The 3 A’s:
Assessment, Accommodations, and
Adaptations
Meher Banajee, Ph.D., CCC-SLP
Sylvia Davis, Ph.D., CCC-SLP
Overview
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Introductions and overview
Definitions
Preparation for assessment
Adaptations and accommodation procedures
and demonstrations
• Practical applications
• Conclusions
Assessment
• Definition
– It is any activity, either formal (through
the use of norm-referenced standardized
criteria) or informal (through the use of
developmental profiles or checklists) that
is designed to elicit accurate and reliable
samples of the student’s behavior upon
which inferences relative to particular
skill status may be made.
Best practices in assessment
• Best practices in assessment
1. Multi-source
2. Multi-discipline
3. Multi-method
4. Multi-cultural
5. Multi-domain
6. Multi-context
7. Multi-occasion
SETT Framework by
Joy Zabala
• The Student
• The Environment
• The Tasks
• The Tools
Preparation for assessment
• Gather information from a variety of
sources
• Determine current communication
techniques
• Seating and positioning status
• Determine factors that might interfere
with the assessment process
Preparation for assessment
• Variety of sources are used to gather information
– Parental data
• Parental reports are usually accurate
• Use interview methods
• Listen to information provided by parents
• LATI
• Case history children (Goossens’, Crain & Elder,
1990)
• Case history adult (Goossens’, Crain &
Elder,1990)
– Medical records report
• Become familiar with range of medical concerns
• Lens through which behaviors can be interpreted
Preparation for assessment
– Other intervention reports
• Reports of other team members
– Test results
• A system that uses a variety of means to
assemble and analyze the samples of
behavior
• A means of structuring observations and
reporting results
• Significant limitations in all available tests
• Assessor should be an effective
elicitor, observer and interpreter of
samples of behavior
Current communication
techniques
Current communication techniques
Current communication techniques
• Every move counts (Jane
Korsten, http://www.everymovecounts.net/)
– Sensory-based communication program.
– Based on the idea that everyone communicates
– Developed for individuals perceived as unable to
communicate due to severe multiple disabilities
– Functioning below the 18-month level in the area of
communication
– The assessment targets six sensory areas:
visual, auditory, gustatory, olfactory, vestibular and
tactile.
Current communication techniques
• Every move counts (Jane Korsten,
http://www.everymovecounts.net/)
– Sensory-based communication program.
– Based on the idea that everyone communicates
– Developed for individuals perceived as unable to
communicate due to severe multiple disabilities
– Functioning below the 18-month level in the area of
communication
– The assessment targets six sensory areas: visual,
auditory, gustatory, olfactory, vestibular and tactile.
Current communication techniques
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During a 10- to 12-minute session
Gain information on how each individual communicates
Motivating activities
Abilities versus disabilities, no right/wrong answers.
The transdisciplinary team determines response mode
Responses range from a slight body movement (eye
gaze, affect or body position)
– Assessment materials are common items (easy and
economical to assemble)
Positioning
• Motor development
– Proximal
– Distal
– Cephalo
– Caudal
Positioning
• Movement
– Mobility
– Stability
– Gross motor (e.g. walking) stability
superimposed on mobility
– Fine motor (e.g., writing) mobility
superimposed on stability)
Positioning
• Tone
– Hypertonic
– Hypotonic
– Fluctuating tone (Athetoid)
Positioning
– Abnormal reflexes
• Asymetrical tonic neck
reflex (ATNR)
– Extensor tone on the
face side
– Flexor tone on the skull
side
• Symetrical tonic neck reflex
(STNR)
– Extensor
– Flexor
• Positive supportive reaction
• Tonic Labyrinthine reflex
– Prone
– Supine
Positioning
• General principles of seating
– Pelvic stability
– Lower extremity support
– Trunk stability
– Head support
– Upper extremity support
– Manipulation of orientation in space
Positioning
• Pelvic stability
– Sling back or sling seat
– Buttocks positioned back and secured in
seat
– Extensor thrust – rigid pelvic restraints
– Proximal pelvic positioners
(e.g., roll, sacral pad or bi-angular back)
Positioning
Positioning
Positioning
• Lower extremity support
– Distal pelvic positioners (e.g., roll or wedge in
front of the seat).
