#146: Assessing Speech Sound Disorders: Getting Started

Marisha: Hello there, and welcome to the SLP Now podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Hello there, and welcome to the SLP Now podcast. This month we have Lindsey Hockel with us. She is the owner and creator behind Speechy Things, LLC, and she specializes in the R sound and currently sees a small private caseload of R kids. We are in for a massive treat. She is bringing her own clinical experience and a ridiculous amount of research, and she is so much fun to learn from. I asked her to help us walk through what we might want to think about when navigating a speech sound disorders evaluation. So all things evaluation today and she's got some really great tips planned. So, without further ado, hello Lindsey.

Lindsey: Hello. Thank you for having me.

Marisha: I am very excited. It's been really fun. We outlined the episode a little bit ahead of time and you've got so many great things for us, so I cannot wait.

Lindsey: I'm excited.

Marisha: Let's just dive right in. I know that you have some other information that you'd like to share as we walk through the evaluation process together, but let's pretend that we got a new speech sound disorders eval. Would you mind walking us through a little bit about how you would approach that and your process there?

Lindsey: Yes. So there's some basic components that you want to include in any evaluation. Gathering case history, a structural oral mech exam. You want to get a speech sample in conversation. We'll do your formal assessment. I recommend also doing some more informal assessment, like just keep on probing, and then if you want to make it a dynamic assessment, you'll do a little bit of teaching and then some trial therapy. I think that's the sweet spot for finding your goals. That's the basics.

Marisha: I think you got it all. And then we'll dive into the details of the case history and the oral mech and the speech sample and all of that in future episodes. We're also going to get to talk about perception tasks, which is super exciting. Can you give us a little sneak peek at what that is?

Lindsey: So basically perception tasks would be everybody has almost like a voice in your head of what a word should sound like, and so basically a perception task teases out whether or not a student can hear someone else's production or their own production, whether it's correct or not. I think it gives a great insight into their awareness, their phenology. I think it's definitely a missing piece for a lot of people, especially with the R sound, which is of course, everything I do now I bring it back to the R sound. But for speech sound disorders in general, I think it's important to include.

Marisha: Yeah. No, that's awesome. That gives us some information about how, in terms of progress we might be able to expect in therapy as well?

Lindsey: Yeah, I think so too. I like the option of if a student isn't stimulable yet, having things we can still work on to make them feel successful and to keep therapy productive, and spending a little bit more time on perception training I think helps with carryover in the long run too. I try to always incorporate from day one in therapy, and even in the assessment I look at it, just self awareness, self monitoring, and their ability to do that.

Marisha: Yeah, awesome. I'm excited to dive in even more on that topic. You also mentioned formal assessment, but we don't have an episode planned on formal assessment. So what are your thoughts and feedback around that?

Lindsey: I think they are helpful to know if a student qualifies, but they don't give you everything you need. Maybe I just have a limited exposure to formal assessments. I've mostly used the CAP and the Goldman Fristoe and I don't love either one of them. I know some assessments over qualify, some under qualify. I don't think they always do a good job of giving you the full picture of the student and their abilities, because there are some students who will pass with flying colors on the assessment, but then the second you get them in a conversation it all falls apart. So I think formal assessments have a place, but I think our informal assessment and our clinical judgment is much more important.

Marisha: Yeah, absolutely. I'm glad we got to touch on that. Super helpful. Can you give us an overview of, you see private clients, which is a little bit different than SLPs who are going through an evaluation in the schools-

Lindsey: Oh, for sure.

Marisha: ... or who are administering an evaluation in the schools. You listed the elements that you include, but let's say you're seeing a client for the first time, what would that workflow look like for you? You're seeing the client for the first time, what's the first thing that you do? Because I assume that we can't just jump into an oral mech exam. How long do you spend on your evaluations? What does that look like for you?

Lindsey: When I was in the clinic, an evaluation for a speech sound disorder, usually an hour face to face. Sometimes hour and a half. It just depends on the kid and what's going on. I really like sending the case history ahead of time for the parent to fill out because it gives me a chance to game plan, pull some tools that I think I'm going to want. I can figure out from the case history what formal assessment I think I'll need, and then if I see something that indicates a possible tongue thrust, then I would do a little feeding evaluation with that, because if they haven't entered in a lisp on an S, there probably is an immature swallow.

I would also just maybe highlight any red flags or a possible tongue tie or breathing airway issue, which is not my area. Please don't ask me a lot about that, I need to learn so much more. And just make note of any follow up questions, anything I wanted to dig more into with the parent, if I wasn't clear on something, because I feel it can give you such a good background. I liked having it ahead of time so I can prepare and get my head right for the assessment.

Then once they're inside, it could be different every time. But typically I would say, I would have the parent in there and if they can stay the whole time, great. If their kid's going to do better without, then we just start with going over the case history. Usually I would set the kid up with some activity that maybe I could use later. Maybe they're drawing a picture or something and we could use that as a conversational sample later. So we're being two birds, one stone. I would chat with the parent, get a sense for what their concerns are, and I feel like it's good to revisit some of these things in person because it can be such a different conversation. Who knows how they filled out that case history and what kind of rush they were in trying to get it to you? So try to ask open-ended questions and get a sense for what's going on.

Then I would probably do a conversation sample with the student so I could get a rough idea of what speech sounds I'm going to be focusing on. Hopefully during that we're building rapport because I'm not correcting, I'm just making either mental notes or jotting them down. Then I would probably go into an oral mech. Usually I would do that next. Then formal assessment. I feel like all throughout this whole thing, informal assessment is happening and I'm making notes to myself. Then we would move into a little bit of teaching and trial therapy. Then I say, "Goodbye, thank you so much." I'm kidding. Then you give recommendations, you give the run down to the parent.

Yeah, I try to give them a sense for, "All right, this is what I noticed. This is a general idea about what therapy is going to look like, either the goals that we're going to work on, I want you here once a week." We talk about therapy times. I try to always send them home with some homework.

Marisha: No, that's super helpful. I could imagine observing a session and seeing how that went. That's super helpful. Thank you, Lindsey.

Lindsey: Sure.

Marisha: Okay, so that is a wrap on our getting started tips and episodes. Stay tuned for episodes throughout the month where we'll dive more into all of the informal assessment tools, including perception tasks and dynamic assessment trial therapy. Then we'll wrap up at the end of the month with all sorts of making those recommendations and some tips to analyze what you find in your evaluation. Thank you Lindsey, and we'll be back next week.

Lindsey: Awesome, thank you.

Marisha: Thanks for listening to the SLP Now podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.