Clinical Decision Making Describing the Decision Rules of Practicing Speech-Language Pathologists Research Article
Research Article  |   February 01, 1994
Clinical Decision Making
 
Author Affiliations & Notes
  • Nancy L. Records
    The University of Iowa Iowa City
  • J. Bruce Tomblin
    The University of Iowa Iowa City
  • Contact author: Nancy L. Records, PhD, Department of Speech Pathology and Audiology, The University of Iowa, Iowa City, IA 52242. E-mail: (Internet) nrecords@wjshc-po.shc.uiowa.edu
Article Information
Professional Issues & Training / Language Disorders / Attention, Memory & Executive Functions / Language / Research Articles
Research Article   |   February 01, 1994
Clinical Decision Making
Journal of Speech, Language, and Hearing Research, February 1994, Vol. 37, 144-156. doi:10.1044/jshr.3701.144
History: Received January 22, 1993 , Accepted September 8, 1993
 
Journal of Speech, Language, and Hearing Research, February 1994, Vol. 37, 144-156. doi:10.1044/jshr.3701.144
History: Received January 22, 1993; Accepted September 8, 1993

The diagnostic decision-making standards used by practicing clinicians to determine language impairment were investigated. Randomly selected ASHA members who worked with children were asked to review hypothetical and real case profiles of children ages 4 to 9:11 (years: months) with language performance skills ranging from slightly above average to substantially below average. Based on the child’s age and language and intelligence test information, clinicians were asked to decide if the child was language impaired (LI) and, if so, to provide a severity rating. Results show significant interrater agreement among the 27 clinicians’ LI decisions (generalized kappa=0.14, p<.0001) and moderate intrarater reliability within clinician’s LI decisions (phi=.68). Most of the clinicians’ diagnostic decision-making standards could be modeled using stepwise logistic regression. These decision rules can provide guidance for those who wish to employ diagnostic standards that reflect those used in clinical practice. Also, these results provide insight into the manner in which clinicians use information for the determination of language impairment.

Acknowledgments
This research was funded by a grant from the National Institutes of Health (NIH USPHS RO1 DC00612-02) to J. Bruce Tomblin. We thank Ning Li for his assistance with the statistical analysis and Paula Buckwalter for her input and help with the case profile development. The anonymous reviewers’ comments were greatly appreciated. Portions of this paper were presented at the ASHA Convention in Atlanta, November 1991.
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