Comprehensive Assessment of Preschool and Kindergarten-Aged Children

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Typically, I write posts pertaining to certain aspects of the assessment and treatment of school-aged children. However, due to an increasing number of requests, today, I wanted to share some advice regarding how speech pathologists can comprehensively assess the language and literacy abilities of preschool and kindergarten-aged children.

Now some professionals may ask, “Isn’t it too early to perform comprehensive assessments for these age groups?” The answer is a resounding, “No!” That is because there are circumstances in which such assessments may be highly relevant and urgently needed.

Below are just two of many examples from real-life situations when such assessments were urgently needed. Emily (not her real name) is a 4-year-old whose four older siblings present with language and literacy needs and have been receiving a variety of literacy-related services in some capacity for years. Her family history is replete with red flags for “dyslexia” on both sides. Her parents are both well-educated professionals in a household where education and reading are highly valued and plenty of time is spent with Emily on both: reading (e.g., bedtime stories) as well as early literacy education (learning letters, numbers, and colors). The problem is that despite the very significant effort used to teach Emily early literacy concepts, she is having massive difficulties recalling taught information, and displays subtle language deficits characterized by word-finding difficulties, memory for names, and basic concepts, in addition to disorganized storytelling skills.

In contrast to “Emily”, 5-year-old “Petey” (not his real name), has great phonemic awareness and pre-reading skills. He is very advanced in math concepts and is functioning in math and reading far about his kindergarten level. However, he is having very significant difficulties in kindergarten because of pragmatic language deficits characterized by significant emotional and physical reactivity, impulsivity, and lack of behavioral inhibition. His parents also report that he is having difficulty using language to verbally reason through age-appropriate situations and cannot tell stories despite the presence of an impressive vocabulary lexicon.

Parents of both children felt it was highly imperative that their language and literacy abilities be comprehensively evaluated so that timely intervention services could be provided to improve social and academic outcomes for both kids.

Given that there is a paucity of psychometrically sound assessments for kids this age, before discussing the testing batteries, it is very important to identify best assessment practices for optimized testing outcomes. I strongly recommend either obtaining a summary of deficits list from the parents or the provision of either self-created or purchased checklists, which the parents can fill out in order to determine the extent of deficits. For these age groups, I myself, utilize the following questionnaire and checklists in order to create appropriate testing batteries:

It is important to note that even though these children are quite young, we should still be assessing the following abilities in some capacity (whether formally, clinically, or observationally via checklists and/or parental reports):

Listening comprehension
- Following directions
- Answering questions about short stories or sentences
Oral expression
- Manipulating vocabulary (stating similarities and differences)
- Telling stories
Play skills
Problem-solving abilities
Pragmatic competence
Social-emotional competence
Executive functions
- Impulse control
- Behavior inhibition
- Set shifting
Phonemic awareness
Rapid naming abilities
Alphabetic knowledge
Early decoding skills (5+)
Early spelling and writing skills

So let’s take a look at some standardized test options available for these age groups. Let’s start with the 4-year age group.

The Clinical Evaluation of Language Fundamentals Preschool-3 (CELF-P3) assesses abilities such as following directions, comprehending and recalling sentences, grammatical structures, as well as expressive, vocabulary, basic concepts, and word similarities. However, because all subtests assess a very discrete set of skills, many children can do quite well on this test but still present with significant language limitations, so of course, supplementation will be needed. Unfortunately, the revision of this test took away the Word-Classes: Expressive subtest, which required children to state how the two words they selected go together. This is a problem because many children who can very effectively receptively recognize which words go together, cannot then coherently and cohesively state, how these words go together, which indicates both expressive as well as verbal reasoning limitations. While this subtest can be administered qualitatively, because no subtest score is calculated based on it, the child could attain an average overall test score and still have an inability to perform this task, which indicates significant oral language deficits for this age.

To supplement this test and further assess the children’s oral language and verbal reasoning competence, I also administer the Preschool Language Assessment Instrument-2 (PLAI-2), which does require many open-ended responses, and possesses a notable amount of verbal reasoning questions. One benefit of it administration is that it does tap into the children’s verbal reasoning abilities by asking them to answer “why” and “how” questions, as well as asking them to compare and contrast semantically related items with similar/different features. However, be advised that this test was last updated in 2003, and its discriminant accuracy is unknown, as studies have not been conducted on this subject. As such, significant caution is still advised with respect to its interpretation.

To assess play skills, I administer the Revised Concise Symbolic Play Scale (Westby, 2000) (for children up to 6 years of age), as it provides excellent information about the children’s play skills, which strongly correlate with oral language competence.

To assess narrative competence, I use the trusty “Frog” books by Mercer Meyer, 4 of which English and Spanish scripts and 2 of its English rubrics can be freely found online.

Assessment of pragmatics and executive functions of 4-year-olds is a bit tough. So far I haven’t quite found the perfect instrument for it and I tried quite a few. So I generally have a tendency to cross-compare the child’s pragmatic and executive functioning with developmental norms. Developmentally, with respect to pragmatic discourse, 4-year-old children are expected to appropriately maintain several conversational turns, change topics, politely interrupt an adult conversation, talk about real vs. false emotions (own and others), as well as tell simple but clear stories (Gotzke & Sample Gosse, 2007).

