NEW ENGLAND CENTER FOR
HEARING REHABILITATION
Hampton, CT
Your Child's Not Just a Number:
Expanding past standardized scores
Katie Eddins, MS, CCC-SLP
Jessica Hasbrouck, MS, CCC-SLP
Where are we headed?
1. Introduction
2. Testing considerations
3. Test-by-Test Adaptation
Strategies
4. Case Studies (dispersed throughout)
5. Non-Standardized tools
6. Auditory Perceptual testing
7. Parent Advice
Things to Consider...
Obviously, Tangible scores are important to schools
BUT…
How can we interpret / analyze these tests relative to the child’s
hearing loss to gain more insight on how the child is functioning?
Introduction:
Why are we talking about this?
● Goals of testing may vary
● Conclusions based solely on standard scores
have limitations
● Scores “within normal limits” don’t offer a
complete picture
● Tests are normed on children with typical
hearing
○ Need to keep in mind unique analysis considerations
Things to consider...
● What is/are the purpose(s) of the
evaluation?
○ Supporting need for continued services?
○ Tracking progress?
○ Identifying areas of need?
● What assessment tools are needed?
○ Which tests will give you the most information?
○ What specific skills are you looking to highlight?
Things to Consider...
When choosing a test:
- Type of stimuli
-
- Setup of the test
verbal
written
pictures
-
choices
self-generated answers
Things to Consider...
Things to Consider...
When teasing out other issues:
- Attention
- Memory
- Articulation/Oral Motor
- Cognition
How?
Remember…
Keeping little ones engaged through testing
● Hide pictures of favorite characters in
testing booklet
● Put goldfish (or mini m&ms or raisins)
on the pictures for reinforcement
● Tell a character to do the work
“Minnie can you find ___?”
● It’s all about ACCESS
● 3x the exposure is needed for
students with hearing loss
● A large majority of language in
classrooms is figurative
● Limited incidental learning /
listening due to hearing loss
Equipment Check
Test - By - Test Guide
Before beginning testing, important to ensure equipment is functioning
properly
● Use listeners to listen to any / all hearing devices
● Check that FM is working properly if using it for any portion of the
testing
● Visually inspect devices and address any concerns
If anything is malfunctioning, best to supply loaner equipment or utilize
backup equipment for optimal access throughout testing
"Appropriate amplification is the most important habilitative tool available for
children with hearing loss." -Mark Ross
Each test listed on the follow slides is normed on
children with normal hearing, the peers with which the
child will be interacting
However,
The tests aren’t inherently sensitive to the unique
areas of difficulty for kids with hearing loss and may
end up assessing the child’s hearing rather than
language
Test - By - Test Guide
Speech Perception / Production
● Not an exhaustive list
● Many of the recommendations can be
attributed to other, similar tests
● Grouped by targeted skill, not by age
● Highlights the top unique considerations for
analysis as they relate to students with
hearing loss
Goldman Fristoe Test of Articulation
(GFTA)
Typical Assessment Areas
Unique Analysis Specific to HL
● Do they misarticulate the
sounds in all word positions?
○ Medial?
○ Initial?
○ Final?
● Single word vs. Connected
Speech
● “Age appropriate” articulation
errors?
● Production vs. Perception
○ Can they hear errors?
○ Consistent errors or only
specific words?
● Errors related to type of
Hearing Loss
● Strategies used for production
facilitation
Speech Perception
● AB isophonemic Word List:
○ 10 CVC (consonant-vowel-consonant) syllables
○ Presented through listening alone in various conditions with
expectation of the student to repeat it back
■ Each device (right / left) separately and then together
■ In close / quiet
■ In far / noise
○ Responses are scored according to the number of phonemes
accurately repeated back,
■ 10 vowels, 10 initial consonants, and 10 final consonants
● Type, severity, &
configuration of hearing
loss
● Aided access
● Strategies used to
facilitate improvement
Modifications to Administration
In order to gain information on Speech
production as it relates to perception:
● Present entire list of target words one at a
time through listen alone
● Go back through, asking student to
spontaneously label the pictures
● Compare performance
Speech Perception
Scoring would look something like:
Both Ears
Normal Level
Both Ears
Soft Level
Total Phonemes
92%
84%
Total Consonants
88%
80%
Initial Consonants
80%
76%
Final Consonants
96%
84%
Vowels
100%
92%
Total Words Correct
76%
64%
Take-Home Points
Speech Perception / Production
● Devices do not restore hearing to the normal range; highly
dependent on the quality of the device programs as well as the
listening environment.