– Abductor pommel
– Widened abductor pommel
– Adductor pads
– Customized seating
Positioning
• Lower extremity
– Feet should be supported with a
foot plate
– Angle of the foot plate should be
adjusted to prevent extension
– Shortened foot plates
– Straps on the feet
Positioning
Positioning
Positioning
• Trunk support
– Thoracic pads (removable or swung
away)
– Lateral pads built into the seat
– Harness (v-harness v/s a butterfly
harness)
– Shoulder straps (do not come from the
top but from shoulder height)
Positioning
Positioning
• Head support
– Access a switch and to visually monitor
a target
– Extended back and side pads not
appropriate
– Curved headrest, neck ring or an Otto
Bock headrest
– Not too far back or too far in front
Positioning
Positioning
• Upper extremity support
– Lap tray
• Too high (bunching of shoulders)
• Too low (cannot weight bear)
• Angled or easel tray
– Bumpers
• Behind elbow and along forearm
• Inhibit extension of arms to the side and
shoulder retraction
• Forward arm position
Positioning
Other factors
• Sensory integration
– Organizing information received through the
senses
– The developing child attaches meaning to
sensations, shifts attention, organizes play
behavior, builds skills, gains control and
regulation of emotions
– Occurs in sub-cortical levels of the brain
– Involves complex interactions with parts of
brain responsible for attention/arousal,
emotions, memory, autonomic functioning and
coordination
Other factors
• Sensory integration
– Vestibular: Gravity and Movement
– Proprioceptive: Body Position and
Movement through Space
– Tactile: Touch throughout the Body
Other factors
• Tactile sensation
– Primary source of comfort and security
– Learning to tolerate early touch is one
aspect of early self-regulation
– Touch sensations help an infant to
suck, chew and swallow
– Tactile discrimination and perception
play critical roles developing hand
skills
Other factors
• Postural control and balance
reactions
– Gravitational Security
– Assists in orienting oneself in space
and in initiating exploratory and
adaptive movements
– A well-regulated vestibular system
helps to integrate both sides of our
bodies
– Regulating: Arousal and Alertness
Other factors
• Proprioceptive system
– Develops through weight bearing and
movement against gravity
– Enables a child to know where he is in
space and how he is moving
– Contributes to development of body
awareness and body scheme
– Calming and organizing input:
normalize arousal levels / aids in self
regulation
Other factors
• Sensory integration
– Sensory Modulation / Self-Regulation
– Sensory Discrimination
– Praxis / Skill Output
Other factors
• Sensory modulation
– Registration of sensory input: orient/alert to
novel events
– Response to sensory input: direct proportion
– Well-modulated system results in appropriate:
– Arousal
– Self-regulation
– Attention
– Focus
– Behavioral and emotional responses
Other factors
• Sensory discrimination
– A well-developed discriminatory
system allows for:
• Skilled hand use
• Oral motor control
• Coordinated body movements
• Complex actions
Sensory Integrative Dysfunction
Dysfunction of Sensory Integration (DSI)
• Sensory processing
• Sensory modulation
• Sensory discrimination
• Motor planning
Sensory Integrative Dysfunction
Dysfunction of Sensory Integration (DSI)
• Problems with Intake/Registration:
Over-orient/ habituate
• Abnormal Responses to Sensory
Input
– Over-responsive: Sensory
Avoidant/Sensory Defensive
– Under-responsive: Sensory
Seeking/Passive
• Influences Self Regulation/Arousal
/Attention
Sensory Integrative Dysfunction
Dysfunction of Sensory Integration (DSI)
• Sensory discrimination problems
– Fine motor problems
– Breaks toys / difficulty judging force
– Difficulty judging source of
sounds, localization of sounds
– Difficulty judging depth, distance, and
space between self and objects
– Clumsy
Sensory Integrative Dysfunction
Dysfunction of Sensory Integration (DSI)
• Sensory diet
– Well-balanced variety of sensation that
match a child’s individual needs
– Combinations of input for regulating state
and enhancing skill
– Sensory input is embedded in the child’s
daily routines or in meaningful activity
– Active engagement of the child, not
“sensory stimulation”
– Monitor response to input through the
child’s behavior, interaction and play
Sensory Integrative Dysfunction
