Epilogue: Perspectives in the Assessment of Children's Speech

Efficacy of phonological intervention is rooted in the assessment of the speech disorder—its nature, characteristics, severity, and prognosis for improvement. From the assessment that a clinician completes on a child, appropriate phonologic goals are targeted that will maximize treatment outcomes. Our treatment goal is to achieve the greatest amount of change in the least amount of time. According to Gierut (1986), our treatments are only as effective as our assessment is accurate and complete. In a typical 60 to 90 minute evaluation session with a child, what do you assess? This is a simple question, and one that clinicians and researchers face daily. It has become so routine to many of us that we no longer question what we will do in an evaluation session. Yet the procedures we choose are a reflection of what we believe speech disorders are, whether speech is viewed as part of a linguistic structure, and how we can utilize treatment to restructure a child’s sound system. The questions embedded in the assessment decision include the following: What data do you collect? What aspects of the child’s communication abilities do you include in your assessment? What analyses do you complete? How do you differentially diagnose articulation impairment (AI) from phonological impairment (PI)? Further, how do you determine whether there is an organic motor speech disorder or a nonorganic basis of the speech disorder? If you accept the possibility of a diagnosis of childhood apraxia of speech (CAS), how would you differentially diagnose CAS from AI and PI? Finally, what are your recommendations for intervention? The goal of this clinical forum is to provide five different perspectives on this essential question of what to assess when the clock is ticking. The contributors discuss their assessment procedures within a time frame and provide a rationale for their procedures. The contributors to this forum were invited to present their evaluation perspective because of their clinical and scholarly competence and their qualifications in working with children who have speech disorders. They also represent a wide variety of perspectives, which provides a range of viewpoints in the assessment of speech disorders in children. In addition to the articles by contributors who practice primarily in university settings, there is also a clinician’s perspective from a community viewpoint. Finally, two brief commentaries from leading experts in child phonology appear at the end of the forum to address assessment issues that are open for debate. It has been about a decade since a forum has been devoted to clinical assessment of child speech. Shelton and others discussed assessment procedures in the 1993 forum in Seminars in Speech and Language for a child, Matthew, who exhibited a persistent sound disorder. Fey (1992) coordinated a clinical forum in Language, Speech, and Hearing Services in Schools (LSHSS) that addressed critical issues in clinical phonology and helped to clarify and expand our thinking with regard to the range and extent of phonological principles in the assessment and treatment of children with speech disorders. As this forum’s articles demonstrate, our field has moved beyond the articulation/ phonology debate discussed in those earlier forums. The present collection of articles does not focus on whether to incorporate phonological principles into the assessment of children’s speech, but rather on the rationale for incorporating specific aspects of phonological principles. The current forum moves previous discussions forward in a way that will allow the reader to compare and contrast the different assessment methodologies, particularly with regard to how each demonstrates the theory-practice coherence and assessment-intervention congruence that Schwartz (1992) and Kamhi (1992) discussed in the LSHSS forum.