BOUNDARY ISSUES (2) / HOW I

left without a parent through smoking related illness, any business or obligation of yours? It could be perceived as crossing the boundary if you mention smoking when youre treating the child for something unrelated. You may think that the trust and therapeutic relationship built up with the child and the parent could be gone in an instant, complaints could be made, and your professional competence could also be questioned. On the other hand, do you say anything to the parents about their own health, stepping over the line to inform them it can only help them too in the long run? Again, a difficult one, but the questions out there, and its up to you how you answer it. Difficult situations are bound to arise where you question how far you go when trying to do your best for a client or the people around them. Personal experience such as the loss of a family member through smoking could also be influencing you. Smoking is a lifestyle choice and an addiction, and as speech and language therapists were not here to influence decisions in that area, except where smoking is the possible cause of the problem being treated. Drawing that line is important, but even more important is deciding if and when to cross it. The World Health Organisation considers we all have a duty as health care professionals to address smoking and tobacco-related problems, stating that Public health is no ones domain but everyones arena (WHO, p.17). They go on to say that smoking related illness cuts across a vast range of health disciplines and one of a health professionals roles is to ensure all affected receive support in one way or another. So how far do you go? Is putting a Stop Smoking poster in your waiting room enough or too far? Do you go that bit further and provide advice? Do you refer on to a smoking cessation service? Its up to you how far you take it, when to draw the line, and if you cross it. Whatever your thoughts or beliefs, as a speech and language therapist you can act by yourself when appropriate, but carefully consider SLTP cooperating closely with others. Roger Newman is senior specialist speech and language therapist at Royal Preston Hospital, email Roger.Newman@lthtr.nhs.uk, and a senior lecturer in speech and language therapy at the University of Manchester.

How I assess for specific languag

A snapshot from
pecific language impairment is a complex communication disorder which can have significant social and educational implications. Early identification is needed so that appropriate management strategies can be put into place. Where specific language impairment is suspected, assessment is an important stage, as the therapist tries to differentiate this disorder from other developmental impairments. But how are we actually going about assessing for specific language impairment, and could we improve the process? To find out, a steering group of academic and clinical speech and language therapists collected data from speech and language therapists here in Ireland. A. PHASE 1 For phase one of this audit, we established a steering group and designed a survey around current practices when assessing language in children and adolescents with suspected specific language impairment. Speech and language therapists working with children in the public health services in Ireland were eligible for inclusion. We asked the Irish Association of Speech and Language Therapy Managers (n=70) to indicate the numbers of therapists of all grades who work with children. Fifty nine percent (n=41) of the managers responded with a total of 349 therapists. We distributed surveys through the managers asking these therapists to indicate which assessments they use most frequently for semantics, syntax and pragmatics in the different age groups, as it is common practice that a description of language strengths and weaknesses should include all three language dimensions (Eadie, 2003). The research team defined informal assessment as any assessment which was not standardised and norm-referenced. There was a 57 per cent response rate (199/349 surveys returned). Twenty per cent had 0-2 years experience, 45 per cent 3-9 years and 35 per cent over ten years. Fifty three percent of respondents reported that they frequently worked with children with specific language impairment, 34 per cent had sometimes, and 10 per cent had rarely. We excluded the 3 per cent who had

When you first see a child whom you suspect has specific langua assessment. But what tools do you choose and why? Rena Lyons to the available literature so that therapists, managers and educa doing and see if there is a need to change it.

never worked with these children. Forty percent of the respondents were working in or had worked in specialist classes in mainstream schools for children with specific language impairment. We asked respondents which three assessment tools they select most frequently when assessing each language dimension across three age groups. The responses for syntax are in figure 1, for semantics in figure 2 and for pragmatics in figure 3. B. PHASE 2 Phase two of the audit used a qualitative methodology to explore therapists experiences of the assessment process. Focus groups are small structured groups with selected participants, normally led by a moderator. They are designed to explore specific topics and individuals views and experiences through group discussion. We used the following topic guide: 1. When we talk about assessment of children who may have specific language impairment, what comes to mind? 2. When you are assessing children who may have specific language impairment, are there any influences on which assessment tools you use? 3. When we talk about assessment, formal and informal, what are your views on the