● Students produce words as they’ve heard them, therefore,
accurate perception of unfamiliar vocabulary should be closely
monitored.
● Students with hearing loss will have difficulty perceiving a
consistently accurate speech signal due to distance and
background noise. As a result, students need access to a personal
FM system.
Peabody Picture Vocabulary Test
(PPVT)
Typical Assessment Areas
● On age level?
● Types of words answered
inaccurately
○ Action Verbs
○ Categories
● Antonyms
○ Word Retrieval
○ Expressive Vocabulary
● Synonyms
○ Receptive Vocabulary
○ Identifying 2 words with
the same meaning
● More to semantic
development than just a large vocabulary
● Attempt to capture what the child DOES with
that vocabulary
● Not only verbal vocabulary but also written
● Consider different tools to ‘dig deeper’
○ Multiple meaning words, synonyms, etc.
Expressive Vocabulary Test - 2
(EVT-2)
Unique Analysis Specific to HL
Typical Assessment Areas
● Accurate perception of word?
● Listen vs. Look and Listen
● Are they using a strategy?
○ Process of Elimination
○ Prefix/Suffix
○ Acoustically Similar
● Standard score within normal
limits?
Comprehensive Assessment of Spoken
Language (CASL) : Synonyms / Antonyms
Typical Assessment Areas
Semantics
Unique Analysis Specific to HL
● Format of the test
○ Ant. = self-generated
response
○ Syn. = choice of 4
● Repeat back targets to ensure
proper perception
● Use of prefixes/suffixes
● Types of items with which the
client struggled
○ Action words?
○ Prompts for synonyms or
“another word for…”
Unique Analysis Specific to HL
● Have they mis-heard and mislearned words?
● Difficulty with language of
directions?
○ “another word for…”
● Wrong verb tense?
● Difficulty with a specific class
of words (i.e. category words)
Test of Semantic Skills - Intermediate :
(TOSS - I)
Typical Assessment Areas
● Semantic Skills
○ Identifying/Stating
■ Labels
■ Categories
■ Attributes
■ Functions
■ Definitions
Unique Analysis Specific to HL
● Scores based on skills or
exposure?
● If easier vocabulary is
substituted can they answer
correctly? Or unfamiliar topic?
● Can they demonstrate similar
skills without the picture?
Test of Adolescent Language - 3 (TOAL-3) :
Speaking Vocabulary
Test of Adolescent Language - 3 (TOAL-3) :
Reading Vocabulary
Typical Assessment Areas
Unique Analysis Specific to HL
Typical Assessment Areas
● Accurate meaning
● Sentence provides enough
context
● Modality
● Accurate perception of target
word
● Ability to use exact form of the
stimulus word
● Confusion with acoustically
similar word?
● Ability to understand meaning
of printed words
● Ability to make semantic
associations
● Modality
Test of Adolescent Language - 3 (TOAL-3) :
Listening Vocabulary
Unique Analysis Specific to HL
● Can they get the answers if
the choices are read?
○ To themselves outloud?
○ By someone else
● Confusion with similar
sounding word
● Vocabulary issue or
association issue?
Test of Adolescent Language - 3 (TOAL-3) :
Written Vocabulary
Typical Assessment Areas
Unique Analysis Specific to HL
Typical Assessment Areas
Unique Analysis Specific to HL
● Ability to understand meaning
of spoken words
● Ability to understand two
meanings for a given word
● Modality
● Accurate perception of target
word
● Picture choices
● Where is the break down?
