Praxis Speech-Language Pathology Ultimate Guide2019-07-18T19:42:26+00:00

Praxis Speech-Language Pathology Ultimate Guide and Practice Test

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Praxis Speech-Language Pathology Quick Facts

The Praxis exam for Speech-Language Pathology tests the knowledge of aspiring clinicians in all settings of possible employment (e.g., schools, skilled nursing facilities, and hospitals). The Praxis is required to obtain the Certification of Clinical Competence awarded by the American Speech Language Hearing Association (ASHA). State licensure boards also utilize exam scores to issue state license to speech-language pathologists. The Praxis exam evaluates knowledge of the “big nine” areas within the scope of practice for speech-language pathologists and provides a chance for examinees to demonstrate skills required to enter the workforce as a competent clinician.

The Praxis exam contains questions from three content categories (e.g., Foundations, Evaluation, and Treatment) resulting in 132 total questions. The examinee has 150 minutes to complete the entire test. The testing format relies solely on “selected response questions” meaning the test taker must choose the correct answer from four possible answer choices (e.g., A, B, C, or D). 

Cost: 

The Praxis exam for Speech-Language Pathology costs $120. 

Scoring: 

The score is reported on a 100-200 point scale, increasing in one point increments. The required score for ASHA is 162.

Pass rate: 

For the 2016-2017 test year, the pass rate for the Praxis exam for Speech-Language Pathology was 82.4%. 

Study time: 

The amount of study time you need will depend on many factors, including your educational history, subject background, and how comfortable you are with a test-taking environment. In general, we recommend people spend 1 to 3 months studying. 

What test takers wish they would’ve done: 

  • Take several practice tests to get an idea of the format
  • Create a study plan
  • Keep track of time during the test
  • Create a pacing plan

Information and screenshots obtained from the ETS Praxis website: https://www.ets.org/praxis/prepare/materials/5331

I: Foundations and Professional Practice

Overview

This content category has 44 selected-response questions. These questions account for 33% of the entire exam.

This content category can be neatly divided into 2 sections:

  • Foundations
  • Professional Practice

So, let’s talk about Foundations first.

Foundations

Let’s talk about some concepts that you will more than likely see on the test.

Swallowing

A normal swallow can be broken down into three different stages. During the oral phase, food is lateralized to the molar table and formed into a cohesive bolus through rotary mastication patterns. The bolus is then transported posteriorly toward the pharynx. The pharyngeal phase is initiated and the bolus then enters the vallecula and slides down the pyriform sinuses. Epiglottic inversion and hyolaryngeal excursion and elevation help protect the airway from penetration and aspiration. The esophageal stage begins once the cricopharyngeus muscle relaxes and opens the upper esophageal sphincter. The esophagus relies on peristalsis to transport the bolus to the stomach. 

Social Communication Benchmarks for 2-3 Year Olds

Social communication refers to the ability to use language during social contexts. Social communication development begins immediately after birth (e.g., preference to look at human faces, vocal turn-taking, etc.). By 2-3 years old, a child should be able to change conversation topics, begin to provide descriptive detail to engage listeners, request clarification during communication breakdowns, and use language for imaginative play.

Professional Practice

Here are some concepts you should know.

Conflict of Interest

The ASHA Code of Ethics was created to protect consumers as well as the integrity of Speech-Language Pathology as a profession. The Code of Ethics describes a conflict of interest as something that overlaps professional obligation and personal interests. A conflict of interest may involve incentives, financial rewards, family relationships, etc. For example, a new hearing aid company might offer advertisement of your clinic in their brochure in exchange for using their company. A conflict of interest would arise due to the personal gain involved with selecting that specific company. It is best practice to avoid all situations that have the potential to result in a conflict of interest. 

Purposes of Documentation

Documentation is crucial for third party reimbursement of skilled services. Clinicians must demonstrate medical necessity in order to deem services necessary and reasonable. The following must be included for Medicare documentation: evaluation, treatment plan, treatment notes, progress reports, and discharge summaries. Medicaid documentation follows the same guidelines as Medicare. However, different states are likely to have state specific Medicaid requirements.

II: Screening, Assessment, Evaluation, and Diagnosis

Overview

This content category has 44 selected-response questions. These questions account for 33% of the entire exam.