With respect to executive function abilities, 4-year-old children are able to shift between simple task requirements, make good choices, generate new concepts and ideas, as well as inhibit behavior without multiple repetitions and redirections (Peters, 2017). I also occasionally use the following free supplemental checklist: Collaborative Problem Solving Assessment and Planning Tool, which I then clinically discuss in the body of my report with respect to both observed and parent-reported behaviors.

Now, let us move on to the assessment of literacy for kids that age. A simple alphabet chart can take care of both: the names of letters as well as the sounds that they make. The administration of the Comprehensive Test of Phonological Processing-2 (CTOPP-2) will assess the phonemic awareness as well as rapid naming abilities for this age group. However, user beware! The discriminant accuracy of this test was not reported in the manual and ~7% of children in the normative sample did have a disability (Manual, pg. 44), so interpret the results you receive from this test with caution.

Finally, if you wanted to obtain standardized writing scores for this age group, the administration of the Test of Early Written Language-Third Edition (TEWL-3), will be helpful. Of course, much like all standardized tests, it is not without its limitations. For starters, its sensitivity and specificity (aka discriminant accuracy) are provided in the context of criterion comparisons (with other existing tests such as the Woodcock-Johnson III and the Wechsler Individual Achievement Test- Second Edition ). The problem is that both of these tests were developed to rank children within the range of the general population, so there’s no mention of sensitivity and specificity in either of the respective technical manuals for both of these tests. The second issue is that the Basic Writing subtest of the TEWL-3 looks at a variety of writing skills in isolation. Thus, a student can make some errors when answering particular questions and still receive partial credit because the subtest does not require skill integration. However, this information is far more relevant to older children vs. 4-5-year-olds.

Now, let us discuss several additional tests relevant to the 5-year-old age group. Here clinicians have slightly more flexibility with selecting the testing instruments. Many of the above-listed tests and checklists will continue to be very useful, so I will not repeatedly mention them below but instead, offer you some additional testing options.

For listening comprehension involving sentences or stories, depending on the student’s abilities either the A Language Processing Skills Assessment-4 (TAPS-4) or the OPUS administration may be quite useful. Selection of either should be made judiciously. TAPS-4 lacks information pertaining to discriminant accuracy studies, and in my clinical experience has a tendency to significantly overinflate test scores. I typically administer it to 5+-year-old children with very impaired oral language abilities, and even in those instances I have observed children receiving much higher scores on this test than on the OPUS. On the OPUS, the General Language Ability Intex (GLAI) of 90 will produce an acceptable sensitivity (87%), albeit slightly lower specificity (78%). So, based on the psychometric properties of the OPUS, the optimal standard score for the detection of deficits is not the standard score of 85 (which has a sensitivity of 79% and a specificity of 87%) but the standard score of 90 (Table 5.8 in the manual).

Now, let us move on to oral language. For verbal children this age, I do not recommend single vocabulary tasks. Studies have found that single-word vocabulary tests have poor psychometric properties and are not representative of linguistic competence embedded in life activities (Gray et al., 1999; Ukrainetz & Blomquist, 2002; Bogue, DeThorne, Schaefer, 2014). Vocabulary tests can overinflate testing scores and not represent the child’s true expressive language competence. Finally, even when students truly have solid or even superior vocabulary knowledge and naming skills, it does not mean that they can effectively utilize these abilities for conversational or narrative production purposes. For these reasons, rather than administering single-word vocabulary tests, I recommend the administration of tests that focus on assessing the student’s semantic flexibility skills in conjunction with the assessment of their narrative abilities.

For the 5-year-old age group, two such tests stand out: Language Processing Test 3: Elementary (LPT-3) as well as Expressive Language Test-Second Edition: Normative Update (ELT-2: NU). The name of the LPT-3 is a bit of a misnomer. What it does assess though are the 5-year-old students’ abilities to name associations, categories, similarities, and differences, as well as attributes. Once again, we lack discriminant accuracy information regarding this test, so please interpret its results with caution and at your own risk.

The ELT-2 assesses similar yet slightly more advanced abilities. The Sequencing subtest measures narrative ability. The Metalinguistics subtest taps into students’ ability to understand and define the meanings of abstract metalinguistics words such as “word”, “sentence”, “verb”, “antonym”, as well as use them in context. Morphology/Syntax subtest measures the ability to repair grammatical or syntactical errors and rearrange words into a sentence. Defining Categories measures the ability to give verbal definitions. With respect to its discriminant accuracy, the Expressive Language Index cutoff score of 90 has a sensitivity of .72 and a specificity of .79, which is below acceptable norms (Vance & Plante, 1994), and as such the results of this test need to be interpreted with caution.

Finally, with respect to phonemic awareness, one additional test bears mentioning, and that is the Phonological Awareness Test-2: Normative Update (PAT-2: NU). One of the benefits of this test is that in addition to assessing the children’s phonemic awareness abilities, it also formally assesses their knowledge of sound/symbol correspondence for consonants, vowels, consonant blends, consonant digraphs, r-controlled vowels, vowel digraphs, and diphthongs, as well as their knowledge of sound/symbol correspondence when blending a variety of sounds into nonsense words 2 -5 letters of increasing length and complexity (e.g., ‘af’, ‘keb’, ‘mun’, ‘chun’, ‘nerg’, ‘pote’, ‘brild’, etc.).

There you have it! These are just some of the formal and clinical test recommendations that are useful for assessing children 4-5 years of age! Using standardized instruments not listed in this post? Please let me know which ones, and why you prefer to utilize them?

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