Article 5

| |
Received: 6 November 2017 Revised: 15 August 2018 Accepted: 28 August 2018
DOI: 10.1111/jar.12530
ORIGINAL ARTICLE Published for the British Institute of Learning Disabilities
Approaches to communication assessment with children and

adults with profound intellectual and multiple disabilities
Darren Chadwick1 | Susan Buell2 | Juliet Goldbart3
1
The University of Wolverhampton,
Wolverhampton, UK Abstract
2
The University of East Anglia, Norwich, UK Communication assessment of people with profound intellectual and multiple disa-
3
Manchester Metropolitan University, bilities (PIMD) has seldom been investigated. Here, we explore approaches and deci-
Manchester, UK
sion making in undertaking communication assessments in this group of people. A
Correspondence questionnaire was sent to UK practitioners. The questionnaire elicited information
Darren Chadwick, The University of
about assessment approaches used and rationales for assessment choices. Fifty-five
Wolverhampton, Wolverhampton, UK.
Email: [email protected] speech and language therapists (SLTs) responded. Findings revealed that the
Preverbal Communication Schedule, the Affective Communication Assessment and
the Checklist of Communication Competence were the most frequently used pub-
lished assessments. Both published and unpublished assessments were often used.
Rationales for assessment choice related to assessment utility, sensitivity to detail
and change and their applicability to people with PIMD. Underpinning evidence for
assessments was seldom mentioned demonstrating the need for more empirical sup-
port for assessments used. Variability in practice and the eclectic use of a range of
assessments was evident, underpinned by practice-focused evidence based on tacit
knowledge.
1 | I NTRO D U C TI O N information will enable the generation of assessment approaches which
can more reliably map progress and change in communication skills and
People of all ages with profound intellectual and multiple disabilities furthermore be generalized across interventions to be explored in prac-
(PIMD) experience significant challenges in relation to communica- tice and research.
tion, with limited comprehension of speech and communication at Burton and Sanderson (1998) identified four paradigms that can be
pre-
symbolic or proto-
symbolic levels (Bellamy, Croot, Bush, Berry, used to understand intellectual disability are as follows: ordinary liv-
& Smith, 2010; Iacono, West, Bloomberg, & Johnson, 2009; Maes, ing/normalization, behavioural, functional and developmental. These
Lambrechts, Hostyn, & Petry, 2007). Accordingly, assessment of their have relevance for the way language and communication assessment
communication needs to be addressed in some detail during these early and intervention are addressed. Assessments of early language and
developmental stages. Brady et al. (2018) clearly identify the “void” in communication can be seen as falling broadly into two groups: norm-
options for detailed assessment of these pre-and proto-symbolic lev- referenced assessments (Dockrell, 2001) and criterion-
referenced
els of communication. This void leaves those attempting to enhance assessments (Kaderavek, 2014). Norm-
referenced assessments fol-
communication in people with PIMD little detail on which to base their low continuous developmental progression (e.g., CELF, Wiig, Secord, &
interventions, and a dearth of sensitive assessments to provide base- Semel, 2004; Reynell-III, Edwards, Fletcher, Garman, Hughes, Letts &
line communication information and measure change in this population. Sinka, 1997). These assessments do not, typically, address the pre-and
Given this challenge, it is crucial that current assessment measures proto-symbolic stages (Brady et al., 2012). Criterion-referenced assess-
utilized formally and the rationales for their use are investigated. Such ments, which determine whether or not the learner can do specific
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction
in any medium, provided the original work is properly cited and is not used for commercial purposes.
© 2018 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd
336 | wileyonlinelibrary.com/journal/jar J Appl Res Intellect Disabil. 2019;32:336–358.

CHADWICK et al. |
337
Published for the British Institute of Learning Disabilities
activities, can therefore be seen as more functional. Examples include This has been operationalized through the integration of patient val-
the Preverbal Communication Schedule (PVCS, Kiernan & Reid, 1987) ues and clinical expertise with the best available research evidence
and the Triple C (Bloomberg, West, Johnson, & Iacono, 2009). Hence, (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Currently,
selection of specific assessments can be informed by the underpinning there is limited empirical evidence that demonstrates the integration of
model of communication employed by practitioners. these three strands in the process of communication assessment selec-
There is limited research on the developmental trajectory of com- tion for people with PIMD. Exploration of the decision making around
munication skills in adults with PIMD, though Rondal and Edwards assessment selection and use by SLTs, the key formal communication
(1997) suggest that some continued progress in “language pragmat- assessment practitioners, would help to address this evidence gap.
ics” continues at least into early adulthood. In this paper, therefore, People with PIMD are a low prevalence and highly heterogeneous
we will adopt a lifespan approach, in which both adults and children group with high demands on specialist services (Timmeren et al., 2017).
are regarded as having the potential for communicative development. Guess et al. (1988) found that participants spent less than half their
This point, in conjunction with the risk of social exclusion, makes an time awake and alert, that is, in behavioural states conducive to learn-
argument for communication intervention with children and adults ing. This could pose difficulties for robust assessment. Also, challenging
with PIMD, even if the aim is to increase opportunities for social infor those wishing to conduct assessments are the co-morbid conditions
teraction and enhance performance rather than to increase compe- and impairments that this client group are likely to experience which
tence per se. This is reinforced by Bunning’s (2009, p. 48) definition: include visual impairments (often cortical, 85%, Van Splunder, Stilma,
“Communication is about two or more people working together and Bernsen, Arentz, & Evenhuis, 2003), hearing impairments (25%–35%,
coordinating their actions in an ongoing response to each other and Evenhuis, Theunissen, Denkers, Verschuure, & Kemme, 2001), epilepsy
the context.” This emphasizes the importance of the active role of (50%, Lhatoo & Sander, 2001), neuro-
motor impairments (Arvio &
the communication partner. However, they may struggle to interpret Sillanpää, 2003) and gastro-oesophageal disorders (Van der Heide, Van
communicative intent or to respond sensitively to the communicative der Putten, Van den Berg, Taxis, & Vlaskamp, 2009). These conditions
behaviours of people with PIMD which are often individual and id- can also have a negative impact on wellbeing and participation (Zijlstra
iosyncratic (De Bortoli, Arthur-Kelly, Foreman, Balandin, & Mathisen, & Vlaskamp, 2005).
2011; De Bortoli, Balandin, Foreman, Mathisen, & Arthur-Kelly, 2012; The complexity and heterogeneity of sensory, perceptual, motor
Forster & Iacono, 2008; Healy & Noonan Walsh, 2007; Hostyn, and cognitive impairments experienced by people with PIMD suggest
Daelman, Janssen, & Maes, 2010). As a result, people with PIMD can that they are unlikely to conform to the standardization sample of pub-
be left socially, societally and educationally excluded. Such commu- lished assessments aimed at the wider population of individuals with
nication difficulties can leave people with PIMD unable to influence communication impairments. People with PIMD, who may experience
their surroundings or instigate interactions with others and may very protracted periods within early developmental stages, cannot
ultimately render them devoid of agency. The assessment of com- be assumed to follow typical trajectories (Brady et al., 2012). Brady
munication skills provides a crucial baseline for “two or more people et al. (2012) discuss a range of syndromes with non-typical progres-
working together” (Bunning 2009, p. 48) by informing them about the sion, suggesting that researchers and practitioners should, at least, be
learner’s level of communication thus providing the starting point for wary of making developmentally based assumptions. In order to sup-
the coordination of actions and ongoing responses. port evidence-based practice, the authors of the Triple C (Bloomberg
Assessment of language and communication is a core professional et al., 2009; Iacono et al., 2009), PVCS (Kiernan & Reid, 1987) and the
skill of Speech and Language Therapists (SLTs). A position paper from Communication Complexity Scale (Brady et al., 2012, 2018, still in
the Royal College of Speech and Language Therapists (RCSLT) in the UK development) have engaged in some evaluation of the psychometric
(Baker, Oldnall, Birkett, McCluskey, & Morris, 2010, p. 10) has identified properties of both assessments.
SLTs as the lead experts on communication for people with intellectual Despite presenting with complex communication profiles, there
disabilities. Further guidelines by the RCSLT (2006, p. 200) described appears to be consistency across categorizations of communication in
the purpose of the assessment process as “to identify and collect the people with PIMD. Using assessment data (Triple C, Bloomberg et al.,
requisite range of relevant information through appropriate formal and 2009), from 72 adults aged 20–70 with severe and profound disabili-
informal methods including discussion with client/carer and consulta- ties, Iacono et al. (2009) have demonstrated progression through five
tion with colleagues.” Amongst other outcomes from assessment, they stages: unintentional passive, unintentional active, intentional formal,
included identification of the client’s communication profile of strengths symbolic (basic) and symbolic established. Rowland’s (2013) communi-
and difficulties, any challenges presented by communication in every- cation matrix reports on seven levels, from pre-intentional behaviour
day functioning, the capacity for change, opportunities for intervention, through to intentional language. The first six of these correspond to the
information for clinical prioritization, management and planning and range described in the Triple C comprising pre-intentional behaviour,
forward referral to other agencies (RCSLT, 2006). Moreover, the impor- intentional behaviour, unconventional communication (pre-symbolic),
tance of robust communication assessment in informing and charting conventional communication (pre-symbolic), concrete symbols and ab-
evidence-based intervention is well substantiated (Brady et al., 2012; stract symbols.
Dockrell & Marshall, 2013). Appropriate assessment selection and use Few published communication assessments are available that
are increasingly seen as part of establishing evidence-based practice. have been specifically devised for people with PIMD (Iacono et al.,
|
338 CHADWICK et al.
2009). The reason for this lack of specific assessment availability is was further refined on consultation with a group of three SLTs ex-
unclear, although we hypothesize that it may be as a result of the perienced in working with PIMD and literature on survey design
low incidence of this population (Mansell, 2010). Those with PIMD (De Vaus, 2013; Oppenheim, 2000). Responses were requested for
are a “Cinderella” (i.e., low status) group within a “Cinderella” group the following: (a) name each assessment used with children and/
(the population of people with an intellectual disability), receiving or adults with PIMD and (b) provide the source of the assessment
less attention in both practice and research, compared with others or descriptive information regarding how and why the assessment
both with and without intellectual disabilities (cf. Harflett, Turner, was created. Participants were asked in open-ended questions to
& Bown, 2015). It is also important to note that the complementary provide their rationales for choosing and using any assessment they
use of multiple assessments, for example, the use of eclectic ap- named. The same information was requested for assessments in two
proaches, including formal and informal language assessments and different categories: (a) published assessments and (b) unpublished
family input, has been advocated in the process of communication assessments. The latter included assessment material devised within
assessment of people with PIMD (Brady & Halle, 1997; Brady et al., the service where the respondent currently worked (in-house as-
2012; Ogletree, Turowski, & Fischer, 1996). sessments), those devised outside the service but unpublished and
Given the limits of assessment material and the complex needs of personally devised assessments. Space was provided at the end
this client group, it is unsurprising that there is a lack of clarity within of the questionnaire for further relevant descriptive information.
the extant literature regarding communication assessment selection Background information about the SLTs was also gathered, compris-
and use. The aim of this paper was to explore how communication ing the level of experience they considered themselves to have in
assessment was conducted in the UK with people with PIMD across the area of communication assessment and intervention with people
the lifespan by SLTs. A survey was employed in an attempt to estab- with PIMD, the type of setting they worked in and other stakehold-
lish a picture of current practice of SLTs who worked with children ers they collaborated with. The finished survey was piloted with
and adults with PIMD and who utilized core assessment as part of three non-participant SLTs and amended in line with their sugges-
their role. Of particular interest was the nature of communication tions to clarify some of the directives and instructions on the ques-
assessments used, and the rationales provided for their selection tionnaire. No change was made to the content or to the information
and use. requested. A copy of the survey can be obtained from the first au-
thor upon request. PMLD rather than PIMD was the terminology
used within the survey as this was believed to be the terminology
1.1 | Research questions
most commonly used with the UK context, PIMD has been used in
1. What communication assessment approaches were most com- this publication to accord with the journal style.
monly used by SLTs working with children and adults with
PIMD?
2.3 | Recruitment and sampling
2. What rationales were given by SLTs working with children and
adults with PIMD for the selection of these assessment The regular RCSLT Bulletin, their CPD e-
newsletter and RCSLT
approaches? Special Interest Groups were targeted for dissemination of recruit-
ment information via letter and an invitation for interested SLT par-
ticipants to contact the principal investigator (PI) directly for further
2 | M E TH O D
details. No reliable data was available to show the number of SLTs
currently working in the UK in this specialist area. Multiple, non-
2.1 | Design
probability sampling techniques were used to maximize response
For this exploratory investigation, a questionnaire-
based survey rate for recruitment. The first, purposive self-selected sample of
was used to collect data from SLTs currently in practice. Descriptive participants were those who self-identified as working with a client
information was gathered about the type of assessments chosen group of children or adults with PIMD. This formed the inclusion
and the priorities given for that choice in working with children and criterion for the study. To increase recruitment, snowball sampling
adults with PIMD. Questions were asked relating to the source of was also employed, where those who had participated were asked
the assessment material, which client group the clinician used it with to identify and forward the questionnaire to colleagues and other
and the rationales for its use. Ethical approval was given for this pro- eligible SLTs they knew of who also worked in the area of PIMD.
ject by South West England Research Ethics Committee.
2.4 | Participants
2.2 | Development and pilot of questionnaire
Final recruitment resulted in usable surveys from 55 SLTs who
Discussion at the Special Interest Research Group for Profound worked with children (30) and/or adults (35) with PIMD (10 par-
and Multiple Learning Disabilities (PMLD) within the International ticipants worked with both children and adults). Within this group,
Association for the Scientific Study of Intellectual and Developmental participants represented all but two Higher Education Institutions
Disabilities (IASSIDD) informed the design of the initial survey. This (HEI) that provided accreditation for qualifying SLTs in the UK. No
CHADWICK et al. |
339
uncompleted surveys were returned, 52 were fully completed with 3 were entered into SPSS on a password protected computer for fu-
having some minimal missing data. ture reference.
2.4.1 | Participant background and experience 2.6 | Data analysis