References

Cook, D.G. & Strachan, D.P. (1999) Summary of Effects of Parental Smoking on the Respiratory Health of Children and Implications for Research, Thorax 54, pp.357-366. RCSLT (2003) Reference Framework: Underpinning Competence to Practise. London: Royal College of Speech & Language Therapists. RCSLT (2006) Communicating Quality 3. London: Royal College of Speech & Language Therapists. WHO (2005) The role of health professionals in tobacco control. Geneva: World Health Organisation.

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HOW I
Figure 1 Assessment of syntax 100 93 90 80 60 48 40 20 0 6-12 yrs 13-18 yrs Age Groups RDLS III CELF 3 (UK) CELF-Preschool TROG RAPT INFORMAL 36 48 36 81 69

age impairment, you will naturally carry out an s audits current practice and relates the findings ators can look critically at what the profession is
use of these assessments in your clinical practice? What are the advantages and disadvantages of formal and informal assessment? 4. What outcomes of assessment make you consider a diagnosis of specific language impairment? To attract participants, we organised a seminar and asked therapists to notify the university in writing if they wished to attend and / or participate in the focus group. We allocated participants into two groups: FG1 was therapists working in community clinics and FG2 was those with specialist experience of working with children with specific language impairment (figure 4, p.26). We analysed the focus group transcripts into three organising themes and an overarching global theme (Attride-Stirling, 2001): (i) Global theme The overall global theme was that assessment is a time-consuming and complex process. Therapists have to make choices about what data needs to be collected, what contexts it needs to be collected in, who needs to be involved, and the most valid and reliable tools. All this decision-making takes place within a context of competing demands on time, policy requirements and new research and evidence in specific language impairment. In addition, experience is important in understanding what the tests actually test and in analysing results beyond test scores. (ii) Organising theme 1: The assessment process The participants in both focus groups consider that assessment is an ongoing process and not a once-off event. They highlighted the importance of collaboration and consultation with parents and other health and education professions when assessing children. They also stressed the need to collect data in a number of different contexts using a variety of assessment tools to obtain a representative profile of the childs strengths and areas of need. They talked about the significance of the case history information and levels of parental anxiety in helping clinicians shape the assessment plan. Participants consider that experience is an important factor in assessing and diagnosing

READ THIS IF YOU WANT TO APPRAISE YOUR ASSESSMENT PRACTICE RAISE THE STANDING OF INFORMAL ASSESSMENT ADOPT EMERGING APPROACHES

% of speech and language therapists

m Ireland

ge impairment:

90

0-5 yrs

children. For example they reported that with additional clinical experience, particularly working in language classes, they were more aware of the risk markers of specific language impairment. In addition familiarity with the various tests can maximise their usefulness. By really understanding what tests actually test, therapists can formulate hypotheses about the underlying impairment, identify areas which require further assessment and plan therapeutic interventions. Some participants feel constrained by policies on eligibility criteria which require standard scores. They also reported that the assessment process can be time-consuming and making a differential diagnosis can be difficult. being aware I suppose from previous experience, you may have warning signs that might be there following screening assessment [FG1] I find a wealth of information can be gained from the case history [FG 1] were forced to fit our kids into boxes to get them into language classes and I think were being pushed into it and I wonder where these criteria come from [FG2] (iii) Organising theme 2: Assessment tools This theme had two parts: standardised assessment and informal assessment. Both groups discussed the benefits of formal standardised assessments, saying they: a. provide objective and concrete measures of language abilities and a profile of strengths and needs b. can be used to examine areas in-depth c. have been developed using rigorous psychometric measures including measures of reliability and validity d. allow comparison with a sample on whom the test was developed e. can be a basis for explaining language impairments to parents and teachers f. can facilitate report writing and therapy planning g. can be quick and relatively easy to administer h. are used frequently in practice because they are required for determining eligibility for services.

