Evaluation Categories
Speech-Language-Communication Assessments
Communication difficulties are common among students diagnosed with ASD (Saulnier & Ventola, 2014), and in fact represent the core of autism (APA, 2013). Social communication includes more than words and grammatical correctness. It includes such skills as back-and-forth social interaction, pointing, sharing information, conversation, perspective-taking, and understanding social situations.
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Communication difficulties are common among students diagnosed with ASD (Saulnier & Ventola, 2014), and in fact represent the core of autism (APA, 2013). Social communication includes more than words and grammatical correctness. It includes such skills as back-and-forth social interaction, pointing, sharing information, conversation, perspective-taking, and understanding social situations. Recognizing different patterns of social communication impairment indicate different individual needs and, therefore, intervention decision-making (Lloyd & Paintin, 2006). Many children with ASD can regulate their caregiver's behaviors by requesting or protesting; they may also label objects and events in the environment or talk in full sentences. Despite these peripheral linguistic skills, they fail to share information with others and communicate within a social context (Rollins, 2014). Some of these children can perform within normal limits on standardized tests of speech or language, particularly if the assessment only requires them to look at and respond to static pictures. Therefore, standardized assessment tools are only a starting point in ASD evaluations and should be used in conjunction with parent and teacher interviews, observations in multiple contexts (e.g., 1:1 and group interactions with familiar and unfamiliar persons, interactions with adults and with peers), and informal communication and language samples. For example, an informal communication assessment could include the range of communicative intentions, cohesion, responsiveness to speech (i.e., the proportion of adult utterances to which the child responds), mean length of utterance (MLU), echolalia, pronoun use, discourse management (e.g., topic maintenance, turn taking, appropriate topic shifts), register variation (i.e., using appropriate language forms with different conversational partners and in varying situations), and presupposition (i.e., the understanding of what it is reasonable to assume the communication partner knows) (Paul, 2007). What is analyzed is determined by the student's age and language abilities.
In ASD evaluations, it is critical to include speech and language pathologists (SLPs). As a member of the multidisciplinary team, the SLP administers standardized assessment tools in the areas of speech and language functioning and should be skilled in providing informal assessments of social communication to determine a disability in the area of speech, language, or social communication. "Given the importance of social communication in the diagnosis of ASD, the SLP plays an important role in both screening and diagnosis" (ASHA, 2006, p. 1). Because autism spectrum disorder (ASD) is a social communication disorder, children identified with ASD usually require the service of an SLP.
Common approaches to assessment in the social-language-communication domain include direct assessment with standardized instruments, as well as rating scales from parents and/or teachers, student interviews, and direct and systematic observations. Language and communication assessment for young students with preverbal/prelinguistic skills should include an assessment of the prelinguistic predictors of language and communication. Prelingusitic predictors include the use of communicative gaze and gestures, quality of vocalizations, joint attention, vocabulary comprehension, and quality of play (Paul, 2007; Rollins, 2014). In addition, rate of communication, range of communicative functions expressed (i.e., behavior regulatory functions versus social functions), and responsiveness to speech and gestures can be measured, and an assessment for use of an augmentative communication device (AAC) can be performed.
Included within this section of the TARGET is summary information about the following assessments for speech-language-communication assessment:
Children's Communication Checklist-Second Edition (CCC-2)
Clinical Evaluation of Language Fundamentals- Fifth Edition (CELF-5)
Clinical Evaluation of Language Fundamentals- Preschool-2 (CELF-Preschool-2)
Communication and Symbolic Behavior Scales (CSBS)
Comprehensive Assessment of Spoken Language, Second Edition (CASL-2)
Expressive Vocabulary Test Third Edition (EVT-3)
Language Curriculum-Referenced Assessment (LCRA)
Peabody Picture Vocabulary Test Fifth Edition (PPVT-5)
Pragmatic Language Observation Scale (PLOS)
Preschool Language Scale Fifth Edition (PLS-5)
Receptive-Expressive Emergent Language Scale- Third Edition (REEL-3)
Test for Auditory Comprehension of Language- Fourth Edition (TACL-4)
Test of Expressive Language (TEXL)
Test of Language Development- Intermediate-4 (TOLD: I-4)
Test of Language Development- Primary-5 (TOLD: I-5)
Test of Pragmatic Language- Second Edition (TOPL-2)
Test of Problem Solving- Elementary, Third Edition Normative Update (TOPS-3E:NU)
Test of Problem Solving 2: Adolescent (TOPS-2:A)
The Communication Matrix
The Rossetti Infant-Toddler Language Scale
The following summary of speech-language-communication assessments is not intended to be all-inclusive. Rather, the assessments were selected based on their prevalence within clinical and academic settings as well as their relevance to children with ASD.
