Child language assessment tools: applicability to handicapped

Abstracts

Este estudo tem como objetivo analisar testes e provas de avaliação de linguagem infantil de modo a discutir a aplicabilidade na população com deficiência física, auditiva, visual, mental e múltipla. No segundo semestre de 2011, pesquisou-se acerca das deficiências e das avaliações diretas de linguagem infantil oral, gestual e escrita, nacionais ou traduzidas. Consultou-se artigos e teses nas bases de dados online, além de livros e avaliações publicadas. Selecionou-se 28 avaliações, que foram agrupadas por objetivos de aplicação, descritas segundo estímulo e realização esperados, e analisadas pelos seguintes critérios: modalidades de avaliação, habilidades requeridas e conversão de códigos. Encontrou-se 23 modalidades de avaliação, cuja análise sugere que indivíduos que têm possibilidade de uso da visão, membros superiores e mente, e que conseguem compreender e utilizar imagem e português oral ou escrito como códigos, provavelmente terão maior gama de avaliações que os atenda. As dimensões semântica e pragmática pareceram ser as mais acessíveis, corroborando com a aplicação encontrada na literatura. Sobre a possibilidade de avaliação completa, verificou-se que apenas a dupla de habilidades "visão/membros superiores" permitiria isto. Um levantamento das informações sobre o perfil comunicativo do examinando comparado com o perfil comunicativo requisitado na avaliação auxilia na decisão sobre a compatibilidade destes e consequente aplicabilidade. No geral, consideradas as particularidades dos casos e das avaliações, instrumentos pré-selecionados poderão ser aplicáveis a indivíduos deficientes. Contudo, poderá ocorrer que, para alguns pacientes, não será possível realizar uma avaliação completa utilizando apenas instrumentos do tipo direto.

Avaliação; Linguagem Infantil; Testes de Linguagem; Barreiras de Comunicação; Transtornos da Comunicação

REVISION ARTICLES

^IInstituto Nacional de Educação de Surdos [Deaf Education National Institute], Rio de Janeiro, Brazil

^IICentro de Especialização em Fonoaudiologia Clínica, Rio de Janeiro, Brazil

Mailing Address

ABSTRACT

The purpose of this study is to analyze tests and assessments tests of child language in order to discuss the applicability of the population with physical, sensory, mental and multiple disabilities. In the second half of 2011, was researched about the deficiencies and direct evaluations of children's oral, gestures and writing language, national or translated. Articles and theses were consulted in online databases, also books and evaluations published. Were selected 28 measurements, which were grouped by goals application, described as stimulus and expected achievement, and analyzed by following criteria: modality of evaluation, required skills and code conversion. There were found 23 evaluation forms, which analysis suggests that individual who are able to use vision, upper limb and mind, and who can understand and use image and oral or written Portuguese codes, will probably have greater range of evaluation that meets. The dimensions semantic and pragmatic appeared to be the most accessible, supporting the application found in the literature. On the possibility of complete evaluation, was observed that only a couple of skills "vision/upper limb" would allow this. A survey of information about the examinee's communication profile compared to the profile required to assess communicative aids in the decision on the compatibility of these and subsequent applicability. In general, considering the particularities of cases and assessment instruments pre-selected can so be applicable to individuals with disabilities. However, it may happen that, for some patients, cannot perform a complete evaluation instruments using only the direct type.

Keywords: Evaluation; Child Language; Language Tests; Language Development; Communication Barriers; Communication Disorders

INTRODUCTION

The best indicator of child evolution, taking into account not only motor functions, but also the so called higher nervous functions, can be considered the appearance of language, as far from simply reflecting a neurological maturational process, the achievement of language expresses communication skills, social, emotional and intellectual significantly evolved and complex¹. It plays an essential role in perceptual organization and the receipt and structuring of information, learning and social interactions of human being². Early identification of changes in the development process of receiving verbal expression prevents later adverse educational and social consequences³.

Language and speaking skills depend on the child's neuromuscular integrity, sensory system, environment influences and emotional conditions⁴ Thus, although it is not possible to generalize the degree of disability and disadvantage that will be present, ⁵ children with physical⁶, hearing², visual⁷, mental⁸ or multiple⁹ disability can present changed communication skills.

