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Child Language Assessment: Writing Legally Defensible Reports
Presented by: Sean Green Director of School-Based Services
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CSAD 223—Only ** on exam Speech Pathology Group 2015
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Why is this topic important?
Research in the communication sciences and disorders in the US has clearly indicated the shortcomings and fallibilities of clinicians in their ability to write formally, correctly and clearly. Much of what you write can become a legal document that may be used in court. Clear and comprehensive records are necessary to justify the need for intervention, to document the effectiveness of intervention, and for legal purposes. Speech Pathology Group 2017
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Why is this topic important?**
SLPs may have documents subpoenaed, be called to mediation, and/or spend valuable time trying to gather information that may have been collected years previously. If documentation is incomplete or incorrect, then school districts may spend thousands of dollars in IEE or fair hearing costs. Speech Pathology Group 2017
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Why is this topic important?
Research in the communication sciences and disorders in the US has clearly indicated the shortcomings and fallibilities of clinicians in their ability to write formally, correctly and clearly. Much of what you write can become a legal document that may be used in court. Clear and comprehensive records are necessary to justify the need for intervention, to document the effectiveness of intervention, and for legal purposes. Speech Pathology Group 2017
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Why is this topic important?**
SLPs may have documents subpoenaed, be called to mediation, and/or spend valuable time trying to gather information that may have been collected years previously. If documentation is incomplete or incorrect, then school districts may spend thousands of dollars in IEE or fair hearing costs. Speech Pathology Group 2017
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What is an IEE?** Independent Educational Evaluation
An assessment conducted by a qualified examiner who is not employed by the public agency responsible for the education of the child in question (34 C.F.R. Sec (a)(3)(i)). Parent has right to choose the assessor as long as the assessor is qualified. Speech Pathology Group 2017
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What is an IEE? Parents have the right to request an IEE if they disagree with the public agency’s assessment and they request an independent evaluation. (20 U.S.C (b)(1); 34 C.F.R. § (b)(1) and (b)(2); Ed. Code §§ 56329(b); 56506(c)). An IEE is a challenge to the appropriateness of the LEA’s assessment. A legally appropriate assessment is the best defense against IEE requests. Even if district’s assessment is legally appropriate, parents can still request an IEE if they disagree with the recommendations! Speech Pathology Group 2017
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What is a legally defensible report?
Per California Education Code § 56327, a report must include: a) Whether the pupil may need special education and related services b) The basis for making the determination c) The relevant behavior noted during the observation of the pupil in an appropriate setting d) The relationship of that behavior to the pupil’s academic and social functioning Speech Pathology Group 2017
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What is a legally defensible report?
Per California Education Code § 56327, a report must include: e) The educationally relevant health, development, and medical findings, if any (involve school nurse as appropriate) f) For pupils with learning disabilities, whether there is such a discrepancy between achievement and ability that it cannot be corrected without special education and related services Speech Pathology Group 2017
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What is a legally defensible report?
Per California Education Code § 56327, a report must include: g) A determination concerning the effects of environmental, cultural, or economic disadvantage, where appropriate h) The need for specialized services, materials, and equipment for pupils with low incidence disabilities Speech Pathology Group 2017
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What is a legally defensible report?- Els**
Per California Education Code § 3023: Assessments shall be administered by qualified personnel competent in the individual’s primary language, or if this is not feasible, administered in collaboration with an interpreter. The report shall document how the validity of the assessment may have been affected. The normal process of second language acquisition, dialect, or sociolinguistic variance shall not be diagnosed as a disabling condition. Speech Pathology Group 2017
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What is a legally defensible report? -- ELs
Students cannot be found eligible for special education merely because they are learning English. IDEA: “a child shall not be determined to be a child with a disability if the determinant factor for such determination is limited English proficiency (20 U.S.C. § (b)(5)(c).). Title 5 of CA Code of Regulations: “The normal process of second-language acquisition, as well as manifestations of dialect and sociolinguistic variance shall not be diagnosed as a handicapping condition.” Speech Pathology Group 2017
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What is a legally defensible report?- ELs