% of speech and language therapists

Figure 2 Assessment of semantics 100 93 87 80 60 40 20 0 0-5 yrs 6-12 yrs 13-18 yrs Age Groups CELF 3 (UK) RDLS III BPVS CELF-Preschool RWFT INFORMAL 51 78

48

44

42

36 27

% of speech and language therapists

Figure 3 Assessment of pragmatics 100 90 84 80 60 40 20 0 60 54 51

75

46 36 38

0-5 yrs

6-12 yrs 13-18 yrs Age Groups REEL PRAGMATICS PROFILE TOPL INFORMAL

Assessment key BPVS: British Picture Vocabulary Scale (Dunn, 1997), GL Assessment CELF-Preschool: Clinical Evaluation of Language Fundamentals Preschool (Wiig, Secord & Semel, 1992), Pearson CELF3: Clinical Evaluation of Language Fundamentals 3 (Semel, Wiig & Secord,1995), Pearson Pragmatics Profile (Dewart & Summers, 1995), NFERNelson (http://wwwedit.wmin.ac.uk/psychology/pp/). RAPT: Renfrew Action Picture Test (Renfrew, 1997a), Speechmark RDLS III: Reynell Developmental Language Scales (Edwards et al., 1997), GL Assessment REEL: Receptive-Expressive Emergent Language Test (Bzoch et al. 2003), Pro-Ed RWFT: Renfrew Word Finding Test (Renfrew, 1995), Speechmark TOPL: Test of Pragmatic Language (Phelps-Terasaki & Phelps-Gunn, 1992), Ann Arbor TROG: Test of Reception of Grammar (Bishop, 2003), Pearson

SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2010

25

HOW I
The participants also noted the limitations. Formal assessments may not be sensitive or specific enough to identify the subtleties of specific language impairment and there are questions about validity, for example if a child has an off day. Even though they have been developed using rigorous procedures, participants also have concerns about reliability and validity in an Irish context as none are standardised on an Irish population and they may not be sensitive to cultural differences. These tests may not provide information on why a child is failing, and children may score poorly on a subtest for different reasons. In addition, participants reported that standardised testing is a crude instrument and may not provide enough information when used in isolation. They also noted a lack of suitable standardised tools to assess social communication and pragmatic ability and auditory processing. Another problem is that standardised tools measure discrete aspects of language and may not provide an integrated, valid overall picture of the childs communication abilities. Older children and adolescents may be aware of their language impairments and standardised testing may exacerbate this. I think sometimes that formal assessment doesnt pick up some of the innuendos of SLI [FG1] In language class contexts, lets say the child is not making progress on the standardised assessment and yet you are fully aware that their self-esteem has really improvedwere not tapping into measuring that in pre- and post- assessments [FG2] I think that they are useful tools [standardised assessment tools] when youre explaining to other professionals and parents ..exactly where the difficulty lies, sometimes its easier for them if they can see it on paper and when we explain what the test is about [FG2]
Years of Experience 0-2 FG1 (n=5) FG2 (n=10) 3 3-9 1 2 > 10 4 5 How frequently have you worked with children with SLI? Frequently 2 7 Sometimes 3 3 Experience in a Language Class None 5 6 4 Previous Current

Figure 4 Focus group participants

be expedient and get on with the referral or whatever paperwork and follow up has to be done afterwards [FG1] I think its [informal assessment] particularly relevant in very young children to spend time just observing and getting feedback.just getting to build up that picture before you go straight into [formal] assessment. [FG1] [informal assessment is a] truer reflection of what the child is capable of [FG2]

Many participants reported using informal assessment with children with specific language impairment. This can provide more ecologically valid data as it involves collection from a range of naturalistic communicative contexts. FG2 highlighted the benefits of language sample analysis, which can provide detailed qualitative data about a childs language. This is useful for planning intervention and may be less threatening for a child than formal testing. All participants acknowledged some limitations of informal assessment. It tends to be subjective, is not as easy to quantify as standardised measures, may be timeconsuming, and is not given the same weighting as standardised measures when determining eligibility for services. because of the demands we are under, theres often a pressure to get in there and get the assessment done so that you can