This content category can be neatly divided into 4 sections:

  • Screening
  • Approaches to Assessment and Evaluation
  • Assessment Procedures and Assessment
  • Etiology

So, let’s talk about Screening first.

Screening

Let’s talk about some concepts that you will more than likely see on the test.

Role of the SLP

A screening for a speech and language disorder is conducted when an impairment is suspected. A screening does not provide a diagnosis, but instead gives the clinician insight to whether a full evaluation is necessary. Screens may include both informal measures (e.g., case history, self-made questionnaires) and formal measures (e.g., provides normative data). 

Communication and Swallowing Disorders in Children

All children develop differently. Therefore, most developmental milestones are provided in age ranges. However, there are signs and “red flags” that may lead to identification of speech and swallowing disorders in the pediatric population. The following are possible indicators of pediatric speech/language and swallowing disorders and warrant further evaluation: 

  • If a parent reports their child is a “quiet baby”
  • If a parent reports recurrent ear infections
  • Child presents with failure to thrive
  • Child exhibits difficulty breathing while eating
  • 7-12 months: limited sound inventory, no gestures
  • 18-24 months: lacks 2-word combinations
  • 24 months: less than 50 words 
  • 2 years old: not producing sounds p, b, m, h, w
  • 3 years old: less than 75% intelligible

Approaches to Assessment and Evaluation

Check out these concepts.

Assessing Speech Disorders

The assessment process begins with a case history interview. The speech-language pathologist may conduct this interview with a parent, patient, teacher, etc. Informal measures utilized for a speech disorder evaluation could contain a language sample, classroom observation, curriculum based assessment, stimulability testing, or an oral motor exam. Formal testing measures include standardized tests like the Goldman-Fristoe Test of Articulation-3 and the Frenchay Dysarthria Assessment -2. A clinician must look at an individual’s cultural background, age, language, and suspected severity to determine the most appropriate methodology for the assessment. 

Interviewing Techniques

The case history interview can provide valuable information to the speech-language pathologist regarding a patient’s disorder. It is important to conduct the interview in a comfortable location and demonstrate non-threatening/ non-authoritative body language. To ensure comprehension, ask questions using layman’s terms. For example, instead of asking a question regarding a child’s speech intelligibility, reword the question to state, “How often do you understand what your child is saying?”

Assessment Procedures and Assessment

Take a look at these testable concepts.

Stuttering versus Cluttering

Disfluencies occur in all speakers. The deciding factor in determining a person who stutters is the type and frequency of the disfluency. Part word repetitions, (e.g., ba-ba-balloon), prolongations (e.g., ssssssmile), and blocks (e.g., difficulty initiating sound production) are typically considered stuttering-like disfluencies. Normal disfluent behaviors include interjections and revisions. 

Cluttering is also a fluency disorder. However, excessive speaking rate, abnormal pauses, and language/phonological errors differentiate the disorder from stuttering. A person who clutters will often coarticulate or omit a syllable (e.g., “I waneatchick”). 

Tympanogram

A tympanogram is the visual representation of the correlation between tympanic membrane movement and pressure in the ear canal. Tympanometry gives clinicians important information regarding the mobility (e.g., moves too much or not enough) and condition (e.g., possible perforation) of the eardrum. The figure below represents the different possible types of tympanograms. 

Type A = WFL

Type As (shallow) = middle ear is stiff

Type Ad (deep) = middle ear is floppy

Type B = possible perforation of eardrum

Type C = middle ear retracted 

For more information on the common types of tympanograms, check out this resource.

Etiology

Here are some concepts you have to know for the test.

Fragile X Syndrome

Fragile X syndrome is caused by a mutation of the X chromosome. It is the leading inherited cause of intellectual disability and is twice as likely to occur in boys than girls. Facial characteristics of Fragile X syndrome include an elongated face and prominent ears. Children with Fragile X commonly present with ADHD and autism-like characteristics (e.g., flapping, poor eye contact). Feeding and swallowing issues may arise in this population due to generalized hypotonia, excessive drooling, narrow arched palate, and oral defensiveness. Language and speech development are typically significantly impacted and some children are even non-verbal. First spoken words are usually produced ~28 months. As clinicians, it’s important to learn the strengths of this population to promote language, cognitive, and speech growth. Children with Fragile X syndrome benefit from visual stimuli, exhibit adequate receptive language skills, and present with a strong desire to communicate with others. 

