Are You Testing What You Think You’re Testing?
By Breanna Waldrup, MS, CCC-SLP
A frequent issue that occurs with children with speech sound disorders, especially childhood apraxia of speech (CAS), is that when we're testing a child's knowledge, we often aren't actually testing only their knowledge, but also their ability to demonstrate this knowledge through speech. This can really muddy the waters and make it difficult to determine what the child knows and what we should be focusing on both in the classroom and in therapy. The issue of what the child actually knows versus what the child can communicate with speech comes up with families, therapists and teachers for our children with speech sound disorders, especially childhood apraxia of speech.
Identifying Colors
Let's start with something that I have seen a number of times with toddlers and preschoolers, and this is identification of colors. In American culture, being able to identify or name colors is often a skill that we look for in young children. There is actually a developmental progression that often occurs for color identification in children developing neurotypically. What you’ll often see first is a young child, such as a toddler, will begin sorting toys or grouping things by color. They will group the blue blocks together and the red blocks together,etc. When we start seeing this behavior, it indicates that the child is recognizing different colors and identifying them in this manner.
At this point, you may start testing a child’s knowledge of colors by asking the child “Which one is blue?” or “Give me the blue one.” Side note – You may see a difference in the response to these two questions, because if you ask the first question, you’re ending with the key word (“blue”), so the child may be more likely to understand that question. This task is receptive in that the child needs to understand the language and vocabulary for the color(s) that you are testing. The child can respond without speech, by pointing or handing you the object.
The next step in color identification is that the child will start using expressive language and/or speech to name colors. However, even this follows a pattern in neurotypical development. First, the child will start saying one color name. When asked “what color is this?” the child will always say the one and only color word that they have learned to say, which is not necessarily the color of the item in question.
At this stage in development, the child’s color identification skills may appear quite differently, depending on how you test. For example, if you ask the child “Which one is yellow?” they may correctly identify the yellow item. However, if the only color word the child is saying is blue (or an approximation of blue, such as “boo”), then you may show the child a yellow object and ask “What color is this?” and the child will answer “blue” (or “boo”). The child will likely say “blue” each time they are asked “what color is it?”, regardless of the color of the item. Meanwhile, when asked receptively, the child will probably be able to identify several colors, especially primary colors and colors that differ substantially (e.g. they won’t confuse red and blue but may confuse red and orange).
When a child is at this stage of development, sometimes families will mistakenly think the child doesn't know their colors because the child always answers with the same color name. However, if we test the skill receptively, we’ll often see that the child can identify several colors.
As the child continues to develop, they will learn to say more color names or more approximations of colors and will then begin naming colors more accurately expressively. The child’s ability to express what they know will be catching up to what they know receptively. As we know in neurotypical development and in analytic language development, this is often the way that cognitive and language skills are acquired: The child understands a word or concept receptively before they then use it expressively. Of course, this isn't a 100% true across-the-board but it is generally how new expressive vocabulary is acquired for analytic language learners.
Differences for Children with Speech Sound Disorders
For children with speech sound disorders, especially childhood apraxia of speech, we may see a difference in their ability to name colors with speech. A variety of things may occur differently. First, the child’s ability to produce the words may be hindered, so that their speech is not as clear/easy to understand. For children with childhood apraxia of speech, who often acquire words at a much slower rate, especially at a young age, we may see some of these skills delayed or extended. For example, we may not see them trying to name the color expressively till much later in their development. It’s important to note: This doesn't mean they're not recognizing colors. They may be doing those cognitive and receptive tasks indicating they understand colors, such as sorting by color and identifying colors accurately when asked. However, even at three or four years of age, they may not yet be able to name a color with speech or be able to name it in a way that can be understood. This can mean that if the child is in a preschool setting and is not naming any colors, it might be brought up as a cause for concern, since color identification is a skill that is looked for in American preschool-aged children.
Often in the treatment of young children with childhood apraxia of speech, speech-language pathologists very carefully select the words and phrases to be targeted in therapy. We know that children with childhood apraxia of speech will need to work hard to learn motor plans for words and often practice those motor plans hundreds or thousands of times for the words or phrases to be accurate and consistent. Given this, I very rarely choose color words as early targets for children for childhood apraxia of speech. I tend to be much more concerned with core or power words or phrases that the child can use in a variety of situations to communicate as much as possible. If the child does learn a color word or approximation, it’s possible that will be the only color word they acquire for quite a long time. This isn’t due to lack of knowledge of colors, but rather due to the difficulty with which new motor plans for speech that children with childhood apraxia of speech experience. However, the result can be that families or teachers form the impression that the child doesn’t have color identification skills, because they are only able to name one color in response to the question “What color is it?” However, when we test color identification in this way, we are not really testing what colors the child can identify. We are really testing what colors the child can name accurately with intelligible speech.
