Hoffman, P.R., & Norris, J.A. (2002). Phonological assessment as an integral part of language assessment. American Journal of Speech-Language Pathology, 11, 230-235.
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Main Point:
The purpose of this article is to inform the reader of a more language based approach to an assessment with a preschool-aged child with a suspected articulation/phonological disorder.
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Relevance:
This article is relevant to the field of speech-language pathology because it provides the reader with an outline of how to complete an assessment with a preschool-aged child with a suspected articulation/phonological disorder. The article discusses why a clinician should perform a comprehensive language assessment when evaluating a child with a phonological disorder because there is research that has shown that children with articulation/phonological disorders also exhibit language deficits. The article provides a completely informal assessment.
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Concepts:
The main concepts presented in this article are: research has shown that many children who have phonological deficits also exhibit delayed grammatical development and because of this it is important to discover the nature of the problem in a naturalistic setting.
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Connections:
While I have been at Marshall University I have heard from several professors that sometimes the best assessment with a child is informal assessment. I really like how the authors of this article approach this as a holistic assessment in which both articulation and all of the aspects of language are assessed. The informal approach is interesting but I can see where it may possibly be more beneficial because it provides a broader picture of the child’s speech and language abilities.
Like Bleile (2002) the authors attempt to figure out the nature of the problem, but they focus more on phonological production from a language standpoint as opposed to a single-word production standpoint. The authors think that it is best to assess the child in a naturalistic context through play and storybook reading as opposed to using standardized testing.
I really liked the authors approach to the assessment. I feel like it would be a good assessment to use with a preschool-aged child, however I am not sure if this assessment could be completed within 60-90 minutes.
Bleile, K. (2002). Evaluating articulation
and phonological disorders when the
clock is running. American Journal of
Speech-Language Pathology, 11, 243-
249.
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Summarize:
I think that this article provides a wonderful assessment for a preschool-aged child. The authors of the article chose to use a natural context which will probably provide the clinician with a more realistic picture of the child’s communication abilities. The authors emphasize the importance of assessing higher-level language as well as phonetic assessment in order to determine the nature of the problem.
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Confusions:
I really liked the authors approach to the assessment. I think that it would provide a clinician with valuable information. At this time, I do not have any questions regarding the information provided within this article.
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Miccio, A.W. (2002). Clinical problem solving: Assessment of phonological disorders.
American Journal of Speech-Language Pathology, 11, 221-229.
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Main Point:
The main purpose of this article is to inform practicing clinicians of a possible assessment that could be completed within 60-90 minutes with a preschool-aged child with a suspected phonological/articulation deficit.
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Relevance:
The article is relevant to the field of speech-language pathology and student clinicians in the field of speech-language pathology because it provides an outline of a possible assessment that could be completed with a preschool-aged child within 60-90 minutes, which is so often the time that is provided for an assessment.
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Concepts:
The main concepts presented in this article include: the efficiency of focusing on the suspected problem as opposed to focusing on the nature of the problem and that assessment should be continuous in nature.
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Connections:
I feel that in order to complete a thorough assessment the clinician should take into account both the suspected problem as well as trying to determine the nature of the problem. I think that this would allow the clinician to form a more thorough assessment as well as being time efficient. I agree with this author’s statement that evaluation should be continuous. A clinician should always be evaluating the performance of a client. What is seen in the initial assessment is a snapshot in time of the client. A client is changing continuously and their skills are adapting. The treating clinician is more able to determine the client’s strengths and weaknesses and should add, modify, and discontinue goals as they see fit.
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Summarize:
To determine the ideal assessment is a difficult task. The author presents what he thinks is ideal for the allotted time and will provide the clinician with the most information. I feel that the author provides a different perspective on assessment that would be beneficial when assessing some children. The articles that I have read on assessment in this forum make me believe that the assessment that is chosen should depend on the client. I believe that this is a good assessment outline, however I do not believe that it could be performed in the allotted time.
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Confusions:
My question is: How can you determine what is more important? To me focusing on the problem and trying to determine the nature of the problem are both important aspects of an evaluation.
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Tyler, A.A., & Tolbert, L.C. (2002). Speech-language assessment in the clinical setting.
American Journal of Speech-Language Pathology, 11, 215-220.
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Main Point:
The purpose of this article is to inform practicing clinicians of a possible assessment outline that could be used to complete a speech and language evaluation on a preschool-aged child.
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Relevance:
The article is relevant to the field of speech-language pathology because it outlines a possible assessment that could be used with a preschool-aged child when there are time constraints of completing a 60-90 minute evaluation, which is often the case for practicing clinicians. This article provides what the authors view as a time efficient thorough evaluation.
