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These guidelines are an official statement of the American Speech-Language-Hearing Association (ASHA). They were approved by ASHA's Legislative Council in March 1999. They provide guidance for school-based speech-language pathologists but are not official standards of the Association. The guidelines were prepared by the ASHA Ad Hoc Committee on the Roles and Responsibilities of the School-Based Speech-Language Pathologist: JoAn Cline, chair; Susan Karr, ex officio; Jacqueline Green; Ronald Laeder; Gina Nimmo; and Ronnie Watkins. Nancy Creaghead, 1997–1999 vice president for professional practices in speech-language pathology, served as monitoring vice president in 1997; Crystal Cooper, 1994–1996 vice president for professional practices in speech-language pathology, served as monitoring vice president in 1996 and consultant in 1997–1998. Committee members have extensive experience providing direct speech-language pathology services in school settings. The contributions of ASHA members, committee members, and staff peer reviewers are gratefully acknowledged and have been carefully considered. Additionally, the committee wishes to thank those who shared state handbooks and district procedure manuals from the following states: California, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, Michigan, Nevada, New York, North Carolina, Ohio.
WHO: Definition of speech-language pathologist
WHAT: Core roles
WHEN: Eligibility determination
WHERE: Caseload management/Service delivery options
WHY: Guiding principles
HOW: “How to” techniques for each of the core roles are learned through pre-service training and clinical practicum experiences. In-service learning continues via clinical fellowships, continuing education programs, literature review, mentorships, Special Interest Division or other professional affiliations, study groups, and research.
School-based speech-language pathology services have changed dramatically during the past decades because of numerous legislative, regulatory, societal, and professional factors. Meanwhile fiscal constraints and increased paperwork have made it more challenging to provide effective services. In order to provide appropriate speech and language services, it is important to understand and consider the corresponding changes in the development and management of the school-based speech-language pathology program.
The current roles and responsibilities of the school-based speech-language pathologist require clarification, expansion, and readjustment. Core roles and responsibilities are described in Section II, while additional roles and opportunities are suggested in Section III.
The purpose of this document is to define the roles and delineate the responsibilities of the speech-language pathologist within school-based speech-language programs.
These guidelines were developed in response to requests by speech-language pathologists, school administrators, lobbyists, and legislators who seek guidance from the American Speech-Language-Hearing Association (ASHA) for a description of the roles and responsibilities of school-based speech-language pathologists. [1] These guidelines can be used as a model for the development, modification, or affirmation of state and local procedures and programs. Parents, [2] families, [3] speech-language pathologists, teachers, school administrators, legislators, and lobbyists may find the information helpful when advocating for quality services and programs for students with communication disorders. This document may also be used as a resource by program administrators and supervisors who wish to support and enhance the professional growth of individual speech-language pathologists.
The following premises guided the development of this document:
“Disability is a natural part of the human experience and in no way diminishes the right of individuals to participate in or contribute to society. Improving educational results for children with disabilities is an essential element of our national policy of ensuring equality of opportunity, full participation, independent living, and economic self-sufficiency for individuals with disabilities.” (U.S. Congress, 1997 [Sec. 601(c)]). [4]
Society's trends and challenges affect the role of speech-language pathologists.
Educational success leads to productive citizens.
Language is the foundation for learning within all academic subjects.
School-based speech-language pathologists help students maximize their communication skills to support learning.
The school-based speech-language pathologist's goal is to remediate, ameliorate, or alleviate student communication problems within the educational environment.
A student-centered focus drives team decision-making.
Comprehensive assessment and thorough evaluation provide information for appropriate eligibility, intervention, and dismissal decisions.
Intervention focuses on the student's abilities, rather than disabilities.
Intervention plans are consistent with current research and practice.
Although speech-language pathologists are bound by federal mandates, state regulations and guidelines, and local policies and procedures, they are also influenced by ASHA's policy statements. School-based speech-language pathologists are encouraged to refer to ASHA's Code of Ethics (Appendix A) when making clinical decisions. As indicated in Figure 1, ASHA's Code of Ethics encompasses all ASHA policy.
The guidelines in this document are consistent with ASHA's Scope of Practice, Preferred Practice Patterns, and position statements, yet are specific to issues relating to school-based speech-language pathologists. Additional complementary documents, such as ASHA guidelines, technical reports, tutorials, and relevant papers, are available through the ASHA National Office (see Appendix B).
These guidelines reflect the Committee's review of current law related to providing services to students with disabilities; policy and procedure documents from a variety of geographic areas; current professional literature; contemporary practices from rural, suburban, and urban areas; and extensive feedback from peer reviewers in the profession. Likewise, the terminology used within this document mirrors current widespread use; however, regional or geographical variations may occur. In the interest of clarity, the various aspects of school-based speech-language pathologists' roles and responsibilities are discussed separately. However, school-based speech-language pathology services are interrelated, as are all aspects of communication.
The field of speech-language pathology is dynamic and evolving, therefore the examples within this document are not meant to be all-inclusive. Additional emerging roles or responsibilities should not be precluded from consideration if they are based on sound clinical and scientific research, technological developments, and treatment outcomes data.
The range of the profession of speech-language pathology has been defined by many sources, including ASHA, federal legislation, and such other sources as the World Health Organization.
Speech-language pathologists are professionally trained to prevent, screen, identify, assess, diagnose, refer, provide intervention for, and counsel persons with, or who are at risk for, articulation, fluency, voice, language, communication, swallowing, and related disabilities. In addition to engaging in activities to reduce or prevent communication disabilities, speech-language pathologists also counsel and educate families or professionals about these disorders and their management (ASHA, 1996c).
The Individuals with Disabilities Education Act (IDEA) includes speech-language pathology as both a related service and as special education. As related services, speech-language pathology is recognized as “developmental, corrective, and other supportive services…as may be required to assist a child with a disability to benefit from special education…and includes the early identification and assessment of disabling conditions in children” [Section 602(22)]. Speech-language pathology is considered special education rather than a related service if the service consists of “specially designed instruction, at no cost to the parents, to meet the unique needs of a child with a disability, including instruction conducted in the classroom, in the home,…and in other settings.” State standards may further specify when speech-language pathology services may be considered special education rather than a related service.
