Professional Documents
Culture Documents
represented in functional architecture models. For abilities. When recommended, the treatment may
example, as shown on Figure 1, the ability to orally focus on the impaired levels of processing (i.e., function
produce a word in picture naming is conceived as a restoration) or on alternative processing routes (i.e.,
staged process in which the activation flow is initiated function reorganization) that will allow the client to
in a conceptual-semantic component and ends with communicate successfully.
the execution of articulation mechanisms.
An assessment process based on cognitive neuro-
psychological models consists in the localization of Classical Tests for the Assessment
the impaired and preserved processing components of Aphasia
for each language modality. This localization is per- Aphasia is the most common disorder of communi-
formed through the administration of specific tasks or cation resulting from brain damage (i.e., stroke,
test batteries (e.g., Psycholinguistic Assessments of brain tumor, head trauma, infections). This affection
Language Processing in Aphasia [PALPA]; Kay et al., mainly involves language problems of production and
1992) aiming at the evaluation of each component comprehension as well as disturbances in reading and
and route of the model. For example, the evaluation spelling.
of naming abilities in an aphasic person could
be performed by the administration of tasks exploring Bedside and Screening Tests
the conceptual-semantic (e.g., semantic questionnaire),
phonological output lexicon (e.g., picture-naming task The patient’s symptoms change rapidly during the
controlled for frequency, familiarity, etc), and phono- first days and weeks following the brain damage.
logical output buffer (e.g., repetition of words and Moreover, patients are often too ill to complete an
nonwords controlled for length) components. Impor- exhaustive aphasia examination and bedside or
tant information regarding the level of impairments screening instruments may be useful to advise rela-
also arises from error analysis. With the same example, tives and health care professionals about the global
an anomic behavior could arise from distinct under- communication profile and the best means to com-
lying deficits (e.g., in the activation of conceptual- municate in functional situations. These instruments
semantic representations or in retrieving phonological are also useful to help clinicians to determine the
forms of words in the output lexicon), leading to dis- necessity of performing a more thorough and exten-
tinct types of errors (e.g., semantic substitutions, pho- sive assessment of language or to establish the priority
nemic errors). The complete cognitive assessment of patients on a waiting list. In addition to actual
process should allow the clinician to understand the screening tests (e.g., Aphasia Screening Test; Reitan,
client’s deficits (i.e., surface manifestations, underlying 1991; for an extensive list see Murray and Chapey,
origins, affected components) as well as to identify 2001 and Spreen and Risser, 2003), clinicians also
the strengths and weaknesses in his communication may administer shortened versions of comprehensive
tests of aphasia (e.g., short form of the Token Test;
Spellacy and Spreen, 1969; for an extensive list see
Murray and Chapey, 2001). As pointed out by Spreen
and Risser (2003), although bedside and screening
tests may be used to identify language impairments
in moderate and severe aphasics (language is obvious-
ly affected, even in simple and natural communica-
tion situations), they are inappropriate or of little use
to distinguish the responses of individuals with mild
deficits from those with normal language skills.
output of a comprehensive examination may consist Comprehension Test; Brookshire and Nichols, 1993).
in the identification of a particular diagnostic of apha- Other tests are available for measuring verbal expres-
sia with the description of severity of deficits in each sion, spoken and written naming, verbal fluency,
language area (clinicopathological approach), or in reading, writing, gestural abilities, etc. An extensive
the localization of specific impairments affecting list of specific language function tests can be found in
functional processing components of language skills Spreen and Strauss (1998), Murray and Chapey
(cognitive neuropsychological approach). (2001), and Spreen and Risser (2003).
There are several classical comprehensive examina-
The Assessment of Functional Communication
tions and aphasia batteries. The most widely used in
clinical and research settings in English are BDAE Traditional tests provide useful information on lin-
(Goodglass et al., 2000), the Western Aphasia Battery guistic abilities and language impairments in aphasia.