Background information about the participant SLTs is presented in Quantitative data were analysed using descriptive statistics. The
Table 1. Most participants had been working as SLTs for 6 years or number of participants using each assessment was determined for
more, with around a quarter having worked between 3 and 5 years in each assessment type. The qualitative data from the open-ended
practice. Few had been in practice for <3 years. With regard to their questions relating to rationales for using each assessment were
working week, around two-thirds of participants worked full time then grouped together and conceptually content-
analysed using
with the remainder working part-time (between 1 and 4.5 days per the method outlined by Carley (1990). This involved grouping the
week). Around two-thirds worked with people with PIMD between rationales into basic themes for each published assessment based
0.5 and 4 days per week with most working 0.5 to 2 days per week. on the similarity of response. The number of participants report-
One-third of participants reported working with people with PIMD ing each rationale was recorded for each assessment. Each author
for half a day or less per week. Most participants rated themselves as took the rationale data for an equivalent number of assessments to
experienced (96.1%) and skilled (78.9%) in working with people with code into basic themes. This allowed identification of the specific
PIMD in the area of communication. rationales for each assessment. To enhance the trustworthiness of
this analysis, initial coding was repeated for each assessment, with
second coding being conducted independently by one of the other
2.4.2 | Team involvement and the workplace
authors. Any coding discrepancies were resolved via discussion. The
Participants worked in a variety of environments, some in more few comments that were difficult to understand and problematic to
than one setting. Most worked in intellectual disability community code, typically due to being unfinished or unclearly articulated, were
teams, while some worked in Primary Care Trusts and educational excluded from the analysis. Subsequently, the first author recoded
settings. Joint multidisciplinary work was evident across a number of the initial list of basic themes into organizing themes and then iden-
settings. The most frequent partnerships were with physiotherapy, tified which assessments these organizing themes corresponded
occupational therapy and with the family carers. More than 50% of to (see Table 2). This provided a synthesis of the various ration-
SLTs reported that they worked closely with teachers, psychologists, ales across the different assessments. This analysis was also inde-
community nurses, SLT assistants, day and residential staff and dieti- pendently checked by the third author, to enhance the credibility
cians. Less common was joint work with social workers, care manag- and trustworthiness of the findings, with discrepancies once again
ers, school nurses, nursery staff and psychiatrists. A number of other resolved via discussion. A similar process was undertaken for the
collaborators were mentioned, each by one respondent. content analysis of the unpublished assessments but, due to their in-
dividual, idiosyncratic and unpublished nature, only the synthesized
rationales are presented in the findings below with frequency and
2.5 | Procedure
percentages provided relating to the number of participants report-
Following ethical approval, contact was made with the RCSLT for ing the theme, rather than the number of assessments that corre-
the distribution of advertising material. This contact took the form sponded to particular themes.
of a letter sent via the RCSLT as explained above. Interested par-
ticipants were encouraged to contact the PI by email or telephone
3 | FI N D I N G S
to request further information or a participant pack. Participant
packs, comprising the information leaflet, consent form and sur-
3.1 | Communication assessments used
vey, were sent to all those who agreed to take part by post in
paper form, or electronically in digital form, according to partici- Over 90% of therapists (50) reported using unpublished assess-
pant preference. These packs included a letter of introduction to ments with both adults (32; 91%) and children (27; 90%) (nine re-
the study, giving the background and outlining the study’s objec- spondents used unpublished assessments with both children and
tives, an information leaflet providing a clear explanation of the adults). Slightly fewer (46; 83.6%) reported using published assess-
expectations from the participant and responsibilities of the pro- ments, again with both adults (29; 82.9%) and children (25; 83.3%).
ject team, a consent form and the survey. All participants were Most of the 55 respondents (42; 76.4%) reported using both pub-
reassured that they could withdraw from the study at any time. lished and unpublished assessments of people with PIMD. Typically,
A 3-week timescale was given for completion and return of the multiple methods were used to assess communication with un-
survey. Follow-up reminders were sent by email after 1 week. On published and published assessments merging into an assessment
arrival, surveys were separated from personal identifying informa- profile, although this was rarely formally described as such in the
tion and secured in separate locked filing cabinets or password surveys. Only five (9.1%) respondents used published assessments
protected folders. All surveys were anonymized and coded. Data only and eight (14.5%) used unpublished assessments alone.
|
340 CHADWICK et al.
TA B L E 1 Showing background information for participants
Background information (N of respondents) N %
Client age groups worked with (N = 55)