○ Once they hit a certain
level
○ Holes
● Accurate meaning
● Written sentence provides
enough context
● Misspelling and problems with
punctuation not counted as
errors
● Modality
● Use as a writing sample for
spelling and punctuation.
● Confusion with acoustically
similar word
● Ability to use exact form of the
stimulus word
● Comparison of sentence
length
Test of Adolescent and Adult Language - 4
(TOAL-4) : Word Opposites
Typical Assessment Areas
● Knowledge of antonyms
Unique Analysis Specific to HL
● Accurate perception of target
word
● Use of prefixes and suffixes
Test of Adolescent and Adult Language - 4
(TOAL-4) : Spoken Analogies
Typical Assessment Areas
Unique Analysis Specific to HL
● Ability to complete analogy
○ Inferencing
○ Similarities/Differences
● Accurate perception of partial
analogy
● Analogy deficit or vocabulary
deficit?
● Maintaining tense/plurality?
Test of Adolescent and Adult Language - 4
(TOAL-4) : Word Similarities
Typical Assessment Areas
Unique Analysis Specific to HL
● Knowledge of synonyms
● Read/Write vs. Listen/Speak
● Spelling doesn’t count
● Analyze writing
○ multisyllabic words
Syntax / Morphology
● Making sure the students are both hearing and
using the grammatical markers
● How are the students using your prompt /
stimulus as a guide for their answer?
● Are they including softer, unstressed words for
complete sentences?
● Inconsistent or absent markers completely
change an intended message
Comprehensive Assessment of Spoken
Language (CASL) : Sentence Completion
Typical Assessment Areas
● Word retrieval skills
● provide words that
appropriately complete
sentences read by the
examiner
Unique Analysis Specific to HL
● Syntax vs. Semantic Mistakes
● Incorrect because of missing
word endings?
○ Effect of HL vs.
Grammatical Issue
● Is there a memory
component?
Take-Home Points
Semantics
● Access to speech does not equal understanding of speech, therefore,
comprehension of unfamiliar vocabulary and instructional language in
school needs to be closely monitored.
● Students with hearing loss do not hear words with the same frequency or
with the same accuracy as normally hearing peers and are at an
increased risk for developing a gap between their skills and chronological
age.
● Missed opportunities to learn words ‘incidentally’ through overhearing
impact mastery of higher level vocabulary skills such as multiple meaning
words, synonyms, and antonyms.
The Structured Expressive Language
Test - 3 (SPELT 3)
Typical Assessment Areas
Unique Analysis Specific to HL
● Elicit specific morphological
and syntactic structures
● Discrepancy between
spontaneous vs. elicited use?
● Analyze specific language
structures that may not occur
in spontaneous language
samples
● Can they hear the
grammatical morphemes?
○ non-standardized
assessment
Comprehensive Assessment of Spoken
Language (CASL) : Syntax Construction
Typical Assessment Areas
Unique Analysis Specific to HL
● Oral expression of words,
phrases, and sentences
within rules in formulating and
expressing sentences
● Ability to imitate and formulate
phrases and sentences
increasing in complexity
● Using model or picture to
formulate own sentence?
● Can they hear the auxiliaries /
unstressed words used in
your stimulus sentence?
● Are they picking up on the
subtle grammatical hints used
in the stimulus sentence?
Test of Language Competence (TLC) :
Oral Expression - Recreating Speech Acts
Typical Assessment Areas
Unique Analysis Specific to HL
● Ability to plan and formulate
expressions of intent (speech
acts) and propositions in
grammatically complete
sentences
● Incorporation of keywords
related to a situation or
context.
● Able to perform within specific
confines of situation?
● Able to think flexibly to create
a unique sentence by
changing word order to fit?
● Formulating sentence using
Theory of Mind or describing
picture?
Test of Adolescent and Adult Language - 4
(TOAL-4) : Sentence Combining
Typical Assessment Areas
● Ability to use proper syntax
○ Sequencing
○ Embedding Clauses
○ Conjunction Usage
Unique Analysis Specific to HL
● Most effective combination?