Velopharyngeal Dysfunction

Velopharyngeal dysfunction (VPD) is a broad term used to describe incomplete closure between the oral and nasal cavity. Effects of VPD on speech include hypernasality, hyponasality, nasal emission, and Cul de Sac resonance. 

Several etiologies are possible when VPD is present. The first type of VPD is velopharyngeal insufficiency. Velopharyngeal insufficiency occurs from anatomical abnormalities such as a cleft palate, short velum, or enlarged tonsils. The second type of VPD is referred to as velopharyngeal incompetence. Velopharyngeal incompetence arises when the soft palate/velum lacks proper mobility. Causes of velopharyngeal incompetence include hypotonia, paralysis, apraxia, and nerve damage. The last type of VPD is noted as velopharyngeal mislearning. Velopharyngeal mislearning occurs when a child learns incorrect sound production and the structure and function of the soft palate is unremarkable. Possible etiologies of velopharyngeal mislearning include hearing loss and conversion disorder.

III: Planning, Implementation, and Evaluation of Treatment

Overview

This content category has 44 selected-response questions. These questions account for 33% of the entire exam.

This content category can be neatly divided into 3 sections:

  • Treatment Planning
  • Treatment Evaluation
  • Treatment

So, let’s start with Treatment Planning.

Treatment Planning

Here are some concepts you need to know.

Age

Treatment plans should reflect a patient’s age and cognitive ability. For example, you are treating a 70-year-old female post-stroke. You want to use a puzzle during your session to target visual neglect and problem solving. Instead of utilizing a puzzle with cartoon characters that might be perceived as childish, create a puzzle from cut up cereal or snack boxes from the pantry. The same goals are being targeted. However, the delivery in which the goals are targeted are more relevant, functional, and tailored to the demographics of the patient. 

Treatment Plan

When generating a treatment plan for any disorder, it is critical to choose treatment targets that will have the greatest impact on the patient’s functional performance. When selecting initial targets for a child with a speech sound disorder, the clinician needs to determine which approach would be most beneficial to the child. The following approaches are considered when choosing initial sounds targets: 

  • client-specific approach (e.g., choosing targets that are relevant in the child’s life)
  • developmental approach (e.g., selecting targets based on developmental norms)
  • intelligibility approach (e.g., targeting sounds that have the most positive impact on improving intelligibility)
  • non-developmental approach (e.g., choosing targets that are more complex to promote the greatest change in the child’s phonological system)

Once sound targets are determined, the clinician must decide if a vertical, horizontal, or cyclical teaching approach is most appropriate. Depending on the severity of the disorder, age, and type of errors, a variety of treatment techniques are available which include the multiple opposition approach, minimal opposition approach, core vocabulary approach, cycles approach, distinctive features therapy, and metaphon approach. The different techniques benefit a certain population within speech sound disorders. Considering client-specific characteristics will allow clinicians to decide which approach will leave a lasting impact on their client’s speech inventory.

Treatment Evaluation

Let’s talk about some concepts that you will more than likely see on the test.

Measuring Baseline Performance

Gathering data regarding a patient’s baseline performance is important to measure progress throughout the course of the treatment period. Clinicians must know where their patient started to create realistic and appropriate goals. For example, if at baseline a patient is NPO with a PEG tube following a massive stroke, the first short term goal a clinician writes should not be expecting the patient to safely swallow a regular diet and thin liquids within the next few weeks. 

Taking baseline data can be as complicated or easy as one makes it. Many clinicians prefer to make probes or datasheets that are administered on a routine basis (e.g., at the end of a six-week period, once a month, every week, etc.). These probes contain whatever prompts necessary to determine a patient’s initial baseline and also allow for an easy and organized way to track growth throughout the treatment period. 

Short- and Long-Term Outcomes

Short-term and long-term outcomes are created to map out the purpose of treatment. It allows for the clinician to know what areas are currently under target and see a glimpse at where the treatment is headed. Short term goals answer the questions, “who?, will perform what?, how well?, and under what context?” At the end of treatment, outcomes allow insurance, clinicians, patients, family members, etc. to see the progress made during the treatment period. Goals can be used as a counseling tool and stated as “At the start of therapy, your child could produce /b/ with 20% accuracy and now he is producing it with 95% accuracy in all word positions.” Without goals and outcomes, treatment plans would lack a concrete focus.

