Communication Assessment for People with Behaviours of ...

Communication Assessment for People with Behaviours of Concern - Literature review.

Teresa Iacono & Nick Hagiliassis, 2010

Background Scope undertook an Office of the Senior Practitioner funded project in 2009 entitled "Building the Foundations for Effective Communication for Victorians with Behaviours of Concern subject to Restrictive Practices". The project creates a mechanism for ensuring people with behaviours of concern have access to appropriate, skilled support in areas where that support is currently inadequate. An objective of the project is to support skilled professionals (speech pathologists) in order that they may be able to undertake focussed communication assessments for people with behaviours of concern (BOC). This will be achieved through compiling a list of assessments for evaluating communication factors as they relate to BOC. Using this information, speech pathology professionals will have access to a summary of relevant assessment tools, from which they can respond directly as well as build the capacity of Direct Support Workers in this area. It includes information about communication assessment tools and resources for:

(1) Identifying the potential communicative functions of the behaviours; (2) Profiling the communication abilities of the individual in order to inform appropriate communication-based interventions; and (3) Observing current environmental barriers and identifying solutions. These aspects are assessed within a wider context captured within the Participation Model (Beukelman & Mirenda, 2005) whereby opportunities and access are assessed. To inform the development of this assessment list, a targeted literature review was undertaken. This literature review identified key assessment instruments and procedures selected against a range of practice, access and psychometric criteria, which are described below. Notably, the review is not intended to be exhaustive.

Identifying Specific Functions of Behaviours of Concern. Many functional behaviour assessments indicate whether BOC are serving functions that could be communicative, but may not always specify the exact communicative function. A completed Motivational Assessment Scale, for example, may indicate that the behaviour serves an escape function, but more information is needed to determine if the person uses behaviours or other means to communicate a request to stop, to reject, or to request help. Speech pathologists will need to either begin with

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administering these `broad' functional assessments, or if one has been conducted (e.g., by a behaviour support team, a psychologist), access the results. These functional behaviour assessments should be followed by more specific functional communication assessments.

Profiling Communication Abilities The assessments have been included to enable identification of BOC and their functions, and then to profile the communication skills of the individual to facilitate the development of appropriate positive behaviour supports. Such supports can include, but are not limited to, Functional Communication Training. Attempts to implement positive behaviour supports may be unsuccessful if the person's communication skills are poorly understood. As an example, a strategy that relies on a verbal explanation of rewards for a particular behaviour is likely to fail with an individual whose comprehension is limited to key words in a sentence, and who instead relies on environmental and social cues. For people who are non-speaking or have limited symbolic ability, a profile of cognitive skills (e.g., ability to understand cause-effect, to respond to familiar faces and events), as well as an understanding of the person's physical and social environment, and socialaffective signalling may assist in developing social and physical environmental supports to reduce the potential for BOC and increase social interactions. Identification of the person's level of communication is needed to tailor appropriate communication supports and ability to benefit from various types of symbolic communication (aided or unaided). For people who comprehend and/or produce language, a profile is needed to determine exactly what level of linguistic input is understood, and to determine language production skills. In particular, there is a need to distinguish echolalia from productive language ? e.g., a person who appears to have good language skills may in fact have poor underlying linguistic ability, but have the potential to benefit from aided or unaided communication systems. This profiling of skills can assist in developing effective social and environmental supports. It also assists in identifying ASD. Criteria for Inclusion of Assessments These assessments are suitable for use by speech pathologists. They include both formal and informal measures that require skills in administration, scoring or recording of responses, and interpretation of results. Some assessments involve obtaining information from paid or family carers. Consideration was given to the number of criteria met by each assessment when deciding those to include.

These criteria are outlined in Table 1. (next page)

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Table 1: Criteria for inclusion of Assessments 1. Must provide information on one of the key areas identified as needed in conducting a communication assessment for people with BOC

a. Identification of functions of any BOC. b. Profile of communication

I. Receptive skills II. Expressive skills, including symbolic ability III. Pragmatic skills (includes social interaction/ discourse, functional

levels) c. Social and physical barriers and enablers

I. Key individuals, their knowledge and attitudes II. System supports III. Physical environment in light of physical, sensory and cognitive

abilities. 2. Must be appropriate for one or more of the following groups

a. Children or adults with developmental disabilities, including ID, autism, CP. b. Children or adults with acquired disability, including ABI, aphasia, degenerative neurological conditions. 3. Must be available for no or `reasonable' cost. 4. Must be easy to obtain (i.e., from a website or purchase within Australia). 5. Must be available to speech pathologists (eg, excluding tests that can be administered or purchased only by registered psychologists). 6. Must not require special training to administer by a speech pathologist (eg., requiring attendance at training course and receipt of a certificate).

