Current Methods of Evaluating Speech-Language Outcomes for Preschoolers With Communication Disorders: A Scoping Review Using the ICF-CY Purpose The purpose of this scoping review was to identify current measures used to evaluate speech-language outcomes for preschoolers with communication disorders within the framework of the International Classification of Functioning, Disability and Health–Children and Youth Version (ICF-CY; World Health Organization, 2007). Method The review involved 5 phases ... Review Article
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Review Article  |   February 01, 2017
Current Methods of Evaluating Speech-Language Outcomes for Preschoolers With Communication Disorders: A Scoping Review Using the ICF-CY
 
Author Affiliations & Notes
  • Barbara Jane Cunningham
    CanChild, McMaster University, Hamilton, Ontario, Canada
  • Karla N. Washington
    Department of Communication Sciences and Disorders, University of Cincinnati, OH
  • Amanda Binns
    Department of Communication Sciences and Disorders, Western University, London, Ontario, Canada
  • Katelyn Rolfe
    Department of Biology, Queen's University, Kingston, Ontario, Canada
  • Bernadette Robertson
    Bloorview Research Institute, Toronto, Ontario, Canada
  • Peter Rosenbaum
    CanChild, McMaster University, Hamilton, Ontario, Canada
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Barbara Jane Cunningham: cunnibj@mcmaster.ca
  • Editor: Rhea Paul
    Editor: Rhea Paul×
  • Associate Editor: Marleen Westerveld
    Associate Editor: Marleen Westerveld×
Article Information
Speech, Voice & Prosodic Disorders / Language Disorders / Speech, Voice & Prosody / Language / Review Article
Review Article   |   February 01, 2017
Current Methods of Evaluating Speech-Language Outcomes for Preschoolers With Communication Disorders: A Scoping Review Using the ICF-CY
Journal of Speech, Language, and Hearing Research, February 2017, Vol. 60, 447-464. doi:10.1044/2016_JSLHR-L-15-0329
History: Received September 20, 2015 , Revised March 31, 2016 , Accepted June 11, 2016
 
Journal of Speech, Language, and Hearing Research, February 2017, Vol. 60, 447-464. doi:10.1044/2016_JSLHR-L-15-0329
History: Received September 20, 2015; Revised March 31, 2016; Accepted June 11, 2016

Purpose The purpose of this scoping review was to identify current measures used to evaluate speech-language outcomes for preschoolers with communication disorders within the framework of the International Classification of Functioning, Disability and Health–Children and Youth Version (ICF-CY; World Health Organization, 2007).

Method The review involved 5 phases outlined by Arksey and O'Malley (2005)  and further developed by Levac, Colquhoun, and O'Brien (2010) : (a) articulating the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results. The ICF-CY was used to frame the measures included.

Results A total of 214 relevant peer-reviewed publications were included in the review. Most publications used measures to evaluate changes in outcomes for Activities (65%), followed by measures evaluating changes in Body Functions (20%), and finally measures evaluating changes at the level of Participation (15%). There has been a slight increase in the evaluation of Participation-based outcomes in the past 4 years (2012–2015).

Conclusion The review revealed a dearth of measures in the pediatric speech-language literature that address Participation-based outcomes. The authors strongly advocate for the use of Participation-based outcome measures to detect meaningful change in the lives of children and families.

Like all health care disciplines in the Western world, pediatric speech-language therapy has traditionally been delivered on the basis of thinking informed by a biomedical approach in which interventions are designed to normalize or “fix” children's communication skills (McCormack, McLeod, Harrison, & McAllister, 2010; McLeod & Threats, 2008; Threats, 2008; Washington, 2007). In the same way, research evaluating the effectiveness of speech-language therapies has traditionally been focused on outcomes related to impairments such as improved articulatory function, use of grammatical markers, or increased sentence length (McCormack et al., 2010; Washington, Thomas-Stonell, McLeod, & Warr-Leeper, 2015). Although important in many ways, this approach has a narrow focus. It assumes that changes in these impairments will translate to improvement in everyday functioning, and it fails to consider the myriad real-world issues that affect children's communication and their ability to use that communication to participate and engage in their world.
The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF; WHO, 2001) and its subsequent Child and Youth version (ICF-CY; WHO, 2007) provide a framework for examining the ways in which we think about and evaluate outcomes in pediatric speech-language pathology. Along with many other international associations, the American Speech-Language-Hearing Association (ASHA) has adopted the ICF to help guide practice, advocating for its use in both clinical and research activities. The ASHA document “Scope of Practice in Speech-Language Pathology” (2016)  specifically states that the “ICF framework is useful in describing the breadth of the role of the SLP [speech-language pathologist] in the prevention, assessment, and habilitation/rehabilitation of communication and swallowing disorders and the enhancement and scientific investigation of those functions” (p. 5).
The ICF-CY, which was based on the original ICF, provides a biopsychosocial framework that uses universal language to address health concerns that are specifically relevant to infants, toddlers, children, and adolescents. The ICF-CY framework comprises two parts: (a) Functioning and Disability and (b) Contextual Factors that influence children's health (WHO, 2007). The Functioning and Disability section consists of two components: Body Functions and Structures, and Activities and Participation. Contextual Factors include both Environmental and Personal ones (WHO, 2007). Definitions for each component of the framework are presented in Table 1.
Table 1. Description of the components of the International Classification of Functioning, Disability and Health—Children and Youth Version.
Description of the components of the International Classification of Functioning, Disability and Health—Children and Youth Version.×
Component Description
Body Functions and Structures Body Structures are anatomical parts of the body such as organs, limbs, and their components.
Body Functions are the physiological functions of body systems (including psychological functions).
Activities and Participation Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Contextual Factors Environmental Factors make up the physical, social, and attitudinal environment in which people live and conduct their lives.
Personal Factors are the particular background of an individual that are not part of a health condition or health states. These factors may include gender, age, other health conditions, upbringing, and coping styles.
Note. Descriptions from International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.
Note. Descriptions from International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.×
Table 1. Description of the components of the International Classification of Functioning, Disability and Health—Children and Youth Version.
Description of the components of the International Classification of Functioning, Disability and Health—Children and Youth Version.×
Component Description
Body Functions and Structures Body Structures are anatomical parts of the body such as organs, limbs, and their components.
Body Functions are the physiological functions of body systems (including psychological functions).
Activities and Participation Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Contextual Factors Environmental Factors make up the physical, social, and attitudinal environment in which people live and conduct their lives.
Personal Factors are the particular background of an individual that are not part of a health condition or health states. These factors may include gender, age, other health conditions, upbringing, and coping styles.
Note. Descriptions from International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.
Note. Descriptions from International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.×
×
Within the ICF-CY framework, a child's functioning and disability are viewed as being in dynamic interaction between health conditions and contextual factors. For instance, an impairment at the level of body functions and structures, such as a speech sound disorder, influences not only the child's speech sound system but also the child's ability to perform Activities (e.g., reading) as well as to Participate (e.g., engage in peer interactions; WHO, 2007). A visual representation of the interaction between the various components of the ICF-CY is presented in Figure 1.
Figure 1.

Interactions between the components of the International Classification of Functioning, Disability and Health—Children and Youth Version. From International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.

 Interactions between the components of the International Classification of Functioning, Disability and Health—Children and Youth Version. From International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007. Copyright © 2007 by the World Health Organization. Reprinted with permission.
Figure 1.

Interactions between the components of the International Classification of Functioning, Disability and Health—Children and Youth Version. From International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.

×
There has been much debate in the literature about whether to distinguish between the Activities and Participation components of the ICF framework (Threats & Worrall, 2004; Washington, 2007). For this reason, the WHO has identified four options that can be used to interpret the relationship between Activities and Participation (WHO, 2001). Option 4, interpreting Activities and Participation as overlapping constructs (e.g., the act of “speaking” is considered under both Activities and Participation) has been the most popular in the literature (Threats & Worrall, 2004). However, for the purposes of this review article, we have chosen to use another option, in which the components of Activities and Participation partially overlap. In this option, certain ICF chapters (e.g., communication) are open to interpretation as both Activities (i.e., execution of a task or action by an individual) and Participation (i.e., involvement in a life situation; WHO, 2007). We felt that this option best accounted for the overlapping nature of children's communication skills, where skills in one area typically affect functioning in other domains (Lee, 2011). For example, increases in vocabulary and sentence length in the Activities component would also likely improve peer engagement and play in the Participation component. In addition, we believed that this option afforded the most comprehensive examination of how clinicians and researchers have thought about and measured communication outcomes within the ICF framework because we could examine Activities and Participation outcomes separately. Examples of intervention outcomes for the various components of the ICF-CY are presented in Table 2.
Table 2. Example intervention outcomes across the various components of the International Classification of Functioning, Disability and Health—Children and Youth Version.
Example intervention outcomes across the various components of the International Classification of Functioning, Disability and Health—Children and Youth Version.×
Component Possible intervention outcomes
Body Functions and Structures Body Structures: medical procedures or prostheses to improve structures of the ear, structures involved in voice or speech (e.g., cleft palate), neurological structures, anatomical structures of the vocal tract, respiratory system and larynx, brain, or nervous system.
Body Functions: improved speech and voice production and quality, speech intelligibility, fluency and rhythm of speech, hearing acuity and discrimination, oral and pharyngeal swallowing, memory, problem solving, attention, and mental functioning.
Activities and Participation Activities: improved understanding of language, use of language (e.g., mean length of utterance, syntax, semantics); use of communication technologies (e.g., augmentative and alternative communication), use of nonverbal communication (e.g., requesting using the Picture Exchange Communication System), reading and writing skills (e.g., decoding and encoding); phonological awareness; production of narratives.
Participation: increased ability to converse and interact with others (e.g., start/end/sustain a conversation); improved interpersonal relationships (e.g., making and maintaining friendships); increased engagement in play with peers; involvement in preschool/community/classroom activities, book reading/home activities.
Contextual Factors Environmental Factors: familial social supports and relationships, access to intervention services, attitudes of others, cultural beliefs, access to products and technology (e.g., augmentative and alternative communication devices), social systems and policies.
Personal Factors: age, other health conditions, lifestyle habits, coping styles, social background, education.
Table 2. Example intervention outcomes across the various components of the International Classification of Functioning, Disability and Health—Children and Youth Version.
Example intervention outcomes across the various components of the International Classification of Functioning, Disability and Health—Children and Youth Version.×
Component Possible intervention outcomes
Body Functions and Structures Body Structures: medical procedures or prostheses to improve structures of the ear, structures involved in voice or speech (e.g., cleft palate), neurological structures, anatomical structures of the vocal tract, respiratory system and larynx, brain, or nervous system.
Body Functions: improved speech and voice production and quality, speech intelligibility, fluency and rhythm of speech, hearing acuity and discrimination, oral and pharyngeal swallowing, memory, problem solving, attention, and mental functioning.
Activities and Participation Activities: improved understanding of language, use of language (e.g., mean length of utterance, syntax, semantics); use of communication technologies (e.g., augmentative and alternative communication), use of nonverbal communication (e.g., requesting using the Picture Exchange Communication System), reading and writing skills (e.g., decoding and encoding); phonological awareness; production of narratives.
Participation: increased ability to converse and interact with others (e.g., start/end/sustain a conversation); improved interpersonal relationships (e.g., making and maintaining friendships); increased engagement in play with peers; involvement in preschool/community/classroom activities, book reading/home activities.
Contextual Factors Environmental Factors: familial social supports and relationships, access to intervention services, attitudes of others, cultural beliefs, access to products and technology (e.g., augmentative and alternative communication devices), social systems and policies.
Personal Factors: age, other health conditions, lifestyle habits, coping styles, social background, education.
×
Since the introduction of the ICF and ICF-CY, clinicians and researchers have been encouraged to use the ICF framework to guide clinical research, practice, and student education; to inform selection of assessment tools; and to define the outcomes of intervention (Campbell & Skarakis-Doyle, 2007; McLeod & McCormack, 2007; McLeod & Threats, 2008; Skarakis-Doyle & Doyle, 2008; Threats, 2008; Washington, 2010; Westby, 2007; WHO, 2007; Yaruss, 2007). To be more specific, clinicians and researchers have been urged to consider communication outcomes as they contribute to a person's overall functioning and life participation. Despite this push, it has been reported that much of the available outcomes research in pediatric speech-language pathology continues to evaluate the impacts of interventions on impairments for the Body Functions and Structures component and limitations in the Activities component (Threats, 2013). Several reports have identified a particular lack of research looking at intervention outcomes for the Participation component, specifically whether speech-language interventions affect how a child uses communication to participate in his or her world (Thomas-Stonell, Oddson, Robertson, & Rosenbaum, 2009; Thomas-Stonell, Washington, Oddson, Robertson, & Rosenbaum, 2013; Washington et al., 2015). We believe these outcomes should be the ultimate goal of all our intervention efforts. For more information on use of the ICF in speech-language pathology, please refer to the special issues of Seminars in Speech and Language (November 2007) and the International Journal of Speech-Language Pathology (2008).
The Current Study
The primary goal of this review was to gain a more thorough understanding of the state of the field by conducting a scoping review of the literature on current methods for measuring speech-language outcomes for preschoolers with communication disorders within the ICF-CY framework. For the purposes of this review article, an outcome was defined as any event (e.g., therapy interventions, child development over time) that might be associated with (causative of) the later event (e.g., changes in speech-language or communication skills; Threats, 2013).
In particular, we wanted to answer a two-part question: How have speech-language outcomes for preschoolers with communication disorders been measured since the introduction of the ICF-CY, and which components of the ICF-CY do they address? In answering these question, we would be able to identify whether outcomes for the various components of the ICF-CY framework have been evaluated equally and whether there has been a shift in how the components have been measured since the ICF-CY was first introduced in late 2007. We acknowledge that the basic tenets of Body Functions, Activities, and Participation have been discussed in the literature since the 2001 release of the ICF; however, discussion in the field of speech-language pathology began to unfold around the time the ICF-CY was released in 2007 with the publication of the special issue of Seminars in Speech and Language.
In clinical terms, SLPs regularly address Participation restrictions that are important to children and families. For instance, in addition to treating a child with speech sound disorder in the clinic, an SLP may also provide consultation to the child care facility, providing augmentative communication tools (e.g., picture symbols) and enabling the child to engage more easily in the preschool classroom. However, as clinicians and researchers, we do not measure outcomes within the Participation component as well as we measure outcomes related to the Body Functions and Structures and Activities components, and we often fail to evaluate Participation outcomes at all (Eadie et al., 2006). For a child with speech sound disorder, traditional outcome measurements might include increases in use of targeted speech sounds and overall speech intelligibility but not improvements in communication and participation in the classroom or increases in the child's ability to engage with and be understood by peers.
Due to our keen interest in the inclusion of outcomes within the Participation component of the ICF-CY in clinical practice and research, a secondary goal of this work was to identify measures that were both valid and reliable that could be used to measure Participation-based communication outcomes. This could ultimately help both clinicians and researchers to better measure this component in the future.
We wanted specifically to identify those studies that had used published (peer-reviewed) evaluative tools to measure outcomes either longitudinally or following a period of intervention. Evaluative outcome measures differ from assessment tools that discriminate between children with and without a particular impairment (e.g., children with and without specific language impairment) because evaluative tools are validated specifically to demonstrate that they are responsive to clinically meaningful change over time (Rosenbaum et al., 1990).
We chose to study outcomes specifically for preschoolers because we understand and endorse the importance and effectiveness of early intervention for children with communication disorders for overall life outcomes (Canadian Association of Speech-Language Pathologists and Audiologists [now Speech-Language & Audiology Canada], 2013). We chose to complete a scoping review because we wanted to examine the extent, range, and nature of research activity in the field broadly (Arksey & O'Malley, 2005):

