How to deal with a preschooler during a speech-language evaluation?
October 18, 2010 4:15 PM   Subscribe

I'm a new student in speech-language pathology doing my first full evaluation. My client is 3 years old. I happen to be the one who screened her and remember that she's extremely shy and unwilling to cooperate. Any thoughts as to what I could do to 1) get her to go through the necessary tests, 2) elicit a language sample, and 3) get her to open her mouth for an oral mech exam? Failing that last one, any ideas for looking at oral function that make it seem like a game? One person suggested having the child blow bubbles, anything else?
posted by RyG to Education (11 answers total) 3 users marked this as a favorite
I'm a Speech Language Pathologist. I've done many tests with that age range, and it is either super easy or ridiculously hard. If possible, have the caregiver there, and have them interact with her. You can take notes or record the session. You can give them instructions to give the child, but make sure they aren't invalidating the test by providing cues, and it would also be something to mention in your report. If the parent isn't avaliable, try to see if someone else in your program can help out.

With kids that shy, I don't try to put on a show at all, but rather just be calm and act like the whole thing is no big deal. She doesn't seem like the "make a monkey face with me!" types by your description. Give her time to feel comfortable in the testing area. Its possible that you may just have one of those tests that's like pulling teeth the whole time. She may scream the whole time, or whatever. We've all had MANY of those. I'm sure you're doing this, but you can also give something like the MacArthur that is all parent report in order to get a more comprehensive view of her communication abilities. Many sections of the Pre-School Language Scale allow for caregiver report as well. Also, if you're doing the PLS or something else with manipulatives, just let her play with them and observe; you may get some of the test items that way, and she'll feel more in control.

Good luck!
posted by afton at 4:34 PM on October 18, 2010 [1 favorite]

I'm also a speech language pathologist working with young kids. Congrats on getting to where you are--the actual therapy part, working with real clients, did NOT come naturally to me. It gets better and easier! (I'm two years in--the learning curve is steep.)

Evals are tough because you don't yet know the kid or what motivates her. I totally second using her parent as a resource--it's NOT a weakness to lean on caretakers, and can make life (or at least the eval) easier for you, the parent, AND the child, and get a more accurate picture of her abilities in a (more) natural setting.

Some kids like clear goals to work for, like, "Let's see if you can earn ten stickers!" Stickers are magic diamonds made by unicorns in a factory under the sea in outer space.

I would attempt a test that is interactive and client-led at first, like the PLS-4. You can start with the receptive language, which shy kids sometimes warm up to because it's just pointing instead of talking. Maybe she can warm up to you that way. If you're doing an artic test like the Goldman Fristoe, that might be an easy place to start. You can build her confidence by saying, "Wow! You know all these pictures. You are SO SMART." Sometimes shy kids need a confidence boost. I also like to start with the Goldman because my attention is best at the beginning, and I can concentrate and really listen to any slight artic errors they may be having.

If you're absolutely not getting anywhere after about 25 minutes (screaming, crying, hiding behind mom, refusing to say one word), then I would go to a parent interview like the MacArther. At 3, she is too old for the REEL. But don't give up too quickly on the PLS or similar test! You can definitely write in the report if shyness or difficulty adjusting to the evaluator or testing situation interfered with the results. Know that sometimes that happens to everyone, and it is definitely appropriate to report that if you feel it skewed the results.

I also found flavored, multi-colored tongue depressors on amazon for pretty cheap. Kids have loved them for therapy, but I haven't used them in oral motor exams yet. Maybe you could try using a flashlight and turning off the lights to look in her mouth. You could say something about exploring the cave inside her mouth or something like that.

Also, I am naturally shy, and I think some kids respond well to my shyness. I don't force over excitement (like afton said, she might not be the "make a monkey face" type). Sometimes I mimick an exagerrated shy face with kids when I first meet them. Works for some, not others. But I've never found it to hurt or degrade the eval process.

Good luck! Message me if you have more specific questions or to vent. :)

(Inside joke: do you think the boy in the Goldman Fristoe is "crying" because he is afraid of that creepy clown right before him??)
posted by shortyJBot at 5:27 PM on October 18, 2010 [3 favorites]

I've sat in on many a speech therapy session with my behavioral students and have learned of two iPhone apps that are like preschooler crack: Talking Carl and Balloonimals. Talking Carl will repeat whatever you say in a squeaky adorable-monster voice which can be good for getting the kiddos to talk. Balloonimals requires that you blow on the microphone, if that's helpful to you, and then you can talk about the balloon animals that it generates.