(Kertesz, 1982), and the Aphasia Diagnostic Profiles However, performance on these tests does not neces-
(Helm-Estabrooks, 1992). All these standardized test sarily predict how a person will communicate in more
batteries comprise different subtests (e.g., BDAE has 27 naturalistic settings and everyday life. Instead of
subtests) that assess all the dimensions of language in focusing on the importance and the nature of deficits,
order to diagnose and classify aphasic syndromes the functional communication approach of ass-
according to clinical localization-based classifications essment aims at the impact of these deficits on the
(i.e., Broca’s, Wernicke’s aphasia, etc.). For a complete person’s activities and participation in society. Func-
description and a critical review of these instruments, tional communication skills may be assessed with
and others not reported here, see Spreen and Strauss specific structured tests or by rating scales and inven-
(1998), Murray and Chapey (2001), and Spreen and tories of communication profiles. Structured tests
Risser (2003). PALPA (Kay et al., 1992) is a compre- such as Communication Activities of Daily Living 2
hensive test battery directly derived from the cognitive (Holland et al., 1999) and the Amsterdam–Nijmegen
neuropsychology approach of assessment. This aphasia Everyday Language Test (Blomert et al., 1994) have
battery, commonly used in the United Kingdom, con- been devised to explore functional communication
sists in a set of resource materials comprising 60 rigor- skills using role-play in daily life activities (shopping,
ously controlled tests that enable the user to select tasks dealing with a receptionist, etc.) and have shown
‘‘that can be tailored to the investigation of an individ- themselves to be useful to track progress over time.
ual patient’s impaired and intact abilities.’’ The scoring However, while they are certainly more ecological
and analysis of errors give the clinician a detailed pro- than comprehensive examinations and tests for specific
file of language abilities, including reading and written aspects of language, structured tests of functional com-
spelling, which can be interpreted within current cog- munication do not necessarily give reliable views of the
nitive models of language. As compared to classical communication skills of a person in real-life situations.
batteries of aphasia, the versatile and flexible nature In this respect, rating scales and inventories of commu-
of PALPA is, however, lessened by the lack of standar- nication profiles are closer to functional situations. For
dization and validity/reliability measures. example, the Functional Assessment of Communica-
tion Skills for Adults (Frattali et al., 1995) is a rating
Tests for the Assessment of Specific
protocol of 43 items, on a seven-point scale, based on
Aspects of Language
the observations made by the speech-language pathol-
Specific aspects of language behavior can also be ogist or other significant person in the following four
assessed through the administration of several tests. domains: social communication (e.g., ‘refers to familiar
These are often used to complete aphasia batteries but people by name’); communication of basic needs (e.g.,
some of them also are used as screening tests. Clin- ‘makes needs to eat’; reading, writing, and number
icians may select these tests according to the different concepts (e.g., ‘writes messages’); and daily planning
aspects of language they want to explore in depth, but (e.g., ‘tells time’). For a more extensive description of
also according to the underlying theoretical model of these functional communication tools, and others not
assessment. For example, comprehension may be test- described here, see Murray and Chapey (2001) and
ed through the administration of specific tests aiming Spreen and Risser (2003).
at the discrimination of phonemic sounds (Phoneme
Discrimination Test; Benton et al., 1994), seman- Classical Tests for the Assessment
tics (Pyramids and Palm Trees Test; Howard and of Speech and Language Impairment
Patterson, 1992), sentence length and syntactic com-
in Children
plexity (Auditory Comprehension Test for Sentences;
Shewan, 1979), commands (Token Test; De Renzi The assessment of language and communication
and Vignolo, 1962), or narrative discourse (Discourse in children can take place from infancy through
442 Classical Tests for Speech and Language Disorders
adolescence, when cognitive abilities are developing. Denver Developmental Screening Test II (Frankenburg
Therefore, the language assessment process must not et al., 1990), a standardized screening battery for
only inform on current specific abilities, but has also children from birth to age 6, is designed to test the
to capture changes over time in the level, sequence, child’s abilities in the following four sectors: person-
and rate of acquisition. The interrelationship between al-social, fine motor, gross motor, and language (in-
language and other cognitive and social skills is also cluding expressive-receptive vocabulary). Screening
of primary importance. As a part of a larger process, tests may also consist in large batteries exploring
usually performed by different professionals, the eval- language and cognitive functions through tasks of
uation of language in children should be completed general verbal and nonverbal intellectual abilities.
by an assessment of nonverbal communication, play For example, the Wechsler Intelligence Scale for Chil-
and social skills, perception, attention and memory, dren IV (Wechsler, 2004) is the most widely used
behavior, etc. Moreover, because of the major influ- measure of verbal and nonverbal intelligence in indi-
ence it has on child development, the evaluation also viduals from age 6 years 0 months to 16 years 11
has to consider the familial and social environment, months. As a screening tool, this battery consists in
especially with respect to adult–child interaction. The 16 subtests of verbal comprehension, perceptual
different components (e.g., sensitivity, promptness) as reasoning, working memory, and processing speed
well as the context (e.g., physical settings, types of skills.
