Sorting through evaluation findings for young children with complex speech sound disorders can be confusing and challenging. As SLPs we strive to complete thorough evaluations and make sense of our evaluation findings to achieve an accurate diagnosis; however, many of the characteristics of CAS overlap with other types of speech sound disorders. Certain key characteristics from a CAS checklist such as inconsistency, atypical prosody, groping, or vowel errors may raise red flags for a diagnosis of CAS, but these characteristics alone should not predetermine the diagnosis until a thorough analysis of the child’s speech productions is completed.
Following are case studies of two children recently seen for consultations. Both children had an incoming diagnosis of CAS, but only one child was given a definitive diagnosis of CAS at the conclusion of the consultation. The other child demonstrated a number of characteristics commonly associated with CAS, but after careful examination of the child’s speech, the underlying nature of the challenges was not consistent with the core impairment of CAS that ASHA (2007) describes as the “planning and/or programming (of) spatiotemporal parameters of movement sequences.”
Case Study 1.
Mark, age 3 years, 7 months, had recently received a diagnosis of CAS by a diagnostic team at a local hospital. The diagnosis was based primarily on the following factors:
Reduced speech intelligibility (judged to be 50% intelligible)
A nearly complete repertoire of consonants and vowels
Inconsistent productions of the same word
Occasional vowel errors
Atypical speech prosody
Because of Mark’s limited speech intelligibility, inconsistency, vowel errors, and prosody differences, it was understandable how a diagnosis of CAS was made, as these characteristics often are associated with a positive diagnosis of CAS. Indeed, the use of a checklist of CAS characteristics alone could lead a clinician to conclude that Mark had CAS.
Balance Function Assessment and Management, Second Edition
The first edition of Balance Function Assessment and Management (BFAAM) represented our attempt to coalesce for the clinician the available information pertinent to the assessment and management of vertigo, dizziness, and unsteadiness. Fortunately for the profession, there have been updates and discoveries since the publication of the first edition—as a result, a need for a second edition. The second edition of BFAAM includes several new chapters: the ontogeny of the vestibular system, mechanisms of central vestibular compensation, effects of old age on the vestibular system, the biomechanics of balance, electrocochleography, and testing the pediatric patient. Also addressed are new diagnostic techniques that have been developed during the past decade, including the ocular vestibular evoked myogenic potential (oVEMP) and the video Head Impulse Test (vHIT). Continue reading →
hy•brid sing•er- (n). Refers to the vocal athlete who is highly skilled performing in multiple vocal styles possessing a solid vocal technique that is responsive, adaptable, and agile in order to meet demands of current and ever-evolving vocal music industry genres.
Through our years of professional singing, training, and performance (resulting in an evolution to become voice pathologists and singing voice specialists), we have encountered a transition in the industry demands and injuries of the 21st-century vocal athlete. Today’s commercial music industry demands versatility of vocal athletes who are now expected to be skilled in multiple styles of singing. Not only are these singers asked to perform vocal gymnastics on an eight-show per week schedule, these vocal athletes must also possess excellent acting skills and strong dancing ability to be competitive. These demands on the voice, body, and psyche necessitate a physically, vocally, and mentally fit singer who is agile and adaptable. Continue reading →
Fran Redstone, Ph.D., CCC-SLP, C/NDT
Editor of Effective SLP Interventions for Children with Cerebral Palsy: NDT/Traditional/Eclectic
Effective SLP Interventions for Children with Cerebral Palsy by Fran Redstone, PhD, CCC-SLP, C/NDT
Is it reasonable to expect a child with shallow breathing, open-mouth posture, and a tongue thrust, whose body is fixed in extension, to manipulate toys or interact with peers in a stimulating home or school environment? Of course the answer is “no.” It is an exercise in frustration for the child and in futility for the child’s unprepared speech-language pathologist (SLP). I know this because I’ve been there.