In the event that you don't have an iPhone, bring a few interesting small toys and casually play with one. If she looks interested or reaches for it, you can say something like, "Do you want a turn? Great, let's make a 'mmm' sound and you can have a turn." This isn't bribery, this isn't cheating. It's providing an incentive to cooperate (and hopefully reinforcing that cooperation), since it doesn't sound like interacting with unfamiliar adults is incentive enough for her.

Windup toys are good for this, as are squishy balls that light up, Silly Putty, and Slinkies.
posted by corey flood at 5:59 PM on October 18, 2010 [3 favorites]

My daughter just turned four. She is currently SUPER competitive; anything you can make into a competition, she will do. "I bet I can open my mouth wider than you!" "I bet I can make a louder MMMMM noise than you can!" Anything.

I dunno if that will help, but it's how I make it through every day.
posted by KathrynT at 6:14 PM on October 18, 2010

I'm the parent of a special-needs preschooler who has seen many speech pathologists. Every kid is different but with my kid, if you can give him a little time to check out the room and let him get comfortable, he'll do much better. Hang back, pretend you don't really notice him or what he's doing and let him show you what he finds interesting. Then use whatever he picks up as your motivator in getting him to do what you need. He is completely uninterested in stickers or bubbles but there are plenty of other things he loves .. just let him give you some cues and roll with that.

And if I may add a side note: Please don't call me "Mom" either when talking to me or talking to one of your colleagues (as in, "Mom reports that Billy always holds a crayon that way" or "Mom, could you please hand Billy this cup?").

Ask me if I prefer to be called Mrs. Jones or Laura and then call me that. It's really annoying and insulting to be called 'Mom' by the professionals treating my child and it happens a lot. I know they don't mean anything by it but I don't like it ... and so many of the other parents I talk with agree it's condescending and sort of lazy. I can remember your name so hopefully you can remember mine. And .. thanks for going into this very important profession. You are needed.
posted by Kangaroo at 6:21 PM on October 18, 2010

I'm a mother who goes to a pediatric practice that has med students every visit. While I don't have anything to say about speech/language stuff, I have observed a lot of students in action. I definitely prefer when the med students ask me, "What's the best way to get a look in his ears?" about my toddler or whatever. I know my kid and I know what will freak him out and what will get him to cooperate. Many of the med students are so anxious about going through their script and about appearing unknowledgeable that they're afraid to ask for my help, but that actually signals comfort and competence and respect for my role as a parent.
posted by Eyebrows McGee at 7:39 PM on October 18, 2010

I didn't mean that to sound quite as stark as it did -- that isn't to say you can't just go ahead with your mad preschooler skillz, but that if you're not sure or if the kid isn't cooperating, I prefer the medical professional ask me, and when students ask, it comes across as a sign of maturity and self-assuredness. :)

My son's pediatrician who sees him often and has years of experience just does her thing with him, although she also keeps up something of a running patter where she'll ask if he'll cooperate with X or if he's likely to pee on her when she checks the diaper. But when the PA sees him, for example, she asks us a lot more and defers to us a lot more. She has a better rapport with older kids, and she doesn't see him very much.
posted by Eyebrows McGee at 9:07 PM on October 18, 2010

It could help a lot to not jump right into the assessment, but to spend some time just playing and talking first. Have some games or toys on hand and just sit on the floor or something and help the little one get a sense of you as a non-threatening, non-scary person; be silly, laugh, and watch her responses to you so you know when to pull back or get even deeper into giggles. (Context: I'm a therapist working with many ages of kids, and my first sessions are usually spent asking about the kid's friends and hobbies, with little mention of any of the "serious" stuff until after I can see that there's some decent rapport built up.)
posted by so_gracefully at 9:20 PM on October 18, 2010

Talking Carl has now taken over my house.
posted by k8t at 10:18 PM on October 18, 2010

Talking Carl is insanely compelling. And not just for preschoolers. Not uh, that I would know or anything.

You can also tickle/poke him. Some of the gentlest children I know enjoy poking Carl in the eye so they can hear him scream "OUCH!" So, y'know, there's another fun activity you can do to build rapport! Poking creatures in the eye!
posted by corey flood at 10:33 PM on October 19, 2010

Response by poster: Thanks, all! I put a lot of these suggestions to use. It was really tough, but I walked away with a lot of useful information for future interactions with shy young children. And stickers really are magic diamonds made by unicorns under the sea in outer space.
posted by RyG at 9:54 PM on October 22, 2010

« Older What in the world do I do with coconut jam?   |   She's The Bees Knees! 23 Skidoo! Newer »
This thread is closed to new comments.