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