MENTAL HANDICAP VOL. 12 DECEMBER 1984

Assessment of children with profound AN ANALYSIS OF 12 SCHEDULES

handicaps:

Tony Best Judy Bell

SUMhWRY This article offers information about 12 schedules used to

assess children who are profoundly handicapped. The comparison of schedules is intended to highlight their similarities and their differences, and to help determine the choice of schedule(s) for use in assessment and programme planning. It is considered that no single assessment instrument possesses all the characteristics to measure every aspect of development adequately. If this viewpoint is accepted, it is important to choose schedules which are complementary to each other, rather than ones which assess the same behaviours under the guise of differences in vocabulary.

This article assembles information about 12 checklists and scales suitable for use with children who are profoundly handicapped. Such scales form the basis of many training programmes as they provide guidance for staff on skills that might be taught. There are dangers, however, in using a single scale without proper examination of its construction and content, as illustrated in the accompanying analysis (see Figure 1).

The 12 scales analysed have all been used successfully with children with profound handicaps. They have been assembled in a number of ways and for a range of purposes. They are variously described as checklists, scales, tests, profiles, or procedures. This article uses the term ‘‘schedule” for them all.

Purpose Staff working with children who are profoundly handicapped

use schedules for three main purposes. 1. To establish performance levels. They provide a

framework for structuring observation of a child and, in a comparatively short time, establishing exactly what he can do.

2. To record progress. Reassessment provides a measure of the child’s progress and the time taken to achieve it. As well as monitoring the effectiveness of teaching, such measurements can be a valuable morale booster to staff who may work for many months without being able to see noticeable progress in a child.

3. Toplm a teachingprogramme. Most schedules list items in the order in which they might be expected to appear in a child, and so can offer guidance on the next stage to encourage in a child’s development. Others, however, specifically state that they should not be used as a curriculum guide but only in conjunction with other procedures. There is a danger that if teaching is based solely on one schedule, insufficient attention may be given to incidental and unstructured experiences, and to activities not directly related to schedule items.

Suitability The selection of activities is a crucial issue in the education of

children with profound handicaps. Schedules are often designed

to ultimately enable a child to read and write; being based on the development of non-handicapped children, they assume goals which may not be attainable by children who are handicapped. Such schedules may be inappropriate for use with them. This point is expressed clearly by Penfold (1978):

“It is evident that we need a forward-oriented, devefopmenraf curriculum, There is a need for a curriculum sufficient to encompass afl development; which looks in detail at the child now and in the way we hope he will develop; which starts from scratch; For example:

a) looking d) talking listening e) rolling

b) holding crawling reaching f ) sitting

c) mouthing g) standing feeding walking.”

Then there is the problem of deciding if a child can perform the skill described in the schedule. For example, what does “eats with a spoon” really mean? That he can take food off a spoon? That he can load a spoon with any food and then put it in his mouth? That he does these things most of the time? Or when he feels like it? Or on a good day with a considerable spilling? The criteria must be clearly established if they are to be applied consistently and so provide reliable guidance as to a child’s progress.

Another difficulty can arise from the way schedules have been constructed. Some of the 12 analysed, and many others that are published by individual schools, have been put together by a group of staff who have agreed on the wording and order of the items listed. There may be considerable benefits to a particular school, for example, from compiling a schedule in this way. The teachers will have clarified their aims for the children they teach and may have developed a clearer understanding of the strengths and weaknesses of schedules as curriculum or assessment aids. As their schedule will be directly relevant to the children they teach, they may be more enthusiastic about using it.

Sometimes, many experienced staff are involved in compiling a schedule, resulting in a list of items which are reasonably accurate in their developmental sequence, and wording that makes clear the behaviour required. Even so, the schedules are rarely evaluated objectively by others who have not been involved in their compilation, and so there is no guarantee that they are “right”. It may be unrealistic to demand such a rigorous standard of research when the children to whom the schedules apply vary so much in the combination and severity of their handicaps, but it is worth remembering that there is little evidence that schedules predict the sequence of skill acquisition for all children.

