diagnostics sphs 5780 (lecture 2). the nature of diagnosis and evaluation

DIAGNOSTICS

SPHS 5780

(LECTU

RE 2)

THE NATURE OF DIAGNOSIS AND EVALUATION

THE NATURE OF DIAGNOSIS AND EVALUATION

We pose questions, then seek and propose answers to them, to better understand the nature of the client’s communication disorder

Some think of this as a “problem-solving,” “puzzle-solving”, a “detective-like” process, or “conducting research”.

Which metaphor do you prefer?

THE NATURE OF DIAGNOSIS AND EVALUATION

Note that the first step is…. posing your questions!

Which metaphor for the diagnostic process is Tomblin using here?

THE NATURE OF DIAGNOSIS AND EVALUATION

We pose questions, then seek and propose answers to them, to better understand the nature of the client’s communication disorder….Formulate some example questions.

UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER”

UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER”

World Health Organization (WHO)

The nature of the client’s communication disorder includes all of these, as well as dynamic changes over time.

Let’s discuss some examples.

UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER”

The “diagnostic model” of your work setting will make assumptions about how to understand “the nature of the client’s communication disorder”-- Medical model-- Behavioral model-- Systems/social model

MODEL Setting Goal of the diagnostic process

Where does the problem rest?

How do we attempt to make changes?Hospital Find cause,

categorize problem

In client

Address cause

Schools Characterize performance within setting

In client

Change behavior

At home, in classroom (natural context)

Figure out which context promotes successful performance

Mismatch b/w client and context

Change context

Medical

Behavioral

Systems/ Social

UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER”

This “understanding” is the goal we constantly strive toward, but this goal is rarely attained.

Why?

UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER”Factors that complicate and challenge our

understandingClients are dynamic and complexTime is limitedInformation is incomplete or unreliableData conflict with each otherInferences are flawed We make mistakesOur experiences may “garden path” usWe are biased as humans (e.g., culturally)

Let’s discuss some examples that you’ve experienced.

UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER”How to overcome complications and challenges

to our understandingPlan ahead, but be ready to change your planRecognize and acknowledge when we don’t know….then follow through on finding an answer.Maintain a sense of curiosityBe flexible, and ready to adapt your inferencesSummon your creativity and innovations to solve problems

UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER”Discuss how you might address each of these challenges. You are seeing your first diagnostic client with aphasia, and you haven’t had

Lang III. Your diagnostic session is limited to one hour, and you need more time. Your client with suspected stuttering did not complete his written

questionnaire. You don’t understand what all the numbers on the CELF mean when you

score it. Your client is Hmong and illiterate. The client asks you a question, and you don’t know the answer. The client who was referred for an “articulation disorder” appears to be an

autistic child with a hearing loss. Your client’s diagnostic profile is so complex that you cannot come up with a

diagnosis. You make a Dx of spastic dysarthria and your co-clinician makes a Dx of

flaccid dysarthria. The client’s medical reports state that he has a left hemiplegia, and when

he arrives, he has a right hemiplegia. There is no standardized test available for testing the vocal quality of your

voice client. You want to assess a child’s functional communication at home, but you can

assess the child only in the clinic.

THE EVALUATION PROCESS

THE EVALUATION PROCESS

Pose _______________________ Gather information Synthesize findings (through process of inference) Disseminate conclusions and act on them Counsel

Look for these process components on your syllabus

THE EVALUATION PROCESS

Look for these process components on your syllabus

THE EVALUATION PROCESS

Where do our original “step” fall in the evaluation process?

Pose question

Gather information

Synthesize findings

Disseminate conclusions and act

Counsel

THE EVALUATION PROCESS

Although these look like sequential “stages”, each part of the process is happening simultaneously, throughout the evaluation process.

INFORMATION GATHERING(ONE PART OF THE EVALUATION PROCESS)

INFORMATION GATHERINGNote that the first step in the information-gathering process is….posing your questions!

Which of these steps are you doing in your diagnostic practicum right now?

Could we take steps 2-5 without step 1?

INFORMATION GATHERINGThe first step is…posing your questions!Change each of these possible diagnostic goals into a

question for your current case. Make the question as specific as possible.

Determination of the complaint Determining the existence of a communication disorder Determining client and family reactions and attitudes to the

disorder Identifying associated problems Determining the factors causing or exacerbating the problem Determining the course of the problem (historical, over time,

prognostic) Determining eligibility for therapy Determining therapy approach Determining the client’s use of his/her communication skills Determining how the client functions in his/her daily contexts

INFORMATION GATHERING

Look for these process components on your syllabus

INFORMATION GATHERING

Look for these process components on your syllabus

INFORMATION GATHERING:FORMAL VS. INFORMAL TESTING…AN INTRODUCTION

INFORMATION GATHERING: FORMAL VS. INFORMAL TESTING

Formal: Norm-referenced testingInformal: Criterion-referenced

testing

PURPOSE OF FORMAL VS. INFORMAL TESTING

Formal: Determine eligibility for services

Informal: Determine nature of services

PURPOSE OF FORMAL VS. INFORMAL TESTING

NATURE OF FORMAL VS. INFORMAL TESTINGFormal: Establish groups of scores against

which client is compared. Uses converted scores to characterize broad trait.).

Where does my client’s score fall in the range of scores for a large group of similar people?

Above or below measure of central tendency?How far above or below the measure of central tendency?

Measure of central tendency

Normal variability of performance around that measure of central tendency (sometimes expressed as standard score)

100

85

NATURE OF FORMAL VS. INFORMAL TESTING

Informal: Establish performance standard (criterion) against which the client is compared. Expressed as Y/N (+/-). Uses raw scores to characterize in high detail.

Examples:Does child have any hypernasity?Does the child display a phonological process of fronting?Does the child understand vocabulary needed for success in a second-

grade classroom?Does the child have MLU in the normal range for his age?Does the adult with aphasia phone a merchant for information?Is the child at least 80% accurate in his producion of /r/ in discourse

contexts?Is hearing sensitivity at least 25 dB in the speech range for both ears?

The standard could be based on:1)Client’s previous performance)2)Normal level of mastery3)Clinician knowledge and experience

INFORMATION GATHERING:CASE HISTORY TAKING

INFORMATION GATHERING:CASE HISTORY TAKING

Written case historyInterview-based case history