According to the IDEA definition, speech-language pathology includes:
identification of children with speech and/or language impairments
appraisal and diagnosis of specific speech and/or language impairments
referral for medical or other professional attention necessary for the habilitation of children with speech or language impairments
provisions of speech and/or language services for the prevention of communication impairments or the habilitation of children with such impairments
counseling and guidance for parents, children, and teachers regarding speech and/or language impairments.
IDEA similarly identifies the early intervention services provided by speech-language pathologists for children from birth to age 3 with communication or swallowing disorders and delays. In Part C of IDEA, early intervention services are defined as being “designed to meet the developmental needs of an infant or toddler with a disability in any one or more of the following areas: physical, cognitive, communication, social or emotional and adaptive development” [Section 632(c)]. An infant or toddler with a disability may also include, at a state's direction, at-risk infants and toddlers [Section 632(5-8)].
School-based speech-language pathologists prevent, identify, assess, evaluate, and provide intervention for students with speech, language, and related impairments, disabilities, and handicaps. The World Health Organization, in an effort to describe what may happen in association with a health condition, defines impairment, disability, and handicap and differentiates outcome measures for each. See Table 1.
School-based speech-language pathologists focus on all three aspects of a student's communication needs: impairment, disability, and handicap. The school-based speech-language pathologist (a) prevents, corrects, ameliorates, or alleviates articulation, fluency, voice and language impairments; (b) reduces communication and swallowing disabilities (the functional consequences of the impairment); and (c) lessens the handicap (the social consequences of the impairment or disability). [5]
Ultimately, the school-based speech-language pathologist's purpose in addressing communication and related disorders is to effect functional and measurable change(s) in a student's communication status so that the student may participate as fully as possible in all aspects of life—educational, social, and vocational (ASHA, 1997e).
The roles and responsibilities of school-based speech-language pathologists have changed over the years in response to legislative, regulatory, societal, and professional influences.
School-based speech-language programs have a long history. Records indicate that in 1910 the Chicago public schools were the first schools to hire “speech correction teachers” (Darley, 1961). In the 1950s, speech-language pathologists who worked in a school setting, formerly referred to as “speech correctionists,” “speech specialists,” or “speech teachers,” worked primarily with elementary school children who had mild to moderate speech impairments in the areas of articulation, fluency, and voice. Later, with increased knowledge about language development, the “speech therapist” developed skills in identifying and remediating language disorders, thereby expanding the range of the profession (Van Hattum, 1982). Students were typically treated in large groups, contributing to caseload sizes that in most situations significantly exceeded those of today. The speech-language pathologist often employed a medical/clinical approach to treating students with communication impairments. With this approach the student's problems were diagnosed, developmental tasks were prescribed, clinical materials were used for treatment, and the individual was treated until the pathology was “corrected.” All of this was most often conducted by pulling students out of the classroom to receive services within a separate therapy resource room. The emphasis was on correcting the specific speech or language impairment.
Federal and state governments have been instrumental in obtaining rights for children with disabilities through the authorization of public laws. Practices defining speech-language pathologists' roles and responsibilities in schools today have been shaped in part by the laws and regulations, administrative policies and procedures, and court rulings that govern the provision of services to students with communication disorders. Relevant federal laws are noted in Table 2.
As can be seen in Table 2, legislative changes have influenced many aspects of speech-language programs. Before the Education for All Handicapped Children Act of 1975 (EHA) and its focus on providing services in the least-restrictive environment, “one million of the children with disabilities were excluded entirely from the public school system and did not go through the educational process with their peers” [Section 601c (2C)]. Others with disabilities were in the public schools, but their disabilities were undetected; this prevented them from having a successful educational experience. With the lack of adequate services within the school system, families had to find services outside the public school system, often far from home and at their own expense [Section 601c (2D-E)]. EHA assured free, appropriate public education for all students. It also increased accountability and documentation, which consequently has directly affected school-based speech-language pathologists.
Other legislation followed. With the enactment of EHA-Part H in 1986, services were expanded to include infants and toddlers and more categories of disabilities. IDEA, in 1990, further broadened the range of the profession with the addition of more discretionary programs. In 1993, Goals 2000: Educate America Act established eight national education goals (see Appendix C) and reinforced the notion that school reform legislation was relevant to speech-language pathology services (see Appendix D and ASHA, 1994i).
Goals 2000, Improving America's Schools Act (IASA), and recent IDEA amendments all underscore the importance of postsecondary initial preparation and continuing professional development to ensure a high quality of education for students with disabilities. And most recently, the IDEA amendments of 1997 require that the IEP include information regarding the impact of the student's disability in terms of the general education curriculum.
In addition to federal legislative mandates, speech-language pathologists must also be familiar with and follow existing state regulations and guidelines and local policies and procedures in carrying out their roles and responsibilities.
External factors other than legislative changes have influenced the roles of the school-based speech-language pathologist. America's racial and ethnic profile is rapidly changing, with an attendant shift in student demographics. By the turn of the millennium, nearly one of every three Americans will be African American, Hispanic, Asian American or American Indian. As a group, minorities constitute an ever-larger percentage of public school students. In addition, the limited-English-proficient population is the fastest growing population in America [Section 601 (7A-F)]. The move toward pluralism—in which numerous distinct ethnic, religious, or cultural groups co-exist—has produced students who are culturally and linguistically more diverse. Hence, speech-language pathologists need to address such professional issues as nonbiased assessment and eligibility and intervention considerations related to a diverse population.
The nature and complexity of disorders have intensified. Speech-language pathologists within general education settings provide services for more students who are medically fragile and/or multihandicapped. The emphasis on least-restrictive environment only partially explains the increase. Medical advancements are saving more lives, yet many who survive are physically or medically challenged. Additionally, with health care reform, many students are released earlier from hospitals or rehabilitation centers and enter public schools requiring intensive speech-language services. Such other societal influences as an aging population and squeezed budgets have often translated to fiscal cutbacks to K-12 and postsecondary education programs (ASHA, 1997h). These fiscal constraints have made it more challenging to provide effective service.
