Webinars are sponsored by AAP/NJ but are open for everybody who are interested in the subject.
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My article entitled: Speech Language Strategies for Multisensory Stimulation of Internationally Adopted Children has been published in the January 2012 Issue of Adoption Today Magazine
Summary: The article introduces the concept of multisensory stimulation and explains its benefits for internationally adopted children of all ages. It also provides suggestions for parents and professionals on how to implement multisensory strategies in a variety of educational activities in order to stimulate interest, increase task participation as well as facilitate concept retention.
References:
Doman, G & Wilkinson, R (1993) The effects of intense multi-sensory stimulation on coma arousal and recovery. Neuropsychological Rehabilitation. 3 (2): 203-212.
Johnson, D. E et al (1992) The health of children adopted from Romania. Journal of the American Medical Association. 268(24): 3446-3450
Ti, K, Shin YH, & White-Traut, RC (2003), Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants. Research in Nursing Health. 26 (6): 424-33.
Milev et al (2008) Multisensory Stimulation for Elderly With Dementia: A 24-Week Single-Blind Randomized Controlled Pilot Study. American Journal of Alzheimer’s Disease and Other Dementias. 23 (4): 372-376.
Tarullo, A & Gunnar, M (2006). Child Maltreatment and Developing HPA Axis. Hormones and Behavior 50, 632-639.
White Traut (1999) Developmental Intervention for Preterm Infants Diagnosed with Periventricular Leukomalacia. Research in Nursing Health. 22: 131-143.
White Traut et al (2009) Salivary Cortisol and Behavioral State Responses of Healthy Newborn Infants to Tactile-Only and Multisensory Interventions. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 38(1): 22–34
Resources:
- American Occupational Therapy Association (AOTA) http://www.aota.org/
- American Speech-Language-Hearing Association (ASHA) http://www.asha.org/
- Anatomy Arcade: http://www.anatomyarcade.com/
- Cannon, Janell (2000) Crickwing. Harcourt Children’s Press.
- DLTK Printable Crafts for Kids www.dltk-kids.com
- Enchanted Learning: http://www.enchantedlearning.com/crafts/halloween/pastaskeleton/ How to make a pasta skeleton;
- Enchanted Learning: http://www.enchantedlearning.com/crafts/edible/ Edible Crafts
- Percival Touch ‘n’ Feel Book (2005). Bendon Publishing International
- Sensory Processing Disorders Foundation Website http://www.sinetwork.org/index.html
- Sensory Processing Disorder Blog http://www.sensory-processing-disorder.com/index.html
- Wendy Z Learning Resources. 5 recycled multisensory learning games. Retrieved October 30th 2011. (http://wendyzshandsonlearning.blogspot.com/2009/06/5-recycled-multisensory-learning-games.html)
Workshop: Special Considerations and Challenges in Assessment and Treatment of Bilingual Children with Developmental Disabilities
Date; January 25th 2012
By the end of the workshop participants will be able to:
•Identify skills and knowledge necessary to qualify a practitioner to be called a bilingual SLP
•Identify and describe cultural and linguistic variables that may impact speech-language pathology services to bilingual/bicultural children
•Explain typical language development for monolingual and bilingual speakers
•Explain the process of second language acquisition in children.
•Contrast communication differences and communication disorders in bilingual children
•Discuss research driven evidence based practice (EBP) assessment strategies for bilingual clients with communication disorders.
•Illustrate potential limitations of standardized tests
•Explain how to use alternative, non standardized methods to reduce assessment bias
•Describe research driven evidence based practice (EBP) treatment techniques for bilingual children with speech-language disorders.
Dec 142011
Workshop Title: Special Considerations and Challenges in Assessment and Treatment of Bilingual Children with Developmental Disabilities
Date: January 25th 2012
Time: 9:00 AM – 3:00 PM Special Considerations and Challenges in Assessment and Treatment of Bilingual Children with Developmental Disabilities
Eligible Hours: Six (6) Professional Development Hours
Learning Community: Speech/Language Specialists/Therapists, Special Education Teachers, Administrators, Child Study Team Members, Guidance Counselors, Psychologists, Social Workers.
