assessment of social-communication deficits in children in

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Created by

Tatyana Elleseff MA CCC-SLP

Smart Speech Therapy LLC

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Assessment of Social-Communication Deficits in

Children in School Aged Children


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Overview

This product is aimed at increasing the participants’ knowledge

regarding the role of speech language pathologists in the assessment

of social communication abilities of school-age children


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Presentation Objectives

Learning Objectives:

Learners will be able to

1. Summarize the role of SLP in assessment of pragmatic language

and social cognitive abilities of school-age children

2. List formal assessment instruments used to assess pragmatic

language and social cognitive abilities of school age children

3. Describe informal assessment procedures used to assess pragmatic

language and social cognitive abilities of school age children


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Role of SLPs Relevant to Social Communication Disorders

SLPs play a critical role in the screening, assessment, diagnosis, and treatment of school-age children with social communication disorders Provide prevention information Educate other professionals Screen social communication skills for early detection Conduct a culturally and linguistically relevant comprehensive assessments of social

cognition, Diagnose the presence or absence of social communication disorders Refer the patient/client to other professionals to rule out other conditions Develop culturally and linguistically relevant treatment and intervention plans Recommend related services (if needed) Counsel individuals with social communication disorders and their families Consult and collaborate with all relevant parties to create an intervention plan focused

on functional outcomes Remain informed of research in the area of social communication disorders Advocate for their clients and their families

http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934980&section=Roles_and_Responsibilities




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Social Communication Skills

More than good eye gaze, nice manners, adequate conversational

abilities or knowing multiple meanings of words

Dynamic and complex process which begins in infancy and continues

to mature well into adulthood

“The ability to adapt your behavior effectively based on the situation

and what you know about the people in the situation for them to

react and respond to you in the manner you had hoped.”

Winner, Michelle Garcia (Oct, 2011) Social Thinking Across the Home

and School Day; YAI Autism Conference.


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Social Communication Skills (cont.)

Ability to initiate social interactions (Prizant & Meyer, 1993)

Ask questions

Obtain help

Initiate academic work

Attend to & interpret social cues (Langton et al, 2000)

Ability to process messages appropriately

Abstract thinking skills

ToM & perspective taking (Baron-Cohen, 1995)

Gestalt processing (Brosnan et al 2004)

Humor (Semrud-Clikeman & Glass, 2010)


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Difficulty with Detection of Social Communication Weaknesses

Tests of communication, typically focus on semantics, syntax,

morphology, and phonology, as these are the performance areas in

which specific skill development can be most objectively measured

(Hill & Coufal, 2005)

Child may receive average scores but present with significant social

pragmatic impairments

Supplemental testing may be URGENTLY needed


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Difficulty with Detection and Recognition of Social

Communication Deficits

May be perceived as challenging behaviors

Severe cases misdiagnosed as Oppositional Defiant Disorder

Common teacher/parent complaints:

“Ignores” presented directions

Follows own agenda

Inappropriately “acts out”

Acts immaturely

Clueless regarding others around him


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What is it really?

Behavior Lack of Skills

Both


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Have you checked their ability to …

Recognize facial expressions

Gage moods

Correctly identify own feelings

Correctly identify other’s feelings

Appropriately initiate social interactions

Appropriately interpret social situations

Create and convey messages to speakers

Relate to peers (“disability barometer”)


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Relevant Assessment Areas

Adaptive Behavior

Pragmatics

Social Emotional Functioning

Problem Solving

Conversational Abilities

Procedural Recall

Narrative Abilities

Listening Comprehension

Executive Function


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Where do we begin?

Data Collection

Create Referral Forms

Give it to the teacher

Send it home

Can’t Assess Everything

Don’t waster TIME!

Target Deficit Areas ONLY!


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SAMPLE FORM: Social Pragmatic Deficits Checklist

Checklist Categories:

•Listening/Processing

•Verbal Expression

•Prosody

•Problem Solving

•Pragmatic Language

•Social Emotional Development

•Behavior •Supplemental* Caregiver/Teacher

Data Collection Form

•Select Assessments Sensitive to

Social Pragmatic Deficits

This checklist was created to assist (SLPs)

in identifying and screening for social

pragmatic language weaknesses/deficits in

school-aged children, who may require assessment and intervention services.