According to Fieber apud Van Dijk¹⁰, all disabled children communicate, but not always using symbolic behaviors, in other words, at least a pre-verbal communication usually happens. Van Dijk¹⁰ classified the receptive pre-verbal manifestations into four cathegories: 1) tactile / kinetic signs, 2) vocal / visual signs, and 3) signs or coercive models and 4) natural gestures. While the expressive pre-verbal communication was divided into two general categories: 1) vocal signs, and 2) physical signs.

As to the verbal communication, in spite of speech to be the most known and widely used, in the case of many disabled people, because of the inability or limitation of their own, they cannot use it to communicate with others ¹¹. Still, regardless their physical, sensory, cognitive or emotional conditions, they need and have the possibility to socialize, interact, exchange, learn, play and be happy, then sometimes resorting paths or different ways ¹², including the communicative modalities.

Augmentative and/or Alternative Communication Resources (AACR) have been used with have been used with a proven positive impact on language and quality of personal and family life of individuals with severe disabilities ¹³. In the literature, the following possibilities of verbal communication used by the disabled have been found, among others, enumerated such as follows via sensory ¹⁴ and motor¹⁵ pathways, alternative or not: 1)Tactile: tactile lip reading (tadoma), tactile signaling (tactileLibras), tactile orthographic writing (braille); 2) Visual: orofacial visual reading, visible signs (LIBRAS), orthographic visible writing (conventional writing), visible sign writing (sign writing); 3) Hearing: audible speech; 4) Motor: communication systems by direct selection or scan, low, medium, or high technology, with or without support.

With all these peculiarities in language development, handicapped children are usually part of the demand of the speech therapist.

Thus, Limongi ¹⁶ points out that regardless of the theoretical model that provides the substrate for clinical practice, any therapeutic action will be both more appropriate and effective as best are made the identification of changes and their evaluation. And spells out that the evaluation takes character of vital importance to the success of therapeutic intervention, as it will be, in the course of the therapeutic process, the reference that will allow to observe the evolution of the individual, in degree and speed; responsible for the definition, maintenance or changes for better matching of the chosen strategies; the determining factor in establishing priorities and objectives to be achieved. This so important task is due to the speech therapist, raising more specific data possible concerning the expressive and receptive language of disabled individuals.

However, Paura and Deliberato ¹⁷ draw attention to the fact that the application of standardized testing in people with alternative communication needs is limited, as most of them are based on the assumption that the person can draw, see, hear, understand, speak and manipulate various types of materials, answer questions or follow instructions. On the other hand, Capovilla¹⁴ argues that such tests, which evaluate directly the speech production and comprehension are superior to usual inventories and scales to be filled by caregivers of the child, so subject to bias.

The purpose of this study is to analyze and test of evaluation of children's language to discuss the applicability in the population with auditory, visual, mental and multiple disabilities.

METHOD

In the second half of 2011, there has been a literature review in articles, theses and books about child language assessment through: a) consultation of scientific databases online, where it drew information from quotes and descriptions; b) handling of some of the reviews published.

Direct assessments (and test) of metalanguage and receptive language and\or expressive, normalized or translated into application in the Brazilian population have been selected.

Evaluative indirect tools, such as inventories and scales, have been excluded; the ones without purpose of assessment of metalanguage or child language; those which were not standardized nor translated into application to the Brazilian population.

The assessments based on the dimensions of the language described by Acosta et al have been organized¹⁸ - phonology, morphology and syntax, semantics and pragmatics -, separated from the ones involving written language - that require formal instruction - and showed them briefly as to stimuli provided and expected (Figures 1 and 2).

Before discussing the applicability in disabled people, it was required to establish analysis criteria of the evaluations that classified possible aspects to be correlated with the individual communicative manifestations of this heterogeneous population. The establishment of these criteria was done as described below.

Based on the review of the particularities of the direct assessments regarding stimulus and realization in order to delimit the variety of evaluationmodalities, the essence of the tools was extracted by means of observation of the combination reception-expression involved (Figure 3). Therefore, for example, if the stimulus contained a form, it was not considered the amount or type of it (except when it was illustratedLibras), classifying the reception as "figure"; If the achievement involves catch or mark the corresponding written expression summarized the classification "select text". It is important to emphasize that there was a separation between oral andLibras on the Portuguese form of presentation, live or not, because of the difference it makes to the tadoma or tactileLibras users who need to touch the interlocutor.

