A Model of Team Assessment for Children with Language Learning Difficulty

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A Model of Team Assessment for Children with
Language Learning Difficulty

• ASHA, Chicago
• 1623
• November 21, 2008

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Plan of Talk

• A. Introduction (CCSN) Center for Children with
  Special Needs
• B. Case 1 Terri
• C. Case 2 Michael
• D. Question Answer

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Who we are

• An interdisciplinary team, consisting of
• Developmental-Behavioral Pediatrics (DBP)
• Neuropsychology
• Speech Language Pathology
• Education
• Social Work
• Case Managers
• Researchers

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What we do
Heliotherapy for infants with Vitamin D
deficiency - 1920

• Evaluation of children with a diverse range of
  disabilities
• Treatment of specific conditions

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Conditions we see - EVALUATION

• ADHD
• Learning Disabilities (e.g., dyslexia)
• Behavior Disorders (e.g., ODD)
• Intellectual Impairment
• Psychiatric conditions (e.g., depression)
• Autism Spectrum Disorders
• Receptive Expressive Language Disorders
• Phonological Disorders

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Special Education Eligibility(MA)
yes
THE STUDENT IS ELIGIBLE FOR SPECIAL EDUCATION
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Services - TREATMENTS

• Behavioral counseling
• Psychotherapy
• Psychopharmacology
• Teaching about how to access services
• Counseling about special education law and how to
  access services
• Community outreach, e.g., classroom observations

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Interdisciplinary model
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Philosophy of Model

• Child behavior and development are inseparable
• More than one clinician is required to evaluate
  all of childs needs
• Treatment is informed by interdisciplinary
  perspectives

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Process

• How we carry out our philosophy

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Process How we put the philosophy into action
Steps of the evaluation

• Review of intake materials, e.g., teacher
  questionnaire
• Scheduling of child for evaluation(s)
• Evaluations are completed
• Team meetings
• Feedback to parents (e.g., invitation to
  educators)
• Report(s)

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The clinical disciplines at the CCSN
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Developmental - Behavioral Pediatrics

• Ludwig von Hahn

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What is a Developmental-Behavioral Pediatrician
(DBP)?

• Born out of general pediatrics and the care
  needed by children with complex needs
• Understanding of families and of children over
  time
• Integration of development and behavior
• Interdisciplinary work

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What is a DBP evaluation?

• Components of DBP evaluation
• Review of Intake materials
• Interview
• child observations
• child assessment
• physical examination
• Feedback session

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Neuropsychology

• Susan Barron

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What is a Neuropsychologist?

• A psychologist who specializes in the study of
  brain-behavior relationships
• A psychologist who looks at how neurological
  dysfunction compromises behavior

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What is a neuropsychological evaluation?

• Evaluate and treat people, i.e., children, with
  suspected nervous system dysfunction.

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What is a neuropsychological evaluation?

• NEUROPSYCHOLOGICAL EVALUATION
• Clinical Interview -
• parents
• child
• Assessment (4 - 6 hours)
• Attention
• Perception
• Language
• Memory
• Motor
• (Personality Dynamics)
• Conferring with School Personnel as Deemed
  Appropriate
• Scoring and Integration of Data
• Feedback Session
• Production of Written Report
• (Parent Counseling)

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Speech Language Pathology

• Kathleen Reilly

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What is a diagnostic SLP?

• Works with caregivers
• Assesses children
• Collaborates with educators

Talking more than informing and persuading it
is Listening to enhance the judgment of a parent
(Luterman, 2008)
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What is a diagnostic SLP evaluation?

• Review of Intake
• Parent Interview (abbreviated) 1 hour
• Plan Assessment 1.5 hours
• Formal testing, only as needed
• Informal testing
• (Outreach to educators)
• Parent Exit Interview

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What is a diagnostic SLP evaluation?

• Interview Questions
• Who lives in the home?
• What language(s) are spoken?
• How is school going this year?
• Have you been in touch with Educators?

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Education

• Cathy Mason

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What is an Educational Specialist?

• M.Ed with special needs certification

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What is an Educational Evaluation?