Registration: $120 Full Tuition, $100 PDA Subscription Members
Location: Professional Development Academy, 1690 Stelton Road, Piscataway, NJ 08854, (732) 777-9848 Ext. 3560
Description: While many children who learn several languages during childhood exhibit appropriate language milestones in both languages, there are some children who present with evident dual language acquisition difficulties, often without a clear reason for the delay. These children are frequently referred for diagnostic assessments due to their dual language based learning deficits (which typically begin to manifest in their primary language first). This workshop will focus on how to provide effective evidence based practice diagnostic and treatment services to bilingual children with suspected and confirmed language deficits. It will discuss normal developmental progression of dual language learning, describe how language impairment signs manifest in bilingual children, list assessment challenges, explain unequal linguistic skills distribution (how communicative and cognitive language mastery differ from home/community vs. school environment) as well as go over latest clinical approaches to assessment and intervention of bilingual children.
Please see attached flyer for more information
Nov 222011
My article regarding the Importance of Orofacial Observations has been published in 156th Issue of the International Adoption Directory Newsletter
Article Title: Orofacial Observations of Internationally Adopted Children: Recommendations for Parents and Non-Medical Adoption Professionals
Article Summary: This article explains what parents should initially do if they note anything unusual regarding their internationally adopted child’s orofacial appearance. It explains how orofacial observations may be relevant to diagnosis of medical, genetic or neurological disorders via clinical case examples. It offers parents general guidelines for noting atypical orofacial features and explains why in some select circumstances, parents may be the first individuals to note unusual facial characteristics in their adopted children.
Portions of this article were originally published in November 17, 2011 Issue of Advance Magazine for Speech Language Pathologists & Audiologists, Online Newsletter, under the title: “Orofacial Assessments: Pediatric Case Studies Illustrate Their Importance”
Several months ago, I’ve administered speech-language testing to a 3-8 year old boy, adopted from Russia at the age of 3. During the course of my assessment I noticed his atypical facial features. He had a very small head, inward set eyes, and widely set ears. At that time, even though this boy had already seen a number of other adoption professionals (including a neurologist, an occupational therapist and another speech language pathologist), I felt that it was very important to record my findings and refer the parent for a second opinion with a pediatrician specializing in working with internationally adopted children. My rationale for seeking a second opinion for this child was further reinforced by a number of additional red flags, which included his significantly decreased play skills, severely impaired language ability, as well as significant social emotional and behavioral manifestations characterized by excessive impulsivity, distractibility, hyperactivity, decreased self-regulation, rapid over-stimulation, as well as anger outbursts and tantrums when others refused to follow his agenda and attempted to set limits on his behavior.
Subsequent, second opinion consultations for this child resulted in a diagnosis of Fetal Alcohol Spectrum Disorder, a term which describes the range of physical, mental, behavioral, and learning disabilities that can occur in children whose prenatal history is remarkable for excessive maternal alcohol consumption.
I use this case to illustrate a point. At the time of adoption this child presented with significant unrecognized deficits, which continued to persist unrecognized and unaddressed post adoption. While I acknowledge that oftentimes little could be done done before a child is adopted, I also want to emphasize that this child could have been receiving relevant and necessary services for 8 months post adoption, but didn’t because his deficits were missed!
The above case is not an isolated occurrence by any means. As a speech language pathologist who works exclusively with various at-risk pediatric populations (including internationally adopted children), I have numerous clinical examples I can share with you. In the past I have encountered undiagnosed feeding and swallowing issues, submucous clefts, vocal webs, Cerebral Palsy, Wilson’s Syndrome, a number of undiagnosed Fetal Alcohol Spectrum Disorder cases, and even several cases of severe infections due to excessive tooth decay and poor oral hygiene. I can go on for a while but I do believe that I have sufficiently demonstrated my point.
Fact is that oftentimes internationally adopted children arrive to US with a host of undetected disorders and deficits. Lack of detection is further increased in children adopted from economically developing countries or from hard to access insular regional orphanages, where they may fail to receive consistent and appropriate medical care, or where overcrowded conditions coupled with staff shortages may cause for deficits to be missed or unrecognized.
Consequently, oftentimes it is the parent(s) who are the first individuals to observe something different or unusual regarding their child’s facial features, oral structures, or any other appearance anomalies.
While many parents, of course, are not professionally trained in recognizing physical signs and symptoms of serious disorders, it is important to note that detection of unusual features is not as difficult as it sounds.
Here are some basic guidelines:
Does your child’s face look symmetrical or do you see any obvious signs of weakness (paralysis) on either side of the face (particularly evident when the child smiles and one side of the face droops or doesn’t move).
Do you find that your child’s features look odd or unusual in any way? Examples may include, but are not limited to: unusually wide or narrow set eyes, unusually set ears, virtual absence of a nose bridge, excessively thin upper lip, flatness of a groove above the lip, and so on (although with respect to facial appearance one needs to be very careful and account for differences in normal facial variation among various ethnic groups).
