I came across a poster on a social media site the other day which said “Thirty things a standardised test can’t measure”.
Then the poster went on to list the following 30 characteristics: resilience, compassion, strength, wit, faith, sense of humour, imitation, kindness, self-esteem, intelligence, motivation, fortitude, morals, work ethic, courage, empathy, determination, manners, personality, diligence, common sense, ingenuity, grit, physical fitness, life skills, creativity and love of learning. It’s quite a list I know, but it really struck a chord with me for many reasons and I was captivated with it.
As speech therapists, a considerable part of our job is spent “measuring” our client’s communication skills and abilities, in order to know which areas need further support and how to help that person? Measurement is a fundamental part of our job. The poster I mentioned is referring to one of the tools that we use to measure with and subsequently what it measures?
So, what is a standardised test and why do we use them? Standardised assessments are formal assessments that have been designed to measure a person’s abilities in various areas. There are numerous assessments on the market designed to measure a variety of skills such as language performance, speech, social interaction skills, attention development, play, oro-motor skills, concept development, stammering, dyspraxia, dyslexia, dyscalculia, dysarthria and aphasia to name a few! The list could go on……………… There are many different kinds of tests available for use with both adults and children. You may have heard the names of some of these tests? CELF 5, Pre-school CELF, Renfrew Action Picture test, Derbyshire language scales, Renfrew Action Picture test, the DEAP, STAP, Comprehensive Aphasia Test, PALPA, the Frenchay Dysarthria test and the Boston naming test are some of the assessments that are available for us to use. If you were to read about these assessments you might hear some confusing terms being used in relation to them such as formal vs informal, standardised vs non-standardised and norm referenced.
For some clients such as very young children, assessment may be done with the therapist playing alongside the child, or watching them play. This is known as informal assessment. Whilst playing they will be looking at the way the child understands language, how well they are talking and which sounds they are able to use in their speech. Observing a child in this way will give lots of information about whether they do or don’t have a particular skill. Sometimes informal assessment is also used with adults too.
Formal assessments fall mainly into two groups, standardised and non-standardised. There is generally a strict criterion for administering formal assessments and the therapist has to follow a set of rules about how to ask questions, what words to say and the order in which things should be done. For example, many assessments will not allow you to give certain clues, or require you to discontinue the test after a certain number of incorrect answers. These strict rules relate to the reliability of the assessment results and anything that might make the results unreliable. Standardised assessments are formulated and tested using a sample of the population, in order to gain an idea of the possible responses to test items. This provides us with information about the typical performance that can be expected from that community, for example when English children typically begin to use and understand prepositions. This data is what we refer to as norm referenced. Using a standardised, norm referenced assessment allows us to relate the performance of the person being tested to peers of the same age and community, and therefore give us an idea about their ability in a specific area.
There are a number of key benefits of using trusted, well-developed standardised tests. Indeed without them it would be difficult to do many aspects of our job effectively and reliably. Assessments can be useful for many things. They can help us identify which areas require intervention and help pinpoint what needs further detailed investigation? Using a standardised assessment can help us establish a baseline and benchmark a person’s ability, prior to our intervention. It can also help us evaluate what impact our intervention has had? Assessment information can help us set targets for that person too, but there is always so much more to a person that what a test can measure.
Although there are advantages to using formal assessments, there are some disadvantages too. There has been controversy about assessments ever since psychometric assessments were introduced in the USA in the late1940s to screen immigrants. Professionals argued then, that these assessments tested for cultural traditions that immigrants would not know the answer to, and were therefore biased, rendering them unfit for purpose. I also read recently on the TES website (Times educational supplement) teachers arguing that our current UK exam system really only assesses the ability to remember and regurgitate facts, rather than a person’s knowledge and ability to use that knowledge.
In the world of speech and language therapists, the biggest drawback to formal assessments is that sometimes therapists can inadvertently become over reliant on them. They have their uses but are only one tool in a whole tool box, and should be viewed that way. We need to be careful as a profession not to become too focused on just the person’s impairments, but rather than see them as a whole, rounded individual. In other words, we can get caught up in focusing on what the assessment tells us they can’t do rather than take into consideration all of the other skills they have. And therein lies the problem with relying only on formal assessment data. In my opinion, focusing solely on assessment data is not a good thing, because there is so much more to a person that what a test measures. We are working with human beings and human beings are all unique. They come in all shapes and sizes and everyone has strengths and something to contribute, especially when it comes to communication.