A scoping review is a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts, types of evidence, and gaps in the research related to a defined area or field by systematically searching, selecting, and synthesizing existing knowledge. (Colquhoun et al., 2014, pp. 1292, 1294)

A scoping review differs from a more traditional systematic review in several ways. The most important distinction in this case is that in a scoping review, the nature of the research question is broadly focused, whereas a systematic review uses a specific research question, typically focused on the effect of a particular intervention (Armstrong, Hall, Doyle, & Waters, 2011).
Arksey and O'Malley (2005)  provided the original methodological framework for conducting scoping reviews, an approach that was further developed by Levac, Colquhoun, and O'Brien (2010) . The current scoping review will use the original Arksey and O'Malley framework, incorporating the enhancements recommended by Levac et al.
Method
The present scoping review involved five key phases: (a) articulating the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results. The optional sixth phase, consulting with stakeholders, was not conducted (Arksey & O'Malley, 2005; Levac et al., 2010). This sixth phase is intended to allow stakeholders to contribute to the review, consulting about inclusion criteria and providing insights about the content and relevance of the scoping review. For this review article, the primary stakeholders were clinical SLPs and speech-language researchers, both of which were well represented on the review team.
Phase 1: Articulating the Research Question
In conducting this review of the literature, we wanted to answer the following question: How have speech-language outcomes for preschoolers (ages birth to 5 years, 11 months) with communication disorders been measured since the introduction of the ICF-CY, and which components of the ICF-CY do they address? The secondary question was: Has there been an increase in the evaluation of participation-level outcomes since the introduction of the ICF-CY in 2007?
Phase 2: Identifying Relevant Studies
In consultation with an experienced McMaster University Health Sciences librarian, we created a search-strategy concept map and detailed search queries for five electronic databases: MEDLINE, Embase, CINAHL, PsycINFO, and ERIC. These databases were selected in an attempt to conduct a comprehensive search that would include speech-language research from a range of disciplines, including health services, education, and psychology. Search queries were tailored to the specific requirements of each database. Queries are included in online Supplemental Material S1.
The initial search of the literature published between 2010 and 2014 was carried out in the summer of 2015. Following feedback from reviewer colleagues, a supplementary search of the literature for articles published in the years 2008–2009 and 2015 was carried out in early January 2016. Limits set on searches were that publications be in English and citations have been published between January 1, 2008, and December 31, 2015.
Phase 3: Selecting Studies
The selection of studies for inclusion in the review was conducted in two phases: an initial title and abstract screening, followed by full-text review of those articles included after the screening.
Title and Abstract Screening
Prior to starting title and abstract screening, three authors (the first, fourth, and sixth) held an initial meeting to develop inclusion/exclusion criteria on the basis of the research question. Inclusion criteria were as follows: (a) published between 2008 and 2015, (b) peer-reviewed research publication (e.g., not a book chapter or invited commentary), (c) involved the study of preschoolers (ages birth to 5 years, 11 months), (d) evaluated outcomes (see Threats, 2013), (e) used published (reliable and valid) measures, (f) used evaluative tools (i.e., to measure change over time), and (g) written in English.
We included articles published between 2008 and 2015 in order to understand how outcomes have been measured in the field of pediatric speech-language pathology since the introduction of the ICF-CY. The ICF-CY, which was specific to children and included more relevant codes than the original ICF (e.g., singing, talking, playing), was first published in late 2007. We reasoned that no studies or articles would have been published between the time the ICF-CY was introduced and the beginning of the 2008 research year. As already described, our second search was run early in 2016 and therefore includes all relevant articles between 2008 and 2015 that were available in the databases at that time. We included only peer-reviewed research publications as a way of controlling for study quality. We included only those studies that used published outcome measures because, presumably, they have been found to be valid, reliable, and responsive to change prior to use in research (Rosenbaum et al., 1990).
Following development of the inclusion/exclusion criteria, we conducted two reliability trial runs in which three authors completed inclusion/exclusion screening on 10 titles and abstracts for each run. After each trial, we met to discuss coding and to review inclusion/exclusion criteria. This was done to help establish consistency of coding and decision making and to finalize our inclusion/exclusion criteria for the review.
Two reviewers (the first and fourth authors) completed inclusion/exclusion screening for each of the eight years to determine whether articles were relevant to the research question. The first reviewer was an experienced SLP and doctoral candidate. The second reviewer was an undergraduate student majoring in biology and psychology who was well versed in the literature. The reviewers used a document outlining the specific criteria indicated to either include or exclude references in an online Mendeley group account (https://www.mendeley.com/). Due to the number of references, each reviewer screened half of the titles and abstracts that were identified for a given year. References were divided alphabetically (i.e., Reviewer 1 screened references with author surnames beginning with A–M and Reviewer 2 screened references with author surnames beginning with N–Z). We alternated the reviewer screening references for the first half of the alphabet for each year to reduce bias. To ensure consistency of coding between the two reviewers, a 5% reliability sample of titles and abstracts screened was taken for each year. Half came from papers with author surnames beginning with A–M and half from papers with author surnames beginning with N–Z. The reviewers met after screening their respective references separately to conduct the 5% reliability sample of that year and to discuss any references they were unsure how to code.
Full-Text Review
Full-text review was conducted by four experienced SLPs who worked both clinically and in research (the first, second, third, and fifth authors). One of these SLPs (the first author) also completed title and abstract screening for the review. These SLPs completed the full-text review because they had valuable knowledge of clinical practice and measurement tools.
Similar to what was done for title and abstract screening, two reviewers completed the full-text review for half of each year, with references divided alphabetically. Prior to beginning full-text review, the two reviewers met to discuss the research question and inclusion/exclusion criteria for full-text articles. We used the same inclusion/exclusion criteria document as was used for the title and abstract screening, as well as a form where reviewers indicated whether each reference met each individual inclusion criterion. There was also a space for comments or queries for references requiring further discussion. Following this, the two reviewers conducted an initial trial on 10 full-text articles and then met to compare and discuss how citations were coded and resolve any differences of opinion. Again, this was done to help establish consistency of coding and decision making. Following initial meetings, we added a “discuss” column to our full-text review form so that any uncertainties could be discussed and the two reviewers could come to an agreement as to whether the reference should be included.
Each SLP reviewed half of the full-text articles (divided alphabetically) for a given year. This time, because the number of articles to review had decreased, we used a 20% reliability sample for each year to evaluate reliability of coding between the two reviewers. The two reviewers met after separately completing the full-text review of their respective references to complete the 20% reliability sample and discuss any references they were unsure how to code. Impromptu meetings were also held mid-review when further clarification or discussion was needed.
Phase 4: Charting the Data
Two members of the research team who were experienced SLPs and researchers (the first and second authors) met to develop a data-charting form that could be used to extract data from the included studies. The charting form was based on the research question and was designed to follow Steps 1–4 for extracting data using the ICF-CY as defined in the manual (WHO, 2007, pp. xix–xx). Those steps, as well as examples of data extracted at each step, are presented below:
  1. Step 1. Define the information available for coding and identify whether it relates to the domain of Body Functions, Body Structures, Activities, Participation, or Environmental Factors (e.g., Preschool Language Scale–Fourth Edition [Zimmerman, Steiner, & Pond, 2002 ]: measures expressive/receptive language development, relates to Activities).

  2. Step 2. Locate the chapter within the appropriate domain that most closely corresponds to the information to be coded (e.g., Activities, Chapter 3: Communication).

  3. Step 3. Read the description of the four-character code and notes related to the description (e.g., d310 Communicating-with-receiving spoken messages; d330 Speaking).

  4. Step 4. Review any inclusion or exclusion notes that apply to the code and proceed accordingly.

Separating tests to represent the individual components (Body Functions and Structures, Activities, and Participation) can be challenging because each individual measure may address overlapping codes. For instance, the Children's Communication Checklist–2 (Bishop, 2003a) has been used to evaluate both Activities- (expressive/receptive language) and Participation-based (social communication) outcomes. In cases such as this, we relied on the rule for linking clinical measures and interventions to the ICF developed by Cieza et al. (2005), which advises researchers to define the aim with which the corresponding measure was used in each individual study because aims can vary from study to study. Steps 5–10 for extracting data using the ICF were not completed because we could not apply more specific codes (i.e., five- or six-character codes), assign qualifiers (i.e., 0 = no impairment/difficulty to 4 = complete impairment/difficulty), or identify environmental barriers for entire outcome measures.
Frameworks for extracting data for the three main areas of communication (speech, language, and hearing) were developed on the basis of relevant literature to facilitate the data-extraction process by providing reviewers with examples of impairments, assessments, and interventions for the various components (Body Functions and Structures, Activities, Participation) of the ICF-CY (McLeod & McCormack, 2007; McLeod & Threats, 2008; Threats, 2013; Washington, 2007; Westby, 2007; Yaruss, 2007). We also created a codebook of the major ICF-CY categories (e.g., d330 Speaking) related to pediatric speech, language, and hearing (WHO, 2007).
Three experienced SLPs and researchers completed all data extraction (the first, second, and third authors). Again, references were divided alphabetically, and two SLPs reviewed half of the references for each year (i.e., for 2008, one SLP reviewed references for authors with surnames A–M, and the other reviewed references for authors with surnames N–Z). As outlined by Colquhoun et al. (2014), reviewers met prior to beginning data extraction to discuss the research question and criteria for data extraction. Following this, reviewers conducted an initial trial on five citations and then met to discuss how data were extracted and resolve any discrepancies. This was done to help establish consistency of data extraction and ensure that the approach to data extraction was consistent with the research question and purpose of the review.
After both reviewers had extracted data for the first five papers of a particular year and met to review the process, data were extracted for the remainder of that year. If reviewers were unsure of how to extract data for a particular citation, that article was flagged for discussion at the end of the review period for that year, and data extraction was done collaboratively between the two reviewers (see Figure 2 for a visual representation of this process). A 20% reliability sample was also taken for the data-extraction phase of the review.
Figure 2.