Treatment

Check out these concepts.

Resonance

Resonance is produced by the vocal folds and filtered by the pharynx and oral and nasal cavities. The size and shape of the vocal tract enhances or dampens harmonics. Languages contain sounds that are created by a specific ratio of oral to nasal energy. Resonance disorders occur when there is an imbalance in the energy’s ratio caused by both anatomical (e.g., velopharyngeal insufficiency, cleft palate, etc.) and physiological issues (e.g., velopharyngeal incompetence, etc.). A variety of treatment options are available including pharmacological, surgical, and prosthetic management. Our role as speech-language pathologists occur when a resonance disorder is present due to a structure malfunctioning. Therapy techniques can include visual feedback, auditory biofeedback, and teaching correct articulator placement. When treating individuals with resonance disorders, interprofessional collaboration with otolaryngologists and craniofacial teams is crucial in providing appropriate care. 

Augmentative and Alternative Communication

AAC encompasses an abundance of ways people communicate non-verbally. The two branches of AAC are classified under unaided systems (e.g., uses your own body) and aided systems (e.g., requires something other than your body). Intervention of AAC can include how to use the device, implementing techniques to increase rate, software updates, symbol selection, and choosing appropriate core and fringe vocabulary. To successfully implement an AAC device, a team approach is required with relevant members (e.g., teachers, family, other therapists, physicians, etc.). When determining an appropriate AAC approach and device, many factors are evaluated to find the best fit for the client. Medical diagnosis, feature matching, sensory/physical abilities, language skills, and opportunity/access barriers are some of the areas under consideration. 

And that’s some basic info about the exam.

Now, let’s look at a few practice questions in each area to see how these concepts might actually appear on the real test.

Practice Questions and Answers

Question 1

A speech language pathologist will receive compensation for utilizing a specific brand of thickener in her private practice. Which ethical dilemma is present in this scenario? 

  1. negligence 
  2. conflict of interest 
  3. fraud
  4. misrepresentation

Correct answer: 2. Conflict of interest is defined as interference of professional practice due to personal gain.

Question 2

Which of the following would be commonly observed in a typically developing 24-month-old child? 

  1. 90% speech intelligibility 
  2. 4-word combinations 
  3. beginning to follow 1-step directions 
  4. an MLU around 2.0

Correct answer: 4. A MLU around 2.0 is commonly observed in 24-month-olds.

Question 3

Public law 99-457 encompasses: 

  1. providing reimbursement for no more than 30 days in the hospital. 
  2. training family members to support the development of a child.
  3. supporting children ages 3 to 21.
  4. providing eligibility for special education for children in middle school.

Correct answer: 2. Public law 99-457 implemented Individualized Family Service Plans (IFSP) to increase family member participation in a child’s intervention plan.

Question 4

Which of the following lists the steps of the evidence-based practice process in the correct order? 

  1. Make clinical decision → Generate clinical question → Evaluate evidence →  Locate evidence
  2. Generate clinical question → Locate evidence → Make clinical decision →  Evaluate evidence
  3. Generate clinical question → Locate evidence → Evaluate evidence → Make clinical decision 
  4. Locate evidence → Generate clinical question → Evaluate evidence → Make clinical decision

Correct answer: 3. A question must be generated to know what evidence to look for and what information to assess within the evidence. After evaluation of the evidence, a clinical decision can be made.

Question 5

Which of the following is true of cognitive academic language proficiency (CALP)?

  1. It is language used during conversation.
  2. It is easily assessed during a language sample.
  3. It takes 5-7 years to acquire. 
  4. It includes turn taking/simple speech acts.

Correct answer: 3. CALP takes longer to acquire due to increased complexity.

Question 6

The prevalence of a stuttering disorder is defined as:

  1. the proportion of people who stutter at any point in time.
  2. the number of people who stutter over a lifetime.
  3. the proportion of people who are likely to be diagnosed with stuttering.
  4. the number of people who are diagnosed with stuttering during a calendar year.