(iv) Organising theme 3: Influences on choice of assessment tools (figure 5) One of the main factors which influences choice of tools is the purpose of the assessment. Eligibility for educational resources is determined by specific standard scores and this requires therapists to select a standardised tool, which participants reported as constraining and frustrating. Where the purpose is to measure progress, or identify strengths and weaknesses, participants reported that they may select informal assessment tools. Other factors influencing choice include whether the purpose is for screening or diagnosis, satisfaction with and the length of time to administer the assessment, and characteristics of the child such as age, concentration and attention levels and severity of impairment. Participants choose specific tools to assess particular domains of language. They also discussed the value of narrative assessment tools, which can assess a range of language abilities. All reported that time influences their choice. Many participants work in busy settings with large caseloads and waiting lists, and an increasing amount of time is allocated to administration. They tend to use tests they are familiar with and may not have time to get to know new assessment tools even when they are available. C. RESULTS Not surprisingly, the results indicate a clear majority of clinicians use formal, published, standardised instruments as part of language assessment. However, they have many concerns about sensitivity to the subtleties of specific language impairment, reliability and validity and how these tools tend to fragment language into discrete components. As a result, many reported supplementing standardised tools with informal and non-standardised tasks. These provide data about the nature of the childs problem which is paramount for

planning intervention goals and selecting targets (Brackenbury & Pye, 2005). These findings are consistent with some of the literature in that therapists seem to rely on full language assessment batteries for diagnostic purposes (Eadie, 2003; Spaulding et al., 2006). However, Law (2002) says therapists in the UK have moved away from an over-reliance on standardised measurement for all but audit and research purposes. Instead, they make greater use of context-sensitive measures such as individual education plans and teachers report of adaptive and social behaviour. A small number of standardised tools dominate the clinicians choice and this is consistent with the literature (Eadie, 2003; Huang et al., 1997). This may be a result of the limited number of published language assessments, restricted resources, familiarity with assessment tools and time. The speech and language therapists also use informal assessment frequently to assess all aspects of language. The literatures agrees that descriptive assessment should always be used in conjunction with standardised tools for all purposes including screening, making placement decisions, obtaining a complete picture of a childs language competence, developing an intervention plan, and monitoring progress (Huang et al., 1997). The speech and language therapists select informal tools to assess syntax and semantics in adolescents more frequently than in the other age groups. Reed (2005) suggests this may be because fewer tests are available and those that are may not be sensitive enough to identify adolescents with language impairment. Given that adolescents are expected to use their language effectively in social, academic and vocational contexts, Reed (2005) recommends that communication in each of these needs to be included in the assessment process. Participants indicated that they use informal assessment most frequently to assess pragmatics. This is not surprising as the constraints imposed by standardised testing violate the social principles of pragmatics (Tomblin et al., 1996). Although we did not specifically ask, some participants discussed the value of assessment of narrative skills. This allows therapists to examine how children integrate sophisticated skills in semantics, syntax and pragmatics when formulating a narrative. In addition, the multifaceted nature of narrative analysis may have predictive value for later

26

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HOW I
Functioning (Washington, 2007) would assess the impact of speech, language and communication skills on childrens everyday activities and participation in society, as well as the impairment. Dynamic approaches to assessment focus on the childs learning potential in different conditions, including the childs responsiveness to intervention, and there is some evidence that this model may be useful for differentially diagnosing children with specific language impairment (Pena et al., 2007). Assessment of narrative skills also provides a more ecologically valid assessment of how the child integrates many different skills. 3. Taking time for critical reflection It is important for therapists to take time out of their busy clinics to critically reflect on their assessment practices, asking: What assessment tools do I use and why do I use them? Are there new assessment tools in my department which I have not had time to look at yet? Do I assess speech, language and communication skills in naturalistic settings? Is there a more systematic approach I could use for my informal assessment such as checklists or more structured recording of my observations? 4. Influencing policy Speech and language therapists need to influence policy makers on eligibility criteria for services so that informal measures will be given consideration as well as the results of standardised assessments. While this research provides a general overview of assessment practices, further well-designed studies are needed to shed light on the black box of clinical decisionmaking (Roulstone, 2001). In addition, further research is needed on how new models of assessment can be used in the assessment and diagnosis of children with specific SLTP language impairment. Rena Lyons is a Senior Lecturer, Discipline of Speech and Language Therapy, at the National University of Ireland Galway, Ireland, tel. 00 353 91 42918, e-mail rena.lyons@nuigalway.ie. This article is based on a longer paper which includes greater cross-referencing with the literature. The full reference list is at www.speechmag.com/ Members/Extras.

