Using the Spanish Battelle Developmental Inventory-2: A case for clinical judgement


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This presentation describes the limitations of the Spanish Edition of the BDI-2, as well as the appropriate use of test norms. It identifies how language differences affect test results and describes how cultural differences can influence test results. Methods for supplemental or alternative assessments are also addressed.

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Using the Spanish Battelle Developmental Inventory-2: A case for clinical judgement

  1. 1. Disclosure Statement Relevant financial relationship(s), no relevant nonfinancial relationship(s) • I have the following relevant financial relationship(s) in the products or services described, reviewed, evaluated or compared in this presentation. SMILE for Young Children is mentioned as a resource. The authors are employees of Bilinguistics. Bilinguistics receives royalties on sales of SMILE. • Name of organization or products/services  Description of financial relationship(s) (not amount) such as ownership interest, employee, own all or part of a licensed patent or copyright, scholarship/grant, financial compensation, etc., • I have no relevant nonfinancial relationship(s) to disclose.
  2. 2. Texas ECI Demographics
  3. 3. Learner Objectives • Describe the limitations of the Spanish Edition of the BDI-2 • Describe the appropriate use of test norms • Identify how language differences affect test results • Describe how cultural differences can influence test results • Describe methods for supplemental or alternative assessments
  4. 4. What is the BDI-2? • Comprehensive measurement of all developmental areas (5 domains, 13 subdomains) • Variety of administration options: structured, observation, interview • Multiple point scoring- helps identify emerging skills • Based on developmental milestones • Used by all ECI programs in Texas since Sept 2011
  5. 5. BDI-2 Domains •Personal-Social •Adaptive •Motor •Communication •Cognitive
  6. 6. Do you need Continuing Education or want  to listen to this course live? Click here to visit  the online courses.
  7. 7. Click for Audio‐over‐Powerpoint Presentation
  8. 8. Standardization Sample • Nationally representative norm sample - n= 2500 - ages birth to 7 years, 11 months • Sample closely matches the percentages for variables identified in the US Census Bureau 2001 publications - age - sex - race/ethnicity - geographic region - socioeconomic level
  9. 9. Spanish Translation • Provides an adaptation/translation of all spoken text • Item books, instructions, and some stimulus materials available on CD (for printing by examiner) • Provides Spanish Record Forms (Full, Screening, Electronic) • Requires English test kit materials and manual • Allows an estimate of abilities combining English and Spanish (only if using software option)
  10. 10. The Spanish version of the BDI-2 is not normed. • Keen clinical judgment is necessary • While many motor skills and daily living skills are not influenced by language, communication skills are obviously strongly affected. • Norms do not transfer from one language to the other. • Understanding the building blocks for speech and language that are similar across languages is essential.
  11. 11. Basal and Ceiling Rules across two test versions • In order for basal and ceiling rules to work, items have to be ordered by level of difficulty from easiest to hardest. • When a test is translated, item difficulty levels are not the same. • When using a translated version of a test, test below the basal and above the ceiling.
  12. 12. Understanding Linguistic and Cultural Differences
  13. 13. All of the documents and charts in this presentation  can be downloaded from our Free Resource Library. Click here to visit the Resource Library
  14. 14. Informed Clinical Opinion • Per DARS ECI, “Teams must use Informed Clinical Opinion when a child qualifies under developmental delay.” • This can apply to: ▫ an individual test item ▫ interpretation of test scores ▫ determining the adequacy of testing tool (i.e., the BDI-2) ▫ when reviewing results ▫ when making a qualitative determination of developmental delay
  15. 15. Linguistic Differences– Communication Domain • RC 14 ▫ English: Responds to the prepositions “out” and “on.” ▫ Spanish: Responde a las palabras “fuera” y “sobre.” • These prepositions are similar in meaning, though they do not have a one-to-one correspondence across languages and therefore likely differ in their level of difficulty.
  16. 16. Linguistic Differences– Communication Domain • RC 17 ▫ English: Understands the possessive form ’s.  Baby’s mommy. Daddy’s boy. ▫ Spanish: Entiende las formas del posesivo.  El bebé de la mamá. El hijo del papá. • In English this deals with morphology and in Spanish it deals with syntax. It cannot be assumed that these will follow the same developmental sequence.
