Speech Therapy

Speech Therapy under IDEA

The Individuals with Disabilities Education Act (IDEA) includes speech and language impairments that adversely affect educational performance among the types of disabilities requiring special education and related services.[1]

In determining eligibility for special education speech and language services, it is critical to distinguish between impairment and disability. The World Health Organization’s (WHO) definitions of these two terms are useful in this regard. According to the WHO, impairment means “any loss or abnormality of psychological, physiological, or anatomical structure or function.” The important words in this definition are loss or abnormality of structure or function. The WHO’s definition of disability refers to “reduced ability to meet daily living needs.” When applied to speech and language, impairment refers to loss of, or abnormality in, the comprehension and/or production of speech and/or language.

For purposes of a child’s IDEA eligibility, such impairment is considered a disability when:

  1. It has an adverse effect on educational performance.[2] and
  2. By reason of that disability, he or she requires special education and related services.[3]

Note: Special education means specially designed instruction, at no cost to parents, to meet the unique needs of a child with a disability.[4]

Related services are defined as those that may be required to assist a child with a disability to benefit from special education.[5]  IDEA has long identified speech and language services as one of the permissible related services. IDEA also has long allowed states to designate speech and language services as special education.

When a child has a primary or sole disability in speech and language, the child’s speech and language services are considered special education (even if the child also needs other special education services to address the speech and language disability). When the speech and language issues are secondary to another disability (e.g., learning disability), speech and language services needed to assist the child to benefit from his or her special education services are considered a related service. IDEA requires demonstrating adverse educational effect when determining eligibility for special education.

Who is eligible for Speech Therapy?

Eligibility for a related service is based upon a child’s need for that service to help him or her benefit from the special education services the PPT has determined are necessary. Notwithstanding this distinction, there continues to be broad consensus among SLPs (speech and language program) around the state that the procedures recommended in these guidelines, including demonstrating adverse educational effect, be used to determine eligibility for speech and language services as either a special education or a related service. This widespread consensus emerged from concerns that the need for decisions about a child’s need for speech and language services as a related service be data-based.

The outcome of the initial PPT meeting does not always have to be a special education speech and language evaluation. Prior to determining whether such an evaluation is warranted, the team needs to: • ensure the presence of the SLP at the meeting;

  • discuss the concerns that prompted the referral;
  • review what early intervening communication strategies or services were implemented, for what duration and with what effect; and
  • determine that the SLP was involved in developing, implementing and monitoring the effectiveness of these strategies or services.

If the SLP was not involved in the regular education early intervening services process, the PPT should determine whether further attempts to resolve the problem might be more successful with such involvement.

How will my child be assessed?

Human communication is a dynamic, interactive process. In the course of a school day, children need to be able to comprehend, integrate and use a number of modalities to process information and communicate effectively. They must be able to communicate in different forms for a variety of purposes, in several settings with different physical arrangements and learning materials, and with many partners who have different communication skills, styles and backgrounds. The competent communicator adapts to all these circumstances, which are not easily controlled. Because of these complexities, adequate sampling of a child’s speech and language cannot be accomplished by a single test or single test session.

While the speech-language evaluation may focus on a particular area of communication, the SLP should be able to comment on the child’s abilities in all areas of communication — language, phonology, fluency and voice. To accomplish this, and to adequately evaluate the educational impact of any communication weaknesses the child exhibits during the assessment, the PPT needs to decide which quantitative and descriptive measures to select.

Quantitative Measures

Quantitative assessments include both norm-referenced and criterion-referenced tests.

Standardized Norm-Referenced Tests: Standardized speech-language tests measure de-contextualized communication skills using formalized procedures. Administered outside the normal contexts in which the child communicates, they capture neither the complexities nor the subtle nuances of the communication process. They are designed to compare a particular child’s performance against the average performance of a group of children with the same age and other characteristics identified by the test authors in selecting the sample or norming population. Meaningful comparisons between the child’s performance and that of the test population are possible only when the test has clear administration, scoring criteria and validity, and when it is reliable and standardized on a sufficiently large and representative sample population. These issues are of particular concern in the implementation of unbiased assessments of culturally and linguistically diverse children, whose life experiences may differ from children in the mainstream culture. Furthermore, existing tests are administered in English or the child’s native language. True evaluation of a bilingual child comes from the interpretation of the information from his or her performance on both the native language and English tests.