School-based speech-language pathologists possess a high degree of clinical competence by virtue of their professional study and experience. The field of speech-language pathology has developed a widened scope of practice. Research and efficacy studies have been conducted and published to help determine best practices relating to speech-language pathology in all settings and within schools in particular. Advanced technology has increased the scope and capabilities of speech-language pathologists.
Personnel shortages and changes in state licensure or department of education certification have affected the roles and responsibilities of school-based speech-language pathologists in many states. The roles of the speech-language pathologist may vary depending upon the composition or severity of the caseload, state or district mandates, and staffing needs.
Although the mission of the school-based speech-language pathologist—to improve the communication abilities of students—has remained constant, the manner in which the school-based speech-language pathologist addresses prevention, assessment, evaluation, eligibility determination, caseload management, and intervention has changed and will continue to evolve.
Today's school-based speech-language pathologists serve students who have complex communication disorders, many of which require intensive, long-term interventions. Many school speech and language caseloads consist of students with a wide range of disabilities and diverse education needs. According to the Twentieth Annual Report to Congress on the Implementation of IDEA, students with speech or language impairments are the second largest category of students served (20.2%) after specific learning disabilities (51.2%) (U.S. Department of Education, 1998). Speech-language pathologists also provide services to students with related disability categories—including mental retardation; emotional disturbance; multiple disabilities; hearing, orthopedic, visual, or other health impairments; autism; deaf-blindness; and traumatic brain injury.
Several education reform initiatives have influenced and shaped the policies that we have today. The regular education initiative (REI) proposed that as many children as possible be served in the regular classroom by “encouraging a partnership with regular education” (Will, 1986, p. 20). Full-inclusion advocates went a step further and supported complete inclusion of students with special needs in the regular education classroom. Legislative mandates and general changes in philosophy have dictated that special education be provided in the least restrictive environment (LRE). Careful consideration of LRE and meaningful curriculum modifications based on the students' needs have led to expanded service-delivery models. Now, in addition to taking students out of the classroom for services, the speech-language pathologist has an array of direct and indirect service-delivery options available to help students with communication disorders (see Table 6). To integrate speech and language goals with educational (academic, social/emotional, or vocational) objectives, direct intervention may take place in a variety of settings, including the general education or special education classroom, the speech-language treatment room, the resource room, the home, or community facility (ASHA, 1996b). Indirect service is also provided for professional staff, parents, and families. [6]
Contemporary speech-language pathologists not only provide assessment and intervention for students identified as having communication disorders, they also may recommend environmental modifications or strategies for communication behaviors of children who have not been identified as being eligible for special education or related services (see Prevention).
With the expanding consulting role, it is essential for school-based speech-language pathologists to have a manageable caseload size. Adequate planning and conference time is needed during the school week to serve the student, educators, and parents appropriately. [7] (See Caseload Management.)
Currently, the school-based speech-language pathologist is expected to fulfill a variety of roles (see Table 3 in Section II). The roles and responsibilities will vary in accordance with the work setting (e.g., home, community, preschool, elementary or secondary school), with the types of communication impairments and disorders exhibited by children in these settings, and with the speech-language pathologist's experience, knowledge, skills, and proficiency. The level of experience, knowledge, skills, and proficiency may be expanded through additional training, such as mentoring, teaming, peer coaching, co-teaching, or through continuing education (CE) opportunities (workshops, seminars, institutes, and course work).
School-based speech-language pathologists keep current with best practices in assessment and intervention. When providing services for students with impairments, disabilities, and/or handicaps, speech-language pathologists work with students with speech, language, hearing, and swallowing or related impairments; promote the development and improvement of functional communication skills for students with communication and swallowing disabilities; and provide support in the general educational environment for students with communication handicaps to facilitate their successful participation, socialization, and learning. School-based speech-language pathologists' roles and responsibilities have evolved. They now include preparing students for academic success and the communication demands of the work force in the 21st century as well as alleviating handicapping conditions of speech and language disorders (ASHA, 1994i).
In the future, research and outcomes data most certainly will alter assessment and intervention techniques, influence models and theories of practice, and further expand ASHA's Scope of Practice (1996c) and Preferred Practice Patterns for the Profession (1997e).
This section describes specific roles and responsibilities of school-based speech-language pathologists. Table 3 on the following page provides an outline of the various core roles and related responsibilities discussed in this section. Note that specific responsibilities may be shared by other members of teams [8] working together to meet the education and communication needs of students with disabilities and their families. (Additional roles and opportunities are discussed in Section III).
Table 3. Core Roles and Responsibilities of School-Based Speech-Language Pathologists
The concept of prevention has broadened in scope in speech-language pathology in the last 20 years. Prevention now includes more than speech improvement and language stimulation; it encompasses providing information on general health maintenance, environmental hazards, and prenatal factors, in addition to early identification and intervention.
The school-based speech-language pathologist has an important role to play on the education team in addressing prevention of communication disorders. For the school-based provider, this may include consultation regarding the acquisition of proficient language and communication skills by students in general education preschool and early intervention classrooms. The school-based speech-language pathologist's active involvement in general education support will promote increased awareness that communication skills are the basis of most teaching, learning, and social relationships (ASHA, 1994i; Cazden, 1988; Nelson, 1989).
Although intervention for students with communication disorders is still the primary role, this emphasis on prevention suggests an expanding role for the school-based speech-language pathologist that goes beyond identification and intervention for children with speech and language disorders (ASHA, 1991c; Butler, 1996; Connecticut State Department of Education, 1993; Kavanaugh, 1991). Prevention requires increased efforts to avoid or minimize the onset or development of communication disorders and their causes (ASHA, 1997d, 1997e). The causes are often characterized as biological, environmental, or multifactorial. In the latter case, the environment interacts with genetic predisposition. This terminology and primary, secondary, and tertiary prevention are defined in ASHA's Prevention of Communication Disorders Tutorial (1991c) and discussed below.