When I am asked why I, as a speech pathologist (SLP), should “handle” the child’s body, I am reminded of a second grade class observation I conducted recently of a child with spastic diplegia. This child was ambulatory and cognitively intact but was in a small class for children with language disorders. He was helped to function within the classroom with a one-to-one aide. The youngster began to demonstrate some negative behaviors stemming from the frustration of not being understood. This had resulted from a loss of stability, which led to poor trunk support, leading to poor oral control. I quietly asked the aide if I could intervene and adjusted the foot support and pelvic positioning. The child sat upright and communicated better immediately. Continue reading →
We are thrilled to announce the winners of the 2014 Plural Publishing Research Awards given in honor of the late Dr. Sadanand Singh. These two scholarships are awarded by the Council of Academic Programs in Communication Sciences and Disorders and honorees and their faculty sponsors are acknowledged at the annual CAPCSD meeting, taking place this year in Orlando, FL, April 10-12. Congratulations to Doreen Hansmann, the master’s level winner and to Meg Simione, the doctoral level winner.
Doreen Hansmann, Master’s level Research Award recipient
Meg Simione, Doctoral level Research Award recipient
Jerry L. Northern, PhD Professor Emeritus, Dept. of Otolaryngology (Audiology) University of Colorado School of Medicine Denver, Colorado USA
This is a personal story about an unconventional childhood. Maybe “unusual” childhood is a better description. It begins way back in 1942 when I was 2 years old and my parents were in the midst of an unpleasant divorce. While my parents were engaged in drawn-out skirmishes over custody for my older brother and me, we were sent to live with my grandparents in Denver, Colorado. The unusual part of the story is that my grandparents were totally deaf. And I mean rock-stone deaf – no measureable hearing and no hearing aids in those early days. The communication between them was solely by American Sign Language (ASL). My brother and I arrived at their home to meet them for the first time and realized that we no means of talking with them. Continue reading →
One New Year’s resolution to keep – learn more about being an effective speech-language pathology assistant (SLPA) supervisor
by Plural author Jennifer Ostergren
If you are like me, as 2014 swings into full gear, you look to your newly inked New Year’s resolutions. One resolution on my list this year is to expand my knowledge and skills as an educator and supervisor of speech-language pathology assistants (SLPAs). Those of you with similar aspirations know that serving as an SLPA supervisor can be highly rewarding, but also challenging, especially given a lack of resources and tools specific to SLPAs. This year, however, the American Speech-Language-Hearing Association (ASHA) continues to expand its efforts in this area, with new programs, policies, and resources specific to SLPAs and their supervisors. In particular, ASHA’s new Practice Portal on the topic of SLPAs, located at http://www.asha.org/Practice-Portal/Professional-Issues/Speech-Language-Pathology-Assistants/, is an excellent source of current information and resources on this topic. The sections that follow also highlight several key resources from ASHA that may be of help as well. Continue reading →
One of the fabulous things about the profession of speech-language pathology is that we are expected to constantly learn. There is always new research being discussed, new ideas to practice, new breakthroughs for therapy, and sadly, new paperwork requirements. Most state licensures require a certain amount of continuing education hours every year or two and ASHA requires a certain amount over three years. Thankfully, we can usually double-dip and count the same CEUs for both state licensure and ASHA. However, in today’s busy schedule of high caseloads and insane paperwork, no one has time to sit through yet another conference that doesn’t pertain to our work.