Criterion Referenced Tests: Criterion-referenced speech-language tests compare a child’s performance on specific skills, grammatical structures or linguistic concepts to a previously determined performance level. The criterion is based on expectations of what the child should be able to do. SLPs can also design their own criterion referenced measures with language, materials, contexts and interaction patterns that are familiar to the child being tested. The use of criterion referenced measures for culturally and linguistically diverse children continues to be hampered by “the lack of well-established developmental information on certain CLD populations.”

Modifying Testing Procedures: Standardized tests may not be easily administered according to the recommended procedures with certain populations. In some cases, modifications of these procedures may yield important descriptive information about conditions under which the child’s performance improves or deteriorates. Even when a child is able to perform under standardized conditions, procedural modifications may provide useful insights into the nature of the child’s communication problem and suggest intervention strategies. When tests are modified in any way, modifications should be reported and test norms cannot be applied, as they are no longer valid.

Test modifications include:

  • Restating or repeating directions;
  • Allowing additional response time;
  • Allowing native language responses or code-switching;
  • Providing extra practice items before the test;
  • Substituting culturally relevant stimulus items;
  • Presenting the stimuli in meaningful situations;
  • Providing feedback to the child about his or her performance (simple or elaborated);
  • Asking the child to verbalize by describing the test question and how they arrived at their answer; or
  • Interviewing the child during the test about the thought process he or she is using (requires meta-linguistic and meta-cognitive skills).

Descriptive (Qualitative) Assessments

Descriptive approaches to assessment examine how a child uses his or her knowledge of linguistic structure and communication rules with different communication partners in a variety of settings at various times and with various levels of support. They provide a more realistic picture of how a child naturally uses his or her communication knowledge and abilities in everyday situations and the impact of speech-language deficits in those settings.

Observation: The purpose of observation is to collect data regarding the child’s functional communicative performance in a variety of naturalistic settings and activities or simulations thereof. The particular aspects of communication to be observed and the selection of settings for such an ecological assessment will be driven by the concerns cited in the referral. If the child attends school, observation should, at a minimum, occur in the classroom. Other recommended settings include the playground, cafeteria, gymnasium, home, daycare facility or preschool, as appropriate. It may be necessary to conduct more than one observation in any of these settings to ensure reliability of the data collected. The number and duration of observations will depend on the data to be collected and the success in gathering them.

The target of the observation is not merely the child’s communication skills, but the various factors that may affect that child’s communication. These include: the communication demands of the situation (including the curriculum materials and rules of discourse and behavior), the communication style of the teachers, the structure of the lessons being observed and the general environment of the observation site.

Informal Comprehension Probes: Communication comprehension cannot be directly observed; it is inferred from behavior. It is heavily influenced by a child’s culture and background knowledge and the communication context. Comprehension probes can be designed to observe a child’s response to requests to: follow expected and unexpected directions in familiar settings and with familiar materials; identify what is silly in improbable commands or statements; carry out unpredictable actions with items not generally associated with each other; or learn nonsense words within meaningful utterances and use the information from those utterances to figure out the conventional word. Discourse comprehension can be probed by the having the child retell a story that has been read or told or respond to inferential questions about the story. The child may also be asked to explain jokes, riddles and puns to explore comprehension of more complex language and meta-linguistic knowledge. Analyzing the linguistic strategies a child uses in interpreting sentences with unexpected syntactic rules following presentation of sentences with more familiar rules can help identify the source of a child’s comprehension problems.

