Nonverbal and Minimally Verbal Children’s Assessment Protocols
From: Hedge & Pomaville (2008)
· Child Case History
· Assessment of Nonverbal and Minimally Verbal Children: Interview Protocol
· Orofacial Examination and Hearing Screening
· Verbalizations of Nonverbal or Minimally Verbal Children: Assessment Protocol
· Nonverbal Expressive Communication: Qualitative and Quantitative Assessment Protocol
· Nonverbal Receptive Communication: Qualitative and Quantitative Assessment Protocol
· Interaction Between Communicative Partners and the Child: Assessment Protocol
· Assessment Report
This section contains a collection of protocols that can be used individually or combined in a variety of ways to facilitate the evaluation of children who are nonverbal verbal or minimally verbal.
These protocols can be individualized and printed out as a group and used for a complete speech and language assessment in a nonverbal or minimally verbal child. Also, one or more protocols may be selectively printed out and used as needed. In assessing children with multiple disorders of communication, the clinician may combine these protocols with other protocols (e.g., speech assessment protocols, language assessment protocols, or voice assessment protocols).
It should be noted that nonverbal and limited verbal children are extremely heterogeneous, representing a wide range of ages, cognitive abilities, and motor abilities. Therefore, specific protocol items may need to be eliminated or adjusted, as needed for a specific child. For example, the interview protocol includes a wide array of questions that may not apply to all children. If the child is not in a school setting, or if AAC is not a consideration, then those questions can be eliminated during the interview.
Note to the clinician: Individualize each protocol as you see fit before printing them for clinical use. Please delete any extraneous comments or notes found in each of the protocols.
Child Case History
Have the parents or other caregivers fill out the case history form given in Section 1 (Common Assessment Protocols). Let the case history form guide your interview.
Interview Protocol
Name______DOB ______Date ______Clinician ______
Preparation
Review the “interview guidelines” presented in Chapter 1.
Make sure the setting is comfortable with adequate seating and lighting.
Record the interview whenever possible.
Find out if the parent is comfortable having the child in the same room during the
interview. If so, have something for the child to do (toys, books, etc.). If not, make arrangements for someone else to supervise the child in a different room during the interview. If it is not too distracting, it might be valuable to have a nonverbal or minimally verbal child in the same room, as there may be opportunities to observe communication attempts at this time (e.g., trying to get mom’s attention).
Review the case history ahead of time, noting areas you want to review or obtain more information about.
Introduction
Introduce yourself. Briefly review your plan for the day and how long you expect it
to take.
Example: “Hello Mr. /Mrs. [parent’s name]. My name is [clinician’s name] and I
am the speech-language pathologist who will be assessing [child’s name] today. I
would like to start by reviewing the case history and asking you a few questions.
Once we are finished talking, I will spend some time observing [child’s name] as
he interacts with you. I may also spend some time working with [child’s name]
individually. Today’s assessment should take about [estimate the amount of time
you plan to spend].
Who is the person(s) being interviewed?
Name(s):
Relationship(s) to child:
Interview Questions: These questions may need to be individualized, depending on the child’s age, communication abilities, cognitive abilities, motor abilities, and living situation. If it is decided to use a standardized measurement instrument based on parent or caregiver report, those questions may be integrated into, or used in lieu of, all or some of the questions listed below.
Review the Case History and ask follow-up questions, as needed, regarding the child’s medical, developmental, educational and social history.
Has anyone else in your family had communication problems?
Has [child’s name] ever had his [her] hearing tested? If yes, what were the results? If no, do you suspect any hearing problems?
Has [child’s name] ever had his [her] vision tested? If yes, what were the results? If no, do you suspect any vision problems?
Has [child’s name] ever had his [her] speech or language assessed before? If yes, when and where was this done? What were the results? How did you feel about that?
Has your child received speech-language therapy before? If yes, when and where? What did they work on in therapy? Can you describe the types of activities that were used? How did your child respond? Do you feel the therapy was helpful? Why or why not?
Has your child seen any other specialists for this problem? If so, who and when? What were their recommendations? How have you followed up on this?
Does [child’s name] have any physical problems? Can you describe them to me?
Do you have any concerns about [child’s name] fine motor or gross motor skills?
Please describe a typical day in the life of your child. (Note information regarding the child’s routine; opportunities for cognitive, speech, and language stimulation; opportunities for socialization and communication; communication partners; household rules; behavioral problems; etc.)
With whom does [child’s name] communicate with throughout the day?
Does [child’s name] attend any type of school or preschool? When? Where? How does he [she] communicate there?
How are your child’s preacademic or academic skills?
What is your child’s primary method of communication?
How does [child’s name] communicate with you?
How does [child’s name] communicate with other family members?
How does [child’s name] communicate with other children?
How does [child’s name] communicate with strangers?
How does [child’s name] tell you he [she] wants or needs something? (points, gestures, vocalizes, pulls on you, etc.)
Does [child’s name] make eye contact when he [she] tries to communicate with you?
Does [child’s name] try to say words?
Does [child’s name] have any true words that you and others understand? If yes, what are they?
About what percent of your child’s speech is understood by you? By others?
Does [child’s name] ever combine words together? If yes, can you give me some examples?
How does [child’s name] react when others do not understand?
What does [child’s name] do when he is upset or does not get what he [she] wants? How do you react to this?
Does your child exhibit any specific behavior problems that you are concerned about? How do you handle these?
Does your child exhibit any antisocial or socially inappropriate behaviors? How do you handle these?
Does [child’s name] exhibit any self-stimulating behaviors (e.g., rocking, flapping arms, spinning, etc.)? If yes, when do they occur?