Flow diagram of the scoping-review process.

 Flow diagram of the scoping-review process.
Figure 2.

Flow diagram of the scoping-review process.

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Phase 5: Collating, Summarizing, and Reporting the Results
Following data extraction, we created tables to summarize our findings, both quantitatively and descriptively, as recommended by Colquhoun et al. (2014) .
Results
Quantitative Findings
Interrater Reliability and Number of Included Citations
In our initial search of the five databases, we identified 7,951 potentially relevant citations. After removing duplicates (n = 3,504) and completing title and abstract screening, we were left with 758 citations for full-text review. There was 92% interrater agreement for the title and abstract screening on the basis of the 5% reliability sample taken (n = 224). An interrater reliability analysis using the kappa statistic was performed to formally determine consistency between the two reviewers (Landis & Koch, 1977). The interrater reliability for the title-and-abstract-screening phase was κ = .66, z = 10.12, p < .001, 95% CI [.52, .81]. Percent interrater agreement for inclusion/exclusion of full-text papers was 89% (n = 153), κ = .77, z = 9.59, p < .001, 95% CI [.67, .87].
Following full-text review, 214 citations remained for data extraction and inclusion in the scoping review. There was 95% agreement between reviewers for the data-extraction phase. The flow of citations from identification through to data extraction, as well as the number of articles removed by exclusion criteria at the full-text-review phase, is presented in Figure 3. The number of included citations by search year is presented in Figure 4. References for the 214 included papers by year of publication are available in online Supplemental Material S2.
Figure 3.

The flow of citations from identification through data extraction.

 The flow of citations from identification through data extraction.
Figure 3.

The flow of citations from identification through data extraction.

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Figure 4.

Percentage of measures evaluating changes in the Body Functions, Activities, and Participation components of the International Classification of Functioning, Disability and Health—Children and Youth Version (n = 214).

 Percentage of measures evaluating changes in the Body Functions, Activities, and Participation components of the International Classification of Functioning, Disability and Health—Children and Youth Version (n = 214).
Figure 4.

Percentage of measures evaluating changes in the Body Functions, Activities, and Participation components of the International Classification of Functioning, Disability and Health—Children and Youth Version (n = 214).