12-schedule analysis The analysis (Figure 1) presents information about the

content of 12 schedules. As their organisation varies, some standard terms have been adopted to enable as fair a comparison as possible to be made. The schedules are divided into “sections”, each listing a number of items (to be recorded as

TONY BEST is a Lecturer in Special Education at the University of Birmingham. JUDY BELL is a Peripatetic Teacher of the Visually Handicapped, Wolverhampton, formerly Head of Department, Queslett School, St Margaret’s Hospital, Walsall LEA. 160 @ 1984 British Institute of Mental Handicap

MENTAL HANDICAP VOL. 12 DECEMBER 1984

FIGURE 1. 12-schedule analysis

Balthazar, E. E. Balthazar Scales of Adaptive Behaviour 1 NFER, 1981

Areas covered Eating, dressing, toileting Examples Dependent Feeding: “mouth is open’’ to

“manipulates food in mouth” in 9 items

of the Jcales. Ptkhase restricted to psychologists.

Bluma, S., Shearer, M., Frohman, A., Hilliard, J. Portage Guide to Early Education NFER. 1976

Areas covered

Examoles

Infant stimulation; socialisation; Innslllgc; self-help; cognitive; motor “reocats sound made bv others” to “asks ,- me& of new or unfadiar words” m 79 items Designed as a package to help in the home-based training of

developmentally delayed pre-school children. Includes developmental Recording Columnar charts checklists indicating age equivalents. Covers period from birth to 6 years. Teaching suegestions c 1 our d d a d with aching suggestions for all items Recommended for use by those who have undertaken a training course. __

Dale, F. J. Areas covered Locomotion; occupation; personal/social; Progress Guide for Deaf-Blind and Severely Handicapped Wdren dressing; feeding; washing; toileting; NADBRH, 1972 communication and language

“makes small throaty noises” to “can read Items taken from scales of normative development and rearranged by the author, an experienced teacher of children who are deaf-blind. sentences, interested in spelling” in 64 items

Training handbook in preparation Recording method Ticks alongside items Teaching suggestions

Gunzburg, H. Progress Assessment Charts RSMHC, 1973

Areas covered Self-help; communication; occupation; socialisation

Examples “throaty noises, cries” to “gives fuil name on request” in 20 items Profile on circular summary chart Separate charts, widely used, cover different developmental levels. The

PPAC, for use with children who are severely mentally handicapped, has four main sections divided into nine sub-sections. ~ ~ ~ ~ s ~ ~ ~ o n s Not included

Kiernan, C., Jones, M. Behaviour Assessment Battery NFER, 1977 Unique in suggesting that prompting and reinforcement be used during testing. Intended as basis for decisions relating to programme planning.

Areas covered Reinforcement and experience; inspection; tracking; visuo-motor; auditory; postural control; exploratory play; constructive play; search strategies; perceptual problem solving; communication-understanding; c o m m u n i c a t i o n - s o u n d imi ta t ion :

Nihira, K. Adaptive Behaviour Scale NFER. 1974

communication-expression; self-help; s o d “Shows preferences or needs” to “uses well- formed sentences with more than one phrase” in 31 items Lattices up to 6 stems

Examples

Recording method Teaching suggestions Not included

Areas covered I n d e p e n d e n t funct ioning; physical development; economic activity; 1- develomnent; numbers and time; domeshc

The frs t part deals with performance in 10 main sections. A second part covers maladaptive behaviours. There are 66 sub-sections, each with between 3 and 7 items. Examples

activity; vocitional activity; seIkIirection; responsibility; socialisation “is non-verbal” to “sometimes uses complex sentences containing ‘but’ ‘because’, etc” in 9 items Ticks alongside items, and linear summary chart with scores converted to deciles

Lying on back lying on front; lying on side; rolling; held against shoulder; sitting; kneeling on all fours; crawling; upright

Recording method

Teaching suggestions Not included

Areas covered Presland, J. Paths to Mobility in “Special Care” BIMH, 1982 A book which outlines principles and practice in teaching “special care” children. Includes a detailed checklist for teaching gross motor skills.

kneeling; standing; walking;. wallring with crutches; walking with sticks; using a wheelchair

Examples

Recording method Ticks alongside items Teaching suggestions Comprehensive teaching suggestions

Revnell. I.. Zinkin. P. Areas covered S o c i a l a d a p t a t i o n ; sensor i -motor

“rotates head to side” to “walks with feet only slightly apart” in 88 items

accompany most items

Divelop&ent Scales for Young Visually Handicapped Children NFER. 1979 - .- ---> - A developmental assessment of visually handicapped (VH) children and basis for planning a programme of early education. Constructed with data from VH children, many with an additional mental handicap. Available to psychologists and qualified teachers of the blind. Examdes

understandink meaningful use of objects; exploration of the environment; response to s o u n d a n d verba l comprehension; vocalisation and expressive language; expressive language, vocabu‘lary and content; communication “vocalisation other than crying” to “can respond appropriately to ‘what happened’ ” in 40 items