Did you ever go in a lift and hear one of those irritating synthesised voices announce what floor you have reached, or a satnav direct you to a certain street which it pronounces incorrectly? Last year on a trip to Paris, my family and I laughed out loud every time our satnav mispronounced a French street name. It was hilarious. It massacred the French language. These devices rely on a computer generating the speech sounds that make up those words. In theory, this is a simple problem: all the computer needs is a huge alphabetical list of words and details of how to pronounce each one (much as you’d find in a typical dictionary, where the pronunciation is listed before or after the definition). For each word, we’d need a list of the phonemes that make up its sound. In theory, if a computer has a dictionary of words and phonemes, all it needs to do to read a word is look it up in the list and then read out the corresponding phonemes, right? In practice, it’s harder than it sounds. As any good actor can demonstrate, a single sentence can be read out in many different ways according to the meaning of the text, the person speaking, and the emotions they want to convey (in linguistics, this idea is known as prosody and it’s one of the hardest problems for speech synthesisers to address). Within a sentence, even a single word like “read” can be read in multiple ways as “red”/”reed” because it has multiple meanings. And even within a word, a given phoneme will sound different according to the phonemes that come before and after it.
This gives us some idea of the complexity of communication. There is so much more involved than we initially realise, and this is where the attributes mentioned in the poster come into play. Much of our communication is not just the sounds we speak and the words we use. Over 70% of our communication is non-verbal and we all communicate differently with different people. If you were to poll my friends they might say that I am funny, whereas if you asked my children they may say that I am strict. Well, they’d definitely say that, and who knows what my manager or colleagues would say? I’ll leave it to you to guess what that might be? Communication is a two way process and unlike a satnav that makes no differentiation for its audience, we as typical human beings are constantly adjusting our communication style for different contexts and situations. An essential element of how we communicate is dependent on our personalities and who we are. In fact I’ll go further and say it is integral to our communication.
Qualities such as empathy, compassion, humour and kindness may make someone easier to communicate with. Whereas strength, fortitude and resilience are factors than can make a massive difference when taking into account how a person will respond to intervention. This is vital when planning targets for a client. I often set work for my clients to do at home, because only so much can be achieved in a one hour therapy session and practice can make a significant difference. When evaluating how much work to set, I take into consideration the client’s personality. An attribute such as diligence would be important. Are they likely to do the work, what are their home circumstances, what support network do they have, would it be overloading them etc.? Questions such as these are vital and just as significant as the data given by standardised assessments results.
Standardised assessments never tell the whole story, just a small part of it. So, it is crucial to consider all of the above factors when assessing a person’s needs. A good therapist will use many sources of information to draw conclusions about a client. This will include employing a variety of assessment methods.
Essentially, it is about whether we see our clients holistically? Holistic practice refers to treating the client as a whole, considering all aspects of their life and needs, including psychological, physical, social, spiritual, cultural and economic needs, and not just their medical needs. It requires us to look at all aspects of their life, not just focusing on the impairment, but on the person as a whole. Do we see just an individual component or do we see the whole? Do we see just their difficulties or do we see their strengths too? Do we appreciate what they have to bring to the therapeutic table? Do we consider them as part of a family? Unless we see the whole we cannot possibly make reliable judgements. Unless we see the whole we will not be able to deliver truly bespoke, effective therapy. Holistic therapy gives the client dignity and respect. Holistic therapy places value on our clients. Studies have shown that it can increase a client’s sense of wellbeing. Holistic practice demonstrates to your client that they have something to contribute to you too. It promotes an equal relationship and places an emphasis on partnership. When we include holism into our clinical practice it benefits us too. There have been many occasions when my life has been enriched by the personal attributes of my clients young and old, and my interactions with them.
And finally…..holistic practice sends a loud message that a person is not defined by what they can’t do, because they are so much more than this.
Written by Alison Mann, Speech and Language Therapist, on behalf of Integrated Treatment Services