• Review intake
• Parent interview
• Thorough assessment of the following
• Reading (phonological awareness, letter/word
  recognition, decoding, fluency, comprehension)
• Writing (handwriting, spelling, punctuation,
  sentence/paragraph formulation, story/essay)
• Math (quantitative knowledge/concepts,
  computations, applications/problem-solving)

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What is an Educational Evaluation? (continued)

• Parent feedback on test results
• Classroom Observation (optional)
• Team Meeting with colleagues
• Written report

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Quick Questions?
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Case 1

• Terri, 5 years old

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Case 1 Terri. What the chart review said about
Terri

• Wears glasses
• Early developmental milestones notable for
  speech/language delays
• Vanderbilt questionnaires Parents. 2/9 symptoms
  of inattention and 2/9 symptoms of
  hyperactivity/impulsivity
• Vanderbilt questionnaires school. 8/9 symptoms
  of inattention and 9/9 symptoms of
  hyperactivity/impulsivity.

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Case 1 Terri. What the parents said about Terri
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Case 1 Terri. What Terri revealed about herself

• Play skills
• Complete a task (clean-up)
• Following instructions for physical examination
• Testing/screening results speech/language
  delays, fine motor delays, inattention/hyperactivi
  ty

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Case 1 Terri DBP evaluation
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Case 1 Terri DBP evaluation
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Case 1 Terri DBP evaluation
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Case 1 Terri. Summary of DBP findings

• ADHD
• Speech/language delays
• Visual fine motor delays

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Case 1 Terri S/L evaluation

• A.
• Review of Intake
• Parent Interview (abbreviated)
• B.
• Plan Assessment
• Formal testing, only as needed
• Informal testing
• C.
• Parent Exit Interview

• A.
• Intake
• Terri in a half day language based program IEP
  with ST 2x30
• Mom is dyslexic does Terri have it?
• English only

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Case 1 Terri S/L evaluation
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Case 1 Terri S/L evaluation

• A.
• Review of Intake
• Parent Interview (abbreviated)
• B.
• Plan Assessment
• Formal testing, only as needed
• Informal testing
• C.
• Parent Exit Interview

• B.
• Assessment
• Prior testing unavailable
• BSRA
• TACL-3
• EOWPVT
• Lang sample
• GFTA-2 Soap Story
• Play Lang Sample

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Case 1 Terri S/L evaluation
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Case 1 Terri S/L evaluation
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Case 1 Terri S/L evaluation
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Case 1 Terri S/L Evaluation _at_ 57 years
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Case 1 Terri S/L evaluation

• A.
• Review of Intake
• Parent Interview (abbreviated)
• Why are you here? How can I help you?
• B.
• Plan An Assessment
• Formal testing, only as needed
• Informatl testing
• C.
• Parent Exit Interview

• C.
• Parent Exit Interview
• Counseling
• Talk about conversational deficits

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Case 1 S/L Parent Exit Interview (feedback)
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Case 1 Terri S/L Parent Exit (feedback)
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Case 1 Terri Team Meeting

• Participants DBP S/L
• Findings were consistent
• Shows mixed mild receptive language delays in
  listening concepts underdeveloped
  conversational skills (pragmatics) secondary to
  ADHD.
• Dyslexia is not a question for this age
  (preschool)
• Parents are frustrated with her energy level and
  lack of responsiveness to their input
• Ongoing parental counseling and support to use
  talking strategies
• Trial of medication

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Case 1 Terri Feedback with DBP

• Discussed strategies for inattention
• Discussed strategies for improving language
• Follow-up plans
• Medication plans

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Case 1 Terri DBP feedback
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Case 2

• Michael, 5th grader

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Case 2 Michael Intake

• Intake Information
• What the chart review/parent interview revealed
  about Michael, a 10 yr.old 5th grader
• Parent Concerns
• difficulties with reading/reading comprehension
• school testing fragmented
• inappropriate/inadequate services.

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Case 2 Michael Intake

• Background/history Information
• Birth, medical, developmental, social/emotional
  histories benign. Family history of dyslexia.
• Enrolled in a regular classroom in a school of
  grades K-4.
• Difficulties began in kindergarten learning
  letters/sounds.
• Repeated K.
• Continued difficulty with literacy skills despite
  small group, pull-out, rule-based (Wilson)
  reading instruction 4 x 45 min/week and
  speech/language services.