What We Can Do to Help
A relatively simple way to help address this issue is educate families and teachers and encourage them to test the child’s color identification skills receptively, by asking the child to identify an object of a given color and allowing the child to point or give them the object to answer.
Another thing we can do for children with speech sound disorders or childhood apraxia of speech is to use total communication. Using total communication means that we're not just modeling, teaching and encouraging speech as a means of expressive language but that were also teaching, modeling, encouraging and accepting other forms of communication or augmentative and alternative communication (AAC). These other forms of communication could be sign language, a communication device, gestures or a combination of all of these things plus more. If we are focusing on color identification, then when we're teaching and talking about colors we not only say the color but we also label the color with a sign and/or show how to name it with a communication device. The child can then also use any and all of these methods to talk about colors. If we've taught colors using total communication, and the child is using total communication (e.g. they are signing and/or using gestures or a communication device, as well as speech), then when we want to test a child's color knowledge we could test receptively and also test expressively. When testing expressively, we accept all forms of communication. So if the child responds with a sign for the color or activates the icon on their communication device, we accept that in addition to or instead of speech.
Sound-Letter Association and Decoding Skills
Another area in which we often do not really test what we think we're testing is literacy. If we're doing structured literacy, which I definitely recommend as the evidence-based approach for teaching reading to children both with and without communication disorders, then we teach sound-letter associations/correspondences.
Typically when we're teaching sound-letter correspondences, we show children the letter and then we say the sound that letter makes and ask the child to produce that sound. So we might be showing the child the letter m as we're saying “this says mmmm.” Then when we are practicing or testing their knowledge, we ask them to make that sound (“mmm”) when they see the letter m. Knowing sound-letter associations is essential for being able to decode or sound out words. However, learning and demonstrating this skill becomes much more complicated when you're talking about a child who is not able to produce all of their speech sounds accurately or consistently, as is often the case for children with speech sound disorders, especially childhood apraxia of speech.
A child with childhood apraxia of speech may be able to produce an “mmm” sound but they may be only able to do so in certain coarticulatory contexts or words. Their speech and speech errors are also often inconsistent, so they may sometimes produce a “b” sound instead of “m” or a “n” sound instead of “m” (or any other number of errors). Thus, even though a child is producing words that contain a “m” sounds, they may not be able to consistently produce an “m” when you are working on sound-letter correspondence. If you are testing the child’s sound-letter association skills, and you show them the letter m and they say a “b” or “n” sound due to issues motor planning and programming for speech, we haven’t actually assessed their sound-letter knowledge. Instead, we have tested what they are able to express with speech.
This can also happen with children with other speech sound disorders, such as a phonological disorder, in which the child is using phonological patterns in their speech. If you have a child who is using the phonological pattern of fronting and you are working on the sound association (“g”) for the letter g, the child will say “d.” The child’s production of the sounds for the letter d and the letter g will thus sound the same. This can also happen with other phonological patterns , such as stopping. If the child is stopping the sound for /s/ to /t/, then if you're working on the sound for the letter s they're going to produce the “t” sound.
What we can do to help
What can we do to more accurately assess a child's letter-sound association knowledge and how can we better teach or practice these decoding skills, which we know are incredibly important for a child’s success in reading?
Similarly to what we discussed about colors, we can use total communication or AAC and we can also practice and test skills receptively. When we're teaching sound-letter correspondences, we as the teacher, family member or speech-language pathologist can show the child the letter and make the sound, but not require the child to produce the sound if it is challenging for them. Then when we think that they are starting to acquire the skill or we want to test their knowledge, we can have an array of letters (maybe 3-5 choices) visible and ask the child: “Show me which letter says “mmm.”” This makes this a receptive task in which speech is not required and will give us more accurate information about the child’s sound-letter knowledge, rather than their ability to produce speech sounds. Another way that we can do this is is to allow the child to respond using AAC. When we say the sound, the child can select the letter on their communication device keyboard (or any keyboard) that is associated with that sound. Some communication devices also have a phonics section, in which we could show the child a letter and ask them to select the correct sound on their device. If the Bjorem Speech Sound cues have been used with the child and the child has them memorized, it’s also possible that we could show the child a letter and the child could select the appropriate sound from an array of Bjorem Speech Sound cue cards. So if we showed the child the letter m and had several Bjorem Speech Sound Cue cards available, the child could select the yummy card that is for the “mmm” sound.
Summary
Remember that when we are testing knowledge and skills for children with speech sound disorders, especially childhood apraxia of speech, we need to do our best to test what the child knows, not what the child is able to communicate about what they know with speech. This usually involves allowing the child to respond without speech, such as using AAC, or by changing our question so that the child can respond using gestures.
Written by: Breanna Waldrup, MS, CCC-SLP
