Assessing Comprehension of Children with Complex Communication Needs: How We Use C-BiLLT & What We Have Learned

Elisa Kingsbury, Rebecca Matthews, Amanda Eiser Hess

There is a critical, unmet need to have an evaluation tool that can assess the language comprehension of young children with complex communication needs; specifically, children with neuromotor disorders (e.g., cerebral palsy). Establishing a child’s comprehension skills is essential for planning appropriate intervention goals and establishing programs that lead to positive outcomes.

SLPs at the Bridge School will share preliminary results from our use of the Computer-Based instrument for Low motor Language Testing (C-BiLLT), a receptive language assessment that may be completed using a variety of access methods.

Currently, most available language assessment tools do not provide valid or reliable ways to assess the language comprehension of children with severe speech and motor impairments, as these measures have not included children who use augmentative and alternative communication () methods in their standardization sample (Beukelman & Light, 2020). This fact often leaves teachers, clinicians and parents to ‘guestimate’ a child’s understanding of language, including their comprehension of vocabulary and grammatical structures. A lack of formal assessment tools for children with complex communication needs can lead to an overestimation or underestimation of a child’s receptive language skills.

For decades children with complex communication needs (CCN) have faced barriers to reliable and valid assessments of language comprehension. Many of these children have had difficulty attending to and cooperating with testing protocols because of motor or vision impairments. Most tests of comprehension rely heavily on a child being able to see and understand pictures, line drawings, and/or photos. A child’s knowledge is tested by requiring responses via pointing to or looking at a selected item. The need for reliable assessment methods and normative data has long been sought after for children who are unable to participate in standardized testing due to fine motor and/or visual concerns. For these and other reasons, speech-language pathologists (SLPs) often have relied on parent interviews, observations and informal or qualitative measures to provide authentic language assessment. SLPs endeavored to adapt formal tests or checklists in an ongoing effort to gather key information about their clients’ language comprehension with mixed results.

SLPs and teachers at The Bridge School (TBS) have extensive experience adapting and modifying assessment tools and utilizing well-researched tools like the MacArthur-Bates Communicative Development Inventories with caregivers to help assess what children understand. However, the population enrolled in the school currently has changed. Students are increasingly more medically fragile, have more physical needs and nearly half of the students now have a diagnosis of cortical vision impairment. Clearly, more reliable assessment methods needed to be identified.

SLPs at the Bridge School will present how we used the C-BiLLT with children at The Bridge School. We will share lessons learned and highlight results obtained from administration of the assessment to children, including some results that were expected and some unexpected. Case examples detailing test strategies, accommodations, results and how information was used in intervention will be presented.