Does [child’s name] seem to understand what you say to him [her]? Can you give me an example?
Does your child respond to his [her] name? How?
Does [child’s name] answer questions? How?
Does [child’s name] follow directions? Can you give me an example?
Does [child’s name] attempt to imitate others? Can you give me some examples?
What types of play activities does your child engage in?
Does [child’s name] play with objects appropriately?
Does [child’s name] use objects to pretend? For example, does he [she] pretend to talk on a toy phone or pretend to drink from a cup?
Does your child use toys for banging, mouthing, spinning, manipulating, or exploring in other ways?
Does [child’s name] play with other children? Does [child’s name] play with other adults? If yes, does your child take turns, share toys, or make eye contact when playing with others?
Is English your child’s first language? If not, what other language(s) is he [she] exposed to?
What language is spoken most often in the home?
The following questions are more specific to AAC. They can be selected and added as part of any assessment where there is a possibility that AAC might be considered.
What types of verbal or nonverbal communication strategies have you tried with your child? (The clinician may need to provide examples of verbal and nonverbal communication strategies.)
Have you ever considered nonverbal communication strategies such as sign language, gestures, pictures, electronic devises or other things that might help your child communicate?
These are also sometimes called augmentative or alternative communication (AAC) systems or devices. Which ones have you tried or considered?
Have you ever seen or known anyone else who used a nonverbal communication system?
Do you have specific concerns regarding nonverbal communication strategies? (If yes, address their concerns here. They can also be addressed as part of the postassessment counseling if AAC is recommended.)
I’m not saying that [child’s name] will need a nonverbal communication system, but if we think it would help him [her] to communicate would you be open to trying it or learning more about it?
How do you think other family members will feel about this? Will they be supportive? Will they use the system to communicate with [child’s name]?
At home, who will be the primary person responsible for helping [child’s name] use the AAC system, and for helping others learn to communicate with [child’s name]?
At school, who will be the primary person responsible for helping [child’s name] use the AAC system, and for helping others learn to communicate with [child’s name]?
At [other environments the child is in], who will be the primary person responsible for helping [child’s name] use the AAC system, and for helping others learn to communicate with [child’s name]?
Some AAC systems or devices don’t cost anything, others may have a minimal cost involved, and still others are relatively expensive. Can you tell me about any financial resources or limitations that we should consider as we move forward with our assessment? Once we complete our assessment and make our recommendations, we will also provide you with additional information regarding costs and possible funding resources.
Closing the Interview
Summarize the major points that you gathered from the interview, allowing the parent or caregiver to interrupt or correct information, as needed.
Is there anything else you would like me to know about [child’s name] communication?
Do you have any questions for me at this point?
Thank you very much for you input. The information has been very helpful.
Now, I want to observe the different ways that [child’s name] communicates with you. I would like you to spend a few minutes playing with him [her]. I may ask you to do some specific things with [child’s name], but other than that, just interact as you normally would. At some point, I may ask you to sit off to the side or leave the room so that I can work individually with [child’s name] for a few minutes. Once we are finished, I will sit down to share my findings with you.
Orofacial Examination and Hearing Screening
Complete the Orofacial Examination and Hearing Screening Protocol given in Section 1 (Common Assessment Protocols). Use this protocol along with the Instructions for Conducting the Orofacial Examination: Observations and Implications.
Verbalizations of Nonverbal or Minimally Verbal Children:
Assessment Protocol
Name______DOB ______Date ______Clinician ______
Typical Vocalization / Communicative ContextAtypical Vocalizations List phonetically transcribed or described atypical vocalizations or idiosyncratic noises:
______
True Words and Word Approximations
List true words and word approximations below. Word approximations should be phonetically transcribed. Circle “O” if you observed the child using the word, and “R” if it was reported by a family member or caregiver.
True Word orApproximation / Phonetic
Transcription / Observed or Reported / Communication Context
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
Words Combinations
(transcribe, as needed) / Observed or Reported / Communication Context
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
Phonetically Consistent Forms (PCFs)
A PCF is a vocalization that is stable and consistently produced in the context of certain objects, persons, or situations. PCFs usually consist of vowels or consonant-vowel combinations.
Phonetically Consistent Forms(transcribe, as needed) / Observed or Reported / Communication Context
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
O R
Add additional rows, as needed.
The Child’s Imitative Phonetic and Basic Language Skills
1. Did the child imitate nonspeech sounds, such as that of a car, a bell,
or animal sounds? No Yes
If yes, provide examples:
2. Did the child imitate speech sounds? No Yes
If yes, provide examples:
3. Did the child imitate simple words? No Yes
If yes, provide examples:
4. Did the child imitate simple phrases? No Yes
If yes, provide examples:
Comments on the Child’s Verbal Speech and Language Skills:
Nonverbal Expressive Communication:
Qualitative and Quantitative Assessment Protocol
Name______DOB ______Date ______Clinician ______
Prior to initiating the assessment, arrange the room in a way that encourages the child to interact. Provide access to a variety of age-appropriate toys, books, and stimulus items. The assessment should include observations of spontaneous play as well as the child’s responses during various tasks designed to evoke social interaction, initiation of communication, joint attention, requests, declaratives, and protest. This protocol is worded to document the child’s interaction with the clinician; however the same activities and protocol can be used to observe the child’s interaction with others. This assessment is based on observation of the child while interacting with: (circle all that apply)
the clinician parent(s) sibling(s)
other children other: ______
Expressive CommunicationCommunication
Skill / Child-Specific Strategy / Behavior / Scoring