Do you notice any unusual spots, nodules, or openings on your child’s face or body or in his/her mouth?
In what condition is your child’s mouth? Is there excessive tooth decay? Do you see an unusual absence of teeth (in older children), or unusual bite (open bite, cross bite, etc)? Is there excessive drooling?
Does your child have a usual voice or unusual cough in the absence of a documented illness?
If you do, then it would be a good reason to consult with a pediatrician specializing in international adoptions, to see whether your observations merit a referral to a specialist (e.g., neurologist, orthodontist, etc).
I realize of course that parents are not trained professionals, but they are observant individuals! Moreover, there is a great likelihood that they are actually the first people to spend a prolonged period of time with the child. There’s an even greater likelihood that they are the first people to actually “see” the child vs. the orphanage staff who may have fulfilled the child’s basic needs (feeding, diapering, etc) but who in reality may have actually spent very little face to face time with the child.
Furthermore, parents should not worry whether something that may see may not be a cause of concern. What if it is and is not addressed? That is why it is so important to share your concerns with relevant medical professionals. It is up to them to investigate further whether your observations merit additional follow ups. If you are concerned, bring it up! You never know! You may paving the way to timely diagnosis and relevant intervention provision for your adopted child.
References:
- Golper, L (2009) Medical Speech Language Pathology: A Desk Reference. Clifton Park, NY: Delmar Cengage Learning
- Shipley, K, & McAfee, J (2008) Assessment in Speech Language Pathology: A Resource Manual. 4th Ed. Clifton Park, NY: Delmar Cengage Learning
In recent years the percentage of “at-risk children” has been steadily increasing across pediatric speech-language pathology caseloads. These include adopted and foster care children, medically fragile children (e.g., failure to thrive), abused and neglected children, children from low socioeconomic backgrounds or any children who for any reason lack the adequate support system to encourage them to function optimally socially, emotionally, intellectually, or physically.
At times speech-language pathologists encounter barriers when working with this population, which include low motivation, inconsistent knowledge retention, as well as halting or labored progress in therapy.
As a speech-language pathologist whose caseload consists entirely of at-children, I have spent countless of hours on attempting to enhance service delivery for my clients. One method that I have found to be highly effective for greater knowledge retention as well as for increasing the kids’ motivation is incorporating multisensory stimulation in speech and language activities.
To date, a number of studies have described the advantages of multisensory stimulation for various at risk populations. For example, in 2003 a study published in Journal of Research in Nursing and Health described the advantages of multisensory stimulation for 2 week old Korean orphans who received auditory, tactile, and visual stimulation twice a day, 5 days a week, for 4 weeks. This resulted in significantly fewer illnesses as well as significant gains in weight, length and head circumference, after the 4-week intervention period and at 6 months of age. Another 2009 study by White Traut and colleagues published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing, found that multi sensory stimulation consisting of auditory, tactile, visual, and vestibular intervention contributed to a reduction of infant stress reactivity (steady decline in cortisol levels). Moreover, multisensory stimulation is not just beneficial for young children. Other studies found benefits of multisensory stimulation for dementia (Milev et al, 2008) and coma patients (Doman & Wilkinson, 1993), indicating the usefulness of multisensory stimulation for a variety of at risk populations of different age groups.
After reviewing some studies and successfully implementing a number of strategies I wanted to share with you some of my favorite multisensory activities for different age-groups.
Before initiating any activities please remember to obtain parental permissions as well as a clearance from the occupational therapist (if the child is receiving related services), particularly if the child presents with significant sensory issues. It is also very important to ensure that there are no food allergies, or nutritional restrictions, especially when it comes to working with new and unfamiliar clients on your caseload.
Multisensory stimulation for young children does not have to involve stimulation of all the senses at once. However, there are a number of activities which come quite close, especially when one combines “touch ‘n’ feel” books, musical puzzles as well as paper and edible crafts.
Here’s one of my favorite speech language therapy session activities for children 2-4 years of age. I use a board book called Percival Touch ‘n’ Feel Book to teach insect and animal related vocabulary words as well as talk about adjectives describing textures (furry, smooth, bumpy, sticky, etc). As I help the children navigate the book, they get to touch the pages and talk about various plant and animals parts such as furry caterpillar dots, shiny flower petals, bumpy frog skin, or sticky spider web. We also work on appropriately producing multisyllabic words and on combining the words into short sentences, depending of course, on the child’s age, skills, and abilities. With this activity I often use animal and insect musical puzzles so the children can hear and then imitate select animal and insect noises.
