ACQ Vol 13 No1 2011

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ACQ Volume 13, Number 1 2011 41
Ethical conversations
question of interest for this column is “Does the purpose of
the assessment and the intended recipient of information
influence the assessment process and the subsequent
written report?” An examination of best practice principles
supports the argument that assessment is part of the
cyclical nature of the clinical management process and that
the role of the speech pathologist should not vary according
to the reason for assessment. However, in everyday
practice, do speech pathologists change their perception
of their role in the assessment process depending on its
purpose? For example, if confirmation of diagnosis of
a language disorder is required in order for the child to
access additional services, guidelines may mandate that the
speech pathologist uses both formal (norm-referenced) and
informal (criterion-referenced) tests in order to highlight the
presenting language impairments and predict the impact
of these on academic performance (Eger, 2007). Further,
depending on the context of the situation, different service
providers may have specific reporting standards to which
speech pathologists must adhere. For example, they may
require that a specific assessment battery consisting of the
Clinical Evaluation of Language Fundamentals, 4th Edition
(CELF-4; Semel, Wiig, & Secord, 2003) and the Peabody
Picture Vocabulary Test, 4th Edition (PPVT-4; Dunn & Dunn,
2007) is undertaken in order to directly benchmark against
established eligibility criteria. These protocols may be in
contrast to what the speech pathologist would typically do in
situations where funding is not being sought. The question
arises then: Does this create an ethical dilemma for the
speech pathologist?
The need for a label or confirmed diagnosis in order to
access additional support services is another ethical issue
at the core of child language assessment. Understandably,
families want the best for their child. Accordingly, parents
and other medical and allied health providers may insist
that the child receive a formal diagnosis or categorical label
following the assessment process based on the perception
that a label is needed in order to fulfil eligibility requirements
for additional funding. This raises the further question: To
what extent does this perceived notion influence the speech
pathologist in their assessment and subsequent written
summary and recommendations?
The role of the assessment report
Speech pathology reports are necessary for communicative,
administrative, and legal purposes (Cranwell & Miller, 1989).
This edition of Ethical Conversations is one
which many readers will find pertinent to their
everyday speech pathology practice. In this
column we will discuss the ethics of
assessment and report writing for children
with language disorders when funding for
additional services for the child is being
sought. Specifically, we will discuss (a) the
speech pathology assessment process and
the role of reports in disseminating results and
recommendations to different recipients, and
(b) potential changes in the perception of the
role of the speech pathologist when the
assessment process involves funding
outcomes. This discussion will highlight
ethical issues faced by speech pathologists
working with paediatric language disorders. It
is not our intention to offer answers to these
issues but to facilitate discussion by posing
reflective questions for consideration by
readers.
The speech pathology assessment
There are many reasons for assessing a child’s language
development. Assessment can be undertaken to screen for
various conditions, to differentiate between language
difference and disorder, to make a differential diagnosis, to
determine goals for intervention, and to establish a baseline
against which the efficacy of intervention can be measured
(Hegde & Davis, 2010). Within the context of initial
assessment and inclusive education, one of the critical roles
of assessment is to assist teachers in the identification and
implementation of realistic, relevant, and functional changes
in the delivery of the classroom curriculum to promote the
child’s activity and participation within their learning
environment (WHO, 2001). Also significant is the need for
confirmation of a diagnosis or categorical label where
required, and the formulation of a holistic communication
profile of each child’s strengths and weaknesses to
determine eligibility for funding or access to additional
resources (Speech Pathology Australia, 2004).
Given the role of diagnosis in the funding process to
determine eligibility for speech pathology services, a
The role of speech pathologists
in assessing children with
language disorders
Does the need for funding make a difference?
Nerina Scarinci, Wendy Arnott, and Anne Hill
Nerina Scarinci
(top), Wendy
Arnott, and
Anne Hill