Correct answer: 1. This answer choice is correct.

Question 7

A speech language pathologist is evaluating a child who only speaks Spanish. Which of the following is not an erroneous assessment strategy for the SLP to utilize for the linguistically diverse patient?

  1. translating the standardized test to Spanish 
  2. modifying the standardized test to make more relevant for the specific culture 
  3. relying on language sampling/observation
  4. including an ethnographic approach

Correct answer: 4. An ethnographic approach encourages the clinician to utilize the child’s family for important information and promotes comparison of the child’s language to expectations of the culture (e.g., gender roles, age roles, and syntax structure).

Question 8

Jimmy is a person who stutters. Which of the following age ranges correctly represents when his onset of stuttering most likely began?

  1. 2-4 years old
  2. 4-9 years old
  3. 9-12 years old
  4. 12-15 years old

Correct answer: 1. The age of onset if typically between the years of 2-4.

Question 9

The 3rd frontal gyrus, also known as Brodmann area 44, correlates with what anatomical area or structure?

  1. Basal ganglia
  2. Broca’s area
  3. Wernicke’s area
  4. Heschl’s gyrus

Correct answer: 2. Broca’s area is located in the frontal lobe and identified as Brodmann area 44.

Question 10

Kennedy is a 57-year-old woman who has noticed increased muscle fatigue during meals. After resting, the fatigue appears to disappear. Kennedy went to the neurologist and was diagnosed with damage to the acetylcholine receptors at the neuromuscular junction. What disease is Kennedy likely diagnosed with?

  1. Parkinson’s disease
  2. Alzheimer’s disease
  3. muscular dystrophy
  4. myasthenia gravis

Correct answer: 4. Myasthenia gravis is caused when there is a miscommunication at the neuromuscular junction. The disease usually first targets jaw, facial, and neck muscles.

Question 11

During an oral motor exam, you notice flattened nasolabial folds. Which of the following cranial nerves (CN) is most likely damaged?

  1. CN VIII
  2. CN XII
  3. CN VII
  4. CN X

Correct answer: 3. CN VII, the facial nerve, innervates muscles of the face (e.g., lips and cheeks).

Question 12

A speech language pathologist evaluates a woman who presents with slurred speech, excess and equal stress, distorted vowels, and irregular articulatory breakdowns. Which type of dysarthria is described? Where is the probable site of lesion? 

  1. ataxic dysarthria, cerebellum
  2. spastic dysarthria, basal ganglia
  3. ataxic dysarthria, basal ganglia
  4. spastic dysarthria, cerebellum

Correct answer: 1. The characteristics described are concurrent with ataxic dysarthria. Ataxic dysarthria is caused by damage to the cerebellum.

Question 13

Austin is a 24-month-old toddler who is utilizing gestures to provide additional meaning to his utterances. For example, he will point to the back door while saying, “go!”. Which of the following is true regarding Austin’s use of gestures?

  1. Austin’s use of gestures does not predict his use of multi-word utterances.
  2. Austin is using supplementary gestures. 
  3. Austin’s caregivers should ignore his gestures and reinforce spoken words.
  4. Austin is using complementary gestures.

Correct answer: 2. Supplementary gestures add information to spoken utterances. Pointing to the back door allowed the caregiver to know exactly where Austin wanted to go. Without the gesture, the caregiver would have been responsible for guessing what Austin wanted.

Question 14

Which of the following is associated with a posterior cerebral artery (PCA) stroke?

  1. apraxia
  2. non-fluent aphasia
  3. fluent aphasia
  4. hemianopia

Correct answer: 4. Typically, a posterior cerebral artery stroke results in hemianopsia. The PCA supplies blood to the occipital lobe which is responsible for vision.

Question 15

Blake, a speech language pathologist, is creating his assessment plan for a pediatric evaluation he has later this week. Which of the following is an example of a formal measure used during assessment? 

  1. language sample
  2. criterion referenced test
  3. developmental scale
  4. behavioral observation

Correct answer: 3. Developmental scales are formal assessment measures because they contain psychometric properties and assess overall achievement/ mastery of skill compared to peers.