  17. 17. Linguistic Differences– Communication Domain • RC 28 ▫ English: Understands irregular plural forms. ▫ Spanish: Usa el plural. • There are no irregular plurals in Spanish. This is a much more challenging item in English than it is in Spanish but the use of basal and ceiling rules that are based on English assumes the same level of difficulty.
  18. 18. Linguistic Differences– Communication Domain • EC 17 ▫ English: Uses three-word phrases meaningfully. ▫ Spanish: Usa frases coerentes de 3 palabras. • Children can express something that is at the same level of complexity with fewer words in Spanish than in English. ▫ “I want cookie.” = “Quiero galleta.” ▫ “Pick me up.” = “Recójame” ▫ “Give to me.” = “Dame”
  19. 19. Linguistic Differences– Communication Domain • EC 19 ▫ English: Uses the pronouns I, you, and me. ▫ Spanish: Usa los pronombres, yo, me, mi, tú, te, ti • The requirement is that each of them is used on a daily basis. The Spanish pronouns “me” and “te” are more complex pronouns that those tested in English. Additionally, pronouns are used with less frequency in Spanish than in English. Thus, this item would be more difficult for Spanish speakers.
  20. 20. Linguistic Differences– Communication Domain • EC 25 ▫ English: Uses the articles the and a. ▫ Spanish: Usa los artículos el, la, un, and una. • In Spanish the article system is more complex because it includes gender, which does not exist with the same complexity in English. Instead of two articles, Spanish has six (un, el, los, una, la, las). The Spanish translation focuses on the four singular articles.
  21. 21. Linguistic Differences– Communication Domain • EC 27 ▫ English: Uses plural forms ending in /s/ and /z/. ▫ Spanish: Usa las terminaciones plurales. • In English this tests two plural forms ending with /s/ and two endings with /z/. In Spanish this difference would be /s/ and /es/. The Spanish item tests three /s/ and one /es/. In English the number of syllables in the word remains the same, while in Spanish the number of syllables increases when /es/ is required.
  22. 22. Linguistic Differences– Communication Domain • EC 29 ▫ English: Repeats familiar words with clear articulation. ▫ Spanish: Repite palabras conocidas articulando claramente. • The sound inventories of the languages are not equally represented. There are no final consonants evaluated in Spanish but there are 6 in English. There are fewer final consonants in Spanish than in English but they do exist.
  23. 23. Considering Culture • Culture can influence performance on test items • Understand how culture can affect responses • Incorporate cultural variation into your Informed Clinical Opinion
  24. 24. Cultural Considerations Receptive Communication 32 ▫ Recalls events from a story presented orally.  En la mesa había huevos, pan tostado y jugo de naranja.
  25. 25. Cultural Considerations Expressive Communication 30 ▫ Follows conventional rules of conversation.
  26. 26. Cultural Considerations • Self Care 13, 15 & 16 ▫ Child uses a spoon or other utensil to feed himself. ▫ Child feeds himself with a utensil without assistance. ▫ Child drinks from a cup (not sippy cup) without assistance.
  27. 27. Cultural Considerations • Self Care 22 & 25 ▫ Child asks for food at the table. ▫ Child obtains a drink from a tap without assistance.
  28. 28. Cultural Considerations Adult Interaction 5, 15, 17 ▫ Child explores adult facial features ▫ Child helps with simple household tasks. ▫ Child greets familiar adults spontaneously
  29. 29. Cultural Considerations Reasoning and Academic Skills 4, 9 & 10 ▫ Child shows interest in books ▫ Child names the colors red, green and blue ▫ Child identifies to sources of common actions  What barks?/Quién ladra?
  30. 30. Determine Percent Delay ▫ Adaptive ▫ Personal-Social ▫ Communication ▫ Gross motor ▫ Fine Motor ▫ Cognitive If the child is from a bilingual environment consider the items carefully and use your informed clinical opinion on each item. If you calculate a percent delay based on test results, know that they might provide a guideline but could misrepresent the child’s abilities.
  31. 31. Participant asks: “What is the Eligibility Requirement now?” • Current Eligibility ▫ 25% delay across the board • Expressive Language Only ▫ 33% or greater delay
  32. 32. Participant asks: “Are we limited to using the BDI to accurately assess younger children?” • The major assessment (in Texas) for early childhood is the BDI. • If you do not have consistency between the scores and your clinical judgment, then you can use an alternative assessment.