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Number of Included Measures by ICF-CY Component
We extracted data regarding the evaluative tools used from each identified citation and subsequently identified which component of the ICF-CY framework (i.e., Body Functions and Structures, Activities, or Participation) was most relevant for that particular measure of change. The number of unique tools used was 155, with the majority measuring changes in the Activities component (n = 87, 56%), followed by Body Functions (n = 44, 28%) and Participation (n = 24, 15%).
The total number of measures reported across all years was 449. This number was significantly higher than the number of citations included in this review (n = 214) and the total number of unique measures reported across all years (n = 155). There were three main reasons for this discrepancy. First, many of the reported measures were duplicates. For example, the Clinical Evaluation of Language Fundamentals–Preschool–2 (Wiig, Semel, & Secord, 2004) was used in many studies and was therefore counted more than once. In addition, there was some overlap between components of the ICF-CY framework because some tools that were used measure changes in more than one component. For example, the Vineland Adaptive Behavior Scales, Second Edition (Sparrow, Cicchetti, & Balla, 2005), were used to measure changes in limitations for Activities (e.g., expressive/receptive language skills) in some studies, whereas in other studies they were used to measure changes in Participation restrictions (e.g., social-skill development). Many studies reported using multiple evaluative tools.
The majority of measures reported across all years used measures related to the Activities component to evaluate speech-language outcomes (n = 290, 64.5%). The second most frequent group of measures evaluated changes in impairments related to the Body Functions component (n = 92, 20.5%), followed by measures evaluating outcomes related to the Participation component (n = 66, 14.7%). One study evaluated an outcome related to the Body Structures component (0.2%) using magnetic resonance imaging to measure changes in cortical thickness following intervention for apraxia of speech (Kadis et al., 2014), but it was not included in further analyses because it was the sole article evaluating changes in Body Structures.
The percentage of measures on the basis of Body Functions, Activities, and Participation used to evaluate speech-language outcomes is presented by year in Figure 4. As can be seen in this figure, the percentage of published evaluative tools used to measure changes in Body Functions has remained relatively stable over the past 8 years, the percentage used to measure changes in Activities has decreased slightly, and the percentage of tools used to measure changes related to Participation has fluctuated since the introduction of the ICF-CY. Although there is fluctuation, there does seem to have been an increase in the evaluation of Participation-based outcomes in the years 2012 to 2015 (n = 45, 19%) as compared with earlier years (i.e., 2008–2011, n = 21, 10%).
Excluded Measures by ICF-CY Component
One consideration in interpreting these results was whether in fact there had been a significant increase in Participation-based research in studies using experimental measures, not those using the published, valid, and reliable tools that were included in this review. To ensure that this was not the case, we also reviewed the references that were excluded at the full-text-review stage for using experimental measures. When linked to the components of the ICF-CY, the distribution of experimental measures was quite similar to that of the published measures included in this review: Body Structures (n = 1, 0.07%), Body Functions (n = 46, 33%), Activities (n = 60, 43%), and Participation (n = 31, 22%). Participation-based tools were still used least often, although the percentage of experimental tools measuring Participation-based outcomes was higher than the percentage of published measures reported in the review. There was no clear pattern demonstrating an increase in the percentage of reported Participation-based experimental measures from 2008 to 2015.
Thematic Description of Included Measures
Almost all citations that used measures designed to evaluate outcomes at the level of Body Functions fell under the broad category of speech, with a few falling under hearing. These studies measured changes in the clarity of children's speech using measures of articulation, phonology, and speech intelligibility. Changes in motor movements used for speech were evaluated using measures of motor planning. Voice-related changes were evaluated using measures of nasality, prosody, and overall voice quality. Measures evaluating changes in speech fluency and hearing, perception, or listening related to speech were also included in this classification. Included measures used to evaluate changes in the Body Functions component are presented in Table 3.
Table 3. Measures used to evaluate changes in Body Functions component.
Measures used to evaluate changes in Body Functions component.×
Body Function (impairment) Measurement tool Reference
Articulation/phonology Arizona Articulation Proficiency Scale–Third Edition Fudala (2000) 
 b320 Articulation function Clinical Test of Articulation Wang & Liao (2007) 
Diagnostic Evaluation of Articulation & Phonology Dodd et al. (2002) 
Early Repetition Battery Seeff-Gabriel et al. (2008) 
Edinburgh Articulation Test Anthony et al. (1971) 
Finnish Articulation Test Remes & Ojanen (1996) 
Glaspey Dynamic Assessment of Phonology Glaspey & Stoel-Gammon (2005) 
Goldman-Fristoe Test of Articulation–Second Edition Goldman & Fristoe (2000) 
Groningen Diagnostic Speech Norms Luinge et al. (2006) 
Hodson Assessment of Phonological Patterns–Third Edition Hodson (2004) 
Hodson Computerized Analysis of Phonological Patterns, Third Edition Hodson (2003) 
Khan-Lewis Phonological Analysis Khan & Lewis (2002) 
Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
Phonological Assessment of Child Speech (Portuguese) Yavas & Goldstein (1998) 
Picture Labelling Test Frontczak et al. (2002) 
Sensory Integration Functions Assessment Scale Lin (2010) 
Teste Fonético-Fonológico-Avaliação da Linguagem Pré-Escolar Mendes et al. (2009) 
Weighted speech sound accuracy Preston et al. (2011) 
Word Complexity Measure Stoel-Gammon (2010) 
Meaningful Use of Speech Scale Robbins & Osberger (1990) 
Fluency Percent syllables stuttered Jones et al. (2005) 
Stuttering Severity Instrument Riley (2009) 
 b330 Fluency and rhythm of speech function Prosodic Assessment Procedure (using visual analogue scales) Samuelsson et al. (2003) 
Hearing Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
 b230 Hearing function Early Speech Perception Test Moog & Geers (1990) 
Glendonald Auditory Speech Perception Test Erber (1982) 
Infant–Toddler Meaningful Auditory Integration Scale Zimmerman-Phillips et al. (2000) 
Listening Progress Score Archbold (1993) 
Meaningful Auditory Information Scale Robbins et al. (1991) 
Speech Perception Battery (PLOTT) Plant (1984) 
Intelligibility Beginner's Intelligibility Test Osberger et al. (1994) 
 b320 Articulation function Children's Speech Intelligibility Measure Wilcox & Morris (1999) 
Speech Intelligibility Rating Scale Allen et al. (1998) 
Test of Children's Speech Plus Hodge et al. (2009) 
Motor planning/apraxia Kaufman Assessment Battery for Children Kaufman & Kaufman (2004) 
 b176 Mental function of sequencing complex movements Spatio-Temporal Index Smith et al. (1995) 
Verbal Motor Production Assessment for Children Hayden & Square (1999) 
Voice Acoustic Voice Quality Index Reynolds et al. (2012) 
 b310 Voice function Consensus Auditory-Perceptual Evaluation of Voice Kempster et al. (2009) 
Dysphonia Severity Index Wuyts et al. (2000) 
Grade, Roughness, Breathiness, Asthenia, and Strain scale Hirano (1981) 
MacKay-Kummer Simplified Nasometric Assessment Procedures Revised MacKay & Kummer (1994) 
Meaningful Use of Speech Scale Robbins & Osberger (1990) 
Pediatric Voice Handicap Index Zur et al. (2007) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
Table 3. Measures used to evaluate changes in Body Functions component.
Measures used to evaluate changes in Body Functions component.×
Body Function (impairment) Measurement tool Reference
Articulation/phonology Arizona Articulation Proficiency Scale–Third Edition Fudala (2000) 
 b320 Articulation function Clinical Test of Articulation Wang & Liao (2007) 
Diagnostic Evaluation of Articulation & Phonology Dodd et al. (2002) 
Early Repetition Battery Seeff-Gabriel et al. (2008) 
Edinburgh Articulation Test Anthony et al. (1971) 
Finnish Articulation Test Remes & Ojanen (1996) 
Glaspey Dynamic Assessment of Phonology Glaspey & Stoel-Gammon (2005) 
Goldman-Fristoe Test of Articulation–Second Edition Goldman & Fristoe (2000) 
Groningen Diagnostic Speech Norms Luinge et al. (2006) 
Hodson Assessment of Phonological Patterns–Third Edition Hodson (2004) 
Hodson Computerized Analysis of Phonological Patterns, Third Edition Hodson (2003) 
Khan-Lewis Phonological Analysis Khan & Lewis (2002) 
Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
Phonological Assessment of Child Speech (Portuguese) Yavas & Goldstein (1998) 
Picture Labelling Test Frontczak et al. (2002) 
Sensory Integration Functions Assessment Scale Lin (2010) 
Teste Fonético-Fonológico-Avaliação da Linguagem Pré-Escolar Mendes et al. (2009) 
Weighted speech sound accuracy Preston et al. (2011) 
Word Complexity Measure Stoel-Gammon (2010) 
Meaningful Use of Speech Scale Robbins & Osberger (1990) 
Fluency Percent syllables stuttered Jones et al. (2005) 
Stuttering Severity Instrument Riley (2009) 
 b330 Fluency and rhythm of speech function Prosodic Assessment Procedure (using visual analogue scales) Samuelsson et al. (2003) 
Hearing Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
 b230 Hearing function Early Speech Perception Test Moog & Geers (1990) 
Glendonald Auditory Speech Perception Test Erber (1982) 
Infant–Toddler Meaningful Auditory Integration Scale Zimmerman-Phillips et al. (2000) 
Listening Progress Score Archbold (1993) 
Meaningful Auditory Information Scale Robbins et al. (1991) 
Speech Perception Battery (PLOTT) Plant (1984) 
Intelligibility Beginner's Intelligibility Test Osberger et al. (1994) 
 b320 Articulation function Children's Speech Intelligibility Measure Wilcox & Morris (1999) 
Speech Intelligibility Rating Scale Allen et al. (1998) 
Test of Children's Speech Plus Hodge et al. (2009) 
Motor planning/apraxia Kaufman Assessment Battery for Children Kaufman & Kaufman (2004) 
 b176 Mental function of sequencing complex movements Spatio-Temporal Index Smith et al. (1995) 
Verbal Motor Production Assessment for Children Hayden & Square (1999) 
Voice Acoustic Voice Quality Index Reynolds et al. (2012) 
 b310 Voice function Consensus Auditory-Perceptual Evaluation of Voice Kempster et al. (2009) 
Dysphonia Severity Index Wuyts et al. (2000) 
Grade, Roughness, Breathiness, Asthenia, and Strain scale Hirano (1981) 
MacKay-Kummer Simplified Nasometric Assessment Procedures Revised MacKay & Kummer (1994) 
Meaningful Use of Speech Scale Robbins & Osberger (1990) 
Pediatric Voice Handicap Index Zur et al. (2007) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
×
Most citations that used measures to evaluate outcomes for the Activities component fell under the broad category of language. These citations looked at changes in children's expressive and receptive language skills, including changes in early communication skills, use and understanding of grammar and vocabulary, and increases in productive language or sentence length. Measures of change in early literacy skills included those related to early reading ability, phonological awareness, narrative skills, and story retelling. Included measures used to evaluate changes related to Activities are presented in Table 4.
Table 4. Measures used to evaluate changes in Activities component.
Measures used to evaluate changes in Activities component.×
Activity (limitation) Measurement tool Reference
Language
 Early communication Bayley Scales of Infant and Toddler Development–Third Edition, Language scale Bayley (2006) 
  d161 Directing attention Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
  d335 Producing non-verbal messages Early Social Communication Scales Mundy et al. (2003) 
Play in Early Childhood Evaluation System Kelly-Vance & Ryalls (2005) 
Test of Early Verbal Comprehension Chilosi et al. (2003) 
 Expressive and receptive language (including syntax and morphology) Autism Behavior Checklist Krug et al. (1980) 
  d310 Communicating with – receiving – spoken messages Autism Diagnostic Observation Scales (ADOS) Lord et al. (1999) 
  d330 Speaking British Abilities Scale Elliott et al. (1997) 
Clinical Evaluation of Language Fundamentals–Preschool–2 Wiig et al. (2004) 
Clinical Evaluation of Language Fundamentals–Fourth Edition Semel et al. (2006) 
Children's Test of Nonword Repetition Gathercole & Baddeley (1996) 
Comprehensive Assessment of Spoken Language Carrow-Woolfolk (1999) 
Fluharty Preschool Speech and Language Screening Test Fluharty (2000) 
Pictorial Test of Intelligence French (1964) 
Grammar and Phonology Screening Gardner et al. (2006) 
Griffiths Mental Development Scales Griffiths (1984) 
Hundred Pictures Naming Test Fisher & Glenister (1992) 
Language Development Survey Rescorla (1989) 
Language sample (mean length of utterance) Brown (1973) 
Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
MacArthur–Bates Communicative Development Inventories Fenson et al. (1993) 
Mullen Scales of Early Learning Mullen (1995) 
Nonword Repetition Test Dollaghan & Campbell (1998) 
Parent Perceptions of Language Development Romski et al. (2000) 
Preschool Language Scale, Third and Fourth Editions Zimmerman et al. (2002) 
Receptive-Expressive Emergent Language Scales Bzoch et al. (2003) 
Renfrew Action Picture Test Renfrew (2003) 
Renfrew Word Finding Vocabulary Test Renfrew (1988) 