Dysfunction of Sensory Integration (DSI)
• Sensory input
– Calming and Organizing
– Body-based sensory input most regulating:
• Rhythmical and slow swinging,
• Bouncing
• Firm hug / deep touch pressure
• Resistive activities / heavy work
– Soft or muted colors
– White noise or music with rhythmic and
slower tempos
– Sucking or blowing / chewy snacks
Sensory Integrative Dysfunction
Dysfunction of Sensory Integration (DSI)
• Sensory input
• Arousing and Organizing
• Repetitive and fast movements
• Light touch
• Bright lights and colors
• Vary frequency, intensity or beat of
sound
• Vary temperature and texture of food:
crunchy snacks /sour tastes / cold
Sensory Integrative Dysfunction
Dysfunction of Sensory Integration (DSI)
• Accommodations during testing
– Over responsive child
• Weighted blanket, weighted vest
• Chewy snacks
• Slow rhythmic music
• Bottoms up cushion
• Fidget toy
• Schedule testing after a strenuous activity
• Picture schedule for testing
• Give breaks
• Alternate hard and easy tasks
Sensory Integrative Dysfunction
Dysfunction of Sensory Integration (DSI)
– Under responsive child
• Teeter-totter stool
• Crunchy or sour snacks
• Cold drinks
• Fidget toy
• Stimulating music
• Alternate hard and easy tasks
• Give breaks
• Picture schedule for testing
Adaptations
• Adaptations are:
– Changes that make learning- or work-more
manageable for someone, regardless of
diagnosis
Examples of adaptations
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Changes in the pace of learning
Changes in how material is presented
Environmental changes
Changes in the amount of material
presented at one time
Accommodations
• Accommodations are:
– Legally required adaptations that ensure persons
with disabilities have an equal chance for
success
Accommodations
• Accommodations are
– Required by law
– Help individuals with disabilities have a fair
chance for success
– Give an equal chance to work in, learn in, and/or
enter a building
Accommodations
• Accommodations are
– Chosen for the individual person’s need
– Are needed when you do similar tasks in other
places
Accommodations
• Examples include
– Using special equipment
– Performing work in a different way
– Performing work in a different place
– Changing how others think about disabilities
Accommodations
• Examples cont’d.
– Note takers
– Additional time to complete tasks
– Repeated instructions or directions
– Large print text or Braille text readers
– Environments free from interruptions and
distractions for learning and completing tests
– Sign language interpreters
Accommodations
• Assistive Technologies
– Work processor
– Word prediction
– Speech recognition software
– Screen magnification
– Text to speech
Adaptations vs. Accommodations
• No special approval needed
– Use of large print
– Use of a paper or non-paper guide (non-ruled)
to facilitate reading
– Use of different color overlays to facilitate
reading
– Use of large diameter pen
Adaptations vs. Accommodations
• No special approval needed
– Seating near natural light
– Completing individual test sections on different
days
– Use of graph paper for math
Adaptations vs. Accommodations
• No special approval needed
– Use of ear plugs
– Use of a seat cushion
Adaptations vs. Accommodations
• Prior approval required
– Audiocassette
– Private room
– Braille
– Extended time
Adaptations vs. Accommodations
• Prior approval required
– Off-site testing
– Supervised frequent breaks
– Scribe
– Use of special equipment
Adaptations vs. Accommodations
• Instructions should be adapted for students
as needed
• Professionals should help students become
familiar with available accommodations
Formal tests of communication
– Nonspeech Test (Huer, M, 1990)
• Infancy to 48 months
• Tests receptive and expressive
skills for nonspeaking children
– Interactive Checklist for AAC
• Initiation
• Facilitation
• Regulation
• Termination
Formal tests of communication
• Norm referenced tests look at the
individual’s performance and
compare it to that of a group
• View an individual’s performance
with reference to group
performance on similar levels
• Direct elicitation of desired
behavior
• Developmental
ages, quotients, age level
scores, mental age or IQ scores
Formal tests of communication
• Limitations include
administration of the test in a
limited narrowly defined fashion
• Individual’s response must fit into