Assess in the language and form most likely to yield accurate information (Ed Code § 56320) Student v. Rialto Unified School Dist. et. al. (SEHO 2002) 38 IDELR 150 Student argued the district was required to assess in Spanish as well as English Parties agreed English was the student’s language or greater proficiency across tasks District attempted to assess in Spanish, but student did not respond to any questions asked in that language Result: Further assessment in Spanish not required Speech Pathology Group 2017
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Common Mistakes Failure to document all assessment procedures used
Reporting only standardized assessments and forgetting descriptive measures (i.e. teacher report/ classroom observations) Omission of Total Test Scores Reporting only subtest scores Reporting Standardized Scores that may be considered invalid for that student Validity/Cautionary Statements Failure to Document if student meets Eligibility Criteria Speech Pathology Group 2017
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Common Mistakes Failure to Document Educational Relevance
Failure to Document any Modifications/Accommodations needed Description of attempt to assess in student’s native language Assessment of all areas of suspected AND related disability Reporting only language or articulation, and leaving out voice or fluency Speech Pathology Group 2017
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Common Mistakes** Failure to explain seemingly contradictory scores
Failure to synthesize/analyze all testing information into a “big picture” Failure to confirm whether or not the difficulties noted are exhibited at school Speech Pathology Group 2017
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Common Mistakes Failure to document any compensatory strategies the student uses and the success of those strategies Failure to differentiate recommendations required for FAPE and those that would just be helpful Avoid “would benefit from” No provision of context and information to aid understanding of results e.g. bell curve Speech Pathology Group 2017
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How do we approach this as SLPs?
Speech Pathology Group 2017
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Choosing Your Assessment Battery
What makes an assessment appropriate? Qualified Assessors Validated Tests Assessment in all areas of suspected AND related disability Assessment measures administered in student’s native language unless clearly not feasible Administering tests in accordance with test instructions Selecting and administering tests so as not to be discriminatory or racially/culturally/sexually biased Speech Pathology Group 2017
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Choosing Your Assessment Battery
What makes an assessment appropriate? Variety of approaches- formal vs informal, alternative assessments (e.g. observations, interviews), dynamic assessments (e.g. test-teach- retest) Variety of sources (e.g. parents, teachers, student) CA Code of Regulations 3030 states that, “No single score or product of scores shall be used as the sole criterion for the decision of the individualized education program team as to the pupil’s eligibility for special education.” Speech Pathology Group 2017
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Choosing Your Assessment Battery
Norm-referenced are used to compare a specific student’s performance with that of peers Must be appropriately selected for validity and reliability Be mindful of whether the subject’s cultural and linguistic background match the test material and the norming population Speech Pathology Group 2017
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Choosing Your Assessment Battery
Assessment means more than “testing” Conducting both non-standardized and standardized assessments enables the SLP to: View the student in settings with and without contextual support Obtain information about the student’s functional communication abilities and needs, present levels of performance, and educational needs that derive from the disability Support/deny the findings & accuracy of formal tests Speech Pathology Group 2017
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Non-Standard/Alternative Assessment Methods
Checklists and developmental scales These tools are used to obtain a large amount of information in an organized or categorized form to note the presence or absence of specific communication behavior. They may be completed either by the speech- language pathologist or by others (i.e. parent, teacher) Speech Pathology Group 2017
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Non-Standard/Alternative Assessment Methods
Dynamic assessment Focuses on the ability to learn language rather than current level of performance. Change in performance when provided with learning opportunity, along with their participation/engagement during intervention, are indicators of the presence/absence of a language disorder. Speech Pathology Group 2017
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Non-Standard/Alternative Assessment Methods
Dynamic assessment Test-teach-retest (Peña, Quinn, & Iglesias, 1992; Lidz & Peña, 1996; Peña et. al. 2001) Compare pre and post-test performance Don’t teach to the test, but provide an opportunity to learn/understand a skill Consider how “modifiable” the student was in the teaching process (e.g. quick to “get it?”) Speech Pathology Group 2017
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Non-Standard/Alternative Assessment Methods
Dynamic assessment Fast Mapping Word Learning Tasks (Horton-Ikard & Weisman, 2007) Assesses word-learning ability, not previous exposure to vocabulary See example videos by Catherine Crowley, LEADERSproject.org: . Speech Pathology Group 2017
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Non-Standard/Alternative Assessment Methods**
It’s as simple as gathering information from a variety of sources! Report cards Work samples Health records Family interview Classroom teacher input Observation across contexts RTI data Speech Pathology Group 2017
