Assessing Language Skills in Autism by SLPs

To all like me who like to have it all in one place, please check the webinar handout on autism and the assessment by Pearson

https://www.pearsonassessments.com/content/dam/school/global/clinical/us/assets/webinar-handout/2021/2021-assessing-language-skills-asd-webinar-handout.pdf

Early Warning Signs:

• Poor eye contact
• Does not look when you point to an object
• Does not engage in pretend or imaginative play
• No response to name
• Does not use gestures to communicate
• Excessive lining up of toys or objects
• No smiling or social responsiveness

(Johnson & Myers, 2007; National Institute of Health, 2013)

Infants and Toddlers

Birth

1. Primary Intersubjectivity-Infants and caregivers sharing feelings and emotions via expressions and gestures
2. Affect Attunement- emotions are nonverbally communicated

~8 months

1. Secondary Intersubjectivity-Determining your reaction's effects on others

~15 months

1. Symbolic/Representational Skills:

• Awareness of Self
• Pretend Play
• Language

Increasing Rate of Early Identification:

Conduct developmental surveillance at every well-child visit.

Administer developmental screenings as a standard at the 9-, 18-, and 30-month visits (or 24-month, if no 30-month visit is anticipated).

Recommend an additional screening prior to beginning preschool or kindergarten or at the 4-year well-child visit (Duby et al., 2006). (Recommendations from American Academy of Pediatrics)

Children with Autism Spectrum Disorder often demonstrate different play skills than peers with typical development. This is especially true of social play and pretend play.

No Joint Attention = difficulty with subtle communication cues like facial expressions, the tone of a speaker's voice, body language, etc. 

Conducting an Evaluation

Review of records and Parent’s Interview:

Medical History (Vision tracking; hearing)

Family History

Communication and Language Development:

Reports/Interview

Observations

Test results (standardized and non-standardized

Educational History and Impact

Age-appropriate assessment tools and procedures

• Obtain assessment data using
• Language sampling
• Dynamic assessment
• Parent and teacher questionnaires or interviews
• Observations:

At home with different family members,
At school with teachers and classmates,
At work (if applicable) with coworkers and supervisors.

• Review portfolios of classroom work 

Suggestions for successful collaboration with stakeholders

• Explain test results to teachers and family in a way that makes it clear what the individual can do and what he/she has difficulty doing in the classroom and at home.
• Identify the pain points - what does each stakeholder consider a pressing need at home and in the classroom?
• Prioritize top needs - and keep the initial plan simple.
• Make the goals/objectives functional for everyday use - not an additional task.
• Provide ideas/suggestions for daily practice within activities the student does at home and at school.
• Keep the communication lines open. Discuss what went well and what is not working or is too difficult to implement as planned. Adjust strategies as needed. 

Sensory Profile

Norm-referenced questionnaire (infant, toddler, child, adolescent, and adult editions)

Determine how sensory processing may be contributing to or interfering with a child's participation at home, school, and community

Provides information about sensory strengths and challenges

Use the information to help you help the student or adult remain calm and focused on activities, supporting behaviors that improve participation and avoid scenarios that trigger behavioral responses that can interfere with participation in home and school activities.

Communication & Language Assessments for Infants and Toddlers

PLS - 5; Birth - 7:11;

• Developmental assessment of emerging interpersonal communication skills, language comprehension, and expressive language

Bayley - 4; 16 days - 42 months;

• SLPs are qualified to administer the Bayley-4, which addresses cognition, receptive and expressive language, fine and gross motor skills, social-emotional, and adaptive behavior skills

Vineland - 3 Parent/Caregiver forms Birth - 90+, Teacher forms 3:0 - 21:11;

• Communication (Receptive, Expressive, Written)
• Daily Living Skills (Personal, Domestic, Numeric,* Community, School Community*)
• Socialization (Interpersonal Relationships, Play and Leisure, Coping Skills)
• Motor Skills (Gross Motor, Fine Motor)
• Maladaptive Behavior (Internalizing, Externalizing, Critical Items.)