○ Awkward wording?
○ Better clause/conjunction
choice?
● Unfamiliar with the situation
being described
● Combining in the exact order
written?
Thinking with Language
● Capture a student’s ability to use language to flexibly
to think through problems and verbalize solutions
● Students that have hearing loss tend to be very
concrete thinkers
● Much of what is said in the classroom is figurative
and requires inferencing
● Identify areas of “break down” to write goals
● Assesses grammatical forms not often assessed in
other tests
Test of Adolescent and Adult Language - 4
(TOAL-4) : Word Derivations
Typical Assessment Areas
● Derivational morphology skills
Unique Analysis Specific to HL
● Accurate perception of root
word and sentence
● Use of prefixes/suffixes
● Knowledge of meaning of root
words
Take-Home Points
Syntax / Morphology
● Grammatical elements of the English language can
often be missed in running speech by a child with a
hearing loss since they are unstressed, soft, and
composed of high frequencies.
● Students with hearing loss tend to need focused
exposure and repeated practice to expand
grammatical knowledge and use various forms
appropriately.
Test of Problem Solving 3 Elementary:
(TOPS- 3)
Typical Assessment Areas
● Reasoning skills
○ Inferences
○ Sequencing
○ Negative Questions
○ Problem Solving
○ Predicting
○ Determining Causes
Unique Analysis Specific to HL
● Analyzing Complex Questions
○ What might...
○ What could...
● Grammatical accuracy of
answers
● Can they do this task without
the picture prompt?
Simulated Classroom Learning
● Students in schools are bombarded with
auditory messages all day
○ Requiring various levels of inference
● Need to identify where, if anywhere, a
breakdown is occurring to facilitate success
● Important to identify strategies that support
comprehension of these messages
Test of Language Competence (TLC) :
Making Inferences
The Listening Comprehension Test - 2
and Adolescent
Typical Assessment Areas
Unique Analysis Specific to HL
● Hearing well enough to keep up
with peers in the classroom.
● Strengths and weaknesses in:
○ integrated language
problem solving
○ reasoning
○ comprehension of material
presented auditorily.
● Are they able to auditorily
keep track of all the
information?
● Are they checking out?
● Are they getting tripped up on
unfamiliar vocabulary?
● Was length or unfamiliar
vocabulary a bigger
roadblock?
Test of Narrative Language (TNL)
Typical Assessment Areas
Unique Analysis Specific to HL
Typical Assessment Areas
Unique Analysis Specific to HL
● Ability to make permissible
inferences on the basis of
existing causal relationships
or chains in short paragraphs
● How well a student is able to
think flexibly about the
reasons for an ambiguous
situation
● Does the student have
familiar with the situations?
● Are they able to think flexibly
to provide more than one
option?
● Are they most successful with
picture support?
● Use of knowledge of
language to engage in
functional discourse
● Ability to answer literal and
inferential comprehension
questions
● Use of language in narrative
discourse
● Auditory fatigue?
● Difficulty with specific types of
questions?
○ ex. Character names?
Dialogue? Multiple
Meaning words?
● Relying on pictures or
listening to the examiner?
Non-Literal / Idiomatic Language
● Typically an area of need for students with
hearing loss, not incidentally learning
● Idiomatic language plays a significant role in
social interactions
● Not just about classic idioms (ex. raining cats
and dogs), but also colloquial expressions (i.e.
ducks in a row, criss cross applesauce)
Test of Language Competence (TLC) :
Figurative Language
Typical Assessment Areas
● Interpretation of a metaphoric
& figurative expression and
selection of an expression
with matching meaning
● Ability to match the
expressions with pictures
depicting their meanings.
Unique Analysis Specific to HL
● Are they hearing the phrase
correctly or are they
substituting in a semantically
or acoustically similar word?
● Is there a pattern to how they
are interpreting the phrases?
