What to Expect When You're Assessing

What to Expect When You're Assessing

Being told someone you love needs a speech assessment can be a frightening, stressful, and confusing time. While dealing with the concept that your child might not be "normal," you are also most likely dealing with insurance, physician referrals, making appointments, and other stressful new experiences. Be not afraid.  An assessment is just a long paper which uses tests, descriptions, and informal measures to give a therapist a snapshot of a client.  

Any therapist that works with a child or adult wants to see what the client can and can't do in comparison to the developmental norms so that they know where to start or where to continue in therapy with your child.  Sometimes, Speech Pathologists utilize assessments to demonstrate that a client does not require therapy because they are performing so well or to help inform caregivers that the client might need to be in therapy after all. Speech Pathologists can also use assessments to help diagnose disorders of language, speech, fluency, or swallowing.  

As mentioned above, an assessment is a snapshot of how a person communicates during a particular day at a particular time with a particular partner.  In my experience, with most clients, the first assessment they receive is with a stranger (meaning a new clinician they most likely have never met before). Sometimes this provides a fantastic picture of exactly what the kid can do, other times, the child or adult has an "off" day or is shy of strangers and their assessment does not provide the most accurate picture.  Remember that an assessment is just a picture of one day. A good clinician will use the assessment, data taken during therapy sessions, observational data, etc. to continue to update their picture of the client, to form goals, and to create future therapy plans.  

Most assessments will include a few or all of the following elements- they may even include extra elements not mentioned.

1. History and Background- assessments should include a background of how the client came to be assessed, what concerns they may have, observations from family members, etc. Additionally, for children, pertinent information regarding developmental milestones such as sitting up, crawling, walking, etc. can be used to establish whether a disorder is global (more than just speech) or if it only affects speech and language issues.
2. Behavioral Observations- these observations would mention if a client had difficulty paying attention, if they required breaks, how they act around their family or other familiar partners versus the examiner, etc.
3. Oral Motor Mechanism Exam- this quick and easy peek into the client's mouth shows important details for speech like a tongue tie, cleft palate, severe bite problems, etc. It also looks at the face and mouth in general to make sure that all of the facial features are able to perform speech functions.
4. Hearing- even if informally assessed, hearing is an important component to any speech and language assessment. If a client has difficulty hearing, it may seriously affect how they perform on any evaluation.
5. Standardized Tests- These are tests which compare the client to other people of similar age or grade based on statistical similarities and differences within that population.  Occasionally, a "criterion-referenced" test is used instead of a standardized test- these test compares the client to another population, however it does not use statistical measures to do so.
1. Expressive Language- this test or combination of tests will assess how the client expresses him/herself.
2. Receptive Language- this test or combination of tests will assess how the client understands language.
3. Expressive Vocabulary- this test will assess the vocabulary the client uses to express themselves
4. Receptive Vocabulary- this test will assess the vocabulary the client understands
5. Fluency- this test will assess the fluency of the client's speech looking specifically at blocks, prolongations, and repetitions.
6. Articulation/Phonology- this test or tests will examine how the client pronounces different sounds and the patterns they use to pronounce those sounds
6. Informal Measures- These are observations or other tools which may have clinical significance, but are not statistically measurable and may include:
1. Informal voice evaluation- essentially, this would be observations about the quality of a client's voice (abnormally high, strained, etc.)- often abnormalities would lead to more serious testing
2. Bedside Evaluation for Swallowing- unlike a "Modified Barium Swallow Study" (or MBSS) this test may be a quick trial of different thicknesses of food and drink to determine if a Modified Barium Swallow Study may be warranted.
3. Informal language observations- this may include a language sample which can calculate several different measures which can be compared with the developmental norms (although not statistically). For example, clinically we know that a child who is 3 should be using 3 "morphemes" (meaningful unit of language) on average per sentence. If we did a language sample and the child only used 1 morpheme on average per sentence, we would know that the child is behind compared to what the child should be doing at that age.
4. Informal Pragmatic language evaluation-  these observations focus on the use 
7. Validity Statements and Explanations of Tools used-  assessments should explain what tools were used and what the score the client received means.  For example, it should be stated that the exam was given according to the instructions and how the scores for each assessment "work."
8. Recommendations- Speech Pathologists should recommend a course of action after finishing the assessment.  It may include seeking out therapy, some tasks to help out at home, that results should be shared with other professionals, etc.

 As was mentioned before, assessments are just a little snapshot in time and the examiner will do their best to provide the best overall picture of a client as they possibly can.  Assessments can be scary, but in my experience the information they provide is so priceless that they end up being worth the overall hassle, time, and energy that it takes to get the finished product.

If you have any questions about assessments, if you would like to receive assessment, or if you have had an assessment that you do not understand, don't hesitate to contact a speech language pathologist who can counsel you and explain everything to your understanding.