Speech-Language Sampling: Collecting representative speech-language samples allows the SLP to identify and analyze the child’s comprehension and use of various linguistic features in functional communication, including: phonological, semantic, grammatical, morphological and syntactic structures; rules and organization of discourse (e.g., conversational, narrative, expository and persuasive); voice and fluency parameters; pragmatic functions of communication. Analyzing speech-language samples of culturally and linguistically diverse children requires knowledge of the linguistic and social rules of the child’s native language and their potential influence on the English sample

Factors to consider in selecting a particular approach to gathering the sample include:

  • age, gender and cultural appropriateness of the activity and materials that will be;
  • the child’s familiarity with the environment and materials;
  • strategies used to collect the sample; length of the sample desired;
  • languages or mode of communication in which the sample should be obtained and the role of an interpreter; and
  • communication partners with whom the child will interact during the sampling.

The procedures for analyzing the sample will vary according to the nature of the sample and the child’s stage of language development. Language sampling is labor intensive because of the time to transcribe and analyze the sample, in addition to recording the samples by hand or using audiotapes or videotapes. Even using available computerized applications for sample analysis requires sample transcription, which may require several replays to ensure correctness of the transcription.

Curriculum-Based Assessment (CBA)

The purpose of curriculum-based speech and language assessment is to examine the child’s communication skills in relation to the communication demands of the school setting, particularly the classroom, in order to identify mismatches. In speech and language pathology, CBA has come to refer to more than classroom curriculum.

Types of curriculums that the SLP should consider:

  • Official: an outline of the goals, objectives and content of various subjects or courses;
  • Cultural: the background or world knowledge gained inside and outside school that students must acquire to become literate and educated;
  • De facto: the textbooks and other materials used in the classroom;
  • School culture: the explicit and implicit rules that guide appropriate behavior; and
  • Hidden: the subtle messages conveyed by teachers.

CBA has valuable potential to clarify the educational impact of communication problems and to help identify relevant intervention targets, including modifications in teacher expectations or instructional approaches that will facilitate the student’s access to the curriculum. Besides examining curriculum materials and student work samples, CBA includes observations and interviews.

Dynamic Assessment

This interactive assessment approach is similar to what in earlier years was referred to as “diagnostic therapy,” but has more focus on selecting targets and collecting data about changes in performance in response to specific facilitation techniques. Based on this principle, examples of commonly used dynamic assessment approaches include: test-teach-retest; modifying the presentation of formal tests; and providing graded prompts. Dynamic assessment is another important avenue for reducing bias in assessing children from culturally and linguistically diverse groups because of its emphasis on a child’s learning potential rather than test performance that “may reflect different learning experiences or a lack of educational opportunity.”

Collaborative Teaming

Collaboration among professionals to evaluate a student’s communicative behavior should be a natural outcome of the basic premises of these guidelines articulated earlier, the legal requirements for evaluation and the recommended assessment procedures described above. Classroom teachers, other pupil support specialists and community service providers are logical partners in the communication evaluation. If the collaboration is planned when the evaluation is being discussed, it should produce more comprehensive, holistic information while using the time of school personnel and the student more effectively. Professional partnering can also facilitate the eligibility decision and lead to the development of a more integrated IEP for the student when a disability is identified. Eligibility decisions for students with cognitive or developmental problems and for culturally and linguistically diverse populations are just two examples of the complexities that can be better addressed when there is collaboration between the SLP and professional colleagues, such as school psychologists and ESL/bilingual teachers.[6]


 

[1] IDEA 2004, § 602(3)(A); 34 CFR, 300.8(a)(1); and 34 CFR, 300.8(c)(11).
[2] 34 CFR § 300.8(c)(11).
[3] IDEA 2004, § 602(3)(A).
[4] IDEA 2004, § 602(29); 34 CFR § 300.39.
[5] IDEA 2004, § 602(26).
[6] State of Connecticut, Department of Education, Guidelines for Speech and Language Programs (2008) http://www.sde.ct.gov/sde/lib/sde/PDF/DEPS/Special/Speech_Language_2008.pdf.

 

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