play, activities) in which this interaction takes place For school-age children, some large screening bat-
should be analyzed through specific assessment tools teries specifically concern academic achievement.
or through direct observation. That is, for example, the case with the Peabody Indi-
The assessment of preschool children (children vidual Achievement Test – Revised (PIAT-R; Mark-
aged 2 to 5 years) and school-age children (5 to 10 wardt, 1998), which provides a screening measure of
or 12 years) is usually based upon a combination achievement in the areas of mathematics, reading
of parent interviews, standardized tests, criterion- recognition and comprehension, spelling, and general
referenced instruments, developmental scales, and information. However, most of the tasks of these
observations. All these tools and methods aim to large screening batteries are multifactorial and are
explore both receptive and expressive language abil- therefore not appropriate to assess specific language
ities in semantics, morphology, syntax, phonology, or cognitive processes. For this purpose, clinicians
and pragmatics. Collecting a communication sample may select among various specific screening tests for
is also a frequently used method to analyze commu- preschool and school-age children that focus only on
nication in terms of sentence length, intelligibility of language. Most of these instruments are designed to
speech, vocabulary, and conversational strengths and explore the different language components. That is
weaknesses. Similarly to tests for aphasia, preschool the case, for example, with the Fluharty Preschool
and school-age tests can be divided into two major Speech and Language Screening Test II (Fluharty,
categories: screening and diagnostic tests. The pur- 2001), which explores articulation, expressive and
pose of screening tests is to determine if the child’s receptive vocabulary, and composite language in
communication should be explored more extensively children from 2 to 6 years old. An exhaustive list
for the presence of a possible impairment. On the of norm-referenced standardized screening tests of
other hand, the main purposes of diagnostic tests is language can be found in Paul (2001).
to establish the presence or absence of a deficit in one
or more areas of language, to identify a possible Comprehensive Examinations and Batteries
difference in language development, to determine As for screening, some diagnostic tools are designed
the child’s eligibility for clinical services, and to iden- to explore language skills as well as other aspects of
tify the targets for intervention. These instruments are development. That is the case, for example, with the
devised to assess language development by reference Communication and Symbolic Behavior Scales Devel-
to the parameters of the normal range. opmental Profile (Wetherby and Prizant, 1998),
which includes tasks exploring expressive and recep-
Screening Tests
tive language, symbolic play, and nonverbal commu-
Screening tests are usually inexpensive and require nication in children from 6 to 24 months old. Another
minimal time for administration and interpretation of example is the Rossetti Infant-Toddler Language
results. Many norm-referenced standardized instru- Scale (Rossetti, 1990), which is used to assess attach-
ments may be used to establish the child’s general ment, play, gestures, and pragmatics, as well as lan-
level of expressive and receptive language functioning guage comprehension and expression in children
as well as other areas of functioning. For example, the from birth to 3 years old. There are also several
Classical Tests for Speech and Language Disorders 443
standardized comprehensive batteries of language vocabulary in individuals from age 2 years 6 months
processing that comprise tests exploring exclusively to adult. A more complete description of available
some or all of the language areas. That is the case, diagnostic tests adapted to preschool and school-age
for example, with the Preschool Language Scale 4 children can be found in McCauley (2001), Paul
(Zimmerman et al., 2002), which is used to identify (2001), Mattis and Luck (2002), and Haynes and
specific strengths and weaknesses in receptive and Pindzola (2003).
