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.
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I’m so happy you brought this up. Our district is currently looking more into this since they use the cognitive referencing model. What would you say about kiddos who are older though, in 3rd, 4th, or 5th grade and whose IQ is more reliable than the example you provided? They have good adaptive skills, have functional communication, and relatively appropriate problem solving skills. If their IQ and language scores are commensurate at this age and present with these functional communication skills, would you still not consider dismissal? Interested to hear your thoughts!
I think as kids get older a few other factors enter the picture:
– Student motivation
– Rate of progress
– Benefit to services vs. detriment of being pulled out of class
– Tx changes to more strategy coaching rather than filling gaps in development. \
I’d say I reduce minutes to a more consultative method of service when kids get older (especially middle school.)
As of now our district only uses this model after nine years old which with most of our kids ends up being more like 11 or 12 due to the times that they are tested. I really can see the difference between using it with a five-year-old and a 10-year-old. There are so many more factors when they are in fifth grade versus kindergarten especially when students have been in therapy or special education for 5 or so years.
I totally agree! There is a big different between 5 year ols and 12 year olds.
How do you explain this to parents? I find that most parents want more services the older the child gets and refuse the consultative and strategy based services. Thanks so much!
Jen
I feel the exact same way. I have been working in a High School for 10 years, and I have more and more parents seeking speech services (for the first time ever!). They are not understanding that high school courses require a lot of work, instructional time, and a lot of motivation! Students do not want their friends seeing them get up and leave for speech therapy. Parents are so adamant and if I qualify them, the attendance for speech therapy is so low. I would love to hear what we can say to the parents of older kids, when they demand speech services.
Do you have any additional information on dealing with older students who are mild ID? I have a student in 8th grade who has been held back twice. Native Spanish speaking, however has a lot of difficulty even in his native language. He was held back in his home country and then held back again when he moved to the US. He barely speaks when with me, and often just answers with “I don’t know.” So, basically, I don’t know what he understands and doesn’t understand and how/if I should be seeing him at this point? IS it going to help at all? Additionally, his “legal guardian” (it’s a bit mucky) wants him being seen at least 1x per week.
I appreciate this post! My state currently uses this model for Language qualification. Students must score 1.5 SDs below their IQ on two language measures to qualify for Language Therapy. As a therapist it is discouraging and frustrating to use a model that is very outdated and unsupported by research. I have had times where students score in the low 60s on two language tests and they do not qualify for services. Unfortunately, I feel too many of the therapists in my state aren’t pushing for change because they know our caseloads will only grow if we change it to a better model.
Hi Amanda. I agree that some districts continue to use the model to limit caseloads and that’s a scary thing. If we’re reassessing a child who is 12 and feels they have maximized the benefit of programming it’s very different than a young student who needs services.
I love this post. My district tells us to use RTI but every school does it differently. I would love see what Tier II language interventions look like for other people.
I would too! Does anyone have Tier II language interventions? Like resources, how it’s set up, progress monitoring, etc.
I would be interested in hearing what others are doing with RTI/tier intervention too!
It’s important, especially when working primarily with younger children, to understand when a method for evaluating eligibility may be less effective than previously thought. If the evaluations are keeping out more and more children who need speech therapy, it may be best to go with the research and find a better alternative that isn’t as limiting to children who need the therapy. Thanks for sharing.
I may be in the minority here, but I do not believe an IQ in the 60’s/70’s is a disability. So once IQ is stable ( late elementary school) I believe that their needs can be met with extra small group instruction in general education. I’m fine with private practice intervention for speech benefit, but I don’t feel that these children meet the criteria as “disabled” in the public schools. It is likely they are working up to their potential. This is based on my experiences working with varied populations over the last 20 years.
I totally agree. I believe in modeling activities and providing language based activities to teachers and para professionals to implement them in the classroom. Keeping kids in for 60 or 90 minutes of therapy past 2nd grade makes no sense. A gradual decline to 30 minutes and then consult services by 4th or 5th grade is appropriate. I have been a therapist for 30 years and question the benefit to keeping kids in therapy forever. Train the caregivers establish maintenance plans establish a mode of communication( where possible), and then consult services only.
Texas Speech Hearing Association (TSHA) developed eligibility criertia since we do not have state mandated ones. You can go to their website view the manual. One specifically addresses Language Impairment and ID. We do not use cognitive referencing. We do look at the student’s own profile and their own “G” scores from intelligence tests. In addition to other functional parameters, etc. it is quite a process to look at eligibility. But school based therapy is designed for functional communication and progress in their curriculum, whether it be gen ed or specialized instruction.
Standard IQ references to me, help determine whether or not the student has a delay or pervasive developmental disorder. The two would be treated very differently, imo, especially expectations for therapy. I do think we’ve gotten away from the concept of bell-curve IQ and into the “everyone can do the same thing at the same time” mind-set. This has pushed NYS to the ‘everyone has to go to college” notion rather than planning for individual students. What’s happened here is that NOT using the cognitive model has ballooned our caseloads over the years. Basically, everyone scoring x amount under the “norm” qualifies, even if their cognitive levels are commensurate.