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Sample Areas of Difficulty

Check all that apply:

Problem Solving

Difficulty making inferences

Difficulty predicting results of actions

Difficulty determining causes of events

Social Emotional

Difficulty recognizing moods

Difficulty interpreting body language

Difficulty assuming perspectives of others

Executive Functions

Difficulty inhibiting behavior

Difficulty with emotional self-control


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Social Pragmatic Language Assessment:

Useful Standardized Tests

Test of Problem Solving-3 Elementary (TOPS-3)

Test of Problem Solving -2 Adolescent (TOPS-2)

Test of Pragmatic Language-2 (TOPL-2)

Social Emotional Evaluation (SEE)

Social Language Development Test -Elementary (SLDT-E)

Social Language Development Test -Adolescent (SLDT-A)

Listening Comprehension Test Adolescent (LCT-A)

Clinical Evaluation of Language Fundamentals-5: Metalinguistics (CELF-5: M)

Test of Executive Functions (EFT)

Theory of Mind Inventory-2 (TOM-2)


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Test of Problem Solving-3 Elementary (TOPS-3)

Ages 6-11:11

Open ended questions based on photos

Critical thinking to analyze, problem solve, evaluate, make

predictions and inferences, etc

Assesses ability to integrate semantic and linguistic knowledge with

reasoning

Subtests:

Making Inferences

Negative Questions

Problem Solving

Predicting

Determining Causes


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TOPS-3: Strengths and Limitations

Strengths:

Open ended questions allow for spontaneous response formulation

The examiner has an opportunity to assess the student's oral language abilities in the

area of sentence formulation as well as coherence and cohesion all the response

Suitable for children with reported difficulties in the area of decision-

making and verbal reasoning

Limitations:

The vast majority of scenarios deal with typical activities of daily living

What will happen if you break something in the supermarket ?

Why do you have to look both ways when crossing the street?

Many children with social communication deficits may possess mastery

of these skills and as such will easily attain average scores on this test

Requires caution in determination of best candidate for testing


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Test of Problem Solving-2 Adolescent

Ages 12-17:11

Open ended questions

Critical thinking abilities based on student's language strategies using

logic and experience

Analysis, interpretation, evaluation, inferencing, self-regulation, etc

Subtests:

Making Inferences

Determining Solutions

Problem Solving

Determining Perspectives

Transferring Insights


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TOPS-2: Strengths and Limitations

Strengths:

Ability to assess the student’s reading skills by asking them to read and

not just follow along the presented passages

Higher order language scenarios requiring knowledge of sophisticated

vocabulary concepts and words

Limitations:

Student is allowed to keep and reference the manual which has the

potential to inflate testing scores

Students from multicultural backgrounds may not have exposure to

some of the presented scenarios/lack knowledge of certain concepts


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Test of Pragmatic Language-2 (TOPL-2)*

Ages 6-18:11 with two formats per different ages

6:0-7:11 years Shorter version:17 items

8:0-18:11 years Full version: 43 items

Open ended questions re: social situations

Addresses Components of:

Physical Setting

Audience

Topic

Purpose

Visual-gestural cues

Knowledge of Abstractions


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TOPL-2: Strengths and Limitations

Strengths: Good for clients with deficits in the areas of understanding rules of polite

conduct who have very limited/severely impaired perspective taking abilities Best for children with impaired IQ and concomitantly impaired pragmatics

Limitations: Subjective and labor intensive scoring Students with severely impaired social communication abilities but with

Average and Above Average IQ do well on this test due to their ability to memorize the rules of politeness

Does not possess scenarios assessing higher order social communication abilities (e.g., conflict resolution, multiple interpretations, etc.)

Takes excessively long to administer Difficult to generate goals based on administration due to the cumulative

nature of the results Generation of goals requires in depth item analysis, which in turn requires

more analysis time


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Social Emotional Evaluation (SEE)

Ages 6-12:11 (color drawings)

Assesses knowledge of social situations and emotional reactions

Subtests:

Recalling Facial Expressions (unscored pretest)

1. Identifying Common Emotions

2. Recognizing Emotional Reactions

3. Understanding Social Gaffes

4. Understanding Conflicting Messages

http://www.do2learn.com/organizationtools/EmotionsColorWheel/index.htm

http://www.smartspeechtherapy.com/shop/are-you-being-social-social-pragmatic-language-bundle/

http://hamaguchiapps.com/Between_the_Lines.html


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SEE: Strengths and Limitations

