Comprehensive Assessment of Elementary Aged Children with Subtle Language and Literacy Deficits

Lately, I’ve been seeing more and more posts on social media asking for testing suggestions for students who exhibit subtle language-based difficulties. Many of these children are typically referred for initial assessments or reassessments as part of advocate/attorney involved cases, while others are being assessed due to the parental insistence that something “is not quite right” with their language and literacy abilities, even in the presence of “good grades.”

Hence, today I wanted to dedicate this post to a review of helpful assessment options (standardized and clinical) available for students 6:00-11:11 years of age with suspected subtle language and literacy deficits.

As mentioned in several previous posts, most comprehensive standardized assessments, “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, p 35) (pg. 8 in the link). Very few of them actually incorporate aspects of literacy into their subtests in a meaningful way.   One comprehensive test, which does an excellent job at incorporating literacy into its assessment is the Test of Integrated Language and Literacy (TILLS) for students 6-18 years of age. Not only does it assess skills such as nonword repetition, nonword reading, reading fluency, reading comprehension, nonword spelling and writing, etc, one of its major appeals is that it possesses excellent psychometric properties as it did not include students with language and learning disorders into its normative sample.

But a good quality comprehensive language assessment is only the beginning for many students with subtle language difficulties. Additional careful testing selection will be needed in order to tease out a variety of subtle language and literacy deficits of elementary-aged children.

The first step in this process is to understand exactly what difficulties the student is displaying in the school setting as well as at home. For that purpose, I recommend distributing comprehensive checklists to parents and teachers so they could identify the students’ specific deficit areas for identification of best testing batteries to administer. Once the checklists have been filled out, the next step is to assemble the best possible battery of tasks to tease out the student’s subtle language and literacy difficulties.

Below are a few suggestions of standardized testing measures aimed at targeting the identification of subtle language and literacy difficulties in elementary-aged students.

Comprehension of Ambiguous and Figurative Language (e.g., idioms, ambiguous expressions, etc.)

• Select Subtests from the Clinical Evaluation of Language Fundamentals -5 Metalinguistics (for children 9+ years of age)
  • • The Multiple Meanings subtest of the CELF-5:M actually does quite a decent job evaluating the student’s ability to recognize and interpret different meanings of selected lexical (word level) and structural (sentence level) ambiguities.
    • The Figurative Language subtest of the CELF-5:M may also be quite useful for the evaluation of the student’s ability to interpret figurative expressions (idioms) within a given context. However, the multiple-choice option of matching each expression with another figurative expression of similar meaning is not representative of authentic real-life experiences. As a result of the presence of the multiple-choice option, score overinflation may occur with those children who do well given compensatory strategies but who have difficulty generating novel spontaneous responses.

Semantic Flexibility (e.g., generation of definitions, synonyms, antonyms, multiple-meaning words, etc.)

• The Metalinguistics subtest from the Expressive Language Test–Second Edition: Normative Update (ELT-2: NU)
  • • The Metalinguistics-Defining subtest of the ELT-2 assesses the student’s ability to define abstract words pertaining to language (e.g., explain the meaning of words such as poem, verb, sentence, compound word, question, etc.). Metalinguistics refers to the ability to think about, talk about, and manipulate language. Metalinguistic skills are necessary for classroom learning.  Students who demonstrate competency in this area show an understanding of how language works.  Students with poor metalinguistic skills have difficulty learning to read, write, and spell. They may not know that spoken words are made up of smaller units of sounds that have beginnings and endings. They may not know that words can form sentences or paragraphs. Students with poorly developed metalinguistic skills cannot use language to talk about concepts like sounds, words, letters, titles, or stories.
    • The Flexible Word Use subtest from the WORD-3 Elementary assesses the student’s ability to provide two different meanings for verbally presented words without using the presented word in the actual definitions.

Social Communication

• Social Language Development Test Elementary (SLDTE-NU)
  • Beware of the Supporting Peers subtest as a high score on that subtest coupled with low scores across other subtests may be indicative of social immaturity and being “easily led” by others
    • Can be supplemented with Informal Social Thinking Dynamic Assessment Protocol®
• Clinical Assessment of Pragmatics (CAPs) (Particularly noteworthy subtests below but this test can certainly be administered in its entirety)
  • • Social Context Appraisal (SCA) subtest (Reading Context Cues) requires the student to engage in effective perspective-taking (assume mutual vs. individual perspectives) by identifying sarcasm, irony, and figurative language in the presented video scenarios. The student is then asked to provide a coherent and cohesive verbal explanation and effectively justify own response.
    • Affective Expression (AE) subtest (Expressing Emotions) assesses the student’s ability to effectively display empathy, gratitude, praise, apology, etc., towards affected peers in the video scenario. It requires the usage of relevant facial expressions, tone of voice, as well as stating appropriately supportive comments.
    • Paralinguistic Signals (PS) subtest (Using Nonverbal Cues) assesses the student’s ability to appropriately use facial expressions, gestures, and prosody (act out vs. recognize and interpret facial expression and gestures). This includes showing appropriate expression of empathy, frustration, alarm, excitement, gratitude, etc., exhibiting relevant inflection in prosody as well as showing appropriate to the situation facial expression (vs. having inappropriate message intent, be monotone, have flat affect, etc.)

Select Literacy Tests for Students with Subtle Deficits

• Word Fluency
  • Rapid Automatized Naming/Rapid Alternating Stimulus  RAN/RAS (5-10 mins to administer)
    • RAN is a consistent predictor of reading fluency in all orthographies and is a quick a reliable way to determine adequate reading fluency via timed tasks.
•  Word Reading
  • The Test of Silent Word Reading Fluency (TOSWRF-2) (3 mins to administer)
    • Assesses the students’ ability to recognize printed words accurately and efficiently
  • Test of Silent Contextual Reading Fluency (TOSCRF-2) (3 mins to administer)
    • The TOSCRF-2 is a companion to the Test of Silent Word Reading Fluency- Second Edition (TOSWRF-2). While the TOSWRF-2 measures a student’s ability to recognize individual words accurately and efficiently, the TOSCRF-2 measures a student’s essential contextual reading abilities (i.e., word identification, word meaning, word building, sentence structure, comprehension, and fluency).  

