Mental State Term
Comprehension
Pragmatics
Author slides used w/t
Dr. Hutchins’ permission
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TOM-2: Strengths and Limitations
Strengths: Addresses the limitations of traditional theory of mind measures Generates reports with clear cut goals and corresponding materials
Report analyzes strengths/challenges in light of the typical developmental sequence of ToM
Recommends specific treatment targets on the basis of their developmental appropriateness
Strong psychometrics, validity, sensitivity and specificity, etc. Quick and easy to use via HIPAA compliant software (just send via email and
collect results)
Limitations (as per authors) Not intended for differential diagnosis (at present) Not intended to be used by educators to rate children (not more reliable than
parent ratings) Should not be used when caregiver has a debilitating psychiatric disorder Results questionable when majority of responses fall in the “undecided” range
For more information and free materials https://www.theoryofmindinventory.com/
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Sally-Anne: First Order False Belief Task (Baron Cohen,
et al 1985)
After introducing the dolls, the child
is asked the control question of
recalling their names (the Naming
Question).Sally then takes a marble
and hides it in her basket. She then
"leaves" the room and goes for a
walk. While she is away, Anne takes
the marble out of Sally's basket and
puts it in her own box. Sally is then
reintroduced and the child is asked
the key question, the Belief Question:
"Where will Sally look for her
marble?
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Sally Anne First Order False-Belief Task
(Baron Cohen, Leslie & Frith 1985)
*Major milestone in ToM’s development is gaining the ability to
attribute false belief
Recognize that others can have beliefs about the world
Mental representations of situations are different from their
own
Be able to predict behavior based on that understanding
In typically developing children mastery occurs ~4 years of age
or even younger in children with higher SES status, strong
vocabulary and good language stimulation
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Second Order False Belief Tasks
Second-order mental states may involve beliefs about belief or
involve beliefs about intentions
Perner & Wimmer, 1985
Inferring one’s person’s belief regarding another person’s intentions
John thinks that Mary thinks that…
Presented children with story in which two characters, John and
Mary, wanted to buy ice cream when each character had separate
knowledge about an ice cream van’s change of location. Both
characters in the story knew where the van was located, but John had
a mistaken second-order belief about Mary’s knowledge of the van’s
true location.
Age of acquisition between 6-7 years of age
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Second Order False Belief Task
(Perner & Wimmer, 1985)
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Strange Stories: Happe 1994
First used in a study of individuals with autism to test ToM
Short vignettes, each accompanied by a picture and two test questions
24 short mentalistic stories
13 physical control stories
Can be used in a testing battery to determine whether a student understands non-literal messages, indirect requests, sarcasm, jokes and metaphorical expressions
Types of stories: comprising lie, white lie, joke, pretend, misunderstanding, persuade, appearance/reality, figure of speech, sarcasm, forget, double bluff, and contrary emotions
https://pdfs.semanticscholar.org/4e63/b3378690202a23bd53cbd31856000dc43e8c.pdf pg. 265 onwards: all stories and scenarios which can be modified
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Informal Assessment: Discourse
Observation of Student conversing with Peers
Direct Engagement
Conversational Turns (balanced turns vs. excessively verbal)
Topic Stringing ↓
Balanced question/comment ratio
Perspective taking
Provide background information
Monitor comprehension
Gage interest in topic
Recognize and repair conversational breakdowns
Body Language
Proximity
Tone/Loudness/Prosody
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Informal Assessment: Procedure Analysis
Ability to coherently verbalize event sequencing (what steps do you need
to take in order to…?)
Directions (e.g., how to get somewhere )
Instructions on how to make something
Rules of a sport or a videogame
Explain a recipe
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Informal Assessment: Procedural Discourse
The purpose of procedural discourse is to coherently explain how to do something
A series of steps leading to a specific goal by centering on events that are contingent upon one another
The steps are organized chronologically
Temporal markers are used (first, second, next, last, etc)
Evaluates:
Gestalt Processing
Create whole from parts in order
ToM
What do you think the people in the pictures talking about?
What are they thinking?
Organizational Ability
Ability to put thought into expression
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Informal Assessment: Narratives
Sequencing Ability Story order
Working Memory Use of relevant details
Grammar Sentence structure (errors, run-on sentences, etc) Use of temporal and cohesive markers to connect the story
Vocabulary Immature vs. age-level Word retrieval issues vs. lexical fluency
Pragmatics Story cohesion /coherence Use of anaphoric references
Perspective Taking Insight into character’s feelings, beliefs, thoughts
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Elements of Narrative Assessment
Story grammar (Stein & Glenn, 1979)
Setting
Initiating event
Internal Response
Attempt
Consequences
Reaction
Conjunctive cohesion
and, but, so, then, and then, however, subsequently, moreover
Temporal Markers
before, after, during, first, firstly, secondly, last, finally
Anaphoric Referencing
appropriate identification of people, locations, events vs. labeling everyone “he” or “she” or using non-specific comments such as “that place”, “that thing”, etc
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Elements of Narrative Assessment (con’t)
Event sequencing
Central theme vs. unconnected story
Explicitness
Fluency
Story fluidity, lack of lexical/phrasal interruptions ↓
Word Retrieval/Word Finding
Word fillers such as um, ah, word/phrase revisions, word/phrase
repetitions, word omissions, word prolongations, false starts, etc
Emotional Relatedness/Perspective Taking
Identify and correctly interpret character’s emotions, ideas, thoughts
Hedgeberg & Westby 1993
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Assessment Conclusion
Use multiple assessment tasks to create a balanced assessment
Assessment has to be functional
Determine strengths not just weaknesses
Descriptive measures vs. standard scores
To qualify for services in cases with Average Standard Scores
but pervasive social pragmatic deficits
Make sure your assessments yield diagnostic information
needed to formulate treatment goals
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New Smart Speech Therapy Resources
Best Practices in Bilingual Literacy Assessments and
Interventions
Comprehensive Literacy Checklist For School-Aged
Children
Dynamic Assessment of Bilingual and Multicultural
Learners in Speech Language Pathology
Differential Assessment and Treatment of Processing
Disorders in Speech Language Pathology
Practical Strategies for Monolingual SLPs Assessing
and Treating Bilingual Children
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Select Helpful Resources
The Checklists Bundle
General Assessment and Treatment Start Up Bundle
Multicultural Assessment Bundle
Narrative Assessment and Treatment Bundle
Introduction to Prevalent Disorders Bundle
Social Pragmatic Assessment and Treatment Bundle
Psychiatric Disorders Bundle
Fetal Alcohol Spectrum Disorders Assessment and Treatment Bundle
Assessment Checklist for Preschool Aged Children
Assessment Checklist for School Aged Children
Speech Language Assessment Checklist for Adolescents
Differential Diagnosis of ADHD in Speech Language Pathology
Creating Functional Therapy Plan
Selecting Clinical Materials for Pediatric Therapy
Social Pragmatic Deficits Checklist for Preschool Children
Social Pragmatic Deficits Checklist for School Aged Children
Language Processing Deficits Checklist for School Aged Children
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Contact Information:
Tatyana Elleseff MA CCC-SLP
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