Reynell Developmental Language Scales Reynell (1977) 
Schlichting Test for Language Production Schlichting et al. (2003) 
Sequenced Inventory of Communicative Development Hedrick et al. (1984) 
Sprachentwicklungstest für zweijährige Kinder Grimm (2000) 
Sprachentwicklungstest fur drei- bis funfjährige Kinder Grimm (2001) 
Sprachscreening für das Vorschulalter Grimm (2003) 
Structured Photographic Expressive Language Test Preschool Werner & Kresheck (1983) 
Taaltoets alle Kinderen Verhoeven & Vermeer (2001) 
Test for Auditory Comprehension of Language–Third Edition Carrow-Woolfolk (1985) 
Test of Grammatical Comprehension for Children Chilosi & Cipriani (1995) 
Test of Early Language Development–Third Edition Hresko, et al. (1999) 
Test of Language Development–Primary: Third Edition Newcomer & Hammill (1997) 
Test of Problem Solving 3–Elementary Bowers et al. (2005) 
Test for Reception of Grammar–2 Bishop (2003b) 
Token Test for Children Di Simoni (1978) 
Vineland Adaptive Behavior Scales, Second Edition Sparrow et al. (2005) 
Wechsler Preschool and Primary Scale of Intelligence–Revised Wechsler (2003) 
 Vocabulary Aktiver Wortschatztest für 3- bis 5-jährige Kinder–Revision Kiese-Himmel (2005) 
  d310 Communicating with – receiving spoken messages British Picture Vocabulary Scale Dunn et al. (1997) 
  d330 Speaking Expressive One-Word Picture Vocabulary Test Brownell (2000) 
Expressive Vocabulary Test Williams (1997) 
MacArthur–Bates Communicative Development Inventories Fenson et al. (1993) 
Peabody Picture Vocabulary Test–III and Fourth Edition Dunn & Dunn (2007) 
Receptive One-Word Picture Vocabulary Test Brownell (2000) 
Woodcock-Johnson III Tests of Achievement Woodcock et al. (2001) 
Literacy
 Narrative skills and story retell Children's Communication Checklist–2 Bishop (2003a) 
  d140 Learning to read Edmonton Narrative Norms Instrument Schneider et al. (2005) 
  d330 Speaking Index of Narrative Complexity Petersen et al. (2008) 
Narrative Assessment Protocol Justice et al. (2010) 
Narrative Comprehension of Picture Books task Paris & Paris (2001) 
Renfrew Bus Story Renfrew (1997) 
Strong Narrative Assessment Procedure Strong (1998) 
Test of Narrative Language Gillam & Pearson (2004) 
Test of Narrative Retell: School Age–Kindergarten Petersen & Spencer (2012) 
 Phonological awareness Assessment of Literacy and Language Lombardino et al. (2005) 
  d140 Learning to read Comprehensive Test of Phonological Processing Wagner & Torgesen (1999) 
Computer-Based Phonological Awareness Assessment Carson et al. (2011) 
Dynamic Indicators of Basic Early Literacy Skills Good et al. (2002) 
Get Ready to Read Whitehurst (2001) 
Observation Survey of Early Literacy Achievement Clay (1993) 
Phonological Abilities Test Muter et al. (1997) 
Phonological Awareness Literacy Screening–PreK Invernizzi et al. (2004) 
Pre-Reading Inventory of Phonological Awareness Dodd et al. (2003) 
Individual Growth Development Indicator: Rhyming Early Childhood Research Institute (2000) 
Ringerike Material Lyster et al. (2002) 
Sutherland Phonological Awareness Test–Revised Neilson (2007) 
Test of Phonological Awareness–Second Edition: Plus Torgesen & Bryant (2004) 
Test of Preschool Early Literacy Lonigan et al. (2007) 
 Reading ability Aimsweb O'Connor & Jenkins (1999) 
  d140 Learning to read Burt Word Reading Test Gilmore et al. (1981) 
Early Childhood Longitudinal Study, Kindergarten Class of 1998–99 reading test Najarian et al. (2009) 
Early Grade Reading Assessment Gove (2008) 
Early Word Reading Test Hatcher et al. (1994) 
Get It, Got It, Go! (Now called the My Individual Growth & Development Indicators [IGDIs] Assessment) McConnell (2012) 
Gray Oral Reading Tests, Fourth Edition Wiederholt & Bryant (2001) 
Graded Nonword Reading Test Snowling et al. (1996) 
Neale Analysis of Reading Ability–Second Revised British Edition Neale (1997) 
Preschool Word and Print Awareness test Justice & Ezell (2001) 
Reading Freedom Diagnostic Reading Test Calder (1992) 
Reading Progress Test Vincent et al. (1997) 
Salzburg Reading and Spelling Test Landerl et al. (1997) 
Schonell Essential Spelling Test Schonell (1932) 
Sheffield Early Literacy Development Profile Nutbrown (1997) 
Woodcock Reading Mastery Tests–Revised, Word Identification subtest Woodcock (1987) 
York Assessment of Reading for Comprehension Hulme et al. (2009) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
Table 4. Measures used to evaluate changes in Activities component.
Measures used to evaluate changes in Activities component.×
Activity (limitation) Measurement tool Reference
Language
 Early communication Bayley Scales of Infant and Toddler Development–Third Edition, Language scale Bayley (2006) 
  d161 Directing attention Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
  d335 Producing non-verbal messages Early Social Communication Scales Mundy et al. (2003) 
Play in Early Childhood Evaluation System Kelly-Vance & Ryalls (2005) 
Test of Early Verbal Comprehension Chilosi et al. (2003) 
 Expressive and receptive language (including syntax and morphology) Autism Behavior Checklist Krug et al. (1980) 
  d310 Communicating with – receiving – spoken messages Autism Diagnostic Observation Scales (ADOS) Lord et al. (1999) 
  d330 Speaking British Abilities Scale Elliott et al. (1997) 
Clinical Evaluation of Language Fundamentals–Preschool–2 Wiig et al. (2004) 
Clinical Evaluation of Language Fundamentals–Fourth Edition Semel et al. (2006) 
Children's Test of Nonword Repetition Gathercole & Baddeley (1996) 
Comprehensive Assessment of Spoken Language Carrow-Woolfolk (1999) 
Fluharty Preschool Speech and Language Screening Test Fluharty (2000) 
Pictorial Test of Intelligence French (1964) 
Grammar and Phonology Screening Gardner et al. (2006) 
Griffiths Mental Development Scales Griffiths (1984) 
Hundred Pictures Naming Test Fisher & Glenister (1992) 
Language Development Survey Rescorla (1989) 
Language sample (mean length of utterance) Brown (1973) 
Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
MacArthur–Bates Communicative Development Inventories Fenson et al. (1993) 
Mullen Scales of Early Learning Mullen (1995) 
Nonword Repetition Test Dollaghan & Campbell (1998) 
Parent Perceptions of Language Development Romski et al. (2000) 
Preschool Language Scale, Third and Fourth Editions Zimmerman et al. (2002) 
Receptive-Expressive Emergent Language Scales Bzoch et al. (2003) 
Renfrew Action Picture Test Renfrew (2003) 
Renfrew Word Finding Vocabulary Test Renfrew (1988) 
Reynell Developmental Language Scales Reynell (1977) 
Schlichting Test for Language Production Schlichting et al. (2003) 
Sequenced Inventory of Communicative Development Hedrick et al. (1984) 
Sprachentwicklungstest für zweijährige Kinder Grimm (2000) 
Sprachentwicklungstest fur drei- bis funfjährige Kinder Grimm (2001) 
Sprachscreening für das Vorschulalter Grimm (2003) 
Structured Photographic Expressive Language Test Preschool Werner & Kresheck (1983) 
Taaltoets alle Kinderen Verhoeven & Vermeer (2001) 
Test for Auditory Comprehension of Language–Third Edition Carrow-Woolfolk (1985) 
Test of Grammatical Comprehension for Children Chilosi & Cipriani (1995) 
Test of Early Language Development–Third Edition Hresko, et al. (1999) 
Test of Language Development–Primary: Third Edition Newcomer & Hammill (1997) 
Test of Problem Solving 3–Elementary Bowers et al. (2005) 
Test for Reception of Grammar–2 Bishop (2003b) 
Token Test for Children Di Simoni (1978) 
Vineland Adaptive Behavior Scales, Second Edition Sparrow et al. (2005) 
Wechsler Preschool and Primary Scale of Intelligence–Revised Wechsler (2003) 
 Vocabulary Aktiver Wortschatztest für 3- bis 5-jährige Kinder–Revision Kiese-Himmel (2005) 
  d310 Communicating with – receiving spoken messages British Picture Vocabulary Scale Dunn et al. (1997) 
  d330 Speaking Expressive One-Word Picture Vocabulary Test Brownell (2000) 
Expressive Vocabulary Test Williams (1997) 
MacArthur–Bates Communicative Development Inventories Fenson et al. (1993) 
Peabody Picture Vocabulary Test–III and Fourth Edition Dunn & Dunn (2007) 
Receptive One-Word Picture Vocabulary Test Brownell (2000) 
Woodcock-Johnson III Tests of Achievement Woodcock et al. (2001) 
Literacy
 Narrative skills and story retell Children's Communication Checklist–2 Bishop (2003a) 
  d140 Learning to read Edmonton Narrative Norms Instrument Schneider et al. (2005) 
  d330 Speaking Index of Narrative Complexity Petersen et al. (2008) 
Narrative Assessment Protocol Justice et al. (2010) 
Narrative Comprehension of Picture Books task Paris & Paris (2001) 
Renfrew Bus Story Renfrew (1997) 
Strong Narrative Assessment Procedure Strong (1998) 
Test of Narrative Language Gillam & Pearson (2004) 
Test of Narrative Retell: School Age–Kindergarten Petersen & Spencer (2012) 
 Phonological awareness Assessment of Literacy and Language Lombardino et al. (2005) 
  d140 Learning to read Comprehensive Test of Phonological Processing Wagner & Torgesen (1999) 
Computer-Based Phonological Awareness Assessment Carson et al. (2011) 
Dynamic Indicators of Basic Early Literacy Skills Good et al. (2002) 
Get Ready to Read Whitehurst (2001) 
Observation Survey of Early Literacy Achievement Clay (1993) 
Phonological Abilities Test Muter et al. (1997) 
Phonological Awareness Literacy Screening–PreK Invernizzi et al. (2004) 
Pre-Reading Inventory of Phonological Awareness Dodd et al. (2003) 
Individual Growth Development Indicator: Rhyming Early Childhood Research Institute (2000) 
Ringerike Material Lyster et al. (2002) 
Sutherland Phonological Awareness Test–Revised Neilson (2007) 
Test of Phonological Awareness–Second Edition: Plus Torgesen & Bryant (2004) 
Test of Preschool Early Literacy Lonigan et al. (2007) 
 Reading ability Aimsweb O'Connor & Jenkins (1999) 
  d140 Learning to read Burt Word Reading Test Gilmore et al. (1981) 
Early Childhood Longitudinal Study, Kindergarten Class of 1998–99 reading test Najarian et al. (2009) 
Early Grade Reading Assessment Gove (2008) 
Early Word Reading Test Hatcher et al. (1994) 
Get It, Got It, Go! (Now called the My Individual Growth & Development Indicators [IGDIs] Assessment) McConnell (2012) 
Gray Oral Reading Tests, Fourth Edition Wiederholt & Bryant (2001) 
Graded Nonword Reading Test Snowling et al. (1996) 
Neale Analysis of Reading Ability–Second Revised British Edition Neale (1997) 
Preschool Word and Print Awareness test Justice & Ezell (2001) 
Reading Freedom Diagnostic Reading Test Calder (1992) 
Reading Progress Test Vincent et al. (1997) 
Salzburg Reading and Spelling Test Landerl et al. (1997) 
Schonell Essential Spelling Test Schonell (1932) 
Sheffield Early Literacy Development Profile Nutbrown (1997) 
Woodcock Reading Mastery Tests–Revised, Word Identification subtest Woodcock (1987) 
York Assessment of Reading for Comprehension Hulme et al. (2009) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
×
The citations that were identified as evaluating outcomes for the Participation component typically fell under the broad category of language and addressed changes in children's nonverbal communication skills such as initiating joint attention, requesting, and social interaction. They also measured changes in children's social engagement, social communication, play, and communication in daily life situations. A list of identified Participation-based measures is presented in Table 5.
Table 5. Measures used to evaluate changes in Participation component.
Measures used to evaluate changes in Participation component.×
Participation (restriction) Measurement tool Reference
 Communicative participation National Outcomes Measurement System Functional Communication Measures American Speech-Language-Hearing Association (2003) 
  d350 Conversation Focus on the Outcomes of Communication Under Six Thomas-Stonell et al. (2010) 
  d720 Complex interpersonal interactions Functional Communication Profile Kleiman (2003) 
  d750 Informal social relationships School Speech Questionnaire Bergman et al. (2002) 
  d880 Engagement in play Selective Mutism Questionnaire Bergman et al. (2008) 
 Nonverbal interaction Early Social Communication Scales Mundy et al. (2003) 
  d335 Producing nonverbal messages Classroom Observation Schedule to Measure Intentional Communication Pasco et al. (2008) 
Child Behavior Rating Scale Bronson et al. (1990) 
Communication and Symbolic Behavior Scales Wetherby & Prizant (2002) 
Children's Communication Checklist–2 Bishop (2003a) 
 Play Communication and Symbolic Behavior Scales Wetherby & Prizant (2002) 
  d880 Engagement in play Developmental Play Assessment Lifter (2000) 
  d720 Complex interpersonal interactions Griffiths Mental Development Scales Griffiths (1984) 
Pragmatics Observational Measure Cordier et al. (2014) 
 Social communication Children's Communication Checklist–2 Bishop (2003a) 
  d335 Producing nonverbal messages Ages and Stages Questionnaire:Social-Emotional Squires et al. (1990) 
  d350 Conversation Autism Behavior Checklist Krug et al. (1980) 
  d720 Complex interpersonal interaction Autism Diagnostic Observation Schedule Lord et al. (1999) 
  d750 Informal social relationships Classroom observation measure Wong & Kasari (2012) 
  d880 Engagement in play Communication Rating Scale Johnson & Wintgens (2001) 
Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
Parent–child interaction measure Shapiro et al. (1997) 
Pragmatics Profile of Everyday Communication Skills in Children Dewart & Summers (1995) 
Social Competence Scale Conduct Problems Prevention Research Group (1995) 
Social Skills Rating System Gresham & Elliott (1990) 
Vineland Adaptive Behavior Scales, Second Edition Sparrow et al. (2005) 
Griffiths Mental Development Scales Griffiths (1984) 
Pragmatics Observational Measure Cordier et al. (2014) 
Strengths and Difficulties Questionnaire Goodman (1997) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
Table 5. Measures used to evaluate changes in Participation component.
Measures used to evaluate changes in Participation component.×
Participation (restriction) Measurement tool Reference