Strengths:

Best for children with impaired IQ/ very impaired Theory of Mind (ToM)

Portions of it can be used to assess abilities of cognitively and linguistically impaired children Recalling Facial Expressions

1. Identifying Common Emotions

2. Recognizing Emotional Reactions

Understanding Conflicting Messages subtest is useful for administration with higher socially functioning children

Limitations:

First two subtests are significantly easier than the last two subtests, which is a problem because the test provides cumulative z scores

Students who do very well on the first two and poorly on the last two subtests often end up with significantly inflated scores

As a result many children in need of services may not qualify for them


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Social Language Development Test –Elementary: Normative Update

Ages 6-11:11

Focuses on language-based skills of social interpretation and

interaction with friends

Assesses students' language-based responses to portrayed, peer-to-

peer situations

Subtests:

Making Inferences

Interpersonal Negotiations

Multiple Interpretations

Supporting Peers

http://www.smartspeechtherapy.com/appdapting-flashcard-apps-to-address-social-skills/

http://www.smartspeechtherapy.com/shop/are-you-being-social-social-pragmatic-language-bundle/

http://www.smartspeechtherapy.com/shop/social-pragmatic-language-multiple-interpretations-therapy-activity/

http://www.smartspeechtherapy.com/spotlight-on-social-language-competence-when-is-a-high-subtest-score-a-cause-for-concern/


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SLDT-E:NU: Strengths and Limitations

Strengths: Assesses sophisticated social communication constructs (perspective

taking, conflict resolution, multiple interpretations, etc.) in children as young as 6 years of age

Open-ended questions are far more illustrative of real world experiences

Subtest subdivision offers in depth understanding of students’ error breakdowns

Terrific for goal generation

Limitations: Not suitable for students with low IQ (< 70), students with more severe

forms of ASD, or students with severe language impairment and limited vocabulary inventories For more information: https://www.smartspeechtherapy.com/review-

of-social-language-development-test-elementary-what-slps-need-to-know/

https://www.smartspeechtherapy.com/review-of-social-language-development-test-elementary-what-slps-need-to-know/

























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SLDT-E: NU and Multicultural Considerations

May not be suitable for English Language Learners (ELL) with suspected social

pragmatic deficits due to the:

Potential for linguistic /cultural bias since answers could be marked

incorrect due to:

Lack of vocabulary knowledge

Lack of exposure

Low socioeconomic status (SES)

Lack of formal schooling

Limited opportunities outside the home

Multiple Interpretations Subtest

May be confusing to some children

Interpreted as trick questions


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Social Language Development Test -Adolescent : Normative Update

Ages 12-17:11

Ability to interpret and respond to sarcasm, engage in peer-to-peer

perspective-taking, respond to sensitive information and rumors as

well as understand socially complex emotions

Subtests:

Making Inferences

Interpreting Social Language

Problem Solving

Social Interaction

Interpreting Ironic Statements

Identifies atypical social language behaviors


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SLDT-A:NU: Strengths and Limitations

Strengths: Student requires to appropriately respond to both portions of select

subtests in order to earn credit Tests ability to interpret not just sarcasm and irony but also tone of

voice Open-ended questions are far more illustrative of real world

experiences Subtest subdivision offers in depth understanding of students’ error

breakdowns which results in terrific goal generation applicable to the real world experience

Limitations: Similar to the SLDT-E: NU this test is not suitable for students with low

IQ (< 70), students with more severe forms of ASD, or students with severe language impairment and limited vocabulary inventories

For more information: https://www.smartspeechtherapy.com/review-of-social-language-development-test-adolescent-what-slps-need-to-know/

https://www.smartspeechtherapy.com/review-of-social-language-development-test-adolescent-what-slps-need-to-know/


























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SLDT-A: NU and Multicultural Considerations

Too abstract/hypothetical to answer “What is he thinking?” if child

is unused to that style of questioning

Questions pertaining to topics such as dating or dieting are based on

exposure/prior experience

May not be appropriate for children 12-16 years of age

Interpreting Social Language subtest

Heavily based on vocabulary knowledge

Problem Solving subtest

Responses may be incongruous with personal cultural values

Interpreting Ironic Statements

Based on idioms

If lack knowledge then ↓ score)


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Listening Comprehension Test Adolescent (LCT-A)

Ages 12-17:11

Composed of 12 story passages and 4 “messages” which assess the

student’s problem solving and inferencing abilities, empathy and

decision making, etc.