Policy Purpose of assessment Time Influences on choice of assessment tools Satisfaction with tools

Aspects of language to be assessed

Familiarity with tools

Childs age

Figure 5 Factors influencing choice of assessment tools

language and literacy difficulties (Eadie, 2003). Narrative is also an ecologically valid way to measure communicative competence and can help distinguish sub-groups of children with language impairments (Botting, 2002). One of the main factors which influences these therapists choice of assessment is time. Given that demand for speech and language therapy is so great, an assessment is unlikely to be undertaken if it cannot be administered quickly and efficiently (Skahan et al., 2007). Therapists choosing tests that require relatively little time for administration, interpretation, and reporting may be a reflection of time pressure on clinical decisions (Huang et al., 1997). This theme emerged strongly from the focus group discussion and is consistent with the literature whereby clinicians are caught in a dilemma between striving for best practice and acceding to time pressures, and may experience frustration and personal dissatisfaction as a result (Huang et al., 1997). Time constraints have been raised as a critical issue that may impede clinicians from completing comprehensive assessments (Skahan et al., 2007). Although this study provides a useful snapshot and preliminary data on how therapists assess and diagnose children with specific language impairment in Ireland, there were shortcomings. The response rate represents just over half of the therapists working with children in Ireland and the results must be interpreted with this in mind. Some aspects were not covered in great depth or at all to keep the survey to a reasonable length (the assessment tools section was part of a longer survey). We didnt collect data on therapists satisfaction with the specific tools, the specific purposes for which they use the tools, how the assessment procedures vary relative to client characteristics and use of emerging models of assessment such as those based on information-processing and psycholinguistic frameworks and dynamic assessment (Tyler & Tolbert, 2002). Therapists

choice of standardised assessments may have been constrained by eligibility criteria for educational resources set by the Department of Education and Science (DOES, 2003). In addition, the survey included the most recent version of the assessment tool and therapists may use other versions. In terms of informal assessment, we did not explore specific types of informal criterion-referenced or childspecific measures described in the literature such as language sampling, checklists, and information from parents, teachers and other professionals (Skahan et al., 2007). In addition, the focus groups were small and we are not claiming that the results are representative or generalisable. D. IMPROVING PRACTICE Reflecting on our findings, I feel there are ways we can improve the assessment process: 1. Making evidence accessible Specific language impairment is an umbrella term used to describe children with a range of profiles, all of which include marked language difficulties in the context of normal cognitive abilities (Botting & Conti-Ramsden, 2004). However, there is growing evidence for markers of a qualitatively distinct deficit such as specific difficulties with aspects of syntax and morphology (Bishop, 2004; Botting & ContiRamsden, 2004). This evidence base needs to be more accessible to busy clinicians so they can reflect on the implications for their practice. 2. Using new frames of reference We designed the survey using a linguistic model frame. However, there is growing recognition that other frames of reference may be useful in assessing and diagnosing children with specific language impairment. This includes assessment of information processing skills such as attention, memory and the speed of processing (Brackenbury & Pye, 2005) and psycholinguistic models (Stackhouse & Wells, 1997). The International Classification of

Acknowledgements

This research project was funded by the National University of Ireland Galway Millennium grant. Thank you to the research team who contributed to this project: Dr. Molly Byrne, Trina Corry, Lily Lalor, Helen Ruane, Ruth Shanahan, Barbara Murphy, and Colette McGinty. Thank you to Lorraine Kent for formatting the questionnaire and assisting with the quantitative data analysis. Thank you to Niamh Gallagher for her assistance with the qualitative data analysis. Thank you also to all the therapists who completed the survey and to those who participated in the focus groups.