Spelling

• Spelling Performance Evaluation for Language & Literacy-2 (SPELL-2) 
  • For FREE Alternatives there are several spelling tests available HERE
    • The Diagnostic Spelling Test – Nonwords (DiSTn) tests a person’s knowledge of English sound-letter-rules. 
      
    • The Diagnostic Spelling Test for Irregular Words (DiSTi) tests how well a person can spell irregular words.
    • The Diagnostic Spelling Test – Sounds (DiSTs) tests if a person can represent some of the very frequently occurring sounds in the English language using the appropriate letter(s).

But of course, when it comes to subtle language difficulties standardized tests possess well-known limitations. Hence, a clinical assessment becomes a required component of all comprehensive evaluations for these clients.

Several areas of language particularly lend themselves to clinical assessment. These include discourse/narratives, reading fluency/comprehension as well as written composition.

First up, narrative assessment. I personally like use the SALT Elicitation Books, which can also be purchased on Amazon or at library sales, etc.  FREE Scripts and Rubrics can also be accessed on the SALT Website.

• Frog Where Are You (Mercer Mayer, 1969)
  • Preschool-1st grade
• Pookins Gets Her Way (Helen Lester, 1986)
  • 2nd grade
• Porcupine Named Fluffy (Helen Lester, 1987)
  • 3rd grade
• Dr. De Soto (William Steig, 1982)
  • 4-6th grade

For in-depth information on how to analyze narratives using these books and scripts, the following posts may be helpful

• Analyzing Narratives of School-Aged Children
• Identifying Word Finding Deficits in Narrative Retelling of School-Aged Children
• The Importance of Narrative Assessments in Speech-Language Pathology 

Next up, is the assessment of reading fluency and comprehension. For this purpose, I tend to use one-page long grade level or below grade-level texts from a Continental Press series entitled: Content Reading for Social Studies & Science Grades 3-7.  I ask the students to read the text aloud, and time the first minute of their reading in order to analyze the oral reading fluency or words correctly read per minute (WCPM). Typically if a child with seemingly “solid” language abilities, is a poor reader, I will use a below grade-level text. This allows me to starkly illustrate the extent of the student’s reading difficulties. Additional clinical reading assessment components include main idea identification, passage summary, answering factual and inferential questions, defining select vocabulary words, as well as recalling text details.

For in-depth information on how to analyze the results of clinical reading assessments, the following posts may be helpful:

• Clinical Assessment of Reading Abilities of Elementary Aged Children
• Adolescent Assessments in Action: Clinical Reading Evaluation

Finally, assessment of writing mechanics and composition should be an integral part of every evaluation of students displaying subtle language deficits. It is very important to understand that writing is the most advanced form of language competence. While students with subtle language difficulties may mask them effectively at the level of oral communication and sometimes reading, they are far harder to conceal when it comes to writing competence. Assessment components will include penmanship, grammar, syntax, semantics, pragmatics, punctuation, capitalization, spelling, etc. These will be cross-referenced against both: developmental milestones as well as common core standards per grade level in order to analyze how the student’s writing abilities compare to grade-level peers. For students under 10-6 years of age, I tend to use a variety of grade-level prompts, salient to their interests such as:

1.  Should kids have a set bedtime every night? Why or why not? 
2.  Explain what it takes to be someone’s friend. What are some good qualities friends should have?
3. What do you think should be done with students who bully other students? What do you think will help them learn to treat people well? 
4.  Write a persuasive letter to your teacher to convince her not to give homework. Give 2-3 reasons why you shouldn’t have homework.  
5. Should students make up missed school days after the school ends in the summer? Why or why not? 

For children 10-6 and older, I use the “Circus Controversy” prompt, described by Nippold and colleagues in a 2005 study, HERE. That study contains helpful information regarding the scoring criteria for the prompt including, abstract nouns, metaverbs, adverbial conjuncts, clauses, fragments, subordination, etc.

For in-depth information on how to analyze the results of clinical writing assessments, the following posts may be helpful: 

• Clinical Assessment of Elementary-Aged Students Writing Abilities: Suggestions for SLPs
• Components of Qualitative Writing Assessments: What Exactly are We Trying to Measure?
• It’s All Due to …Language: How Subtle Symptoms Can Cause Serious Academic Deficits

It is very important to understand that students presenting with subtle language and literacy deficits will not outgrow these deficits on their own.  Consequently, SLPs must consider the “underlying deficits that may be masked by early oral language development” and “evaluate a child’s language abilities in all modalities, including pre-literacy, literacy, and metalinguistic skills” (Sun & Wallach, 2014).

There you have it. These are my suggestions as pertaining to helpful assessment options for SLPs tasked with assessing students 6:00-11:11 years of age with suspected subtle language and literacy deficits.

How about you?  What type of assessment batteries are you using to assess your elementary-aged students’ subtle language and learning difficulties and why do you like using them? Please feel free to comment below to share your knowledge with our readers.

Helpful Narrative Related Materials:

1. Clinical Assessment of Narratives in Speech Language Pathology
2. Narrative Assessments of Preschool, School-Aged, and Adolescent Children
3. Narrative Assessment Bundle
4. Evidence Based Narrative Interventions via Use of Picture Books
5. Improving Critical Thinking Skills via Picture Books in Children with Language Disorders