 Communicative participation National Outcomes Measurement System Functional Communication Measures American Speech-Language-Hearing Association (2003) 
  d350 Conversation Focus on the Outcomes of Communication Under Six Thomas-Stonell et al. (2010) 
  d720 Complex interpersonal interactions Functional Communication Profile Kleiman (2003) 
  d750 Informal social relationships School Speech Questionnaire Bergman et al. (2002) 
  d880 Engagement in play Selective Mutism Questionnaire Bergman et al. (2008) 
 Nonverbal interaction Early Social Communication Scales Mundy et al. (2003) 
  d335 Producing nonverbal messages Classroom Observation Schedule to Measure Intentional Communication Pasco et al. (2008) 
Child Behavior Rating Scale Bronson et al. (1990) 
Communication and Symbolic Behavior Scales Wetherby & Prizant (2002) 
Children's Communication Checklist–2 Bishop (2003a) 
 Play Communication and Symbolic Behavior Scales Wetherby & Prizant (2002) 
  d880 Engagement in play Developmental Play Assessment Lifter (2000) 
  d720 Complex interpersonal interactions Griffiths Mental Development Scales Griffiths (1984) 
Pragmatics Observational Measure Cordier et al. (2014) 
 Social communication Children's Communication Checklist–2 Bishop (2003a) 
  d335 Producing nonverbal messages Ages and Stages Questionnaire:Social-Emotional Squires et al. (1990) 
  d350 Conversation Autism Behavior Checklist Krug et al. (1980) 
  d720 Complex interpersonal interaction Autism Diagnostic Observation Schedule Lord et al. (1999) 
  d750 Informal social relationships Classroom observation measure Wong & Kasari (2012) 
  d880 Engagement in play Communication Rating Scale Johnson & Wintgens (2001) 
Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
Parent–child interaction measure Shapiro et al. (1997) 
Pragmatics Profile of Everyday Communication Skills in Children Dewart & Summers (1995) 
Social Competence Scale Conduct Problems Prevention Research Group (1995) 
Social Skills Rating System Gresham & Elliott (1990) 
Vineland Adaptive Behavior Scales, Second Edition Sparrow et al. (2005) 
Griffiths Mental Development Scales Griffiths (1984) 
Pragmatics Observational Measure Cordier et al. (2014) 
Strengths and Difficulties Questionnaire Goodman (1997) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
×
Discussion
This scoping review examined the ways in which speech-language outcomes have been evaluated for preschoolers with communication disorders. We linked the outcome measures used in the included studies to three main components of the ICF-CY framework (Body Functions, Activities, and Participation) to determine whether there had been a shift toward measuring outcomes related to the Participation component since the ICF-CY was first introduced in late 2007.
The majority of studies included in the review used measurement tools that evaluated outcomes related to the Activities component, followed by the Body Functions component. The Participation component was measured least often. This finding is consistent with previous reports of the pediatric speech-language-pathology literature (Thomas-Stonell, Oddson, Robertson, & Rosenbaum, 2010; Thomas-Stonell et al., 2013; Threats, 2013). Use of Participation-based outcomes has fluctuated since the introduction of the ICF-CY and seems to have increased slightly in the last 4 years, but they are still relatively underrepresented in the literature.
Although there has been a slight increase in the evaluation of Participation-based outcomes, most articles included in this review that evaluated changes related to Participation did so for groups of children for whom those changes would be the primary goal of therapy. For example, many studies reporting Participation-based outcomes evaluated changes in social communication skills for children with autism spectrum disorder. Those studies used tools such as the Vineland Adaptive Behavior Scales, Second Edition, and the Communication and Symbolic Behavior Scales Developmental Profile (Wetherby & Prizant, 2002) to evaluate changes in children's ability to engage in reciprocal social relationships. Other studies reported Participation-based outcomes using measures for children with selective mutism for whom the primary goal of intervention is to increase speaking in various social contexts. Thus, the observed increases in studies evaluating Participation-based outcomes may be due to increases in research related to children with autism spectrum disorder and selective mutism.
Findings from this scoping review are relevant to both researchers and clinicians working in the field of pediatric speech-language pathology. Implications for both communities are presented next.
Research Implications
What we would like to see in future research is an increase in Participation-based outcomes looking at changes in the way speech-language interventions affect a child's ability to engage in life—or, said differently, changes in their communicative participation. For children, this means “the child's communication and interaction in real world situations at home, school, or in the community” (Eadie et al., 2006). This construct is more broadly focused than the Participation-based outcomes evaluated in populations such as children with autism spectrum disorder and selective mutism but is an important outcome for children with all types of communication disorders, who we know are often socially isolated from their peers (Brinton & Fujiki, 2005) and struggle to engage in environments outside the home, such as school (McLeod, Daniel, & Barr, 2013).
Many studies have assessed the broad-based impact of speech-language therapy on untargeted outcomes related to participation using tools such as the Vineland Adaptive Behavior Scales, Second Edition, that probe parental perspectives of children's social skills (Washington et al., 2013, 2015). Drawbacks to using this type of tool are that although they provide useful information, they were not designed for use specifically with children with communication disorders, and the construct evaluated focuses specifically on social skills (e.g., table manners) rather than communication as it relates to life participation.
More measures that are designed to evaluate Participation-based outcomes for preschoolers related to communication, such as the Focus on the Outcomes of Communication Under Six (Thomas-Stonell et al., 2010), should be developed. On the basis of published findings using that tool, it appears that speech-language interventions do in fact improve children's communicative participation (Thomas-Stonell et al., 2009, 2013). We believe that as researchers begin to develop new tools and use them to evaluate Participation-based outcomes more frequently, it will become even clearer that speech-language interventions are important in supporting and enhancing a child's ability to be included with others, which is a key intervention outcome (ASHA, 2004).
Assessing Participation-based outcomes in research for children with communication disorders that are not specific to social communication and engagement is not without its challenges. One issue associated with implementing these types of more broadly focused Participation-based outcome measurements in pediatric speech-language pathology is that Participation-based goals are not often directly targeted in therapy. In the absence of a specific and measurable goal related to participation, it would be difficult to know whether the intervention was responsible for any observed changes.
One way to address the uncertainty associated with using an outcome measurement tool that is not directly related to intervention goals in a study might be for researchers to include a Participation-based outcome measure in combination with measures of change for other components of the ICF-CY. For example, researchers evaluating changes in children's speech intelligibility in the Body Functions component might also include a Participation-based outcome measure to see whether those children who demonstrated significant improvements in speech intelligibility also made meaningful gains in communicative participation. This would increase confidence that changes in participation were in fact due to the intervention.
A second issue associated with measuring Participation-based outcomes relates to the reciprocal and interactive nature of the ICF-CY. This scoping review focused on Part 1 of the ICF-CY but did not address Part 2 of the framework, which includes two components: Environmental Factors, which are “the physical, social, and attitudinal environment in which people live and conduct their lives” (WHO, 2007, p. 9), and Personal Factors, not classified in the ICF-CY. A focus on these components in future research would be beneficial, as Environmental and Personal Factors are likely to be strongly linked with Participation-based outcomes. For example, an intervention targeting Participation-based outcomes would likely modify the environment in some way. On the converse, an intervention could focus solely on Environmental Factors (e.g., changes in parents' behavior) using communicative participation as the outcome. Personal Factors can also influence Participation and could be investigated looking at personality traits and children's interests associated with some communication disorders (e.g., stuttering).
Clinical Implications
For SLPs, it is our hope that this review article will shed light on an important component of the ICF-CY that is often overlooked in evaluating the effectiveness of clinical intervention. Most clinicians are already addressing Participation-based issues in therapy. We encourage practicing clinicians to use some of the broadly focused, valid, and reliable Participation-based outcome measures identified in this review (see Table 5) to evaluate the more broadly focused effects of their important interventions.
Including a Participation-based outcome assessment tool in addition to those focused on the Body Functions and Activities components would provide clinicians with a bigger picture of how interventions affect children and families in their everyday lives. The traditional role of an SLP has been to correct speech and language errors in the clinic, but we know that parents are much more interested in how their child's communication disorder affects his or her ability to participate in school and with peers (Thomas-Stonell et al., 2009). Measuring Participation-based outcomes may be more meaningful to families and may facilitate conversations related to goal setting and therapy using family-friendly language.
The inclusion of Participation-based outcomes would also allow health care organizations to evaluate the impacts of speech-language interventions for children with all types of communication disorders, whereas traditionally it has been impossible to compare outcomes for children with different types of disorders (e.g., comparing outcomes for children with speech sound disorders vs. receptive language delays). This could make program evaluation less complicated. Having program-level information related to the outcomes of therapy may also serve an important role for organizations wanting to connect with policy makers and funders. This idea is supported by recent research with adults that has shown that Participation-based outcomes can be relevant and meaningful for individuals with a range of communication impairments (Cieza et al., 2015). Not only would organizations be able to show meaningful changes for large groups of children, they would be able to present information in family-friendly language rather than technical jargon, which may not resonate well with their audiences.
Limitations
This review is not without its limitations, one of which is that some relevant publications may not have been identified despite our systematic search methods. We reviewed citations for the years 2008–2015, but our most recent search was completed at the beginning of January 2016, and databases may not have had up-to-date lists of publications from 2015. Also, only citations that had full text available in English were included in the review. We acknowledge this as a possible limitation. Another limitation is that individual reviewers completed inclusion/exclusion coding for only one half of each year. We tried to mitigate this limitation by including an option for discussing citations and by conducting reliability checks at each stage of the review, but we have no way of knowing whether some citations were missed by not having both reviewers screen all references. As a final limitation, this review identified the measures currently being used but did not undertake a detailed exploration and analysis of the measurement properties of these tools. That kind of analysis is beyond the scope of this review article.
Conclusion
This scoping review identified current practices for evaluating speech-language outcomes for preschoolers with communication disorders. As expected, we found that most outcomes were evaluated for the ICF-CY Body Functions and Activities components, with fewer evaluating outcomes related to the Participation component. The ASHA document “Scope of Practice in Speech-Language Pathology” (2016)  emphasizes the need for continued commitment to the evaluation of outcomes for all components of the ICF, including Participation. Although the ICF has been in use since 2001 and has been included in the ASHA scope of practice since 2007, there continues to be a paucity of Participation-based outcomes research in the field. We encourage others to consider including meaningful Participation-based outcomes in future research, and we strongly advocate for use of these measures in future research and practice so we can explore and capture whatever meaningful life changes might result from children's participation in speech-language interventions beyond changes associated with the Body Functions and Activities components.
Acknowledgments
The first author was supported in part by the American Speech-Language-Hearing Foundation with a New Century Scholars Doctoral Scholarship.
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Figure 1.