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HOW I

Attride-Stirling, J. (2001) Thematic networks: an analytic tool for qualitative research, Qualitative Research (1), 385-405. Bishop, D. V. M. (2004) Specific Language Impairment: Diagnostic Dilemmas, in L. Verhoeven & H. van Balkom (Eds.), Classification of Developmental Language Disorders Theoretical and Clinical Implications. London: Lawrence Erlbaum Associates. Botting, N. (2002) Narrative as a tool for the assessment of linguistic and pragmatic impairments, Child Language Teaching and Therapy, 1-21. Botting, N., & Conti-Ramsden, G. (2004) Characteristics of children with specific language impairment, in L. Verhoeven & H. van Balkom (Eds.), Classification of Developmental Language Disorders Theoretical Issues and Clinical Implications. London: Erlbaum Associates. Brackenbury, T., & Pye, C. (2005) Semantic deficits in children with language impairments: issues for clinical assessment, Language, Speech, and Hearing Services in Schools, 36, pp.5-16. DOES (2003) Allocation of resources for pupils with special educational needs in national schools. Retrieved 15/11/07, from http://www. sess.ie/sess/Files/Circular_SPED_24_03.doc. Eadie, P. (2003) Speech pathology assessment practices: One assessment or many? Advances in Speech-Language Pathology, 5(1), pp.65 - 68. Huang, R., Hopkins, J. & Nippold, M. (1997) Satisfaction with standardized language testing: a survey of speech-language ADVERTISEMENT

References

pathologists, Language, Speech, and Hearing Services in Schools, 28, pp.12-29. Law, J. (2002) Having your cake and eating it: the apparent paradox of long-term outcomes of SLI, Advances in Speech-Language Pathology, 4(1), pp.65-67. Pena, E.D., Resendiz, M., & Gillam, R.B. (2007) The role of clinical judgements of modifiability in the diagnosis of language impairment, International Journal of Speech-Language Pathology, 9(4), pp.332 - 345. Reed, V. (2005) An Introduction to Children with Language Disorders. (3rd edn.) Boston: Pearson Education Inc. Roulstone, S. (2001) Consensus and variation between speech and language therapists in the assessment and selection of preschool children for intervention: a body of knowledge or idiosyncratic decisions?, International Journal of Language & Communication Disorders, 36(3), p.329. Skahan, S.M., Watson, M., & Lof, G.L. (2007) Speech-Language Pathologists Assessment Practices for Children With Suspected Speech Sound Disorders: Results of a National Survey, American Journal of Speech and Language Pathology, 16(3), pp.246-259. Spaulding, T., Plante, E. & Farinella, K. (2006). Eligibility criteria for language impairment: is the low end of normal always appropriate?, Language, Speech, and Hearing Services in Schools, 37, pp.61-72. Stackhouse, J., & Wells, B. (1997) Childrens speech and literacy difficulties - a psycholinguistic framework. London: Whurr Publishers.

Tomblin, J.B., Records, N. & Zhang, X. (1996) A system for the diagnosis of specific language impairment in kindergarten children, Journal of Speech and Hearing Research, 39, pp.1284-1294. Tyler, A.A., & Tolbert, L.C. (2002) SpeechLanguage Assessment in the Clinical Setting, American Journal of Speech and Language Pathology, 11(3), pp.215-220. Washington, K. (2007) Using the ICF within speech-language pathology: application to developmental language impairment, Advances in Speech-Language Pathology, 9(3), pp.242-255.