Only children 20 36.3
Only adults 25 45.5
Both children & adults 10 18.2
Total working with children 30 54.5
Total working with adults 35 63.6
Experience working as an SLT (N = 52)
>10 years 23 41.8
6–9 years 8 14.5
3–5 years 14 25.5
2 years or less 7 12.8
Time spent working each week (N = 53; 1 session = ½ a day)
5 days/10 sessions per week 35 66.0
4–5 days/8–9 sessions per week 6 11.4
1–3.5 days/3–7 sessions per week 12 22.7
Time spent working with people with PIMD each week (N = 40; 1 session = ½ a day)
2.5–4 days/5–8 sessions per week 2 5.0
0.5–2 days/1–4 sessions per week 24 60.0
<0.5 days/<1 session per week 14 35
Self-rating of experience of working on communication with people with PIMD (N = 52)
Highly experienced 23 53.8
Experienced 22 42.3
Some experience 5 9.6
Limited experience 2 3.8
Self-rating of expertise and skill working on communication with people with PIMD (N = 52)
Highly skilled 16 30.8
Skilled 25 48.1
Some skill 6 11.5
Limited skill 5 9.6
Workplace (N = 54)
Intellectual disability community team 28 51.9
Primary care trusts 26 48.1
Education 14 26.0
Mental health/behavioural team 5 9.1
Collaborative working
Physiotherapist 43 79.6
Occupational therapist 41 75.9
Family carer 41 75.9
Teachers 35 63.5
Psychologists 36 65.5
Community nurses 32 58.2
SLT assistants 34 61.8
Day & residential support staff 30 54.5
Dieticians 28 50.9
Social worker/care manager 7 12.9
Specialist, nursery and school nurses 5 9.25
(Continues)
CHADWICK et al. |
341
TA B L E 1 (Continued)
Background information (N of respondents) N %
Psychiatrists 3 5.5
All mentioned by a single respondent: Play specialist, 1 1.9
school tutor, special educational needs coordinator
(SENCO), behaviour specialist, music therapist, sensory
support coordinator, “Seeability” worker (for profound
cognitive and sensory impairments), medical officer,
paediatrician, respite carer, Portage worker and racial
minority link worker
Use of unpublished assessments reportedly involved developing likes and dislikes (2; 7.4%), and demonstrated their communication
new assessments, but it also involved taking a number of existing strengths (3; 11.1%). They also helped them to better understand
assessments, adapting each and merging them into a new assess- the specific ways people communicated across different contexts
ment, or taking an individual published assessment and adapting it. (1; 3.7%).
Hence, an eclectic approach to assessment was evident in the work Third, use of particular assessments supported effective work-
of the SLTs surveyed. The purpose in all cases was to develop, in ing with communication partners, including family and paid carers
the opinion of the participant, a more functionally useful assess- and teachers (10; 37.0%). Some assessments were described as
ment. Unpublished assessments were used more often with adults helpful for explaining communication levels of the person with
(26; 52%) than children (20; 40%); only three used them with both PIMD to communication partners. This enabled a shared under-
adults and children (3; 6%). Hence, these tended to be used with ei- standing of the person’s communicative behaviours to be reached
ther adults or children with few using unpublished assessments with (8; 29.6%). Assessments were also used in training communica-
both groups. This contrasts with the published assessments, which tion partners and in setting joint goals with them (5; 18.5%). Using
were more often used with both adults and children. assessments in this way was described as helping to build more
positive relationships between the clinician and these stakehold-
ers (2; 7.4%).
3.2 | Published communication assessment use
Fourth, 12 (44.4%) of the assessments were used because they
A list of all published assessments reportedly used by the re- supported and informed the development of communication inter-
spondent clinicians can be seen in Table 2. Appendix 1 provides ventions (10; 37.0%) and provided a baseline against which develop-
an overview of the aims, methods, outputs and specific rationales mental and functional change (3; 11.1%) and intervention success (3;
reported by respondents for using each of the different assess- 11.1%) could be measured.
ments. Only three assessments were cited by more than 5 SLTs: the Fifth, the utility of assessments was a key influencing factor in
Preverbal Communication Assessment (25; 45.5%), the Affective clinicians’ motivation to use them (18; 66.7%). Some assessments
Communication Assessment (21; 38.2%) and the Checklist of were selected based on their “user-friendliness” and because they
Communication Competence (Triple C) (9; 16.4%). were easy to use with unfamiliar clients on initial assessment (8;
Synthesis of the specific rationales provided for using the pub- 29.6%). The comprehensiveness in detail, breadth and thoroughness
lished assessments resulted in six core motivators for assessment of the information assessments provided was also mentioned (4;
selection and use (Table 2). First, the potential information that 14.8%). Conversely, the brevity of some assessments was deemed
could be gleaned about the person’s communicative developmen- a benefit when assessing people with more limited concentration
tal level informed the selection of 16 (59.3%) out of the 27 assess- (2; 7.4%). The utility of assessments within educational settings was
ments. Comments were made about assessments being appropriate deemed an important part of some assessments (2; 7.4%) because
to the communicative level of people with PIMD because they en- they mapped onto developmental stages or locally based curricula.
abled identification and distinguishing of early communicative de- Flexibility in how information could be gathered was another con-
velopmental stages (7; 25.9%), levels of receptive and expressive sideration (1; 3.7%). A final practical aspect reported was the ob-
communication (5; 18.5%), pre-intentional, intentional and formal servational focus and ability to use some assessments to structure
intentional communication (3; 11.1%) and vocabulary and grammar observations (5; 18.5%).
use (2; 7.4%). Finally, the fact that assessments were underpinned by re-
Second, assessments were selected because they provided search evidence was mentioned by one respondent. For only
information about how the person with PIMD communicated (7; two assessments (7.4%), the fact that they were recognized and
25.9%). This included identifying specific, personalized communi- research-b ased was mentioned, although the nature of this re-
cation behaviours used (2; 7.4%), how they communicated their search was not provided as part of their rationale for choosing the
desires and needs (4; 14.8%), how they made choices, indicated assessment.
|
342 CHADWICK et al.
These six drivers and motivators have been summarized corre-

3.3.4 | The need for an individual and flexible
sponding with each assessment in Table 2. Specific rationales given
approach in assessment
by respondents for choosing each of the published assessments are
detailed in Appendix 1. Use of unpublished assessments was linked to a need for an indi-
vidualized and client-led focus when assessing the communication of
people with PIMD (13; 26.5%). This sometimes led to inconsistency
3.3 | Unpublished assessment use
in approach and was often reported alongside acknowledging the
Unpublished assessments included those solely devised by prac- heterogeneity of this group of people. It resulted in the expressed
titioners and practitioner groups. Assessments developed from need for a more flexible approach in order to engage the individual
pre-existing materials included pre-existing published communi- during assessments (10; 20.4%).
cation assessments and unpublished assessments that practition-
ers had not been involved in developing but had used. Almost all
3.3.5 | Functions of unpublished assessments: 1.
of the SLTs using unpublished assessments provided rationales for
Understanding the individual’s communication
their use (49; 98%). Eight main themes were identified during the
conceptual content analysis of the rationales and explanations for A further driver and fundamental function of developing unpub-
the development of these unpublished assessments as presented lished assessments was to understand the individual communication
below. level and preferences of the person. Therapists aimed to gauge the
communication preferences and best ways to engage the person
with PIMD (8; 16.3%) and to determine their expressive (13; 26.5%)
3.3.1 | Development of unpublished assessments
and receptive comprehension (10; 20.4%), including communica-
Unpublished assessments had in some cases been devised locally tive styles and symbolic understanding (8; 16.3%). Unpublished as-
prior to participant employment within the particular setting (7; sessments were also used to reveal how communication varied in
14.2%). When the respondent had been instrumental in develop- different environments (2; 4.1%), to identify the functions of com-
ing an assessment, the contributing factors reported were prior municative behaviours (7; 14.3%) and to show areas of communi-
discussion and development with colleagues (14; 28.6) and having cative strength and difficulty (10; 20.4%). Unpublished assessments
developed assessments over time based on their experience as were reported to provide a more comprehensive picture of a per-
practitioners (14; 28.6%). For the latter, both trial and error over son’s communication, enabling aspects of communication to be as-
years of experience (2; 4.1%) along with learning, reading and sessed which might otherwise be overlooked with formal measures
evidence (6; 12.2%) were reported to underpin the development (12; 24.5%).
process.
3.3.6 | Functions of unpublished assessments: 2.

3.3.2 | Adaptation of existing assessments Working towards a unified approach by involving key
people in person’s environment
Some unpublished assessments were reportedly adapted from other
communication, developmental or behavioural assessments or from Practitioners used informal discussion or developed surveys and check-
intervention approaches (17; 34.7%). These involved taking exist- lists with stakeholders to gather information as part of assessments
ing published assessments and interventions and either modifying (11; 22.5%). These were conducted with familiar interaction partners
them for use with people with PIMD or developing new assessments and enabled therapists to determine how consistent the description of
based on existing assessments or interventions. This need for ad- communication was amongst different stakeholders, thus informally
aptation was linked to the lack of existing suitable communication carrying out triangulation of sources (13; 26.5%). Outcomes were used
assessments and associated materials (17; 34.7%) reported by a to identify the optimal personal modes of communication and how to
number of respondents. ensure that responses were consistent across communication part-
ners in the person’s environment. Involvement of key stakeholders in
assessment also enabled negotiation of how to move forward along
3.3.3 | Observation in unpublished assessments
the developmental trajectory in communicating with the person with
Informal unstructured and formal structured observations were the PIMD. This was reported as a complex decision-making process.
primary forms of communication assessment for people with PIMD
reported by respondents (31; 63.3%). These observations involved
3.3.7 | Functions of unpublished assessments: 3. To
the use of everyday objects (16; 32.7%) gathered from the local en-
provide a baseline from which to compare and track
vironment and kept as a bag or box of materials by the practitioner to
changes in communication
be used as part of each assessment. Structured observations incor-
porated formal methods using checklists and other qualitative and A final function of the unpublished assessments was to provide a
quantitative methods of recording. baseline from which to compare and track progress and changes
TA B L E 2 Showing the number of respondents using each specific type of published communication assessment with children and adults
with PIMD and the rationales given for their use
Overall Both Child Adult Rationales Informs intervention

Provides Provides planning and
CHADWICK et al.
information about information Supports development &

the person’s about how the effective provides a baseline Pragmatic
communicative person with working with against which change/ utility of Assessment
developmental PIMD communica- progress can be assess- is evidence
Assessment N % N % N % N % level communicates tion partners measured ment based
PreVerbal Communication Schedule 25 45.5 2 3.6 8 14.5 15 27.3 ✓ ✓ ✓ ✓ ✓ ✓

(PVCS; Kiernan & Reid, 1987)
Affective Communication Assessment 21 38.2 4 7.3 10 18.2 7 12.7 ✓ ✓ ✓ ✓ ✓ ✓
(ACA; Coupe et al., 1985)
Checklist Of Communication 9 16.4 3 5.5 3 5.5 3 5.5 ✓ ✗ ✓ ✓ ✓ ✗
Competencies (Triple C; CCC; Iacono
et al., 2005)
Individualized Sensory Environment 4 7.3 2 3.6 0 0.0 2 3.6 ✓ ✓ ✗ ✓ ✗ ✗
(ISE; Bunning, 1996, 1998)
Pragmatics Profile of Everyday 3 5.5 0 0.0 2 3.6 1 1.8 ✗ ✓ ✓ ✗ ✗ ✗
Communication (Dewart & Summers,
1988, 1996)
St Margaret’s Curriculum (No 3 5.5 0 0.0 3 5.5 0 0.0 ✓ ✗ ✗ ✓ ✓ ✗
reference available)
Early Communication Assessment 3 5.5 1 1.8 1 1.8 1 1.8 ✓ ✗ ✗ ✗ ✓ ✗
(ECA; Coupe-O’Kane & Goldbart,
1998)
Supporting Communication through 3 5.5 2 3.7 1 1.8 0 0.0 ✗ ✓ ✗ ✗ ✗ ✗
AAC (Hazell & Larcher, 2006)
Test of Receptive Grammar (TROG; 2 3.6 1 1.8 0 0.0 1 1.8 ✓ ✗ ✗ ✗ ✗ ✗
Bishop, 2003)
Receptive-E xpressive Emergent 2 3.6 0 0.0 2 3.6 0 0.0 ✓ ✗ ✓ ✓ ✗ ✗
Language Test (REEL; Bzoch, League,
& Brown, 2003)
See What I Mean (SWIM; Grove, 2 3.6 0 0.0 0 0.0 2 3.6 ✓ ✓ ✓ ✗ ✓ ✗
Bunning, Porter, & Olsson, 1999)
Communication Profile (For People 2 3.6 0 0.0 1 1.8 1 1.8 ✗ ✗ ✓ ✗ ✓ ✗

with learning disabilities; McConkey
& Valentine, 2008)
Clinical Evaluation of Language (CELF; 2 3.6 0 0.0 1 1.8 1 1.8 ✗ ✗ ✗ ✗ ✗ ✗
Wiig et al., 2004)
|
(Continues)
343
|
344
TA B L E 2 (Continued)
Overall Both Child Adult Rationales Informs intervention

