Let’s Help Kids Succeed
The Big Picture SLP is teaching professionals around the world how to use evidence-based decision making to achieve the best results for clients and ourselves.
I’m a speech-language pathologist with board certification in child language assessment and a passion for research in child language disorders. The language development process fascinates me because oral communication skills are critically important for success in all areas of development. Ensuring children have strong language skills sets a stronger foundation for academics, literacy, social-emotional skills, and so much more.
In our field, SLPs are increasingly focusing on diagnostic accuracy. Within the last 15 years we’ve seen a growing shift towards collecting critical information that goes beyond standardized scores. What should you be looking for? What are good norm reference tests and if you have to use them, how are those tests aligned with your goals?
One area of our focus is feasible language sample analysis. Speech-language pathologists aren’t currently trained in how to take a language sample and make that quantifiable to another professional, such as a school administrator, whose support we seek for service approvals. Taking a language sample is highly desirable, but it’s also a time-consuming process and often, there just isn’t time to do it.
We’re now teaching clinicians how to achieve effective child language assessments in a more time-efficient manner. For some children, and depending on the clinicians’ goal, it’s not always necessary to do a full language sample analysis. Once you understand a variety of time-effective methods to collect and analyze samples, you’ve got a very helpful tool that can give you more detailed and individualized data than a standardized test.
My colleagues and I have spent many years collecting child language assessment data.
Consider one of our examples: Lisa, a five-year-old girl, whose mother noticed her daughter wasn’t progressing with speech, completed a questionnaire with concerns: Lisa was speaking in short sentences, mixing up pronouns, and struggling with grammar - all red flags for a language disorder.
A teacher rating form also noted concerns about Lisa’s speech and language development. When we examined Lisa's language sample, it confirmed what her mother and teacher had been telling us: Lisa was using very short sentences for someone aged five. However, to our surprise, when we followed up with standardized tests, Lisa’s scores were within normal limits.
We frequently see children like Lisa who present with concerns but are diagnosed as not having a language disorder, even though a parent and/or teacher has legitimate concerns about their speech development.
These are critical, teachable moments for a speech-language pathologist. The determining assessment can change a child’s life. When we investigated further, we came to understand that Lisa had symptoms of developmental language disorder (DLD), a condition that is more prevalent than autism. DLD is often undiagnosed because, according to standardized scores, these kids are doing okay. Typically, people with DLD have a good vocabulary which pulls up their overall scores. But when you look at individual subsections, you see their problem is with the language structure. Completing a more micro-level analysis of all parts of language is critical to an assessment and standardized testing doesn’t always do that. I encourage you to dig into research studies here and here.
We know that when students are passed over for speech services, they are at increased risk for reading and math problems. Statistically, children with DLD are eight times more likely to experience anxiety and depression. As they grow older, we see that they are more likely to have difficulty in post-secondary education, more likely to work part-time instead of having full-time employment, and more likely to serve jail time. The implications of these types of misdiagnoses are significant and potentially life-altering. Read the LSHSS journal study that supports this here.
Communication is our greatest power and currency. Communication enables us to establish who we are, what we want and how we will be treated.
As speech-language pathologists, it’s our job to help children develop their best abilities. We need to stand firm in our roles as curious educators, keep asking questions, and encourage open-mindedness. If our goal is to provide top notch care, we’ve got to stay invested, and ask the hard questions in the pursuit of important answers that will make a difference.