Assessments that Address Vocabulary

Peabody Picture Vocabulary Test, Fifth Edition (PPVT – 5); 2:6 - 90+;

• Evaluates receptive vocabulary without the need to read or write

Expressive Vocabulary Test, Third Edition (EVT – 3); 2:6 - 90+;

• Evaluates expressive vocabulary without the need to read or write

Bracken Basic Concept Scale, Third Edition: Receptive (BBCS - 3:R); 3:0 - 6:11;

• Evaluates understanding of basic concepts needed to be successful in formal education

Bracken Basic Concept Scale: Expressive (BBCS:E); 3:0 - 6:11;

• Evaluates labeling of basic concepts needed to be successful in formal education

Boehm Test of Basic Concepts, Third Edition Preschool (Boehm - 3 Preschool); 3:0 - 5:11;

• Measures understanding of 26 basic concepts relevant to preschool and early childhood curriculum. Each concept is assessed twice to determine the child's understanding across contexts

Assessments that Address Comprehensive Language

Preschool Language Scales, Fifth Edition (PLS - 5); Birth - 7:11;

• Assesses communication development, with items that range from pre-verbal, interaction-based skills to emerging language to early literacy

Clinical Evaluation of Language Fundamentals, Preschool, Third Edition (CELF Preschool - 3); 3:0 - 6:11;

• Assesses a child's semantics, morphology, syntax, pragmatics, and pre-literacy skills
• Ideal for children who communicate at the sentence level and who are suspected of having specific skills deficits rather than overall language delays

Semantics

• May have difficulty understanding figurative language (e.g., It is raining cats and dogs. She is under the weather.)
• May associate one meaning with a word; may have difficulty with words with multiple meanings (e.g., The baseball player caught the fly.)
• May have limited vocabulary

Morphology

• Development of morphological forms is consistent with peers with typical language development
• Morphological error patterns are similar to those of children with developmental language disorder (e.g., 3rd person singular, regular past tense - ed, pronoun case)
• It may be difficult to assess children's morphological productions if they have limited verbal skills (e.g., one- to two-word utterances, idiosyncratic phrases, echolalia/"movie talk")

Syntax

• Development of syntactic forms is consistent with peers with typical language development
• Understanding of sentence structures with multiple meanings may be difficult (e.g., The children ran into the room with balloons.)
• Understanding of complex sentences may be limited (e.g., After driving Jordan to school, his mother goes to work.)
• Understanding and production of any sentence types is limited
• It may be difficult to assess children's syntax if they have limited verbal skills

Pragmatics

• Understanding the nuances of social language may be difficult (e.g., understanding figurative language, jokes, facial expressions, body language)
• Taking the perspective of a communication partner may be difficult (e.g., understanding the relevance of communication topic, provides sufficient context)
• Engaging in social interactions with communication partners may be difficult (e.g., understanding how to initiate and maintain a conversation)

Assessments that Address Comprehensive Language

Clinical Evaluation of Language Fundamentals, Fifth Edition (CELF - 5); 5:0 - 21:11;

• Assesses a student's semantics, morphology, syntax, and pragmatic skills.
• Provides information about the impact of oral language skills on written language using the Reading Comprehension and Structured Writing tests.

Clinical Evaluation of Language Fundamentals, Fifth Edition Metalinguistics CELF - 5 Metalinguistics); 9:0 – 21:11;

• Ideal for students with subtle language disorders
• Evaluates higher-level language skills for students who have difficulties in the classroom but do not qualify for services on tests of basic language skills

CELF5 Metalinguistics

• Metalinguistics Profile (MP) - Examples: Uses abstract words like kindness or paradigm
• Making Inferences (MI) - Examples: I was hoping to wash my car today. Guess I'll wash it tomorrow. I thought of two reasons why he didn't wash his car today: it's raining or he doesn't have time.
• Conversation Skills (CS) - Examples: I heard some people talking but only heard a few words...I heard the words Pam, late dinner. Look at the picture and tell me what the girl could have said.
• Multiple Meaning (MM) - Examples: A sentence can mean more than one thing. Your glasses are dirty. What two things can the sentence mean?
• Figurative Language (FL) - Examples: The girl said I have to change the tire, so would you give me a hand? What does that mean? Now find the sentence that means almost the same thing. (Correct answer: I sure wish you would pitch in.)