Primary Prevention: The elimination or inhibition of the onset and development of a communication disorder by altering susceptibility or reducing exposure for susceptible persons.
The emphasis of primary prevention is on eliminating or reducing biological and environmental risk factors through disseminating prevention information to parents, families, education personnel, health care and social service professionals, organizations, and policy-making groups. Students who do not qualify for services under IDEA may benefit from the services of the school-based speech-language pathologist who provides primary prevention services.
Primary prevention activities may range from individual conferences to school-wide presentations or community in-services. They may include educating and collaborating with parents, families, educators, administrators, and the community regarding:
classroom strategies that will enhance communication for all students
injury/accident prevention (e.g., wearing seat belts or bicycle helmets)
fluency-enhancing strategies
prevention of vocal abuse
students' lifestyle choices affecting their communication skills and that of their offspring
Secondary Prevention: Early detection and treatment of communication disorders. Early detection and treatment may lead to elimination of the disorder or retardation of the disorder's progress, thereby preventing further complications.
Tertiary Prevention: Reduction of a disability by attempting to restore effective functioning. The major approach is rehabilitation of the disabled individual who has realized some residual problems as a result of the disorder.
Early screening, assessment, and treatment of an impairment—traditionally considered special education or related services—may actually prevent further disability or handicapping conditions. Such secondary and tertiary prevention activities are included in the following sections on Identification, Assessment, and Intervention.
A core role of the speech-language pathologist is to participate as a member of a team in identifying students who may be in need of assessments to determine possible eligibility for special education or related services. These assessments assist in determining the presence of disabilities and eligibility/ineligibility for special education and related services under IDEA. It is necessary for the speech-language pathologist to examine the identification and assessment/evaluation process through the prism of legal and ethical codes, policies, procedures, and guidelines specific to the state or local education agency.
The basic phases of the identification process are prereferral, screening, and referral when indicated.
Although not always required, the prereferral process is a recommended option in many districts as a first step in deciding whether a student is in need of referral for a special education and related services evaluation or simply needs assistance or modification within the general education environment. Many schools establish educational problem-solving teams, often referred to as a Child Study Team, Intervention Assistance Team, or Student Success Team. These teams are defined as school-based problem-solving groups whose purpose is to assist teachers with intervention strategies for addressing the learning needs and interests of students before a formal referral for an evaluation (Ohio Department of Education, 1991). This process is consistent with IDEA. The emphasis is on classroom modifications and supports that, when successful, actually prevent the need for special education intervention. Team members collaborate to determine if accommodations or modifications have been successful. An effective method is using dynamic assessment to gauge a student's potential to learn independently when given a mediated learning experience (see the Assessment Methods and Intervention sections). Some schools have more than one team. The first-level team is responsible for the prereferral process and documentation of general education intervention implemented in the classroom; a second-level team is responsible for the assessment and identification process, when recommended.
A core prereferral team may consist of any combination of the following: an administrator; the student's teacher; one or more other regular education teachers; a curriculum specialist; and student or pupil service personnel, as appropriate, such as the school psychologist, social worker, counselor, or nurse. Parents/families may also participate on prereferral teams. The composition of a prereferral team varies considerably among districts and states. Some teams are limited to general education staff; others include special education and related service staff. One or more special education or related service providers may be added as necessary for specific student concerns. The speech-language pathologist may consult regarding perceived communication needs of students who may benefit from classroom accommodations or special education services. During the prereferral phase, it may be the responsibility of the speech-language pathologist, as a team participant, to provide one or more of the following services as appropriate for specific students:
review pertinent school records
collect and review data to substantiate the outcomes of attempted classroom modifications and interventions
observe the student in the classroom
collaborate with parents, teachers, and other professionals to provide strategies, resources, and additional recommendations for teacher interventions in the classrooms
demonstrate intervention strategies, procedures, and techniques
provide follow-up consultation or participate in processing a formal referral for assessment
gather additional data
Screening is the process of identifying candidates for formal evaluation. Any procedure that separates those students in need of further evaluation from those not needing evaluation fulfills the purpose of screening. Screening may be accomplished by using published or informal screening measures administered by the speech-language pathologist. In some states, trained support personnel may conduct screening under the direction of the speech-language pathologist, who then interprets the measures. Nonstandardized checklists, questionnaires, interviews, or observations interpreted by the speech-language pathologist may also be considered screening measures. Individual or mass speech/language screenings may be mandatory in some regions and optional in others. If and when it is the responsibility of the school-based speech-language pathologist to conduct the screenings, the speech-language pathologist:
selects screening measures meeting standards for technical adequacy
administers and/or interprets a speech/language screening
administers and/or interprets a hearing screening in accordance with state and local policy, procedures and staffing patterns (ASHA, 1997e)
When accommodations and interventions have been attempted but have not been successful, a referral for assessment may be initiated by any individual, including a parent, teacher, or other service provider. The referral is a request for assessment of a student with suspected special education needs. The assessment focuses on all areas related to a suspected disability that may result in eligibility for special education and/or related services. The written referral includes a brief description of any previously attempted supplementary aids and services, program modifications and supports to the general education environment, a statement regarding the effectiveness of those modifications, and a rationale for the assessment.
If a speech-language pathologist is a member or case manager of a team, in accordance with local policies, it may be the responsibility of the speech-language pathologist to:
review referrals
participate in the development of the assessment plan
obtain the results of current hearing/vision screenings and monitor follow-up when appropriate
initiate referrals for additional assessment to other service providers
serve as liaison to appropriate nonpublic school agencies and/or providers
communicate with general education classroom teacher(s) and parent(s) regarding the status of the referral
schedule referral meetings
obtain written parent/guardian consent for evaluation in accordance with federal mandates, state regulations and guidelines, and local policy and procedures
complete and distribute the paperwork to process the referral
A core role of the school-based speech-language pathologist is to conduct a thorough and balanced speech, language, or communication assessment. Within this document, a distinction is made between the role of assessment and the role of evaluation. Assessment “refers to data collection and the gathering of evidence”; evaluation “implies bringing meaning to that data through interpretation, analysis and reflection” (Routman, 1994, p. 302).