Karen you are on the ball. I agree with everything you have said. And yes, cognitive referencing is important because I am looking at the student’s potential to improve! If there is no gap for me to close between thinking and communicating then the student doesn’t need speech. “He doesn’t talk” is a rationale for speech services from a parent’s or teacher’s perspective. I would expect better reasnonong from SLPs with master’s degrees…but alas, not. If an aphasia oatient who is 4 years s/p CVA walks into my office, I would say “your potential to improve beyond your current function is about zero percent”. I wouldn’t feel comfortable taking the patient’s money or giving the patient false hope. That’s unethical and it’s fraud. We need to look at this tremendous overuse and abuse of school based SLP services the same way. Karen-You should ready the book entitled “SPED 2.0…” by Miriam Freedman. It’s a short read. Look into it. I want to be this woman’s friend.
I teach people to do it everyday. We use something called speech generating devices or AAC. Ever heard of them? It’s amazing what people who score absolutely nothing on an IQ test can do once they can actually communicate. Luckily we aren’t all like you.
Julz,
I would say once all of the AAC has been taught and then there remains the commensurate IQ to language scores then services should be discharged or consult be provided. The student is then able to utilize their mode of communication in everyday life.
I find that I struggle how to effectively explain to parents the change in services as a child gets older. Often times parents want more and more direct services when it would benefit the child to have consultative or strategies based therapy.
I live in CA and we use a discrepancy model here. I explain “my job is to close the gap between how your child is thinking and how your child is communicating. There is no gap for me to close. S/he is thinking like a #YO and communicating like a #YO”. And you highlight a very important point: it is hard to explain why the student was ever in speech in the first place if we never had the ability to change the student’s capacity.
Karen! I COMPLETELY agree with you! NOT using cognitive referencing has indeed allowed school-based caseloads to explode. A number of SLPs in this post have replied that fading away services and switching to a consultative model in later elementary/middle school may be more beneficial. I propose our dear leaders at ASHA examine students given an eligibility of ID (we do not have DD in CA anymore) who have commensurate communication skills upon entry into special education(or give it a range-cognition and communication within 3-6 months of one another). Then re-examine their cognitive and communication scores at 3 years and 6 years and so on(CA uses a cognitive referencing model and I do my best to dismiss these kids at their first triennial as I am not on the preschool team. I do work with many SLPs who simply keep all kids in speech though regardless of cognition). A longitudinal study as one I described above would assist in setting up parameters for entry into speech services. As of now, ASHA says “some research says…..” with regards to communication surpassing cognition. Really ASHA??? “Some research….”. That’s the best you can do? Shameful. This is anectodal but I have worked strictly with the Special Day Class population here in CA for the past 2 school years and I have done 77 assessments in addition to therapy. These ID students DO NOT get better. We also need to ask ourselves “what service am I providing that the teacher/aide” is not already providing in the classroom???” Also, “would I charge the parent $150/hr for this individual session or $60/hour for this group session?” If you answered “none” to question number one and/or “no” to the second question, you have no business pulling the kid out of class.
I used to live in California and we used the cognitive referencing model, but we only compared language scores to the non-verbal score, not the verbal score. I thought that was the case for everyone using this model, is it not? We also considered other factors, of course, like if they had functional communication, etc. Is it still problematic to use the non-verbal score for referencing if it’s leaving language out of cognition?
I, too, work in CA and use the cognitive referencing model. We compare nonverbal cognitive scores with our language scores. Recently I’m seeing a lot of kids (middle school age++) who are presenting with low-average nonverbal skills, but their verbal cognitive are ID (SS 65) and language testing is below SS 70. What would you do with these type kids?? Qualify or not?
I live in CA and work at a HS and while I understand why cognitive referencing can be harmful to younger students I think it’s needed at the HS level. When you have a student who’s 17 years old, has been in speech for 9-12 years and STILL cannot use grammatically appropriate sentences, I think it’s time to consider cognition when deciding eligibility. I think ASHA’s reasoning is flawed and should be revisited.
Measuring a disability does not necessarily imply recommending direct intervention. I think we lost that somewhere in IEP-land.
People have brought that up regarding older students and those with stable IQ’s. For these students, let’s look at any functional skills that are outstanding:.
– Are they looking to enter the job market? If so, would the benefit from some role play for interviewing/customer service type interactions?
– For life skills-type students, do they have self-advocacy and social comm. skills, such as interacting with a bus driver vs. roommate vs. boss vs. co-worker? Identifying safe community members and how/when to seek their assistance.
– Social interaction/dating/texting as teens and young adults – it’s real, people! 🙂
But yes, the days of scores dictating services should be over. I hope we can strengthen our presentation of rationale why to teams and families.
Hi! So are you saying cognitive referencing is more appropriate when older?
Thanks
Also…yes there are other factors…
So if a student is in 3rd with language scores higher than cognitive what do you think?