Diagnostic decisions in child assessment (Fulcher-Rood et al., 2019)

Purpose: The current study used a case review diagnostic assessment task to examine the diagnostic decisions speech-language pathologists (SLPs) working in the United States made after reviewing child language cases.
Method: Fourteen SLPs were given 5 case studies that presented either congruent or incongruent results between standardized testing and informal measures. After reviewing the assessment data, SLPs were asked to make a diagnostic decision.
Results: Unanimous consensus regarding diagnostic decisions was found when the assessment data were congruent. When the data were incongruent, unanimous consensus was not achieved. Standardized testing seemed to guide the diagnostic decision. This pattern of reliance on standardized testing was evident even when 80% of SLPs reviewed informal language data. In 97% of cases, a standardized test was used to guide clinical decision making.
Conclusion: Three patterns of clinical decision making in child language assessment emerged: (a) use of both standardized testing and informal measures, (b) a reported concern tool as a 1st step in the process, and (c) standardized testing as the most influential data for guiding diagnostic decisions. Although this study provides initial evidence regarding the process of diagnostic decision making, future studies should examine decision making in real time to further validate the implicit rules used during decision making.

Supplemental Material S1. Standardized testing score summary.

Supplemental Material S2. Teacher questionnaire summary.

Supplemental Material S3. Summary of parent questionnaire.

Supplemental Material S4. Language sample, story retell, Case 1 (congruent data).

Supplemental Material S5. Language sample, picture elicitation, Case 1 (congruent data).

Supplemental Material S6. Language sample, story retell, Case 2, congruent data.

Supplemental Material S7. Language sample, picture elicitation, Case 2, congruent data.

Supplemental Material S8. Language sample, story retell, Case 3, incongruent data.

Supplemental Material S9. Language sample, picture elicitation, Case 3, incongruent data.

Supplemental Material S10. Language sample, story retell, Case 4, incongruent data.

Supplemental Material S11. Language sample, picture elicitation, Case 4, incongruent data.

Supplemental Material S12. Language sample, story retell, Case 5, congruent data.

Supplemental Material S13. Language sample, picture elicitation, Case 5, congruent data.

Fulcher-Rood, K., Castilla-Earls, A., & Higginbotham, J. (2019). Diagnostic decisions in child language assessment: Findings from a case review assessment task. Language, Speech, and Hearing Services in Schools, 50, 385–398. https://doi.org/10.1044/2019_LSHSS-18-0044