A responsibility of the school-based speech-language pathologist is to select assessment measures that:
are free of cultural and linguistic bias
are appropriate for the student's age
match the stated purpose of the assessment tool to the reported needs of the student
describe differences when compared to peers
describe the student's specific communication abilities and difficulties
elicit optimal evidence of the student's communication competence
describe real communication tasks (see Appendix E)
A comprehensive assessment plan is developed within local or state mandated time lines. It documents the areas of speech and language to be assessed, the reason for the assessment, and the personnel conducting the assessment. If an initial screening was completed, the results are used to identify the specific areas of speech and language to be addressed. The student's dominant language and level of language proficiency are specified in the assessment plan. Parents may participate in the development of the assessment plan. The written assessment plan is provided to parents in their dominant language or native language, whenever possible, as per IDEA [Section 612(a)(6)(B)]. (See specific evaluation considerations below.)
The foundation of a quality individualized assessment is to establish a complete student history. That information will direct subsequent assessment selection. The assessment data should reflect multiple perspectives. No single assessment measure can provide sufficient data to create an accurate and comprehensive communication profile (Haney, 1992; IDEA [Section 612(a)(6)(B)]). Conducting both nonstandardized and standardized assessments enables the speech-language pathologist to view the student in settings with and without contextual support.
Combining standardized (norm-referenced) with nonstandardized (descriptive) assessment using multiple methods will assure the collection of data that can furnish information about the student's functional communication abilities and needs. Examples of descriptive assessment methods are checklists and developmental scales, curriculum-based assessment, dynamic assessment data, and portfolios of authentic assessment data [9] (e.g., student classroom work samples, speech and language samples, and observations of the student in various natural contexts). A descriptive assessment allows focus on language during actual communication activities within natural contexts.
During assessment data collection, it is the responsibility of the speech-language pathologist to gather information, select appropriate assessment methods, and conduct a balanced assessment.
This balanced assessment may include:
gathering information from parent(s), family, student, teachers, other service-provider professionals and paraprofessionals
compiling a student history from interviews and thorough record review
collecting student-centered, contextualized, performance-based, descriptive, and functional information
selecting and administering reliable and valid standardized assessment instruments that meet psychometric standards for test specificity and sensitivity
Examples of each follow.
Parent/staff/student interviews. Parents are an essential source of information—especially for students who are very young or who have severe disabilities. Parents provide insight regarding communication skills in various settings outside the school and provide additional information about functional and developmental communication levels.
Classroom teachers, instructional assistants, and other school professionals are a primary source of information regarding a student's functional communication skills among peers within the classroom and school environment. They also provide specific information regarding listening, speaking, reading, writing, spelling/invented spelling, and the relationship between the student's communication skills and the curriculum. Various teacher/staff checklists provide information specific to disability areas or communication functions.
Student interviews are appropriate in many cases, depending on the student's age or cognitive level. The speech-language pathologist may gain insight into personal attitudes of the student related to communication difficulties and motivation to change.
Student history. The speech-language pathologist collects relevant and accurate information through record review, observation, and parent, teacher, or student interviews. Information regarding the student's medical and family history, communication development, social-emotional development, academic achievement from previous education placements, language dominance, community/family language codes and social-behavioral functioning are especially valuable when completing a student case history.
Checklists and developmental scales. These tools are used to obtain a large amount of information in an organized or categorized form to note the presence or absence of specific communication behavior. They may be completed either by the speech-language pathologist or by others for the speech-language pathologist.
Curriculum-based assessment. Curriculum-based assessment (CBA) refers to the “use of curriculum contexts and content for measuring a student's language intervention needs and progress” (Nelson, 1998). Nelson suggests that CBA may extend the assessment beyond the identification of a student as communication-impaired by including activities/skills that may assess the acquisition of effective oral and written communication abilities.
An example of a curriculum-based measure that may be used by the speech-language pathologist is an information reading inventory that could be analyzed collaboratively by the speech-language pathologist and the classroom teacher.
Dynamic assessment. Dynamic assessment is defined as a “term used to identify a number of distinct approaches that are characterized by guided learning for the purpose of determining a learner's potential for change” (Palincsar, Brown, & Campione, 1994). Dynamic assessment is concerned with how well a student can perform after being given assistance. The response the student makes to assistance helps to determine future effective instruction (see Intervention).
Portfolio assessment. Portfolio assessment can be defined as a collection of such products as student work samples, language samples, dictations, writing samples, journal entries, and video/audio recordings and transcriptions. A portfolio approach requires decisions regarding:
what samples are included
how many samples are included
student reflections on his or her work over time
analysis of the underlying processes represented by the samples as either learned or not learned
Observation/anecdotal records. The observation of real-life communication behavior and the application of the resulting data describe language development and function in a variety of natural contexts. The speech-language pathologist can also use the anecdotal records and observations conducted by other individuals to complete various checklists, surveys, and developmental scales.
Standardized assessment information. When appropriately selected for validity and reliability, standardized tests yield important information regarding language and speech abilities and are part of the comprehensive assessment. They are norm-referenced and used to compare a specific student's performance with that of peers. Statistical scores are valid only for students who match the norming population described in the test manual.
Although all areas of speech, language, and communication are interrelated, broad spectrum, norm-referenced tests may be used to measure such skills of language comprehension and production as syntax, semantics, morphology, phonology, pragmatics, discourse organization, and following directions. Additional tests may be administered to assess such specific areas as auditory abilities and auditory processing of language. Tests are used to assess articulation, phonology, fluency, and voice/resonance; and instrumental and noninstrumental protocols are used to assess swallowing function.
The assessment data are compiled, records are reviewed, and observations and interviews are noted. The best means to valid, nonbiased testing may be a speech-language pathologist with a solid knowledge base in speech and language development, delay, difference, and disorders who understands the value and the inherent obstacles of standardized and nonstandardized assessments and who possesses the skills to analyze data generated through all assessment methods.