Autism Related Research
Current research regarding speech-language-communication assessment instruments within the ASD population may help clinicians with test selection and test interpretation when used in ASD evaluations.
With regard to research related to psychometric properties (i.e., various types of validity and reliability), among children and adolescents with higher functioning ASD, the Pragmatic Judgement and Inferences subtests of the original CASL were found to measure adaptive use of language for communication (Reichow, Salamack, Paul, Volkmar, & Klin, 2008). Volden and Phillips (2010) found that the CCC-2 is a more sensitive tool than the TOPL for identifying pragmatic language impairment in high-functioning speakers with ASD who also have structural language and nonverbal cognitive scores within typical limits—it is useful for identifying children who might otherwise "slip through the cracks". While these authors found that the TOPL identified only 56% of the participants in the high-functioning ASD group as pragmatically impaired, while the CCC-2 identified 81%, they did note that the TOPL did not identify any typically developing controls with pragmatic language impairments.
Also with the CCC-2, Norbury and colleagues (2004) found that the social-interaction difference index identified children with disproportionate pragmatic and social difficulties in relation to their structural language impairments. With regard to the CSBS Developmental Profile (CSBS-DP; derived from the CSBS), Allen and colleagues (2002) found moderate to large correlations between all three components and language outcomes two years after evaluation. Moreover, these authors found that the three composites were a significant predictor of receptive and expressive language outcomes, and they concluded that the CSBS DP could be used as a language/communication screening tool for young children. The CELF-4 was shown to be a sensitive marker of language impairment in ASD (Condouris, Meyer, & Tager, Flusberg, 2003; Rapin et al., 2009), and the PLS-4 was determined to be useful for obtaining a general index of early syntax and semantic skill in young children with ASD (Volden et al., 2011).
Some research has also investigated the utility of speech-language-communication assessment instruments for alerting clinicians to the possibility of ASD, specifically. For example, the CCC-2 distinguished children with communication impairments from non-impaired peers (Norbury, Nash, Baird, & Bishop, 2004). The CSBS-DP was found to aid primary care providers of communicative problems that could indicate ASD, LD, and DD at one-year well-checks (Pierce et al., 2011). Young and colleagues (2005) found that the original TOPL distinguished participants with ASD from those with typical development.
Patterns of difficulties in ASD have also been investigated with some of the instruments included in this section. For example, on the original CELF Preschool, children with ASD, those with specific language impairments (SLI), and those with characteristics of both SLI and ASD all had difficulty repeating sentences of increasing length and complexity; those with ASD showed a relative weakness in identifying word associations.
If the child tests within normal limits on a language assessment, including the pragmatics subtest on a standardized assessment tool, the child cannot qualify as speech impaired.
Reality:
The child may have underlying communication deficits that these standardized assessment tools do not directly identify as autism spectrum disorder. "There are few methods for identifying pragmatic difficulties other than clinical opinion; most published language tests do not assess language use across multiple communicative contexts" (Bellon-Harn & Harn, 2006, p. 4). Although standardized assessments are typically helpful in determining present levels of performance, they often result in a deficits profile that does not translate well to interventions that are family-centered and focused on real-life activities (Diehl, 2003).
If the child gets passing grades and is not struggling academically, there is no need for speech therapy interventions.
The child may still be failing at the underlying social communication/social interaction curriculum in the educational setting. For children with ASD, the goals of communicating, socializing, and conforming to societal rules and expectations are the most important part of a child's curriculum (Klin & Volkmar, 1995).
The child appears to chat with some friends, so he must be social and has good social skills. "He talks to his friends in the cafeteria."
"… a short encounter or routine interaction will not reveal anything unusual. However, over time and in unexpected situations, it appears that the façade of normality cannot be kept up" (Frith, 2004, p. 675).
"Echolalia is just a normal part of language development."
