By Susan Berkowitz, M.S., M.Ed., CCC-SLP
I periodically write about the Myths of Augmentative-Alternative Communication, many of which still persist, despite evidence to the contrary. One that particularly stands out is the mantra that, “His cognitive skills aren’t good/high enough to use AAC.”
I had hoped to stop hearing this one, as ASHA’s policy on cognitive referencing - otherwise known as the discrepancy model - is strong.
“Cognitive Referencing is the practice of comparing IQ scores and language scores as
a factor for determining eligibility for speech-language intervention. It is based on
the assumption that language functioning cannot surpass cognitive levels. However,
according to research, some language abilities may in fact surpass cognitive levels.
Therefore, ASHA does not support the use of cognitive referencing.” (ASHA, 2016)
Unfortunately, the discrepancy model does not take into account the fact that cognitive and language skills are intertwined and interdependent; not linear. Language is as likely to improve cognitive function as increased cognitive skills are to improve language. (Nelson, N. 1995)
This becomes a bigger issue for nonspeaking students than for those with speech; as we are unlikely to know exactly what a child can do given correct instruction if we ban them from the “game” before they even start.
Students with significant disabilities are often denied access to services and supports because their language and cognitive skills are believed to be commensurate. But this gives the impression that communication skills only warrant intervention when language skills are “below” a student’s cognitive skills. (Miller & Chapman, 1980; Shane & Bashir, 1980).
Newborns communicate. Communication, in and of itself, does not require linguistic skills. And what children can do with structured intervention often far exceeds our expectations; telling us loudly and clearly that we are not expecting enough. That we need to presume competence.
ASHA’s position statement concludes:
“Evidence from research has shown that all individuals can benefit from appropriate communication services to improve the effectiveness of their communication. A child's cognitive age relates to where along the continuum of communication he or she will begin the communication and language process. A child's cognitive age should not be used to deny communication services and supports."
People used to believe that individuals had to demonstrate certain cognitive skills before they would be able to benefit from communication services. Recent research has shown that communication and language develop from early infancy along with cognitive and thinking skills. In fact, sometimes teaching new communication skills can help a child develop other thinking skills.
The use of "discrepancy" between measured cognitive and measured language levels is not an acceptable approach to eligibility decisions. It is appropriate to provide communication services to an individual whose language age is commensurate with his or her mental age.
The relationship between language and cognition is neither simple nor static. Tests that purport to assess either cognitive or language skills often measure the same fundamental skills. Research has shown that individuals with disabilities whose cognitive and language skills were measured as equal nonetheless benefit from language intervention.”
The position of the National Joint Committee for the Communication Needs of Persons With Severe Disabilities is an official policy of the American Speech-Language-Hearing Association. It states that determining eligibility on pre-formulated criteria, rather than the specific individual’s needs, environment, response to intervention, and supports may violate federal statute and state laws.
There is a reason why this is often referred to as the “wait to fail” model of intervention. But just why do we need to wait for the student to fail before providing intervention that could have prevented such failure?
Nickola Wolf Nelson suggests we ask, not who can benefit from intervention based on their IQ, but, “Who has language and communication skills that are insufficient to support them in the important contexts of their lives?” She sites the evidence from Lahey (1992), Cole (1990, 1992) , & Terrell (1978) that:
1. Cognitive and language tests may reflect the same things;
2. Some combinations of language tests and cognitive tests show a discrepancy when others may not—and at
some times, but not others;
3. Formal testing often yields biased results for children from diverse cultural and linguistic communities;
4. Formal tests fail to assess contextually-based needs for language intervention;
5. Validity for determining the need for language intervention services is questionable; and,
6. Children can benefit from language intervention services whether or not they show discrepancies
Students should be served based on their unmet communication needs. Communication is a basic need and a basic right, says the National Joint Committee for Communication Needs of Persons with Severe Disabilities (1992).
Susan Berkowitz, MS, CCC-SLP, MEd., has been a speech-language pathologist for 40 years. She has worked mostly with children and adults with Autism, Cerebral Palsy, and other developmental disabilities, as well as 8 years in the language-based classrooms in a school district. Susan has worked in public and non-public schools, residential settings, and nonprofit community agencies. She has written for peer-reviewed professional journals and presented at international conferences. Visit her website and blog for additional resources. For her complete resume, click here.
Cole, K. N., Dale, P. S., & Mills, D. E. (1990). Defining language delay in young children by cognitive referencing: Are we saying more than we know? Applied Psycholinguistics, 11, 291-302.
Cole, K. N., Dale, P. S., & Mills, P. E. (1992). Stability of the intelligence quotient—language quotient relation: Is discrepancy modeling based on a myth? American Journal on Mental Retardation, 97(2) 131-143.
Discrepancy Models and the Discrepancy Between Policy and Evidence (April 1996; 3:1). The Newsletter of Special Interest Division 1, Language Learning and Education. ASHA
Eligibility and Dismissal in Schools. http://www.asha.org/slp/schools/prof-consult/eligibility/
Lahey, M. (1990). Who shall be called language disordered? Some reflections and one perspective. Journal of Speech and Hearing Disorders, 55, 612-620.
Lahey, M. (1992). Linguistic and cultural diversity: Further problems for determining who shall be called language disordered. Journal of Speech and Hearing Disorders, 56, 638-639.
National Joint Committee for the Communication Needs of Persons With Severe Disabilities. (2003). Position statement on access to communication services and supports:
Concerns regarding the application of restrictive “eligibility” policies [Position Statement]. Available from www.asha.org/policy or www.asha.org/njc.
Ourand, P. (2010). Cognitive Prerequisites Not Required for AAC Use. SpeechPathology.com; from AAC: Demystifying the "Assessment Process"
Special Education Eligibility: When Is a Speech-Language Impairment Also a Disability? Retrieved from http://leader.pubs.asha.org/article.aspx?articleid=2279030. (2011).
Terrell, F., Taylor, J., & Terrell, S. L. (1978). Effects of type of social reinforcement on the intelligence test performance of lower-class Black children. Journal of Consulting and Clinical Psychology, 46, 1538-1539.