Once the comprehensive assessment has been completed, the results are interpreted. It is the interpretation that gives value to the assessment data, hence the term evaluation (Routman, 1994). Consideration is given to the nature and severity of a student's disorder and its effect on academic and social performance. Clinical judgment is used when evaluating assessment information. Informed decisions are made about eligibility and subsequent intervention strategies.
It is the responsibility of the speech-language pathologist, as part of a team, to assist in interpreting data that will:
identify strengths, needs, and emerging abilities
establish the presence of a disorder, delay, or difference—including determining the student's communication abilities within the context of home and/or community
determine a severity rating (when required by state regulations and guidelines or local policy and procedures)
define the relationship between the student's level of speech, language, and communication abilities and any adverse effect on educational performance
determine if the communication disability is affected by additional factors influencing the results of the communication assessment
summarize evaluation results and make recommendations
The speech-language pathologist's responsibilities in specific areas are described below:
A careful analysis of the assessment data reveals the student's strengths, needs, and emerging abilities. These may include differences between receptive and expressive oral and written language skills. Analysis may also reveal differences in the components of language form (phonologic, morphologic, and syntactic systems), content (semantic system), or function/use of language in communication (pragmatic system).
Strengths, needs, and emerging abilities are also identified within specific speech areas including articulation/phonology, fluency, and voice or resonance. The student's preferred communication modality is also considered. Identifying communication strengths and needs as prognostic indicators assists in determining the probable potential for remediation and creates a direct link from assessment to planning and conducting intervention. These strengths and needs are considered within the broader context of classroom, home, and community.
Research on the sequence and process of normal language and speech development provides the framework for determining whether the student exhibits a communication disorder, delay, or difference (see Appendix F, Developmental Milestones). Although the distinction among disorder, delay, and difference is not always easily determined, the following ASHA definitions are provided to clarify the terms.
A communication disorder is an impairment in the ability to send, receive, process, and comprehend verbal, nonverbal, and graphic symbol systems. A communication disorder may be evident in the process of hearing, language, or speech; may be developmental or acquired; and may range in severity from mild to profound. A communication disorder may result in a primary disability or may be secondary to other abilities (ASHA, 1993a, p. 40).
A communication delay exists when the rate of acquisition of language or speech skills is slower than expected according to developmental norms; however, the sequence of development is following a predicted order (Nicolosi, 1989). For eligibility purposes, determination of the level of delay that is considered significant is specified in state regulations and guidelines or local policies and procedures.
A communication difference is a “variation of a symbol system used by a group of individuals that reflects and is determined by shared regional, social, or cultural/ethnic factors. A regional, social, cultural, or ethnic variation of a symbol system is not considered a disorder of speech or language” (ASHA, 1993a, p. 41).
A severity rating scale provides a consistent method of describing overall communication functioning. Many states have developed and published severity rating scales to help substantiate eligibility or dismissal criteria. Some states use the determined severity rating as a “best practice” guide to assist in determining a recommended amount of intervention per week. An example of a matrix based on severity was developed by the Illinois State Board of Education (see Appendix G). Obviously, the needs of the student and clinical judgment affect the amount of service that the student receives. Consult state regulations and guidelines or local policies and procedures for severity rating information.
Education takes place through the process of communication. The ability to participate in active and interactive communication with peers and adults in the educational setting is essential for a student to access education (Michigan Speech-Language-Hearing Association, 1995). In order for a communication disorder to be considered a disability within a school-based setting, it must exert an adverse effect on educational performance. The speech-language pathologist and team determine what effect the disorder has on the student's ability to participate in the educational process. The educational process includes preacademic/academic, social-emotional, and vocational performance.
A speech, language, or hearing disorder may severely limit a student's potential vocational or career choices regardless of the student's other competencies. (See Appendix H for examples of signs and effects of communication disorders and Appendix I for an example of a chart to document educational relevance.)
Many factors affect a child's learning. Some of these include quality of instruction; emotional status; home environment/support; family attitudes toward school services; composition of the classroom; characteristics of the teacher; educational history; and the student's planning, attention, and simultaneous and sequential processing abilities. The student's communication competence is evaluated in the context of the student's history and educational environment. All aspects of the assessment and evaluation are documented within the evaluation report. The speech and language information may be written in a self-contained communication report or may be included in a unified team report. The report interprets, summarizes, and integrates all relevant information that has been gathered, and describes the student's present level of functioning in all speech, language, and hearing areas and the relationship to academic, social-emotional, and/or vocational performance.
The evaluation report serves as the basis for the team's discussion of alternatives and recommendations. It includes the following information:
student history information from record review and parent, teacher, and/or student interview
date(s) of assessment(s)
relevant behaviors noted during observation
assessment information from all disciplines
observation/impressions in a variety of communication settings
results of previous interventions
descriptive assessment results
standardized assessment results and documentation of any variations from standard administration
discussion of student's strengths, needs, and emerging abilities
disorder/delay/difference determination, including the student's communication abilities within the context of home and community
severity rating (when applicable)
educational relevance, including academic, social-emotional, and vocational areas
interpretation/integration of all assessment data
evaluation results and recommendations for strategies, accommodations, and modifications
When interpreting the assessment data, consideration is given to the effect of specific factors influencing the results of the communication evaluation. Numerous relevant factors follow in alphabetical order.
Chronological age and developmental level are considered during assessment and evaluation. School-based speech-language pathologists assess individuals from birth through age 21. The validity of standardized tests varies among instruments and across age levels. Careful observation and use of nonstandardized procedures assure a balanced assessment whether the assessment is conducted with infants and toddlers, preschool and/or elementary school children, or secondary school adolescents. Dynamic and authentic assessment data for all age levels provide information on the student's functional abilities or needs and potential to learn.
Speech-language pathologists involved in infant/toddler and preschool assessment should have an understanding of the health issues and effects of hospital stay on the child and the family, have access to a complete medical history, communicate with medical personnel, and should interview an affected child's family as part of a family-based assessment so that a detailed developmental history can be obtained. School-based speech-language pathologists charged with responsibility for early identification and preschool students need to be sensitive to the wide variation in family systems and interactive styles surrounding successful communication and language development, as well as have knowledge of all aspects of “normal” development. With respect to assessment and evaluation, speech-language pathologists assume the ongoing monitoring of a child's communication, language, speech, and oral-motor development. Because young children change rapidly and families respond differently to their children at various periods in development, speech-language pathologists devise systematic plans for periodic evaluation of progress (ASHA, 1989b).