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Non-Standard/Alternative Assessment Methods
Language Sampling Can provide better illustration of student’s functional communication skills than standardized testing Can target many areas of suspected deficit, and be consistent with SLI eligibility criteria areas Pragmatics (e.g. double interview task) Receptive or Expressive language Gather samples from different contexts With peers Structured activities Narrative tasks For bilingual students, bilingual sampling can be helpful for making direct comparisons between languages Speech Pathology Group 2017
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Cultural Background Considerations
Consider the social norms of each culture. You may want to consider asking the parent/guardian if the student’s social behaviors are considered typical within their culture. Speech Pathology Group 2017
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STEP ONE: REVIEW OF RECORDS
The Assessment STEP ONE: REVIEW OF RECORDS Speech Pathology Group 2017
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Step One: Review of Records
After the initial referral, the SLP must begin by gathering information. Information should be available from: Previous speech and language evaluations Physicians report listing medical diagnosis Intelligence testing results included in reports from clinical or educational psychologist Academic testing results included in reports from regular or special education teachers/reading specialists Speech Pathology Group 2017
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Review of Records If the student is learning English as a second language: Identify the primary language of the family Review California English Language Development Test (CELDT) scores to determine his/her level of English understanding and speaking proficiency as well as looking for progress over time Date of last hearing and vision screening Speech Pathology Group 2017
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Review of Records Caution:
Information obtained from outside sources may potentially lead to a biased view of your student’s condition Remember to rely primarily on your direct observation Speech Pathology Group 2017
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STEP TWO: PARENT/TEACHER INTERVIEW AND REPORTING MEASURES
The Assessment STEP TWO: PARENT/TEACHER INTERVIEW AND REPORTING MEASURES Speech Pathology Group 2017
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Step Two: Parent/Teacher Interview and Reporting Measures
Parent/Teacher checklists should be completed before actual assessment session is conducted This enables the clinician to anticipate those areas that will require further clarification such as “doesn’t respond to questions”, or “difficulty with peers” This also allows the clinician to preselect appropriate evaluation materials and procedures Speech Pathology Group 2017
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Parent/Teacher Reporting Measures
Sample Interview Questions: (Friedland 2000) is a sample of questions you may want to ask the caregiver regarding: Communication development Current concerns Social interests. Example open-ended questions are provided to yield maximum parent responses Scan form Speech Pathology Group 2017
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Parent/Teacher Reporting Measures
Children’s Communication Checklist-2 (CCC-2): is a parent or caregiver rating scale used to identify children with pragmatic language impairment The 70-item questionnaire is norm referenced Appropriate for students aged 4:0-16:11 It rates items such as: Speech Vocabulary Sentence structure Social language skills Speech Pathology Group 2017
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Parent/Teacher Reporting Measures
Social Responsiveness Scale (SRS-2): Includes parent and teacher forms, is norm referenced, and is appropriate for ages years It is used to identify severity of social deficits in individuals with autism spectrum disorders Subscales include: social awareness social cognition social communication social motivation autistic mannerisms Add picture Speech Pathology Group 2017
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Parent/Teacher Reporting Measures
Pragmatic Skills Language Inventory (PLSI): An easy to use norm referenced scale appropriate for ages years This 45 item inventory has 3 subscales. The manual provides cut off scores for determining if the student presents a pragmatic disorder Includes guidelines for results interpretation Speech Pathology Group 2017
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Parent/Teacher Reporting Measures
Pragmatic Skills Language Inventory (PLSI) Cont’ Personal interaction skills (Initiating conversation, asking for help, participating in verbal games, using appropriate nonverbal gestures) Social Interaction Skills (When to talk and when to listen, understanding classroom rules, taking turns in conversations, predicting consequences) Classroom Interaction Skills (using figurative language, topic maintenance, explaining how things work, writing stories and using slang) Speech Pathology Group 2017
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Parent/Teacher Reporting Measures
Social Skills Improvement System (SSIS) - This norm referenced instrument has parent, teacher and student forms Social Skills, Competing Problem Behaviors, and Academic Competence Subscales are provided for communication, engagement, bullying, and autism spectrum Ages 3-18 years (Preschool) Available in Spanish Speech Pathology Group 2017
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CELF-5 Observational Rating Scale (ORS):
Designed to describe classroom and home language skills May be completed by teacher, parent/caregiver, student (40 items) Areas include: Listening, Speaking, Reading, Writing Enables clinician to identify areas of concern Speech Pathology Group 2017