Provides Provides planning and
information about information Supports development &
the person’s about how the effective provides a baseline Pragmatic
communicative person with working with against which change/ utility of Assessment
developmental PIMD communica- progress can be assess- is evidence
Assessment N % N % N % N % level communicates tion partners measured ment based
Derbyshire Language Scheme (DLS; 2 3.6 0 0.0 2 3.6 0 0.0 ✓ ✗ ✓ ✓ ✗ ✗

Knowles & Masidlover, 1982)
Renfrew Action Picture Test (RAPT; 2 3.6 0 0.0 2 3.6 0 0.0 ✓ ✗ ✗ ✗ ✓ ✗
Renfrew, 2011)
Redway School’s Communication 2 3.6 0 0.0 0 0.0 2 3.6 ✗ ✗ ✓ ✓ ✓ ✗
Assessment (no reference available)
Object related Schemes (Coupe & 2 3.6 0 0.0 2 3.6 0 0.0 ✓ ✗ ✗ ✓ ✓ ✗
Levy, 1985)
Assessing and Promoting Effective 1 1.8 0 0.0 1 1.8 0 0.0 ✗ ✗ ✓ ✓ ✓ ✗
Communication (APEC; Bolton,
2004; Latham & Miles, 1996, 2001)
Boehm—Test of Basic Concepts 1 1.8 0 0.0 1 1.8 0 0.0 ✓ ✗ ✗ ✓ ✓ ✗
(Boehm, 1986)
Communication Matrix (Rowland, 1 1.8 0 0.0 1 1.8 0 0.0 ✗ ✓ ✗ ✓ ✓ ✗
2013)
Do-Watch-Listen-Say (Quill, 2000) 1 1.8 0 0.0 1 1.8 0 0.0 ✗ ✗ ✗ ✗ ✓ ✗
Living Language (Pre-language record 1 1.8 0 0.0 1 1.8 0 0.0 ✗ ✗ ✗ ✗ ✓ ✗
book; Locke, 1985)
PreSchool Language Scales (PLS; 1 1.8 0 0.0 1 1.8 0 0.0 ✓ ✗ ✗ ✗ ✓ ✗
Zimmerman, Steiner, & Pond, 2011)
Reynell Developmental Language 1 1.8 0 0.0 1 1.8 0 0.0 ✗ ✗ ✗ ✗ ✓ ✗
Scales (RDLS; Edwards, Letts, &
Sinka, 2011)
Symbolic Play Test (SPT; Lowe & 1 1.8 0 0.0 1 1.8 0 0.0 ✓ ✗ ✗ ✗ ✓ ✗
Costello, 1988)
Communication Assessment Profile 1 1.8 0 0.0 0 0.0 1 1.8 ✓ ✗ ✗ ✗ ✗ ✗
(CASP; van der Gaag, 1988)
CHADWICK et al.
CHADWICK et al. |
345
in communication (17; 34.7%). Linked to this, individual reports With regard to key assessment functions and the assessments
showed that therapists had also developed assessments to enable most commonly used by respondents (N > 5), both the PVCS and the
staff to identify development and change by breaking down skills ACA reportedly provided information about developmental levels of
into smaller steps. This was reported as supporting staff focus on communication, information about how individuals communicated,
aspects of communication that they might have missed and which supported communication partner understanding and collabora-
could evidence change (2; 4.1%). tion and informed intervention planning and the charting of change.
Moreover, they were reportedly pragmatically viable to use and sup-
ported by evidence. The Triple C assessment also met the majority of
3.3.8 | Organizational reasons for using unpublished
the same functions identified, with the exception of providing details
assessments
of how an individual communicates. It also lacked mention of being
Finally, organizational policy influenced the use of assessments and an evidence-based assessment, despite the availability of psychomet-
in some cases prompted development of in-house and adapted as- ric information (Bloomberg et al., 2009; Iacono et al., 2009). By using
sessments of communication (8; 16.3%). Lack of resources and time these core communication assessments a shared language could be
in services to create more complex in-depth assessments led to the developed to enable a more robust process of communication assess-
development of shorter screening tests and checklists which were ment for people with PIMD to enhance intervention and research.
quicker and easier to administer (8; 16.3%). The development of in- As expected, the complexity of impairments experienced by peo-
house assessment recording forms also enabled a more consistent ple with PIMD leads SLTs to use specialized assessments, designed for
approach within teams of practitioners and encouraged clear record this client group, rather than norm-referenced assessments standard-
keeping (2; 4.1%). ized on a typically developing population. In particular, SLTs identified
the importance of the in-depth focus on very early communication,
which would not be evident in norm-referenced assessments and
4 | D I S CU S S I O N which typically do not address developmental levels below 18 months
(Brady et al., 2012; Dockrell, 2001). The assessments commonly cited
This survey endeavoured to establish a picture of current practice of by informants in this study all address issues such as the transition
SLT assessment of communication in people with PIMD. This enabled from pre-intentional to intentional communication which would be
us to discern consistency and robustness of assessment processes and relevant to intervention planning for this client group. In this context,
associated decision making. Being able to generate assessments that it was surprising to see two SLTs reporting use of the TROG (Bishop,
can reliably map progress in communication skills and that could be 2003), which begins at a comprehension age of four years.
generalized across the work of SLTs would undoubtedly strengthen Rationales for assessment use centred around pragmatic utility
their potential to define more effective interventions and to research and how practical, easy and effective the assessments were in pro-
these with more replicability in the future. If taken up by other practi- viding fine-grained early-stage communication information about
tioner and researcher groups, this consistency would also strengthen the particular person. Providing a good vehicle for discussing com-
the accumulating research evidence base. munication and interaction frameworks with carers and family was
also cited as a reason. The rationales further indicated that SLTs used
assessments, to gauge how an individual communicated and how
4.1 | Communication assessment with people
best to engage with him/her, over and above ascertaining their de-
with PIMD
velopmental level of communication and strengths and weaknesses.
The assessment in practice of communication skills is an under- Assessments were also reportedly used as a baseline for designing
studied aspect of PIMD. Three published communication assess- and tracking the success of interventions. A mirroring of the key
ments were reportedly most often used by respondent SLTs: the motivational and beneficial aspects of assessments was observed
Preverbal Communication Schedule (PVCS; Kiernan & Reid, 1987), across the published and unpublished assessments.
the Affective Communication Assessment (ACA; Coupe, Barton, The rationales indicated some limited fitness for purpose amongst
Collins, Levy, & Murphy, 1985) and the Checklist of Communication the published assessments used. Many respondents, however, re-
Competence (Triple C; Iacono et al., 2005). It is difficult to con- ported using an eclectic mix of published, unpublished and self-
trast our findings here with non-U K literature because the ter- devised assessments. This suggests that no single assessment was
minology and criteria around profound intellectual disability vary considered adequate to fully assess all aspects of communication for
considerably (Bellamy et al., 2010), and we could not identify par- clients with PIMD. Indeed, using a patchwork of unpublished assess-
allel research from other parts of the world. All three, and indeed ments gathering information from observation, case notes and proxy
all the assessments reported, are from Anglophone countries stakeholder sources, alongside published assessments appeared to
(Two from the UK and one from Australia). While at the preverbal be common amongst participants. The robustness of such an eclectic
level, a non-English language-b ased assessment would be equally approach and whether assessment practices were individualized to
relevant, it is likely that these are more difficult for practitioners the setting where the SLT worked, their practice experience and ap-
to access and use. proach (e.g., developmental or functional approach to communication
|
346 CHADWICK et al.
assessment), or to the assessment needs of the individual with PIMD through Melland School (Manchester, UK), although it has been re-
is not fully clear from the data accrued here. SLT assessment practice produced in part in a number of published books and training pro-
revealed in this study accords with the use of multiple approaches grammes (e.g., at http://complexneeds.org.uk/). This may reflect the
and holistic assessment involving various stakeholders in evaluating limited commercial viability for assessments for a low prevalence
skills in children with complex needs (Brady & Halle, 1997; Brady group. The 2nd edition of the Triple C (Bloomberg et al., 2009) has
et al., 2012; DeVeney, Hoffman, & Cress, 2012; Ogletree et al., 1996). been published and is commercially available, although not through a
It is notable that unpublished assessments were more often used mainstream publisher. It appears that once practitioners begin to use
with older rather than younger people with PIMD. A number of po- an assessment they may continue to use it, even if it becomes unavail-
tential reasons may explain this finding, but would require further able. No SLTs reported using the Communication Complexity Scale
investigation. Fewer assessments were specifically designed for (CCS; Brady et al., 2012, 2018), but this is not surprising, as it had only
adults (5; 18.5%) or both adults and children (5; 18.5%) than for chil- been described in the research literature at the time of the survey. As
dren (17; 62.9%) (See Appendix 1), and because of this, there may the psychometric properties of this scale are now being published,
be more need for unpublished assessments to be developed for and appear robust, this would appear to be a valuable addition to the
adults with PIMD. There may also be more focus on functional as- assessment resources available for this underserved group.
sessment in adults rendering some of the more developmentally fo-
cused child assessments to be viewed as less useful for practitioners.
4.3 | Limitations & future directions
Nonetheless, there was evidence of some assessments devised for
children being used and adapted for adults in participant accounts. This study is UK focused and as such cannot be generalized beyond
this context. It is difficult to discern the representativeness of the
sample due to lack of information regarding the number and dis-
4.2 | Evidence-based assessment
tribution of UK SLTs working on communication with people with
As with interventions for people with PIMD (Goldbart, Chadwick, PIMD. Future research should aim to broaden this work, as assess-
& Buell, 2014), the needs of this client group and the integral im- ment use may vary considerably based on setting, geographical loca-
portance of those providing daily support seemed to underpin tion and availability of assessment material.
the choice of communication assessment. The expertise of the A further limitation of the present study is that it solely focuses
respondents, although self-r ated, was seldom mentioned as a ra- on SLTs as respondents. For younger people with PIMD, teachers
tionale. This, however, may be incorporated into the pragmatic are also likely to use communication assessments. Some assess-
utility rationale where participants mentioned the assessments ments e.g., Routes for Learning (Welsh Assembly Government,
they found easier, quicker and more flexible to use based on their 2006), Assessing Communication in the Classroom (Latham & Miles,
experience. Limited use of empirical evidence to support assess- 1996), the Communication Development Profile (Child, 2006) and the
ment selection decisions was evident, suggesting the need for SCOPE curriculum (Hazell & Larcher, 2006) were seldom mentioned
more work determining the efficacy of different communication by respondent SLTs but may be commonly used by teachers. Parallel
assessments for people with PIMD. Perusal of the extant literature research work investigating assessment use by teachers is indicated.
revealed limited reliability and validity information in existence for More recent assessments which are available and show promise in
the published assessments. The Triple C, developed for use with this field include the CCS (Brady et al., 2012, 2018; as indicated ear-
adolescents and adults with PIMD, has some published informa- lier) and the Scale for Dialogical Meaning Making (Hostyn et al., 2010)
tion about its psychometric properties (Iacono et al., 2009) but for neither of which were reportedly used by the respondents here.
other commonly used assessments, psychometric information was As noted, the respondent SLTs were not always clear in their
not available. It would be useful for SLTs to pay further attention description of rationales and use. For example, in some instances
to the published psychometric properties of assessments they se- discerning whether a child or adult version of an assessment was
lect and their relevance to this client group. being used was not fully articulated. A final point of note is that
For the published assessments, only one SLT referred to both some assessments reportedly used with people with PIMD were de-
the PVCS and the ACA as “research-based” with more participants velopmentally inappropriate and unlikely to provide beneficial infor-
(6) reporting learning, reading and evidence as underpinning unpub- mation for this group (e.g., TROG, REEL, CeLF). This led to questions
lished assessment development. The robustness and trustworthi- of how and why these assessments had been cited as used which
ness of the literature in informing practice as perceived by the SLTs cannot be addressed by the available data.
needs further consideration. It is unclear whether SLTs were con- Utilizing a survey to gather data regarding the rationales for se-
sidering non-peer-reviewed professional publications such as SLT lection of assessments was useful in gaining a breadth of information,
in Practice and the RCSLT Bulletin as research evidence. Further although it sometimes led to responses which did not illuminate the
exploration of what is considered robust evidence in assessment thought processes behind assessment decision making (e.g., describ-
use by practitioners working with people with PIMD is needed. ing the assessment as useful without explaining why and in what
Of the assessments used with people with PIMD, the PVCS has ways it was useful). Nevertheless, this investigation contributes to
been out of print for several years, and the ACA is available only the existing evidence base, by providing some information about the
CHADWICK et al. |
347
clinical rationales for assessment choice and use in a typically under- further work is urgently needed to fully explore communication
served and overlooked group. As the questionnaire was devised spe- assessment that leads to effective intervention with this often
cifically for this project, the robustness of this approach is difficult to overlooked group of people.
gauge. The questionnaire format may have also led to greater social
desirability bias in responses, where practitioners may have reported
AC K N OW L E D G M E N T S
their most ideal practice. Further research utilizing observational,
focus group or interview methodologies may allow more robust, and We would like to acknowledge the work of Margaret Glogowska for
deeper understanding of assessment practices and the rationales for her work on an early version of the survey.
specific assessment use with people with PIMD to further contribute
to the evidence base and guide practice developments in this area.
ORCID
Darren Chadwick http://orcid.org/0000-0002-4963-0973