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Concepts:
Concepts presented by the authors in this article include: standardized testing is important in an assessment because it allows the child’s performance to be compared to his peers and nonstandardized procedures are important in the assessment process because the tasks allow clinicians to make clinical judgments based on the child’s performance.
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Connections:
The authors of this article emphasize the need for standardized measures as well as informal testing. When comparing their assessment outline with the outline provided by Bleile (2002), the authors of this article chose to perform a standardized language assessment and phonological assessment while Bleile only performed a standardized articulation assessment with the child. After reviewing the authors plan I do not believe that it is possible to complete this assessment within 60-90 minutes with a preschool-aged child. The authors have planned to give two standardized assessments as well as performing a language sample. The two standardized assessments in my opinion would take at least an hour. This would leave only a half an hour to perform the pre-interview and the nonstandardized procedures that the authors outlined. When comparing the authors assessment to Bleile’s assessment I believe that Bleile has provided an assessment that is more realistic in keeping with the time constraints placed upon the evaluation.
Reference:
Bleile, K. (2002). Evaluating articulation
and phonological disorders when the
clock is running. American Journal of
Speech-Language Pathology, 11, 243-
249.
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Summarize:
The authors of this article have designed a thorough assessment that could be used with a preschool-aged child. The authors emphasize the importance of formal and informal measures within an assessment throughout the article. The formal assessment that is standardized allows a clinician to compare the child’s scores with scores of children his or her age. The informal assessment allows the clinician to use clinical judgment when determining goals and the level of deficit. It provides additional information to the snapshot of the child.
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Confusions:
My only problem with this article is that the authors would probably go over 90 minutes if they were to administer this assessment. I was also wondering what the Bankson-Bernthal Test of Phonology is used for? Is it just a screening or is it an assessment?
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Bleile, K. (2002). Evaluating articulation and phonological disorders when the clock is
running. American Journal of Speech-Language Pathology, 11, 243-249.
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Main Point:
The purpose of this article is to inform the reader of a way to evaluate a preschool-aged child with a phonological/articulation disorder within a 60-90 minute period.
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Relevance:
The article is relevant to the field of speech-language pathology because it outlines how a clinician can effectively assess a preschool-aged child with a phonological/articulation disorder within an allotted amount of time. The author also takes into consideration that an articulation/phonological deficit may be an indicator of a language disorder and may cause trouble when the child begins to read and spell, so he also assesses the child’s language during the evaluation.
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Concepts:
The concepts presented in this article include: determine if the client has a communication deficit that would warrant therapy, what is the general nature of the deficit, and to complete a thorough evaluation within 60-90 minutes.
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Connections:
While reading this article I reflected on how students at Marshall University are taught to complete an evaluation. The questions that the author chose to ask within his interview are generally covered on the case history form at Marshall University. This makes me comfortable with saying that the case history at Marshall is thorough and asks pertinent questions. I also reflected on the authors test selection and his decision to complete a language sample during the play break. I like that the author kept the room simple and directed the assessment. His idea for administering the articulation assessment was great. To introduce it as a picture activity and to then have a small break is an idea that I will definitely use the next time I complete an assessment with a young child. These are the connections that I made while I read this article.
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Summarize:
The article clearly outlines an assessment that could be completed with a preschool-aged child whose case history reveals that the main concern is a possible articulation or phonological deficit. The assessment that is outlined investigates if there is a possible communication deficit in the areas of speech and language as opposed to just focusing on the speech intelligibility deficit. The assessment is complete and in-depth enough to provide pertinent information to the clinician performing the assessment.
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Confusions:
I think that this author clearly explains how to complete an assessment within 60-90 minutes with a preschool-aged child. I think the most challenging thing for me about reading this article is that the author does not clearly provide a back-up plan. However he does tell the reader to phonetically transcribe the child’s utterances, which I guess could be used if the standardized test was not complete. I also wish that the author would have provided information into why he selected the particular standardized assessment that he chose. My remaining question is: theoretically if you had to choose which standardized articulation test would you choose and why?
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To Whom It May Concern:
Over the past month and a half I have acquired new and exciting information in my phonology class. I have learned how to complete a critically appraised topic assignment. I now know for sure that there is not a lot of research in our field of study directly related to social dialect and group and individual treatment. I have learned more about APA format and how to better use the manual. I have read and learned about the importance of basing assessment on theory in order to provide the client with more efficacious treatment. In fact, I am planning to try using theory the next time I have a phonological or articulation assessment. My learning at this point means that I am growing as a clinician and as a person. I feel that I am developing my skills and learning knew ways to develop and improve my skills in the assessment of phonological disorders. I still have some questions about theory. Which theories are the most commonly used in the treatment of phonological disorders? How can you structure an assessment from theory? This is what I have learned and what I am wondering. Thank you for your time.