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Case 2 Michael Intake - continuedPrior
school testing (3rd grade)
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Case 2 Michael

• Neuropsychological Testing - Susan

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Case 2 Michael NP /Neuropsychological
Evaluation

• Tests Administered - Summary
• WISC-IV
• TT
• BNT
• NEPSY Sentence Repetition Test
• Buschke Learning and Memory
• WRAML - Story Memory Subtest
• Assessment of Buccal-lingual Praxis

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Case 2 Michael NP Data

• NP Index Scores - WISC-IVFull Scale IQ 98
  (45thile)

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Case 2 Michael NP WISC

• VCI vs PRI type of info
• What split means
• Significant splits vary by age

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Case 2 Michael NP Assessment - 2
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Case 2 Michael NP AssessmentStory Memory Job
Story (Ages 9.5 )

• The day before high school graduation, Judy heard
  from her soccer coach about a job at the hospital
  gift shop. Stopping there on her way home from
  school, Judy filled out the 2-page application,
  and an interview was scheduled for Thursday.
• Maybe it was the good luck bracelet she wore at
  the interview, but after talking to the store
  manager, Mr. Stone, Judy was asked to start right
  away. She was to be paid 8.00 an hour, work 6
  hours each day, and have Mondays off.
• Judy enjoyed the work, and by the end of the
  summer she had earned more than 500. and
  received an invitation to return next June as an
  assistant manager.

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Case 2 Michael NP FINDINGS

• Strengths
• Attention
• Perception
• Comprehension
• Memory
• Motor

• Weaknesses
• Expressive Language
• Word finding
• Buccal-lingual praxis

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Case 2 Michael

• Speech-Language Testing - Kathleen

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Case 2 S/L Assessment

• A.
• Review of Intake
• Parent Interview
• (abbreviated)
• B.
• Plan Assessment
• Formal testing, only as needed
• Informal testing
• C.
• Parent Exit Interview

• A.
• Addl to Intake (30 min)
• No new information
• English only
• Size up parent (frustration about slow progress
  and increasing academic delays) despite services
• Parent Question What is the nature of my sons
  LLD?

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Case 2 S/L Assessment

• A.
• Review of Intake
• Parent Interview
• (abbreviated)
• B.
• Plan Assessment
• Formal testing, only as needed
• Informal testing
• C.
• Parent Exit Interview

• B.
• Assessment
• Prior testing available
• R/E lang average
• (TOLDI, PPVT, TAPS-3)
• No S/L services on IEP
• EOWPVT
• TLC-2
• Language Sample

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Case 2 S/L Assessment
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Case 2 S/L Assessment
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Case 2 S/L Assessment
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Case 2 S/L Assessment DATA
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Case 2 S/L Assessment Findings

• Strengths
• Scatter limited to expressive tasks, that is
  Michael knew inference but could not put
  explanations in words
• Relative strength in use of vocabulary, when
  retrieval controlled for
• Expressively, relative strength at word level,
  and decreasing verbal skills beyond, in sentences
  and discourse, and most notably in open-ended
  contexts

• Weaknesses
• Morphosyntax
• Complex language
• Discourse words/relations
• (Paul, 2001)
• Temporal e.g., after
• Causal e.g., because
• Conditional e.g., if/then
• Epistemic e.g., that
• WH-conjunctions e.g., ..where
• Specification e.g., that
• Adversative e.g., but

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Case 2 Michael

• Educational Testing - Cathy

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Case 2 Michael

• Academic Profile

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Case 2 Kaufman Test of Educational Achievement

• Purpose school achievement,
• grades 1 - 12
• Description K-TEA II consists of two overlapping
  forms Comprehensive and Brief. The Brief Form
  globally samples the areas of reading,
  mathematics, and spelling, whereas the
  Comprehensive Form measures more specific skills
  in the areas of reading decoding and
  comprehension, mathematics applications and
  computation, and spelling.