Test of Language Competence (TLC) Ambiguous Sentences
Typical Assessment Areas
● Evaluates the ability to
recognize and interpret the
alternative meanings of
selected lexical and structural
ambiguities.
Unique Analysis Specific to HL
● Was the student able to choose
more than one meaning for any
of the items?
● Was the student able to be
more successful selecting
pictures associated with
sentences?
But...
District - Wide Testing
How does this play into school-based
standardized testing?
● Explore types of subtests
○ All written?
○ Any listening portions?
● Consider necessary modifications
○ Extended time?
○ Live reader?
Consider...
Non-Standardized Measures!
What if you can’t
find a standardized
test to assess the
skill you are after?
●
●
●
●
Classroom Language Comprehension
Grammatical Morpheme Perception
Unfamiliar Words / Sentences
Language Sample Analysis
Classroom Language
Grammatical Morphemes
Set up situations throughout the evaluation to
assess comprehension of information obtained
during classroom consults
● Language of directions
Used to assess whether a child has auditory
access to the subtle changes in nouns and
verbs created by grammatical morphemes
● Listen alone vs. Look & Listen
○ Before you ___, _____
○ If you ___, _____
● Academic Vocabulary
○ What shape vs color vs number?
○ In isolation: PLAY / PLAYS / PLAYED / PLAYING
○ In a sentence: The girl PLAYS / PLAYED nicely.
Doing in all conditions allows for thorough analysis
Unfamiliar Words in Sentences
● Capture a student’s ability to perceive the
complex phonetic and syllabic components
of unfamiliar vocabulary
● Sentences are presented:
Unfamiliar Words in Sentences
Ex. The wind DESECRATED the grapes on the vine
Scores provide information on:
1. Total number of words repeated back
2. Number / percentage of UNFAMILIAR words repeated back
3. Percentage of phonemes of unfamiliar words imitated
○ Listen alone // Look & Listen // In noise
● Ask the student to define the word
● Repeat the unfamiliar word in isolation
○ Note strategies needed for successful imitation
Language Sample Analysis
● Many ways, varying in depth of analysis
● Depending on age, want to comment on:
○ HOW they are using language
■ ex. Commenting on pictures? Making
connections? Asking for information or
clarification?
○ WHEN they are using their language
■ ex. Only when prompted? Spontaneously?
Contemplate...
An Auditory Perceptual Evaluation!
● Loudspeaker Listening
● TV and Captioning
● Listening to Peers in the Classroom
● Note taking
Completed in conjunction with an Audiologist
Words Correct
92%
Unfamiliar Words Correct
50%
Phonemes Correct in
Unfamiliar Word
92%
What Else?
We know the child’s
hearing loss based
on their audiogram,
but how does it
affect their
functioning in the
classroom?
Functional Assessments
● Provide information regarding learning impediments in
difficult listening environments
● Result in concrete recommendations for teachers, parents,
and most of all students
■ Assistive technologies
■ Modifications
■ Supports
● Help students identify their own weak areas and strengths
● Logically lead to accommodations that are useful and
acceptable.
Is it that difficult?
Listening Through a Speaker System
● Who needs the evidence?
○ School Professionals
■ Teacher’s
■ Therapists
■ Special Education Providers
■ TOD/TOHI
■ Paraprofessional
○ Parents/Guardians
○ And MOST importantly, STUDENTS
Listening Through a Speaker System
Listening Through a Speaker System
Paragraph Example:
Appropriate for school aged children
● “Good morning Ridgeway students. I need
your attention for a few minutes to discuss a
very serious issue. It appears there is a thief
here at school. We know that $50.00 is
missing from the athletic department fund…..”
Simulated Announcements
● Sentences
• “Ms. Sidney’s class will have pictures taken at 9 AM.”
● Paragraph
• What was the problem at school?
• What was the name of the school?
• Informational paragraph
• Questions to answer
Listening Through a Speaker System
Listening Through a Speaker System
What can this tell the team?