5 | CO N C LU S I O N S Susan Buell http://orcid.org/0000-0002-1496-6557
Juliet Goldbart http://orcid.org/0000-0003-1290-7833

Findings from this study showed that therapists in practice were using
formal and more flexibly developed informal, unpublished assessments.
These were both utilized for unstructured and structured assessment
work which often incorporated informal, formal and/or structured ob- REFERENCES
servation where everyday objects were used to gauge engagement, Arvio, M., & Sillanpää, M. (2003). Prevalence, aetiology and comor-
comprehension and symbolic understanding. Discussions with key bidity of severe and profound intellectual disability in Finland.
Journal of Intellectual Disability Research, 47(2), 108–112. https://doi.
people in the person’s life augmented these assessment processes.
org/10.1046/j.1365-2788.2003.00447.x
Communication assessment and accessing the inner world
Baker, V., Oldnall, L., Birkett, E., McCluskey, G., & Morris, J. (2010).
of people with PIMD are inherently challenging. The need for Adults with learning disabilities (ALD) Royal College of Speech and
time-
consuming observational work, involving discussion and Language Therapists Position Paper. RCSLT: London.
collaboration with all key communication partners, while under or- Bellamy, G., Croot, L., Bush, A., Berry, H., & Smith, A. (2010). A study
to define: Profound and multiple learning disabilities (PMLD).
ganizational pressure to progress work with numerous clients can
Journal of Intellectual Disabilities, 14(3), 221–235. https://doi.
all contribute to the difficulties inherent in conducting sensitive and org/10.1177/1744629510386290
effective communication assessment with people with PIMD. As Bishop, D. V. M. (2003). Test for reception of grammar-2. London, UK:
a result, communication work with this client group may arguably Pearson.
Bloomberg, K., West, D., Johnson, H., & Iacono, T. (2009). Triple C: Checklist
result in innovative, well-considered and structured efforts to as-
of communication competencies. Box Hill, Vic.: Scope. Revised Edition.
sess communication and chart developmental progress with carers. Boehm, A. E. (1986). Boehm test of basic concepts: Preschool version. San
However, it is also possible that due to the pragmatic challenges Antonio, TX: Psychological Corporation.
of assessing communication with this group, less well-considered, Bolton, G. (2004). APEC 2: Assessing and promoting effective communica-
tion. UK: Bolton.
unstructured practice may be common. In part, this could be due
Bradley, H. (1991). Assessing communication together: Training package.
to the complexity of their communication needs and the lack of Penarth, UK: MNHA Publications.
clear, usable, practical psychometrically robust measures available. Brady, N. C., Fleming, K., Romine, R. S., Holbrook, A., Muller, K., & Kasari,
The survey conducted here lends some indirect evidence to both C. (2018). Concurrent validity and reliability for the communication
complexity scale. American Journal of Speech-L anguage Pathology,
of these assertions. Unstructured work without adequate record-
27(1), 237–246. https://doi.org/10.1044/2017_AJSLP-17-0106
ing and charting of receptive and expressive communication was Brady, N. C., Fleming, K., Thiemann-Bourque, K., Olswang, L.,
identified in a minority of responses, and these may be unlikely to Dowden, P., Saunders, M. D., & Marquis, J. (2012). Development
guide therapists and carers towards better understanding of the of the communication complexity scale. American Journal
of Speech- L anguage Pathology, 21(1), 16–28. https://doi.
specific communication needs of the person being assessed. This
org/10.1044/1058-0360(2011/10-0099)
further highlights the need for more psychometrically valid com- Brady, N. C., & Halle, J. W. (1997). Functional analysis of communica-
munication assessments for this group and further development of tive behaviors. Focus on Autism and Other Developmental Disabilities,
existing assessments; some such work is underway already (e.g., 12(2), 95–104. https://doi.org/10.1177/108835769701200205
Triple C, Iacono et al., 2009 and CCS, Brady et al., 2018). Bunning, K. (1996). Development of an ‘individualised sensory environment’
for adults with learning disabilities and an evaluation of its effects on their
An argument can be made that the complexity of gathering in-
interactive behaviours (Doctoral dissertation, City University London).
formation from people with PIMD is not a valid reason for lack Bunning, K. (1998). To engage or not to engage? Affecting the interac-
of rigour in assessment approaches. Certainly, for more reliable tions of learning disabled adults. International Journal of Language
measurement of therapeutic outcomes and for research purposes, & Communication Disorders, 33(Suppl 1), 386–391. https://doi.
org/10.3109/13682829809179456
communication assessments with good psychometric properties
Bunning, K. (2009). Making sense of communication. Profound intellectual
that are fit for purpose are required. Due to the limited existing and multiple disabilities: Nursing complex needs. Chichester: Wiley-
evidence base for practitioners and educationalists to draw upon, Blackwell, 46–61.
|
348 CHADWICK et al.
Burton, M., & Sanderson, H. (1998). Paradigms in intellectual disability: International Journal of Language & Communication Disorders, 49(6),
Compare, contrast, combine. Journal of Applied Research in Intellectual 687–701. https://doi.org/10.1111/1460-6984.12098
Disabilities, 11, 44–59. https://doi.org/10.1111/j.1468-3148.1998. Grove, N., Bunning, K., Porter, J., & Olsson, C. (1999). See what I mean:
tb00033.x Interpreting the meaning of communication by people with severe
Bzoch, K. R., League, R., & Brown, V. L. (2003). Receptive-expressive emer- and profound intellectual disabilities. Journal of Applied Research in
gent language test: Examiner’s manual. Austin, TX: Pro-ed. Intellectual Disabilities, 12(3), 190–203. https://doi.org/10.1111/
Carley, K. (1990). Content analysis. In R. E. Asher (Ed.), The encyclope- (ISSN)1468-3148
dia of language and linguistics (Vol. 2, pp. 725–730). Edinburgh, UK: Guess, D., Mulligan-Ault, M., Roberts, S., Struth, J., Siegel-Causey,
Pergamon. E., Thompson, B., … Guy, B. (1988). Implications of biobehavioral
Child, C. (2006). Communication development profile. Brackley, UK: states for the education and treatment of students with the most
Speechmark Publishing Ltd. profoundly handicapping conditions. Journal of the Association
Coupe, J., Barton, L., Collins, L., Levy, D., & Murphy, D. (1985). The affec- for Persons with Severe Handicaps, 13(3), 163–174. https://doi.
tive communication assessment. Manchester, UK: M.E.C. org/10.1177/154079698801300306
Coupe, J., & Levy, D. (1985). The object related scheme assessment Harflett, N., Turner, S., & Bown, H. (2015). The Impact of Personalisation
procedure: A cognitive assessment for developmentally young chil- on the Lives of the Most Isolated People with Learning Disabilities: A
dren who may have additional physical or sensory handicaps. British Review of the Evidence. Bath, UK: National Development Team for
Journal of Learning Disabilities, 13(1), 22–24. Inclusion.
Coupe-O’Kane, J., & Goldbart, J. (1998). Communication before speech: Hazell, G., & Larcher, J. (2006). Supporting Communication through AAC.
Development and assessment. London, UK: David Fulton. Communication Aids Project UK: SCOPE. Retrieved from http://
De Bortoli, T., Arthur-Kelly, M., Foreman, P., Balandin, S., & Mathisen, B. www.scope.org.uk/education/aac.php
(2011). Complex contextual influences on the communicative inter- Healy, D., & Noonan Walsh, P. (2007). Communication among nurses and
actions of students with multiple and severe disabilities. International adults with severe and profound intellectual disabilities: Predicted
Journal of Speech-Language Pathology, 13(5), 422–435. https://doi.org and observed strategies. Journal of Intellectual Disabilities, 11(2), 127–
/10.3109/17549507.2011.550691 141. https://doi.org/10.1177/1744629507076927
De Bortoli, T., Balandin, S., Foreman, P., Mathisen, B., & Arthur-Kelly, M. Hostyn, I., Daelman, M., Janssen, M. J., & Maes, B. (2010). Describing
(2012). Mainstream teachers’ experiences of communicating with dialogue between persons with profound intellectual and multiple dis-
students with multiple and severe disabilities. Education and Training abilities and direct support staff using the scale for dialogical meaning