  33. 33. Four Possibilities after BDI-2 Administration BDI ✗ C. J. ✔ BDI ✗ C. J. ✗ BDI ✔ C. J. ✔ BDI ✔ C. J. ✗ Eligible  Not Eligible C. J. = Clinical Judgment
  34. 34. Language samples in all languages Inside HELP PLS-4-Spanish or PLS-5-Spanish and English Use intelligibility guidelines Other resources about bilingualism
  35. 35. Language Samples • Conversational • Story telling • Story retelling • Interactive book reading
  36. 36. Analyzing Language Samples • Transcribe online or record • Identify errors • Classify the errors
  38. 38. Participant asks: “How do we bill insurance companies when they require standardized testing but we don’t have a useable standardized score?” • Use the qualitative information from a language sample and identifying errors that don’t make sense based on the child’s ▫ Language ▫ Age
  39. 39. Inside HELP • Identifying and Interpreting Needs for Intervention ▫ Poor oral motor skills ▫ Auditory processing difficulties ▫ Oral motor planning difficulties ▫ Hearing impairment ▫ Other causes of differences not indicative of disabilities  Cultural/dialectal differences  Different speech models
  40. 40. Highlights from Inside HELP • Speech production ▫ Consider vowel productions – frequent vowel distortions are not typical ▫ Omission of word-initial sounds is not typical ▫ 35+ months: 80% intelligible
  41. 41. PLS-4-Spanish • Norm-referenced • Normed on Spanish-speaking children in in the U.S. • Separate versions for Spanish and English
  42. 42. PLS-5-Spanish and English • Norm-referenced • Normed on children from Spanish-speaking homes in the United States • Uses conceptual scoring ▫ Items are administered in Spanish ▫ If missed, items are administered in English ▫ Allows for different knowledge/vocabulary in two languages
  43. 43. • For parents: (Lynch, Brookshire & Fox, 1980) ▫ 18 months - ~25% intelligible ▫ 2 year olds - 50-75% intelligible ▫ 3 year olds - 75%-100% intelligible • For unfamiliar: (Flipsen, 2006) ▫ 18 months - ~25% intelligible ▫ 2 year olds - ~50% intelligible ▫ 3 year olds - ~75% intelligible ▫ 4 year olds - 100% intelligible Click here to download this chart as a pdf.
  44. 44. • Difficulty learning both languages,  even with adult assistance • Difficulty producing sounds in both languages • Family history of language/learning disabilities  • Slower development than siblings • Difficulty interacting with peers • Inappropriate pragmatic/social language skills (i.e., turn‐taking, topic  maintenance, considering listener needs, non‐verbal communication) • Difficulty with language in many routines • Idiosyncratic error patterns  • Speech and language performance unlike others with similar  cultural/linguistic experiences Click here to download this chart as a pdf.
  45. 45. /ɲ/ /ɾ/ /R/ /x/ /ð/ /dʒ/ /h/ /ŋ/ /θ/ /r/ /ʃ/ /v/ /w/ /z/ /ʒ/ SPANISH ENGLISH /b/ /d/ /ɡ/ /p/ /t/ /k/ /m/ /n/ /s/ /tʃ/ /j/ /l/ /f/ Click here to download this chart as a pdf.
  46. 46. Case Study • Child – Juan Diego • Age 2 years, 6 months • Language background ▫ Father speaks mostly Spanish, some English ▫ Mother is fluent in both English and Spanish ▫ Two older siblings are fluent in both ▫ In the home Spanish is the primary language. ▫ Juan Diego stays home with his mother who speaks Spanish 90% of the time with him.
  47. 47. Juan Diego Case Study Continued • BDI is administered in Spanish • Per publisher directions, English norms are referenced • You (savvy ECI person), know the norms are not a good representation of Juan Diego because: ▫ The test you administered was not normed. ▫ You did not use basal and ceiling rules. • The child did well in all areas except communication and you are on the fence about whether his communication skills are delayed.
