Determining student speech therapy eligibility for school based services is always a discussion at local SLP meetings, state conferences, or just a friendly chat with a fellow SLP. One topic that has been brought up recently in a few discussions is cognitive referencing.
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)
The Problem with Cognitive Referencing to determine Speech Therapy Eligibility:
The discrepancy model doesn’t take into account that language and cognitive functioning are not always the same or that they can change through high quality instruction. Eligibility for speech and language services can be a difficult decision. Emphasis on functional communication, language in context, adaptive behavior and problem solving is the focus, rather than a single score. The relationship between language and cognition is neither simple nor static. In the discrepancy model, a Kindergarten student with an IQ of 60 and Language score of 63 would not qualify for speech and language services. Have you tried to give an IQ test to a Kindergartener? Well, me either, but I have given them a language test and know that so many factors can impact their ability to test well on standardized measures. What if social anxiety impacting their test taking. What if they were ill on the day of the test? What if their non-verbal IQ is average and their verbal IQ is severely delayed? Did their language cause that low IQ score? IQ tests are language based and therefore language will always impact an IQ score. What if they have influences from learning a second language or having a different culture?
Does the person saying, “no speech for you” to that 5 year old with a language score of 63, think we should withhold therapy and wait for the child to fail?
The U.S. Department of Education (page 31) also describes it as potentially harmful to students as it results in delaying intervention until the student’s achievement is sufficiently low so that the descrepancy in achieved. Not surprisingly the “wait to fail” model… does not result in significant closing of the achievement gap for most students placed in special education.” Instead they recommend that states implement the RtI model. “The type of model most consistently recommended uses a process based on systematic assessment of the student’s response to high quality, research-based general education instruction.”
In Ohio, our mandates for special education (page 103) require that we use an intervention model. “Each school district shall use data from interventions to determine eligibility for special education services, appropriate instructional practices, and access to the general curriculum. In the case of a preschool-age child, data collected through interventions is part of the differentiated referral process.” We must also “Not use any single source of information, such as a single measure or score, as the sole criterion for determining whether a child is a child with a disability and for determining an appropriate educational program for the child (page 106).
Making a Change
So, what does this mean for the school SLP in a district still using the cognitive referencing model? Frank Cirrin says, “First, professionals have both the responsibility and the ability to change state and/or district eligibility criteria when they are based on unsupported assumptions about who can benefit from language intervention.” He’s right! You can’t sit back and not challenge your eligibility criteria if it isn’t supported by research and your national organization. Implement a high quality Response to Intervention program for your language impaired students and identify if they make progress with Tier II interventions. If your student succeeds with these interventions, you know the level of instruction required. If they continue to need these individualized learning opportunity, you now have evidence to support special education services.
If you have a coworker or administrator using the Cognitive Referencing model and need evidence to support your stance ASHA has some for you. Cognitive Referencing is an outdated model not supported by ASHA for almost 20 years. I’d love to hear your thought! Leave me a comment below.
Join the SRN newsletter!
I'm so glad you stopped by! If you'd like to keep up with the newest posts and get exclusive free downloads, please sign up for the newsletter! Your first freebie is ready as soon as you subscribe and confirm your email!