Why Did You Use That Test? Exploring Speech-Language Pathologists' Clinical Decision Making in Bilingual Language and Literacy Assessment.

IF 2.5 3区医学 Q1 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY

American Journal of Speech-Language Pathology Pub Date : 2025-09-04 Epub Date: 2025-07-17 DOI:10.1044/2025_AJSLP-24-00569

Emily Wood, Mariya Kika, Olivia Daub, Monika Molnar

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引用次数: 0

Abstract

Purpose: Our overarching goal is to advance our understanding of clinical decision-making processes in bilingual language and literacy assessment. When evaluating bilingual children, speech-language pathologists (SLPs) use static norm-referenced assessments (SAs) developed for English monolinguals more frequently than less-biased dynamic assessments (DAs). To date, no research has considered why SLPs use SAs over DAs or examined SLPs' conceptualization of validity beyond knowledge of psychometrics. In this study, we explore factors that affect SLPs' choice and use of assessments and how clinicians conceptualize and employ validity through the lens of modern validity frameworks.

Method: Canadian SLPs (N = 21) participated in semistructured interviews, using a guide informed by the Theoretical Domains Framework and Kane's Validity Framework. Reflexive thematic analysis was used to generate themes.

Results: Clinicians rarely report using "dynamic assessment" but did "assess dynamically" by incorporating teaching in testing. When assessing oral language, SLPs acknowledged that using SAs with bilinguals may be inappropriate but that they continue to do primarily because scores from these measures are necessary for diagnosis and accessing services. To contend with this friction between clinical beliefs and workplace requirements, most SLPs report caveats alongside SA scores to contextualize findings. Though individual clinical knowledge of psychometrics and validity in assessment varies, systemic issues play a key role in perpetuating current assessment practices with bilinguals. Finally, bilingual literacy assessment practices differ. Clinicians use a wider variety of assessments and rely less on scores to achieve desired outcomes for students.

Conclusions: Clinical decision making in bilingual language and literacy assessment is influenced by both individual and contextual factors. Accordingly, efforts to shift practice patterns cannot solely focus on individual clinical knowledge but must also examine and address these systemic issues.

Supplemental material: https://doi.org/10.23641/asha.29474237.

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你为什么要用那个测试？语言病理学家在双语语言和读写能力评估中的临床决策探索。

目的：我们的总体目标是促进我们对双语语言和读写能力评估的临床决策过程的理解。在评估双语儿童时，语言病理学家（slp）更频繁地使用为英语单语者开发的静态规范参考评估（sa），而不是较少偏见的动态评估（da）。到目前为止，还没有研究考虑过为什么slp使用sa而不是da，也没有研究过slp在心理测量学知识之外的效度概念。在本研究中，我们探讨了影响slp选择和使用评估的因素，以及临床医生如何通过现代效度框架来概念化和使用效度。方法：加拿大slp （N = 21）参加半结构化访谈，采用理论领域框架和凯恩效度框架指导。反身性主位分析用于生成主位。结果：临床医生很少报告使用“动态评估”，但确实通过将教学与测试结合来“动态评估”。在评估口头语言时，语言服务提供者承认对双语者使用语言辅助评价可能是不合适的，但他们继续这样做，主要是因为这些评价的分数对于诊断和获得服务是必要的。为了应对临床信念和工作场所要求之间的这种摩擦，大多数slp在报告SA分数的同时报告了一些警告，以将结果置于背景中。尽管个体对心理测量学的临床知识和评估的有效性各不相同，但系统问题在双语者的评估实践中发挥着关键作用。最后，双语读写能力评估实践有所不同。临床医生使用更广泛的评估方法，减少对分数的依赖，以达到学生期望的结果。结论：双语语言和读写能力评估的临床决策受到个体和情境因素的双重影响。因此，改变实践模式的努力不能仅仅关注个人临床知识，还必须检查和解决这些系统问题。补充资料：https://doi.org/10.23641/asha.29474237。

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来源期刊

American Journal of Speech-Language Pathology AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-REHABILITATION

CiteScore

4.30

自引率

11.50%

发文量

353

审稿时长

>12 weeks

期刊介绍： Mission: AJSLP publishes peer-reviewed research and other scholarly articles on all aspects of clinical practice in speech-language pathology. The journal is an international outlet for clinical research pertaining to screening, detection, diagnosis, management, and outcomes of communication and swallowing disorders across the lifespan as well as the etiologies and characteristics of these disorders. Because of its clinical orientation, the journal disseminates research findings applicable to diverse aspects of clinical practice in speech-language pathology. AJSLP seeks to advance evidence-based practice by disseminating the results of new studies as well as providing a forum for critical reviews and meta-analyses of previously published work. Scope: The broad field of speech-language pathology, including aphasia; apraxia of speech and childhood apraxia of speech; aural rehabilitation; augmentative and alternative communication; cognitive impairment; craniofacial disorders; dysarthria; fluency disorders; language disorders in children; speech sound disorders; swallowing, dysphagia, and feeding disorders; and voice disorders.