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Case 2 Kaufman Test of Educational Achievement
II (KTEA-II)
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Case 2 The Root of Michaels Reading Disorder

• Phonological Processing Disorder
• Phonological awareness is an understanding that
  words we hear have an internal structure based on
  sounds (phonemes).
• If a student is not sensitive to the phonological
  structure of speech, instruction in the use of
  letters to represent sounds in words will not
  make much sense, and the student will have a
  difficult time making inferences about
  letter-sound regularities and use these to decode
  many words.

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Case 2 Michaels Reading Disorder

• What is Rapid Naming?
• The ability to read well depends on automaticity
  in recognizing and reading orthographic patterns.
• Word finding problems in speed and accuracy
  differentiate average from dyslexic readers from
  pre-reading to adulthood.

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Case 2 Comprehensive Test of Phonological
Processing
The CTOPP assesses phonological awareness,
phonological memory, and rapid naming, in
children from ages 50 - 24 years. The CTOPP
assesses phonological awareness, phonological
memory and rapid naming. A deficit in one or
more of these phonological processing abilities
is the most common cause of reading disabilities.
                        
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Case 2 Comprehensive Test of Phonological
Processing
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Case 2 Effect on Michaels Reading / TEXT

• According to legend, the phoenix is a bird that
  rises from its own ashes. The phoenix is
  described as a beautiful bird with feathers of
  red and gold and a very melodious voice. Its
  life span is said to be 500 to 600 years. When
  it feels death approaching, it sings a mournful
  song. Then it builds a funeral pyre of wild
  cinnamon, and dies in the flames. But it arises
  anew from the ashes to begin another long life.

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Case 2 Written Expression

• The Written Expression subtest of the K-TEA-II
  requires the student to complete writing tasks in
  the context of an age-appropriate story format.
  Tasks include writing sentences from dictation,
  adding punctuation and capitalization, filling in
  missing words, completing sentences, combining
  sentences, writing compound and complex
  sentences, and starting at the spring of grade 1,
  writing an essay based on the story the student
  helped to complete. The essay tasks focuses on
  elements such as quantity, subject matter,
  organization, logical flow of ideas and planning.

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Case 2 Effect on Michaels Writing

• The Amazing Scrapbook
• Text
• Emily and Ramon discover a magic scrapbook when
  helping their neighbor clean her attic that
  transports them to the location of any picture
  they put in the book, and when they write in the
  scrapbook, they return to the attic. They visit
  Tahiti, an ant farm and the moon. Before using
  the last scrapbook page, they read a newspaper
  article about a lost boy. They decide to rescue
  him by placing his picture in the scrapbook.

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Case 2 Michaels Story Summary

• There was amazing thing haping there is a cool
  crapbook that takes you places like China. The
  boy was so halping to be back with his famil,
  those to chids saved the boys life. Thise haping
  a Miss Browns house the cids found this scrapbok
  and they were heros. They went the an ant farm.
  How they got back bye yousing writing words.
  How they got in bye a pictures.

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Case 2 Team Meeting on Michael

• Participants NP, SLP, and ED Specialist
• Evidence of expressive language disorder
• Word reading / decoding skills significantly
  delayed due to underlying phonological processing
  and rapid naming disorder.
• Reading comprehension was depressed at levels
  consistent with word reading skills
• Written language depressed secondary to oral
  language disorder

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Case 2 Feedback With Michaels Parents

• Elicit parents questions and concerns
• Present findings
• Strengths
• Weaknesses
• Implications for learning
• Recommendations
• Final questions

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In closing

• Weve looked at Interdisciplinary process from
  top to bottom in two straightforward assessment
  cases
• 5 year old girl with ADHD and a mixed
  receptive/expressive language delay
• 11 year old 5th grade student with expressive
  language disorder and dyslexia
• Collaboration can cross discipline boundaries,
  I.e., M.D. vs Ph.D. vs M.Ed vs CCC
• Collaboration can transcend medical models
  (etiology-driven) and educational models
  (deficit-driven)
• We hope from this talk you take away ideas and
  motivation to collaborate more deeply within
  school and into home

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ContactFor a copy of slides and/or questions

• Kathleen Reilly
• kreilly_at_tuftsmedicalcenter.org

http//www.floatinghospital.org/OurServices/Specia
lServices/CenterSpecialNeeds