Assessments that Address Pragmatics

Children's Communication Checklist - 2, U.S. Edition (CCC - 2); 4:0 - 16:11;

• Evaluates a student's language abilities in speech, vocabulary, sentence structure, and social language.
• Provides profiles for students who may have a pragmatic impairment

Assessments that Address Behaviors Associated with ASD

Sensory Profile 2; Birth - 14:11;

• Evaluates a child's sensory processing patterns in the context of home, school, and community-based activities

Social Skill Improvement System (SSIS) Rating Scales; 3:0 - 18:0;

• Measures social skills: communication, cooperation, assertion, responsibility, empathy, engagement, and self-control Allows for a comprehensive picture of a student's abilities across the school, home, and community settings with the teacher, parent, and student forms.

Vineland Adaptive Behavior Scales, Third Edition (Vineland - 3); Birth – 90;

• Measures adaptive behavior of individuals in 5 domains: Communication, Daily Living Skills, Socialization, Motor Skills, and Maladaptive Behavior

Middle and High School Students and Adults with Autism

Young adults want to be as independent as possible. Regardless of language level, they want to be like their age-level peers.

They demonstrate behaviors that show they want to be more independent at home and participate in the same school activities as age-level peers. Even when their communication skills are limited.

Improving their ability to communicate enthusiasm, anger, need for help, etc. Is even more critical as they age for their own (and others') health, well-being, and safety.

Age-appropriate norm-referenced assessments that address vocabulary

(middle/high school and adults)

Peabody Picture Vocabulary Test, Fifth Edition (PPVT – 5); 2:6 - 90+;

• Evaluates receptive vocabulary without the need to read or write

Expressive Vocabulary Test, Third Edition (EVT – 3); 2:6 - 90+;

• Evaluates expressive vocabulary without the need to read or write

Age-appropriate, norm-referenced tests for general language skills for older students and adults

Vineland Adaptive Behavior Scales-3 (Vineland-3); Birth-90;

• Interview with parents/caregivers and teachers Measures Adaptive Behavior of individuals in 5 domains: Communication, Daily Living Skills, Socialization, Motor Skills, and Maladaptive Behavior

Children's Communication Checklist (CCC-2); 4-16;

• Caregiver report: ratings based on frequency observed Domain scaled scores General Communication Composite (GCC) Social Interaction Difference Index

CELF-5; 5-21;

• Tasks: Structured, semistructured, observational, and interactive Core Language, Receptive Language, Expressive Language, Language Content and Structure, Pragmatics, Reading, Writing

CELF-5 Metalinguistics; 9-21;

• Interview, structured tasks Metalinguistics index, Meta-Semantic and Meta-Pragmatic Index

Age-appropriate, norm-referenced assessments that address pragmatics/social communication

(older students/adults)

Children's Communication Checklist - 2, U.S. Edition (CCC - 2) 4:0 - 16:11;

• Evaluates a student's language abilities in speech, vocabulary, sentence structure, and social language.
• Provides profiles for students who may have pragmatic impairment for Initiation, Scripted Language, Context, Nonverbal Communication, Social Relations, and Interests

CELF-5 Pragmatics Profile; 5:0-21:11;

• 50-item test examining the presence of appropriate pragmatic language behaviors in the areas of
• Rituals and conversation
• Asking for, giving, responding to information
• Non-verbal communication

Norm-referenced assessment of adults who are nonverbal or have emerging language skills

CELF-5 Pragmatics Profile; 5-21;

• Rating scale to examine rituals & conversation, asking/giving/responding to information, and nonverbal communication

