Wednesday, May 6, 2015

Understanding an Articulation Assessment

Dear Parents,
Have you been told your child needs an evaluation to assess their articulation skills?   Has your child already had an articulation assessment and you still feel confused about what it means?   This post is to give you some more detailed information about all of the parts of an articulation assessment.

Standardized Tests

You child was most likely given a standardized test.  These test are considered norm-referenced tests. Here is a list of the most common:
  • GFTA-2 Goldman-Fristoe Test of Articulation 2nd Edition
  • PAT-3 Photo Articulation Test 3rd Edition
  • CAAP-2 Clinical Assessment of Articulation and Phonology 2nd Edition
  • Arizona-3 Arizona Articulation Proficiency Scale–Third Edition

Each of these tests will yield a standard score, percentile rank, and some time an age equivalency. They will also report which sounds your child had in error. Please note: each school district, clinic, or setting will have their own report writing but you should generally find the following information in their reports.

Standard Score: A standard score is a measure tells how your child scored when compared to the norming sample. These tests will have a normal or average range to compare your child's score to.  In the above tests, one standard deviation above and below the mean is the normal range. This is commonly shown in a bell curve. Here is a great visual of a bell curve by Home-Speech-Home. 
The tests listed above have a mean of 100 and the standard deviation is  +/- 15 standard points; making the normal or average range 85-115.  So if you child's standard score is below 85, their articulation skills can be considered below average. This doesn't mean they will automatically qualify for speech therapy services. Private speech therapy services and school speech therapy services have different qualification guidelines. I will give a brief summary of these guidelines but each clinic/school district has their own policy.

Percentile Rank: This number lets you know how well your child did compared to other children their age.  It basically states the percentage of children that your child scored as well as or better than in the norming sample/population.  So if you child had a percentile rank of 6% then they only performed as well as or better than 6% of the norming population.

Age Equivalency: This measure takes your child's raw score and compares it to different ages.  This can be misleading or even alarming for parents to hear. What the age equivalency score really means is that the child's raw score corresponds to the mean score for children that age. You may not see this on your child's report because many schools and clinics don't report these scores because their are the least helpful. (A raw score is the number of test items the student got correct, in articulation it is the number of phonemes (sounds) the child said correctly).

INFORMAL ASSESSMENTS
You may also see some of the following informal assessments in your child's speech and language report.

Articulation Norms:  The report may say something about articulation norms.  There are charts and guidelines that report when a sound is typically developed. Here is a simple chart by Mommy Speech Therapy. Most charts have a statistic similar to this: "90% of children have acquired the /f/ sound by 4 years of age. It is important to consider norms to determine if your child's sound errors are developmental or not. For example:  The /r/ phoneme is a later developing sound (between 7-8), so it wouldn't be a concern if your 3 year old couldn't say it. 

Speech Sample: A speech sample is an analysis of your child's articulation during spontaneous speech. The most common analysis you will see are intelligibility ratings and percentage of consonants correct. 
  • Intelligibility rating: An intelligibility rating is the percentage of words understood by the examiner in a spontaneous speech sample. If your child used 100 words in the sample and 60 were intelligible, then their intelligibility rating would be 60%. A typical child is 90-100% intelligible by age 5. 
  • Percentage of Consonants Correct: This is a measure where the speech therapist will count how many consonants your child says in a speech sample and then mark how many were said correctly. They will then do the same (count the correct consonants) with the standardized test given (like the GFTA-2 or PAT) and compare the two. This is done to see if there is a difference when your child produces one word responses (during the GFTA or PAT) vs. connected speech (spontaneous speech sample). If there is a huge difference (greater than 15 points) it indicates that your child's articulation is more impaired during spontaneous speech. 
Observations and Teacher Reports: If you child was assessed in a school, the speech therapist will most likely observe them in class or at recess. They will be noting whether or not your child struggles in class due to their articulation errors.  They will also have the teacher fill out checklists and simple reports to gain more information on the academic impact.

Phonological Processing Disorder:
Another term you may hear is Phonological Processing Disodrder. This is when your child's errors are made in patterns. There are specific tests that identify a Phonological processing disorder such as:  
  • Diagnostic Evaluation of Articulation and Phonology (DEAP) 
  •  CAAP-2 Clinical Assessment of Articulation and Phonology 2nd Edition
 Here are the most common processing errors: 
  • Final Consonant Deletion: This is when a child leaves off all final consonants. They may say the phrase- "The cat has a hat" like this "The ca ha a ha." This can  make them hard to understand. Young children often do this but usually grow out of it by 3 years 6 months. 
  • Velar fronting: This is when a child uses the /t/ sound for all /k/ sounds and the /d/ sound for all /g/ sounds. (t/d are made in the front of the mouth where k/g are made in the back, so they are fronting the sounds). For example: instead of saying cookie, they would say "tootie, " or instead of saying goat, they would say "doat." 
  • Cluster Reduction: This is when the child reduces a consonant blend to one consonant. For example: The student would say "poon" when trying to say /spoon/. 
  • Stopping: This is when a child will use a stop sound (p,b, t, d) for a continuent, fricative, or affricate sound (f, v, s, z, ch, sh, j).  For example: Instead of saying /sun/ they would say "tun."
  • Gliding: This is when a child uses /w/ for /r/ and /l/. For example: The student would say "wizard" for lizard and "wed" for red.
There are many more but these are the most common I see in my caseload. Mommyspeechtherapy.com has an excellent handout on Phonological Processes
Click Here to view it.

                          How do you qualify for services?

I work in Texas in the schools and in an outpatient clinic. The guidelines are very different between the two. Here are general guidelines (again these are general, refer to your child's service provider for their specific guideline).

School Services: To qualify for school speech therapy (which is provided under special education for the most part), there are two main areas to look at:
  • The first is the severity of the speech impairment. Generally their needs to be a moderate to severe impairment to qualify in the school.  In Texas where I work; the percentile rank, intelligibility rating,  and articulation norms are typically the areas that they look at. A percentile rank below 7% typically indicates that therapy is needed. A mild articulation delay (only 1-2 sounds) typically doesn't qualify in the school system.
  • The second factor is educational impact. You child's articulation error has to directly impact their academic performance. Sometimes this can be obvious (the student is writing the sound they hear that they say wrong) or sometimes it can be more of an indirect impact (the student is embarrassed to speak in class and does poorly on oral assignments).
Private speech therapy services: Private services are billed through your child's insurance or through self-pay. Some insurances (such as medicaid) have specific guidelines for qualifying (or in insurance terms: authorizing). In general a standard score below the normal range would qualify in a private setting. They may also consider potential educational impact or social impact.







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