CASLPO News

Assessment in Speech-Language Pathology and Audiology: Key Considerations for Diverse Populations

Assessment is a core part of practice in audiology and speech-language pathology. Standardized tools are designed to support consistency and objectivity in clinical decision-making. However, as patient populations become increasingly diverse, questions are being raised about how well these tools reflect differences in language, culture, and lived experience.

Language and communication are shaped by many factors, including culture, environment, and identity. When standardized tools are developed using narrow population samples, they may not fully account for this variability. This can contribute to assessment bias - where the way a test is designed, normed, or interpreted leads to certain groups being more likely to be identified as needing intervention services, regardless of their actual needs. ¹

Research has shown that bilingual and multilingual individuals may perform differently on standardized language assessments compared to monolingual norms, even when no disorder is present. 

There is also growing discussion about how some assessment tools reflect assumptions about what is considered “typical” communication. In some cases, this can lead to natural linguistic differences being interpreted as deficits. ²

In audiology, similar considerations have been identified. Traditional measures may not always capture how individuals experience hearing in everyday contexts, particularly when language and listening environments differ from standardized testing conditions. ³

How assessment bias can affect clinical practice

Assessment bias may show up in clinical settings in different ways:

• Interpretation of differences as disorders: Linguistic or cultural variation may be viewed through a deficit-based lens rather than as a difference.
• Mismatch between test results and lived experience: Standardized tasks may not fully reflect how a patient communicates or hears in real-world environments.
• Impact on access to care: Assessment outcomes can influence diagnosis and eligibility for services, making interpretation especially important.
• These considerations do not suggest that standardized tools lack value. Rather, they highlight the importance of understanding how context may shape both performance and interpretation.

Considerations in practice

Clinicians may already be navigating these complexities in different ways. The literature highlights several approaches that are being explored or used to support more inclusive assessment:

• Using multiple sources of information: Standardized tools may be considered alongside observation, patient or caregiver report, and informal measures.
• Adapting to linguistic and cultural context: Testing conditions or interpretation may be adjusted depending on the patient’s background.
• Incorporating flexible assessment approaches: Methods such as dynamic assessment are increasingly discussed as ways to better understand communication abilities across languages. ⁴
• Engaging additional supports where appropriate: Interpreters or cultural knowledge keepers may help provide context for assessment findings. ⁵

These approaches do not replace standardized tools but reflect ways they may be used as part of a broader assessment process.

Key Takeaways 

Communication and hearing are central to participation in daily life. When assessment approaches do not fully reflect a patient’s context, there may be implications for how needs are understood and addressed.

Recognizing assessment bias and the diversity of communication experiences can support more inclusive and responsive care. Ongoing reflection on how standardized tools are used is one way that clinicians can continue to adapt their practice to better serve all populations.

CASLPO Resources for Registrants

• Guide for Equitable and Inclusive Services – Principles and practice scenarios for inclusive service delivery
• Culturally Appropriate Intervention Standard – Guidance on acknowledging socio-cultural and linguistic factors in clinical care
• Practice Advice & FAQs – Practical advice on equity and inclusive practice
• DEI E-Forum Series – Ongoing professional development webinars on equity, diversity and inclusion

References:

1. Teoh, W.Q., Brebner, C.M., & Mccormack, P.F. (2012). Assessing the language skills of children from culturally and linguistically diverse backgrounds: The expressive vocabulary performance of Singaporean English-Mandarin bilingual pre-schoolers. International Journal of Speech-Language Pathology, 14, 281 - 291.
2. Nair, V.K., Farah, W., & Cushing, I. (2023). A Critical Analysis of Standardized Testing in Speech and Language Therapy. Language, speech, and hearing services in schools, 1-13.
3. Lelo de Larrea-Mancera, E.S., Solís-Vivanco, R., Sánchez-Jiménez, Y., Padilla-Bustos, K., Correa-Medina, E.I., Clamage, D.S., Bologna, W.J., Gallun, F.J., & Seitz, A.R. (2023). Testing the Informativeness of Diverse Measures of Auditory Processing for Clinical Audiological Practice in Middle-Aged Adults in Mexico. American journal of audiology, 1-11.
4. Laing, S.P., & Kamhi, A.G. (2003). Alternative Assessment of Language and Literacy in Culturally and Linguistically Diverse Populations. Language, speech, and hearing services in schools, 34 1, 44-55.
5. Guiberson, M.M., & Atkins, J.L. (2012). Speech-Language Pathologists’ Preparation, Practices, and Perspectives on Serving Culturally and Linguistically Diverse Children. Communication Disorders Quarterly, 33, 169 - 180.