Accuracy of IQ scores with global apraxia
Cognitive testing, psychological evaluation, IQ, psychologist, neuropsychologist. What do all these have in common? What do they have to do with a child who has a speech delay? What does it matter?
Tests of intelligence, commonly referred to as “cognitive” testing in the schools, are standardized measures usually administered to children as part of a complete battery of testing a child will receive when being considered for special education services (including just speech).
Ashlynn never had a cognitive test administered when she was first found eligible for special education services because she was so young. She is now five, and it is her three year review. As part of the battery of assessments, the school district is really pushing for a cognitive assessment. I’ve been hesitant for multiple reasons. This article on apraxia-kids.org Special Considerations for Psychological/Educational of Children with No Speech or Unintelligible Speech sums up my main fear.
“The first thing to keep in mind when testing children with significant speech delays is that most standardized tests of intelligence will either be inappropriate or of questionable validity.”
Apraxia of Speech definitely fits the bill in the definition of “significant speech delay.” In the schools, at least in the districts I have worked in for the past ten years, the test of choice remains the WISC (Weshler Intelligence Scale for Children) and the WPSII (Weschler Preschool and Primary Scale of Intelligence). These tests are great and provide a lot of information about how children learn. However, as the article points out, they would “at best, provide a crude comparison of a child’s ability in certain areas.” I would also add, that if a child has GLOBAL APRAXIA, meaning motor planning issues effecting the entire body, they are at even MORE of a disadvantage. There are visual scanning and visual motor components that will obviously come out low if the child is still in OT working to improve these skills. There are fine motor and pencil/paper tasks that will also come out low if the child is still working to improve these motor skills. To be blunt, I don’t think they are many subtests that could be validly assessed when a child is globally impacted. Which leads to my second fear that again this article sums up nicely,
“The second consideration (and most important), is that these types of tests should never be used to make predictions about a severely language impaired child’s eventual functioning.”
I want to laugh, and this is really NOT funny. I want to laugh because unfortunately this DOES happen ALL the time in the schools. It’s sad to say but I hear this statement quite frequently, “Well, he’s performing to his potential.”
Yep friends. It’s not like I’ve heard this once. I’ve heard this so, so, soooooo many times over my career.
Now, it’s not all bad. If the cognitive assessment is an accurate reflection of the child’s abilities, then it is important that we are not pushing a child to do something that they just cannot do. It’s not fair to the child. It causes stress, it makes them feel stupid, and many times they feel like failures. Accepting a child where they are at is important.
However, if the score is inaccurate, this is also not fair to the child. That is why these types of tests should never be used to make predictions about the child’s eventual functioning……but as I’ve just explained, they are, more frequently than not, at least in my experience.
So, what do we DO about this? Well that certainly has been my dilemma as of late. I can tell you what I am doing. If the school pushes to test, then I will talk to the psychologist and make sure a nonverbal test of intelligence is administered. I do not want a test that has a verbal section. Period.
I am going to take Ashlynn to a neuropsychologist for testing. A school psychologist is trained and qualified to assess cognition, but they do not have the advanced training in neuropsychological and cognitive testing that a neuropsychologist does. Why is this important? Well, I personally think a psychologist with more advanced training in neurological disorders and subsequent testing will yield more accurate results.
Lastly, I’m still going to be Ashlynn’s biggest fan, the one who has her back, and the one in her corner. I know her potential and I’m going to make sure she always knows it too.
