Greece Seminar Assessment Issues

7/30/2019 Greece Seminar Assessment Issues

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Assessment issues:

Developmental verbal dyspraxia



ASHA recommendations

…”report does not include specific guidelines

for the assessment and treatment of CAS

primarily due to lack of research support todate…”

“Deferred to future ASHA policy documents”

General recommendations by expert clinical

practitioners included under Professional

issues



ASHA – Assessment domains for

childhood apraxia of speech Non-speech oral motor skills

Speech production

Prosody

Voice

Speech perception

Language Metalinguistic literacy skills (older children)

Case History



Assessment of any child with a

speech disorder Detailed case history

Hearing information and auditory

discrimination Language skills (VC & VX)

Screening of speech output

Detailed assessment of speech output Assessment of Oral skills

Phonological awareness skills



Case History

Family history

Early speech development, including

babbling Feeding –history and current

Oral skills – history and current

Hearing

General motor development

Language development

Current speech and language skills



Hearing and auditory

discrimination Important to know whether the child has

normal hearing

Look out for intermittent conductivehearing loss caused by “glue ear”

Also need to check that child is able to

discriminate words, non-words andsounds



Language skills

It is important to assess the language

skills (receptive and expressive

language) of any child who has aspeech disorder

Many children with verbal dyspraxia

have expressive languagedelay/disorder; some also have

receptive language difficulties



Phonological awareness skills(1)

The ability to reflect on and manipulatethe structure of spoken language

PA tasks include: rhyme, syllable andsound segmentation and blending

Important skill required to make sense

of alphabetic script PA is associated with reading and

spelling performance



Phonological awareness (2)

PA tasks at level of phoneme are bestpredictors of reading outcome eg

segmenting or blending of individualsounds: c-a-t to make “cat”

Letter knowledge is also a strongpredictor of reading outcome

Focus on “synthetic phonics” to teachreading is back in favour in UK



Oral Skills

Why do we assess them?

“The assessment of oro-motor skills is anintegral part of the initial assessment of a child presenting with disordered

speech”

Bradford and Dodd 1996



Oral Dyspraxia (1)

Inability to copy volitional movements of

oral organs (tongue, lips, jaw face) on

command or demonstration in theabsence of attempts to articulate

(Milloy 1991)

Drooling or dribbling may be indicatorsof poor control of oral movements.



Oral Dyspraxia (2)

The child has difficulties with carrying

out oral movements on verbal request,

or through copying – these may be

single or sequences of movements.

Literature suggests sequences of

movement are particularly difficult.



Key features of Oral Dyspraxia

Difficulties are withvolitional control

Child can:

Lick an ice cream

which is close to hismouth

Child cannot:

Stick out his tongue



Does Oral Dyspraxia always

accompany Verbal Dyspraxia?

“Oral dyspraxia is considered adominant, although not mandatory,attribute of developmental apraxia of

speech”

Crary (1993)



Relationship between Oro-motor

and Speech Difficulties (1)

Wide variation in clinical presentation

some children with typical features of DVD have severe OM difficulties; others

do not (Evans 1994)



Relationship between Oro-motor

and Speech Difficulties (2)

Some children with poor speech have good

oro-motor skills and others with strong

speech skills have very poor oro-motor skills; Some authors therefore propose that control

of oro-motor and speech skills are

independent. (Lancaster and Pope 1989)

Others report a close neurological link

between non-speech oral movement and

speech production. (Crary 1993)



What are DDK skills?

Diadochokinesia – “…motor control

integrity in bodily functions through

performance in rapidly alternatingmovements”

In speech…sound/ syllable repetition at

a maximum rate of utterance(Fletcher 1972)



Relationship between Diadochokinetic

(DDK) skills and DVD

Difficulties with DDK tasks often used to select participants with dvd in research

Difficulties with DDK tasks apply to children withother speech disorders (i.e. not only those w DVD)

(Ozanne 1996)

As part of a speech assessment, DDK tasks can beuseful for assessing motor programming and

planning skills.