Recording method Itemised record sheet Teaching suggestions Not included -

Continued overleaf ~~ ~

@ 1984 British institute of Mental Handicap 161

MENTAL HANDICAP VOL. 12 DECEMBER 1984

Most advanced visual khaviocu s p e c i k d

Picks out object from other items of similar size

Rspoods to visual stimuli with eyc blink, pupil constriction, mJption of activity Can fauson 1 or2 objcsts shown

Coordinates movements of eys sideways and up and down

Rcfogniscs size ofobjects by diffamtipl gnsp A c a m m d a t c s m m c n s h todistanceinvolved in rrsdunn

Tracksslowiymovingoh~at 46fl

Fig. 1. continued

Rudolph, J. M., Bjorling, B. J., Collins, M. T. Manual for be Assessment of a Deaf-Bliad Multiply Handicapped Child Mid-West Regional Centre for Deaf-Blind, Lansing, Michigan, USA, 1975 Developed for mentally handicapped, deaf-blind population, but useful for all profoundly handicapped children. Emphasis on use of the scales in measuring performance rather than as a curriculum guide.

Number of item in sectional

sub sections

7

2 7 6

4

7 5

Areas covered Gross motor; fine motor; self-help; communication; auditory development; visual development; cognition; social development; mobility “random vocalisation” to “combines three words in a sentence and/or uses common phrases” in 9 steps Columnar chart for each scale, display sheet of overall profde

Examples

Recording method

Teaching suggestions Not included

Rnponds toobjofkrs than 1“ dinmetaat 6 foot distana

M p t c h 9wy shon written words

Cuts out arch on Line

Rfspxlds to nght ofobpxwith smik

~ ~

Areas covered

Examples

Recording method Columnar summary chart Teaching suggestions

Use of sight and hearing; movement; manual dexterity; social development and personal contact; self-help skills; communication “makes several different non-specific sounds” to “asks for things he wants by naming them” in 9 steps

Comprehensive teaching sugge s t io n s accomoanv most items

Simon, G. B. (Ed) Tbe Next Step on b e Ladder BIMH, 1981 Designed specifically for children with mental handicaps and additional sensory imparilnents.

8

29

43

21

Stillman, R. Areas covered Motor development; perceptual abilities; CnLUer-Azusa Scale daily living skills; cognition, communication W e t Hearing and Speech Center, Dallas, USA, 1976 and language; social development

“undifferentiated cry” to “uses past tense Developed specifically for children with mental handicap and additional appropriately in approximately 90% of cases where it should be used” in 50 steps sensory deficits. Many items assume some useful vision and hearing.

Provides age equivalents based on normative data. Several different Columnar charts giving age equivalence editions exist.

Examples

Recording method Teaching suggestions Not included

Sacurrsobjxt hid& with 3 M Q ~ S

Uqaris, I. C., Hunt, J. McV. ordirrpl Scales of Psychological Development University of Illinois Rcss, 1975 Universitv Park Rcss. Baltimore. 1980 Ed. C. 1. Dunst)

21

Areas covered Visual pursuit and permanence of objects; means-ends development; vocal imitation; gestural imitation; operational causality; schemes relating to objects .-

Examples

Recording method

“Responds to voice” to “imitates at least 4 novel words” in 20 items Columnar charts for each scale; comparative Summary Rofde Sheet

Based on Piagetian model of sensori-motor development, birth to two y e w . h s u ~ s good h o d e d g e of -tian theory. 1980 edition padcularly relevant to profoundly handicapped children.

Teaching suggestions Not included

FIGURE 2. Comporton of schedules with separate scction/sub-mction to -s vision

Schedule Sectiolu/rub-wctions rrl* to virion

Earliest visual khaviour 9-

Turns h a d toward light

Norrsponse to any visual stimuli No focus or lixation Doesnotvisdyfollowmovement

the 2 eyes

V i y p I c i a s p a ! p l c t o ~

No aardiaatioo of movement in

Novisurldepthpaocpdon

Respondstofaccat 12”-18“

Does not =pond to visual s h u l u s

Does m -pond to visual stimulus

Childknodrsdom. . . toobtaindesm obiect

I

obtain9 third cube whilst hddingwo 27

162 0 1984 British Institute of Mental Handicap

MENTAL HANOKAP VOL. 12 DECEMBER 1984

present or absent in a child) which are often grouped into “sub-sections”. To give an idea of the developmental range covered and the size of the step between items, the first and last item in the expressive communication sub-section, and the number of steps between them, is given. In schedules with no expressive communication sub-section, information on another sub-section is given.