expressive language skills in children from birth to
6 years 11 months. The Clinical Evaluation of The Assessment of Reading and Writing
Language Fundamentals 4 (Semel et al., 2003) is a The relationship between language acquisition and
multidimensional battery that can be used in indivi- academic achievement is well established. Develop-
duals between the ages of 5 and 21 years to explore mental disorders of language in preschool children
semantics, expressive and receptive language, and are frequently associated with later difficulties in
syntax, as well as working memory. The Compre- learning to read and write. The most common referral
hensive Assessment of Spoken Language (Carrow- for a speech-language pathology assessment concerns
Woolfolk, 1999), designed for children from age 3 school-age children who encounter problems in pro-
to 21, is another comprehensive battery of language gressing beyond the developing language phase and
skills, comprising 15 tests that provide an assessment present with difficulties in learning and acquiring
of expressive and receptive skills in four language communicative and academic skills. As for other
categories: lexical/semantic, syntactic, supralinguis- populations, but especially at this stage of develop-
tic, and pragmatics. An extensive list of avail- ment, a significant difficulty in assessing school-age
able comprehensive examinations and batteries of children arises because of important comorbidity
language for children can be found in McCauley between language and learning disorders and other
(2001), Paul (2001), Mattis and Luck (2002), and cognitive and clinical pathological profiles, such as
Haynes and Pindzola (2003). attention deficit/hyperactivity or executive function
disorders. Therefore, the assessment process should
Tests for Specific Aspects of Language
include specific tests of language and communication
Different components of language can be affected but also instruments designed for exploring other
with more or less intensity in children according to cognitive functions, such as attention, working mem-
the origin of developmental disorders. Therefore, the ory, and executive functions. In addition to formal
in-depth assessment of language and communication tests, another important source of information also
disorders in children is a critical component in the comes from structured interviews of the child himself,
clinical process. Core tests can be used to evaluate his parents and his teacher. With respect to language,
each of the language areas in order to identify specific phonological processing deficits are considered as an
impairments, establish baselines, and identify precise underlying cause of dyslexia and also play a role in
therapeutic and intervention goals. For example, developmental disorders of spelling. For example,
there are several core tests and instruments for the dyslexic children often show problems with word
evaluation of word retrieval (e.g., naming and verbal and nonword repetition tasks, phonological aware-
fluency tests), phonology (e.g., word and nonword ness tasks (e.g., word and nonword segmentation
repetition tests), receptive and expressive vocabulary tasks, phoneme manipulation, etc.), and working
(e.g., word definition tests), receptive and expressive memory tasks for verbal material (i.e., word or digit
syntax and morphology (e.g., sentence-to-picture span tasks). The semantic processing is another cog-
matching tests), and pragmatic skills (e.g., narrative nitive area highly related to reading and writing.
production, story comprehension tests). School-age children usually learn new words through
A combination of different tests, each focusing on reading and writing. Those who encounter problems
specific language components, may also be used to in reading and writing often present with poor
establish such a language and communication profile. vocabulary as well as with difficulty in word associa-
For example, to assess vocabulary, clinicians may tion and comprehension. Therefore, the assessment
select the following standardized norm-referenced procedure for written language problems should be
specific tests: the Expressive One-Word Picture part of a more exhaustive evaluation of language and
Vocabulary Test Revised (Gardner, 2000), to exclu- cognition. It should also include a close control of
sively explore expressive vocabulary in individuals psycholinguistic parameters (e.g., orthographic regu-
ages 2 years 0 months through 18 years 11 months; larity, lexical frequency) that are known to play an
or the Peabody Picture Vocabulary Test (Dunn important role in written and spoken word recogni-
and Dunn, 1997), to exclusively explore receptive tion, reading comprehension, phoneme–grapheme
444 Classical Tests for Speech and Language Disorders
conversion, decoding, etc. However, very few stan- language and cognitive tests performed to exclude
dardized assessment tools fulfill these conditions. As other possible disease processes or identify specific
an exception, French-speaking clinicians may use the forms of a given disease. In that particular domain,
Batterie d’Évaluation du Langage Écrit et de Ses the assessment of speech and language usually includes
Troubles (Mousty et al., 1994), a written-language- tests allowing for differential diagnosis. For example,
testing battery based on current models of reading tests that specifically tap either semantic processing
and writing, to assess children between the ages of 7 or written spelling can contribute to differentiating
and 12 years. In addition to experimental tasks, one common disease processes in the elderly population.
can resort to standardized achievement or specific Semantic deficits are prominent characteristics of indi-
tests of reading and writing skills. Among the most viduals diagnosed with Alzheimer’s disease and these
used of achievement tests are PIAT-R (Markwardt, individuals usually differ from patients diagnosed with
1998), which comprises subtests of reading compre- vascular dementia or frontotemporal dementia because
hension, reading recognition, and spelling, and the of the presence of surface dysgraphia, a specific spelling
Wide Range Achievement Test (Wilkinson, 1993), a disorder.
brief test measuring reading recognition, spelling, and It is obviously not possible to exhaustively describe
arithmetic computation. For a description of specific here the various tests adapted to special populations.
clinical tests of reading and writing, see Spreen and The reader will find a more complete description of
Strauss (1998) and Bailet (2001). such tests in McCauley (2001), Paul (2001), Haynes
and Pindzola (2003), and Spreen and Risser (2003).