Subtests

Main Idea

Details

Reasoning

Vocabulary and Semantics

Understanding Messages


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LCT-A: Strengths and Limitations

Strengths: The Main Ideas subtest assesses the student's Gestalt Processing abilities

which is the capacity of see the ‘Big Picture” vs. focus on small/irrelevant details

Requires synthesis of the presented information

Verbal Reasoning subtest requires extrapolation of text information to reach an appropriate conclusions

Great opportunity to test the student’s semantic flexibility skills which are important for narrative development as well as social communication

Limitations:

This is not a test of social communication and as such only the Main Ideas subtest is truly applicable to the determination of the student’s weaknesses as well as goal generation

Definitely requires significant supplementation of formal/informal social communication testing tasks and procedures


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Clinical Evaluation of Language Fundamentals 5: Metalinguistics

For ages 9-22, it includes 4 tests (can be administered individually

or as part of a battery) of higher-level language skills that are

embedded in upper-grade curricula and are critical to classroom

success.

Measures the student’s ability to think about and use language to

make inferences, manipulate conversational speech given a context,

use words in multiple ways, and use language in a non-literal

manner.

Making Inferences

Conversation Skills

Multiple Meanings

Figurative Language


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CELF-5:M: Strengths

Assesses student’s abilities to use figurative and ambiguous language and produce open ended responses as well as formulate sentences given presented context and select words

Assesses student’s ability to interpret contextual and situational demands of conversation

Allows for identification of more subtle language based difficulties in verbal children with average to high average intelligence (or Emerging Social Communicators as per Winner, 2011) who present with metalinguistic and social pragmatic language weaknesses in the following areas: Social predicting and inferencing Conversational rules and breakdown repairs Knowledge of high-level and abstract vocabulary words Identification and usage of ambiguous and figurative language Coherent and cohesive discourse and narrative formulation Knowledge and use of multiple meaning words in a variety of

conversational and text-embedded contexts

https://www.socialthinking.com/images/stories/ST SCP Ver 6.12.pdf





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CELF-5:M: Limitations

Test administration begins at 9 years of age which is very late since much younger

children can present with glaring metalinguistic deficits

Presence of visual and written stimuli on select testing subtests since children are

not provided with multiple-choice answers or written support in daily social and

academic situations

Score over inflation may occur with children who do well given compensatory

strategies but who have difficulty generating novel spontaneous responses

Many higher functioning students with ASD or language deficits will pass this test

with flying colors (e.g., Nuance Challenged Social Communicators, Winner,

2011)

Not appropriate for the Severely Challenged and Challenged Social

Communicators (Winner, 2011)

For more information: https://www.smartspeechtherapy.com/test-review-celf-5-

metalinguistics/





https://www.smartspeechtherapy.com/test-review-celf-5-metalinguistics/










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Test of Executive Functions (EFT)

For children 7-12:11 years of age, it is a test of language skills which affect

executive functions of working memory, problem solving, inferring, predicting

outcomes, and shifting tasks.

Attention and Immediate Memory - Auditory

Pay attention to details from short passages & answer follow-up questions

Attention and Immediate Memory - Auditory and Visual

Answer questions about what you've heard and seen in the pictures

Working Memory and Flexible Thinking

Generate novel responses and answer 2 critical thinking questions based on

short passages

Shifting

Quickly and accurately shift your thinking by naming a member of a related

category after you hear 4 items in a related category e.g., “Add, subtract, multiply

and divide are math words. Now tell me a grammar word”)


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EFT: Strengths and Limitations

Strengths: Assesses problem solving, inferring, predicting outcomes, and shifting tasks all

the skills associated with social communication weaknesses Requires extrapolation of text information to reach an appropriate conclusions

on select subtests Laden with sophisticated vocabulary words so it’s a terrific opportunity to test

the student’s semantic flexibility skills which are important for narrative development as well as social communication

Requires synthesis of the presented information

Limitations: This is not a test of social communication Definitely requires significant supplementation of formal/informal social

communication testing tasks and procedures Not for students with intellectual disabilities, severe language impairment and

limited vocabulary inventories, or students with significant memory and language processing deficits