Interactions between the components of the International Classification of Functioning, Disability and Health—Children and Youth Version. From International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.

 Interactions between the components of the International Classification of Functioning, Disability and Health—Children and Youth Version. From International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007. Copyright © 2007 by the World Health Organization. Reprinted with permission.
Figure 1.

Interactions between the components of the International Classification of Functioning, Disability and Health—Children and Youth Version. From International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.

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Figure 2.

Flow diagram of the scoping-review process.

 Flow diagram of the scoping-review process.
Figure 2.

Flow diagram of the scoping-review process.

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Figure 3.

The flow of citations from identification through data extraction.

 The flow of citations from identification through data extraction.
Figure 3.

The flow of citations from identification through data extraction.

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Figure 4.

Percentage of measures evaluating changes in the Body Functions, Activities, and Participation components of the International Classification of Functioning, Disability and Health—Children and Youth Version (n = 214).

 Percentage of measures evaluating changes in the Body Functions, Activities, and Participation components of the International Classification of Functioning, Disability and Health—Children and Youth Version (n = 214).
Figure 4.

Percentage of measures evaluating changes in the Body Functions, Activities, and Participation components of the International Classification of Functioning, Disability and Health—Children and Youth Version (n = 214).

×
Table 1. Description of the components of the International Classification of Functioning, Disability and Health—Children and Youth Version.
Description of the components of the International Classification of Functioning, Disability and Health—Children and Youth Version.×
Component Description
Body Functions and Structures Body Structures are anatomical parts of the body such as organs, limbs, and their components.
Body Functions are the physiological functions of body systems (including psychological functions).
Activities and Participation Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Contextual Factors Environmental Factors make up the physical, social, and attitudinal environment in which people live and conduct their lives.
Personal Factors are the particular background of an individual that are not part of a health condition or health states. These factors may include gender, age, other health conditions, upbringing, and coping styles.
Note. Descriptions from International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.
Note. Descriptions from International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.×
Table 1. Description of the components of the International Classification of Functioning, Disability and Health—Children and Youth Version.
Description of the components of the International Classification of Functioning, Disability and Health—Children and Youth Version.×
Component Description
Body Functions and Structures Body Structures are anatomical parts of the body such as organs, limbs, and their components.
Body Functions are the physiological functions of body systems (including psychological functions).
Activities and Participation Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Contextual Factors Environmental Factors make up the physical, social, and attitudinal environment in which people live and conduct their lives.
Personal Factors are the particular background of an individual that are not part of a health condition or health states. These factors may include gender, age, other health conditions, upbringing, and coping styles.
Note. Descriptions from International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.
Note. Descriptions from International Classification of Functioning, Disability and Health—Children and Youth Version, by the World Health Organization, 2007 . Copyright © 2007 by the World Health Organization. Reprinted with permission.×
×
Table 2. Example intervention outcomes across the various components of the International Classification of Functioning, Disability and Health—Children and Youth Version.
Example intervention outcomes across the various components of the International Classification of Functioning, Disability and Health—Children and Youth Version.×
Component Possible intervention outcomes
Body Functions and Structures Body Structures: medical procedures or prostheses to improve structures of the ear, structures involved in voice or speech (e.g., cleft palate), neurological structures, anatomical structures of the vocal tract, respiratory system and larynx, brain, or nervous system.
Body Functions: improved speech and voice production and quality, speech intelligibility, fluency and rhythm of speech, hearing acuity and discrimination, oral and pharyngeal swallowing, memory, problem solving, attention, and mental functioning.
Activities and Participation Activities: improved understanding of language, use of language (e.g., mean length of utterance, syntax, semantics); use of communication technologies (e.g., augmentative and alternative communication), use of nonverbal communication (e.g., requesting using the Picture Exchange Communication System), reading and writing skills (e.g., decoding and encoding); phonological awareness; production of narratives.
Participation: increased ability to converse and interact with others (e.g., start/end/sustain a conversation); improved interpersonal relationships (e.g., making and maintaining friendships); increased engagement in play with peers; involvement in preschool/community/classroom activities, book reading/home activities.
Contextual Factors Environmental Factors: familial social supports and relationships, access to intervention services, attitudes of others, cultural beliefs, access to products and technology (e.g., augmentative and alternative communication devices), social systems and policies.
Personal Factors: age, other health conditions, lifestyle habits, coping styles, social background, education.
Table 2. Example intervention outcomes across the various components of the International Classification of Functioning, Disability and Health—Children and Youth Version.
Example intervention outcomes across the various components of the International Classification of Functioning, Disability and Health—Children and Youth Version.×
Component Possible intervention outcomes
Body Functions and Structures Body Structures: medical procedures or prostheses to improve structures of the ear, structures involved in voice or speech (e.g., cleft palate), neurological structures, anatomical structures of the vocal tract, respiratory system and larynx, brain, or nervous system.
Body Functions: improved speech and voice production and quality, speech intelligibility, fluency and rhythm of speech, hearing acuity and discrimination, oral and pharyngeal swallowing, memory, problem solving, attention, and mental functioning.
Activities and Participation Activities: improved understanding of language, use of language (e.g., mean length of utterance, syntax, semantics); use of communication technologies (e.g., augmentative and alternative communication), use of nonverbal communication (e.g., requesting using the Picture Exchange Communication System), reading and writing skills (e.g., decoding and encoding); phonological awareness; production of narratives.
Participation: increased ability to converse and interact with others (e.g., start/end/sustain a conversation); improved interpersonal relationships (e.g., making and maintaining friendships); increased engagement in play with peers; involvement in preschool/community/classroom activities, book reading/home activities.
Contextual Factors Environmental Factors: familial social supports and relationships, access to intervention services, attitudes of others, cultural beliefs, access to products and technology (e.g., augmentative and alternative communication devices), social systems and policies.
Personal Factors: age, other health conditions, lifestyle habits, coping styles, social background, education.
×
Table 3. Measures used to evaluate changes in Body Functions component.
Measures used to evaluate changes in Body Functions component.×
Body Function (impairment) Measurement tool Reference
Articulation/phonology Arizona Articulation Proficiency Scale–Third Edition Fudala (2000) 
 b320 Articulation function Clinical Test of Articulation Wang & Liao (2007) 
Diagnostic Evaluation of Articulation & Phonology Dodd et al. (2002) 
Early Repetition Battery Seeff-Gabriel et al. (2008) 
Edinburgh Articulation Test Anthony et al. (1971) 
Finnish Articulation Test Remes & Ojanen (1996) 
Glaspey Dynamic Assessment of Phonology Glaspey & Stoel-Gammon (2005) 
Goldman-Fristoe Test of Articulation–Second Edition Goldman & Fristoe (2000) 
Groningen Diagnostic Speech Norms Luinge et al. (2006) 
Hodson Assessment of Phonological Patterns–Third Edition Hodson (2004) 
Hodson Computerized Analysis of Phonological Patterns, Third Edition Hodson (2003) 
Khan-Lewis Phonological Analysis Khan & Lewis (2002) 
Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
Phonological Assessment of Child Speech (Portuguese) Yavas & Goldstein (1998) 
Picture Labelling Test Frontczak et al. (2002) 
Sensory Integration Functions Assessment Scale Lin (2010) 
Teste Fonético-Fonológico-Avaliação da Linguagem Pré-Escolar Mendes et al. (2009) 
Weighted speech sound accuracy Preston et al. (2011) 
Word Complexity Measure Stoel-Gammon (2010) 
Meaningful Use of Speech Scale Robbins & Osberger (1990) 
Fluency Percent syllables stuttered Jones et al. (2005) 
Stuttering Severity Instrument Riley (2009) 
 b330 Fluency and rhythm of speech function Prosodic Assessment Procedure (using visual analogue scales) Samuelsson et al. (2003) 
Hearing Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
 b230 Hearing function Early Speech Perception Test Moog & Geers (1990) 
Glendonald Auditory Speech Perception Test Erber (1982) 
Infant–Toddler Meaningful Auditory Integration Scale Zimmerman-Phillips et al. (2000) 
Listening Progress Score Archbold (1993) 
Meaningful Auditory Information Scale Robbins et al. (1991) 
Speech Perception Battery (PLOTT) Plant (1984) 
Intelligibility Beginner's Intelligibility Test Osberger et al. (1994) 
 b320 Articulation function Children's Speech Intelligibility Measure Wilcox & Morris (1999) 
Speech Intelligibility Rating Scale Allen et al. (1998) 
Test of Children's Speech Plus Hodge et al. (2009) 
Motor planning/apraxia Kaufman Assessment Battery for Children Kaufman & Kaufman (2004) 
 b176 Mental function of sequencing complex movements Spatio-Temporal Index Smith et al. (1995) 
Verbal Motor Production Assessment for Children Hayden & Square (1999) 
Voice Acoustic Voice Quality Index Reynolds et al. (2012) 
 b310 Voice function Consensus Auditory-Perceptual Evaluation of Voice Kempster et al. (2009) 
Dysphonia Severity Index Wuyts et al. (2000) 
Grade, Roughness, Breathiness, Asthenia, and Strain scale Hirano (1981) 
MacKay-Kummer Simplified Nasometric Assessment Procedures Revised MacKay & Kummer (1994) 
Meaningful Use of Speech Scale Robbins & Osberger (1990) 
Pediatric Voice Handicap Index Zur et al. (2007) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
Table 3. Measures used to evaluate changes in Body Functions component.
Measures used to evaluate changes in Body Functions component.×
Body Function (impairment) Measurement tool Reference
Articulation/phonology Arizona Articulation Proficiency Scale–Third Edition Fudala (2000) 
 b320 Articulation function Clinical Test of Articulation Wang & Liao (2007) 
Diagnostic Evaluation of Articulation & Phonology Dodd et al. (2002) 
Early Repetition Battery Seeff-Gabriel et al. (2008) 
Edinburgh Articulation Test Anthony et al. (1971) 
Finnish Articulation Test Remes & Ojanen (1996) 
Glaspey Dynamic Assessment of Phonology Glaspey & Stoel-Gammon (2005) 
Goldman-Fristoe Test of Articulation–Second Edition Goldman & Fristoe (2000) 
Groningen Diagnostic Speech Norms Luinge et al. (2006) 
Hodson Assessment of Phonological Patterns–Third Edition Hodson (2004) 
Hodson Computerized Analysis of Phonological Patterns, Third Edition Hodson (2003) 
Khan-Lewis Phonological Analysis Khan & Lewis (2002) 
Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
Phonological Assessment of Child Speech (Portuguese) Yavas & Goldstein (1998) 
Picture Labelling Test Frontczak et al. (2002) 
Sensory Integration Functions Assessment Scale Lin (2010) 
Teste Fonético-Fonológico-Avaliação da Linguagem Pré-Escolar Mendes et al. (2009) 
Weighted speech sound accuracy Preston et al. (2011) 
Word Complexity Measure Stoel-Gammon (2010) 
Meaningful Use of Speech Scale Robbins & Osberger (1990) 
Fluency Percent syllables stuttered Jones et al. (2005) 
Stuttering Severity Instrument Riley (2009) 
 b330 Fluency and rhythm of speech function Prosodic Assessment Procedure (using visual analogue scales) Samuelsson et al. (2003) 
Hearing Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
 b230 Hearing function Early Speech Perception Test Moog & Geers (1990) 
Glendonald Auditory Speech Perception Test Erber (1982) 
Infant–Toddler Meaningful Auditory Integration Scale Zimmerman-Phillips et al. (2000) 
Listening Progress Score Archbold (1993) 
Meaningful Auditory Information Scale Robbins et al. (1991) 
Speech Perception Battery (PLOTT) Plant (1984) 
Intelligibility Beginner's Intelligibility Test Osberger et al. (1994) 
 b320 Articulation function Children's Speech Intelligibility Measure Wilcox & Morris (1999) 
Speech Intelligibility Rating Scale Allen et al. (1998) 
Test of Children's Speech Plus Hodge et al. (2009) 
Motor planning/apraxia Kaufman Assessment Battery for Children Kaufman & Kaufman (2004) 
 b176 Mental function of sequencing complex movements Spatio-Temporal Index Smith et al. (1995) 
Verbal Motor Production Assessment for Children Hayden & Square (1999) 
Voice Acoustic Voice Quality Index Reynolds et al. (2012) 
 b310 Voice function Consensus Auditory-Perceptual Evaluation of Voice Kempster et al. (2009) 
Dysphonia Severity Index Wuyts et al. (2000) 
Grade, Roughness, Breathiness, Asthenia, and Strain scale Hirano (1981) 
MacKay-Kummer Simplified Nasometric Assessment Procedures Revised MacKay & Kummer (1994) 
Meaningful Use of Speech Scale Robbins & Osberger (1990) 
Pediatric Voice Handicap Index Zur et al. (2007) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
×
Table 4. Measures used to evaluate changes in Activities component.
Measures used to evaluate changes in Activities component.×
Activity (limitation) Measurement tool Reference
Language
 Early communication Bayley Scales of Infant and Toddler Development–Third Edition, Language scale Bayley (2006) 
  d161 Directing attention Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
  d335 Producing non-verbal messages Early Social Communication Scales Mundy et al. (2003) 
Play in Early Childhood Evaluation System Kelly-Vance & Ryalls (2005) 
Test of Early Verbal Comprehension Chilosi et al. (2003) 
 Expressive and receptive language (including syntax and morphology) Autism Behavior Checklist Krug et al. (1980) 
  d310 Communicating with – receiving – spoken messages Autism Diagnostic Observation Scales (ADOS) Lord et al. (1999) 
  d330 Speaking British Abilities Scale Elliott et al. (1997) 
Clinical Evaluation of Language Fundamentals–Preschool–2 Wiig et al. (2004) 
Clinical Evaluation of Language Fundamentals–Fourth Edition Semel et al. (2006) 
Children's Test of Nonword Repetition Gathercole & Baddeley (1996) 
Comprehensive Assessment of Spoken Language Carrow-Woolfolk (1999) 
Fluharty Preschool Speech and Language Screening Test Fluharty (2000) 
Pictorial Test of Intelligence French (1964) 
Grammar and Phonology Screening Gardner et al. (2006) 
Griffiths Mental Development Scales Griffiths (1984) 
Hundred Pictures Naming Test Fisher & Glenister (1992) 
Language Development Survey Rescorla (1989) 
Language sample (mean length of utterance) Brown (1973) 
Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
MacArthur–Bates Communicative Development Inventories Fenson et al. (1993) 