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Assessments

A summary of assessments is provided in Table 2. Table 2: Communication Assessment for People with Behaviours of Concern Included Assessments

Domain

Assessment

Population

Identification of BOC

1. Overt Behaviour Scale (Kelly,Todd, Simpson, Kremer & Martin, 2006)

Adults with Head Injury

Functions of BOC

2. Motivation Assessment Scale (Durand, & Crimmins, 1992)

Anyone demonstrating self-injurious behaviours

Preferences

3. Questions about Functional Behavior (Matson, & Vollmer, 1995).

4. Affective Communication Assessment (Coupe, Barber & Murphy, 1988).

Anyone demonstrating BOC.

Children with severe/profound ID, likely to be suitable for adults with severe/profound ID (Unintentional).

Cognitive and early

communication skills

5. Triple C: Checklist of Communicative Competencies (Iacono, Bloomberg & West, 2005)

munication Matrix (Rowland, 1996).

municative Temptations ? Children (e.g.' Fey, 1998; Paul, 2001).

Adults with severe and multiple disabilities (unintentional ? early symbolic).

Children at early stages of communication.

Children with pre-symbolic to early symbolic skills.

8.Modified Communicative Temptations ? children (Iacono, Carter & Hook, 1998)

Children with multiple disabilities with pre-symbolic to early symbolic skills.

9.Structured communication sampling (McLean, et al., 1991).

Children or adults with developmental disabilities with unintentional to early symbolic skills

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Functions of Echolalia

10.Echolalia Protocol (based on Prizant, & Duchan, 1981; Prizant, & Rydell, 1993).

Anyone demonstrating echolalia, most relevant to adults or children with ASD

munication Assessment Profile for People with Learning Disabilities (CASP) (van der Gaag, 2009).

Adults with severe to profound intellectual/ developmental disabilities. May also be suitable for adults with dementia and younger individuals with intellectual disabilities.

Communication functions/ pragmatics

12.Pragmatic Profile of Everyday Communication ? Child (Dewart & Summers, 1995).

Children (0-4years; 5-10 years) with developmental disabilities.

Communication functions/ pragmatics

13.Pragmatic Profile of Everyday Communication - Adults (Dewart & Summers, 1996).

Adults with developmental disabilities and severe communication impairment.

Receptive and expressive symbolic abilities

14.Symbol Assessment (Beukelman & Mirenda, 2005).

Children or adults who are non-speaking but thought to have some symbolic abilities.

Comprehensive / Broad

Communication Skills

15.Social Networks Inventory (Blackstone & Hunt Berg, 2003)

rmal Language Processing Screen (Prince of Wales Hospital, NSW, 1999)

Child or adult with developmental or acquired disabilities and complex communication needs

Adult with acquired disabilities.

Receptive language

17.Test of Auditory Comprehension of Language (CarrowWoolfolk, 1999).

Children with suspected receptive language difficulties; adults with intellectual/ developmental disabilities (for latter, norms cannot be used).

Language?based 18.Test of Problem Solving Child or adult with developmental or

? Scope 2015 .au | (03) 9843 2000 | circ@.au

problem solving

3 - Elementary (Bowers, Huisingh & LoGiudice, 2005)

acquired disabilities who uses speech.

19.Westmead Post Traumatic Amnesia (PTA) Scale (Shores, Marosszeky, Sandanam & Batchelor, 1986).

Adults with closed head injury.

20.Fuld Object Naming and Memory Test Object naming and memory (new learning) -

Child or adult with developmental disabilities

Cognitive and processing skills

21.Boston Naming Test (Goodglass & Kaplan, 2001) ? visual confrontation naming.

Adults with aphasia and other forms of acquired disabilities.

22.Digit Span - Auditory sequential memory / auditory short term memory

Child or adult with developmental or acquired disabilities who uses speech.

Phonological Awareness and

Literacy

Other assessments:

23.Corsi Visual Span Test - Visual sequential memory/ visual short term memory

Child or adult with developmental or acquired disabilities

24.APAR- Assessment of Phonological Awareness and Reading

Adults with Physical and/or intellectual disabilities

25.Boston Diagnostic Aphasia Examination (BDAE) 3rd edition (Goodglass,Kaplan & Barresi,2001) 26.Wessex Head Injury Matrix (Shiel, Wilson, McLEllan, Horn & Watson, 2000)

Table 3 provides a description of these assessments in terms of (a) the name of the tool/procedure, (b) what it purports to assess, (c) how information is obtained using this tool, (d) how information is analysed, (e) the population that the tool is suitable for, and (f) research pertaining to this tool. The criteria met for each assessment is provided in the last column.