CELF-5 Pragmatics Activities Checklist; 5-21; 

• Checklist of atypical nonverbal communication and relevance/ manner/ quality/ quantity of communication

Vineland Adaptive Behavior Profile; Birth to 90;

• Sensory Profile for Adolescents and Adults 11+ Examine sensory processing patterns in an interview with client and/or caregiver 

For the list of Language Tests by Person go to:

https://www.pearsonassessments.com/professional-assessments/products/speech---language.html

Autism Assessments and Other Resources

The Gilliam Autism Rating Scale, Third Edition (GARS-3), 

• It is one of the most widely used instruments for the assessment of autism spectrum disorder in the world, assists teachers, parents, and clinicians in identifying autism in individuals and estimating its severity, and determining appropriate intervention, by https://www.proedinc.com/

The Gilliam Asperger’s Disorder Scale (GADS), 3 years to 22 years, 

• It is a 32-item parent/caregiver or teacher norm-referenced questionnaire designed to identify individuals with Asperger’s Disorder by https://www.proedinc.com/

Autism Diagnostic Observation Schedule -  Second Edition (ADOS-2) by Publish.com

ChildhoodAutism Rating Scale, Second Edition (CARS-2) by Publish.com

Social Skills Improvement Rating Scales (SSIS) by Pearson.com

Social Thinking (Michelle Garcia Winner) by SocialThinking.com

Ages and Stages, CSBS Brookes by Publishing.com

Autism/Social Communication titles by PluralPublishing.com

Examples of Screening Tools for Autism

Let’s explore a few of the available screening tools that might be used to decide whether a child should receive a further evaluation for autism. Some of the most common of these screening tools include:

Ages and Stages Questionnaire (ASQ)

• The ASQ screening tool addresses a variety of areas that might indicate that a child is behind his or her typically developing peers. Examples of developmental domains that are assessed or screened using the ASQ include communication skills or how a child expresses his or her thoughts, feelings, wants, and needs as well as how they respond to other people’s expressions, gross motor skills such as walking or running, fine motor skills such as picking things up with his fingers, problem-solving skills, as well as self-care and daily living skills.

Modified Checklist for Autism in Toddlers (M-CHAT)

• The M-CHAT is a screening tool that is typically used for children between 16 months and 30 months old, so children who are in the toddler years. This screening assessment is designed for assessing children who may be at risk for having autism spectrum disorder. Findmore details about using the M-CHAT autism checklist.

Screening Tool for Autism in Toddlers and Young Children (STAT)

• This screening assessment is somewhat different than many other screening tools because it involves more hands-on activities for the child to complete, while many other screening tools are primarily based on interviews with parents and have less focus on observing the child. 

Examples of ASD Assessment Tools

The most common assessments for autism spectrum disorder (ASD) include:

Autism Diagnostic Observation Schedule -  Second Edition (ADOS-2)

• The ADOS-2 is an assessment that evaluates social and communication skills and play skills in individuals who may have autism. One of the features of ADOS is that it can be used for a large age range, from toddlers to adults. It can also be used for individuals who do not have verbal communication or those who don’t speak vocally to individuals who do have more fluent vocal communication skills.

Autism Diagnosis Interview-Revised (ADI-R)

• The ADI-R is an assessment tool for autism spectrum disorder that can be used for individuals from toddlers at about age 18 months old through adults. This assessment focuses on the main core symptoms of ASD, including social interactions, communication skills, and restricted and repetitive behaviors.

ChildhoodAutism Rating Scale, Second Edition (CARS-2)

• The CARS-2 is another diagnostic tool that helps to identify the presence of an autism spectrum disorder diagnosis. This assessment is used for children two years and up. This assessment can provide information about the severity level of each symptom that is identified. The CARS-2 can identify ASD from mild to moderate to severe. It is also appropriate for children who have both low and high cognitive abilities.

https://superpowerspeech.com/2013/02/functional-communication-assessment.html

https://www.pearsonassessments.com/professional-assessments/products/speech---language.html