REFLECTIONS DO I CONSIDER HOW NEW RESEARCH INTO THE NATURE OF A COMMUNICATION DIFFICULTY IMPACTS ON HOW I ASSESS FOR IT? DO I MAKE A CONSCIOUS EFFORT TO THINK ABOUT WHAT ASSESSMENT TO CHOOSE AND WHY? DO I SET ASIDE TIME TO FAMILIARISE MYSELF WITH NEW ASSESSMENTS AS THEY BECOME AVAILABLE?
Do you wish to comment on the impact this article has had on you? Please see guidance for Speech & Language Therapy in Practices Critical Friends at www. speechmag.com/About/Friends.

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SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2010

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This is the full reference list used by Rena Lyons in the development of How I assess for specific language impairment: A snapshot from Ireland, Speech & Language Therapy in Practice, Summer 10, pp.24-28. Attride-Stirling, J. (2001) 'Thematic networks: an analytic tool for qualitative research', Qualitative Research (1), pp.385-405. Baker, L. (1988) 'The use of language sample analysis - results of a questionnaire', Bulletin of the College of Speech Therapists pp.2-4. Bishop, D. V. M. (2004) 'Specific Language Impairment: Diagnostic Dilemmas', in L. Verhoeven & H. van Balkom (Eds.), Classification of Developmental Language Disorders Theoretical and Clinical Implications. London: Lawrence Erlbaum Associates. Bloom, L. & Lahey, M. (1978) Language development and language disorders. New York: John Wiley & Sons. Botting, N. (2002) 'Narrative as a tool for the assessment of linguistic and pragmatic impairments', Child Language Teaching and Therapy, pp.1-21. Botting, N. & Conti-Ramsden, G. (2004) 'Characteristics of children with specific language impairment', in L. Verhoeven & H. van Balkom (Eds.), Classification of Developmental Language Disorders Theoretical Issues and Clinical Implications. London: Lawrence Erlbaum Associates. Brackenbury, T. & Pye, C. (2005) 'Semantic deficits in children with language impairments: issues for clinical assessment', Language, Speech, and Hearing Services in Schools, 36, pp.516. Busari, J. & Weggelaar, N. (2004) 'How to investigate and manage the child who is slow to speak', British Medical Journal, 328, pp.272-276. DOES (2003) Allocation of resources for pupils with special educational needs in national schools Retrieved 15/11/07, from http://www.sess.ie/sess/Files/Circular_SPED_24_03.doc. Duchan, J. (2004) Frame work in language and literacy: how theory informs practice. London: The Guilford Press. Eadie, P. (2003) 'Speech pathology assessment practices: One assessment or many?', Advances in Speech-Language Pathology, 5(1), pp.65 - 68. Gutierrez-Clellen, V. & Pena, E. D. (2001) 'Dynamic assessment of diverse children: a tutorial', Language, Speech, and Hearing Services in Schools, 32, pp.212-224. Hammill, D. & Newcomer, P. (1988) The Test of Language Development. Austin PRO-ED. Hedge, M. N. & Maul, C. A. (2006) Language Disorders in Children - an evidence based approach to assessment and treatment. London: Pearson Education Inc. Huang, R., Hopkins, J. & Nippold, M. (1997) 'Satisfaction with standardized language testing: a survey of speech-language pathologists', Language, Speech, and Hearing Services in Schools, 28, pp.12-29. Hux, K., Morris-Friehe, M. & Sanger, D. (1993). Language sampling practices: a survey of nine States. Language, Speech, and Hearing Services in Schools, 24, 84-91. Kemp, K. & Klee, T. (1997) 'Clinical language sampling practices: the results of a survey of speech-language pathologists in the United States', Child Language Teaching and Therapy, 13, pp.161-176. Law, J. (2002) 'Having your cake and eating it: the apparent paradox of long-term outcomes of SLI', Advances in Speech-Language Pathology, 4(1), pp.65-67. Law, J., Garrett, Z. & Nye, C. (2004) 'The Efficacy of Treatment for Children With Developmental Speech and Language Delay/Disorder: A Meta-Analysis', J Speech Lang Hear Res, 47(4), pp.924-943.

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