When a young child's communication skills are evaluated, the areas discussed below are generally considered to be important parts of the total picture and are compared to typical developmental patterns. These areas include general behavior and the ability to pay attention, and prelinguistic, receptive language, expressive language, articulation, oral-motor, voice, fluency, hearing, play skills, and problem-solving skills.
General Behavior and Ability to Pay Attention
When evaluating communication skills, it is important to consider a child's general demeanor and activity level. The speech and language pathologist notes how a child reacts to new people and situations and may encourage a brief separation from the parent during the evaluation. The child's ability to make or maintain eye contact with others is also observed. In most cases, when given appropriate toys and materials children exhibit curiosity and interest in touching and playing with them. The child's ability to pay attention to age-appropriate activities is noted as are the activity level, level of distractibility, impulsiveness, or perseverance. The child's frustration level when faced with a challenging task is also evaluated (Creaghead, Newman, & Secord, 1989).
A number of skills prerequisite for a child to develop language are usually mastered during the first year of life. These skills are considered when assessing very young children or those who exhibit significant language delays. Prelinguistic skills include:
- The ability to pay attention to visual and auditory information;
- The ability to imitate gestures and sounds;
- The development of object permanence (understanding that an object still exists even when it is removed from sight);
- The ability to take turns;
- The ability to understand that objects have intended purposes (understanding of cause-and-effect relationships);
- The use of basic communicative gestures and the ability to associate a word a child hears with its meaning. (McCormick & Schiefelbusch, 1990)
A child who has a severe language delay but talks is often found to have inconsistent prelinguistic (also called pre-symbolic) skills (Owens, 1982). "Missing links" in the full set of prelinguistic skills often underlie difficulties with more complex language skills (Cantwell & Baker, 1987).
Receptive Language Skills
Receptive language refers to understanding language, also called comprehension. Receptive language skills include:
- Understanding vocabulary (words);
- Understanding sentences and grammatical structures;
- Following directions;
- Understanding concepts (e.g., prepositions, sizes, colors, numbers);
- Understanding questions (e.g., "What?" "Where?" "Who?").
Children may demonstrate much better skills in some of these areas than in others. They may be able to speak relatively well yet have receptive language deficits.
Expressive Language Skills
Expressive language refers to the language a child produces. A commonly accepted model of expressive language consists of three parts:
- Expressive vocabulary. which refers to the number and type of words a child has acquired;
- Word and sentence formation:
- Pragmatic development, which includes the ability to use language socially (to interact and accomplish an objective). (Bloom & Lahey, 1978)
All of these parts working together constitute expressive language. Many children who have a language delay or language disorder exhibit a large discrepancy between their receptive and expressive language skills (Nelson, 199 I).
Articulation is the production of speech sounds. This means using muscles and other body structures to shape sounds from exhaled air. Children might be able to understand and produce language without being able to speak clearly. When articulation is assessed, the therapist evaluates:
- Whether a child uses the oral structures (muscles, teeth, or tongue) to produce sounds correctly;
- How a child uses sounds to create meaning.
For children with severe articulation disorders, assessment is complex and detailed. Some basic elements that are evaluated include how individual sounds are produced in words and continuous speech, the child's overall speech intelligibility (clarity), and the child's ability to imitate sounds correctly that the child often produces incorrectly when speaking. An ability to imitate sounds indicates that these sounds are more likely to be corrected without direct treatment (Mannix, 1987). Certain error patterns (e.g., difficulty clearly pronouncing "s" or "th" sounds) are normal in development and must be considered in the context of a child's age and language level.
Oral-motor skills involve the development of the mouth and surrounding area in terms of its structure and functional ability. Weaknesses in this area often affect articulation development. An important part of assessing oral-motor skills is determining if a child has any problem with eating, drinking, or swallowing. The speech and language pathologist often works on oral-motor and feeding skills in conjunction with other professionals such as the occupational therapist (Mannix, 1987).
The physical health of the voice, as well as how it is used to communicate, is within the realm of speech and language pathology. Some aspects of the voice that are assessed formally and informally are the pitch (high or low voice), volume (loud or soft), and quality (such as hoarseness or extreme nasality) (Moore, 1986). The speech pathologist will recommend that a child be evaluated by an ear, nose, and throat doctor (ENT) if any aspect of the voice suggests a possible physical problem. This evaluation should be done before providing voice therapy (Lindfors, 1987).
Fluency problems, often called stuttering or dysfluency, refer to interruptions in the flow of speech. Dysfluency consists of pauses, prolonged sounds, or repetition of sounds and words. In severe dysfluency secondary characteristics such as jerking motions or blinking often are present. It is important to note that a certain amount of mild dysfluency is normal for many young children. Children whose level of dysfluency interferes with their ability to communicate or the willingness of others to interact with them often require speech therapy services. The speech and language professional assesses dysfluency to determine whether it is a developmental stage or a true disorder (Owens, 1991).
For most children, hearing is a primary means of learning to communicate. For this reason, when speech and language development is delayed or disordered, it is essential to find out if the child is hearing adequately (Oyler, Crowe, & Haas, 1987). Assessment takes the form of a screening or full hearing evaluation. If a hearing impairment is found, the speech and language pathologist often works with an audiologist or teacher of the deaf and hearing impaired to provide intervention services.
Children progress through developmental stages of play. Each of these stages of play relates to speech and language and cognitive milestones. A variety of play experiences should take place for language to develop, especially as the child uses more symbolism (Cheng, 1989). It is important for the speech and language pathologist to engage or observe children during play activities to better understand their level of speech and language development.
Language assessment also includes consideration of how a child uses language to perform thinking and reasoning tasks appropriate to the child's age. In younger children these skills are manifested in abilities such as matching or naming. As children become older they should be able to analyze things they encounter in more complex ways. They should become able to use language to perform more difficult tasks such as explaining and predicting (Blank, Rose, & Berlin, 1978).
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