Thanks,
Whitney
Tyler, A.A., Tolbert, L.C., Miccio, A.W., Hoffman, P.R., Norris, J.A., Hodson, B., Scherz, J., & Bleile, K. (2002). Five views of the elephant: Perspectives on the assessment of articulation and phonology in preschoolers. American Journal of Speech-Language
Pathology, 11, 213-214.
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Main Point:
The purpose of this article is to inform the reader of the information that was given to the authors of the following articles to help devise an assessment plan, and to reiterate the importance of assessment in clinical practice.
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Relevance:
This article describes the following studies and the reason for the study. This is relevant because it provides background information to the following articles. It also emphasizes the guidelines and importance of assessment in speech disorders. This article provides new clinicians with information on what is possible in real life clinical assessment, not just what is possible in an ideal situation.
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Concepts:
The concepts in this article are that assessment can be challenging in a clinical setting due to the time constraints, an assessment should be thorough, and to provide the reader with best practice in real life situations.
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Connections:
As I read the article it made me think of everything I have been taught to do and what I have been able to do in clinical situations. I have found in my practice as a clinician that it is sometimes difficult to perform the ideal “in a perfect world” evaluation. When in the clinical setting you have to think on your feet because the plan usually does not go the way you think it will go. I think that the following articles will be very helpful to a starting clinician.
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Summarize:
This article emphasizes that it is important to be thorough in a clinical assessment in order to provide efficacious treatment. The author tells the reader why the following articles are important because of the challenge of the clinical setting and the importance of an efficacious assessment. This article summed up the constraints given to seasoned clinicians who are experts in the field. The constraints given are common to the clinical setting, which makes it relevant to the new clinician as well as seasoned clinicians who wish to improve their assessments.
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Confusions:
This article is mostly a precursor to the following articles. The article did not leave me confused and did not leave me with any questions at this time.
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Williams, A.L. (2002). Prologue: Perspectives in the assessment of children’s speech. American
Journal of Speech-Language Pathology, 11, 211-212.
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Main Point:
The purpose of this article is to inform speech-language pathologists and students studying speech-language pathology of the importance of theory in assessment and treatment of phonological disorders. The hope is that this will lead to more efficacious treatment.
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Relevance:
This article is relevant to the field of speech-language pathology because the author discusses the positive outcomes of using theory to prepare for assessment and the underlying treatment goals that would follow. By using theory to develop the assessment the clinician is providing a more efficacious assessment that will help in the development of treatment for the disorder.
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Concepts:
The concepts in this article are that intervention is rooted in assessment and using theory to guide assessment will provide for a more efficacious treatment.
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Connections:
I recently evaluated a child that has a moderate-severe phonological disorder. After reading this article, I feel the assessment would have been more beneficial if I would have started by looking at theory and developing my assessment in that way. Developing the goals for therapy after the assessment was a task due to the amount of phonological processes the child used. Using a theory to develop my assessment would have helped me in developing the goals of therapy, and therefore would have provided me with more of an idea of an intervention plan. I feel that the next time I evaluate a child with a phonological disorder I will develop my assessment based on a theory.
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Summarize:
The author of this article emphasizes the importance of basing assessment and treatment on theory. By doing this clinicians will be able to provide more efficacious treatment, which is the goal of our profession. The author tells the reader by basing the assessment on theory we will be able to build stronger evidence as to why and which is the best and most efficacious assessment and treatment approach.
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Confusions:
For me theory has always been abstract and somewhat confusing. I think to be able to use the approach the author calls for the clinician must understand the theory. What could we as practicing clinicians do to better understand and use theory in assessment and treatment?
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American Speech-Language-Hearing Association (2004). Evidence-based practice in communication disorders: An introduction [Technical Report]. Available from www.asha.org/policy.
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Main Point:
The purpose of this technical report is to provide an overview of evidence-based practice, to describe the importance an d relevance of evidence-based practice, and to outline ways in which more credible evidence could become available in the fields of speech-language pathology and audiology.
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Relevance:
This report is a technical report issued by the American Speech-Language Hearing Association (ASHA) that outlines why evidence-based practice should be used and how the amount of pertinent research could be increased in order to aid in evidence-based practice in the fields of speech-language pathology and audiology. This is definitely relevant to the fields because it is derived from ASHA, which is the national association that governs both speech-language pathology and audiology. This is the association that created the Code of Ethics which practicing clinicians abide by.
