How do we test narrative listening comprehension and inferencing?

We’ve talked before about the importance of listening comprehension skills for children’s reading outcomes. But listening comprehension can be tricky to assess. How do we know whether our client is struggling more than the average preschooler? The authors of this study have it covered, with a quick, cheap narrative listening comprehension and inferencing test— AND performance data from children ages 4–6. They used the Squirrel Story Narrative Comprehension Assessment (NCA; available here, paired with the book or app), which requires children to listen to an illustrated short story and answer literal and inferential comprehension questions at the end.  

Literal Comprehension

understanding details from the story

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Inferential Comprehension

making connections beyond the story

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Based on this study, the NCA looks like a useful measure of narrative listening comprehension. The researchers found that scores increase over the preschool years, are lower in kids with DLD, and are sensitive to changes after intervention (as found in this previous study). You can give the NCA, compare to other children age 4–6 using the data from Table I in the paper, and see whether your clients’ literal and inferential comprehension skills might warrant treatment (or whether your treatment is working).

Note that this is guideline data— with a small sample size, these aren’t definitive norms, but do provide us with a good start. See more research on development of inference skills here, and how to work on inferencing here and here.


Dawes, E., Leitão, S., Claessen, M., & Lingoh, C. (2019). Oral literal and inferential narrative comprehension in young typically developing children and children with developmental language disorder. International Journal of Speech-Language Pathology. doi: 10.1080/17549507.2019.1604803.

Why did that AAC device fail? Listen to parents for insight.


In AAC evaluations, we do our best to select a system that meets the client’s and family’s needs, but far too many AAC systems are rejected or abandoned. Why does this happen—and can we prevent it? Since families are so important in implementation, one way to approach this challenge is to understand family members’ experiences of AAC that didn’t succeed for them.

The authors of this study interviewed 16 mothers who rejected/abandoned an AAC system for their child with complex communication needs when he or she was 6 or younger. The systems included sign-based systems and low and high tech devices. So it’s not that parents dismissed a certain type of AAC; rather, parents rejected or abandoned any AAC system that did not meet the needs of their child and family. It makes sense that some reported abandoning systems if the child did not use them to communicate, but the other main barriers were related to parent needs and values. We’ve laid them out for you below along with suggestions to beef up your support.

  • Barrier: Lack of emotional readiness or resilience to implement AAC

    • Support Strategy: Incorporate counseling with a focus on experiencing disability and readiness to use AAC

  • Barrier: Lack of satisfaction with the AAC system

    • Support Strategy: Get on the same page with families about their values regarding cost, functionality, and language level of AAC systems

  • Barrier: Extra work associated with implementing AAC

    • Support Strategy: Focus parent education on efficient support strategies and how to embed AAC in family routines

This qualitative research article is also jam-packed with parent quotes. To get you geared up for family-centered practice in AAC, there’s no better way to get started than to read straight from the source.

Moorcroft, A., Scarinci, N., & Meyer, C. (2019). “I’ve had a love-hate, I mean mostly hate relationship with these PODD books”: Parent perceptions of how they and their child contributed to AAC rejection and abandonment. Disability and Rehabilitation: Assistive Technology. doi:10.1080/17483107.2019.1632944.

Functional speech assessment for children with CP


Although there’s a lot of information out there about children with cerebral palsy (CP) who use AAC, what about those who are verbal? The speech of children with CP presents uniquely, with at least half having dysarthria. Because of the myriad presentations of dysarthria (flashback to motor speech disorders in grad school!) it can be difficult to differentiate between dysarthria and other speech/sound disorders. Detecting motor speech disorders at the youngest age possible is vital to ensuring that we are using the most appropriate, evidence-based treatment.

Hustad et al. used measures of functional speech in an attempt to differentiate five-year-old children with CP who have motor speech involvement (i.e. dysarthria) and those who do not. Those functional measures of speech included intelligibility, speech rate, and intelligible words per minute (a measure of speech efficiency). Children’s speech was measured using delayed imitation, so that evaluators knew the target words. However, these measures could be used with just about any speech sample! Below is a little review for how to calculate these handy measurements:

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All three measures readily differentiated children with dysarthria from children without dysarthria (with both typical development and CP). Furthermore, they even differentiated children with CP but without dysarthria from typically developing children, showing that even kids with CP who appear to have typical speech may have borderline to mild speech difficulties. Intelligibility was the strongest differentiator, with 90% of typically developing five-year-olds falling at 87% intelligibility or greater. See Figure 1 in the article for the hard data, including cutoff scores for differential diagnosis of dysarthria in kids with CP.

Note: Although this study focused on children with CP, functional measures of speech can be useful for any speech evaluation. These measurements, along with other assessment tools, can help us both to identify speech disorders at the earliest possible age and to make decisions regarding intervention and the use of AAC.


