Speech-Language Pathologists' Clinical Decision Making for Children With Specific Language Impairment

Purpose The goal of this study was to provide guidance to clinicians on early benchmarks of successful word learning in an interactive book reading treatment and to examine how encoding and memory evolution during treatment contribute to word learning outcomes by kindergarten children with specific language impairment (SLI). Method Twenty-seven kindergarten children with SLI participated in a preliminary clinical trial using interactive book reading to teach 30 new words. Word learning was assessed at 4 points during treatment through a picture naming test. Results The results indicate that the following performance during treatment was cause for concern, indicating a need to modify the treatment: naming 0–1 treated words correctly at Naming Test 1; naming 0–2 treated words correctly at Naming Test 2; naming 0–3 treated words correctly at Naming Test 3. In addition, the results showed that encoding was the primary limiting factor in word learning, but memory evolution also contributed (albeit to a lesser degree) to word learning success. Conclusion Case illustrations demonstrate how a clinician's understanding of a child's word learning strengths and weaknesses develop over the course of treatment, substantiating the importance of regular data collection and clinical decision-making to ensure the best possible outcomes for each individual child.

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Clinical Decision Making in Speech-Language Intervention for Toddlers With Autism and Other Social Communication Delays

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig1-2018-0010 ◽

2019 ◽

Vol 4 (2) ◽

pp. 228-239 ◽

Cited By ~ 1

Author(s):

Sheri T. Stronach ◽

Janine L. Schmedding-Bartley

Keyword(s):

Decision Making ◽

Young Children ◽

Continuing Education ◽

Social Communication ◽

Clinical Decision Making ◽

Clinical Decision ◽

Language Intervention ◽

Communication Delays ◽

Clinical Experiences ◽

Speech Language Pathologists

Purpose This study investigated current speech-language intervention practices with young children with social communication delays including autism and the educational experiences that shape these practices. Method A 25-item web-based survey was completed by 264 speech-language pathologists who worked with children under the age of 3 years. Results A majority of respondents reported targeting a variety of areas of social communication across daily activities, regularly utilizing the parent as the primary agent, and often providing in-home services; however, a minority of respondents reported only using materials available in families' homes. Previous clinical experiences and continuing education were reported to most influence clinical decision making. Results indicated the incorporation of many aspects of evidence-based naturalistic interventions into practice and the use of continuing education opportunities to expand clinical knowledge. Conclusion Although speech-language pathologists reported promising directions toward recommended best practices, further research and training are needed to optimize services provided to young children and their families.

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Assessing Bilingual Children: Are Their Disfluencies Indicative of Stuttering or the By-product of Navigating Two Languages?

Seminars in Speech and Language ◽

10.1055/s-0038-1667161 ◽

2018 ◽

Vol 39 (04) ◽

pp. 324-332

Author(s):

Courtney Byrd

Keyword(s):

Decision Making ◽

Differential Diagnosis ◽

Language Learning ◽

Language Impairment ◽

Second Language Learning ◽

Clinical Decision Making ◽

Clinical Decision ◽

English Speakers ◽

Decision Making Process ◽

Speech Behaviors

AbstractClinicians commonly report difficulty determining whether the disfluencies produced by their clients are indicative of stuttering or suggestive of something else, such as cluttering, autism, language impairment, or second language learning. In our clinical decision-making process, we identify features unique to specific speech and/or language disorders. This identification enables differential diagnosis in most cases. But what happens when features appear to overlap and, as a result, compromise our clinical decision making? This article provides information to assist in the differential diagnosis of stuttering, particularly as it pertains to the assessment of children who speak more than one language. It explores similarities in the speech behaviors produced by these speakers, contrasting them with stuttering behaviors in monolingual English speakers.

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The Influence of Linguistic Bias Upon Speech-Language Pathologists’ Attitudes Toward Clinical Scenarios Involving Nonstandard Dialects of English

American Journal of Speech-Language Pathology ◽

10.1044/2021_ajslp-20-00382 ◽

2021 ◽

pp. 1-17

Author(s):

Catherine Easton ◽

Sarah Verdon

Keyword(s):

