Assessment choice

7.10 When considering assessment of aphasia in Aboriginal and Torres Strait Islander clients, speech pathologists should be mindful of the significant limitations of and potential harms in using formal assessment tools.

Reference: Armstrong et al., 2017: Discussion paper; McDermott, 2019: Discussion paper; Penn & Armstrong, 2017: Discussion paper; SPA, 2023a: Position statement

NHMRC level of evidence: GPP 

Rationale: Rationale: Currently no formal (standardised) assessments nor screening tools exist for exploring aphasia in Aboriginal and Torres Strait Islander peoples. Tools for assessing English have been standardised on non-Indigenous people and while many Aboriginal and Torres Strait Islander people speak English, these tools may yield misdiagnoses for some people (SPA, 2023a). Speech pathologists should be aware that a lack of familiar vocabulary, grammar and format in standardised language tests may significantly disadvantage Aboriginal and Torres Strait Islander Australians leading to an underestimation or misinterpretation of an individual’s language abilities. In addition, negative experiences of being tested may be triggered among some Aboriginal people as a result of language assessments and it is important to be mindful of this. On a more fundamental note, assessment can reinforce deficit discourse and privilege a western/colonial lens (McDermott, 2019) and can therefore feel very unsafe for Aboriginal and Torres Strait Islander people.

Speech pathologists are therefore encouraged to refrain from performing formal assessments and instead to move towards a non-deficit focused, person-centred approach. Dynamic assessment that involves observations and clinical yarning (see statement 7.8) is a culturally safe way of understanding a person and their needs and can be used to agree on a treatment approach.

Should formal assessments be necessary (e.g., for NDIS applications), an informal and authentic conversation between the speech pathologist and the client is necessary to explain the purpose of the assessment. Yarning should always take place prior to assessment. In addition, it is important for speech pathologists to regard all varieties of English equally, as failure to do so devalues community languages and dialects and promotes structural racism (SPA, 2023a). Phonology, semantics, grammar, pragmatics and narrative styles can differ significantly between Aboriginal and Torres Strait Islander Australians and non-Aboriginal and Torres Strait Island Australians (Armstrong et al., 2017). Hence caution must be taken by speech pathologists to ensure that speech patterns arising from linguistic and cultural differences are not inaccurately be labelled as errors; Armstrong et al., 2017; Penn & Armstrong, 2017). Engaging with a client’s family, other community members, and/or an ALO/AHW may help to better understand language processes in their community. 

References:

1. Armstrong, E., McKay, G., & Hersh, D. (2017). Assessment and treatment of aphasia in Aboriginal Australians. Journal of Clinical Practice in Speech-Language Pathology, 19(1), 27-34.
2. McDermott, D. (2019). arms? International Journal of Speech-Language Pathology, 21(3), 252-262, DOI: 10.1080/17549507.2019.1617896
3. Penn, C., & Armstrong, E. (2017). Intercultural aphasia: New models of understanding for Indigenous populations. Aphasiology, 31(5), 563-594. DOI: 10.1080/02687038.2016.1213788
4. Speech Pathology Australia (2023a). Anti-racism position statement. Retrieved from: https://www.speechpathologyaustralia.org.au/Public/libraryviewer?ResourceID=54