"Echolalia peaks at around age 30 months in normal children, and then decreases" (Lovaas, 1981, p. 5). The use of spontaneous language in ASD often does not naturally occur. "Persons with autism can get stuck at any point in the continuum and language may not progress beyond echolalia".
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).Arlington, VA: American Psychiatric Publishing.
Allen, L., Cleary, J., Goldstein, H., Kublin, K., & Wetherby, A. (2002). Validity and reliability of the Communication and Symbolic Behavior Scales Developmental Profile with very young children. Journal of Speech, Language, and Hearing Research, 45(6), 1202–1218.
American Speech-Language-Hearing Association. (2006). Principles for speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span [Technical Report]. Available from www.asha.org/policy.
Bellon-Harn, M. L., & Harn W. E. (2006). Profiles of social communicative competence in middle school children with Asperger's Syndrome: Two case studies. Child Language Teaching and Therapy, 221), 1–26.
Condouris, K., Meyer, E., & Tager-Flusberg, H. (2003). The relationship between standardized measures of language and measures of spontaneous speech in children with autism. American Journal of Speech-Language Pathology, 12, 349–358.
Diehl, S. F. (2003). The SLP's role in collaborative assessment and intervention for children with ASD. Topics in Language Disorders, 23(2), 95–115.
Frith, U. (2004). Emanuel Miller lecture: Confusions and controversies about Asperger syndrome. Journal of Child Psychology and Psychiatry, 45(4), 672–686.
Klin, A., & Volkmar, F. R (1995). Asperger's Syndrome: Guidelines for treatment and intervention. New York, NY: Guilford.
Lovaas, O. (1981). Teaching developmentally disabled children: The me book. Austin, TX: Pro-Ed.
Lloyd, H, & Paintin, K. (2006). Performance of children with different types of communication impairment on the Clinical Evaluation of Language Fundamentals. Child Language Teaching and Therapy, 22(1), 47-67.
Norbury, C.F., Nash, M., Baird, G., & Bishop, D.V.M. (2004). Using a parental checklist to identify diagnostic groups in children with communication impairment: A validation of the Children's Communication Checklist-2. International Journal of Language and Communication Disorders, 39(3), 345–364.
Paul, R. (2007). Assessing communication in autism spectrum disorders. In F.R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and Pervasive developmental disorders: Volume 2: Assessment, interventions, and policy (3rd ed.). Hoboken, NJ: John Wiley and Sons.
Pierce, K., Carter, C., Weinfeld, M., Desmond, J., Hazin, R., Bjork, R., & Gallagher, N. (2011). Detecting, studying, and treating autism early: The one-year well-baby check-up approach. The Journal of Pediatrics, 159(3), 458–465.e6. http://doi.org/10.1016/j.jpeds.2011.02.036
Rapin, I., Dunn, M., Allen, D., Stevens, M., & Fein, D. (2009). Subtypes of language disorders in school-age children with autism. Developmental Neuropsychology, 34(1), 66–84.
Reichow, B., Salamack, S., Paul, R., Volkmar, F. R., & Klin, A. (2008). Pragmatic assessment in autism spectrum disorders: A comparison of a standard measure with parent report. Communication Disorders Quarterly, 29(3), 169-176. doi: 10.1177/1525740108318697
Rollins, P. R. (2014). Facilitating early social communication skills: From theory to practice. Shawnee Mission, KS: AAPC.
Saulnier, C. A., & Ventola, P. E. (2012). Essentials of autism spectrum disorders evaluation and assessment. Hoboken, NJ: John Wiley & Sons, Inc.Volden, J., & Phillips, L. (2010). Measuring pragmatic language in speakers with autism spectrum disorders: Comparing the Children's Communication Checklist-2 and the Test of Pragmatic Language. American Journal of Speech-Language Pathology, 19(3), 204–212.
Volden, J., Smith, I. M., Szatmari, P., Bryson, S., Fombonne, E., Mirenda, P., . . .Thompson, A. (2011). Using the Preschool Language Scale, Fourth Edition to characterize language in preschoolers with autism spectrum disorders. American Journal of Speech-Language Pathology, 20, 200-208.
Young, E., Diehl, J., Morris, D., Hyman, S., & Bennette, L. (2005). The use of two language tests to identify pragmatic language problems in children with autism spectrum disorders. Language, Speech, and Hearing Services in Schools, 36, 62-72