Mullen Scales of Early Learning Mullen (1995) 
Nonword Repetition Test Dollaghan & Campbell (1998) 
Parent Perceptions of Language Development Romski et al. (2000) 
Preschool Language Scale, Third and Fourth Editions Zimmerman et al. (2002) 
Receptive-Expressive Emergent Language Scales Bzoch et al. (2003) 
Renfrew Action Picture Test Renfrew (2003) 
Renfrew Word Finding Vocabulary Test Renfrew (1988) 
Reynell Developmental Language Scales Reynell (1977) 
Schlichting Test for Language Production Schlichting et al. (2003) 
Sequenced Inventory of Communicative Development Hedrick et al. (1984) 
Sprachentwicklungstest für zweijährige Kinder Grimm (2000) 
Sprachentwicklungstest fur drei- bis funfjährige Kinder Grimm (2001) 
Sprachscreening für das Vorschulalter Grimm (2003) 
Structured Photographic Expressive Language Test Preschool Werner & Kresheck (1983) 
Taaltoets alle Kinderen Verhoeven & Vermeer (2001) 
Test for Auditory Comprehension of Language–Third Edition Carrow-Woolfolk (1985) 
Test of Grammatical Comprehension for Children Chilosi & Cipriani (1995) 
Test of Early Language Development–Third Edition Hresko, et al. (1999) 
Test of Language Development–Primary: Third Edition Newcomer & Hammill (1997) 
Test of Problem Solving 3–Elementary Bowers et al. (2005) 
Test for Reception of Grammar–2 Bishop (2003b) 
Token Test for Children Di Simoni (1978) 
Vineland Adaptive Behavior Scales, Second Edition Sparrow et al. (2005) 
Wechsler Preschool and Primary Scale of Intelligence–Revised Wechsler (2003) 
 Vocabulary Aktiver Wortschatztest für 3- bis 5-jährige Kinder–Revision Kiese-Himmel (2005) 
  d310 Communicating with – receiving spoken messages British Picture Vocabulary Scale Dunn et al. (1997) 
  d330 Speaking Expressive One-Word Picture Vocabulary Test Brownell (2000) 
Expressive Vocabulary Test Williams (1997) 
MacArthur–Bates Communicative Development Inventories Fenson et al. (1993) 
Peabody Picture Vocabulary Test–III and Fourth Edition Dunn & Dunn (2007) 
Receptive One-Word Picture Vocabulary Test Brownell (2000) 
Woodcock-Johnson III Tests of Achievement Woodcock et al. (2001) 
Literacy
 Narrative skills and story retell Children's Communication Checklist–2 Bishop (2003a) 
  d140 Learning to read Edmonton Narrative Norms Instrument Schneider et al. (2005) 
  d330 Speaking Index of Narrative Complexity Petersen et al. (2008) 
Narrative Assessment Protocol Justice et al. (2010) 
Narrative Comprehension of Picture Books task Paris & Paris (2001) 
Renfrew Bus Story Renfrew (1997) 
Strong Narrative Assessment Procedure Strong (1998) 
Test of Narrative Language Gillam & Pearson (2004) 
Test of Narrative Retell: School Age–Kindergarten Petersen & Spencer (2012) 
 Phonological awareness Assessment of Literacy and Language Lombardino et al. (2005) 
  d140 Learning to read Comprehensive Test of Phonological Processing Wagner & Torgesen (1999) 
Computer-Based Phonological Awareness Assessment Carson et al. (2011) 
Dynamic Indicators of Basic Early Literacy Skills Good et al. (2002) 
Get Ready to Read Whitehurst (2001) 
Observation Survey of Early Literacy Achievement Clay (1993) 
Phonological Abilities Test Muter et al. (1997) 
Phonological Awareness Literacy Screening–PreK Invernizzi et al. (2004) 
Pre-Reading Inventory of Phonological Awareness Dodd et al. (2003) 
Individual Growth Development Indicator: Rhyming Early Childhood Research Institute (2000) 
Ringerike Material Lyster et al. (2002) 
Sutherland Phonological Awareness Test–Revised Neilson (2007) 
Test of Phonological Awareness–Second Edition: Plus Torgesen & Bryant (2004) 
Test of Preschool Early Literacy Lonigan et al. (2007) 
 Reading ability Aimsweb O'Connor & Jenkins (1999) 
  d140 Learning to read Burt Word Reading Test Gilmore et al. (1981) 
Early Childhood Longitudinal Study, Kindergarten Class of 1998–99 reading test Najarian et al. (2009) 
Early Grade Reading Assessment Gove (2008) 
Early Word Reading Test Hatcher et al. (1994) 
Get It, Got It, Go! (Now called the My Individual Growth & Development Indicators [IGDIs] Assessment) McConnell (2012) 
Gray Oral Reading Tests, Fourth Edition Wiederholt & Bryant (2001) 
Graded Nonword Reading Test Snowling et al. (1996) 
Neale Analysis of Reading Ability–Second Revised British Edition Neale (1997) 
Preschool Word and Print Awareness test Justice & Ezell (2001) 
Reading Freedom Diagnostic Reading Test Calder (1992) 
Reading Progress Test Vincent et al. (1997) 
Salzburg Reading and Spelling Test Landerl et al. (1997) 
Schonell Essential Spelling Test Schonell (1932) 
Sheffield Early Literacy Development Profile Nutbrown (1997) 
Woodcock Reading Mastery Tests–Revised, Word Identification subtest Woodcock (1987) 
York Assessment of Reading for Comprehension Hulme et al. (2009) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
Table 4. Measures used to evaluate changes in Activities component.
Measures used to evaluate changes in Activities component.×
Activity (limitation) Measurement tool Reference
Language
 Early communication Bayley Scales of Infant and Toddler Development–Third Edition, Language scale Bayley (2006) 
  d161 Directing attention Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
  d335 Producing non-verbal messages Early Social Communication Scales Mundy et al. (2003) 
Play in Early Childhood Evaluation System Kelly-Vance & Ryalls (2005) 
Test of Early Verbal Comprehension Chilosi et al. (2003) 
 Expressive and receptive language (including syntax and morphology) Autism Behavior Checklist Krug et al. (1980) 
  d310 Communicating with – receiving – spoken messages Autism Diagnostic Observation Scales (ADOS) Lord et al. (1999) 
  d330 Speaking British Abilities Scale Elliott et al. (1997) 
Clinical Evaluation of Language Fundamentals–Preschool–2 Wiig et al. (2004) 
Clinical Evaluation of Language Fundamentals–Fourth Edition Semel et al. (2006) 
Children's Test of Nonword Repetition Gathercole & Baddeley (1996) 
Comprehensive Assessment of Spoken Language Carrow-Woolfolk (1999) 
Fluharty Preschool Speech and Language Screening Test Fluharty (2000) 
Pictorial Test of Intelligence French (1964) 
Grammar and Phonology Screening Gardner et al. (2006) 
Griffiths Mental Development Scales Griffiths (1984) 
Hundred Pictures Naming Test Fisher & Glenister (1992) 
Language Development Survey Rescorla (1989) 
Language sample (mean length of utterance) Brown (1973) 
Le Profile Acceptation, Perception, Compréhension, Expression, Intelligibilité Noel-Petrof et al. (2006) 
MacArthur–Bates Communicative Development Inventories Fenson et al. (1993) 
Mullen Scales of Early Learning Mullen (1995) 
Nonword Repetition Test Dollaghan & Campbell (1998) 
Parent Perceptions of Language Development Romski et al. (2000) 
Preschool Language Scale, Third and Fourth Editions Zimmerman et al. (2002) 
Receptive-Expressive Emergent Language Scales Bzoch et al. (2003) 
Renfrew Action Picture Test Renfrew (2003) 
Renfrew Word Finding Vocabulary Test Renfrew (1988) 
Reynell Developmental Language Scales Reynell (1977) 
Schlichting Test for Language Production Schlichting et al. (2003) 
Sequenced Inventory of Communicative Development Hedrick et al. (1984) 
Sprachentwicklungstest für zweijährige Kinder Grimm (2000) 
Sprachentwicklungstest fur drei- bis funfjährige Kinder Grimm (2001) 
Sprachscreening für das Vorschulalter Grimm (2003) 
Structured Photographic Expressive Language Test Preschool Werner & Kresheck (1983) 
Taaltoets alle Kinderen Verhoeven & Vermeer (2001) 
Test for Auditory Comprehension of Language–Third Edition Carrow-Woolfolk (1985) 
Test of Grammatical Comprehension for Children Chilosi & Cipriani (1995) 
Test of Early Language Development–Third Edition Hresko, et al. (1999) 
Test of Language Development–Primary: Third Edition Newcomer & Hammill (1997) 
Test of Problem Solving 3–Elementary Bowers et al. (2005) 
Test for Reception of Grammar–2 Bishop (2003b) 
Token Test for Children Di Simoni (1978) 
Vineland Adaptive Behavior Scales, Second Edition Sparrow et al. (2005) 
Wechsler Preschool and Primary Scale of Intelligence–Revised Wechsler (2003) 
 Vocabulary Aktiver Wortschatztest für 3- bis 5-jährige Kinder–Revision Kiese-Himmel (2005) 
  d310 Communicating with – receiving spoken messages British Picture Vocabulary Scale Dunn et al. (1997) 
  d330 Speaking Expressive One-Word Picture Vocabulary Test Brownell (2000) 
Expressive Vocabulary Test Williams (1997) 
MacArthur–Bates Communicative Development Inventories Fenson et al. (1993) 
Peabody Picture Vocabulary Test–III and Fourth Edition Dunn & Dunn (2007) 
Receptive One-Word Picture Vocabulary Test Brownell (2000) 
Woodcock-Johnson III Tests of Achievement Woodcock et al. (2001) 
Literacy
 Narrative skills and story retell Children's Communication Checklist–2 Bishop (2003a) 
  d140 Learning to read Edmonton Narrative Norms Instrument Schneider et al. (2005) 
  d330 Speaking Index of Narrative Complexity Petersen et al. (2008) 
Narrative Assessment Protocol Justice et al. (2010) 
Narrative Comprehension of Picture Books task Paris & Paris (2001) 
Renfrew Bus Story Renfrew (1997) 
Strong Narrative Assessment Procedure Strong (1998) 
Test of Narrative Language Gillam & Pearson (2004) 
Test of Narrative Retell: School Age–Kindergarten Petersen & Spencer (2012) 
 Phonological awareness Assessment of Literacy and Language Lombardino et al. (2005) 
  d140 Learning to read Comprehensive Test of Phonological Processing Wagner & Torgesen (1999) 
Computer-Based Phonological Awareness Assessment Carson et al. (2011) 
Dynamic Indicators of Basic Early Literacy Skills Good et al. (2002) 
Get Ready to Read Whitehurst (2001) 
Observation Survey of Early Literacy Achievement Clay (1993) 
Phonological Abilities Test Muter et al. (1997) 
Phonological Awareness Literacy Screening–PreK Invernizzi et al. (2004) 
Pre-Reading Inventory of Phonological Awareness Dodd et al. (2003) 
Individual Growth Development Indicator: Rhyming Early Childhood Research Institute (2000) 
Ringerike Material Lyster et al. (2002) 
Sutherland Phonological Awareness Test–Revised Neilson (2007) 
Test of Phonological Awareness–Second Edition: Plus Torgesen & Bryant (2004) 
Test of Preschool Early Literacy Lonigan et al. (2007) 
 Reading ability Aimsweb O'Connor & Jenkins (1999) 
  d140 Learning to read Burt Word Reading Test Gilmore et al. (1981) 
Early Childhood Longitudinal Study, Kindergarten Class of 1998–99 reading test Najarian et al. (2009) 
Early Grade Reading Assessment Gove (2008) 
Early Word Reading Test Hatcher et al. (1994) 
Get It, Got It, Go! (Now called the My Individual Growth & Development Indicators [IGDIs] Assessment) McConnell (2012) 
Gray Oral Reading Tests, Fourth Edition Wiederholt & Bryant (2001) 
Graded Nonword Reading Test Snowling et al. (1996) 
Neale Analysis of Reading Ability–Second Revised British Edition Neale (1997) 
Preschool Word and Print Awareness test Justice & Ezell (2001) 
Reading Freedom Diagnostic Reading Test Calder (1992) 
Reading Progress Test Vincent et al. (1997) 
Salzburg Reading and Spelling Test Landerl et al. (1997) 
Schonell Essential Spelling Test Schonell (1932) 
Sheffield Early Literacy Development Profile Nutbrown (1997) 
Woodcock Reading Mastery Tests–Revised, Word Identification subtest Woodcock (1987) 
York Assessment of Reading for Comprehension Hulme et al. (2009) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
×
Table 5. Measures used to evaluate changes in Participation component.
Measures used to evaluate changes in Participation component.×
Participation (restriction) Measurement tool Reference
 Communicative participation National Outcomes Measurement System Functional Communication Measures American Speech-Language-Hearing Association (2003) 
  d350 Conversation Focus on the Outcomes of Communication Under Six Thomas-Stonell et al. (2010) 
  d720 Complex interpersonal interactions Functional Communication Profile Kleiman (2003) 
  d750 Informal social relationships School Speech Questionnaire Bergman et al. (2002) 
  d880 Engagement in play Selective Mutism Questionnaire Bergman et al. (2008) 
 Nonverbal interaction Early Social Communication Scales Mundy et al. (2003) 
  d335 Producing nonverbal messages Classroom Observation Schedule to Measure Intentional Communication Pasco et al. (2008) 
Child Behavior Rating Scale Bronson et al. (1990) 
Communication and Symbolic Behavior Scales Wetherby & Prizant (2002) 
Children's Communication Checklist–2 Bishop (2003a) 
 Play Communication and Symbolic Behavior Scales Wetherby & Prizant (2002) 
  d880 Engagement in play Developmental Play Assessment Lifter (2000) 
  d720 Complex interpersonal interactions Griffiths Mental Development Scales Griffiths (1984) 
Pragmatics Observational Measure Cordier et al. (2014) 
 Social communication Children's Communication Checklist–2 Bishop (2003a) 
  d335 Producing nonverbal messages Ages and Stages Questionnaire:Social-Emotional Squires et al. (1990) 
  d350 Conversation Autism Behavior Checklist Krug et al. (1980) 
  d720 Complex interpersonal interaction Autism Diagnostic Observation Schedule Lord et al. (1999) 
  d750 Informal social relationships Classroom observation measure Wong & Kasari (2012) 
  d880 Engagement in play Communication Rating Scale Johnson & Wintgens (2001) 
Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
Parent–child interaction measure Shapiro et al. (1997) 
Pragmatics Profile of Everyday Communication Skills in Children Dewart & Summers (1995) 
Social Competence Scale Conduct Problems Prevention Research Group (1995) 
Social Skills Rating System Gresham & Elliott (1990) 
Vineland Adaptive Behavior Scales, Second Edition Sparrow et al. (2005) 
Griffiths Mental Development Scales Griffiths (1984) 
Pragmatics Observational Measure Cordier et al. (2014) 
Strengths and Difficulties Questionnaire Goodman (1997) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
Table 5. Measures used to evaluate changes in Participation component.
Measures used to evaluate changes in Participation component.×
Participation (restriction) Measurement tool Reference
 Communicative participation National Outcomes Measurement System Functional Communication Measures American Speech-Language-Hearing Association (2003) 
  d350 Conversation Focus on the Outcomes of Communication Under Six Thomas-Stonell et al. (2010) 
  d720 Complex interpersonal interactions Functional Communication Profile Kleiman (2003) 
  d750 Informal social relationships School Speech Questionnaire Bergman et al. (2002) 
  d880 Engagement in play Selective Mutism Questionnaire Bergman et al. (2008) 
 Nonverbal interaction Early Social Communication Scales Mundy et al. (2003) 
  d335 Producing nonverbal messages Classroom Observation Schedule to Measure Intentional Communication Pasco et al. (2008) 
Child Behavior Rating Scale Bronson et al. (1990) 
Communication and Symbolic Behavior Scales Wetherby & Prizant (2002) 
Children's Communication Checklist–2 Bishop (2003a) 
 Play Communication and Symbolic Behavior Scales Wetherby & Prizant (2002) 
  d880 Engagement in play Developmental Play Assessment Lifter (2000) 
  d720 Complex interpersonal interactions Griffiths Mental Development Scales Griffiths (1984) 
Pragmatics Observational Measure Cordier et al. (2014) 
 Social communication Children's Communication Checklist–2 Bishop (2003a) 
  d335 Producing nonverbal messages Ages and Stages Questionnaire:Social-Emotional Squires et al. (1990) 
  d350 Conversation Autism Behavior Checklist Krug et al. (1980) 
  d720 Complex interpersonal interaction Autism Diagnostic Observation Schedule Lord et al. (1999) 
  d750 Informal social relationships Classroom observation measure Wong & Kasari (2012) 
  d880 Engagement in play Communication Rating Scale Johnson & Wintgens (2001) 
Deafness and Additional Disabilities Questionnaire Palmieri et al. (2012) 
Parent–child interaction measure Shapiro et al. (1997) 
Pragmatics Profile of Everyday Communication Skills in Children Dewart & Summers (1995) 
Social Competence Scale Conduct Problems Prevention Research Group (1995) 
Social Skills Rating System Gresham & Elliott (1990) 
Vineland Adaptive Behavior Scales, Second Edition Sparrow et al. (2005) 
Griffiths Mental Development Scales Griffiths (1984) 
Pragmatics Observational Measure Cordier et al. (2014) 
Strengths and Difficulties Questionnaire Goodman (1997) 
Note. Complete reference list available from the authors.
Note. Complete reference list available from the authors.×
×
Supplemental Material S1.Strategies used to search each health database
Supplemental Material S2.Final reference list of included citations by publication year