From the modalities, we analyzed the corresponding combinations of sensory/physical motor skills-required (Figure 4). For example: "figure-select writing" modality involves "vision" for the reception of conventional figure and writing, in addition to writing "higher members" to express themselves by selecting writing, forming the double "vision/upper limbs". The procedures that contain live interlocutor allow the use of touch as an option via receptive sensory without requiring adaptations for users of tadoma or tactileLibras, for this reason sometimes the sensory ratings appeared as "vision and hearing or touch", "hearing or touch" and "vision or touch".

The assessment modalities have also been analyzed as for code conversion requested (reception code - expression code) (Figure 4). Thus, for example, the mode "figure - select writing", requests the conversion "image- written Portuguese".

Established the three criteria of analysis of the evaluative instruments (methods of instruction-reply, skills required e conversion of codes that require) with their proper subgroups, the tests and exams available were resumed and organized within these criteria and objectives (Figure 5), making them ready to discuss proposal.

LITERATURE REVIEW

Twenty eight (28) evaluative direct tools have been chosen for this study. Among them, it can be seen that 08 (eight) were standardized to a specific audience of disabled: the deaf. These tools are: Lip Reading Assessment Dória model (Plof - D) ¹⁹, Lip Reading Assessment Articulatory-Phonetic model (TVPlof-FA)¹⁹, Receptive Vocabulary Test in Libras (TVRSL) ²⁰, Picture-Print Matching Test (TNF-escolha)²⁰, Picture Naming by writing Test (TNF-escrita)²⁰, Sign Naming by Choice Test (TNS - escolha)²⁰, Sign Naming by free-writing Test (TNS- escrita)²⁰ e Sign Language Assessment Tool (IALS)²¹. Among the 20 (twenty) remaining tools (Expressive Vocabulary Test or TVExp¹⁹, Auditory Vocabulary Test or TVAud¹⁹, Auditory Comprehension Test for Sentences or TCAS¹⁹, Sentence Reading Understanding Test or TCLS²⁰, Phonological Discrimination Test or TDF²², Word and Pseudo-words Repetition Test or TRPP²², Test of Phonological Awareness by Oral Production or PCFO²², Syntactic Awareness Test or PCS²², Vocabulary Test by Images Peabody or TVIP ²², ABFW-Phonology²³, Phonological Awareness Test by Choice of Figures or PCFF²⁴, Vocabulary Test by Figures USP or TVFusp²⁵, Token Test²⁶, ABFW-Vocabulary²⁷, ABFW-Pragmatics²⁸, Written Test under Word and Pseudoword Dictation or Pesd-PP ²⁸, Assessment of Reading Processes Test or PROLEC²⁹, Reading Competency Test for Words and Pseudo-words or TCLPP³⁰, Silent Reading Competency Test or TeCoLeSi ³¹ and Reading Aloud Evaluation or PLVA ³²), i.e., that do not have specific disabled as target public, in scientific articles, only the tests ABFW-Vocabulary ²⁷ and ABFW-Pragmatics ²⁸ were found being applied to the public concerned being the first in the deaf ³³ and individuals with Down syndrome ¹²and the second on deaf ³⁴individuals with Down syndrome ³⁵, autistic ^36,37 and individuals with pervasive developmental disorder not otherwise specified with mental disabilities ³⁷.

Considering the needs of adaptations to improve accessibility assessments, in addition to the traditional versions, some tests (TCLPP, TCLS, TNF, TNS and TVRSL, for instance) have received computerized versions, incorporating multimedia resources as a stimulus, such as digitized voice and graphic animation. As to the form of achievement in order to allow an assessment of people with the most severe motor disturbances, employ the paradigm of multiple alternatives that enable the examining to make choices directly via touchscreen or mouse, or indirect via serial scanning of alternatives and selection by devices sensitive, to groans, to blow, to moving any part of the body or to the change in the direction of the look. The temporal parameters of touch screen reading and scanning of alternatives can be adjusted specifically to the degree of residual motor ability of examining ³⁸.

Analyzing the 28 direct searched reviews, following the three criteria previously exposed to trace the profile of them, are found:

- 23 different modes. Since sometimes it was necessary to dismember the evidence to contain more than one modality, thereby generating 38 instruments at all it was necessary to dismember the evidence because of containing more than one modality, thus generating 38 instruments at all (Figure 3);

- 7 combinations of possible required skills. It is important to emphasize that a minimum of psychic ability is fundamental, because direct assessments depend on active participation, i.e., psychic ability is required in all modes (Figure 4);

- 11 types of double code conversion, without considering the direction of conversion (Figure 4).

In search of an overview on the applicability of direct assessments in disabled, the total number of modalities (n=23) was taken as the basis, unlike the total amount of assessments, avoid considering those very similar.