For more information: https://www.smartspeechtherapy.com/the-executive-functions-test-elementary-what-slps-and-parents-need-to-know/

https://www.smartspeechtherapy.com/the-executive-functions-test-elementary-what-slps-and-parents-need-to-know/
























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The Theory of Mind Task Battery: (Hutchins & Prelock, 2016)

Taps a wide range of

ToM domains

Variety of content

Easy – difficult

Co-developed with

the ToMI-2

Subscales:

Early: ~ 1-3.5 yrs

Basic: ~ 3.5 – 6.5

yrs

Advanced: ~ 6.5 –

10 yrs

• Consists of 15 test questions embedded in 9 tasks

• All content presented in storybook format

• Color illustrations of persons from a variety of racial and ethnic

backgrounds

• Items presented in ascending difficulty (empirically determined)

• Memory control questions are must be passed for credit on the

test questions

Task A: basic emotion-recognition

Task B: desire-based emotion

Task C: seeing-leads-to-knowing

Task D: line of sight

Task E: perception-based action

Task F: first-order false belief

Task G: belief- and reality-based emotion and second

order emotion

Task H: inferring belief of another when interpreting a

statement of desire in the context of a change location

Task I: second-order false belief Author slides used w/t Dr.

Hutchins’ permission


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TOM-2 Parent Questionnaire (Hutchins & Prelock, 2016)

60 items designed to tap a wide

range of social-cognitive

understandings

“My child understands

whether someone hurts

another on purpose or by

accident.”

Empirically-derived subscales:

Early

Basic

Advanced

Rationally-derived subscales:

Emotion Recognition

Mental State Term

Comprehension

Pragmatics

Author slides used w/t

Dr. Hutchins’ permission


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TOM-2: Strengths and Limitations

Strengths: Addresses the limitations of traditional theory of mind measures Generates reports with clear cut goals and corresponding materials

Report analyzes strengths/challenges in light of the typical developmental sequence of ToM

Recommends specific treatment targets on the basis of their developmental appropriateness

Strong psychometrics, validity, sensitivity and specificity, etc. Quick and easy to use via HIPAA compliant software (just send via email and

collect results)

Limitations (as per authors) Not intended for differential diagnosis (at present) Not intended to be used by educators to rate children (not more reliable than

parent ratings) Should not be used when caregiver has a debilitating psychiatric disorder Results questionable when majority of responses fall in the “undecided” range

For more information and free materials https://www.theoryofmindinventory.com/

https://www.theoryofmindinventory.com/about/rationale-for-the-tomi/

https://www.theoryofmindinventory.com/

https://www.theoryofmindinventory.com/


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Informal Assessments


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Sally-Anne: First Order False Belief Task (Baron Cohen,

et al 1985)

After introducing the dolls, the child

is asked the control question of

recalling their names (the Naming

Question).Sally then takes a marble

and hides it in her basket. She then

"leaves" the room and goes for a

walk. While she is away, Anne takes

the marble out of Sally's basket and

puts it in her own box. Sally is then

reintroduced and the child is asked

the key question, the Belief Question:

"Where will Sally look for her

marble?


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Sally Anne First Order False-Belief Task

(Baron Cohen, Leslie & Frith 1985)

*Major milestone in ToM’s development is gaining the ability to

attribute false belief

Recognize that others can have beliefs about the world

Mental representations of situations are different from their

own

Be able to predict behavior based on that understanding

In typically developing children mastery occurs ~4 years of age

or even younger in children with higher SES status, strong

vocabulary and good language stimulation


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Second Order False Belief Tasks

Second-order mental states may involve beliefs about belief or

involve beliefs about intentions

Perner & Wimmer, 1985

Inferring one’s person’s belief regarding another person’s intentions

John thinks that Mary thinks that…

Presented children with story in which two characters, John and

Mary, wanted to buy ice cream when each character had separate

knowledge about an ice cream van’s change of location. Both

characters in the story knew where the van was located, but John had

a mistaken second-order belief about Mary’s knowledge of the van’s

true location.