Question 16

Residue in the vallecula is most likely caused by:

  1. reduced tongue base retraction.
  2. reduced laryngeal elevation.
  3. reduced buccal tension.
  4. reduced peristalsis.

Correct answer: 1. The vallecula is formed by the tongue base and the epiglottis. Reduced tongue base retraction will result in incomplete bolus expulsion in the vallecula.

Question 17

Which of the following would be the most appropriate assessment material for a child in 5th grade with difficulties in content, form, and use?

  1. CELF-5
  2. GFTA-3
  3. The Rossetti
  4. SSI-4

Correct answer: 1. The CELF-5 is normed on children 5-21 and assesses language skills using a variety of different subtests.

Question 18

Katie is a full time vocal performer. She notices a problem with her voice and schedules an appointment with the ENT where she is diagnosed with vocal nodules. What type of vocal disorder was Katie diagnosed with?

  1. neurogenic voice disorder
  2. psychological voice disorder 
  3. structural voice disorder 
  4. conversion voice disorder

Correct answer: 3. Structural voice disorders result in physical changes in the tissue.

Question 19

Which of the following is true regarding core words used in augmentative and alternative (AAC) devices?

  1. AAC devices contain only core words.
  2. Core words are a list of developmental words.
  3. Core words are the most important words for users to learn.
  4. Core words are a small number of words that make up the majority of conversation.

Correct answer: 4. Core words can be used across many different contexts, settings, and hold a variety of different meanings.

Question 20

A speech language pathologist is evaluating a child with Fragile X Syndrome. Which of the following characteristics can the clinician expect to observe?

  1. smooth philtrum 
  2. wide mouth, full lips
  3. macroglossia 
  4. elongated face, prominent ears

Correct answer: 4. These facial characteristics are common in children with Fragile X Syndrome.

Question 21

A speech language pathologist is treating a patient who just underwent a total laryngectomy. Which of the following is not an appropriate speaking option for the patient?

  1. speaking valve 
  2. electrolarynx 
  3. TEP
  4. esophageal speech

Correct answer: 1. Speaking valves redirect air to the vocal folds. A laryngectomee no longer has vocal folds therefore, this option would not be effective.

Question 22

Luke was born at 32 weeks weighing 3.5 lbs. He is now 9 months old and is exhibiting difficulty putting on weight. Luke is also experiencing symptoms of GERD and is hypotonic. When his mom turns on the lights, claps her hands, or sings a nursery rhyme, Luke barely reacts.

What is Luke’s adjusted age? 

  1. 5 months
  2. 6 months
  3. 7 months
  4. 8 months

Correct answer: 3. Since Luke was born 8 weeks early (40 weeks- 32 weeks), and estimated 2 months must be subtracted from his age. Example: 9 months (his current age) – 2 months (how many weeks he was premature) = 7 months.

Question 23

Luke was born at 32 weeks weighing 3.5 lbs. He is now 9 months old and is exhibiting difficulty putting on weight. Luke is also experiencing symptoms of GERD and is hypotonic. When his mom turns on the lights, claps her hands, or sings a nursery rhyme, Luke barely reacts.

Which of the following types of bottles would be most beneficial for Luke?

  1. a vented bottle to decrease the amount of air Luke receives
  2. a bottle with a slow flow nipple
  3. a brightly colored, angled bottle
  4. a soft bottle used for external pacing

Correct answer: 3. Luke would benefit from a brightly colored bottle since he is hyporeactive to stimulus items in his environment. An angled bottle would allow Luke to sit more upright during feeding times to help reduce symptoms of GERD.

Question 24

A speech language pathologist is treating a patient with hearing loss. Which of the following should the clinician always do before beginning every session?

  1. equipment check
  2. Ling-9 sound test
  3. invite the patient’s siblings into the room to provide peer models
  4. turn on the Ipad to create a visual distraction to improve generalization

Correct answer: 1. An equipment check is crucial to having an effective session. The clinician might think the patient is not attending to sound when in reality, the patient’s hearing aids might have an old battery.

Question 25

Which of the following might be included in a treatment plan for a child with cleft palate? 

  1. targeting posterior sounds
  2. targeting increased oral awareness
  3. targeting use of nasal sounds 
  4. targeting marked sounds

Correct answer: 2. To reduce nasality, promoting oral awareness is crucial with this population.

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