Decision Making ◽

Service Provision ◽

Clinical Decision Making ◽

Linguistic Diversity ◽

Clinical Decision ◽

Assessment Tools ◽

Speech Language Pathology ◽

Speech Language Pathologists ◽

Clinical Scenarios ◽

Language Pathology

Purpose Variation within languages, including dialects, takes on an indexical function, marking belonging and connection. Meanwhile, attitudes toward these speech varieties become marked by linguistic bias. Within the speech-language pathology profession, research evidence, assessment tools, and intervention programs have largely been designed for and by the White, English-speaking middle class. As such, linguistic bias with a preference for standardized dialects is prevalent in the training and practice of the speech-language pathology profession, resulting in discriminatory and racialized practices. Method To investigate the influence of linguistic bias upon speech-language pathologists' (SLPs') clinical decision making, data were collected from 129 Australian SLPs via an online survey. Inferential statistics were used to investigate the relationship between clinical decision making and SLPs' attitudes toward nonstandard dialects as well as personal and professional factors. A content analysis of extended responses was conducted to identify themes in clinical decision making. Results SLPs with more years of experience and those who had received professional development were significantly more likely to seek out more information before making a diagnosis, while those with more negative attitudes toward linguistic diversity were significantly more likely to identify a disorder than a difference. SLPs provided a range of justifications for their clinical decision making, but few acknowledged the influence of their own attitudes and bias upon their decision making. Conclusions SLPs' linguistic bias towards speakers of nonstandard dialects has the potential to impact upon their clinical judgment of difference versus disorder and lead to inequality of service provision for speakers who do not express themselves in standardized forms. Before the profession can truly move toward an antiracist approach of equitable service provision for all, SLPs must engage in critical self-reflection to disrupt the adherence of the speech-language pathology profession to standardized “White” norms of communication.

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How To Practice “Undefensively”

Perspectives on Gerontology ◽

10.1044/gero15.2.54 ◽

2010 ◽

Vol 15 (2) ◽

pp. 54-64 ◽

Cited By ~ 2

Author(s):

Paula Leslie ◽

Kate Krival

Keyword(s):

Decision Making ◽

Best Practice ◽

Clinical Decision Making ◽

Clinical Decision ◽

Evidence Based ◽

Speech Language Pathology ◽

Speech Language Pathologists ◽

Internal Resources ◽

Language Pathology ◽

Decision Making Processes

Speech-language pathologists (SLPs) are increasingly challenged by the medical complexities our patients present and gripped by the fear of litigation, if patients decline physically under our care. One response to these pressures may be to practice defensive medical speech-language pathology. We propose that best practice is ethically achieved by deliberately using specific external and internal resources to practice undefensively. We suggest how consideration of these materials and processes will help SLPs ensure evaluation and clinical decision-making processes are as effective, evidence-based, and transparent to patients, caregivers, administrators, and payers as possible.

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Dysphagia therapy post stroke: An exploration of the practices and clinical decision-making of speech-language pathologists in Australia

International Journal of Speech-Language Pathology ◽

10.1080/17549507.2016.1265588 ◽

2017 ◽

Vol 20 (2) ◽

pp. 226-237 ◽

Cited By ~ 11

Author(s):

Olivia Jones ◽

Jade Cartwright ◽

Anne Whitworth ◽

Naomi Cocks

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Speech Language Pathologists ◽

Post Stroke ◽

Dysphagia Therapy

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Children's English Consonant Acquisition in the United States: A Review

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-19-00168 ◽

2020 ◽

Vol 29 (4) ◽

pp. 2155-2169 ◽

Cited By ~ 1

Author(s):

Kathryn Crowe ◽

Sharynne McLeod

Keyword(s):

United States ◽

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

The United States ◽

Typically Developing ◽

Multiple Sources ◽

Speech Language Pathologists ◽

Cross Sectional ◽

Developmental Norms

Purpose Speech-language pathologists' clinical decision making and consideration of eligibility for services rely on quality evidence, including information about consonant acquisition (developmental norms). The purpose of this review article is to describe the typical age and pattern of acquisition of English consonants by children in the United States. Method Data were identified from published journal articles and assessments reporting English consonant acquisition by typically developing children living in the United States. Sources were identified through searching 11 electronic databases, review articles, the Buros database, and contacting experts. Data describing studies, participants, methodology, and age of consonant acquisition were extracted. Results Fifteen studies (six articles and nine assessments) were included, reporting consonant acquisition of 18,907 children acquiring English in the United States. These cross-sectional studies primarily used single-word elicitation. Most consonants were acquired by 5;0 (years;months). The consonants /b, n, m, p, h, w, d/ were acquired by 2;0–2;11; /ɡ, k, f, t, ŋ, j/ were acquired by 3;0–3;11; /v, ʤ, s, ʧ, l, ʃ, z/ were acquired by 4;0–4;11; /ɹ, ð, ʒ/ were acquired by 5;0–5;11; and /θ/ was acquired by 6;0–6;11 (ordered by mean age of acquisition, 90% criterion). Variation was evident across studies resulting from different assessments, criteria, and cohorts of children. Conclusions These findings echo the cross-linguistic findings of McLeod and Crowe (2018) across 27 languages that children had acquired most consonants by 5;0. On average, all plosives, nasals, and glides were acquired by 3;11; all affricates were acquired by 4;11; all liquids were acquired by 5;11; and all fricatives were acquired by 6;11 (90% criterion). As speech-language pathologists apply this information to clinical decision making and eligibility decisions, synthesis of knowledge from multiple sources is recommended.

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