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Parent/Teacher Reporting Measures
CELF- Preschool 2, Descriptive Pragmatic Profile describes the child’s language use at school or at home Criterion referenced measure for ages Indicates adequate or inadequate communication abilities in context Speech Pathology Group 2017
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Parent/Teacher Reporting Measures
Gard, Gillman, Gorman Chappel Hill Scale Speech Pathology Group 2017
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STEP THREE: OBSERVATION
The Assessment STEP THREE: OBSERVATION Speech Pathology Group 2017
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Step 3: Observation It is best to observe the student in a variety of settings in order to assess the use of social skills in a natural/daily environment. Speech Pathology Group 2017
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Functional Communication Profile-Revised
Subtests include : Sensory/Motor auditory, visual, gross-motor, and fine- motor skills and behavior Receptive Language comprehension of verbal and nonverbal language and basic concepts, interest in pictures and objects, following commands, and object and two-dimensional recognition Attentiveness attention span, alertness, response levels, cooperation, and level of awareness) Expressive Language verbal and nonverbal comm’, manner and modality of communication, quality of self- expression, object use and interactions, cause and effect, vocabulary, grammar, and phrase length Speech Pathology Group 2017
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Functional Communication Profile- Revised
Pragmatic/Social Language communicative intent; questioning skills; conversational skills; turn- taking; topic initiation, maintenance, & elaboration; appropriateness of comm’; reading/literacy; writing/ spelling; memory Non-Oral Communication use of sign language, two-dimensional expression, yes/no, fine-motor abilities, and effectiveness of current augmentative or alternative communication system Speech intelligibility of sounds produced, dentition, and oral-motor imitation Voice loudness, vocal quality, and pitch Oral mouth breathing, drooling, tongue thrust, and swallowing/diet Fluency rate of speech, rhythm and intonation Speech Pathology Group 2017
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Observation: Pragmatic/Social Communication Checklists
Assessment of Pragmatic Skills Form (Shipley, McAffee 2009) is a list of 15 pragmatic behaviors and corresponding sample activities the SLP can use to elicit those behaviors from a student during assessment or observation Observation Guide- Look and Listen (Friedman, 2010) is a list of behaviors to “look and listen” for when conducting observations, in the areas of social, communication and behavior. Speech Pathology Group 2017
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STEP 4: STANDARDIZED ASSESSMENTS
The Assessment STEP 4: STANDARDIZED ASSESSMENTS Speech Pathology Group 2017
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STEP 4: STANDARDIZED ASSESSMENT
Across the fields of psychology, education, and speech- language pathology, evaluations using IQ tests and other standardized tests are usually inadequate, by themselves, for assessing the depth and complexity of a social learning disability Speech Pathology Group 2017
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STEP 4: STANDARDIZED ASSESSMENT**
Valuable information may be gained from the use of standardized assessments as long as the clinician considers what the tests is actually measuring Inferencing skills Problem solving Context of the student’s response (i.e. in a structured, untimed situation) How the results compare to the student’s performance in the general social and academic environments Speech Pathology Group 2017
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Receptive Expressive & Social Communication Assessment-Elementary
RESCA–E For ages 5 through 12 Core subtests designed to be administered in one hour or less Tasks presented range from basic naming (vocabulary) to advanced inference skills to accommodate a wide range of abilities Receptive tasks include: vocabulary, following oral directions, story and question comprehension, syntax/morphology comprehension Expressive tasks include: vocabulary, describing and explaining, storytelling and narrative, syntax/morphology Speech Pathology Group 2017
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Receptive Expressive & Social Communication Assessment-Elementary
RESCA–E Social Communication tasks include: interpreting body language/facial expressions, inference (slang, idioms, hidden meaning) and situational language use Social Communication Inventory included in English and Spanish (other languages to be added) to find out how adults in the child’s life perceive his/her everyday social language and behaviors across environments Normative data: Standard Scores, Percentiles and Age Equivalents for individual subtests and Receptive, Expressive, and Social Communication Cores Speech Pathology Group 2017
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Comprehensive Assessment of Spoken Language-2
Comprehensive Assessment of Spoken Language-2 (CASL-2) Ages Includes online scoring 14 stand-alone individually administered tests Measures spoken language across four structural categories: Lexical/Semantic: Knowledge and use of words and word combinations Syntactic: Knowledge and use of grammar Supralinguistic: Knowledge and use of language in which meaning is not directly available from the surface lexical and syntactic information Pragmatic Language: Knowledge of language that is appropriate across different situational contexts and ability to modify language according to the social situation Speech Pathology Group 2017