? Scope 2015 .au | (03) 9843 2000 | circ@.au

Table 3: Communication Assessment for People with Behaviours of Concern - Detailed Description of Assessments

Tool/ Procedure

What is Assessed?

Motivation Assessment Scale (Durand, & Crimmins, 1992).

Functions of SelfInjurious Behaviours ? sensory, escape, attention, and tangible

Questions about Behavioral Function (Matson, & Vollmer, 1995).

Functions of behaviours ? includes attention, sensory/ non-social, tangible, escape physical.

How is information obtained? Carers provide a rating for 16 items

How is information analysed? Scores indicate if any of the 4 functions are being served by the BOC

Carers provide a rating for items

Scores provide an endorsement and total score that indicate the functions of behaviours

Who is it suitable for? Anyone who demonstrates SIB

Anyone who has BOC

Notes

Research

Criteria Met

Available for purchase from Widely researched instrument. Early 1.a.

Monaco Associates (USA)

evaluation by Sturmey (1994)

2.a.

indicated that it was one of the most 3.

researched tools, but differences

4.

evident across studies led him to

5.

query its robustness. Problem may lie 6.

in there being only 4 items per scale, 7.

and the scales failing to capture

behaviours not motivated by simple

discrete consequences. Hence, should

not be used on its own to determine

functions. Durand & Crimmins (1992) ?

reported moderate to high test-retest,

inter-rater reliability, high (0.99)

concurrent validity with functional

analysis; 4 factor structure. Bihm,

Kienlen,

Ness & Poindexter, (1991) ? internal

consistency from 0.69-0.81. Spreat &

Connelly (1996) ? inter-rater reliability

from 0.31-0.57.

There has been some

Paclawskyj, Matson, Rush, Smalls &

1.a.

concern that the person

Vollmer (2000): Test-retest: Total

2.a.

completing the QABF needs agreement ranging from 70% - 97%; 3.

training.

Cohen's kappa 0.64 ? 1.0; For item

4.

Advantage over the MAS is it severity scores for items 0.26 ?0 .56. 5.

includes physical, which

Cohen's kappa for severity scores for 6?

addresses potential for

items 0 .21 ? 0.38. Factors -

7.

health problem to contribute Paclawskyj et al. (2000) ? 5 factor

to BOC.

solution (76%); Nicholson,

Email Dr. Johnny Matson -

Konstantinidi & Furniss (2006) ? 6

Tool/ Procedure

What is Assessed?

Overt Behaviour Scale (Kelly et al., 2006).

Challenging behaviours according to their type, severity, frequency and impact.

Functional assessment of echolalia.

Communication ? in particular, distinguishing echolalia from

How is information obtained?

How is information analysed?

Who is it suitable for?

Direct observation (over a no. sessions) and/or interview of one or more informants.

Descriptive rating on a scale.

Adults with ABI. Designed for community settings, though has been used in hospitals.

Observatio nal/ language sample,

The potential interactive and noninteractive

Anyone who has BOC and demonstrates echolalia.

Notes

Johnmatson@

The OBS enables identification of challenging behaviours and provides a measure of change over time, but it does not identify their functions. It may be most useful as a first step prior to a functional assessment, such as through a MAS or QAFB.

A checklist can be developed to assist the analysis process, based on the work of Prizant,

Research

Criteria Met

factor solution (71%). Internal

consistency: Paclawskyj et al. - 0.90-

0.93; Nicholson et al. 0.71-0.92.

Paclawskyj et al. (2001) Concurrent

Validity: 56.3% with functional

analysis; 61.5% with MAS.

b

MAS and QABF subscales 0.13 ?0.86

Developed at Liverpool District

2.b.

Hospital, NSW. The developers have 3.

reported some psychometric

4.

properties - Kelly et al. (2006) - Inter- 5.

rater reliability and stability

6.

coefficients for the OBS total score

7.

was strong (0.97 and 0.77,

respectively). Initial

evidence of convergent and divergent

validity was shown by the differential

pattern of correlations with other

measures.

Moderate-to-strong coefficients

(range 0.37?0.66) were observed

between the OBS and other measures

that had

behavioural content (i.e. Mayo-

Portland Adaptability Inventory,

Current Behaviour Scale,

Neurobehavioural Rating

Scale?Revised).

Based on work of Prizant, Rydell, Wetherby (Prizant and Duchan 1981; Prizant & Rydell 1993; Rydell & Mirenda 1994).

1. b. ii, iii 2. a. 3.

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