Also, since all of Percival’s friends are garden insects and animals, it’s fairly easy to turn the book characters into paper crafts. Color paper templates are available from free websites such as www.dltk-kids.com, and range in complexity based on the child’s age (e.g., 2+, 3+ etc). While looking innocuously like simple paper cutouts, in reality these crafts are a linguistic treasure trove and can be used for teaching simple and complex directions (e.g., after you glue the frog’s arm, glue on his foot) as well as prepositional concepts (e.g., glue the eyes on top of the head; glue the mouth below the nose, etc).
So far we have combined the tactile with the auditory and the visual but we are still missing the stimulation of a few other senses such as the olfactory and the gustatory. For these we need a bit more creativity, and that’s where edible crafts come in (inspired by Janell Cannon’s ‘Crickwing’). The child and I begin by constructing and gluing together a large paper flower and dabbing it’s petals with various food extracts (almond, vanilla, raspberry, lemon, root beer, banana, cherry, coconut, etc). Then, using the paper flower as a model, we make an edible flower using various foods. Pretzel sticks serve as stems, snap peas become leaves while mango, tomato, apple, peach and orange slices can serve as petals. After our food craft is finished the child (and all other therapy participants) are encouraged to take it apart and eat it. The edible flower is not just useful to stimulate the visual, tactile, gustatory, and olfactory senses but it also encourages picky eaters to trial new foods with a variety of textures and tastes, as well as serves to develop symbolic play and early abstract thinking skills.
It is also important to emphasize that multisensory activities are not just for younger children; they can be useful for school-age children as well (including middle school and high school aged kids). In the past, I have incorporated multisensory activities into thematic language and vocabulary units for older children (see resources below) while working on the topics such as the senses (e.g., edible tasting plate), nutrition (e.g., edible food pyramid), the human body (e.g., computer games such as whack a bone by anatomy arcade), or even biology (building plant and animal cell structures out of jello and candy). From my personal clinical experience I have noticed that when I utilized the multisensory approach to learning vs. auditory and visual approaches alone (such as paper based or computer based tasks only), the children evidenced greater task participation, were able to understand the material much faster and were still able to recall learned information appropriately several therapy sessions later.
I find multisensory stimulation to be a fun and interactive way to increase the child’s learning potential, decrease stress levels, as well as increase retention of relevant concepts. Try it and let me know how it works for you!
References:
· Doman, G & Wilkinson, R (1993) The effects of intense multi-sensory stimulation on coma arousal and recovery. Neuropsychological Rehabilitation. 3 (2): 203-212.
· Ti, K, Shin YH, & White-Traut, RC (2003), Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants. Research in Nursing Health. 26 (6): 424-33.
· Milev et al (2008) Multisensory Stimulation for Elderly With Dementia: A 24-Week Single-Blind Randomized Controlled Pilot Study. American Journal of Alzheimer’s Disease and Other Dementias. 23 (4): 372-376.
· Tarullo, A & Gunnar, M (2006). Child Maltreatment and Developing HPA Axis. Hormones and Behavior 50, 632-639.
- White Traut (1999) Developmental Intervention for Preterm Infants Diagnosed with Periventricular Leukomalacia. Research in Nursing Health. 22: 131-143.
· White Traut et al (2009) Salivary Cortisol and Behavioral State Responses of Healthy Newborn Infants to Tactile-Only and Multisensory Interventions. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 38(1): 22–34
Resources:
- Anatomy Arcade: http://www.anatomyarcade.com/
- Cannon, Janell (2000) Crickwing. Harcourt Children’s Press.
- DLTK Printable Crafts for Kids www.dltk-kids.com
- Enchanted Learning: http://www.enchantedlearning.com/crafts/halloween/pastaskeleton/ How to make a pasta skeleton;
- Enchanted Learning: http://www.enchantedlearning.com/crafts/edible/ Edible Crafts
- Percival Touch ‘n’ Feel Book (2005). Bendon Publishing International
October 25, 2011
My article on the topic of School Based Speech and Language Intervention for Internationally Adopted Children has been published in 154th Issue of the International Adoption Directory Newsletter.
Article Title: Understanding the extent of speech and language delays in older internationally adopted children: Implications for School Based Speech and Language Intervention
Article Summary: This article introduces options available to parents with regard to determining the extent of their child’s birth language delay at the time of adoption. It refutes select myths regarding common school placements (e.g., ESL) for adopted children as well as reviews strategies of qualifying school age children with birth language delays for speech language services. The article reiterates the difference between communicative and cognitive language mastery of adopted children as well as cites select resources (e.g., letter template) available for parents who are requesting speech language services for their adopted child within the school system.