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Clinical Evaluation of Language Fundamentals-5
CELF-5 A comprehensive assessment normed for ages 5:0 -21:11. Battery of 16 stand alone tests. Core Language Score, Receptive Language, Expressive Language, Language Structure and Language Content. Subtests include Word Classes, Following Directions, Formulated Sentences, Word Definitions, Sentence Assembly, Semantic Relationships and Pragmatics Profile. Speech Pathology Group 2017
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Social Language Development Test –Elementary (SLDT-E)
Social Language Development Test –Elementary (SLDT-E) This diagnostic test assesses social language skills, including nonverbal communication Elementary students aged 6:0 to 11:11 Tasks focus on Taking someone else’s perspective Making correct inferences Negotiating conflicts with peers Being flexible in interpreting situations Supporting friends diplomatically Speech Pathology Group 2017
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Social Language Development Test –Elementary (SLDT-E)
Subtest A: Making Inferences: Student takes perspective of someone in a photo and, based on the context clues (facial expression, posture, gesture etc) tells what the person is thinking as a direct quote from the character Subtest B: Interpersonal Negotiation: Student imagines being in a conflict situation with a friend. They must then state the problem, propose an appropriate solution, and explain why that solution would be a good one Subtest C: Multiple Interpretations: Student provides two different interpretations of the same photograph Subtest D: Supporting Peers: Student assumes the perspective of a main character in a situation with a friend. The student tells the friend something that supports or pleases the friend, even if the comment isn’t truthful (doesn’t match the student’s true belief) Speech Pathology Group 2017
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STEP 5: DYNAMIC AND ALTERNATIVE ASSESSMENTS
The Assessment STEP 5: DYNAMIC AND ALTERNATIVE ASSESSMENTS Speech Pathology Group 2017
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Dynamic and Alternative Assessments**
The CA Ed Code further defines that, “When standardized tests are considered to be invalid for a specific pupil, the discrepancy shall be measured by alternative means as specified on the assessment plan.” Speech Pathology Group 2017
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Dynamic and Alternative Assessments**
Typically, standardized tests cannot reveal the complexity of social thought required to think through and engage in the complex tasks that occur throughout the school day such as: Having conversations Actively sustaining group play Participating in classroom discussions Working as part of a group in the classroom Speech Pathology Group 2017
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Dynamic and Alternative Assessments
Other critical problems include that they do not require students to rapidly respond to socially based test prompts, such as interpretation of language meaning or idioms In reality, if it takes a person longer than 2 to 3 seconds to respond in a communicative interaction Speech Pathology Group 2017
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Michelle Garcia Winner-Social Thinking Dynamic Assessment
Several assessment tools have been created including: The Double Interview Writing Samples Thinking With Our Eyes Sequencing Pictures Assessing Organizational Skills Speech Pathology Group 2017
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Michelle Garcia Winner’s-Social Thinking Dynamic Assessment Cont.
Double Interview Student is questioned on how they perceive his/her life at home and school environments Notes are taken on pragmatic skills related to: Body language; maintaining eye contact; keeping his head, body and shoulders turned towards me, etc. Conduct actual interview Speech Pathology Group 2017
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Michelle Garcia Winner’s-Social Thinking Dynamic Assessment Cont.
Double Interview Notes are taken on pragmatic skills related to: Ability to modulate his volume and tone of voice: Does he talk too loud or too soft? Is his prosody within normal limits? Are the students responses related to the questions asked or tangential to the topic? Does the student have one particular topic they are eager to talk about? Speech Pathology Group 2017
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Double Interview The second part includes the student interviewing the assessor Errors in the double interview may indicate: Weak narrative skills Ineffective use of own body language and facial expressions Problems with eye contact Difficulty with prosody Difficulty reading peoples faces quickly enough Limited ability to generate language, specifically questions Inability to ask follow up questions Difficulty self regulating his talking time Speech Pathology Group 2017
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Double Interview Recommendations based on weaknesses in these tasks include: Identifying the weaknesses and prioritizing based on developmental age and functional needs Write specific IEP goal to address this need Impact on academics and social elements Student may appear uninterested in others Student may be a challenge because lack of participation Student will likely encounter problems with written expression Student fails to work well in group classroom projects Speech Pathology Group 2017
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Double Interview Example
Speech Pathology Group 2017
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Speech Pathology Group 2017
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Michelle Garcia Winner’s-Social Thinking Dynamic Assessment Cont.
