Communication Assessment Kit for People who engage with Behaviours of Concern

Developed by the Communication Resource Centre, December, 2009

Purpose

This kit provides speech pathologists with resources that will assist with conducting communication assessments for people who display behaviours of concern (challenging behaviours). It has been designed for speech pathologists who are new graduates or new to working with people with behaviours of concern (challenging behaviours); clinicians experienced in working with this group may also find the kit useful. The kit should be used as a resource comprising a range of assessment types, including structured norm-based tests (the relevance and usefulness of norms will vary for each person tested), informant interviews, structured sampling strategies, and structured observations. Clinicians are encouraged to select the most appropriate tests to use according to the aims of the assessments and the characteristics of the person being assessed.

Content

This kit contains:

1. documentation in the form of background information, fact sheets on Functional Communication Training and each included assessment, which are collated in a folder, and
2. score sheets and copies of some assessments (and instructions), which are also collated in the folder, and manuals and stimuli within the assessment box.

Background Principles

In using the kit, basic principles of speech pathology assessment apply. The primary purpose of any assessment is to explore and describe a person’s communication profile: that is, areas of relative skills and weaknesses across the communication and communication-related domains, including cognition, semantics, receptive and expressive language, and functional and conversational pragmatics. This information is then used to develop interventions of relevance to the person’s needs, preferences, and social and physical environments. A profile of an individual’s communication skills is of relevance to all individuals with communication disorders. For children and adults with behaviours of concern, a communication assessment must more specifically address three key aspects:

• Identifying the potential communicative functions of the behaviours,
• Profiling the communication abilities of the individual in order to inform appropriate communication-based interventions to reduce the behaviours of concern, and
• Observing current environmental barriers and identifying solutions.

These aspects are assessed within a wider context captured within the Participation Model (Beukelman & Mirenda, 2005), whereby opportunities and access are assessed.

Key questions and areas to address:
Opportunities

1. Who are the key people in the child/adult’s social environment? What are their roles? Who should be involved in the assessment by providing information?
2. What policies or supports do they receive from relevant organisations (e.g., early intervention, mainstream or special education), accommodation or day services)? 
3. What are the knowledge, skills, and attitudes of people in the child/adult’s social environment of relevance to the child/adult’s behaviours and/or communication?

Access

1. Does the child/ adult’s physical environment facilitate or impede communication? 
2. Are there medical or mental health concerns that need to be addressed? 
3. What is known about the child/ adult’s hearing, vision, visual perception, and motor skills? 
4. What are the child/ adult’s underlying disabilities (e.g., Down syndrome, other syndrome or cause of ID; CP; ASD; ABI)? How might these impact on the assessment and intervention? 
5. What are the child/ adult’s current communication skills?

Identifying Functions of Behaviours of Concern

Many functional behaviour assessments indicate whether BOC are serving functions that could be communicative, but may not always specify the exact communicative function. A completed Motivational Assessment Scale, for example, may indicate that the behaviour serves an escape function, but more information is needed to determine if the person uses behaviours or other means to communicate a request to stop, to reject, or to request help. Speech pathologists will need to either begin with administering these ‘broad’ functional assessments, or if one has been conducted (e.g., by a behaviour support team, a psychologist), access the results.

These functional behaviour assessments should be followed by more specific functional communication assessments. Such detailed assessments are usually conducted by behavioural support professionals.

Profiling Communication Abilities

The assessments in this kit have been included to enable identification of BOC and their functions, and then to profile the communication skills of the individual to facilitate the development of appropriate positive behaviour supports. Such supports can include, but are not limited to, Functional Communication Training. Attempts to implement positive behaviour supports may be unsuccessful if the person’s communication skills are poorly understood. As an example, a strategy that relies on a verbal explanation of rewards for a particular behaviour is likely to fail with an individual whose comprehension is limited to key words in a sentence, and who instead relies on environmental and social cues.

For people who are non-speaking or have limited symbolic ability, a profile of cognitive skills (e.g., ability to understand cause-effect, to respond to familiar faces and events), as well as an understanding of the person’s physical and social environment, and social-affective signalling may assist in developing social and physical environmental supports to reduce the potential for BOC and increase social interactions. Identification of the person’s level of communication is needed to tailor appropriate communication supports and ability to benefit from various types of symbolic communication (aided or unaided).

For people who comprehend and/or produce language, a profile is needed to determine exactly what level of linguistic input is understood, and to determine language production skills. In particular, there is a need to distinguish echolalia from productive language – e.g., a person who appears to have good language skills may in fact have poor underlying linguistic ability, but have the potential to benefit from aided or unaided communication systems. This profiling of skills can assist in developing effective social and environmental supports. It also assists in identifying ASD.