  48. 48. Juan Diego- Additional Information • Speech sample during play ▫ Utterance English Translation ▫ Atos (zapatos) shoes ▫ a-eta (galleta) cookie ▫ o-o-a (pelota) ball ▫ Un o-ito (un osito) a bear ▫ Ete niña (este niña) this girl ▫ Iya oto (mira oso) look, bear • Intelligibility rating ▫ Mom understands approximately 50% ▫ Unfamiliar people understand roughly 25%
  49. 49. Participant asks: “Is he stimulable for the consonants he is producing?” Intelligibility is a big indicator for impairment.
  50. 50. Juan Diego- Additional Information • Language sample using wordless picture book ▫ Utterance English Translation ▫ Guau guau dog ▫ Dis this (?) ▫ Una ana (rana) a frog ▫ X [unintelligible] ▫ Una ana (rana) a frog ▫ Ete (este), mio this, mine ▫ Una on a X ▫ Iño (niño) boy ▫ Ayó (cayó) fell down ▫ Ete, oyos. This, X ▫ I (si) Yes
  51. 51. Assessment • Language ▫ PLS-4-Spanish score was 85 (low average) ▫ Language sample indicated below average • Speech ▫ Inside HELP indicates that initial consonants are not typically omitted ▫ Intelligibility is lower than it should be. ▫ Child omits 2+ consonants in 3-syllable words ▫ Child gets frustrated when not understood • Eligibility: Delayed speech development ▫ Enroll and re-evaluate in 6 months
  52. 52. Participant asks: “In Spanish one command word can contain two English words (dame = Give me) “Do you give a child credit for two-word phrases?” • Yes. If a child is putting together two to three different morphemes then give them credit.
  53. 53. Participant asks: “We have to re- evaluate every 6 months. Can these other strategies serve as the evaluation?” • These evaluations are not progress tracking tools. • Learning can occur if a child is exposed to the same instrument frequently. • We do not have many options and we cannot re- use the same tool so we have to use informal data is part of our continual evaluation process.
  54. 54. Participant asks: “The goals and objectives we are given are from the evaluation. How can we expand on these goals to get more information?” • Give the evaluation but then probe further to identify: ▫ Can the child generalize his abilities to other activities. • The end goal is to increase our confidence in our decision by building clinical judgment.
  55. 55. Click to visit
  56. 56. References Battelle Developmental Inventory, Second Edition (BDI-2). (2005). Riverside Publishing: Illinois. Determining Eligibility. (n.d.). Retrieved August 9, 2012 from Flipsen, P., Jr. (2006). Measuring the intelligibility of conversational speech in children. Clinical Linguistics & Phonetics. 20(4), 202-312. Goldstein, B. (2011, ed.), Bilingual language development and disorders in Spanish-English speakers (2nd ed.). Baltimore, MD: Brookes Publishing. Hofstede, Geert (2001). Culture consequences (2nd ed.). London: Sage. Iglesias, A. (2002). Latino Culture. In D. Battle (Ed.), Communication disorders in multicultural populations (p. 179-202). Boston: Butterworth-Heinemann. Kester, E. S. & Peña, E. D. (2002). Language ability assessment of Spanish-English bilinguals: Future directions. Practical Assessment, Research, and Evaluation, 8, 4. Langdon, H.W.. (2008) Assessment and intervention for communication disorders in culturally and linguistically diverse populations . Book. Clifton, NY: Cengage, (2008). Lynch, E.W., & Hanson, M.J. (2004). Developing cross-cultural competence: A guide for working with children and their families (3rd ed.). Baltimore: Brookes. Lynch, J.I., Brookshire, B.L., & Fox, D.R. (1980). A Parent - Child Cleft Palate Curriculum: Developing Speech and Language. Tigard, OR: CC Publications.
  57. 57. References Making It Work: The Nuts and Bolts of the ECI Process. (n.d.). Retrieved December 11, 2012 from McLeod, S. (Ed.). (2007). The international guide to speech acquisition. Clifton Park, NY: Thomson Delmar Learning. Peña, E., Bedore, L., & Rappazzo, C. (2003). Comparison of Spanish, English and bilingual children's performance across semantic types. Speech, Language, and Hearing Services in Schools, 34, 5–16. Prath, S., Alvarez, A., Anderson Sanchez, K., Stubbe Kester, E., Wirka, M., and Lebel, K., (2012) SMILE for Young Children: A Program for Improving Communication Skills in English and Spanish. Austin: Bilinguistics.