in Autism and Developmental Disabilities, 47, 236–252. making. Journal of Intellectual Disability Research, 54(8), 679–690. https://
De Vaus, D. A. (2013). Surveys in social research. London, UK: doi.org/10.1111/j.1365-2788.2010.01292.x
Routledge. Iacono, T., West, D., Bloomberg, K., & Johnson, H. (2009). Reliability
Department for Education (2014). Training materials for teachers of learn- and validity of the revised Triple C: Checklist of communicative
ers with severe, profound and complex learning difficulties. Retrieved competencies for adults with severe and multiple disabilities.
from http://complexneeds.org.uk/ Journal of Intellectual Disability Research, 53(1), 44–53. https://doi.
DeVeney, S. L., Hoffman, L., & Cress, C. J. (2012). Communication-based org/10.1111/j.1365-2788.2008.01121.x
assessment of developmental age for young children with develop- Iacono, T., Bloomberg, K., & West, D. (2005). A preliminary investigation
mental disabilities. Journal of Speech, Language, and Hearing Research, into the internal consistency and construct validity of the Triple C:
55(3), 695–709. https://doi.org/10.1044/1092-4388(2011/10-0148) Checklist of communicative competencies. Journal of Intellectual and
Dewart, H., & Summers, S. (1988). The pragmatics profile of early commu- Developmental Disabilities, 30, 127–138.
nication. Windsor, UK: NFER Nelson. Kaderavek, J. N. (2011). Language disorders in children: Fundamental con-
Dewart, H., & Summers, S. (1996). The pragmatics profile of everyday com- cepts of assessment and intervention. Pearson/Prentice.
munication skills in adults. Windsor, UK: NFER Nelson. Kiernan, C., & Reid, B. (1987). Preverbal communication schedule (PVCS).
Dockrell, J. E. (2001). Assessing language skills in preschool children. Windsor, UK: NFER.
Child Psychology and Psychiatry Review, 6(2), 74–85. Knowles, W., & Masidlover, M. (1982). The Derbyshire language scheme.
Dockrell, J. E., & Marshall, C. R. (2015). Measurement issues: Assessing Derby, UK: Derbyshire County Council.
language skills in young children. Child and Adolescent Mental Health, Latham, C., & Miles, A. (1996). Assessing communication. London:
20(2), 116–125. University of West Virginia: David Fulton Pub.
Edwards, S., Garman, M., Hughes, A., Letts, C., & Sinka, I. (1999). Latham, C., & Miles, A. (2001). Communication, curriculum & classroom
Assessing the comprehension and production of language in young practice. London: University of West Virgina: David Fulton Pub.
children: An account of the Reynell Developmental Language Scales Lhatoo, S. D., & Sander, J. W. A. S. (2001). The epidemiology of ep-
III. International Journal of Language & Communication Disorders, 34(2), ilepsy and learning disability. Epilepsia, 42(S1), 6–9. https://doi.
151–171. org/10.1046/j.1528-1157.2001.00502.x
Edwards, S., Letts, C., & Sinka, I. (2011). The new Reynell developmental Locke, A. (1985). Living language programme. Windsor, UK: NFER Nelson.
language scales. London, UK: GL Assessments. Lowe, M., & Costello, A. J. (1988). Symbolic play test. Windsor, UK:
Evenhuis, H. M., Theunissen, M., Denkers, I., Verschuure, H., & Kemme, NFER.
H. (2001). Prevalence of visual and hearing impairment in a Dutch Maes, B., Lambrechts, G., Hostyn, I., & Petry, K. (2007). Quality-
institutionalized population with intellectual disability. Journal enhancing interventions for people with profound intellectual and
of Intellectual Disability Research, 45(5), 457–464. https://doi. multiple disabilities: A review of the empirical research literature.
org/10.1046/j.1365-2788.2001.00350.x Journal of Intellectual and Developmental Disability, 32(3), 163–178.
Forster, S., & Iacono, T. (2008). Disability support workers’ experience https://doi.org/10.1080/13668250701549427
of interaction with a person with profound intellectual disability. Mansell, J. (2010). Raising our sights: Services for adults with profound in-
Journal of Intellectual and Developmental Disability, 33(2), 137–147. tellectual and multiple disabilities. Tizard Learning Disability Review, 15(3),
https://doi.org/10.1080/13668250802094216 5–12.
Goldbart, J., Chadwick, D. D., & Buell, S. (2014). Speech and language McConkey, R., & Valentine, J. (2008). The communication profile for peo-
therapists’ approaches to communication intervention with chil- ple with intellectual disabilities: Access to participation through working
dren and adults with profound and multiple learning disability. with communication partners. Milton Keynes, UK: Speechmark.
CHADWICK et al. |
349
Ogletree, B. T., Turowski, M., & Fischer, M. A. (1996). Assessment targets people with profound intellectual and multiple disabilities.
and protocols for nonsymbolic communicators with profound dis- Journal of Intellectual Disability Research, 53, 161–168. https://doi.
abilities. Focus on Autism and Other Developmental Disabilities, 11(1), org/10.1111/j.1365-2788.2008.01141.x
53–58. https://doi.org/10.1177/108835769601100107 Van Splunder, J., Stilma, J. S., Bernsen, R., Arentz, T. G., &
Oppenheim, A. N. (2000). Questionnaire design, interviewing and attitude Evenhuis, H. M. (2003). Refractive errors and visual im-
measurement. London, UK: Bloomsbury Publishing. pairment in 900 adults with intellectual disabilities in the
Quill, K. A. (2000). Do-watch-listen-say: Social and communication intervention Netherlands. Acta Ophthalmologica, 81(2), 123–130. https://doi.
for children with autism. Baltimore, MD: Paul H. Brookes Publishing Co. org/10.1034/j.1600-0420.2003.00035.x
Regnard, C., Reynolds, J., Watson, B., Matthews, D., Gibson, L., & Clarke, Welsh Assembly Government (2006). Routes for Learning: Assessment
C. (2007). Understanding distress in people with severe communication Materials for Learners with Profound Learning Difficulties and Additional
difficulties: Developing and assessing the Disability Distress Assessment Disabilities. Cardiff, UK: Welsh Assembly Government, Qualifications
Tool (DisDAT). Journal of Intellectual Disability Research, 51(4), 277–292. and Curriculum Group, DELLS (Dept of Education, Lifelong Learning
https://doi.org/10.1111/j.1365-2788.2006.00875.x and Skills).
Renfrew, C. E. (2011). Action picture test. Milton Keynes, UK: Speechmark. Wiig, E. H., Secord, W., & Semel, E. M. (2004). CELF preschool 2: Clinical
Rondal, J., & Edwards, S. (1997). Language in mental retardation. London, evaluation of language fundamentals preschool. Toronto, ON: Pearson/
UK: Whurr. PsychCorp.
Rowland, C. (2013). ‘Communication Matrix’. Portland, OR: Design to Zijlstra, H. P., & Vlaskamp, C. (2005). Leisure provision for persons with
Learn. Retrieved from www.communicationmatrix.org/ profound intellectual and multiple disabilities: Quality time or kill-
Royal College of Speech and Language Therapists (RCSLT) (2006). ing time? Journal of Intellectual Disability Research, 49(6), 434–448.
Communicating Quality 3. London, UK: RCSLT. https://doi.org/10.1111/j.1365-2788.2005.00689.x
Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (2011). PLS-5: Preschool
R. B. (2000). How to practice and teach EBM. Edinburgh, UK: Churchill language scale-5 [measurement instrument]. San Antonio, TX:
Livingstone. Psychological Corporation.
Timmeren, E. A., Schans, C. P., Putten, A. A. J., Krijnen, W. P., Steenbergen,
H. A., Schrojenstein Lantman de-Valk, H. M. J., & Waninge, A. (2017).
Physical health issues in adults with severe or profound intellectual
and motor disabilities: A systematic review of cross-sectional stud- How to cite this article: Chadwick D, Buell S, Goldbart J.
ies. Journal of Intellectual Disability Research, 61(1), 30–49. https://doi. Approaches to communication assessment with children and
org/10.1111/jir.12296 adults with profound intellectual and multiple disabilities. J
van der Gaag, A. (1988). CASP: The communication assessment profile for
Appl Res Intellect Disabil. 2019;32:336–358. https://doi.
adults with a mental handicap. London, UK: Speech Profiles Limited.
Van der Heide, D. C., Van der Putten, A. A. J., Van den Berg, org/10.1111/jar.12530
P. B., Taxis, K., & Vlaskamp, C. (2009). The documentation
of health problems in relation to prescribed medication in
APPENDIX 1
|
Showing additional information for each assessment reported by SLTs as used with people with PIMD
350
Target How information How information is

Assessment & Reference groupa Information gathered is gathered analysed & data output Specific rationales given for choosing published assessments
PreVerbal Communication Schedule (PVCS)