Hustad, K.C., Sakash, A., Broman, A.T., & Rathouz, P.J. (2019). Differentiating typical from atypical speech production in 5-Year-Old children with cerebral palsy: A comparative analysis. American Journal of Speech–Language Pathology. doi: 10.1044/2018_AJSLP-MSC18-18-0108.

ChOMPS: A parent-report measure for children with feeding problems

Published in both our Birth to Three and Preschool & School-Age reviews this month.


Ever wish for a parent-report measure to include as part of your evaluation and treatment of children with feeding problems? Thanks to Pados et al. we now have the Child Oral and Motor Proficiency Scale (ChOMPS) to assist us in gaining an objective assessment of eating and movement abilities. This checklist does NOT replace clinical assessment or provide a diagnosis, but it does help assess eating and related skills in children ages 6 months to 7 years. Sounds good, right? Well, it gets even better. The ChOMPS is available for free!* 

We’re going to review two related studies on the ChOMPS: the first study by Pados et al. details the development and content validation of this measure.

The ChOMPS was developed in four phases:

  1. Item generation based on existing literature and assessment tools

  2. Content validation with feeding experts

  3. Content validation with parents

  4. Readability testing

The ChOMPS was developed to help quantify what a child can or cannot do when it comes to observable eating skills like, “my child can drink from a straw” or, “my child can sit upright without support.” Parents can respond to these items by checking yes, sometimes, or not yet. The checklist was made in phase one and revisions to the checklist were made after phases two and three. This ultimately yielded a 70-item list written below a sixth-grade reading level. If you want more specific information on each phase be sure to click over to the article.

The next study, by Park et al., statistically analyzed the items on the checklist and evaluated the psychometric properties of the ChOMPS. A total of 364 parents of children with and without feeding problems completed the checklist. The authors used a statistical analysis (principle component analysis to be specific, more here for you stats whizzes) to determine subscales within the checklist. Based on the various analyses made by the researchers, seven items were removed. This left the researchers with a 63-item measure that represented four subscales: complex movement patterns, basic movement patterns, oral–motor coordination, and fundamental oral–motor skills. They also determined that the final version of the ChOMPS is both valid (e.g. differentiates children with vs without feeding difficulties, and subscales align as we’d want with tests like ASQ-3 and PROMIS) and reliable (e.g. test–retest—you’ll get the same or similar scores if you give it twice). Long story short, the ChOMPS is looking pretty good! 

So now what? Well, remember, this measure is not intended to replace clinical assessment or provide a diagnosis. However, we could pretty easily integrate it into our feeding evaluations and even use it to help evaluate a child’s response to intervention. For more information on norms by age, check out their 2018 paper. Also, keep your eyes peeled for a 10-question ChOMPS screener the authors hope to release in the near future. Thanks to these researchers we’ve now got a great new tool to add to our SLP toolbox! 

*This link connects you to several free feeding assessment tools, including the ChOMP’s complementary assessment the Pediatric Eating Assessment Tool (PediEAT). These measures were gathered together by a group called Feeding Flock. We have yet to review all of these measures because we just launched medical content. But stay tuned for some Throwbacks!


Pados, B.F., Thoyre, S.M., Park, J., Estrem, H.H., & McComish, C. (2019). Development and content validation of the Child Oral and Motor Proficiency Scale (ChOMPS). Journal of Early Intervention. doi: 10.1177/1053815119841091.

Park, J., Pados, B.F., Thoyre, S.M., Estrem, H.H., & McComish, C. (2019). Factor structure and psychometric properties of the child oral and motor proficiency scale. Journal of Early Intervention. doi:10.1177/1053815119841092.

What we need to know about childhood trauma and narrative language skills


Childhood maltreatment is an unfortunate reality, and we know that children who have experienced trauma are also likely to have lower language skills. The authors of this study looked specifically at narrative language skills in children removed from their homes because of maltreatment. Why narrative? Victims of suspected maltreatment are likely to be interviewed as part of criminal cases, and the interviews may be the only evidence of what happened to them. When the stakes are that high, it’s crucial that we know about these children’s narrative ability.

The authors tested a group of elementary-aged children who were living away from their biological parents (with a relative, in foster care, or in a care facility) due to neglect and/or abuse. Children completed standardized tests of narrative and general language ability. Children’s narrative results were mixed, but 42% scored in the lower range, and they showed the most difficulty with producing (vs. comprehending) narratives. General language ability was related to narrative ability, but not perfectly. Children whose caregivers had lower levels of education also tended to have lower narrative skills. 

So what can we do about this? As a field, we can increase awareness about the impact of early experiences on language development and on children’s ability to report their experiences. In our practice, we can assess narrative production in children who’ve experienced trauma or who’ve had difficult home lives and help those children build crucial narrative skills. And of course, we can be part of the village that steps in to give support to the children who need it most. 


Snow, P. C., Timms, L., Lum, J. A. G., & Powell, M. B. (2019). Narrative language skills of maltreated children living in out-of-home care. International Journal of Speech-Language Pathology. doi:10.1080/17549507.2019.1598493.