Speaker System Scores:
Sentences, words correct:
32%
Paragraph, correct answers: 0%
● How much information it is possible to hear through
speaker systems
● They need to ask what is said on announcements
Recommendations
● Written announcements
● Review of announcements in classroom
● Student advocating for the information
Captioning
Captioning
● Late elementary school, middle, and high school
● Student seated in front of Computer
● Two segments of YouTube
○
○
1 – Caption
2 – No Caption
● Questions to answer following each segment
NO Captioning
Captioning
“The Kangaroo is a Marsupial”
Captioning Scores
Captioning
● What does the score tell the team?
○ Missing?
●
YouTube without captioning
●
YouTube with captioning
0%
60%
Listening to Peers in the Classroom
■ Details?
■ Bigger picture?
● Recommendations
○ Captioning
○ Written notes
○ Pre/post teaching
Listening to Peers in the Classroom
Two Versions:
● When focus is on the PEER
○ Effect of visual and auditory access
● When the focus is on TEACHER and the PEER
comments
○ Incidental listening to peer questions and comments
Listening to Peers in the Classroom
4 Conditions:
NO Visual Cues
& NO FM
Microphone
Visual Cues &
NO FM
Microphone
Listening to Peers in the Classroom
● Example of Scores:
○ Visual + FM
○ Visual, NO FM
○ NO Visual +FM
○ NO Visual, NO FM
=
=
=
=
90%
60%
85%
40%
● Suggests relying on FM & a good auditory signal!
Visual Cues
& FM
Microphone
NO Visual
Cues & FM
Microphone
Listening to Peers in the Classroom
Listening to Peers in the Classroom
● Another Example:
● Appropriate for late elementary, middle, and
high school age children
○
○
○
○
Visual + FM
Visual, NO FM
=
NO Visual +FM
NO Visual, NO FM
= 90%
85%
= 60%
= 50%
● Simulate a classroom
environment
● Suggests relying on visual cues!
Listening to Peers in the Classroom
Listening to Peers in the Classroom
● Student listens to a class lecture where both a teacher
and a classmate are talking.
●
The score reflects number of questions
correctly answered for:
● No visual access to the classmate
(as is common in a typical classroom)
●
Teacher:
● Student is asked questions regarding the information
provided by the teacher and the classmate.
●
Classmate:
● Student has visual and FM access to the teacher
100 %
75 %
Listening to Peers in the Classroom
Notetaking
● What does this tell the student?
○ Dependence on hearing the information
○ Dependence on seeing the information
○ Difficulty/Success hearing other students in the classroom
● Recommendations
○ Team teaching FM system
○ Preferential Seating & Classroom Setups
■ U-Shaped Classrooms
○ Visual & Auditory modifications for the classroom
○ Note taker/Scripter
Notetaking
● High School/Middle School
Students
● Paragraphs
○ No visual cues
○ Access to FM
○ Grade level appropriate
paragraphs
Notetaking
Notetaking
●
Four Different Scenarios
○
○
○
○
Listen to lecture only
Listen to lecture while taking notes
Listen to lecture with outlined notes
Listen to lecture following preview of notes
Notetaking
● Scoring
○ Number of questions correctly answered
● Other Analyses
○ Informal assessment of notes taken by the student
■ Are they on topic?
■ Do they provide detailed information?
● Condition 1: Listening Only:
20%
● Condition 2: Listening Taking Notes: 0%
● Condition 3: Listening Having Notes: 40%
Notetaking
Notetaking
● What does this tell the students?
○ Their ability to take notes & listen
○ Their need to be familiar with the material
● Recommendations
●
●
●
●
Condition 1: Own Notes: 40%
Condition 2: Provided Notes: 60%
Condition 3: Preview of Notes:
80%
Condition 4: Captioned Notes: 100%
Parent Advice
○
○
○
○
○
Preview of materials for class lectures
Written notes of class lectures
Review of class lecture with teacher (s)
Paraprofessional in the classroom
CART – Communication Access Realtime Translation
Thank You!
CONTACT US
Advice from those that have been there
Katie Eddins
[email protected]
Jessica Hasbrouck
[email protected]