Writing Sample Student is asked to fill out a form that requests basic information Majority of students with autism present some difficulty with fine motor skills (Large, bulky handwriting) Writing is laborious and can lead to behavior problems Student may present difficulty asking for help or clarification Observe the student to identify how long they sit without writing something or asking for help Ask the student what they do at school when they are stuck Speech Pathology Group 2017
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Michelle Garcia Winner’s-Social Thinking Dynamic Assessment Cont.
Thinking With Our Eyes Your eyes are “tools” that help you figure out your environment It puts the emphasis on the students becoming good observers and using clues to make guesses about what other people may be thinking If you use your eyes to look at a person, it makes them feel that you are thinking about what they are saying or doing Active participation Speech Pathology Group 2017
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Thinking With Our Eyes Errors in this section may imply:
Difficulty understanding that eyes are used to convey information about thought and emotion among people Difficulty quickly and efficiently using eye-gaze to interpret what people are looking at and what their related thoughts may be Speech Pathology Group 2017
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Thinking With Our Eyes Recommendations based on weaknesses in these tasks include: Work with student to practice identifying eye-gaze direction Work with student to practice making “smart guesses” about what people might be thinking based on what they are looking at Work on interpreting what people mean when they say “I caught a glimpse of…” What does that mean in terms of what they now may know Speech Pathology Group 2017
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Thinking With Our Eyes**
Impact on academics and social elements Student has difficulty regulating around others given that he is not efficient at reading others’ thoughts Student may have extreme difficulty learning in a large classroom setting where one is expected to actively track the eye-gaze direction of fellow teachers and students Student is likely to be unknowingly tricked, given that he cannot read peoples intentions as conveyed through their eyes Student is likely to have significant to severe problems with socially relating to all others and particularly peers who understand how eyes are used in social situations as early as elementary school Speech Pathology Group 2017
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Michelle Garcia Winner’s-Social Thinking Dynamic Assessment Cont.
Sequencing Pictures This assesses the students ability to see the big picture and relate pieces from an overarching thought or concept. It also gives us insight into the students ability to arrange things in logical sequence or flow Select 6-8 pictures for the student to sequence Create interest in the activity and remind the student that this is a non-speaking task Speech Pathology Group 2017
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Sequencing Pictures**
Difficulty with picture sequencing may indicate that the student may have deficits in: Understanding the relationship of parts to the whole Organizational problems, understanding sequences presented in the classroom, possible reading comprehension issues Recognizing contextual cues Understanding inferences This may be adapted for younger students by reducing the # of cards to 3-6 Speech Pathology Group 2017
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Michelle Garcia Winners-Social Thinking Dynamic Assessment
Assessing-Organizational Skills Includes a list of questions appropriate for students in the 4th grade and higher. They include; Motivation for good grades Time management skills Willingness and emotional response to homework Daily homework study habits Long term study habits including procrastination Ability to organize and prioritize homework assignments Ability to ask for help Ability to take meaningful notes in classroom Ability to gather relevant study material Speech Pathology Group 2017
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STEP SIX: ANALYZING AND INTERPRETING RESULTS
The Assessment STEP SIX: ANALYZING AND INTERPRETING RESULTS Speech Pathology Group 2017
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Summary and Recommendations
The summary should never include new information Summarize the strengths and weaknesses of the client Indicate how the child’s language skills affect daily functioning Provide recommendations for services and supports Speech Pathology Group 2017
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Conclusion:** 5 steps of assessing social pragmatic skills
STEP ONE: REVIEW OF RECORDS STEP TWO: PARENT/TEACHER INTERVIEW AND REPORTING MEASURES STEP THREE: OBSERVATION STEP 4: STANDARDIZED ASSESSMENTS STEP 5: DYNAMIC AND ALTERNATIVE ASSESSMENTS STEP SIX: ANALYZING AND INTERPRETING RESULTS Speech Pathology Group 2017
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Questions/Comments Speech Pathology Group 2017
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Contact Sean Green: Speech Pathology Group 2017
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