DESP-8, ch. 1

Diagnosis & Eval in Speech Pathology, 8th ed. (DESP-8)  by Haynes & Pindzola

Diagnosis is an ongoing process to get answers, at least partial answers...

Msmt is based on,
1. RTI - short-term (ST) response
2. EBP - Measures effectiveness of intervention; chooses psychometric instruments - tx - ongoing data collection to aid clinician
3. Dynamic assessment (DA): "therapy-like interaxns to determine prognosis, tx direction, and diagnostic category.

RTI - departure from classic "discrepancy formulas" or 'wait to fail' model
- RTI attempted to be proactive by attending to student needs earlier on
-- Tier I Modif goals of gen ed by gen ed teacher
-- Tier II SLP collab with gen. ed. personnel w/suggestions for indirect svc
-- Tier III SLP provides intensive ST intervention and monitor student progress
-- Tier IV SpEd svcs are provided for students who fail to respond to tx in Tier III
EBP - based in high-qlty research - Clinician expertise - Client pref.

DA - must be goal oriented to be effective -> it builds on Dx
- vs. Static assessment a "snapshot" - see p. 10 for differences (chart)
Stdzd Assessment (SA) = child as passive participant; Examiner = observer; Results id deficits; stdzed admin
DA = active; participant; results describe modifiability; admin = fluid, responsive (examiner's responss contingent on child's behavior...)
- heavily relies on Vygotsky's notion of ZPD

WHO: 'comprehensive assessment'
1. Body strx/fx
2. Activities & participation
3 Contextual factors:

ASHA PPP 'preferred practice pattern' - ASHA PPP (a position paper or a body of practice?) check it out...
1. Measuring outcomes.
2. Going beyond SA:
3. Approaching Assessment scientifically:

Dx to determine the reality of the problem (disorder or no?)
1. Speech diff vs disturbance (breakdown in the msg) => disorder (handicapping condition)
2. Intelligibility of the message
3. Handicapping condition..

Dx to determine etiology of the problem:
Forest through the trees & vice versa... neither relegating cx to a label, nor going clean slate in the approach to dx/eval...

Dx to provide clinical focus: Using qq on condition(s); kn. of cx; expertise; aux svc; intervening factors, etc.

Dx: Science & Art
- Art - clinician's abilities, skills, experience, instinct - beware of "fat folder syndrome" - more is known of the clinician vs client!
- Sc. - EBP, etc. albeit this alone can be confining..

Dx vs eligibility: working w/in parameters of public policy...

Dx'n as a factor
- Experience; flexibility; healthy skepticism to critically eval... interpersonal relationship attributes; objectivity

Cx-Clinician relationship:

Cx as a factor - children-adolesc-adults

. Young children:
Apprehension may stem from:

1. Inadequate prep for exam by parents
2. Uncertainty as to how to approach this
3. Vivid memories of trauma to specialist visits (dentist, etc.) 

• Help parent prep for dx session (don't come empty handed)
• Play over small talk to engage child 
• Gen rule: Ask less/observe more!
• Learn everything about normal children in order to provide baseline...
• Limit choices you offer child
• Be flexible in your use of tests/examinations
• Absolute honesty and candor - don't make promises you can't keep
• Whole assessment doesn't have to be done in one session
• Watch language complexity when talking to child

- Teens: may be resistant & diff to assess

• Understand pressures they experience
• Desire to conform to perceived group norms & stds
• Don't become a teen
• Tolerance and good humor
• Explain procedure - satisfy their qq
• If cx/family is critical of school/staff - avoid being judgmental
• Review results w/client b4 family/staff

- Elderly cx
* Take into account fatigue, don't talk down to, reduce distrxns, noise, interference...

Putting Dx to work - synthesizing...

• Bedrock - clinician's kn & skill base
• 6 boxes => case hx; prior testing & reports; observ cx; interview findings; informal/formal testing
• Synthesis of findings
• 5 boxes => Clinical mgmt suggest; referral; progn; further testing; parent info & counseling + Additional clinic experience & kn. base...

PROGNOSIS:
1. Age
2. Length of time of impairment existence
3. Existence of other probs
4. Rxn of significant others
5. Client motivation


PRECEPTS REGARDING THE CLINICAL EXAM:

• Persons not communic prob
• clinical exams r conducted interpersonally
• Sh*t happens
• OJO - a thorough understanding of normalcy is important
• Dx doesn't nec happen in a single session
• Tx is often Dx'ic
• Determine person's self-image/perception
• Cx's adjustments to certain prob may be a cover; while these may be part of the prob, they are not hte prob...
• Behavior is a fx of the ind and situation - cx needs to be able to generalize
• Dx should be conducted in a multitude of environments
• Tests = tools
• Testing can be iatrogenic in that it can suggest probs that may not reflect cx reality
• Etc.