Kiernan and Reid (1987), All ages Performance on 27 areas of Rating of Profile indicating Rationales were varied but coherent. The PVCS was regarded by six
Currently out of print. “pre-communicative,” performance in strengths and people as comprehensive or detailed, and as providing guidance on
Profile available at informal communicative and discussion with limitations across the early communication development (3). It was regarded as available (4)
[http://complexneeds. formal communicative familiar parson, 28 areas assessed. and well known (1). Only one SLT identified the PVCS as research-
org.uk/modules/ behaviours, from very early e.g., family Scores on six based. Others noted that it was appropriate to the level of clients, that
Module-2.4- underpinning skills to member, communicative it was developmentally based (1) and also that it was functional (1).
Assessment- communication through signs, teacher, care functions: Attention Three SLTs reported that it was “useful,” with others commenting on
monitoring-and- symbols and words staff, and direct Seeking, Needs specific utility; in informing intervention (5), in informing and education
evaluation/B/ testing of some Satisfaction, Simple staff and SLT students (5) and in establishing relationships (1) and joint
downloads/m08p030b/ items Negation, Positive goal setting (1) with families. It was regarded as easy to use with
the_pvcs.pdf Accessed Interaction, Negative unfamiliar clients (1) and as providing a useful starting point or baseline
21/04/2016] Interaction and Shared (2). The profile within the assessment was regarded as identifying
Attention. strengths and needs across areas of communication (3) and in plotting
Some psychometric progress (2). Three SLTs used the assessment to differentiate between
properties were pre-intentional, intentional and formal communication or to identify
evaluated (details in the client’s overall level (1). One used the PVCS to structure observa-
the PVCS manual) tional assessments and one described using it in combination with the
Redway assessment to provide a different perspective
Affective Communication Assessment (ACA)
Coupe et al. (1985), Children Pre-intentional communica- Observation, Interpretation of these The rationales given for using the ACA were varied but often connected.
Available from Melland (though tion; physical, facial and vocal preferably using responses as The thorough, comprehensive and detailed nature of the assessment
High School, 50 used responses to an individualized video, and conveying “like,” was commented on by SLTs (4) with many (11) describing the assess-
Wembley Road Gorton more set of stimuli; events, people, coding of these “dislike,” “want,” ment as useful in one way or another. More specifically that it was
Manchester M18 7DT, widely) actions, sensations affective “reject” and other. designed for people with PIMD (2) and there was currently little
UK (emotional) These interpretations available for people with PIMD (4). The fact that it was research-based,
responses by can then be assessed and a recognized assessment was also mentioned (1). The ACA
familiar people against another set of reportedly had utility at the initial assessment during the first meeting
stimuli to identify and acted as a starting point when working with people with PIMD (2),
clusters of behaviours helping to identify the communicative behaviours of this group (2) and
that can be inter- helping to determine the person’s strengths and needs (1). Ways in
preted as like, dislike which the ACA contributed to and informed assessments were also
etc. noted by some SLTs. Going through the ACA together was said to help
Reliability data improve relationships with family and staff (2), be useful in training (3)
available in Coupe- and it was said to support intervention choice (2). The developmental
O’Kane and Goldbart nature of the assessment (1) and that it provides a baseline, allowing
(1998). progress to be tracked, and goal and target setting (5) were also given
Communication as reasons for its use. Finally, indirect reasons for its use were
before Speech. provided, these were that it provides an alternative viewpoint and
London: Fulton additional information (2) and that the SLT gave it to students to use
when teaching (1)
CHADWICK et al.
(Continues)
CHADWICK et al.
A P P E N D I X 1 (Continued)

Triple C: Checklist of Communicative Competencies (CCC)

Bloomberg et al. (2009) Adults Detailed checklist, of early Checklist to be Scores indicate level of Three out of the 9 SLTs who said they used the CCC (or Triple C) for
and Psychometric communicative responses and carried out by communication: from assessment also identified it as most useful for its breakdown of
properties reported in behaviours, organized by five familiar people, “Unintentional passive developmental stages, particularly relating to pre-intentional and
Iacono et al. (2009) levels: Unintentional passive who have communication, intentional communication and early functioning. One clinician found it
communication, Unintentional known the Unintentional active difficult to use because it focuses on physical and sensory information
active communication, client for at communication, but others found it quick to use (2). Two therapists mentioned the
Intentional informal least 6 months. Intentional informal CCC’s flexibility as one of the reasons they used it; being able to collect
communication, Basic Involvement of communication, information through direct observation, liaison with others and by
symbolic communication to a “communica- Basic symbolic setting up situations that could provide baseline measures for future
Established symbolic tion specialist” communication to progress. Other reported reasons were that it was good for explaining
communication is recom- Established symbolic communication levels to carers (1) and that the detailed developmental
mended but not communication.” steps provided fed into intervention (1)
required Feeds into
InterAACtion: Strategies
for Intentional and
Unintentional
Communicators
Bloomberg, K., West,
D. & Johnson, H.
Scope Vic/Spectronics
Inclusive Learning
Technologies
Individualized Sensory Adults Observational assessment Designed for Leads directly into the Respondents identified its usefulness in establishing likes and dislikes (2)
Environment (ISE) Not identifying distribution of adults. Detailed ISE approach to and also as a valuable way of establishing pre-intentional and
commercially available time across five levels or observations of intervention intentional communication levels (3). One therapist reportedly found
Bunning (1996, 1998) forms of engagement: engagement in that knowledge from the ISE approach about intentional communica-
self-neutral, self-active, different tion fed easily into planning for intervention
person, object, person–object contexts
(momentary
time sampling)
|
351
(Continues)
|
352

Pragmatics Profile of Two The child’s communicative Informal but Not intended to be The reasons given for use included that it provides insight into how the
Everyday versions: functions, how they respond structured standardized. Skills in person with PIMD communicates. Another SLT mentioned that the
Communication Children to others’ communication, interview the four areas are findings from the pragmatics profile can be used to compare the
Dewart and Summers & adults interaction strategies and the eliciting summarized in a communication of people with PIMD across settings (1). All those that
(1988, 1996). impact of context on information profile sheet used it reported that it was useful to use with family members and
Children’s version communication from teachers, staff supporters (3) and that it provides a joint understanding of the
downloadable from parents or other person with PIMD’s communication (1)
http://complexneeds. familiar people
org.uk/modules/
Module-2.4-
Assessment-
monitoring-and-
evaluation/All/
downloads/m08p080c/
the_pragmatics_profile.
pdf (Accessed
01/03/17)
St Margaret’s Curriculum Children No detail publicly available No information The assessment is an The assessment was viewed as detailed (1) and appropriate for the client
(Renamed as “The Communication is listed as available integral part of the group (1). Two SLTs identified its utility in informing intervention and
Children’s Trust”): one of five Key Skill Areas in curriculum one that it was helpful in identifying the child’s communication level
Unclear if this is the the IMPACTS programme
IMPACTS curriculum
currently used by the
school. See https://
www.thechildrenstrust.
org.uk/our-curriculum-
Early Communication Children Detailed checklist of communi- Observation and Maps onto intervention All three clinicians commented on how easy the ECA was to use,
Assessment (ECA) cation behaviours organized direct elicitation approaches described especially for clients functioning at lower cognitive levels. They liked
In Coupe-O’Kane and to check for consistency of by familiar in the source book the fact that it was broken down into small steps and one SLT remarked
Goldbart (1998) responses and levels of people using a that there were very few suitable alternatives for assessing at this level
intentionality in communica- variety of
tion from pre-intentional sensory stimuli
through to fully intentional
(Continues)
CHADWICK et al.

CHADWICK et al.
SCOPE Supporting Children A full package for assessing Close observa- Detailed developmental A respondent used this to assess the kind of visual support that a client
Communication through & adults needs with a view to tion of the checklists used to requires, namely assessing the appropriate symbol size to use with
AAC providing AAC. Module 9 individual’s establish baseline of clients (1). Another used it to establish what type of AAC a child might
Hazell and Larcher comprises frameworks for behaviours in a behaviours. These are be able to access and at what level (1)
(2006). Communication assessing communication of variety of described and
Aids Project UK: children and adults with contexts over a matched to P-Levels.
SCOPE) PIMD using a range of period of time Summary charts are
behaviour checklists linked to provided to track
national curriculum P Levels progress across
“milestones”
Test of Receptive Children Measures the understanding of Specific ability to Standardized test with SLTs reported using the TROG as an aid to comprehension assessment
Grammar (TROG) 20 grammatical constructs 4 understand age norms (2), despite the TROG developmentally only beginning at four years of
Bishop (2003) times each using pictures grammatical age. This indicates it was used with people with severe to moderate
Multiple choice picture concepts cognitive impairment rather than PIMD
material is shown, requested without the
to point to the correct picture help of context
in relation to a spoken
statement
Receptive-E xpressive Children Developmental test designed Results obtained Norm referenced to Although both SLTs who reported using this assessment did so to
Emergent Language to identify infants and from caregiver provide age determine individual children’s level, one regarded the steps in the
Test (REEL) toddlers who have language interview equivalents assessment as too large. The other found that the assessment
Bzoch et al. (2003) difficulties. Provides identified the next step to work on. S/he also used it in joint observa-
breakdown of small stages in tional assessment with parents
early language development
See What I Mean (SWIM) Children Guidelines for ascribing Interviews and Protocols/forms SLTs described using SWIM as an assessment tool because it is useful
Grove et al. (1999) (out & adults meaning to communication in discussion with provided for gathering for gathering initial information (2). Therapists also used it as a tool for
of print) context of decision making. caregivers, key relevant descriptive empowerment, advocacy and awareness raising, through its focus on
Sets of procedures provided people, information from a identifying communication skills in clients with PIMD, this led to
for gathering info, for creating Consensus variety of sources to opportunities for choice and decision making. This second aspect was
formal discussion and for discussions, reach consensus on noted as the most important aspect of this tool by the therapists who
checking interpretations Observations how person communi- also commented that SWIM was a good tool to demonstrate these
cates: level of intent, skills and abilities to carers and family members
with or without
physical prompt,
ability to persist in
communication
(Continues)
|
353
|
354

Communication Profile Adults Part 1 provides a joint Information Descriptive profile of Clinicians stated that they used the Communication Profile because
(for people with framework for dialogue gathered expressive and they found it “user-friendly”, simple and it provided useful summary
learning disabilities) around communication issues. through receptive communica- information for education professionals and family. One SLT com-
McConkey and Part 2 is a one-page discussion with tion skills leading to mented that the link with curriculum P-Levels (English Statutory
Valentine (2008) (No user-friendly summary sheet a range of key clear aims for Performance Scales for pupils with PIMD designed to indicate
longer available) which encapsulates this communication intervention, planning, developmental level) was also an advantage
discussion, giving an overview partners charting change, and
of understanding and training
expressive communication in
basic practical terms
Clinical Evaluation of Children Measures broad range of A range of Standardized norms SLTs reported using the CELF but it was apparent from their rationales
Language (CELF expressive and receptive picture and provided that they used it with less cognitively impairment people with
PreSchool) language skills in young auditory intellectual disability
Wiig et al. (2004) children; Subtests include: prompts are
sentence structure, word provided to test
structure, vocabulary, both receptive
following directions, recalling and expressive
sentences, phonological language skills
awareness
Derbyshire Language Children Primarily an intervention Combination of Expressive and The DLS was regarded as useful in assessing comprehension (2) and
Scheme (DLS) programme (Levels 1–10) that picture and toy receptive levels of informing therapy (2). One SLT also used it to inform parents and
Knowles and starts with assessment of stimulus language measured by teachers of the appropriate level of language to use with a child
Masidlover (1982) early expressive and material that use and understanding
receptive language levels are pointed to, 1–4 information
responded to carrying words. Not
verbally or standardized
moved/
manipulated by
person being
tested
Renfrew Action Picture Children Provides samples of spoken A series of Designed for 3-to Therapists reported using the RAPT because they found it a good
Test (RAPT) language that can be pictures are 8-year-olds; standard- assessment to gauge expressive language level, it was also used to
Renfrew (2011) evaluated in terms of shown to the ized norms provided assess use of grammar. Because it was a short test it was considered
grammar and language client with set useful with people more limited concentration
content: use of nouns, verbs, questions
prepositions, tense, irregular designed to
forms of plurals and tense, elicit the target
simple and complex sentence response
construction, passive voice
(Continues)
CHADWICK et al.

