The evaluation process is supposed to be very detailed, with testing of the child in a variety of settings completing a variety of tasks. The testing performed on Drew was completed in one setting, an isolated, small, quite therapy room. In addition, only one test was administered. The PLS-4 was completed in this setting, and Drew's IEP team, including myself and Drew's Dad, his EI therapist, a parent advocate, and then representatives from the school district, attempted to determine educational needs off of this one test.
Here's the problem: The PLS-4 sucks. It's basically like a vocabulary test, which when administered to a deaf child with any almost-normal language makes them look like an absolute genius. It's completed in a quite - seriously quite - environment, and allows for rephrasing and gestures. Seriously. If the speech therapist didn't think Drew understood her the first time, she would rephrase her question and allow him additional time to answer. What a joke! Will he get that extra time in a noisy classroom? Will the teacher even know he struggled to understand the context of the sentence? Will the teacher constantly repharse her directions until Drew understands? Heck no!
I seriously sat in my chair as the test was administered knowing there would be an issue if the district was only going to base my son's needs off of this test. To give an example, in the expressive category of the test, the school therapist could not find a threshold level of language for Drew. She stopped the test at 60 months (or five years of age). He never got more than two answers in a row incorrect. I mean, it was really quite disgusting. Of course, I know the amount of work, therapy, language that went in to that score, but I knew the school district would take that test as basis for denying my son services. (And I was right...)
Here's the thing about the whole evaluation process: No one, no one, understands hearing loss! At our MFE Meeting, where eligibility for an IEP is determined, Drew's Dad and I spent forty-five minutes explaining Drew's aided and unaided audiogram, cochlear implants and their educational impact and the effects of hearing loss on children in a classroom setting. The school district representative didn't even know what the threshold for normal hearing children is, nor did she understand that even with his cochlear implants, Drew's hearing is not restored to normal levels. Her comment when we explained cochlear implants? "That's fascinating!" Oh, it is just disgusting.
After a three-and-a-half hour meeting trying to establish Drew eligible for services, the meeting ended with the Special Education Agency representative storming out of our meeting. It was eventually decided, over the course of a week, that additional testing needed to be administered in order to determine Drew's educational needs. (Of course we knew this going in to the original testing, as it is supposed to be a multi-factored evaluation, and I can hardly see how an evaluation takes in multiple factors when only one test is administered, but I am just the Mom.)
Below is the evaluation that was conducted that resulted in eligibility. I would strongly encourage parents to make sure that the TACL-3, Goldman-Fristoe Test of Articulation and SPICE are administered, as they are excellent at identifying the speech sounds that our children can not hear, and omit in their speech. This is the summary:
Drew was seen on August 27, 2009, to further assess his auditory and articulation skills. He was accompanied by his mother. This assessment session lasted for approximately 90 minutes and Drew again exhibited an attention span and ability to focus on structured activities that appears more mature than his age. Testing was administered in a relatively quiet room with Drew sitting on his own in a chair, approximately 6 feet from a low volume air conditioning unit. Testing was alternated between listening and speaking tasks, in order to help Drew maintain his attention. He needed to return to some tests to complete sections.
Drew was administered the Test for Auditory Comprehension of Language, Third edition (TACL-3). Norms for 3-0 year olds were used to derive his scores. Drew obtained a TACL-3 quotient of 102 (mean=100, s.d.=10), which is within the average range. He obtained the following sub test standard scores (mean=10, s.d.=2): I. Vocabulary=8, II. Grammatical Morphemes=11, III Elaborated Phrases and sentences=12. Drew’s sub test scores were all within the average range. During this assessment, Drew demonstrated difficulty identifying both simple and elaborated sentences, characterized by lengthy pausing, repeating sentences quietly a few times and looking to the examiner for clarification, and reviewing picture choices. Lengthier pauses of up to 20 seconds were noted on 4 out of 17 sentences during the Grammatical Morphemes sub test and 5 out of 15 sentences during the Elaborated Phrases and Sentences sub test. Single repetitions of TACL-3 sentences are allowable following pauses of more than 10 seconds for children younger than 5-0. Drew required at least one repetition and extra time before responding to almost half of all sentences presented. Sometimes he required 2 and 3 repetitions of sentences, including simple structures such as “The cat is in the box.”, “The boys ran.”, and “She jumped rope.”