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Concepts:
Evidence is available for practicing clinicians, however before using a piece of evidence one should evaluate the quality of the research presented. ASHA has presented five themes that will help rate the evidence that is being evaluated. The themes include: independent confirmation and converging evidence; experimental control; avoidance of subjectivity and bias; effect sizes and confidence intervals; and relevance and feasibility.
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Connections:
In classes we are always told that evidence-based practice is best practice when treating a client. We are also told that we must use the best current evidence and our clinical judgment. I have found that whenever I read a research article I always question who wrote the article, who published the article, was the article bias, etc. As I question I also take into account methods and techniques that I have used that have worked and that I have seen work. The technical statement made me realize how important it is that evidence-based practice is engrained in future speech-language pathologists and audiologists. I think that this should continue to be stressed to future clinicians. However, I do not feel that individuals just beginning the program would fully understand the importance of evidence-based practice. I know that I did not value it’s importance until later on in my academic career.
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Summarize:
Evidence-based practice is the best way to practice as a clinician. In order, to best treat our clients, clinicians need to review the evidence available, use their judgment, and take into account the values and beliefs of the client and his/her family. When reviewing evidence the clinician should take into account five themes: independent confirmation and converging evidence; experimental control; avoidance of subjectivity and bias; effect sizes and confidence intervals; and relevance and feasibility. Based on these themes the clinician can evaluate the quality of the research evidence. Evidence-based practice is encouraged by ASHA. Furthermore, ASHA has outlined ways in which more credible research can be obtained.
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Confusions:
Knowing that evidence-based practice is the best practice, what if a client’s values or beliefs conflict with the best method of treatment? What should a clinician do if this happens? Is it OK to try and convince the client to follow the method? Should results of case studies be used if they are the only available source? What if there are several conflicting reports of a specific treatment method, should the clinicians clinical judgment be used?
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Gruber, F.A., Lowery, S.D., Seung, H.K., & Deal, R.E. (2002). Approaches to speech-language intervention and the true believer. Journal of Medical Speech-Language Pathology, 11 (2), 95-104.
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Main Point:
The purpose of this article is to inform speech-language pathologist and students in speech-language pathology of some factors that may influence clinical outcomes other than treatment itself.
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Relevance:
This article is very relevant to the field of speech-language pathology because it informs the reader of effects that will influence the outcomes of therapy. It cautions practicing clinicians and future clinicians from using a technique just because the clinician has used it before and it works. It tells us that we should know why the treatment approach works and it suggest possible controls that could be used in experiments to ensure that these effects are not a factor in the viability of the treatment.
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Concepts:
The main concepts of this article are that five extraneous effects may influence the outcome of therapy when using a technique. The article presents the placebo effect, the Hawthorne effect, the natural history effect, the experimenter (Pygmalion) effect, and regression to the mean as effects that may affect the outcomes of therapy and research studies. The article also presents various research designs that can be used to guard against these effects influencing the outcome of the treatment approach.
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Connections:
Recently I attended the American Speech-Language Hearing Association (ASHA) annual conference in which I went to a short course. At this short course the research available in voice therapy and voice therapy techniques were discussed. The presenters’ spoke of the importance and need of more Class I research in the field of speech-language pathology in order for evidence based practice to be more effective and efficient. This article made me think about that particular event because it made me realize that just because it works is not a good enough reason to employ the therapy technique which is what the presenters in that session were emphasizing. I think with more Class I research studies the efficacy and effectiveness of treatment will vastly improve.
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Summarize:
The placebo effect, Hawthorne effect, natural history effect, experimenter (Pygmalion) effect, and regression to the mean may be factors in the outcome of therapy, which is why saying I used the technique because it works is not good enough. As speech-language pathologists and students of speech-language pathology we need to ask ourselves, “Why did the technique work?” We should not just settle for the fact that the technique worked before so it has to work again. This is not good enough in a profession driven by evidence based practice. Furthermore, there is a call for more research to be done in the field using research designs that will help prevent the five effects that were discussed in detail in this article. The field is in great need of Class I research. Through research we can find out which approaches are best and why the approaches are best. This will help further establish the profession of speech-language pathology.
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Confusions:
As speech-language pathologists and future speech-language pathologists we discuss the need for more research in our field. It makes me ponder why there is not a lot of research available in our field? I also wonder if the five effects are a bad thing when we do therapy, if they help aid in the improvement of the client’s condition. However, I do see how they would affect the basis of evidence based practice. Are there negative outcomes if the effects influence the outcome of the treatment? Will the client not truly improve and have to come back for further treatment? This is what the article has left me to ponder.
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