The method of recording scores varies. For example, some schedules have summary charts which give a clear visual presentation of a child’s scores, while others simply provide for ticks alongside each item. The analysis indicates the method of recording for each schedule and also whether any teaching suggestions are offered.

Detailed analysis of one sub-section The 12 section analysis highlights differences of approach and

depth of coverage of the schedules. A more detailed analysis of one sub-section, however, can bring out points which are not seen clearly in the more general analysis.

As many of the 12 schedules include some form of visual or visually-related assessment this area has been chosen for detailed analysis (see Figure 2). The assessments are designed to be teacher-administered and are meant to complement, not replace, clinical ophthalmological examination. Such assessment is important because many of the skills needed by people who are profoundly handicapped are heavily dependent on visual components.

Difficulties in comparison The visual domain of the schedules is complex, incorporating

a mass of ill-defined terms such as “occulomotor co- ordination,” “visual skills”, and “visual perceptual abilities”. This makes comparison difficult as the same behaviour is given different names by the various authors. The structure of the visual assessments reflects the underlying theoretical approach and purpose of the schedules. The assessment items listed can be divided into the following two main categories although many of them, having a wide-ranging application, fall into both.

1. Items primarily concerned with the degree to which an individual makes use of his available sight. This provides information for decisions relating to the presentation of visual material or the adoption of alternative sensory input in any educational programme. It also indicates whether limited use of vision is resulting in poor functioning in other areas of development, as many skills depend on the ability to use vision effectively.

Schedules which incorporate this form of assessment include the Next Step of the Ladder and the Behaviour Assessment Battery.

2. Items primarily concerned with the developmental sequence of visual skills, such as fixation, tracking, scanning, and searching, which form the basis of all visually directed behaviours. This facilitates the planning of activities to foster the emergence of the next stage in s w 1 development, or the generalisation of an established visual skill to new materials and situations. Additional information may be derived about the preferred size, shape, colour, and distance of viewed objects.

The Manual for the Assessment of a Deaf-Blind Multiply Handicapped Child and the Callier-Azusa Scale inchde assessment items of this nature. So, too, does the Behaviour Assessment Battery which is a good example of a schedule which contains items which fall into both categories.

The very close links between visual and cognitive skills result in many visually related behaviours being included in scales primarily concerned with cognition. For example, the Manual for the Assessment ofa Deaf-Blind Multiply Handicapped Child includes items relating to the matching of colours and shapes in its cognition scale, whilst the Callier-Azusa Scale covers identical skills in its visual development section. Such differences complicate direct comparison of schedules.

Some schedules do not have separate sections concerned

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solely with vision, items relating to visual skills being scattered throughout. Such schedules do not imply that vision is unimportant, but that it is inextricably linked with other aspects of behaviour. For example, the Portage Guide to Early Education includes items concerned with vision in its section: on infant stimulation, socialisation, and cognition.

The Ordinal Scales of Psychological Development include one section, Visual Pursuit and Permanence of Objects, which ie entirely concerned with visual behaviours. Other visual sk% are included in the sections on Operational Causality and Development of Means for Obtaining Desired Environmental Ends. This reflects a somewhat different theoretical standpoint from most schedules mentioned in this article, emphasis being on levels of cognitive organisation characterised by the performance of particular behaviours. Visual behaviours figure prominently, because at early stages of development vision provides much information about the environment.

A second difficulty is the degree of analysis within sub- sections. Schedules vary considerably in terms of: the number of items concerned with vision; the size of the steps between items; and the difference between the simplest and the most advanced visual behaviours covered. All 12 schedules include skills which are usually established or emergent during the first weeks of life. Some go on to cover skills which develop during the next six years whilst others concentrate on the first two years only. Schedules which include the largest number of items concerned with vision are not necessarily the most detailed. Indeed, some include items which are couched entirely in negative terms, being concerned with the absence rather than the presence of skills. This can give a misleading impression of a schedule’s detail.

Figure 2 compares the schedules which include a separate section or sub-section concerned with vision. It highlights the differences in vocabulary, the level of the behaviours specified, and the number of items included in the sections.

@ 1984 British Institute of Mental Handicap 163