Age of acquisition between 6-7 years of age


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Second Order False Belief Task

(Perner & Wimmer, 1985)


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Strange Stories: Happe 1994

First used in a study of individuals with autism to test ToM

Short vignettes, each accompanied by a picture and two test questions

24 short mentalistic stories

13 physical control stories

Can be used in a testing battery to determine whether a student understands non-literal messages, indirect requests, sarcasm, jokes and metaphorical expressions

Types of stories: comprising lie, white lie, joke, pretend, misunderstanding, persuade, appearance/reality, figure of speech, sarcasm, forget, double bluff, and contrary emotions

https://pdfs.semanticscholar.org/4e63/b3378690202a23bd53cbd31856000dc43e8c.pdf pg. 265 onwards: all stories and scenarios which can be modified

https://pdfs.semanticscholar.org/4e63/b3378690202a23bd53cbd31856000dc43e8c.pdf




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Informal Assessment: Discourse

Observation of Student conversing with Peers

Direct Engagement

Conversational Turns (balanced turns vs. excessively verbal)

Topic Stringing ↓

Balanced question/comment ratio

Perspective taking

Provide background information

Monitor comprehension

Gage interest in topic

Recognize and repair conversational breakdowns

Body Language

Proximity

Tone/Loudness/Prosody


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Informal Assessment: Procedure Analysis

Ability to coherently verbalize event sequencing (what steps do you need

to take in order to…?)

Directions (e.g., how to get somewhere )

Instructions on how to make something

Rules of a sport or a videogame

Explain a recipe


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Informal Assessment: Procedural Discourse

The purpose of procedural discourse is to coherently explain how to do something

A series of steps leading to a specific goal by centering on events that are contingent upon one another

The steps are organized chronologically

Temporal markers are used (first, second, next, last, etc)

Evaluates:

Gestalt Processing

Create whole from parts in order

ToM

What do you think the people in the pictures talking about?

What are they thinking?

Organizational Ability

Ability to put thought into expression


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Informal Assessment: Narratives

Sequencing Ability Story order

Working Memory Use of relevant details

Grammar Sentence structure (errors, run-on sentences, etc) Use of temporal and cohesive markers to connect the story

Vocabulary Immature vs. age-level Word retrieval issues vs. lexical fluency

Pragmatics Story cohesion /coherence Use of anaphoric references

Perspective Taking Insight into character’s feelings, beliefs, thoughts


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Elements of Narrative Assessment

Story grammar (Stein & Glenn, 1979)

Setting

Initiating event

Internal Response

Attempt

Consequences

Reaction

Conjunctive cohesion

and, but, so, then, and then, however, subsequently, moreover

Temporal Markers

before, after, during, first, firstly, secondly, last, finally

Anaphoric Referencing

appropriate identification of people, locations, events vs. labeling everyone “he” or “she” or using non-specific comments such as “that place”, “that thing”, etc


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Elements of Narrative Assessment (con’t)

Event sequencing

Central theme vs. unconnected story

Explicitness

Fluency

Story fluidity, lack of lexical/phrasal interruptions ↓

Word Retrieval/Word Finding

Word fillers such as um, ah, word/phrase revisions, word/phrase

repetitions, word omissions, word prolongations, false starts, etc

Emotional Relatedness/Perspective Taking

Identify and correctly interpret character’s emotions, ideas, thoughts

Hedgeberg & Westby 1993


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Assessment Conclusion

Use multiple assessment tasks to create a balanced assessment

Assessment has to be functional

Determine strengths not just weaknesses

Descriptive measures vs. standard scores

To qualify for services in cases with Average Standard Scores

but pervasive social pragmatic deficits

Make sure your assessments yield diagnostic information

needed to formulate treatment goals


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General Assessment and Treatment Start Up Bundle

Multicultural Assessment Bundle

Narrative Assessment and Treatment Bundle

Introduction to Prevalent Disorders Bundle

Social Pragmatic Assessment and Treatment Bundle

Psychiatric Disorders Bundle

Fetal Alcohol Spectrum Disorders Assessment and Treatment Bundle

Assessment Checklist for Preschool Aged Children

Assessment Checklist for School Aged Children

Speech Language Assessment Checklist for Adolescents

Differential Diagnosis of ADHD in Speech Language Pathology

Creating Functional Therapy Plan

Selecting Clinical Materials for Pediatric Therapy

Social Pragmatic Deficits Checklist for Preschool Children

Social Pragmatic Deficits Checklist for School Aged Children

Language Processing Deficits Checklist for School Aged Children

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