After discussions on social media, it has come to my attention that not everyone realizes there are alternatives to sitting in a conference room just to get the CEUs. Don’t misunderstand me – I’m all for conferences. There is a lot to be said about the camaraderie of sitting in a room of similar professionals. However, as wonderful as that camaraderie is, if the subject matter doesn’t pertain to your job, or interest you, is it truly time well-spent? Thankfully there are many alternative ways to gain professional development and continuing education credits. Thankfully there are many alternative ways to gain professional development and continuing education credits. Continue reading →
By James M. Mancinelli, MS CCC-SLP and Evelyn Klein, PhD. CCC-SLP
This article provides an overview of important issues facing clinical training of graduate students today. In light of current training models, budget constraints, staffing shortages, and productivity demands, it is time to take a hard look at the requirements and demands set by our profession in the hopes of making needed changes
The 2005 and 2014 ASHA Standards require that the student enrolled in a Master’s degree program in Communication Sciences and Disorders (CSD) obtain 400 clinical hours “across the lifespan with varied disorders”: 375 hours in direct contact with the patient/client and 25 observation hours. This is a broad guideline and superficially seems reasonable and achievable. After all, the requirement that the student obtain a specified number of contact hours in each of the disorders, with adults and children, in assessment and treatment have been removed. Unfortunately, the current service delivery contexts in which speech-language pathologists practice are all impacted by fiscal constraints, staffing shortages, and productivity requirements. Although these three factors may not necessarily affect the quality of care, they are seriously impacting the ability to clinically train graduate students in CSD. It is imperative that other models be developed for clinical education and training and that the discipline reviews the evidence that supports maintaining the status quo. This is especially critical as some programs are being asked to admit more students into the graduate program, creating the need for even more external clinical practicum experiences. Continue reading →
There are an estimated 337 different languages used (spoken, written, and/or signed) in the United States. Even bilingual speech-language pathologists will encounter situations in which the client’s primary language is unknown. There are standardized, evidence-based tests for the Spanish-English population. But what about Russian, Vietnamese, German and so on? What do you do?
Here are some key practices that can aid any SLP evaluating a child who speaks an unfamiliar language:
Conduct a family/caregiver interview, which can help minimize cultural and linguistic biases. Understanding how others in the family view the client’s communication gives insight into expectations and the possibility for deficits. Is the client able to meet these expectations? If not, why and how? Do they differ significantly from others in that communication circle?
Use an interpreter. Meet with the interpreter prior to any contact with the family to review the process, terminology, and what you want him or her to do. If possible, use someone outside the child’s family and circle of friends to reduce the possibility of bias. Interpreters can provide key information, such as, “It was very hard for me to understand him,” or, “He doesn’t use prepositions correctly.” Using such information, along with additional testing measures can help support or negate a true disorder.
Use highly pragmatic tests if formal/standardized testing is not available in the child’s primary language. These tests will help determine the client’s grasp of conversational language, which is the first building block to more complex language. The same is true in monolinguals—that the first language we learn is social in nature. We e acquire more complex understanding and use of language by building on social language. You cannot report standard scores when using standardized testing not normed for that language. You can use the information as qualitative data to support the rest of your findings. I personally like administering the Oral and Written Language Scales (OWLS), now a second edition, for this population. It is relatively easy and quick to administer.
Employ Dynamic Assessment, which involves pretest of a skill, an intervention to address that skill, and then a post-test to determine if there was progress. This method of assessment can be useful for evaluating multilingual individuals. If intense intervention is needed, this can indicate impairment.Review the ASHA website for more information on Dynamic Assessment.
Things to be mindful of regarding typical bilingual language development include the following.
The silent period occurs when a client is first exposed to a new language. Typically this period ends between six months to a year. Some common misidentifications in this phase are Autism Spectrum Disorder, Selective Mutism, and language delay. It has also been noted that with a significant change in school, family situation and the like can trigger some children to revert to the silent period. This is why family and caregiver interviewing is so essential to diagnosing a language disorder.
Bilingual development is recognized in two stages. Basic Interpersonal Communication Skills (BICS), also known as “conversational language,” typically takes two to three years to acquire. Cognitive Academic Language Proficiency (CALP), also known as “academic language,” takes five to seven years to develop. Some common misidentifications during these phrases are Language Disorder and Specific Learning Disability. Be careful that the years refer to a 12-month period of constant and consistent exposure. Our academic calendars are typically nine months, so it may take more academic years to acquire conversational and academic language.
Remember when evaluating any child that there is variety among the “same” cultures and languages.
What additional information do you, or would you, include in an evaluation?
ABOUT THE AUTHOR: Leisha Vogl, MS CCC-SLP, is the owner of Sensible Speech-Language Pathology, LLC, in Salem, Oregon. She’s worked in the field of speech-language pathology for about 7 years ranging from early intervention, school-age populations, and adults in an acute care setting. Leisha is proficient in Spanish and American Sign Language. You may follow Sensible Speech on Facebook or Twitter. Check out the website at www.sensiblespeech.com