What published oro-motor

assessments can be used?

Diagnostic Evaluation of Articulation andPhonology (DEAP) – oromotor assessment(Dodd, Hua, Crosbie, Holm and Ozanne2002)

Nuffield Dyspraxia Programme (NDP)assessment – oromotor assessment (1985;1992; 2004)

Paediatric Oral Skills Package (POSP),(Brindley, Cave, Crane, Lees and Moffat1996)



DEAP

Standardised screening assessment of

oral skills (based on Ozanne’s study

1992) Isolated oral movements

Sequenced oral movements

DDK assessment



NDP assessment:

Oro-motor tasks easily achieved by 4 year olds (80% + level)

Sharples (1989)



Ozanne’s study (1992)

Study of sequenced oral

movements andmovements in context for

children aged 3-5 years



Ozanne’s findings:

Below 4 years – wide variability in oro-motor function

Above 4 years – most children can performroutine oro-motor tasks

Tasks vary in difficulty – tongue elevation most

difficult

Children often cooperated for tasks in context (e.g.licking and blowing) but would not produce oral

movements on command or imitation.



Williams and Stackhouse (2000)

Study of 30 normally-

developing 3 -5 year olds, on production of isolated and

sequenced oral movements




Difficulties with tongue elevation were shown by :

- 7/10 three year olds

- 4/10 four year olds

- 7/10 five year olds




Difficulties on silent lip and tongue DDK

sequences:

3 years 4 years 5 years

Lips 4/10 1/10 1/10

Tongue 7/10 3/10 5/10



Fletcher 1972; 1978

384 children aged 6 – 13

Assessed on:

single consonant repetition

repetition of 2-consonant sequences

repetition of 3-consonant sequences



Fletcher 1972 /1978

Speed of performance increased

with age on all tasks.




Study of 30 normally-developing 3-5 year

olds

Assessed on spoken DDK tasks:

Repetition of real words

Repetition of non-words

2 and 3 syllable sequences

Scored for accuracy, consistency and rate




3-year olds varied in performance, but generallyhighly consistent even if inaccurate

4 and 5 year olds generally both accurate andconsistent

Speed increases with age. Little difference between 3, 4 and 5 year olds



Assessing speech production

ASHA ideally assessment in multiple contexts:

Spontaneous

Elicited Imitation

Syllable

Single word

Phrase

Sentence

Discourse



Tests for screening speech

Diagnostic Evaluation of Assessment

and Phonology (UK)- standardised

South Tyneside Assessment of Phonology (UK)

Goldman-Fristoe (USA)

Hodson Assessment of PhonologicalPatterns-3rd edition (USA)





Speech assessment - DEAP

Typical profile of a child with dvd:

Poor performance on oro-motor

assessment

Poor performance on isolated speech

sounds

Poor performance on Inconsistencyassessment



Speech assessment - NDP

Imitation of single sounds (consonants andvowels)

Single word naming (CV, VC, CVC, CVCV,multisyllabic, clusters etc

Imitation of phrases and sentences

Oro-motor assessment

DDK assessment Prosody assessment

Connected speech assessment



NDP - Data are analysed at each level, in

terms of:

Sounds, or sequences of sounds, correct

Sounds, or sequences of sounds, incorrect

Patterns in incorrect sounds/sequences

Problems with syllable structure and

junction between sounds

Voice and prosodic features



NDP - Interpretation

NDP is not standardized. Research intoearlier edition:

a normally developing 4 year old can say

almost all single sounds and words on theCV, CVC, and CVCV lists.

But will make some errors on more complexmulti-syllabic, clusters and phrases andsentences

For more information see NDP Manual,chapter 3



How can the NDP assessment

data be used? To provide an individual profile of the

child’s speech difficulties

To help identify the nature of the child’sproblem (differential diagnosis)

To set therapy targets

To provide a basement measurement torecord progress following intervention

Documents

Greece Seminar Assessment Issues