Regarding skills required, the duo that appeared among the possibilities of assessment modalities found were "vision/upper limbs" (11; 49%). And, as explained earlier, 100% of the modalities need a minimum of psychic ability. (Figure 4)

As to the code conversion, the most frequent doubles were "image/ oral Portuguese" and "image/written Portuguese" (4; 17% each). Analyzed individually, most requested codes were: for reception, the "oral Portuguese" (6; 26%) and for expression, "image" and "written Portuguese" appeared in same amount (8; 35% each). (Figure 4)

Thus, the analysis suggests that individuals who have the possibility of use of vision, of upper limbs and mind, and who can understand and use image and oral or written Portuguese as codes, will probably have greater range of direct evaluations that meet their needs.

With the organization regarding modalities and objectives, you can check that evaluations of phonology appeared in 4 different modalities, morphology and syntax in 3, semantics in 9, pragmatic in 2, reading in 7 and writing in 4 (Figure 3). Being so, the evaluation of semantic dimension seemed to be the most accessible by offering greater variety of benchmarking options, but it is important to note that, as one of the reviews of pragmatic dimension lies in the "free interaction-free interaction", this should also be considered as quite affordable, which corroborates with the application found in the scientific literature.

About the possibility of full assessment (language dimensions + written language) using the same type of modality or double of skill or code conversion, it was possible to verify that only the duo of skills "vision/ upper limbs" would allow this completeness. The mode that most managed to encompass different goals (evaluating the dimensions of language, but not coming to assess reading and writing) was "cartoon - retell inLibras", consequently the code conversion which also did this was "image/LIBRAS", both because of the richness of data collection allowed by sub-item expressive language of "Sign Language Assessment Tool -IALS" ²¹; for the aspects of reading and writing, 4 options of conversion were regularly available: "LIBRAS/written Portuguese", "LIBRAS illustrated /written Portuguese", "oral Portuguese /written Portuguese" and "written Portuguese/written Portuguese". (Figure 3).

CONCLUSION

In general, on the applicability of direct assessments to disabled people, the deaf are at an advantage on the possibility of using direct assessments with tools specifically designed for them and the physically and motor handicapped can benefit from automated versions, which allow adaptations to residual abilities.

As to the applicability of direct assessments to meet the individuality of the disabled, considering the fact that there is no fixed correspondence between the type of disabilities and the degree of incapacity, or the degree of disadvantage, or the present communicative (ies), it is not possible to generalize and offer ready list on which repertoire of evaluative instruments will be more appropriate. Including such a statement is still valid that the evaluation instrument has been specifically created for certain disabilities. As an example, it may be cited the case of deaf individuals, who may or may not have contact withLibras and/or oral Portuguese and/or written Portuguese. If a particular deaf does not knowLibras, one cannot assert that certain test or proof, which was done for the deaf and contains this language applies to him.

However, in the midst of this search, data that help the therapist select the set of reviews relevant to the individuality of his patient ended up being made available. To do this, it is simply necessary that in possession of Figure 3, the possible modalities are delimited to examining, among the exposed as characteristics of evaluative instruments, and an assessment in each goal is selected. The answer about the applicability of the assessment tools will be in compatibility between the profile comparison of evaluations (modalities, skills required, and code conversion) and the patient's profile.

And yet, if one wants to apply an instrument that was not exposed in this study, as just being formulated a proposal to draw the profile of the assessments, the tool in question can be analyzed as is done with the other and fit it in the table in Figure 5.

Not all tests and evidence reviewed here were created for the population with disabilities, but it was sought to draw attention to this demand, at the same time that there was an attempt to minimize the barriers imposed by the shortage of direct evaluative resources that are accessible to users of the various forms of alternative communication.

Considered the particularities of cases and assessments, pre-selected instruments may be applicable to individuals with disabilities. However, it may occur that for some patients, it is not possible to perform a complete evaluation (dimensions of language + reading and writing) using only instruments of direct type.

As more research about the diversification of modalities of child language assessment tools are implemented and available, the greater the range of compatible tools of implementation in the disabled population with communication special needs.

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Child language assessment tools: applicability to handicapped

Cristhiane Ferreira Guimarães^I; Adriana Leico Oda^II

Publication Dates

• Publication in this collection
  24 Jan 2014
• Date of issue
  Dec 2013

History

• Received
  16 Mar 2012
• Accepted
  01 July 2012