Commission on Dental Competency Assessments (CDCA) ADEX Dental Hygiene Examination

Correct: Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is the most appropriate choice for assessing fatigue-related dysphagia because it does not involve radiation exposure. This allows the clinician to observe the patient for an extended period, such as a full meal, to identify if and when swallow safety begins to decline. In neurodegenerative conditions, swallow function may be adequate initially but deteriorate as the patient fatigues, making the duration of the assessment a critical factor.

Incorrect: A bedside swallow evaluation is an inappropriate primary diagnostic tool for this scenario because it cannot reliably detect silent aspiration or visualize pharyngeal residue. While VFSS provides a superior view of the pharyngeal phase during the height of the swallow (avoiding the white-out effect of FEES), the radiation safety limits (ALARA principle) generally restrict the duration of the study, making it difficult to observe the cumulative effects of fatigue over a 20-30 minute meal. Standardized VFSS protocols are efficient for identifying structural or physiological deficits but are not designed for long-term fatigue monitoring.

Takeaway: FEES is the preferred instrumental assessment when the clinical goal is to observe the impact of fatigue on swallowing safety over an extended period without the constraints of radiation exposure.

Correct: Consistent spatial arrangement, often referred to as motor planning or robust layout design, is critical for AAC users, especially those with motor planning deficits like CAS. By keeping icons in the same location regardless of the page or context, the user can develop motor memory for word locations. This allows communication to become more automatic over time, as the user does not have to visually scan and cognitively process the screen every time they wish to select a word.

Incorrect: Dynamic reorganization of icons based on frequency of use is counterproductive for motor planning because it forces the user to visually search for the icon every time its position changes. Category-based hierarchies with deep sub-folders often increase the cognitive and navigational load, which can lead to communication breakdown for a young child. While photographic symbols may be easier for some to recognize, they do not address the specific need for motor automaticity and navigation efficiency in the way that consistent spatial layout does.

Takeaway: Maintaining consistent icon placement is the primary strategy for fostering motor automaticity and reducing cognitive load in AAC implementation for individuals with motor planning challenges.

Correct: Internal validity is the degree to which a study can rule out alternative explanations for its findings. In the context of speech-language pathology research, factors such as maturation (the child improving simply because they are getting older) or history must be controlled through experimental design to ensure that the intervention is the actual cause of the observed change.

Incorrect: External validity refers to the generalizability of the results to other populations or settings, but it does not address the causal link within the study itself. Statistical power indicates the likelihood of detecting an effect if one exists, but a high power does not prove that the effect was caused by the intervention. Correlation coefficients measure the strength and direction of a relationship between variables, but they cannot establish a cause-and-effect relationship.

Takeaway: Internal validity is the foundational requirement for concluding that a specific intervention caused the observed change in a patient’s performance.

Correct: Statistical significance (p < .05) only indicates that the observed difference is unlikely to have occurred by chance. However, clinical significance refers to the practical importance of the treatment effect. Effect size (such as Cohen's d) measures the magnitude of the difference; a value of 0.15 is generally considered a 'small' effect, suggesting that while the change was not random, it may not be large enough to result in a noticeable or functional improvement for the client in a clinical environment.

Incorrect: The p-value does not measure the magnitude or importance of an effect; it only measures the probability that the results occurred by chance. Double-blind procedures are excellent for reducing bias but do not change the interpretation of a small effect size’s clinical relevance. While sample size affects statistical power, a small effect size remains small regardless of the number of participants; in fact, very large samples can make clinically insignificant differences appear statistically significant.

Takeaway: Clinicians must distinguish between statistical significance and clinical significance by evaluating effect sizes to determine if a treatment provides meaningful functional benefits.

Correct: In the Briefing, Interaction, and Debriefing (BID) process, the SLP must ensure the interpreter understands the necessity of literal translation. When an interpreter adds prompts or modifies the clinician’s words, it invalidates the standardized nature of the assessment and prevents the SLP from accurately identifying the student’s true linguistic capabilities or deficits.

Incorrect: Providing immediate cultural adaptations during standardized testing violates the administration protocol and invalidates the results. Focusing only on general meaning ignores critical diagnostic data regarding syntax, morphology, and phonology. Providing cues or encouragement is the responsibility of the clinician and, if done by the interpreter, can introduce bias and lead to an overestimation of the student’s abilities.

Takeaway: The SLP must ensure the interpreter acts as a verbatim conduit during testing to maintain the validity and reliability of the diagnostic assessment.

Correct: In the early stages of Alzheimer’s disease, the most prominent language deficit is anomia, or difficulty retrieving specific words. Patients typically maintain fluent speech, correct syntax, and clear articulation, but they compensate for word-finding failures by using circumlocution (describing a concept because they cannot name it) and indefinite pronouns, which results in ’empty’ but grammatically correct discourse.

Incorrect: Non-fluent output and agrammatism are characteristic of Broca’s aphasia or the non-fluent variant of primary progressive aphasia, rather than typical early-stage Alzheimer’s. While social communication may eventually decline, a total loss of turn-taking is not a hallmark of the early stage. Phonemic paraphasias involve sound-level substitutions (e.g., ‘pable’ for ‘table’) and are more indicative of conduction aphasia or more advanced stages of cortical degradation, whereas early Alzheimer’s is primarily a semantic-level deficit.

Takeaway: Early-stage Alzheimer’s disease is primarily characterized by semantic naming deficits and circumlocution while syntactic and phonological abilities remain relatively preserved.

Correct: The use of a wait-list control group is a significant threat to internal validity because it does not control for non-specific factors such as the Hawthorne effect (participants improving because they are being observed) or the simple effect of receiving professional attention. To isolate the specific efficacy of a new phonological intervention, the study should ideally compare the new treatment to an ‘active’ control group receiving a different, established treatment.

Incorrect: Option B is incorrect because a 12-month duration is generally a strength in longitudinal research; maturation is controlled for as long as the control group is of a similar age and developmental profile. Option C is incorrect because while funding sources must be disclosed to assess potential bias, they do not mathematically invalidate the statistical results of a study. Option D is incorrect because quasi-experimental designs are typically ranked as Level II or III evidence, not Level I, and all research designs require appraisal of internal validity regardless of their evidence level.

Takeaway: To ensure high internal validity in intervention research, studies should utilize active control groups to differentiate specific treatment effects from general therapeutic attention and maturation.

Correct: Contrastive analysis is the most appropriate procedure because it allows the clinician to systematically compare the child’s speech patterns against the known, rule-governed features of their specific dialect, such as African American English (AAE). By identifying which features are consistent with the dialect (e.g., habitual be or copula absence) and which are not, the clinician can accurately distinguish a language difference from a language disorder, ensuring ethical and valid diagnostic outcomes.

Incorrect: Applying a fixed standard deviation adjustment to raw scores is not a psychometrically valid or evidence-based method for addressing linguistic diversity and can lead to further diagnostic inaccuracies. Using tests normed only on General American English (GAE) speakers is the primary source of bias in this scenario and would fail to provide a valid assessment of a dialect speaker’s true language abilities. Implementing a curriculum to eliminate dialectal features treats a natural language variation as a deficit, which is contrary to the professional and ethical standards of speech-language pathology that recognize dialects as valid linguistic systems.

Takeaway: Contrastive analysis is a critical evidence-based tool for distinguishing rule-governed dialectal variations from true language disorders in linguistically diverse populations.