Empirically Derived Combinations of Tools and Clinical Cutoffs: An Illustrative Case With a Sample of Culturally/Linguistically Diverse Children

Abstract

Purpose-Using a sample of culturally/linguistically diverse children, we present data to illustrate the value of empirically derived combinations of tools and cutoffs for determining eligibility in child language impairment.Method-Data were from 95 4-and 6-year-olds (40 African American, 55 White; 18 with language impairment, 77 without) who lived in the rural South; they involved primarily scores from the Comprehension subtest of the Stanford-Binet Intelligence Scale-Fourth Edition (CSSB; R. Thorndike, E. Hagen, & J. Sattler, 1986), but scores from an experimental nonword repetition task (NRT; C. Dollaghan & T. Campbell, 1998) were also included as supplements to these scores.Results-Although the CSSB led to low fail rates in children without impairment and a statistically reliable group difference as a function of the children's clinical status but not their race, only 56% of children with impairment were accurately classified when −1 SD was employed as the cutoff. Diagnostic accuracy improved to 81% when an empirically derived cutoff of −.5 SD was used. When scores from the NRT were added to those from the CSSB, diagnostic accuracy increased to 90%.Implications-This illustrative case adds to the growing number of studies that call for empirically derived combinations of tools and cutoffs as one option within an evidence-based practice framework. Keywords assessment; child language disorders; cultural/linguistic diversity Norm-referenced tests, although not the only tools used within assessment, play an important role in determining who is eligible for clinical services in the field of speechlanguage pathology. This is especially true in public school settings where established eligibility guidelines in the form of −1 SD, −1.5 SD, or −2 SD are set at the district, parish, or state level. In a recent article, however, Spaulding, Plante, and Farinella (2006) examined the diagnostic accuracy rates of 43 assessment tools, and from their review argued against "wholesale" use of a single low cut-off score to determine eligibility. In this article, we © American Speech-Language-Hearing Association Contact author: Janna B. Oetting, Department of Communication Sciences and Disorders, 64 Hatcher Hall, Louisiana State University, Baton Rouge, LA 70803. cdjanna@lsu.edu. NIH Public Access Author ManuscriptLang Speech Hear Serv Sch. Author manuscript; available in PMC 2012 July 05. Our illustrative case focuses primarily on scores from the Comprehension subtest of the Stanford-Binet Intelligence Scale-Fourth Edition (CSSB; Thorndike, Hagen, & Sattler, 1986), although scores from an experimental nonword repetition task (NRT; Dollaghan & Campbell, 1998) are also included as supplements to these scores. Our data for both of these tools were collected in the late 1990s because research from other labs supported their use for children from culturally/linguistically diverse backgrounds. Unfortunately, our initial evaluation of these tools using some very basic methods led to mixed findings that were difficult to reconcile...

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