How do we determine the impact of a speech and language disorder?

“…a speech-language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance” (34 C.F.R. Section 300.8(c)(11)).

By Charlotte Granitto, MS, CCC-SLP
Adriana Lavi, PhD, CCC-SLP

Speech and language disorders can impact a child in many ways – whether it be a child’s ability to raise his/her hand to volunteer an answer or ask a question, retell an event or a story, interact and converse with friends at recess, or the ability to speak clearly and confidently and be understood by others – difficulties with articulation, fluency, language, and social skills can have a profound and lasting impact on a student’s academic and future success.

In the school setting, speech-language pathologists (SLPs) are often asked to demonstrate the potential impact a speech and/or language disorder may have on a child’s academic success. SLPs are asked to do this because the Individual’s with Disabilities Education Act (IDEA, 2004), as well as many state education codes, consider the impact on education as part of the eligibility criteria for school-based services. IDEA (2004) states, “…a speech-language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance” (34 C.F.R. Section 300.8(c)(11)).

As SLPs, we know the many challenges a child with a speech and language disorder may face in the school setting, but how can we judge this impact in an objective and fair way?

The most effective way to objectively judge the impact of a speech and/or language disorder is to collect data through natural and authentic observations. SLPs can use questionnaires, checklists, and rating scales while observing a student in his/her everyday environment. Additionally, SLPs can ask teachers and parents to observe and complete rating scales of a child in the classroom and in the home environment. Once data is collected from multiple settings and sources, SLPs can compare the results to data from typically developing children of the same age. If the child that is being tested is outside the limits of what is considered typical, and the results correlate to a difficulty in school, we can assume there is a significant impact in that area.

Example: If a child’s parent, teacher, and SLP observe the child as avoiding speaking in class or in front of others, not being able to understand and/or follow directions in class or at home, and as having difficulty making friends, we may be seeing the impact of a speech and/or language disorder. This student may have a pragmatic language disorder, or, may be feeling the impact of an articulation, language, or fluency disorder.

Introducing the IMPACT Rating Scales

The IMPACT Rating Scales were created to assist SLPs and IEP team members in determining the impact of a speech and/or language disorder on a child’s education and social interactions. There are currently three IMPACT Rating ScalesThe IMPACT Social Communication Rating Scale focuses on pragmatics, The IMPACT Articulation and Phonology Rating Scale focuses on speech sound production, and The IMPACT Language Functioning Rating Scale focuses on spoken language and spoken language comprehension. Each IMPACT Rating Scale has three separate forms, for the clinician, parent, and teacher. The data and results of each rating form are analyzed via an online platform that calculates whether the speech and/or language disorder has a significant impact on a child’s education and social interactions.

Research and Development of the IMPACT Rating Scales

When we began developing the IMPACT Rating Scales, we started the process by conducting a thorough research review for each scale’s focus. We analyzed the most predictive areas in education and social interactions that are affected by poor articulation and phonology, oral expression and spoken language comprehension, and social communication, respectively. Additionally, we asked teachers and parents to complete surveys to provide their input on the potential impact of deficits in these areas.

Based on our research review, analysis, and input from teachers and parents, we developed and compiled a list of questions. A pilot study was then conducted with over 100 students for each of our rating scales. Items were reviewed for content quality, clarity and lack of ambiguity, and sensitivity to cultural issues. Once the pilot studies were validated, some questions were eliminated and supplemental questions were added. Then, a final list of questions was prepared and finalized for each rating scale. The scales were then normed in the second phase of the standardization project.

Each of the IMPACT Rating Scales is composed of several target areas.

The IMPACT Articulation and Phonology Rating Scale items focus on: speech characteristics, social interactions, academic and home/after school life.

The IMPACT Language Functioning Rating Scale items focus on: spoken language comprehension, oral expression, language processing and integration, literacy, and social language skills.

The IMPACT Social Communication Rating Scale items focus on: social context, intent to socialize, nonverbal language, social interactions, theory of mind, ability to accept change, social language and conversational adaptation, social reasoning, and cognitive flexibility.

Psychometric Properties of IMPACT Rating Scales

When selecting an assessment for an evaluation, it is important to consider whether it is truly a good assessment tool. A good assessment is one that produces results that will benefit the individual being tested or society as a whole (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education [AERA, APA, and NCME], 2014). There are a few ways we can examine whether a test is considered a good and strong assessment. We can take a look at the standardization, normative information, and the psychometric properties of each test.

For example, previous research has suggested that the inclusion of children with disabilities in a normative sample can have a negative impact on a test’s ability to differentiate between children with disorders and children who are typically developing (Peña, Spaulding, & Plante, 2006). Thus, normative data for the IMPACT Rating Scales was based solely on typically developing children to allow for high sensitivity and specificity. Since the purpose of the IMPACT Rating Scales is to help to identify speech and language disorders and the impact of these disorders, it was critical to exclude students from the normative sample who had diagnoses that are known to influence each area of speech and language (Peña, Spaulding, & Plante, 2006). For example, students who had previously been diagnosed with a specific language impairment or learning disability were not included in the normative sample for the IMPACT Rating Scales. Further, students were excluded from the normative sample if they were diagnosed with autism spectrum disorder, intellectual disability, hearing loss, neurological disorders, or genetic syndromes.

Additionally, research has suggested that we consider the potential impact of biases when evaluating an assessment tool. Responses to questionnaires, tests, and scales, may be biased for a variety of reasons. For example, response bias may occur consciously or unconsciously and when it does occur, the reliability and validity of our measure will be compromised. The IMPACT Rating Scales use balanced set of questions in order to protect against response biases. A balanced scale is a test or questionnaire that includes some items that are positively keyed and some items that are negatively keys.

Here is an example taken from the IMPACT Social Communication Rating Scale. Items on this scale are rated on a 4-point scale (“never,” “sometimes,” “often,” and “typically”). Now, imagine if we asked a teacher to answer the following two items regarding one of their students:

  1. Appears confident and comfortable when socializing with peers.
  2. Does not appear overly anxious and fidgety around group of peers.

Both of these items are positively keyed because a positive response indicates a stronger level of social language skills. To minimize the potential effects of acquiescence bias (“yea-saying and nay-saying” when an individual consistently agrees or disagrees [Danner & Rammstedt, 2016]), the test creator may revise one of these items to be negatively keyed. For example:

  1. Appears confident and comfortable when socializing with peers.
  2. Appears overly anxious and fidgety around group of peers.

Now, the first item is keyed positively and the second item is keyed negatively. The revised scale, which represents a balanced scale, helps control acquiescence bias by including one item that is positively keyed and one that is negatively keyed.

To read more about the psychometric properties of each IMPACT Rating Scale, please review the technical manual for each scale.

Time to explore

The IMPACT Rating Scales are psychometrically sound assessment tools that will help determine the impact of a speech and language disorder on a child’s education and social interactions. To learn more about the IMPACT Rating Scales please visit www.videolearningsquad.com and www.videoassessmenttools.com

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