Evaluating the speech and language skills of any individual is no easy task, but it can appear even more daunting if the person has complex communication needs (CCN). By balancing formal tests with informal assessments and using different therapeutic strategies, you can get a great snapshot of your student’s performance. These are tools, tips, and techniques that I have used, learned, and honed through my six years of working with students with CCN that I recommend keeping in mind!
The Communication Matrix is your friend
The Communication Matrix is a free, online tool that asks simple questions about what communication behaviors an individual is demonstrating at seven different levels of communication. It examines what communication behaviors the student is using for different communicative functions, such as gaining attention, expressing comfort, requesting an object, or protesting. This is great for any student, regardless of what type of communication system or access point they use. Plus, you can complete it on your own or with other team or family members.
Working on the matrix with family members can demonstrate how an individual might be communicating at different levels in different places like in the home or at school. For example, a student’s matrix might show that they primarily use unconventional communication, such as early sounds and body movements at home but they are beginning to use abstract symbols, such as picture symbols or words at school.
The best part is that it generates a colored table to show parent’s exactly where their child’s strengths and weaknesses are which makes comparison in future years easier!
Try the Functional Communication Profile – Revised (FCP-R)
The Functional Communication Profile, or FCP-R, examines areas such as attention, sensory and motor skills, and expressive and receptive abilities which affect a person’s overall communication. Although it is informal, it provides a lot of detailed information about different skill sets. It lists a skill and you simply check off if and how the patient is doing it.
For example, under the receptive language area, you can check off which routine directions they can follow (e.g., “sit down”, “stand up”, “come here”), and under the expressive language area, you can check off how they use objects (e.g., “for intended use”, “randomly”, “unable due to motor restriction”).Sometimes I’ll mark a skill down as “+/-” to indicate it is an emerging skill.
This assessment is completely subjective, so, much like the matrix, it's great to complete with team and family members so you can get a more full picture of the student’s abilities. This can be used to evaluate students with a wide range of abilities because it allows you to score skills as “unable” or “N/A” if it is a skill not yet demonstrated. There is also an Early Functional Communication Profile, for use with younger children.
Use formal assessments informally
Graduate school teaches that standardized tests are not normed on students with disabilities, but that does not mean that they can’t offer good information! If students have the motor ability to participate in tests that require touching pictures (think Clinical Evaluations of Language Fundamentals or Receptive One-Word Picture Vocabulary Test) or manipulating objects (think the Preschool Language Scales), pick some subtests or tasks and give it a try!
You can also try to adapt the assessment to use with students who access materials differently. For example, one of my co-workers has started adapting the Receptive One-Word Picture Vocabulary Test so that we can use it with our students who use eye gaze to communicate.
You may find some emerging concept or pretend play skills to guide your treatment. You can even try informally using tests meant for younger individuals with older students. Make sure you write a statement in your report that “results are for comparison purposes only because this assessment was not normed on students with disabilities” and detail any adaptations you made to the original procedure.
Tips and Techniques
Include Augmentative and Alternative Communication
Make sure to include what AAC system the individual is using and make note if and when the student responded to test items using their speech-generating device (SGD). You never know when the student might respond to an expressive task using their SGD, so make sure to record if they explored it, looked at related words, or said words that sounded similar!
It’s also important to include any AAC systems you are currently trialing, or have trialed in the past, in your report. This can also include the display types, positioning, and access points you have considered. Not only are you documenting what strategies work best for the student, but you are also helping future clinicians understand the student’s history. For example, you can document that you trialed a single message SGD accessed at three different body parts, and found that the individual was most successful accessing it at the left foot.
Test out the Augmentative-Alternative Communication Profile
If the student has their own SGD, the AAC Profile gives great information on the linguistic, strategic, and operational skills needed to be a competent AAC user. You can even complete it with different communication partners to see if the individual is communicating differently with other people or in different contexts. From there, you can more easily identify areas of weakness., and these areas of weakness can become your goal areas and help plan your therapy. This is also another great assessment for tracking progress over a few years.
Wait for it
The standard procedure for administering a formal assessment typically requires about 10 seconds of response time. Individuals with CCN need (and deserve!) more response time than that. During assessments, your patients might even require more time than they do during routine therapy activities because the tasks are novel and rigorous.
When administering an assessment, you have to read the directions in a specific way, and there are only one or two trial items to introduce the concept or task to the student. This can lead to even more confusion. Waiting and letting students take their time allows them time to process what you are asking of them and do their best.
It’s okay to prompt
Provide repetition and gestural prompts as necessary and record what prompts helped the individual to succeed when they attempted different tasks. This can be beneficial when determining what skills are emerging and when writing goals for these skill areas.
An individual might be able to follow one-step directions independently but needs the second half of a two-step direction repeated to be successful. If you didn’t provide the necessary prompts while assessing, you wouldn’t know they demonstrated emerging skills in this area.
Consider the impact of an individual’s diagnosis
Many students with CCN have complex motor impairments that make it difficult for them to touch pictures or manipulate objects. They may have cortical visual impairments that make it difficult for them to see pictures in a testing book. Keep in mind how these impairments might affect their ability to participate in an assessment, and write a justification.
As you take notes, you can include things like, “The patient’s cortical visual impairment may have impacted their performance on the Receptive One-Word Picture Vocabulary Test because they are still learning to look at pictures or objects in a field of 4. This can also be attributed to the patient struggling with looking and reaching at the same time.”
Test above the ceiling
This is also against standardized procedures, but individuals with CCN already don’t fit the standardization. If you are wondering about a patient’s skill areas that are above the ceiling item, check them out!
Many students with CCN demonstrate skills at a wide range of developmental levels, but most evaluations are set up to test in the order that skills are traditionally developed.
If you always follow standardized procedures to a "T," you might miss some strengths and emerging skills that are at a higher developmental level than the other skills the student is demonstrating.
Celebrate the positives
Students with CCN have tons of skills, but sometimes it can be difficult to uncover them. Perhaps they’re nonverbal, an emerging communicator, or they have different access points such as eye gaze or switch scanning. As their SLP you have to avoid being discouraged because this can discourage the parents, caregivers, and even the student themselves! All of their behavior is communication, and even the smallest changes, such as learning to protest or participating in a pretend play routine for one minute, should be celebrated.
Although it might not always be apparent at first glance, individuals with CCN have tons of abilities and lots to communicate about. These tips can help you get a thorough picture of what they are doing now, with or without support, so that you can plan your therapy targets, guide parents, caregivers, and team members, and help students be the best communicators they can be!