CHADWICK et al.
Redway School’s Children Unclear whether this is the No further No further information One respondent reported using Redway School’s assessment because
Communication same as APEC below. No information available there was a dearth of suitable approaches for this client group and
Assessment further information available available because it was collaborative, holistic, universal, and had an education
(No Reference focus. It was regarded as useful in presenting a child’s level to teachers
available) (1) and developing interventions collaboratively (1)
Object Related Schemes Children Piaget-based assessment of Observation of Level of cognitive Both therapists that identified Object Related Schemes worked with
Coupe and Levy (1985) (but cognitive development during behaviours in development in children. One found that it provided good information on “learner
widely the sensori-motor period response to a months, as determined schemes” or when observing children with objects and the other stated
used range of by “schema age;” the that it gave quick information on the child’s cognitive level and could
with objects. Familiar age that corresponds be easily translated into intervention using objects
adults) adult presents a to the most sophisti-
series of cated scheme shown
elicitation
activities
Below are assessments mentioned by 1 SLT
Assessing and Children APEC is a course introducing No further No further information This assessment was favoured because of its links with the national
Promoting Effective an assessment framework and information available curriculum which leads easily into setting goals for use within the
Communication teaching approaches. It available child’s communication environment. It was reported as easy use and as
(APEC) covers developmental stages, such, good for use with teachers, to train other staff and with families
Bolton, G. (2004). breakdowns in language and for joint observation
APEC 2 (Assessing using context to develop
and Promoting language
Effective
Communication;
APEC references
unavailable).
(as developed at The
Redway School by
Latham & Miles,
1996, 2001; David
Fulton Publishers)
Boehm—Test of Basic Children Used to identify clients who Verbal instruc- Provides information This was used by the SLT to assess children’s understanding of concepts.
Concepts Boehm might be at risk of learning tion is on understanding of It was found easy to use and helped to identify areas for intervention
(1986) difficulty. Assesses 26 basic presented to linguistic concepts
linguistic concepts at 2 age the child with Standardized

levels: 3 and 4–5. e.g., same/ picture material
different, more/less, before/ e.g., how are
after missing these things the
same?
|
(Continues)
355
|
356

Communication Matrix Children Free assessment tool to Observation and Descriptive profile of This was mentioned for its easy use in assessing communicative
Rowland (2013) & adults provide communication completion by communication functions and means with this information feeding into new target
status, progress, and unique family member behaviours setting, while at the same time providing a baseline for evaluation
needs of early stage or carer
communication.
Online checklist of communi-
cation behaviours
Communication Adults Assessment of communicative Questionnaire Final outcome is a This was used with adults with PIMD to determine comprehension of
Assessment Profile abilities of adults with severe completed by profile of language vocabulary and sentence length
(CASP) to mild intellectual disabilities. carer/ strengths and
van der Gaag (1988) Part 1 Questionnaire on keyworker weaknesses percentile

communication environment; Part 2 by SLT to rank, communication
Part 2: photographs and gather environment rating
material to assess under- information scale and outline of
standing and use of language about language priorities for change
Part 3 by carer/ Standardized
client and SLT assessment
as a discussion
document
Do-Watch-Listen-Say Children Provides checklist for the Observation Information about early This was reportedly useful for structuring observations.
Quill (2000) assessment of social and developmental levels
communication skills./early of social and
developmental milestones communication skills
Living Language Children Provides an assessment with No further No further information Living Language (Pre-language record book): This was seen as a quick
(Pre-language record pictures “First words” and a information available way to gain an overall idea of the skills and progress of clients
book) pre-language teaching manual available
Locke (1985) (Out of “Before Words” along with
print) record booklets
PreSchool Language Children Interactive assessment of Pointing or Scores for total This was reportedly less linguistically challenging for children compared
Scales (PLS) developmental language skills verbal response language, auditory to other assessments, while still allowing a detailed assessment of
Zimmerman et al. from birth to 7;11 by client to comprehension, some aspects of language
(2011) pictures or expressive communi-
objects cation (standard
scores) growth scores,
percentile range and
age equivalents
(Continues)
CHADWICK et al.

CHADWICK et al.
Reynell Developmental Children Identifies speech and language Uses toys/ Standardized scores for Only parts of the Reynell were used by the SLT who mentioned it. One
Language Scales delay and impairment in objects and receptive and of the main advantages was its accessibility in terms of eye pointing (at
(RDLS) young children. Tests for pictures. Clients expressive language the pictures), with the caveat that the assessment does need to be
Edwards et al. (2011) expressive and receptive point or (Aged 2–7;6) adjusted to the particular needs of each child
language abilities. Has respond
multilingual toolkit verbally to
prompts
Symbolic Play Test Children Test to identify early skills Observation of Standardized score for This was chosen for its low linguistic demands on children, and the
(SPT) required for language play with small levels of concept specific information that could be gained about early play and
Lowe and Costello development; uses play with objects formation or conceptual development
(1988) miniature objects in 4 presented symbolization
different situations systematically observed through play
to the client on
4 occasions
Use of Language Not No further information No further No further information None given
questionnaire known available information available
Non-verbal communi- available
cation schedule
(No reference
available)
Assessing Adults Training package that included No further No further information None given
Communication “Communication” as one information available
Together (ACT) section out of 6 all related to available
Bradley (1991) meeting the needs of adults
with PIMD. Within this, was
“assessing and developing
communication”
Non communication focus
P-scales Children Breakdown of curriculum For use by Information related to P-Scales provided a shared language for joint work and joint target
UK Department for targets into very small teachers: curriculum targets at setting between education colleagues and the SLT who mentioned
Education, (2014), incremental steps descriptors of P-scale level using them. There is an acknowledgement that P-Scales are not
Performance—P Scale targets available formally considered an assessment, but the value of including teachers
attainment targets for all areas of and Learning Support Assistants in making “best fit” judgments based
for pupils with special the curriculum on their knowledge of the child proved useful
educational needs at for assessment
gov.uk and planning
purposes
|
(Continues)
357
|

358
DisDAT Disability Adults Provides carers with details Structured Appearance and None given
Distress Assessment (but may about how adults with PIMD observation of behaviour when
Tool be used might show that they are individuals content is contrasted
Regnard et al. (2007) with experiencing pain with appearance and
(Northumberland children) behaviour when
Tyne and Wear HNS person is distressed.
Trust & St. Oswalds The Clinical decision
Hospice). distress checklist is
used to hypothesis
possible causes of
distress so they can be
managed. A 5-level
statement on
communication level is
included
a
We have indicated the groups for which the assessments were initially developed. This does not necessarily mean they are inappropriate for other age ranges, where this is the case we
have indicated this. Clinician and professional judgements will have bearing on this decision.
CHADWICK et al.
Copyright of Journal of Applied Research in Intellectual Disabilities is the property of Wiley-
Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's express written permission. However, users may print,
download, or email articles for individual use.

Article 5

Uploaded by

Copyright:

Available Formats

Article 5

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Article 5

Uploaded by

Copyright:

Available Formats

| |

Received: 6 November 2017 Revised: 15 August 2018 Accepted: 28 August 2018

ORIGINAL ARTICLE Published for the British Institute of Learning Disabilities

Approaches to communication assessment with children and

Darren Chadwick1 | Susan Buell2 | Juliet Goldbart3

336 | wileyonlinelibrary.com/journal/jar J Appl Res Intellect Disabil. 2019;32:336–358.

2.4.1 | Participant background and experience 2.6 | Data analysis

TA B L E 1 Showing background information for participants

Background information (N of respondents) N %

Client age groups worked with (N = 55)

Background information (N of respondents) N %

These six drivers and motivators have been summarized corre-

3.3.6 | Functions of unpublished assessments: 2.

Overall Both Child Adult Rationales Informs intervention

information about information Supports development &

PreVerbal Communication Schedule 25 45.5 2 3.6 8 14.5 15 27.3 ✓ ✓ ✓ ✓ ✓ ✓

Communication Profile (For People 2 3.6 0 0.0 1 1.8 1 1.8 ✗ ✗ ✓ ✗ ✓ ✗

Overall Both Child Adult Rationales Informs intervention

Derbyshire Language Scheme (DLS; 2 3.6 0 0.0 2 3.6 0 0.0 ✓ ✗ ✓ ✓ ✗ ✗

Darren Chadwick http://orcid.org/0000-0002-4963-0973

Juliet Goldbart http://orcid.org/0000-0003-1290-7833

Target How information How information is

PreVerbal Communication Schedule (PVCS)

Target How information How information is

Triple C: Checklist of Communicative Competencies (CCC)

Target How information How information is

Target How information How information is

Target How information How information is

Target How information How information is

linguistic concepts at 2 age the child with Standardized

Target How information How information is

van der Gaag (1988) Part 1 Questionnaire on keyworker weaknesses percentile

Target How information How information is

Target How information How information is

You might also like

336 | wileyonlinelibrary.com/journal/jar J Appl Res Intellect Disabil. 2019;32:336–358.