this narrow fashion
• Violation of either of these
principles places the
normalization and standardization
in jeopardy (e.g., tracking of
object vs. tracking a person across
the room)
Formal tests of communication
• Lack of predictive ability until 3 years of
age
• Therefore the predictability of normreferenced tests is questionable at the
best
• Scoring difficulties related to item
validity or do the scores actually measure
what they actually are suppose to
measure
• In determining an overall score, the items
are not weighted and therefore unable to
determine an accurate overall score
• Norm-referenced tests are of little value
in determining the intervention strategies
Formal tests of communication
• Criterion referenced tests
– Look at mastery of a particular item in a
domain
– Clinician can elicit desired behaviors in a
manner best fits a child (spontaneous
naming of an object vs. naming of an object
on demand)
– Determine strengths and weaknesses
– Seamless transition between test results to
intervention
– More sensitive to change
– Not a diagnostician but an inference maker
– Can be adapted for use with physically
challenged children
Phonological Awareness Test
• 7 subtests
– Rhyme
• Identification
• Response
– Letters to sounds
– Sounds to letters
– Isolation
• Initial
• Medial
• Final
– Segmentation
– Substitution
Boston Diagnostic Aphasia
Examination
• Subdivided into five functional
sections.
• Conversational and Expository
Speech
• Auditory Comprehension
• Oral expression (including the Boston
Naming Test)
• Reading
• Writing
Test adaptations
• Research
– Bristow and Fristoe (1987)
• Compared scores using the standard
protocol and 6 alternative response
modes
• Peabody Picture Vocabulary Test
• Preschool Language Test
• Eye gaze, scanning, headlight
pointing, pointing, head pointing
• Scores correlated highly
Test adaptations
• General guidelines
– Use criterion referenced rather than
norm based standardized measures
– Standardization violated
– Document the adaptations you have
used in a narrative and descriptive
manner
– Attempt to get to the skill the test item
represents (e.g., “uses a stick to attain an
out of reach object”. Underlying skill
being measured is tool use.)
Test adaptations
• Examples of modifications
– Providing choices of answers
• Test item – “assemble 3-piece body puzzle
correctly”
– Provide 1 correct puzzle and 1 incorrect
– One correct answer and 2 foils
– Asking “yes/no” questions
• Test item – “match colored cubes (field of
5)”
– Provide 5 colored containers and colored cubes
– Hold each cube over each container, asking the
child if the cube belongs in that container
Test adaptations
– Eye gaze
• Test item – “identifies three objects by their use”
– Place 3 objects in front of the child and
score based on which item they look at in
response to each question
• Test item match sound to letter
– Place correct letter with 2 foils on a choice
board
– Eye gaze or point with finger
• Test item- identify initial, medial and final
position of sound in a word
– Use train with engine, carriage and caboose
– Use eye gaze or pointing
Test adaptations
– Test items or other picture based items
– Cut apart pictures and place on
• Choice board
• Communication vest
• Eye-gaze frame
Test adaptations
• Use a low technology
communication device such as a
rotary scanner
• Use numbers or letters as choices
on a high technology
communication device such as a
Springboard, etc.
Informal tests
•
Dynavox V series
– Teddy bear
– Language activities
• Color recognition
• Letter recognition
• Number recognition
• Same and different
• Association
• Categorization
• Object identification
• Reading comprehension
• Word recognition
• Sentence construction
Informal tests
• Prentke Romich - Unity
–Catch the rabbit
–Picture identification
–Categorization
• Tobii/ATI
–Catch the rabbit
–Games for calibration
Informal tests
• Universal Language Monitor
(ULAM)
– AAC institute
• Performance report tool (PeRT)
http://www.aacinstitute.org/Resource
s/ProductsandServices/PeRT/03082
0_co_i_exam.html
Summary
• The goal of assessment
– Gather a sufficient amount of
information for the AAC team
– To make intervention decisions that
meet the individual’s current and
future communication needs
– Sometimes leads to over assess
capabilities
– Takes too much time, places too
much responsibility on the assessor