Comprehensive evaluation of school-age children and adolescents includes assessment of the understanding and use of both oral and written language, including pragmatic abilities (Damico, 1993; Nippold, 1993). Intervention strategies reflect the student's changing developmental stages and language needs/proficiencies throughout elementary and secondary educational programs (Larson, McKinley, & Boley, 1993; Nelson, 1998; Work, Cline, Ehren, Keiser, & Wujeck, 1993).
Attentional behaviors and activity levels differ across ages, genders, and cultural background (ASHA, 1997e). The student's ability to focus and attend during the assessment is considered when evaluating the results of the assessment. The effectiveness of modifications used during an assessment are documented. Information about the type and extent of variation from standard test conditions is included in the evaluation report. This information is used by the team to evaluate the effects of variances on validity and reliability of the reported information.
Speech-language pathologists and audiologists are increasingly involved with students with attention deficit hyperactivity disorders (ADHD). These professionals are often among the first to assist in the evaluation of students and youth suspected of having ADHD because of its co-occurrence with language learning disabilities and central auditory processing disorders (ASHA, 1997f).
Attention deficit hyperactivity disorder is a syndrome characterized by serious and persistent difficulties in terms of inattention and hyperactivity-impulsivity. According to the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association (1994), to confirm a diagnosis of ADHD, at least six characteristics within either category “must have persisted for 6 months to a degree that is maladaptive and inconsistent with developmental level” (p. 84). [10]
An inattentive student may not exhibit hyperactive or impulsive characteristics and, therefore, may be overlooked in the classroom. That student may be at higher risk for educational failure than the student with hyperactive and/or impulsive tendencies because the student's needs are not apparent.
Some professionals assert that hyperactive/impulsivity behaviors may not be due to inattention but caused instead by poor inhibition or poor self-regulation (Barkley, 1990; Westby, 1994). This may be related to executive function, which is discussed further in ASHA's technical report on ADHD (1997f).
A diagnosis of ADHD is made by medical professionals only after ruling out other factors related to medical, emotional, or environmental variables that could cause similar symptoms. Therefore, physicians, psychologists, educators and speech-language pathologists conduct a comprehensive evaluation, which includes medical studies, psychological and educational testing, speech-language assessment, neurological evaluation, and behavioral evaluations compiled by both the parent and teacher(s). The student's performance should be assessed across multiple domains in multiple settings by several persons. A differential diagnosis is difficult because of the complex interaction existing between ADHD and cognitive, metacognitive, linguistic, social-emotional, and sensori-integrative abilities.
A central auditory processing disorder (CAPD) is an observed deficiency in sound localization and lateralization, auditory discrimination, auditory pattern recognition, temporal aspects of audition, use of auditory skills with competing acoustic signals, and use of auditory skills with any degradation of the acoustic signal (ASHA, 1995a). CAPD may affect language learning and language use as well as cognitive language processing areas (e.g., attention, memory, problem solving, and literacy). According to Chermak, “The behavioral profiles of students with CAPD, specific learning disabilities and ADHD often overlap, as might be expected given the complex interactions among auditory processing, language skills, cognition, and learning” (1995, p. 208). CAPD may be evident in combination with other disabilities, making differential diagnosis difficult.
The assessment of central auditory processing disorders (CAPD) is a crossover area between the two professions of audiology and speech-language pathology and requires a cooperative effort among parents, teachers, speech-language pathologists, audiologists and other professionals for a successful outcome. Speech-language pathologists contribute to the assessment process by formally evaluating receptive language and phonemic processing skills and by documenting observed auditory processing behaviors. This information is used by the audiologist to augment the formal central auditory processing assessment battery (Keith, 1995). ASHA has established preferred practice patterns in CAPD assessment and treatment for both professions (ASHA, 1997d, 1997e). The current developments in CAPD are described in Central Auditory Processing: Current Status of Research and Implications for Clinical Practice (ASHA, 1995a).
Cognition and language are intrinsically and reciprocally related in both development and function. An impairment of language may disrupt one or more cognitive processes; similarly, an impairment of one or more cognitive processes may disrupt language. Cognitive-based impairments of communication are referred to as cognitive-communication impairments and are disorders that result from deficits in linguistic and nonlinguistic cognitive processes. They may be associated with a variety of congenital and acquired conditions (ASHA, 1988; 1991b). Speech-language pathologists are integral members of interdisciplinary teams engaged in the identification, diagnosis, and treatment of persons with cognitive-communication impairments (ASHA, 1987).
The role of the school speech-language pathologist in evaluating the communication needs of students with cognitive-communication impairments is delineated in the Guidelines for Speech-Language Programs (Connecticut State Department of Education, 1993, pp. 90–91). Examples include:
collaborating with families, teachers, and others in locating and identifying children whose communication development and behavior may suggest the presence of cognitive impairments or whose communication impairments accompany identified cognitive impairments
collaborating with other professionals to interpret the relationship between cognitive and communication abilities
assessing communication requirements and abilities in the environments in which the student functions or will function (Cipani, 1989)
assessing the need for assistive technology in collaboration with audiologists including alternative/augmentative communication systems and amplification devices (Romski, Cevcik, & Joyner, 1984; Flexer, Millin, & Brown, 1990, Baker-Hawkins & Easterbrooks, 1994).
The demographics of our society are changing rapidly and dramatically. The number of students with cultural and/or linguistic diversity is increasing in school systems across the nation, especially in large cities. In some states, over 40% of residents come from culturally and linguistically diverse backgrounds (California Speech-Language-Hearing Association, 1996). It has been estimated that in the near future onethird of the U.S. population will consist of racial and ethnic minorities [IDEA Section 601(7)(A-D)]. The American Speech-Language-Hearing Association's position paper on social dialects (ASHA, 1983) emphasizes the role of the speech-language pathologist in distinguishing between dialects or differences and disorders. Additionally, the Office of Multicultural Affairs has developed a related reading list on this topic (ASHA, 1997a).