Sections of the Speech Perception Instructional Curriculum and Evaluation (SPICE) were attempted, in order to screen selected auditory skills. During more casual conversations on familiar topics, Drew was observed to respond more readily than he did during structured sentence comprehension tasks. He demonstrated an ability to delay and correctly repeat back modeled sentences following demonstrations with toys during play. He did continue to require extra processing time, repetitions, rephrasings and exaggerated key words intermittently, in order to respond in conversations. Drew responded to most simple questions and some more complex questions accurately. He was able to comment back with related statements readily, when presented with statements that he understood. When Drew did not understand a question or statement, he often did not respond and/ or would smile and look to the examiner for more information. Due to Drew’s level of fatigue, he was unable to respond to tasks, requiring him to identify among SPICE word sets of up to 4 choices or maintain his attention for a large enough sample of oral directions with one to two key words varied.
Drew was administered Simple Consonant Steps 1 and 2 sections of the Phonetic Level Speech Evaluation and items 1 through 26 of the Goldman Fristoe Test of Articulation 2. These tests were used to obtain information on Drew’s ability to auditorally discriminate and produce sounds when imitating syllables and words. Results of the Phonetic Level Speech Evaluation indicate that Drew can consistently imitate single syllables with initial position /b,p,w,f,m,n,y/ sounds, using only audition. Drew was inconsistent in imitating single syllables with initial position /v/ and /h/ using only audition. He was able to improve or repair both /v/ and /h/, through speech reading and tactile cues. Drew was unable to imitate syllables with voiced or voiceless /th/, final position /p,t,d/ and initial position /sh,s,z,l,/ using only audition. It should be noted that Drew produces most of these consonant sounds (except /th/), that he could not imitate in syllables correctly, when producing familiar words in connected speech samples. Specific substitution errors noted when Drew imitated syllables during this test were: vowel for /h/, /d/ for /t/, /s/ for /z/, /n/ for /y/, voiced /th/ for /z/, /l/ for voiced /th/, /p/ for /t/, and /b/ for /v/. Drew also demonstrated the following substitutions when imitating or identifying words during administration of the Goldman-Fristoe and TACL-3, that are related to difficulty with auditory discrimination of consonant sounds: /h/ for /k/, /t/ for final position /p/, and /t/ for final position /k/. These sounds were also noted as correctly produced in familiar words produced by Drew, during connected speech samples. Consistent substitution errors with voiced and voiceless /th/, /l/ (vocalized and glided), /r,er/ (glided and vocalized) were again noted in connected speech samples and when imitating words included in the Goldman Fristoe Test of Articulation 2. These later types of errors are common in children Drew’s age with normal hearing, although he may have difficulty discriminating them. Because Drew was unable to complete the Goldman-Fristoe Test of Articulation 2, he did not obtain a standard score for this test. Remaining words included consonant clusters. Drew has shown emerging skills with /s/ and /z/ clusters and inability to produce /l/ and /r/ clusters in connected speech samples.
After the completion of a more multi-factored evaluation, Drew was found to be a student of educational need under the category of Hearing Impaired - Deafness (who would have thunk?). Below is Drew's Educational Need Statement:
Drew has difficulty identifying/comprehending both simple and elaborated sentences. Drew needs direct instruction to: improve and practice his comprehension skills, to maintain development of his auditory memory skills, which will help reduce processing time, and he needs to acquire and maintain these skills at a pace typical of his age group. Drew needs to apply these skills to verbally indicate his need for clarification when he doesn't understand.
Drew needs direct instruction on phonetic listening skills in order to better produce and discriminate among phonemes, especially for those sounds he doesn't hear well, in order to improve overall auditory skills. Further development of phonetic skills will improve his understanding and use of word endings and sentence endings.
Drew needs to maintain expressive and receptive vocabulary at a level typical for his age group. To do so, he will require direct instruction, which will include ample practice along with repetition and review.