Recently, I have been given quite a few reports about children on my caseload which have been written by other professionals – Occupational Therapists, Educational Psychologists and Specialist Dyslexia Teachers for example. It’s always really useful to read these to get a better picture of a child and incorporate ideas and suggestions into my own work with them. Reading other people’s reports does make me think about my own report writing though. Is what I write easy for other people to understand and does it clearly summarize the information I have and the child’s strengths and areas of difficulty? We wrote a series of posts a while back about understanding your child’s speech and language therapy report – you can read these here (I’ve linked to the last one of the series as it links back to all the other parts if you want to read them). Hopefully these are useful, but I think there are probably many other things that can be puzzling.
The thing I can find most difficult to understand in other professionals’ reports can be assessment results. They usually explain them within the rest of the report which is great, but I sometimes find myself wondering what exactly the child was asked to do. So, I thought some people might find the same information useful about our assessments – what was the child asked to do and why?
First of all, a word about formal assessments. They are very prescriptive in the way they have to be administered – the exact rules vary from assessment to assessment but they can only be carried out by people with certain qualifications, you have to start at a certain point and there are strict rules about when to stop testing. There are also rules about whether you can repeat questions or help the child in any way. The reason for the rules is so that the scores that they give are meaningful. We have to be certain that the questions were presented in exactly the same way to everyone, otherwise it would be impossible to determine an “average range” of scores. So sometimes when we’re carrying out formal assessments, we can look like we’re being really unhelpful to the child, or keeping going long after it’s obvious that they are struggling, but it’s because we have to follow the rules. That doesn’t mean we can’t be encouraging and give breaks between sub-tests and generally be nice, child-friendly people (!), but it does mean that we can’t always ask again or stop when the child’s concentration is wearing thin! It hasn’t stopped me from carrying out a formal assessment under a table before now though, or letting a child play Hungry Hippos on my iPad between sub-tests or with one child, letting him stand up for most of the assessment, fidgeting, chewing on his jumper and wandering around the table between questions!
Another thing – most of the sub-tests are designed to assess children across quite a wide age range. So if you’re watching a speech and language therapist carry out an assessment with a child, be aware that they are not expecting your child to be able to answer every single question correctly. Even if a child scores way above average, they will still have been asked questions that they are unable to answer – that’s the way assessments work.
If a child is school-age in the UK, probably the most likely assessment for a speech and language therapist to have carried out is a CELF-4 (Clinical Evaluation of Language Fundamentals). This has many different parts (sub-tests) and a therapist may carry out all sorts of different combinations of these depending on the age of the child and what the concerns are. There are some sub-tests I love and others that I really don’t, but I use them all at different times for different purposes. I’ll explain a few of these sub-tests today and others another day – it’s not the most thrilling of topics and I’d send you all to sleep if I went through every single one today!
Concepts and Directions
This sub-test can be LOOONG! On each page there is a series of pictures and the child is asked to point to a picture or pictures. The instructions start short and simple (eg “Point to the red tree”) and become longer and more complicated (eg “point to the blue bus after you point to the third big hat”) NB All my examples throughout are made up, but are similar to the sorts of things that are asked.
Again there is a picture or series of pictures on each page. This time the tester starts off the sentence and the child has to try and finish it. The aim is to elicit particular grammatical structures each time – eg a past tense verb (such as “jumped” or “sat), or a pronoun (such as “him” or “her”). So for example, there might be a picture of a house on the left hand side of the page and a row of houses on the right hand side. The therapist would say “here is one house. Here are two…” and the child has to complete the sentence.
I think this is one of the clearest from its title. The therapist says a sentence and the child has to repeat exactly what they heard. It’s as simple as that. Except it’s not simple at all – these are really hard towards the end. While learning how to carry out these assessments at university, we tested them on one another and I remember making quite a few mistakes!
This is my favourite CELF-4 sub-test as it tells me so much about a child’s language! Here the child is shown a big picture on each page of a scene with various things happening. Then they are told a word and then asked to put that word into a sentence to describe what’s happening in the picture. So for example, the child might be shown a picture of various people on a beach, and asked to put the word “sand” into a sentence. So a child might say “the people are lying on the sand sunbathing” or “sand is yellow” or “baby eat sand” or all sorts of other things. As with all of the sub-tests they start quite easy (like my sand example) and get harder – so towards the end the words are more like “meanwhile” or “since”.
I think that’s probably enough for one day! I’ll talk about the other few sub-tests another day.
You can read the second part of this post here.
If you have found this post useful, do check out our e-book, which is full of practical advice to help you and your child at every step of the way through the speech therapy process.