Responsibilities relating to assessment of students with culturally and linguistically diverse backgrounds include:
reviewing the student's personal history, including cultural, linguistic, and family background
assisting instructional staff in differentiating between communication disorders and culturally or linguistically based communication differences
determining difference/disorder distinctions of a dialect-speaking student and recommending intervention only for those features or characteristics that are disordered and not attributable to the dialect
School-based speech-language pathologists play an important role in determining appropriate identification, assessment, and academic placement of students with limited English proficiencies (Adler, 1991; ASHA, 1998f). Prereferral interventions using Interventinon Assistance Teams are used to address student, teacher, curriculum, and instruction issues (Garcia & Ortiz, 1988). The differing mores, cultural patterns, and—particularly—the linguistic behaviors of these students require input from their family members and a culturally sensitive and competent team of professionals, which may include bilingual speech-language pathologists, teachers, English as a second language (ESL) staff, interpreters/translators, and/or assistants (Cheng, 1991; Langdon, Siegel, Halog, & Sanchez-Boyce, 1994; Leung, 1996). Many speech-language pathologists are trained to distinguish students who have a communication disorder in their first (also called home or native) language (L-1) from students who may be in the process of second language (L-2) acquisition. The speech-language pathologist who has not had such training must seek consultation with knowledgeable individuals.
In order to effectively distinguish difference from disorder in bilingual children, it is important for speech-language pathologists to understand the first as well as the second language acquisition process and to be familiar with current information available on morphologic, semantic, syntactic, pragmatic, and phonological development of children from a non-English language background. Assessment includes measuring both social language and academic language abilities. Proficiency in social language may develop within the first 2 years of exposure to English; it may take an additional 5 years for academic language proficiency to develop. Basic interpersonal communication skills (BICS) are the aspects of language associated with the basic communication fluency achieved by all normal native speakers of a language (social language). Cognitive academic linguistic proficiency (CALP), on the other hand, relates to aspects of language proficiency strongly associated with literacy and academic achievement (Cummins, 1981).
Approximately 200 languages are spoken in the United States (Aleman, Bruno, & Dale, 1995). Within each group of students whose first language is other than English, there is also a continuum of proficiency in English (ASHA, 1985a). In evaluating speakers of languages other than English, some of whom may be accustomed to more than two languages, the continuum is particularly relevant. The continuum of English language learners includes speakers who fall within the following designations:
bilingual English proficient (proficient in L-1 and L-2)
limited English proficient (proficient in L-1, but not L-2)
limited in both English and the primary language (limited in L-1 and L-2)
A further caution regarding bilingual evaluation is that if a test was not normed on bilingual or limited-English-proficient students, then the test norms may not be used for a bilingual or limited-English-proficient student (Langdon & Saenz, 1996). Responsibilities related to bilingual assessment may include:
serving as a member of the interdisciplinary prereferral team when there is concern about a limited-English-proficient student's classroom performance
seeking collaborative assistance from bilingual speech-language pathologists, qualified interpreters, ESL staff, and families to augment the speech-language pathologist's knowledge base (ASHA, 1998f)
teaming with a trained interpreter/translator to gather additional background information, conduct the assessment, and report the results of assessment to the family (Langdon et al., 1994)
compiling a history including immigration background and relevant personal life history such as a separation from family, trauma or exposure to war, the length of time the student has been engaged in learning English, and the type of instruction and informal learning opportunities (Cheng, 1991; Fradd, 1995)
gathering information regarding continued language development in the native language and current use of first and second language
providing a nonbiased assessment of communication function in both the first (native/home language) and second language of the student (Note: IDEA Section 612(a)(6)(B) requires assessment in “the child's native language or mode of communication unless it clearly is not feasible to do so.”)
evaluating both social and academic language proficiency
In the United States, more than 1.2 million children under 18 years of age have either a congenital or an acquired hearing loss (Adams & Marano, 1995). The ultimate academic and social outcomes for these students depend on the coordinated efforts of many individuals, including but not limited to, the student, parents, classroom teachers, the audiologist, and the speech-language pathologist. A teacher of the deaf and hard of hearing, a speech-language pathologist, or an audiologist often serves as the coordinator of services and liaison for the parents and student to the school system. The heterogeneous population of children with hearing loss or deafness encompasses a broad range of functional communication styles and abilities and types of services ranging from students in regular education classes requiring support services to students attending a school for the deaf. The relationship that exists between a child's and family's choice of communication systems and his/her ability to develop a language or languages in one or more communication modalities varies among children (ASHA, 1998c).
When a student has a hearing loss, the methods chosen for development of language skills are related to such factors as:
age of onset of the hearing impairment
type/severity of hearing loss
availability and use of residual hearing
presence of additional disabilities
access to assistive technology (computer-assisted real-time captioning, hearing aids, FM systems) and interpreters/translators (sign, ASL, cued speech)
level of acceptance, skills, and support by family, educators, and peers
acoustic environment of the classroom and other spaces used for instruction and extracurricular activities
Numerous reports and studies document the effects of hearing loss on speech, language, social-emotional, and academic development (Baker-Hawkins & Easterbrooks, 1994, Kretschmer & Kretschmer, 1978, Maxon & Brackett, 1987, Quigley & Kretschmer, 1982). Even students with mild, fluctuating, or unilateral hearing loss often exhibit significant academic delays and grade failure (Bess et al., 1998; Connecticut Advisory School Health Council, 1988; Davis, Elfenbein, Schum, & Bentler, 1986; Gallaudet University Center for Assessment and Demographic Study, 1998; Joint Committee on Infant Hearing, 1994; Oyler, Oyler, & Matkin, 1988).
The Agency for Health Care Policy and Research reports that the most common etiology of temporary and fluctuating hearing loss in children from birth to 3 years of age is otitis media, which can be acute or chronic and may occur with or without effusion (U. S. Department of Health and Human Services, 1994). Not all children who experience otitis media have significant hearing